Non-Cochrane · intervention · PM41814348
Evaluation of psychological effects of orthodontic treatment vs. orthognathic surgery: a systematic review and meta-analysis.
Cenzato Niccolò, Alicchio Francesca, Manti Antonino, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-08040-z
Findings
Population Adults (18 years or older) treated with orthodontic treatment or orthognathic surgery
25 findings
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Palomares, 2016 | Pooled mean score 9.29 [6.89, 11.69] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Alfawal (Aligners), 2022 | Pooled mean score 10.04 [7.45, 12.64] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Choi, 2017 | Pooled mean score 9.67 [7.20, 12.14] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) Unresolved: the two extractors disagree on this row. | Pooled mean score 9.66 [7.30, 12.02] GRADE not reported 14 studies · 435 participants |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Kapetanovic, 2022 | Pooled mean score 9.69 [7.23, 12.16] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Pithon, 2021 | Pooled mean score 9.94 [7.08, 12.80] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Pelo (Surgery first), 2017 | Pooled mean score 10.27 [8.10, 12.44] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Al Nazeh, 2020 | Pooled mean score 9.40 [7.05, 11.75] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Alfawal (Fixed), 2022 | Pooled mean score 9.76 [7.22, 12.30] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Feu (Traditional), 2016 | Pooled mean score 9.46 [7.05, 11.87] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Pelo (Traditional), 2017 | Pooled mean score 10.23 [7.67, 12.80] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Feu (Surgery first), 2016 | Pooled mean score 9.80 [7.35, 12.24] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Ni, 2019 | Pooled mean score 8.93 [6.70, 11.17] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Tunca (Aligners), 2024 | Pooled mean score 9.45 [7.02, 11.89] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) and Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Leave-one-out sensitivity analysis omitting Tunca (Fixed), 2024 | Pooled mean score 9.27 [6.88, 11.66] GRADE not reported 13 studies |
| Orthodontic treatment (fixed appliances or clear aligners) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Orthodontic treatment (OT) studies | Pooled mean score 9.70 [7.74, 11.65] GRADE not reported 8 studies · 306 participants |
| Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OHIP-14 score (higher is worse OHRQoL) Last available assessment after treatment (time points not consistent) · Orthognathic surgery (OST) studies | Pooled mean score 9.59 [4.86, 14.32] GRADE not reported 6 studies · 129 participants |
| Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OQLQ score (higher is worse OHRQoL) Last available assessment after surgery · Leave-one-out sensitivity analysis omitting Alanko, 2017 | Pooled mean score 20.24 [14.98, 25.49] GRADE not reported 6 studies |
| Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OQLQ score (higher is worse OHRQoL) Last available assessment after surgery · Leave-one-out sensitivity analysis omitting Feu (Traditional), 2016 | Pooled mean score 19.33 [12.44, 26.23] GRADE not reported 6 studies |
| Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OQLQ score (higher is worse OHRQoL) Last available assessment after surgery Unresolved: the two extractors disagree on this row. | Pooled mean score 19.50 [14.65, 24.36] GRADE not reported 7 studies · 151 participants |
| Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OQLQ score (higher is worse OHRQoL) Last available assessment after surgery · Leave-one-out sensitivity analysis omitting Feu (Surgery first), 2016 | Pooled mean score 21.76 [18.43, 25.10] GRADE not reported 6 studies |
| Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OQLQ score (higher is worse OHRQoL) Last available assessment after surgery · Leave-one-out sensitivity analysis omitting Pelo (Surgery first), 2017 | Pooled mean score 19.08 [12.69, 25.48] GRADE not reported 6 studies |
| Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OQLQ score (higher is worse OHRQoL) Last available assessment after surgery · Leave-one-out sensitivity analysis omitting Ni, 2019 | Pooled mean score 17.93 [12.90, 22.95] GRADE not reported 6 studies |
| Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OQLQ score (higher is worse OHRQoL) Last available assessment after surgery · Leave-one-out sensitivity analysis omitting Pelo (Traditional), 2017 | Pooled mean score 18.03 [12.90, 23.15] GRADE not reported 6 studies |
| Orthognathic surgery (traditional or surgery-first) | None (single-arm pooled post-treatment mean) | OQLQ score (higher is worse OHRQoL) Last available assessment after surgery · Leave-one-out sensitivity analysis omitting Palomares, 2016 | Pooled mean score 20.21 [14.69, 25.72] GRADE not reported 6 studies |
Included primary studies 15
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Alfawal 2022 The impact of non-extraction orthodontic treatment on oral health-related quality of life: clear aligners versus fixed appliances-a… PMID:35395075 | 2022 | 3 other reviews | OHIP-14 score (higher is worse OHRQoL) | not extracted yet |
| Alhafi 2024 The Impact of Non-Extraction Orthodontic Treatment on the Oral-Health-Related Quality of Life between a Modified Aligner Appliance with… PMID:39064568 | 2024 | 2 other reviews | not stated | not extracted yet |
| Tunca 2024 Comparison of anxiety, pain, and quality of life in individuals with mild or moderate malocclusion between conventional fixed orthodontic… PMID:38760747 | 2024 | 2 other reviews | OHIP-14 score (higher is worse OHRQoL) | not extracted yet |
| Al Nazeh 2020 Relationship between oral health impacts and personality profiles among orthodontic patients treated with Invisalign clear aligners. PMID:33235288 | 2020 | 1 other review | OHIP-14 score (higher is worse OHRQoL) | not extracted yet |
| Choi 2017 Changes in psychological health, subjective food intake ability and oral health-related quality of life during orthodontic treatment. PMID:28853165 | 2017 | 1 other review | OHIP-14 score (higher is worse OHRQoL) | not extracted yet |
| Alanko 2017 A longitudinal study of changes in psychosocial well-being during orthognathic treatment. PMID:28579266 | 2017 | this review only | OQLQ score (higher is worse OHRQoL) | not extracted yet |
| Bengtsson 2018 Treatment outcomes and patient-reported quality of life after orthognathic surgery with computer-assisted 2- or 3-dimensional planning: A… PMID:29853236 | 2018 | this review only | not stated | not extracted yet |
| Feu 2016 Oral health-related quality of life changes in patients with severe Class III malocclusion treated with the 2-jaw surgery-first approach. PMID:28554450 | 2017 | this review only | OHIP-14 score (higher is worse OHRQoL); OQLQ score (higher is worse OHRQoL) | not extracted yet |
| Kapetanovic 2022 What is the Oral Health-related Quality of Life following Miniscrew-Assisted Rapid Palatal Expansion (MARPE)? A prospective clinical… PMID:36138473 | 2022 | this review only | OHIP-14 score (higher is worse OHRQoL) | not extracted yet |
| Ni 2019 Impact of surgical orthodontic treatment on quality of life in Chinese young adults with class III malocclusion: a longitudinal study. PMID:31196054 | 2019 | this review only | OHIP-14 score (higher is worse OHRQoL); OQLQ score (higher is worse OHRQoL) | not extracted yet |
| Palomares 2016 Impact of orthosurgical treatment phases on oral health-related quality of life. PMID:26827973 | 2016 | this review only | OHIP-14 score (higher is worse OHRQoL); OQLQ score (higher is worse OHRQoL) | not extracted yet |
| Paunonen 2020 Quality of life several years after orthodontic-surgical treatment with bilateral sagittal split osteotomy. PMID:32037937 | 2020 | this review only | not stated | not extracted yet |
| Pelo 2017 Surgery-first orthognathic approach vs traditional orthognathic approach: Oral health-related quality of life assessed with 2… PMID:28760287 | 2017 | this review only | OHIP-14 score (higher is worse OHRQoL); OQLQ score (higher is worse OHRQoL) | not extracted yet |
| Pithon 2021 Impact of oral-health-related quality of life and self-esteem on patients with missing maxillary lateral incisor after orthodontic space… PMID:33367539 | 2021 | this review only | OHIP-14 score (higher is worse OHRQoL) | not extracted yet |
| Souza 2024 Impact of treatment with orthodontic aligners on the oral health-related quality of life. PMID:38580945 | 2024 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (18 years or older) undergoing orthodontic treatment or orthognathic surgery | Adults in 15 studies (8 orthodontic, 7 orthognathic surgery) |
| Intervention | Orthodontic treatment (fixed appliances or clear aligners) | Orthodontic treatment: fixed appliances, clear aligners, MARPE, modified aligner appliance (n=8 studies) |
| Comparison | Orthognathic surgery (traditional or surgery-first approaches) | Orthognathic surgery: traditional and surgery-first approaches (n=7 studies) |
| Outcomes | Oral health related quality of life, with a focus on psychological impact, measured by OHIP-14 and OQLQ | OHIP-14 (n=10 studies in meta-analysis); OQLQ (n=6 studies in meta-analysis) |
| Study designs | RCTs and observational studies (cross-sectional, longitudinal) | 5 RCTs and 10 observational studies |
| Timing | Not specified | Last available post-treatment assessment of each study |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Partial Yes | no |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | No | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Partial Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: No | NRSI: No · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |