Evaluation of Knowledge, Attitude & Practice of Various Types of Attachment Design Used in Aligners among Postgraduate Students of Orthodontics All Over India – A Questionnaire Study

Abstract

Introduction: Clear aligners have transformed orthodontic treatment with their aesthetic appeal and patient comfort. However, the efficacy of aligners is largely influenced by the type, position, and design of attachments used. Understanding how postgraduate orthodontic students apply and perceive these variables is critical for ensuring optimal clinical outcomes. Aim: To assess the knowledge, attitude, and practice (KAP) regarding various attachment designs used in aligner therapy among IOS-registered third-year postgraduate students of Orthodontics across India. Methodology: A cross-sectional questionnaire-based study was conducted at the Department of Orthodontics and Dentofacial Orthopaedics, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth. The pre-validated and reliability-tested questionnaire was distributed via WhatsApp to all IOS-registered third-year postgraduate students (n=1900), as per the Indian Orthodontic Society directory (2023). A minimum sample size of 320 was estimated using standard formulae at a 95% confidence level. Responses were collected over four weeks, with reminders sent weekly. Content validity, construct validity, and internal consistency (Cronbach’s α = 0.8) were ensured. Data were subjected to descriptive and inferential statistical analysis. Results: The response rate was adequate, and most participants demonstrated fair knowledge and positive attitudes regarding aligner attachments. While vertical rectangular occlusally beveled attachments were favoured for retention, many also recognized the importance of attachment positioning, overcorrection, and controlled staging. However, gaps in preference were noted in aspects like torque control, extrusion strategies, and optimal material choices. Conclusion: Although third-year postgraduate orthodontic students possess a foundational understanding of aligner attachment designs, the study highlights areas requiring further training and evidence-based reinforcement. Incorporating aligner-specific biomechanics and attachment protocols into the postgraduate curriculum is recommended to enhance clinical efficacy and aligner treatment predictability.