Factors Influencing Parental Decision-making in Choosing Between Clear Aligners and Fixed Appliances for Their Wards in Urban India: A Twin-center Mixed-methods Study

OBJECTIVE: To evaluate the esthetic perception of different appliances by Brazilian lay adults and its influence in the attributed value of orthodontic treatment, considering evaluators' socioeconomic status, age and gender. METHODS: Eight different combinations of orthodontic appliances and clear tray aligners were placed in a consenting adult with pleasing smile. Standardized frontal photographs were captured and incorporated into a research album. A sample of adults (n = 252, median = 26 years old) were asked to rate each image for (1) its attractiveness on a visual analog scale and (2) the willingness to pay (WTP) for a cosmetic appliance when compared to a standard metalic appliance and a clear tray aligner. Comparisons between the appliances' attractiveness were performed using the Friedman's test and Dann's post-hoc test. Correlation between appliances' attributed value, socioeconomic status, age, gender, and esthetic perception was assessed using Spearman's correlation analysis. RESULTS: Attractiveness ratings of orthodontic appliances varied significantly in the following hierarchy: Clear aligners>sapphire brackets>self-ligating/conventional stainless steel brackets>and golden metal appliances. The correlation between WTP and esthetic perception was week. However, for individuals with better socioeconomic status and aged between 17-26 years old significantly, a significantly higher WTP was found. CONCLUSION: Clear aligners and sapphire brackets with esthetic archwire were considered better esthetic options in this sample. Nevertheless, patients were not willing to pay more money for appliances they deemed more esthetic, however, they were significantly influenced by their socioeconomic level and age.

BackgroundInstagram is a key source of health information, particularly for promoting clear aligners therapy but raising concerns about misinformation. Despite over 400 million Arabic speakers across 22 countries, their representation in health information quality research is limited. Thus, this prospective cross-sectional study aimed to qualitatively and quantitatively analyses Arabic Instagram posts about clear aligner therapy.MethodsOn 21 April 2025, Arabic posts were collected using 14 popular hashtags following a stratified random sampling approach, with the top 20 posts per hashtag included. Posts were classified by format, poster role, content type, thematic focus and type. Claim accuracy was assessed using established misinformation frameworks and orthodontic guidelines. Inter-rater reliability was ensured with a multi-coder protocol. Statistical analyses included Mann–Whitney U, Chi-square and Kruskal–Wallis tests with Bonferroni corrections (α = 0.05).ResultsOf 1,058,700 initial posts, 264 were included. Most were promotional (63%), photo-based (75%) and originated from Saudi Arabia (56%). Video and sharing experience posts had higher likes and engagement than photo and marketing posts (p < 0.05). Clinical and educational posts contained more balanced facts (p < 0.001), while 36% of claims were non-factual, particularly in promotional, marketing and practice advertisement posts (p < 0.001, p < 0.05 and p = 0.011, respectively).ConclusionArabic Instagram content on clear aligners is mainly promotional with substantial misinformation. Educational posts, though more accurate, are less common. Given Instagram's impact on treatment decisions, improving the quality of Arabic orthodontic content is crucial for informed consent and public awareness.

The clinical protocol and effectiveness of dental expansion with Clear Aligner Therapy (CAT), especially among adults is still unclear. There is a need to map and explore knowledge gaps of dental expansion with CAT among children and adults. This scoping review explores the extent and depth of the available literature regarding the effectiveness and predictability of CAT in performing orthodontic expansion in both children and adults. The following databases were consulted as sources of information: PubMed, MEDLINE, Embase, Web of Science, Scopus, LILACS, COCHRANE Library, and ProQuest Dissertations & Thesis, in which the search was limited to studies on children or adults requiring transverse arch expansion and using clear orthodontic aligners. Two independent reviewers assessed the citations and extracted data, which was then synthesized in a narrative format. Over all, 698 citations were retrieved, and 33 were included. Among these, 3 were systematic reviews, 4 were cohort studies, 2 were case-control studies, and 24 were case series. Eighty-five percent of the included studies were published in the last 5 years. Despite different protocols and measurement methods, aligners were effective for arch expansion in adults and children, and the expansion predictability was greater for the lower arch than for the upper arch. The evidence suggests that arch width increment is more predictable in the premolar region and less predictable in the canine and second molar areas, with high variability across studies. Orthodontic aligners have demonstrated effectiveness in expanding arches in both adults and children. However, the literature suggests a decrease in arch width toward the posterior region, and there is no evidence of skeletal gains. To provide more conclusive evidence, randomized controlled clinical studies are warranted. This review was registered in the Open Science Framework database (DOI: https://doi.org/10.17605/OSF.IO/6EG8F).

Awareness regarding fever is reportedly low among Indian urban parents, leading to its over- management among under five children. We attempted to study the awareness and fever management practices of South Indian urban parents. The objectives were to find the awareness of parents regarding childhood fever management, and correlates of practices. One hundred parents of under-five children with history of fever in past three months were randomly selected and interviewed using a predesigned tool. Children's weight and height was measured. Awareness scores for causes of fever and fever management were constructed. Logistic regression was done to identify correlates of incorrect practices. 95% parents were aware about correct temperature above which fever became harmful. Awareness score for causes of fever was poor (<1) among 41% parents. Mothers' complications awareness scores were better than fathers (p<0.05). 81% parents used antibiotics; only 18% consulted a doctor before doing so. 17% parents using antibiotics did not complete the prescribed course. The independent correlates of poor fever management practices were working parents (OR: 6.28; 95%CI: 1.7-23.16), lesser number of children (OR: 3.08; 95%CI: 1.01-9.37), poor compliance for antipyretics (OR: 9.20; 95%CI: 1.64-51.52) and giving antipyretics without consulting doctors (OR: 5.43; 95%CI: 1.69-17.47). Poor knowledge of available pediatric antipyretic preparations was negatively correlated (OR: 0.13; 95%CI: 0.02-0.64). Fever awareness was fair among urban parents. Mothers had better awareness than fathers. Increased awareness for correct fever management of under-five children is desirable among urban parents to reduce misuse of antibiotics and antipyretics.

This study aimed to compare three-dimensional (3D) alveolar bone changes and root resorption in skeletal Class I malocclusion treated with fixed appliances (FAs) or clear aligners (CAs), under extraction and non-extraction protocols, using Cone-beam computed tomography (CBCT). This retrospective study involved 120 adult patients, divided into an equal groups of non-extraction and extraction treatment. Each group received either FAs or CAs. A total of 960 incisors from all patients, and 480 canines and second premolars from 60 patients in the extraction group, were analyzed. CBCT scans were evaluated using InVivo 6.0.3 software for 3D measurements of alveolar bone thickness (ABT), height (ABH), root length, and bone defects. All patients underwent CBCT scans immediately before- (T0) and after-treatment (T1). The reported measurements represent the changes between these two time points. Intra-group comparisons were analyzed using paired t-tests, and inter-group comparisons were examined using independent t-tests. Statistical significance was set at P < 0.05. In the non-extraction group, FAs demonstrated greater increases in labial ABT at upper central incisors (U1) and lateral incisors (U2), with smaller reductions at lower central incisors (L1) compared to CAs. FAs also resulted in more pronounced decreases in lingual ABT at U1 and L1 but showed larger increases at U2 and L2. In the extraction group, FAs induced more labial thickening at L1 and L2, greater lingual thinning at U1 and L1, and higher levels of root resorption, particularly at U2 and L1. FAs also triggered larger increases in bone measurements at upper canines and second premolars (P < 0.05). Fixed orthodontic appliances resulted in more pronounced alveolar bone remodeling and root resorption compared to clear aligners, most notably in extraction cases. While Clear aligners helped in preserving labial bone and minimizing root resorption, neither method completely averted bone loss. Therefore, treatment decisions should take into account clinical objectives, anatomical risks, and patient factors. Not applicable.

This systematic review aimed to critically assess the available evidence regarding the effectiveness and efficiency of clear aligners in the comprehensive treatment of complex cases accompanied by premolars extraction. An electronic literature search by two reviewers was independently done on 27 February 2023 in the following databases without time and language limitations: Pubmed®, Scoups®, Google Scholar, Cochrane Library database, Web of Science™, and Proquest Database Open. Randomized controlled trials (RCTs) of any type, non-randomized clinical trials (CCT), cohort studies, and prospective, retrospective, and cross-sectional studies were reviewed. The risk of bias in included studies was assessed using the Risk of Bias (RoB 2.0) tool for randomized trials and the Risk of Bias in Non-randomized Studies (ROBINS-I) tool for non-randomized studies. After carefully searching the literature, six trials were included in this systematic review, three RCTs, two retrospective cohort studies, and one CCT. Two hundred eighty-three patients were included (186 females, 97 males). Three studies found that there were no differences between the clear aligners and fixed appliances when evaluations were done using the American Board of Orthodontists Objective Grading System (ABO-OGS) or the Peer Assessment Rating (PAR) index. Two studies found that there were some differences between predicted and achieved tooth movements when clear aligners were used in premolars extraction cases. Based on the included studies, the duration of treatment was shorter with fixed appliances than the clear aligners when applied to orthodontic extraction cases. Both clear aligners and fixed appliances were found effective in the orthodontic treatment of premolar extraction-based cases. Fixed appliances have the advantage of achieving better buccolingual inclination and occlusal contacts in a shorter treatment duration. Treatment with clear aligners might be associated with differences between predicted and achieved tooth movements. Therefore, the characteristics of these techniques should be considered when making a treatment decision.

Integrating artificial intelligence (AI) and advanced three-dimensional (3D) imaging has revolutionised dentistry by enhancing diagnostics and treatment planning. Advanced algorithms and machine-learning techniques may enable orthodontists to analyse complex cases and predict treatment outcomes accurately. This technology facilitates the creation of customised treatment plans that consider individual tooth morphology and periodontal health, optimising force application and minimising treatment time. Since their introduction, clear aligners have gained popularity, with over 17 million people treated by 2023. Compared with fixed appliances, clear aligners offer advantages, such as better aesthetics, comfort and oral hygiene. Treating patients with a compromised periodontium requires accurate diagnosis and treatment planning. This paper reviews how AI-driven treatment planning software predicting root movement and visualising bone structures may impact treatment decisions and, ultimately, treatment outcomes. The technology behind machine learning and AI in designing clear aligners is discussed. Research shows that when viewing the cases in 3D, clinicians are more comfortable when treating crowding cases with a non-extraction approach using interproximal reduction (IPR) only. However, it was interesting to note that clinicians with extensive experience treating clear aligner patients were more comfortable using IPR to address severe crowding cases when viewed in 2D, compared with those less experienced with clear aligners. However, when the cases were visualised in 3D, both groups showed equal comfort in using IPR, as the roots were within the bone. AI-driven treatment planning software, utilising machine learning in conjunction with 3D modelling, may enhance the predictability of orthodontic movements while reducing treatment time and increasing patient satisfaction.

To identify the characteristics of joint displays illustrating the data integration in mixed-methods nursing studies and to make recommendations for effective use of joint displays for the integration of qualitative and quantitative data in mixed-methods studies. Discussion Paper. We have completed this paper as a part of a mixed-methods prevalence review of 190 studies published in nursing journals. We searched 10 nursing journals and three databases from January 2014-April 2018, additional journal search was performed from May-September 2018. We reviewed 17 studies that used joint displays as the method of data integration. Using a joint display typology, checklists, summary tables, and personal experiences of using joint displays, we evaluated the quality of displays. Nurse researchers should use advanced data integration approaches to increase the rigour of the mixed-methods studies. Joint displays can enable nurse researchers to efficiently integrate and synthesize the qualitative and quantitative data in mixed-methods studies. However, nurse researchers should clearly label the type and title of the display, include both qualitative and quantitative data and interpretations, and highlight the mixed-methods interpretations as confirmed, divergent, or expanded in the displays. Joint displays are adopted for data integration in nursing mixed-methods studies. Improvements are required concerning data presentation in the displays. Researchers should provide clear titles and supporting data and inferences and identify the meta-inferences by assessing the fit between quantitative and qualitative data. Despite the importance of integration in mixed methods, reviews indicated a consistent lack of integration in nursing research. Joint displays are structured frameworks used for the integration and synthesis of the qualitative and quantitative data at the analysis and interpretation levels. The discussed typology and characteristics of displays can enable nurse researchers to enhance the quality and presentation of integrated results in mixed-methods studies.

Background and Objectives: Orthodontic treatment, whether fixed or removable, offers several benefits, including improved aesthetics, enhanced oral function, and increased self-confidence. However, it may also cause discomfort and pain, particularly following adjustment visits. This study aimed to assess pain characteristics (latency and continuity), food impairment, weight loss, and analgesic use in relation to treatment duration and appliance type. Methods: This observational study included 160 orthodontic patients who completed a structured questionnaire comprising 13 single-choice items. The questionnaire assessed age, gender, residential environment, educational status, type and duration of orthodontic treatment, pain characteristics (duration, latency, continuity), food impairment, and analgesic use. Inclusion criteria specified patients with moderate anterior crowding undergoing fixed orthodontic treatment or treatment with clear aligners on both arches, for at least one month. All fixed appliance cases involved 0.022-inch-slot Roth prescription brackets. Results: Patients undergoing fixed orthodontic treatment reported a higher frequency of pain (91.4%), greater need for analgesics (95.2%), and more food impairment compared to those with clear aligners. Patients treated for less than 6 months more frequently reported pain lasting 1 week (57.1%), while those treated for 1-2 years more commonly reported pain lasting several days (43.8%). Conclusions: Fixed orthodontic appliances are associated with greater discomfort, longer pain latency, more frequent analgesic use, and higher dietary impact compared to clear aligners. These findings emphasize the importance of personalized patient counseling and proactive pain management to improve compliance, enhance quality of life, and support informed decision-making in orthodontic care.

BackgroundRisk perception plays an important role in decision-making processes. Differences in obstetric intervention rates suggest that, in addition to medical indications, the risk perception of obstetric health professionals might have a major influence on their decision-making process during childbirth. Although studies have investigated whether risk perception affects the role of midwifery or influences decision making during childbirth, little is known about what obstetric health professionals actually perceive as risk or risky situations and whether different risk perceptions lead to more interventions during intrapartum care.ObjectiveThe objective of this study is to understand the association of risk perception and the decision-making processes of obstetric health professionals (midwives and obstetricians) in Germany during intrapartum care. The study has 3 specific aims: (1) gain insight into what obstetric health professionals perceive as risk in the German clinical setting, (2) assess the extent to which personal and systemic factors have an impact on obstetric health professionals’ risk perception, and (3) investigate whether different perceptions of risk are associated with different decisions being made by obstetric health professionals.MethodsThis is an exploratory sequential mixed methods study with 2 phases, a qualitative followed by a quantitative phase. In the first phase, qualitative data are collected and analyzed by conducting focus group discussions and applying qualitative content analysis to address aim 1. In the second phase, for aims 2 and 3 and to help explain the qualitative results, quantitative data are collected and analyzed by conducting an observational study using case vignettes within a survey constructed on the basis of the qualitative results.ResultsEnrollment in the first (qualitative) phase began in July 2019, and data collection and analysis have been completed. The second (quantitative) phase is currently planned, and data collection is expected to start in December 2020. First results of the qualitative phase are expected to be submitted for publication in 2020, with completion of the second phase scheduled for 2021.ConclusionsThis mixed methods study will examine the perception of risk and its association with the decision-making processes of obstetric health professionals during their care of women in childbirth. The rationale for this approach is that the qualitative data and their analysis explore participants' views in more depth, while the quantitative data will help to provide and explore a general understanding of the research problem. The results are expected to be relevant to health care professionals, policymakers, and educational institutions in order to minimize underuse, overuse, and misuse of interventions during intrapartum care.Trial RegistrationGerman Clinical Trials Register DRKS00017172; https://tinyurl.com/y2zoowkxInternational Registered Report Identifier (IRRID)DERR1-10.2196/21443

A<sc>BSTRACT</sc>This systematic review evaluates the long-term stability and retention of clear aligner treatment, focusing on factors like aligner compliance, attachment use, and treatment duration. Following PRISMA guidelines, we searched electronic databases and manual sources, identifying 112 records and narrowing down to six relevant studies. These studies compared clear aligners to traditional braces, highlighting their effectiveness, especially for mild crowding and anterior movements. Clear aligners, particularly Invisalign, showed benefits like shorter treatment times and higher patient satisfaction. However, variability in treatment accuracy and limited long-term follow-up indicate a need for further research. Overall, clear aligners offer a discreet, flexible, and effective orthodontic option.

In a survey of UK consumers, we elicited their willingness to accept (WTA) a discount for GM foods and willingness to pay (WTP) a premium for non-GM foods in order to assess their valuation on the non-GM characteristic in food products. Mean WTA is found to exceed mean WTP, suggesting the valuation of the non-GM characteristic reflects an endowment effect, imperfect substitutability between GM and non-GM foods, or both. Regression results show that perceived risks (benefits) associated with GM foods significantly increase (decrease) WTA and WTP estimates. Additional regression models using the difference between WTA and WTP as the dependent variable indicate that risk (benefit) perceptions increased (decreased) the discrepancy between WTA and WTP estimates. The role of risk perceptions in explaining this discrepancy is congruent with consumers' propensity toward loss aversion as predicted by the endowment effect hypothesis and prospect theory.

&lt;p&gt;In Iowa, the state with the largest percent of its land used for agriculture (90 percent) in the nation, compromised water quality is a chief concern among experts. The primary problem is related to the negative environmental impacts caused by nutrient runoff from fields. Although several innovative land-management practices have demonstrated nutrient reduction potential and other soil health related benefits, the practices are not widely utilized on Iowa farm fields. Thus, water quality is at the center of a contentious debate in the state and many farmers are receiving contradictory advice depending on the source of the information.&lt;/p&gt;&lt;p&gt;Media and interpersonal communication channels play a primary role in disseminating environmental risk information to the public and farmers (Katz &amp; Lazarfeld, 1955; Rogers, 2010). However, little is known about the way contradictory risk information may shape farmer’s conceptualizations of the water problems in Iowa. Correspondingly, little is known regarding the individuals who are most influential to farmer’s behaviors related to these water issues. To address the potential communication process problems resulting from the clashing ideologies related to the environment and agriculture, this study seeks to investigate the flow of information and networks of influence within the agricultural community in Eastern Iowa.&lt;/p&gt;&lt;p&gt;Three studies are conducted to address media, interpersonal, and risk communication components at play in this context. Because mass media are a key source of risk information for the public (McCallum, Hammond, &amp; Covello, 1991; Morton &amp; Duck, 2001; Ho et al., 2013) the first study consists of a thematic textual analysis of online news articles about Iowa’s water quality. A total of 305 articles, published by the Des Moines Register (DMR), Iowa Farmer Today (IFT), and the Farm Bureau Spokesman (FBS), are examined. Themes related to key narratives about Iowa’s water quality problems and the way risks and uncertainty are conveyed in the articles is also investigated. A combination of qualitative and quantitative data was collected to document the types of organizations and key spokespeople used as informational sources in the articles. Findings demonstrate that some messages simultaneously place the blame for causing and the responsibility for solving the problem on the farmers; while others suggest that nutrient excesses are not anthropogenic, are natural, expected, weather dependent, and uncontrollable. Based on the media sources themselves, and the organizations and individuals cited in the articles, this distinction reflects a preeminent pro-agriculture versus pro-environment ideological divide in Iowa.&lt;/p&gt;&lt;p&gt;The second study examines farmers’ perspectives on the nutrient issues in Iowa, including their risk perceptions, and preferred sources of information on water quality, both mediated and interpersonal. The study utilizes intercept interviews conducted over a two-month period between July and September 2016 in Middle and Easter Iowa. Analysis of risk perceptions, uncertainty levels, and current mitigation practices revealed a pattern of lower environmental risk perceptions associated with adoption of fewer nutrient reducing practices, and greater uncertainty regarding current nutrient levels.&lt;/p&gt;&lt;p&gt;The third and final study built upon data from the previous study and involved in-depth interviews with the individuals who were identified as influential to farmer’s water related land management practices. Definitions of influencers from the level of the individual (i.e., self-identification as an influential), community (i.e., identification of an influential by other farmers), and media narratives (i.e., identification of an influential in an article or media source), in addition to definitions of influentials from previous literature were compared. Findings revealed that influence is highly related to employment position and opportunity to communicate with multiple, various farmers. Personal motivation for engaging in persuasive communication efforts with farmers was revealed as an important factor which may help strengthen theoretical conceptualizations of influential individuals within social networks.&lt;/p&gt;&lt;p&gt;This project is a study of environmental communication products, processes, and effects and sought to disentangle the relationships between the risk representation and perception, and influence within agricultural network information flow—an area of research currently lacking. Results help extend scholarship in these areas and illuminate the differing conceptualizations of these variables by mainstream media, agricultural industry media, influential individuals, and agricultural producers themselves. This improved understanding paves the way for subsequent research and intervention efforts to communicate more productively with farmers. The effects of such efforts could help redirect negativity and blame away from farmers, and towards a more productive and holistic approach to solving Iowa’s water quality problems.&lt;/p&gt;

ABSTRACTIntroduction:This study aims to compare patient-reported outcomes (PROs) between clear aligners and conventional fixed braces. Orthodontic treatments not only focus on functional outcomes but also patient satisfaction, comfort, and aesthetics. Understanding PROs can guide treatment decisions for better patient-centered care.Methods:A comparative study involving 150 orthodontic patients treated with either clear aligners or conventional braces was conducted. The PROs evaluated included comfort, aesthetics, oral hygiene maintenance, and speech impairment. Surveys were administered at the beginning and at regular intervals during treatment. Data were analyzed using statistical tests to compare the two groups.Results:Clear aligners showed superior outcomes in comfort and aesthetics, with a significant difference (P < 0.05) compared to fixed braces. Patients with conventional braces reported more difficulties with oral hygiene and speech. However, both groups had similar overall treatment satisfaction.Conclusion:Clear aligners are associated with higher comfort and aesthetic satisfaction, while conventional braces may be less favorable in terms of hygiene and speech. PROs play a crucial role in orthodontic treatment selection, emphasizing the need for personalized approaches based on patient preferences.

Qualitative data helps explore factors surrounding patients' decisions with orthodontic treatment. The objectives were (1) to understand patients' motivation to undertake orthodontic treatment, (2) to understand their choices of a specific treatment modality, and (3) to determine the kinds of information provided to patients prior to receiving treatment. The study was an exploratory case study design. Thirty adults who completed orthodontic treatment with three different treatment modalities within the last twelve months in New Zealand were recruited. Patients undergoing treatment and those who had orthognathic surgery were excluded. Semi-structured, one-to-one interviews were conducted. The transcripts were analysed with NVivo software using a qualitative thematic analysis inductive approach. Three principal themes were identified in the data: Motivation for orthodontic treatment, the decision for treatment with a specific treatment modality, and patient information and education. Self-consciousness, aesthetics, relapse of previous orthodontic treatment, cleanability, and a previous financial barrier to seeking orthodontic treatment were motivating factors. Patients opted for traditional fixed appliances due to recommendation and trust; clear aligners due to age, working environment, and aesthetics; and direct-to-consumer clear aligners due to low cost. All participants had little knowledge about orthodontics prior to commencing treatment, and the provision of information for informed consent was not equal for each of the three groups. The primary motivators of individuals seeking treatment were self-consciousness, aesthetics, and previous financial constraints. Cost had the most significant impact when selecting a specific treatment modality.