Orthodontic care is a commitment. At the end of treatment, patients have an aligned, functional and aesthetic smile, with the potential for dramatic change over months or years. But success relies on many elements, including the skill of the clinician and a patient’s engagement with care.
The latter includes the diligent performance of an oral hygiene routine, and simply wearing an appliance such as a clear aligner for the prescribed amount of time every day. If a patient fails to keep up with these responsibilities, treatment times could extend, or the treatment could fail altogether. When a patient is lackadaisical in their oral hygiene routine, failing to remove plaque or food debris from interdental spaces, the gingival margin or around brackets and wires, they may develop white spot lesions, caries or periodontal disease over time.
Understanding extended orthodontic cases, and factors that can influence patient motivation, is essential for all clinicians. It ensures that they are prepared to support individuals with the challenges that they face, better ensuring they achieve an ideal final result that they have to wait so patiently for.
A tale of time
No two orthodontic cases are the same. Each individual has unique needs, from the actual required movements of the dentition in order to align the teeth, to additional considerations for care alongside systemic conditions. A diabetes diagnosis, for example, can influence bone remodelling and the inflammatory response.[i] However, treatment times are typically fairly predictable.
If a patient follows orthodontic advice, targeted results can usually be achieved within 6 to 30 months of use, depending on the complexity of the case.[ii] The average fixed appliance treatment takes around 19.9 months, or just under 2 years,[iii] and patients should be aware of this before commencing with treatment. The literature notes that if a patient or their parents (as orthodontics is commonly undertaken by adolescent patients) do not have a clear understanding of the duration of treatment and requirements throughout care, they can find it more challenging to reach satisfactory outcomes.[iv]
Patients undergoing different types of orthodontic procedure need to be aware of how the choice between fixed and removable aligners will impact treatment timelines. Clinical literature finds that the length of treatment is often underestimated during the consultation for clear aligners, potentially impacted by noncompliance with regular wear. The actual length of treatment is often similar to fixed braces – a 2023 report found that average length of care was 5.1 months longer than estimated during consultation.[v]
Understanding motivation
With such long treatment times, its vital to understand what can demotivate a patient during care. To begin with, motivation can be driven by a number of factors. Individuals want an evidence-based approach from their practitioner, resulting in a positive health outcome; they typically wish to have immediate, convenient solutions, which value their time and aid with immediate gratification; and they wish to be understood through personalised connection with a professional, who ensures their specific needs are met.[vi]
Whilst the length of treatment is in contrast to the innate wish for immediate gratification, this source of motivation could be supported during in-person appointments. For example, clinicians make a concerted effort to maximise the use of time in a session, with orthodontist, dental nurse, and any other professionals working together to educate and coach patients, and use technology where suitable for more efficient care.vi
The literature finds that challenges such as discomfort and pain can strongly affect treatment satisfaction, but that despite this, there are overwhelmingly positive patient-reported outcomes.[vii] This is often because patients feel the challenges are worthwhile due to the impact of the final result.
Keeping comfortable
Managing pain and discomfort due to orthodontic appliances is vital for treatment satisfaction and engagement. They are reported to be the most negative side effects of the treatment, and a main reason for non-compliance.[viii]
Encouraging patients to use a solution like the Orthodontic Relief Wax from Kemdent ensures they can minimise irritation from brackets and wires, making treatment more comfortable. The Orthodontic Relief Wax can be simply warmed in a patient’s hands, and applied over the cause of pain to act as a smooth barrier before being easily removed when eating, drinking or performing the oral hygiene routine. Stored in a recyclable tin, the wax can be carried around for use throughout the day.
Understanding what keeps patients motivated throughout orthodontic treatment is key to providing ongoing support. Clinicians should ensure care is personalised and advice is given prior to it beginning, so that patients are prepared for the follow months or years to come.
For more information about the leading solutions available from Kemdent, please visit www.kemdent.co.uk or call 01793 770 256
Author – Alistair Mayoh
[i] García-Rios, P., Rodríguez-Lozano, F. J., Guerrero-Gironés, J., Pecci-Lloret, M. R., Oñate-Sánchez, R. E., & Pérez-Guzmán, N. (2025). The Influence of Diabetes on Orthodontic Treatment: A Systematic Review of the Clinical Considerations and Challenges in Response. Journal of Clinical Medicine, 14(14), 4879.
[ii] NHS, (2023). Orthodontic treatments. (Online) Available at: https://www.nhs.uk/tests-and-treatments/orthodontics/treatments/ [Accessed September 2025]
[iii] Tsichlaki, A., Chin, S. Y., Pandis, N., & Fleming, P. S. (2016). How long does treatment with fixed orthodontic appliances last? A systematic review. American journal of orthodontics and dentofacial orthopedics, 149(3), 308-318.
[iv] Yao, J., Li, D. D., Yang, Y. Q., McGrath, C. P. J., & Mattheos, N. (2016). What are patients’ expectations of orthodontic treatment: a systematic review. BMC oral health, 16(1), 19.
[v] Kravitz, N. D., Dalloul, B., Zaid, Y. A., Shah, C., & Vaid, N. R. (2023). What percentage of patients switch from Invisalign to braces? A retrospective study evaluating the conversion rate, number of refinement scans, and length of treatment. American Journal of Orthodontics and Dentofacial Orthopedics, 163(4), 526-530.
[vi] Levin, L., Khehra, A., Kowal, S., & Romer, K. (2025). Patient Experience and Expectations in Oral Health Care: A Nation-Wide Survey. International Dental Journal, 75(2), 1003-1010.
[vii] Bradley, E., Shelton, A., Hodge, T., Morris, D., Bekker, H., Fletcher, S., & Barber, S. (2020). Patient-reported experience and outcomes from orthodontic treatment. Journal of Orthodontics, 47(2), 107-115.
[viii] Torsello, F., D’Amico, G., Staderini, E., Marigo, L., Cordaro, M., & Castagnola, R. (2022). Factors influencing appliance wearing time during orthodontic treatments: a literature review. Applied Sciences, 12(15), 7807.
