Adolescents’ adherence to intraoral removable appliances: a scoping review
Bibliographic record
Abstract
BACKGROUND: Adolescents' lack of adherence to intra-oral removable appliances (IORAs) can lead to poor treatment outcomes. Available literature on this topic hasn't been comprehensively summarized. Existing reviews often combine data from various age groups, lack a standardized conceptual definition of adherence to IORAs, and offer limited evaluation of interventions aimed at improving adherence among adolescents. This scoping review aims to map the breadth and depth of the literature on adolescents' adherence to IORAs and identify research gaps for developing tailored interventions. METHODS: In accordance with Arksey and O'Malley's framework and PRISMA-ScR guidelines, a comprehensive search strategy was implemented across MEDLINE, CINAHL, Web of Science, and ProQuest Theses and Dissertations. Two researchers independently screened titles, abstracts, and full texts. A pilot-tested form facilitated data extraction. Risk of bias was evaluated using RoB 2, ROBINS-I, and JBI tools. Extracted data then underwent both descriptive and content analysis. RESULTS: The 14 included studies focused on adherence to wear-time recommendations (n = 13), with only one examining appointment adherence. Only seven studies (50%) were deemed high-quality. Adherence rates varied across IORAs: vacuum-formed retainers showed wear-time of less than 24 h/day, Hawley retainers averaged 12-15 h/day, Twin Blocks averaged 21 h/day, and Activators averaged 11.5 h/day. Studies pursued various aims: four explored patient perspectives and experiences; one assessed designed interventions; two evaluated treatment adherence and assessed adherence to both recommendations and appointments; and five identified associated factors. Several studies pursued multiple aims. Patient perspectives highlighted challenges like discomfort and social pressures, and enablers such as parental support. Limited intervention studies indicated potential benefits of digital and image-based monitoring. Adherence consistently fell short of recommended daily wear time (DWT), often influenced by motivation, parental involvement, and psychosocial factors. CONCLUSION: Adherence among adolescents to the DWT for intraoral removable appliances is frequently suboptimal, displaying considerable variability depending on appliance type. Both individual and social determinants influence adherence. Robust study designs and a standardized conceptualization of adherence are imperative to generate high-quality, comparable evidence. Evidence-based interventions must be developed and tested to enhance adherence and ultimately optimize treatment outcomes within this patient population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.057 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.004 |
| Bibliometrics | 0.017 | 0.016 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".