Evaluation of the effectiveness of a tailored mobile application in increasing the duration of wear of thermoplastic retainers: a randomized controlled trial

Abstract

Summary Background The ‘My Retainers’ mobile application is a patient-informed intervention designed to enhance removable retainer wear and associated patient experiences during the retention phase. Objectives To evaluate the effect of receiving the ‘My Retainers’ application on objectively assessed thermoplastic retainer (TPR) wear time, stability, periodontal outcomes, patient experiences, and knowledge related to retainers. Materials and methods Eighty-four participants planned for removable retention with TPRs were assigned either to receive the ‘My Retainers’ application or to control not receiving electronic reminders during the 3-month period. Randomization was based on computer-generated random numbers and allocation was concealed using opaque, sealed envelopes. The primary outcome was objectively assessed retainer wear recorded using an embedded TheraMon® micro-electronic sensor. Secondary outcomes, including irregularity of the maxillary and mandibular incisors, plaque levels, bleeding on probing and probing depth, were assessed at baseline and 3-month follow-up; and analysed using a series of mixed models. Experiences and knowledge related to orthodontic retainers were recorded using questionnaires. The outcome assessor was blinded when possible. Results Receipt of the mobile application resulted in slightly higher median wear time (0.91 hours/day); however, this difference was not statistically significant (P = 0.56; 95% confidence interval [CI]: −2.19, 4.01). No significant differences were found between the treatment groups in terms of stability (P = 0.92; 95% CI: −0.03, 0.04), plaque levels (P = 0.44; 95% CI: −0.07, 0.03), bleeding on probing (P = 0.61; 95% CI: −0.05, 0.03) and probing depth (P = 0.79; 95% CI: −0.09, 0.07). Furthermore, similar levels of patient experiences (P = 0.94) and knowledge related to retainers (P = 0.26) were found. However, marginally better levels of knowledge were identified in the intervention group. No harms were observed. Limitations A relatively short follow-up period with the study confined to a single-center in a university-based hospital. Conclusions Provision of the bespoke ‘My Retainers’ application did not lead to an improvement in adherence with TPR wear over a 3-month follow-up period. Further refinement and research are required to develop and investigate means of enhancing adherence levels. Clinical registration NCT03224481.

Remote digital monitoring during the retention phase of orthodontic treatment: A prospective feasibility study

“… 19 , 20 In the past few years, the market has assisted an increased availability of orthodontic apps to enhance long-distance monitoring and compliance, 21 and a recent study confirmed the positive attitude of patients towards this new digital technology. 22 In orthodontics, it can be applied for monitoring of several treatment aspects, 23 including patients’ oral hygiene during the therapy, 16 , 24 , 25 treatment with clear aligners, 26 , 27 rapid palatal expansion, 15 , 28 , 29 adherence to the use of removable retainers, 8 active working time of self-ligating straight-wire appliances, 30 and clinical follow-up of corticotomy-accelerated orthodontic therapies. 31 …”

“…For this purpose, several remote systems have been developed in the last decade, including the embedding of a microsensor into the acrylic of the appliance to record temperature, such as the Smart Retainer (Scientific Compliance, Atlanta, GA, USA) 4 and TheraMon Sensor (Handelsagentur Gschladt, Hargelsberg, Austria). 5 Other studies on mobile applications providing active reminders 6 - 8 suggest that regular control of patients by the orthodontist can positively influence patient compliance. 9…”

Orthodontic retention: what's on the horizon?

“…A mobile retainer reminder app was developed to improve adherence to retainers; however, it did not seem to significantly improve objectively assessed adherence levels, stability or patient experiences at three-month follow-up. 21 With conventional mobile reminder apps, tracking is dependent on patients entering the usage data themselves and some users perceived this as a 'commitment' and 'time-consuming' . 22 To overcome this issue, another pilot study coupling Bluetooth tracking with reminders has shown that this type of compliance tracking has a clinically acceptable level of accuracy and usability, validating its use within future clinical studies.…”

Evaluation of relapse with thermoplastic retainers equipped with microsensors

“…6 Microsensors have demonstrated that patients wear their retention appliances for a shorter time per day than is recommended. [7][8][9][10][11][12][13] The published data regarding stability are based on subjective wear-time measures such as patient and parent reports or estimates of orthodontists. [14][15][16][17][18][19][20][21][22][23] Although wear data are subjective, part-time retainer wear (8-12 h/d) is reported to be as beneficial as fulltime wear in preserving treatment results.…”

“…15,17,22 Only one previous study assessed stability outcomes with objectively measured retainer wear. 13 However, the question of whether short wear times (SWTs) or long wear times (LWTs) are effective for the maintenance of stability remains questionable. Therefore, the aim of this study was to determine how the amount of objectively measured retainer wear affects posttreatment stability.…”