EFFECT OF ORTHODONTIC TREATMENT ON ORAL HEALTH-RELATED QUALITY OF LIFE AND PSYCHOSOCIAL OUTCOMES IN PATIENTS WITH MALOCCLUSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Abstract

Background:

Malocclusion can impair appearance, oral function, social confidence, and oral health related quality of life (OHRQoL). Although orthodontic treatment can lead to short-term discomfort, it can also enhance psychosocial well-being.

Objectives:

To assess the impact of orthodontic treatment on OHRQoL and self-esteem-related psychosocial outcomes in patients with malocclusion, a pooled analysis comparing clear aligners and fixed appliances was performed, where possible.

Methods:

This systematic review and meta-analysis followed PRISMA 2020 guidelines. Randomized clinical trials reporting OHRQoL, self-esteem, anxiety, discomfort, emotional well-being, or social well-being of patients undergoing orthodontic treatment for malocclusion were eligible. Nonrandomized studies, reviews, meta-analyses, and trials that did not provide extractable psychosocial or OHRQoL data were excluded. The RoB 2-style approach was used to assess the risk of bias. For similar OHIP-14 outcomes, mean differences (MDs) with 95% confidence intervals (CIs) were pooled, whereas for the heterogeneous trials, a narrative synthesis was performed. Publication bias was not evaluated as there were fewer than 10 studies for each pooled outcome.

Results:

167 records were identified, 17 of them were full-text assessed, and 12 randomized clinical trials were included. Four trials of four clear aligners (or orthodontic aligners) versus fixed appliances supported the OHIP-14 meta-analysis. Clear aligners showed lower OHIP-14 scores than fixed appliances at 7–10 days (MD = −8.16; 95% CI, −13.30 to −3.02; I² = 81.9%), 1 month (MD = −6.41; 95% CI, −7.91 to −4.90; I² = 0%), 6 months (MD = −3.62; 95% CI, −5.49 to −1.74; I² = 29.9%), and 12 months (MD = −3.85; 95% CI, −5.72 to −1.98; I² = 0%). Scale data were not extractable to pool direct self-esteem outcomes.

Conclusion:

Clear aligners could be more beneficial in terms of OHRQoL, particularly in early orthodontic treatment. There is still limited evidence due to a few pooled trials and heterogeneity of interventions and follow-up periods. Standardized OHRQoL and self-esteem measures should be used in future RCTs