A Behavioral Classification Framework for Orthodontic Patients: Understanding Demand, Compliance, Trust, and Treatment Response
DOI:
https://doi.org/10.52783/jns.v14.2949Keywords:
Behavioral classification, orthodontic patients, treatment compliance, aesthetic demand, smileAbstract
Background: The emphasis on both practical and esthetic results has led to a substantial evolution in orthodontic therapy. However, patient behaviour has a big impact on treatment success. This includes compliance, treatment desire, and trust in orthodontists. Based on these behavioural characteristics, orthodontic patients can be categorised in an organised way to improve outcomes and provide more individualised care.This study aims to develop a behavioral classification framework for orthodontic patients based on their treatment demand, trust in the orthodontist, compliance with treatment protocols, and treatment response.
Materials and Methods: A cross-sectional study was conducted among 100 orthodontic patients evaluated by their treating orthodontists and residents. A structured questionnaire assessed patient demand, trust, and compliance. Content validity ratio (CVR), content validity index (CVI), inter-rater, and intra-rater reliability analyses were performed. Data were statistically analyzed using SPSS.
Results: Patients were classified into five categories:
- Idealists – High-demand, trusting, compliant, and positive responders.
- Inconsistents – Moderate-demand, trusting, partially compliant, and variable responders.
- Skeptics – Low-demand, distrustful, non-compliant, and limited responders.
- Strugglers – High-demand, trusting, non-compliant, and moderate responders.
- Unpredictables – Moderate-demand, trusting, compliant, but with unpredictable responses.
Statistical analyses confirmed the validity and reliability of the classification system.
Conclusion: The proposed behavioral classification provides a structured approach to understanding orthodontic patient behavior. It enables clinicians to tailor treatment strategies, improve patient adherence, and enhance overall treatment outcomes. Future research should explore interventions to optimize compliance in different patient categories.
Downloads
Metrics
References
Sowmithra Devi S, Sundari S. Occlusal Contact Changes With Traumatic Occlusion After Orthodontic Treatment: A Prospective Study. Journal of Advanced Oral Research. 2023;14(2):134-142. doi:10.1177/23202068231190202.
Rebekah R, Jain RK, Balasubramaniam A, Sreenivasagan S. Photographic Frankfort plane subnasale pogonion (FSA) angle for assessment of anteroposterior discrepancies in malocclusion subjects: A prospective study. J Orthod Sci. 2023 Sep 4;12:57. doi: 10.4103/jos.jos_7_23. PMID: 37881674; PMCID: PMC10597371.
Prasanna Arvind T.R. & A. Sumathi Felicita (2021) Correlation between collum angle and lower lip position in different Class II malocclusions - A retrospective cephalometric study, Orthodontic Waves, 80:2, 81-86, DOI: 10.1080/13440241.2021.1924417.
Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. Mosby; 2013.
Kiyak HA. Does orthodontic treatment affect patients’ quality of life? J Dent Educ. 2008;72(8):886-894.
Mehra T, Nanda RS, Sinha PK. Orthodontists’ assessment and management of patient compliance. Angle Orthod. 1998;68(2):115-122.
Christensen, Alan J. Patient adherence to medical treatment regimens: Bridging the gap between behavioral science and biomedicine. Yale University Press, 2004.
Winkler S. House mental classification system of denture patients: the contribution of Milus M House. J Oral Implantol. 2005;31(6):301-303.
Wright GZ, Kupietzky A. Behavior Management in Dentistry for Children. John Wiley & Sons; 2014.
Bos A, Hoogstraten J, Prahl-Andersen B. Towards a comprehensive model for the study of compliance in orthodontics. Eur J Orthod. 2005;27(3):296-301.
O’Brien C, Benson PE, Marshman Z. Evaluation of a quality of life measure for children with malocclusion. J Orthod. 2007;34(3):185-193; discussion 176.
Al Shammary, N.H., Alshammari, A.K. Ethical dilemmas concerning orthodontic treatment among orthodontists in a sample from Saudi Arabia: a pilot study. BMC Med Ethics 26, 6 (2025). https://doi.org/10.1186/s12910-024-01142-9.
Borzabadi-Farahani A. A review of the evidence supporting the aesthetic orthodontic treatment need indices. Prog Orthod. 2012;13(3):304-313.
Farrow AL, Zarrinnia K, Azizi K. Bimaxillary protrusion in black Americans--an esthetic evaluation and the treatment considerations. Am J Orthod Dentofacial Orthop. 1993;104(3):240-250.
Geoghegan, Finn, Ana Ahmadi Birjandi, Guilherme Machado Xavier, and Andrew T. DiBiase. "Motivation, expectations and understanding of patients and their parents seeking orthodontic treatment in specialist practice." Journal of orthodontics 46, no. 1 (2019): 46-50.
Nahajowski M, Lis J, Sarul M. Orthodontic Compliance Assessment: A Systematic Review. Int Dent J. 2022;72(5):597-606.
Shaadouh RI, Hajeer MY, Burhan AS, et al. Evaluation of the Impact of Orthodontic Treatment on Patients’ Self-Esteem: A Systematic Review. Cureus. 2023;15(10):e48064.
Downloads
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.