In this descriptive cross-sectional survey study, an electronic, anonymous questionnaire consisting of a series of 31 short-answer and multiple-choice questions was administered to practicing orthodontists. The target population in the study included currently practicing orthodontists who were graduates of an accredited orthodontic residency program. Participants were recruited through collaboration with the American Association of Orthodontists (AAO) Partners in Research Program and the Harvard School of Dental Medicine Orthodontic Alumni Association. International American Association of Orthodontists (AAO) members were included in the study; however, AAO student members and retired or honorary AAO members were excluded to ensure the survey participants were most likely to be graduates of an accredited orthodontic residency and currently practicing orthodontics. The questionnaire aimed to understand whether orthodontists have incorporated remote monitoring platforms into their practices, their experiences doing so, and if the COVID-19 pandemic has influenced their use of these advancing resources.

After receiving approval from the Institutional Review Board (IRB) of the Harvard Faculty of Medicine (IRB21-0129) and the AAO legal/academic review teams, the recruitment email was sent out by the AAO to a subsection of their members (a random, deidentified sample and the maximum number they allow a single survey to be sent to) and the consent form was included in the survey as the first question. AAO has a membership of approximately 19,000 orthodontists; however, per the AAO Partners in Research program policy, the recruitment email could only be sent to approximately 2,300 members. Further, the AAO only allows surveys to be sent out once with one reminder email. The questionnaire was delivered via email to a random sample of 2,303 AAO listserv members on June 21, 2021, with a reminder email sent four weeks later. The AAO Partners in Research Program initially identified all members that met the inclusion criteria (i.e., active service, U.S. and international AAO members who were not students, retired, or honorary members), had not opted out of their emails and had not received a different Partners in Research survey within the last 45 days. Of that total, they then used the RAND function in Microsoft Excel to assign each eligible member a random number and selected 2,303 members to be sent the survey recruitment email and questionnaire. The Partners in Research Program did not factor member demographics into the sample selection.

Due to the low response rate, the questionnaire was sent out in a second wave in hopes of collecting more responses. A question was added at the beginning of the survey to confirm the participant had not taken the survey previously. If a participant indicated they had previously taken the survey, the survey would automatically end. The questionnaire was sent to a new random sample of 2,153 orthodontists from the AAO listserv on December 15, 2021, with a reminder email sent approximately 4 weeks later.

A panel of practicing orthodontists were recruited to conduct a cognitive interviewing technique to construct and validate the questionnaire. The content validation process included having the orthodontic experts independently complete the survey followed by one-on-one Zoom meetings between the PI and the experts, to conduct cognitive interviews to gather their feedback [15, 16]. The survey consisted of a series of 31 short-answer and multiple-choice questions about the orthodontists’ usage, experiences, and opinions of utilizing remote monitoring platforms to monitor clear aligner and braces treatment prior to, during, and following the COVID-19 pandemic. Examples of survey questions included multiple-choice questions such as, “In a practice where you work, [prior to/during] the COVID-19 pandemic, did you use a remote secure video conferencing platform (e.g., Zoom for Healthcare) for initial orthodontic patient consults or treatment planning appointments?” and “In a practice where you work, on average, what was the interval between clear aligner orthodontic appointments [prior to/during] the COVID-19 pandemic?”. Additionally, statements followed by Likert scale responses (ranging from “strongly agree (1) ” to “strongly disagree (5)”) were asked such as “Orthodontists can use remote monitoring platforms to monitor treatment progress between in-person orthodontic appointments to the standard of care for the majority of patients.” in which participants were asked to rate how much they agreed with the given statement. Moreover, participants were asked several demographic questions including their age, gender, and location of practice. The initial set of questions confirmed participants’ interest in completing the survey and inclusion criteria: currently practicing orthodontists who have graduated from accredited orthodontic residency programs. Following these eligibility questions, subsequent survey questions were optional.

Survey Administration: This study was designed as an anonymous, voluntary, electronic survey (Qualtrics, Provo, UT). An introductory email was sent to the AAO listserv by the AAO Partners in Research Program describing the study along with the link to the questionnaire. Interested participants clicked on the link and were directed to the Qualtrics survey, starting with the Longwood Medical Area (IRB21-0129) Exempt Human Research Consent statement. The survey was designed to take approximately 10 min to complete. No compensation was provided to participants.

Data Analysis: De-identified data were collected via Qualtrics and analyzed. Descriptive analysis was conducted and frequency (N and %) distributions for each question were reported.