Malocclusion affects 56% of adolescents globally. Fixed orthodontic treatment spans 18 to 24 months during peak self-esteem development, yet psychosocial outcomes are not routinely monitored. Evidence is divergent: some studies report post-treatment improvement in self-esteem; others document paradoxical decline during active treatment. Key moderators including appliance type, dental anxiety, and social media exposure remain inconsistently captured. This narrative review synthesises evidence on self-esteem trajectories across three orthodontic treatment stages, compares the sensitivity of validated psychometric instruments, and proposes a psychosocial monitoring framework for clinical practice. Literature published between 2010 and 2025 was searched across PubMed, Scopus, PsycINFO, and Web of Science. Studies specified adolescent populations aged 10 to 19 using validated instruments: the Rosenberg Self-Esteem Scale (RSES), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), Oral Health Impact Profile (OHIP-14), and Modified Dental Anxiety Scale (MDAS). Thirty-one studies (n=4,200) met inclusion criteria. Self-esteem followed a non-linear trajectory: measurable decline during early active treatment, followed by progressive improvement, with post-treatment scores exceeding baseline in 78% of studies. The PIDAQ demonstrated superior sensitivity to treatment-related psychosocial change compared to the RSES. Clear aligners were associated with lower social impact scores during active treatment than fixed metal appliances. Dental anxiety and social media emerged as underrecognised moderators. Current orthodontic practice does not routinely capture the psychosocial consequences of treatment. We propose the Assess, Monitor, Review (AMR) framework: validated instruments at treatment initiation to identify at-risk patients, brief psychosocial check-ins within review appointments, and structured post-treatment outcome assessment for audit and service improvement.

Syed Ghazi Abbas is a pre-dental researcher based in the UK, admitted to Dentistry at the Szeged University, commencing Sept.2026. His research sits at the intersection of dentistry, psychiatry, and AI; a niche developed in close collaboration with a Consultant Psychiatrist. His work on dental anxiety in children and culmination in the clinical framework (Screen–Match–Review pathway), earned third prize at the BPPA Conference and was accepted for oral presentation at EPA Annual Congress 2026 in Prague.