Patient compliance has always been one of the more difficult variables to manage in orthodontics.
Aligner therapy has made this particularly visible. While the biomechanics are well understood, outcomes remain closely tied to how consistently patients wear their aligners. A daily wear time of 20 to 22 hours is typically recommended, yet in practice, many patients fall short.
This raises an important clinical question. If compliance is variable, what actually helps improve it?
A recent randomised controlled trial published in the American Journal of Orthodontics and Dentofacial Orthopaedics investigated whether awareness of monitoring could influence aligner wear time.
Study Overview
This single-centre, two-arm parallel randomised clinical trial included 43 adult patients undergoing clear aligner therapy with aligners fitted with microsensors.
These microsensors recorded intraoral temperature at regular intervals, enabling objective measurement of aligner wear time based on temperature changes between intraoral and ambient conditions. Wear time was recorded over six consecutive two-week aligner stages, providing longitudinal data across approximately three months of treatment.
Participants were randomly assigned to one of two groups.
In the “unaware” group, patients were informed that the microsensor recorded temperature only, without being told that it was used to measure compliance. In contrast, patients in the “aware” group were explicitly informed that the device monitored their aligner wear time.
All aligners were prescribed for the standard recommended wear time of 20 to 22 hours per day. The primary outcome was the mean daily wear time of aligners measured objectively by the microsensors. A linear mixed-effects model was used to analyse the data while adjusting for potential confounders such as age and sex.
Advance your career by studying for a world-leading postgraduate diploma
Study at the cutting-edge of dental research with curricula taught by global experts and an online schedule that suits you.
Findings
Forty patients completed the study.
Patients who were aware of monitoring demonstrated a statistically significantly higher mean wear time, with an increase of approximately 4.4 hours per day compared to the unaware group. This difference is clinically relevant, as even small deviations in daily wear can influence tracking and treatment progression.
However, a key finding was that neither group achieved the recommended average wear time of 20 to 22 hours per day. Overall mean wear time was approximately 13.7 hours per day in the unaware group and 16.7 hours per day in the aware group.
Another notable finding was the temporal trend in aligner wear time, which declined progressively over the six observation periods. Even in the aware group, predicted wear time decreased over time, suggesting that initial motivation may reduce as treatment progresses.
Clinical Interpretation
The findings indicate that awareness of monitoring can positively influence patient behaviour and improve aligner wear time.
However, this improvement alone is not sufficient to achieve recommended levels of compliance. Even when patients know they are being monitored, a meaningful gap remains between prescribed and actual wear.
For clinicians, this highlights two important considerations.
First, behavioural factors play a significant role in treatment success, and strategies that increase accountability may have value in practice.
Second, compliance is not static. The gradual decline in wear time suggests that maintaining motivation requires ongoing engagement rather than a single conversation at the start of treatment.
Study Limitation
The trial included only adult patients treated in a university setting, with a relatively short three-month follow-up period. These factors may limit how widely the findings can be applied to broader patient populations and longer treatment durations.
About Dr. Jamal
Dr. Jamal Giri is an orthodontist and associate professor at B.P. Koirala Institute of Health Sciences in Nepal. He obtained his orthodontic training from the Institute of Medicine, Tribhuvan University, Nepal, in 2014.
Currently pursuing a PhD at the University of Adelaide, Dr. Jamal’s research focuses on the genetic and environmental factors influencing malocclusion development. He also holds a postgraduate certificate in clinical education from the University of Edinburgh and a master’s in medical education from the University of Nottingham.
Dr. Jamal teaches on the Diploma in Orthodontics and Dentofacial Orthopaedics at the London Dental Institute.
Read More
Sabbagh H, Baumert U, Liedtke J, Thiem S, Venkova V, Wichelhaus A. Objective assessment of wear time during orthodontic aligner therapy using microsensors: A randomized controlled trial. American Journal of Orthodontics and Dentofacial Orthopaedics. 2026;169:272–84.
Get Our Research Round-Ups in Your Inbox
Each month, we share concise summaries of clinically relevant research to help you stay engaged with current developments in dentistry.
These updates are designed to highlight interesting and evolving topics from across the literature, offering context and perspective that can inform your day-to-day thinking in practice. They are not intended to replace or add to the structured teaching within the Virtual Learning Environment, but to sit alongside it as a broader reflection on emerging evidence.
If you would like to receive these updates directly, you can subscribe to the Research Round-Up and have each edition delivered to your inbox, or catch up by reading past clinical updates here.
