# User Experience, Satisfaction, and Complications of Direct-to-Consumer Orthodontics in Spain: A Cross-Sectional Study

## TL;DR

This study examines user experiences with direct-to-consumer orthodontics in Spain, finding that while cost and convenience are appealing, many users face complications and unmet expectations.

## Contribution

The study provides new insights into DTCO user experiences, satisfaction, and complications specifically in the Spanish context.

## Key findings

- Most respondents reported unmet expectations and would not recommend DTCO.
- Cost was the main reason for choosing DTCO, followed by convenience.
- Many users experienced complications requiring dental consultations.

## Abstract

Background/Objectives: Direct-to-Consumer Orthodontics (DTCO) has gained popularity through social media, offering clear aligner treatments without in-person supervision. However, there is limited research on the related user experiences, satisfaction, and complications, particularly in Spain. This study aimed to evaluate user experiences, satisfaction levels, and complications associated with DTCO in a sample of Spanish consumers. Additionally, differences among major DTCO providers were analyzed. Methods: A cross-sectional online survey was conducted over one year. This questionnaire, adapted from previous studies and reviewed by certified orthodontists, assessed user awareness, reasons for treatment selection, communication with providers, discomfort, complications, and satisfaction. A total of 101 valid responses were analyzed using statistical means. Results: The majority of respondents reported that their expectations were not met, and they would not recommend DTCO. Cost was the primary motivation for treatment selection, followed by convenience. Many users experienced complications, leading to dental consultations. While overall satisfaction levels did not significantly differ among providers, variations were observed in discomfort levels, in-person care availability, and the need for additional consultations. Conclusions: DTCO offers affordability and convenience but raises concerns regarding treatment quality and supervision. In most cases, users’ expectations were not met, highlighting the need for greater patient education and regulatory oversight.