title: Factors associated with patient and parent satisfaction after orthodontic treatment: a systematic review.
abstract: BACKGROUND
  Our objective was to identify factors associated with orthodontic treatment satisfaction of patients and their caregivers, when applicable.
  
  
  METHODS
  MEDLINE via Ovid, PubMed, EBM Reviews and EMBASE via OVIDSP, LILACS, Web of Science, and Google Scholar were searched electronically. Reference lists of included articles were also screened for potential relevant studies missed during the electronic searches. Studies evaluating the satisfaction levels of patients or caregivers after orthodontic treatment were considered. Methodologic quality of the included studies was assessed using a modified Newcastle-Ottawa scale.
  
  
  RESULTS
  Eighteen studies satisfied the inclusion criteria, representing 2891 patients and 464 parents. The risk of bias was moderate in 13 and low in 4 of the included articles. The studies used different questionnaires and timings to assess postorthodontic treatment satisfaction. Based on the available limited evidence, satisfaction was associated with perceived esthetic outcomes, psychological benefits, and quality of care. The latter was specifically linked to dentist-staff-patient interactions. Dissatisfaction was associated with treatment duration, pain levels and discomfort, and the use of retention appliances. When both assessments were available, the patient's and the parent's satisfaction levels were strongly correlated.
  
  
  CONCLUSIONS
  Based on the limited available evidence with moderate risk of bias, we identified factors that appear to be more commonly associated with a high or low level of satisfaction. Consideration of these factors could be important for practitioners attempting to set realistic expectations of their patients and caregivers regarding orthodontic treatment outcomes.
authors.affiliation: Clinical assistant professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: cppereir@ualberta.ca.
authors.forename: Camila
authors.initials: C
authors.lastname: Pachêco-Pereira
authors.affiliation: Private practice, Edmonton, Alberta, Canada.
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Pereira
authors.affiliation: Associate professor, Departments of Anesthesiology and Pain Medicine, Psychiatry and Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Dick
authors.affiliation: Doctoral candidate, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Perez
authors.affiliation: Professor and division head of orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Carlos
authors.initials: C
authors.lastname: Flores-Mir
mesh_terms: D004955:Esthetics, Dental; D006801:Humans; D009971:Orthodontics, Corrective / Q000523:psychology* / Q000592:standards; D010290:Parents / Q000523:psychology*; D017060:Patient Satisfaction; D010549:Personal Satisfaction; D016896:Treatment Outcome