The impact of colorful orthodontic appliances on children’s motivation and treatment perceptions: a single-center cross-sectional study

Background: Color customization of removable orthodontic appliances is widely used in pediatric care, but evidence linking color-related perceptions to motivation and adherence is limited. Methods: In this retrospective cross-sectional study, routine patient and parent/guardian questionnaires from 316 children aged 8-16 years treated with removable appliances in a private clinic in Germany were analyzed. Outcomes were retrospective patient-reported perceptions of motivation and treatment experience assessed using 5-point Likert items and self-reported adherence (missed a full day of wear in the past week; daily wear-hours). Age group (8-11 vs. 12-16) and gender were key predictors. Likert outcomes were analyzed using Mann-Whitney U tests and adjusted proportional-odds ordinal logistic regression; adherence outcomes were analyzed using chi-square tests and multivariable logistic regression. Results: Perceptions were favorable: 60.7% agreed/strongly agreed they were motivated to wear the appliance, 53.2% that color made them more eager to wear it, and 94.2% that wear would improve dental health. Younger participants and females reported higher color-related anticipation/enjoyment and lower endorsement that color "does not matter." Missed full-day wear was reported by 27.3% (70/256); older age was associated with lower odds of missed full-day wear (OR 0.39, 95% CI 0.21-0.72), while color engagement was not. Parent responses were often neutral; younger age was associated with stronger parent endorsement across items. Conclusions: Color customization is positively perceived and differs by age and gender, but shows limited association with self-reported adherence. Prospective studies incorporating objective wear-time monitoring are warranted.