Value of Esthetic Orthodontic Appliances

Objectives: To quantify laypersons assessment of attractiveness and value of orthodontic appliances. Methods: Orthodontic appliances were placed on one consenting adult and digital images subsequently captured, standardized, and incorporated into a computer-based survey. The survey displayed various images of orthodontic appliances for rating by a sample of adults (n=50, supported by power analysis). Subjects rated each image for: 1) attractiveness on a visual analog scale (VAS); and 2) monetary value of each appliance for adults/child relative to a metal appliance standard. Rater reliability for the attractiveness and value ratings was assessed by rating 3 images twice. Results: Overall reliability for attractiveness rating was r=0.90 and k=0.88 for value ratings. Raters' annual income was not significant in attractiveness or value ratings. There was no significant difference between appliance value for parent and child. Appliance brand, material, and wire were significant factors affecting attractiveness and value ratings. Attractiveness ratings were grouped in the following hierarchy of appliance types: alternative appliances such as clear trays and simulated lingual appliances > ceramic appliances > hybrid self-ligation appliances > all stainless steel appliances. The assessed additional value of appliances relative to a metal standard appliance ranged from $629.00 for lingual appliances to $167.00 for a hybrid self-ligation appliance (Ormco Damon 3™). Conclusions: The findings of this research demonstrate that a significant number of patients find those appliances commonly used in practice unattractive. Patients are willing to pay more money for appliances they deem more esthetic.