Relationship between Angle's Classification of Malocclusion and Satisfaction with Teeth Arrangement among Adolescents in Northern Nigeria: A Cross-Sectional Study

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Abstract
Background: Adolescents' satisfaction with dental appearance is a key patient-reported outcome in orthodontics. While Angle's classification is the standard for assessing sagittal molar relationships, its association with self-reported satisfaction in sub-Saharan Africa is underexplored. Since posterior molar relationships are not visible to adolescents, satisfaction likely depends on anterior features. This study examined this association in Northern Nigeria, hypothesizing no significant relationship given their conceptual mismatch.Methods: In a cross-sectional study, 198 in-school adolescents aged 12–15 years were selected via multistage sampling in Kano State, Nigeria. Clinical examinations used Angle's classification (intra-examiner kappa: 0.92–0.96). Satisfaction was assessed with a single-item measure. Data were analyzed using Fisher's exact test due to small expected cell counts.Results: Mean age was 13.5±1.1 years; 52.0% were female. Most participants (89.4%) reported satisfaction. Angle's Class I was predominant (91.4%), followed by Class II (5.6%) and Class III (3.0%). Satisfaction rates were 92.3%, 72.7%, and 100%, respectively. The association was not significant (p=0.108). Although dissatisfaction was higher in Class II (27.3%) than Class I (7.7%), the difference was not statistically significant.Conclusions: Most adolescents were satisfied, and Angle's Class I was predominant. No significant association was found, supporting the theoretical expectation that posterior molar relationships do not predict satisfaction. However, null findings must be interpreted cautiously due to limited power, single-item measurement, and absence of anterior feature assessment. Anterior aesthetics, cultural norms, and psychosocial factors may be more influential. Future research should include comprehensive anterior dental measures. Orthodontic assessment should integrate clinical evaluation with patient-reported satisfaction for patient-centered care.