Effectiveness of a compliance indicator for clear aligners.

263 P compliance is crucial in orthodontic treatment involving removable appliances. This is especially true for adult patients, who have no growth remaining to help compensate for poor cooperation. The orthodontist’s ability to predict a given individual’s level of compliance is also important, because patients who are not expected to be cooperative may be better treated with fixed rather than removable appliances. Studies have shown no association, however, between patient cooperation and such factors as quality of life, socioeconomic status, and educational level,1-3 although females have been found to be generally more compliant than males.4 Assessing cooperation is equally challenging: a study of the reliability of patient reports and clinicians’ ratings of compliance found that neither had an accuracy rate of more than 43%.5 Attempts to improve compliance through behavior modification using a reward system have yielded mixed results; although such efforts have been found to have a positive effect on patients who were already more compliant than average, they had little effect on patients with below-average cooperation.6 The degree of patient motivation and the rapport between the patient and the orthodontist seem to be more significant.7,8 Align Technology recently introduced a “compliance indicator” for teen-agers being treated with the Invisalign system.* Although patients are generally required to wear each set of the clear