Self-reported pain during different phases of orthodontic treatment with fixed appliance: A multi-centre randomized controlled trial in adolescents with crowding

OBJECTIVES

To compare self-reported pain levels across various treatment phases using passive self-ligating (Damon) and conventional (Victory) standardized fixed appliance systems.

MATERIALS AND METHODS

Adolescents (12-17 years old) with crowding and displaced teeth, planned for non-extraction treatment, were recruited from four orthodontic clinics. They were randomized into stratified blocks (1:1 ratio) using concealed allocation to receive Damon Q™ (34 boys, 28 girls) or Victory™ (39 boys, 31 girls). Pain and analgesic intake were assessed on seven different occasions with validated self-report questionnaires using a 10-grade scale.

RESULTS

Of the 132 patients included, six were lost to follow up. Clinically relevant mean pain scores (≥4) were registered in both groups after bonding upper and lower arches and after insertion of 0.019 × 0.025 stainless steel archwire. The highest mean scores were reported on day two after bonding the upper arch (Damon 5.96, Victory 7.18, P = .011). In both groups, at least 40% reported taking analgesics during various treatment phases. The Damon group reported a lower intake of analgesics on days one and two (P = .042 and .037) after treatment initiation. In the entire sample, boys reported significantly higher mean pain scores than girls on the second and third days after bonding (P = .008 and .026, respectively).

CONCLUSIONS

Lower pain levels were reported from the Damon group after bonding. In general, boys reported higher pain than girls did. Clinicians and adolescents need to be aware that clinically relevant pain levels can be expected not only after bonding but also in later phases.

Effect of verbal and written information on the perception of pain and analgesic consumption, in adolescent orthodontic patients: A randomised controlled trial

OBJECTIVE

To investigate the impact of written instructions, about post-bonding pain, on patients' pain perception and analgesic consumption and to evaluate the correlation of pain with personality types.

DESIGN

Two-arm parallel randomised controlled trial.

SETTING

University Hospital Centre Zagreb, Zagreb, Croatia.

METHODS

Participants included adolescents in the permanent dentition with mild or moderate crowding.

RANDOMISATION

The participants were randomly allocated, using computer-generated random list, into two groups.

INTERVENTIONS

After bonding and archwire insertion, all participants received oral instructions on potential pain occurrence and pain control. Participants in the study group also received written information on post-bonding pain.

OUTCOMES

Pain intensity was evaluated using the Numerical Rating Scale immediately after (T0), 2 days (T1) and 7 days (T2) after the placement of the fixed orthodontic appliance. Analgesic consumption was assessed as yes or no, and personality traits were assessed using the Big Five Inventory. Operators who scored pain intensity and recorded analgesic consumption and personality traits were blinded to the group allocation. Statistical analyses included the t-test, Mann-Whitney U-test, Spearman correlations and stepwise regression analysis.

RESULTS

The highest rate of pain was recorded at T1 (P < 0.001). No statistically significant difference in pain perception between groups was observed. There was no statistically significant difference in analgesic consumption between the two groups (P = 0.81). The correlations between personality traits and pain perception were not significant.

CONCLUSION

The additional written information had little impact on pain perception, and it had no relationship to personality types. The perception of pain and analgesic consumption were not affected by the provision of additional written information (P = 0.81). Participants' personality types did not affect the impact of the information given.

Comparison of pain intensity and impacts on oral health-related quality of life between orthodontic patients treated with clear aligners and fixed appliances: a systematic review and meta-analysis

OBJECTIVE

This study aimed to compare the pain intensity and impacts on oral health-related quality of life (OHRQoL) between orthodontic patients treated with clear aligners (CAs) and fixed appliances (FAs).

METHODS

A systematic search was conducted up to December 2022 using PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and Embase. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (non-RCTs) comparing pain intensity or OHRQoL between patients treated with CAs and FAs were included. The risk of bias (RoB) of individual studies was evaluated using the Cochrane RoB tool 2.0 and ROBINS-I tool for RCTs and non-RCTs, respectively. Further, meta-analyses were separately conducted for each included study using the total oral health impact profile (OHIP)-14 and visual analog scale (VAS) scores to evaluate OHRQoL and pain intensity, respectively.

RESULTS

Overall, 12 studies (5 RCTs and 7 non-RCTs) were included in the study. Subgroup analyses conducted according to the total OHIP-14 scores revealed that patients treated with CAs had higher OHRQoL at 1 week, 1 month, and 6 months of the treatment. Meanwhile, subgroup analyses conducted according to the VAS scores revealed that pain levels were lower in the CA group only at 3 and 4 days of the treatment.

CONCLUSIONS

Patients treated with clear aligners had higher OHRQoL than those treated with fixed appliances during orthodontic treatment. However, OHRQoL appeared to be similar between the two groups at the end of the treatment. Moreover, patients treated with clear aligners experienced lesser pain than those treated with fixed appliances on the third and fourth day after the initial treatment. The difference in pain intensity between the two treatment modalities was not noted at other time points.

Human salivary concentrations of brain derived neurotrophic factor correlates with subjective pain intensity associated with initial orthodontic therapy

Current study aimed to evaluate presence & concentration of salivary molecular pain biomarkers Calcitonin Gene Related Peptide (CGRP) and Brain-Derived Neurotrophic Factor (BDNF) during initial stages of orthodontic treatment and correlation with subjective pain scales, Numerical Rating Scale (NRS), Visual Analogue Scale (VAS), Verbal Rating Scale (VRS) and McGill Pain Questionnaire (MPQ). Consented, healthy-pain free patients (n = 40) undergoing orthodontic therapy, having moderate crowding with pre-molar extraction were recruited. Unstimulated whole saliva was collected and stored at -80 °C in cryotubes. Levels of CGRP & BDNF in salivary samples was assessed by enzyme-linked immunosorbent assay. Samples were collected under stipulated 5 time periods using saliva collection tube by passive drooling method: immediately after bonding but before wire placement (T0-baseline), after 24 h (T1), 48 h (T2), 72 h (T3) & 168 h (T4) after wire placement. Consolidated subjective pain scales were administered concurrently. Regression value (R² > 0.9) confirmed BDNF & CGRP in saliva. Significant change was observed from baseline to 168 h in all subjective parameters (p < 0.05). CGRP did not correlate with subjective pain scales statistically (p > 0.05). BDNF levels correlated with all the subjective pain scales, NRS (T3-p = 0.0092&T4-p = 0.0064), VRS (T3-p = 0.0112&T4-p = 0.0500), VAS (T3-p = 0.0092 &T4-p = 0.0064) &MPQ (T1-p = 0.0255). Mean BDNF & median subjective pain scale graphs were similar. BDNF correlated with all the subjective pain scales warranting further investigation.Trial registration; Clinical Trial Registry-India (CTRI) Reg No: CTRI/2018/12/016571; Registered 10th December, 2018 (10/12/2018) prospectively; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=29640&EncHid=&userName=Dr%20Sagar%20S%20Bhat .

A randomized controlled trial to evaluate the effectiveness of different methods on pain management during orthodontic debonding

BACKGROUND

Orthodontic treatment procedures like separator placement, archwire placement, orthodontic force application, miniscrew placement and debonding procedure usually involve pain and discomfort. Pain perception and methods to reduce pain during debonding in regard to gender and different locations of oral cavity is still a poorly documented issue in orthodontics. The aim of this study was to evaluate the effectiveness of different methods on pain management during debonding and its association with gender and location.

MATERIALS AND METHODS

One hundred and forty orthodontic patients in the stage of debonding were randomly assigned into four groups according to different methods used during debonding; Group A: Medication group (Paracetamol given 1 h before debonding), Group B: Finger pressure group, Group C: Stress relief group and Group D: Control group. A visual analog scale (VAS) was used to assess the pain intensity just after debonding for each sextant.

RESULTS

Among 140 participants, 61 (43.57%) were males and 79 (56.43%) were females. Differences in VAS score in different areas of oral cavity among all groups were found to be significant (p < 0.05). Total VAS score was greater in control group (16.67) followed by stress relief group (13.33) and finger pressure group (10) and least in medication group (8.33). The VAS score was higher in the upper front and lower front sextants in all the groups. Females reported higher VAS score and in upper front sextant, it showed significant difference (p = 0.018). On comparison, total VAS scores were statistically significant difference in medication-stress relief arm pair (p = 0.009), medication-control arm pair (p < 0.001) and finger pressure-control arm pair (0.002). The total VAS score comparison between medication-finger pressure arm was not significant (p = 0.172).

CONCLUSIONS

Pain perceived during debonding varies in different areas of oral cavity among all the groups. Anterior area of oral cavity and female seems to be more sensitive to pain. Use of finger pressure can be used effectively for pain management during debonding.

Orthodontic pain in maxilla and mandible during the first week of orthodontic treatment

Background/Aim: This investigation aimed to evaluate the intensity of self-reported pain and frequency of self-medication with analgesics during the initial phase of orthodontic treatment with fixed appliances and to compare possible differences between the maxillary and mandibular teeth. Material and Methods: In this observational clinical trial 68 patients had similar orthodontic forces (the same bracket-slot and prescription, archwire size and material, and treatment plan) applied on maxillary and mandibular teeth. The patients recorded pain intensity and use of analgesics for the first seven days of treatment. Comparisons between maxillary and mandibular teeth regarding the pain intensity and self-medication frequency were performed by Wilcoxson Signed Ranks Test and McNamara Test for Matched Pairs, respectively. Results: The patients reported moderate pain in both jaws which decreased significantly with each day of treatment. Still, during the initial three days of treatment intensity of pain for maxillary teeth was significantly lower compared to the mandibular teeth. Patients reported analgesics consumption for both jaws, without a statistically significant difference between them. Conclusions: The patients have reported orthodontic pain of higher intensity in the mandibular arch compared to the maxillary arch during the initial phase of orthodontic treatment with fixed appliances.

Is there any difference between conventional, passive and active self-ligating brackets? A systematic review and network meta-analysis

AIM

To test the null hypothesis that there was no difference in treatment efficiency between therapies undertaken with conventional (CBs), passive self-ligating (PSLBs) or active self-ligating (ASLBs) brackets.

MATERIALS AND METHODS

An electronic search was performed in 3 data bases (Pubmed, Web of Science, Cochrane Library) from their origin up to January 2019. Additional references were hand searched. Search was strictly restricted to randomized controlled trials (RCTs) and split-mouth design studies (SMDs). RCTs and SMDs were initially processed separately and subsequently combined in a network meta-analysis. The following variables were evaluated: treatment duration, number of visits, occlusal outcomes, alignment rate, transverse arch dimensional changes, incisor position modification, rate of space closure, anchorage loss, bond failure, root resorption, perception of discomfort during the initial phase of alignment, time to ligate in or to untie an archwire, periodontal variables, quality of life.

RESULTS

On 229 papers, 30 RCTs and 9 SMDs were finally included in this study. Out of 85 comparisons, 16 only revealed statistically significant differences. It was quicker to untie and ligate an 0.014 NiTi arch from/in 6 ASLBs anterior ceramic brackets compared to 6 ceramic CBs. It was also more painful to insert and remove an 0.019×0.025 SS wire in/from PSLB's brackets compared to CB's attachments. Compared to conventional brackets, there was less maxillary incisor proclination with PSLBs in non-extraction cases. Moreover, there was less bleeding on probing 4-5 weeks after bonding with PSLBs compared to CBs brackets. The only significant difference between ASLBs and PSLBs was that alignment was 10 days faster with active self-ligating braces compared with passive self-ligating braces even if treatment duration between ASLBs and PSLBs was not significantly different. The network meta-analysis revealed that IMPA was greater in extractions cases with CBs compared with both ASLBs (+2,5°) and PSLBs (+1,6°).

CONCLUSIONS

The vast majority of the studied variables did not show any significant differences between the three types of brackets. The most significant findings were that it was quicker to insert and remove archwires from ASLBs compared to CBs, and it was more painful to insert and remove an 0.019×0.025" stainless steel wire in/from PSLBs compared to CBs. The major difference between ASLBs and PSLBs was that alignment was 10 days faster with active self-ligating braces compared with passive self-ligating braces even if treatment duration between ASLBs and PSLBs was not significantly different. Most of the claims put forward by the suppliers were not substantiated by our network meta-analysis.

Evaluation of self-perceived pain and jaw function impairment in children undergoing slow and rapid maxillary expansion: A prospective clinical trial

OBJECTIVES

To evaluate and compare perceived pain and jaw function impairment during the first 4 weeks with slow maxillary expansion (SME) using quadhelix and rapid maxillary expansion (RME) using conventional banded hyrax.

MATERIALS AND METHODS

Sixty patients aged 10.2 to 15 years were enrolled and consecutively recruited to either the quadhelix group (QG) or hyrax group (HG). A questionnaire was used to evaluate pain, jaw function impairment, and analgesic consumption in the first 7 days, at 2 weeks, and at 4 weeks.

RESULTS

Fifty-five patients (43 girls and 12 boys) completed the questionnaire at all time points (27 in the QG and 28 in the HG). Except at 4 hours, there were no significant differences between the groups regarding pain from teeth, tongue, and palate. Patients started to adapt after day 3. Patients in the HG group reported significantly higher scores for difficulty in swallowing (moderate to severe) during the first 6 days. In both groups, minimal effects were found on speech and the majority of patients did not experience difficulty in yawning or laughing. There was no significant difference in analgesic consumption between the groups. No correlations were found between age, gender, or malocclusion type and any of the investigated outcomes.

CONCLUSIONS

Quadhelix for SME and conventional banded hyrax for RME were well tolerated by patients after 1 week. The decision to use either appliance could be based on factors not related to patient experiences.

The Influence of Friction on Design of the Type of Bracket and Its Relation to OHRQoL in Patients Who Use Multi-Bracket Appliances: A Randomized Clinical Trial

Background and objectives: The aim of this study was to evaluate the influence of friction on design of the type of bracket, patients’ perception of pain and the impact on their oral health-related quality of life. Materials and Methods: A randomized clinical trial was carried out with 90 patients (62.2% women and 37.8% men) with three kinds of fixed multi-bracket appliances: Conventional (GC), fixed multi-bracket low friction (GS) and self-ligating (GA). The VAS (Visual Analogue Scale) was used to determine pain during the first seven days of treatment at different points in time. The patients were also given the OHIP-14 (Oral Health Impact Profile) questionnaire to analyse their oral health-related quality of life (OHRQoL) after the first 30 days of treatment. The ANOVA test was used for the analysis of the variables and the post hoc Bonferroni test for the comparison between groups. Results: Maximum pain was observed between one and two days after the start of treatment. The GC group showed the greatest degree of pain, with maximum values (4.5 ± 2.0) at 24 h. The self-ligation brackets show lower impact on patients’ oral health-related quality of life (0.8 ± 2.2, p < 0.01). Conclusions: Friction in the type of bracket influences pain and the Oral Health-Related Quality of Life of patients who use multi-bracket fixed orthodontics.

Effect of verbal and written information on pain perception in patients undergoing fixed orthodontic treatment: a randomized controlled trial

BACKGROUND

Pain can discourage patients from seeking orthodontic treatment or compromise their compliance during therapy.

OBJECTIVES

To determine the effects of verbal and written information on orthodontic pain after fixed appliance placement.

TRIAL DESIGN

Two-arm parallel design randomized controlled trial.

METHODS

Healthy adolescents with permanent dentition enrolled for orthodontic treatment were assigned to the study or control group using computer-generated random lists and allocation concealment with sealed envelopes. Participants completed baseline questionnaires to assess anxiety (State-Trait Anxiety Inventory Trait Version, Form X-2) and somatosensory amplification (Somatosensory Amplification Scale). Brackets were placed in the maxillary arch, from first molar to first molar, and an Australian archwire 0.012 inch was used for alignment. General verbal information on orthodontic treatment was given to all patients by the same clinician. Participants included in the study group received also detailed verbal instructions on orthodontic pain together with a take-home information leaflet by another clinician. Outcome included assessments of pain intensity with a Numerical Rating Scale (NRS) on the day of appliance placement (Day 1, bedtime) and twice a day for the following 6 days (Day 2 to Day 7, morning, bedtime), and analgesic consumption. Participants, statistician, and clinicians who gave general verbal information on orthodontic treatment and instructions about how to score pain intensity were blinded to group assignment.

RESULTS

Sixty patients were assigned to the study (n = 30, mean age: 15.4 ± 1.3 years) or control group (n = 30, mean age: 14.7 ± 3.2 years). At baseline, no significant between-group differences were present in terms of anxiety and somatosensory amplification. Orthodontic pain scores were significantly lower in the study group compared with the control one, at bedtime on Day 1 (P < 0.05) and in the morning of Day 2 (P < 0.01). No significant between-group differences were found in following measurements. Overall, analgesic consumption was significantly lower in study compared with the control (P < 0.01).

CONCLUSION

A combination of verbal and written information on orthodontic pain after placement of fixed appliances reduced patient's self-reported pain in the early stages.

REGISTRATION

This study was not registered.

Pain and Oral-Health-Related Quality of Life in Orthodontic Patients During Initial Therapy with Conventional, Low-Friction, and Lingual Brackets and Aligners (Invisalign): A Prospective Clinical Study

The aim of this study was to compare pain and its relationship with the oral quality of life of patients with different types of orthodontic appliances: conventional and conventional low-friction brackets, lingual brackets, and aligners. A prospective clinical study was carried out with a sample size of 120 patients (54 men, 66 women) divided into 4 groups of 30 patients each. The modified McGill questionnaire was used to measure pain at 4, 8, and 24 h and 2, 3, 4, 5, 6, and 7 days after the start of treatment, and the Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to measure the oral-health-related quality of life (OHRQoL) in the first month of treatment. The maximum peak of pain was obtained between 24 and 48 h of treatment. It was found that patients in the lingual orthodontic group described lower levels of pain at all times analyzed, and their scores in the total OHIP-14 indicated less impact on their oral quality of life (1.3 ± 1.2, p < 0.01) compared with the other groups analyzed. There was little difference with the aligners group (Invisalign) (1.7 ± 1.9, p < 0.01). The technique used influences the pain and quality of life of patients at the start of orthodontic treatment.

Influence of a Lubricating Gel (Orthospeed®) on Pain and Oral Health-Related Quality of Life in Orthodontic Patients during Initial Therapy with Conventional and Low-Friction Brackets: A Prospective Randomized Clinical Trial

The aim of this study was to investigate whether statistically significant differences exist regarding pain and the impact on oral quality of life of orthodontic treatment. A conventional brackets system was compared with low-friction brackets. A total of 90 patients (male = 35, female = 55) were chosen for this randomized clinical trial. Pain was assessed at 4, 8, and 24 hours and 2, 3, 4, 5, 6, and 7 days after the start of treatment using the McGill Pain Questionnaire. Oral health-related quality of life (OHRQoL) was assessed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Oral quality of life was assessed at one month, with patients with low-friction brackets describing lower levels of pain. The patients with conventional brackets indicated a worse impact on their quality of life compared to the group with low-friction brackets. Statistically significant differences were found between the groups, with maximum pain observed between the first 24 and 48 hours, and the values of minimum pain are reached after 7 days. The pain and impact on oral quality of life was statistically worse in patients with conventional brackets compared to patients with low-friction brackets. The type of bracket system used was therefore shown to influence patients' perceptions of pain and impact on their OHRQoL.

Comparison of self-ligating Damon3 and conventional MBT brackets regarding alignment efficiency and pain experience: A randomized clinical trial

Background. Self-ligating brackets might be more efficient than conventional appliance systems during the initial alignment stage of orthodontic treatment due to reduced frictional resistance. This study aimed to compare the alignment efficiency and pain experience of Damon3 self-ligating and MBT pre-adjusted brackets in the initial alignment stage.

Methods. In this randomized clinical trial, 30 patients aged 14‒20 years, who needed non-extraction treatment in both maxillary and mandibular arches, were randomly assigned to two groups; 15 patients were treated with MBT pre-adjusted brackets, and 15 patients received Damon3 self-ligating brackets, both with 0.022-in slots. Alginate impressions were taken at the start of treatment (T0) and four monthly visits (T1, T2, T3, and T4). Little’s irregularity index (LII) was used to assess the tooth displacements. The patients rated their pain experience immediately after the insertion of the archwire, 4 hours, 24 hours, 3 days, 7 days, and at each monthly visit using a visual analog scale (VAS).

Results. The rate of upper dental alignment between T0 and T4 was significantly higher with the Damon3 compared to MBT brackets (P=0.015). Although significantly more changes in the lower LII scores were observed during the first three months with the Damon3 system, the rate of improvement in the irregularity of lower teeth over the 4-month period was not significantly different between the two groups (P=0.50). The patients’ pain experience was not significantly different between the bracket groups (P=0.29).

Conclusion. During the four-month alignment stage, significantly more improvement in the upper dental irregularity was observed with self-ligating compared to conventional brackets. The bracket type had no effect on pain experience during the alignment stage.

Comparison of pain levels in patients treated with 3 different orthodontic appliances - a randomized trial

Background and aims

To compare pain levels experienced during initial alignment with three different orthodontic appliance types and to correlate pain with male and female differences, if any.

Methods

A prospective, randomized 3-arm parallel trial allocated 36 adult orthodontic patients into three appliance groups: MBT 0.022" slot (Mini Twin, Ormco, Glendora, USA), self ligating 0.022" slot Damon 3MX (Ormco, Glendora, USA) and clear aligners (Smile align, Mumbai, India). The level of discomfort was assessed through a questionnaire based on the visual analogue scale at four hours, twenty four hours, third and seventh day after appliance placement.

Results

Patients treated with clear aligners reported less pain than patients treated with conventional and self ligating fixed appliances. Patients treated with MBT conventional appliances showed greater pain levels than Damon appliances. A significantly higher visual analogue scale score was observed at 24 hours and the least visual analogue scale scores on the seventh day post appliance placement.

Conclusion

During the first week of orthodontic treatment, patients treated with clear aligners reported lower pain than those treated with conventional and self-ligating appliances.

Perceived pain for orthodontic patients with conventional brackets or self-ligating brackets over 1 month period: A single-center, randomized controlled clinical trial

BACKGROUND/PURPOSE

The objective of this 2-arm parallel trial was to test the superiority of self-ligating brackets (SLB) over conventional brackets (CB) in terms of perceived pain for orthodontic patients.

METHODS

Patients about to undergo treatment were included to fixed appliance placed with CB or SLB. Eligibility criteria included malocclusion patients whose age between 12 to 40 years and suitable for orthodontic fixed appliance treatment. The main outcome was pain intensity measured by visual analog scale (VAS) with all patients followed at 4 h, 24 h, 3 days, 1 week and 1 month. Randomization was accomplished with a computer-generated list of random numbers. Blinding was applicable for outcome assessment only. Data were analyzed using multi-level nonlinear mixed effect model, Friedman's test and Wilcoxon signed rank test with the Bonferroni correction for multiple tests.

RESULTS

Eight-eight patients were randomized in a 1:1 ratio to either SLB or CB. All patients completed the study, and none were lost to follow-up. There were no drop-outs after randomization. Baseline characteristics were similar between groups. The is no statistical significant difference in pain intensity between CB and SLB at 4 h, 24 h, 3 days, 1 week and 1 month. Data were analyzed on an intention-to-treat basis. No serious harm was observed.

CONCLUSION

The results of this study indicated no evidence that the pain intensity differs between CB and SLB at 4 h, 24 h, 3 days, 1 week and 1 month.

Evaluation of pain perception during orthodontic debonding of metallic brackets with four different techniques

Objective

The aim of this study was to evaluate patients’ pain levels during four different debonding procedures. The null hypothesis was that the pain perception of the patients undergoing four different debonding applications was not statistically significant different.

Material and Methods

One hundred and twenty orthodontic patients who underwent orthodontic debonding were included in this study. The patients were randomly divided into 4 groups according to technique used in the patients. Debonding groups were as follows: Group 1) Conventional debonding group, Group 2) Medication group (acetaminophen was given 1 hour before debonding), Group 3) Soft bite wax group, and Group 4) Soft acrylic bite wafer group. The patients’ levels of anxiety and fear of pain were evaluated before debonding, and Numerical Rating Scale (NRS) was applied to evaluate their pain perception during debonding. Mann-Whitney U and Kruskal–Wallis tests were used to evaluate non-normally distributed data. Categorical data analysis were carried by chi-square and McNemar tests. The significance level was set at p<0.05.

Results

Anxiety scores of the patients were not statistically significant between both genders and debonding groups. In the quadrants in which the patients were perceived, the highest pain level was in the left side of the mandible. The teeth in which the highest pain level was perceived were the lower left and upper right lateral incisors. Although there was no statistically significant difference among the pain scores of the patients in each group, quadrant scores of female patients showed significant differences, being the lowest scores in the soft bite wax group.

Conclusions

Majority of the patients had no fear of pain before debonding. Pain levels of the patients in the conventional debonding group were not significantly different from those of the other groups, except quadrant scores of females in the soft bite wax group. The null hypothesis was accepted.

Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign® aligners during the first week of orthodontic treatment

Objective

This study was performed to compare the perception of pain between patients treated with passive self-ligating fixed appliances and those treated with Invisalign aligners.

Methods

This prospective study conducted in Saudi Arabia used an estimated sample of 64 patients from a private dental clinic. After obtaining written informed consent, the patients were divided into two groups; one group (n = 32) was treated using passive self-ligating fixed appliances and the other group (n = 32) using Invisalign^® aligners. Immediately after fitting the appliances, the patients' perception of pain was evaluated through a close-ended and coded self-administrated questionnaire by using a visual analog scale (VAS). Their responses were recorded at 4 hours, 24 hours, day 3, and day 7. Mann-Whitney U-test, Kruskal-Wallis test, and Pearson's chi-square test were performed for statistical analysis.

Results

A lower percentage of patients treated with Invisalign aligners reported pain than did patients treated with passive self-ligating fixed appliances, and these differences were statistically significant (p = 0.001). Similarly, the mean VAS score for the Invisalign group was significantly lower than that for the passive self-ligating fixed appliance group at different intervals during the first week of treatment. The intensity of pain with both appliances peaked at 24 hours (mean VAS score, 3.87) and was lowest (mean VAS score, 1.62) on day 7.

Conclusions

During the first week of orthodontic treatment, patients treated with Invisalign aligners reported lower pain than did those treated with passive self-ligating fixed appliances.

Initial arch wires used in orthodontic treatment with fixed appliances

BACKGROUND

Initial arch wires are the first arch wires to be inserted into the fixed appliance at the beginning of orthodontic treatment and are used mainly for the alignment of teeth by correcting crowding and rotations. With a number of different types of orthodontic arch wires available for initial tooth alignment, it is important to understand which wire is most efficient, as well as which wires cause least amount of root resorption and pain during the initial aligning stage of treatment. This is an update of the review entitledInitial arch wires for alignment of crooked teeth with fixed orthodontic braces, which was first published in 2010.

OBJECTIVES

To assess the effects of initial arch wires for the alignment of teeth with fixed orthodontic braces, in terms of the rate of tooth alignment, amount of root resorption accompanying tooth movement, and intensity of pain experienced by patients during the initial alignment stage of treatment.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 5 October 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 9), MEDLINE Ovid (1946 to 5 October 2017), and Embase Ovid (1980 to 5 October 2017. The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of initial arch wires to align teeth with fixed orthodontic braces. We included only studies involving participants with upper or lower, or both, full arch fixed orthodontic appliances.

DATA COLLECTION AND ANALYSIS

Two review authors were responsible for study selection, 'Risk of bias' assessment and data extraction. We resolved disagreements by discussion between the review authors. We contacted corresponding authors of included studies to obtain missing information. We assessed the quality of the evidence for each comparison and outcome as high, moderate, low or very low, according to GRADE criteria.

MAIN RESULTS

For this update, we found three new RCTs (228 participants), bringing the total to 12 RCTs with 799 participants. We judged three studies to be at high risk of bias, and three to be at low risk of bias; six were unclear. None of the studies reported the adverse outcome of root resorption. The review assessed six comparisons.1. Multistrand stainless steel versus superelastic nickel-titanium (NiTi) arch wires. There were five studies in this group and it was appropriate to undertake a meta-analysis of two of them. There is insufficient evidence from these studies to determine whether there is a difference in rate of alignment between multistrand stainless steel and superelastic NiTi arch wires (mean difference (MD) -7.5 mm per month, 95% confidence interval (CI) -26.27 to 11.27; 1 study, 48 participants; low-quality evidence). The findings for pain at day 1 as measured on a 100 mm visual analogue scale suggested that there was no meaningful difference between the interventions (MD -2.68 mm, 95% CI -6.75 to 1.38; 2 studies, 127 participants; moderate-quality evidence).2. Multistrand stainless steel versus thermoelastic NiTi arch wires. There were two studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from the studies to determine whether there is a difference in rate of alignment between multistrand stainless steel and thermoelastic NiTi arch wires (low-quality evidence). Pain was not measured.3. Conventional NiTi versus superelastic NiTi arch wires. There were three studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from these studies to determine whether there is any difference between conventional and superelastic NiTi arch wires with regard to either alignment or pain (low- to very low-quality evidence).4. Conventional NiTi versus thermoelastic NiTi arch wires. There were two studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from these studies to determine whether there is a difference in alignment between conventional and thermoelastic NiTi arch wires (low-quality evidence). Pain was not measured.5. Single-strand superelastic NiTi versus coaxial superelastic NiTi arch wires. There was only one study (24 participants) in this group. There is moderate-quality evidence that coaxial superelastic NiTi can produce greater tooth movement over 12 weeks (MD -6.76 mm, 95% CI -7.98 to -5.55). Pain was not measured.6. Superelastic NiTi versus thermoelastic NiTi arch wires. There were three studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from these studies to determine whether there is a difference in alignment or pain between superelastic and thermoelastic NiTi arch wires (low-quality evidence).

AUTHORS' CONCLUSIONS

Moderate-quality evidence shows that arch wires of coaxial superelastic nickel-titanium (NiTi) can produce greater tooth movement over 12 weeks than arch wires made of single-strand superelastic NiTi. Moderate-quality evidence also suggests there may be no difference in pain at day 1 between multistrand stainless steel arch wires and superelastic NiTi arch wires. Other than these findings, there is insufficient evidence to determine whether any particular arch wire material is superior to any other in terms of alignment rate, time to alignment, pain and root resorption.

Comparison of Changes in Incisors Position in Cases Treated with Damon Self-Ligating and Conventional Fixed Appliances

Objective:

This study aimed to compare the changes in maxillary and mandibular incisors position in cases treated with Damon self-ligating and conventional fixed appliances.

Methods:

The sample comprised 51 patients with Class I malocclusion, mild to moderate crowding, treated without extractions, divided into 2 groups: Group 1 consisted of 20 patients treated with Damon self-ligating appliance, with a mean initial age of 15.00 years, treated for a mean period of 2.01 years; and Group 2 comprised 31 patients treated with conventional fixed appliances, with a mean initial age of 14.98 years, treated for a mean period of 1.81 years. The initial and final cephalograms of each patient were measured. The intergroup comparisons were performed with independent t or Mann-Whitney tests.

Results:

Both groups showed a mild protrusion and a buccal inclination of the maxillary and mandibular incisors, with no statistically significant difference between them.

Conclusion:

The changes in maxillary and mandibular incisors position were similar between the groups treated with Damon self-ligating and conventional fixed appliances.

Pain experience in adults undergoing treatment: A longitudinal evaluation

OBJECTIVES

To quantify the intensity and duration of pain experience in adults over the initial three visits of fixed appliance-based orthodontic treatment. A secondary objective was to assess the relationship between pain experience and analgesic use, dental irregularity, gender, and age.

MATERIALS AND METHODS

A prospective longitudinal study design was adopted. Fifty-eight adults undergoing fixed appliance treatment in five orthodontic practices recorded pain experience at four time points (4 hours, 24 hours, 3 days, and 7 days) following the initial bond-up appointment (T0) and first (T1) and second (T2) routine follow-up adjustment appointments using a visual analogue scale. In addition, subjects recorded the dosage and frequency of analgesic use.

RESULTS

A slightly greater proportion of women (57%) were recruited, with a mean sample age of 34.69 (SD 12.11) years. Peak pain was experienced between 24 hours and 3 days following appliance placement (T0) and subsequent adjustments (T1 and T2). The highest mean pain score arose at T0 followed by T2 and T1 adjustments, with the difference between pain levels at these appointment intervals being statistically significant ( P < .001). The use of analgesics following each appointment mirrored pain experience, with pain score, appointment, and time point all being significant predictors of analgesic consumption. The level of dental irregularity, gender, or age did not predict pain levels reported.

CONCLUSIONS

Adults undergoing fixed orthodontic therapy should be advised that they are most likely to experience increased levels of pain for 1 to 3 days following placement of their appliance and subsequent adjustment visits.

Does orthodontic debonding lead to tooth sensitivity? Comparison of teeth with and without visible enamel microcracks

INTRODUCTION

Our aim was to assess the possible changes in sensitivity of teeth with and without visible enamel microcracks (EMCs) up to 1 week after the removal of metal brackets.

METHODS

After debonding, 15 patients possessing teeth with visible EMCs and 15 subjects whose teeth were free of EMCs were enrolled in the study. For each experimental group, a control group was formed. The assessments of tooth sensitivity elicited by compressed air and cold testing were performed 5 times: just before debonding, immediately after debonding, and at 1, 3, and 7 days after debonding. Tooth sensitivity was recorded on a 100-mm visual analog scale.

RESULTS

For the patients without visible EMCs, discomfort peaked immediately after debonding and started to decrease on day 1; at 1 week after debonding, the visual analog scale scores were lower than just before debonding and immediately after debonding. For the subjects possessing teeth with visible EMCs, the pattern of sensitivity dynamic was inherently the same. However, the patients with visible EMCs showed higher visual analog scale values at each time interval.

CONCLUSIONS

Debonding leads to a short-term increase in tooth sensitivity. EMCs, a form of enamel damage, do not predispose to greater sensitivity perception in relation to bracket removal.

Therapeutic efficacy of self-ligating brackets: A systematic review

INTRODUCTION

Over the last few years, the use of self-ligating brackets in orthodontics has progressed considerably. These systems have been the subject of numerous studies with good levels of evidence making it possible to evaluate their efficacy and efficiency compared to conventional brackets. The aim of this study was to evaluate the therapeutic efficacy of self-ligating brackets by means of a systematic review of the scientific literature.

MATERIALS AND METHODS

A systematic study was undertaken in the form of a recent search of the electronic Pubmed database, oriented by the use of several keywords combined by Boolean operators relating to the therapeutic efficacy of self-ligating brackets through the study of tooth alignment, space closure, expansion, treatment duration and degree of discomfort. The search was limited to randomized controlled studies, and two independent readers identified studies corresponding to the selection criteria.

RESULTS AND DISCUSSION

The chosen articles comprised 20 randomized controlled trials. The studies analyzed revealed the absence of significant differences between the two types of system on the basis of the clinical criteria adopted, thereby refuting the hypothesis of the superiority of self-ligating brackets over conventional systems.

Treatment of Adults with Anterior Mandibular Teeth Crowding: Reliability of Little's Irregularity Index

The attempt of this article was to assess reliability of Little's Irregularity Index (LII) as for stability of the treatment outcomes in adults with crowded mandibular incisors. LII was measured on a digital cast prior to an orthodontic treatment (T1) of the 302 patients thus allowing us to establish the treatment plan, which called for (a) expansion (group 1), interproximal stripping (group 2), or extraction of one of the mandibular incisors. LII was measured after debonding (T2) and a year after retention (T3). Treatment resulted in significant reduction of LII values after treatment, in T1-T2 period in all groups. As for T2-T3 period it brought significant but clinically irrelevant relapse that occurred in groups 1 and 2; group 3 presented with insignificant improvement of occlusion. Conclusively, 30 years after introducing LII it has been a reliable parameter that allows selection of optimal treatment methods, provided that the appropriate ranges of values displaying dentoalveolar discrepancy are obeyed, namely, (1) up to 3 mm: expansion, (2) from 3 to 5 mm: interproximal enamel reduction, and (3) above 5 mm: extraction.

Supplemental vibrational force does not reduce pain experience during initial alignment with fixed orthodontic appliances: a multicenter randomized clinical trial

This prospective randomized trial investigated the effect of supplemental vibrational force on orthodontic pain during alignment with fixed-appliances. Eighty-one subjects < 20 years-old undergoing extraction-based fixed-appliance treatment were randomly allocated to supplementary (20-minutes/day) use of an intra-oral vibrational device (AcceleDent^®) (n = 29); an identical non-functional (sham) device (n = 25) or fixed-appliances only (n = 27). Each subject recorded pain intensity (using a 100-mm visual-analogue scale) and intake of oral analgesia in a questionnaire, following appliance-placement (T1) and first-adjustment (T2) for 1-week (immediately-after, 4, 24, 72-hours and at 1-week). Mean maximum-pain for the total sample was 72.96 mm [SD 21.59; 95%CI 68.19–77.74 mm] with no significant differences among groups (P = 0.282). Subjects taking analgesics reported slightly higher maximum-pain although this was not significant (P = 0.170). The effect of intervention was independent of analgesia (P = 0.883). At T1 and T2, a statistically and clinically significant increase in mean pain was seen at 4 and 24-hours, declining at 72-hours and becoming insignificant at 1-week. For mean alignment-rate, pain-intensity and use of analgesics, no significant differences existed between groups (P > 0.003). The only significant predictor for mean pain was time. Use of an AcceleDent vibrational device had no significant effect on orthodontic pain or analgesia consumption during initial alignment with fixed appliances.

A multicenter randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: Part 2: Pain perception

OBJECTIVE

To compare pain experience between self-ligating and conventional preadjusted edgewise appliance systems with a two-arm parallel trial.

MATERIALS AND METHODS

A prospective multicenter randomized controlled clinical trial was conducted in three hospital orthodontic departments. Subjects were randomly allocated to receive treatment with either a self-ligating (3M SmartClip™) or conventional (3M Victory™) bracket system with stratification for operator and center. Standardized protocol was followed for bracket bonding procedure and archwire sequence. Subject pain was recorded using a Verbal Rating Scale to assess discomfort felt on the teeth and soft tissues at the time of the appointment and 1, 3, and 5 days after each archwire change up to the working archwire. Multilevel modeling was used to analyze the data by blinded assessors.

RESULTS

One hundred thirty-eight subjects (mean age 14 years 11 months) were enrolled in the study, of which 135 subjects (97.8%) completed the study and 113 (82%) returned the required data regarding pain/discomfort. Perceived pain was statistically higher with the SmartClip™ system compared to the Victory™ system, but this difference was not deemed to be clinically significant. Discomfort was greatest after placement of the initial 0.014-inch nickel-titanium archwire, compared with subsequent wires, and was greatest on day 1, less on day 3, and much less on day 5 after each archwire change. Age and gender did not affect the level of discomfort experienced by subjects undergoing fixed appliance treatment.

CONCLUSION

No clinically significant difference in pain experience was found between patients treated with a self-ligating bracket system compared to those treated with a conventional ligation system.

Mandibular changes during initial alignment with SmartClip self-ligating and conventional brackets: A single-center prospective randomized controlled clinical trial

Objective

To test the null hypothesis that SmartClip self-ligating brackets are more effective than conventional brackets for initial mandibular alignment and identify influential factors.

Methods

Fifty patients were randomly allocated to two equal treatment groups by using an online randomization program: self-ligating group (SmartClip brackets) and conventional group (Gemini brackets). The archwire sequence was standardized. Changes in anterior irregularity index, intercanine width, and intermolar width were assessed on plaster models at 8th and 16th weeks. Changes in incisor position and inclination were assessed on lateral cephalometric radiographs at 16 weeks. Intragroup and intergroup comparisons were performed with paired t-test and Student's t-test, respectively. Multiple linear regression was performed to identify variables affecting improvement in anterior ambiguity.

Results

Data of 46 patients were analyzed; those missing an appointment (n = 2) or showing bracket breakage (n = 2) were excluded. Incisor inclination (p < 0.05), intercanine width (p < 0.05), and intermolar width (p > 0.05) increased at 8 and 16 weeks in both the groups; no significant intergroup differences were noted (p > 0.05). Initial anterior irregularity index and intercanine width change were significantly associated with improvement in anterior irregularity (p < 0.001).

Conclusions

The null hypothesis was rejected. Bracket type has little effect on improvement in anterior ambiguity during initial mandibular alignment.

Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy

Background

The aim of this study was to evaluate and compare the difference in the level of pain using the visual analog scale (VAS) between cases treated with the edgewise appliance and Invisalign. In addition, the cause of pain and discomfort in the Invisalign cases was identified.

Methods

The sample consisted of 145 cases for the edgewise group (EG; n = 55), Invisalign group (IG; n = 38), and edgewise and Invisalign group (EIG; n = 52). VAS scores were collected during the first three stages (first stage: 0 to 7 days, second stage: 14 to 21 days, and third stage: 28 to 35 days) and at the end of the treatment (overall VAS score). Evaluation of the cause of pain was categorized into three different types of problem (category 1: non-smoothed marginal ridge or missing materials, category 2: deformation of attachments, and Category 3: deformation of the tray). Statistical comparison of VAS scores between groups was performed by two-way analysis of variance.

Results

A significantly higher VAS score was observed at 3 and 4 days after, at 1, 2, and 3 days after, and at 2 and 3 days after in stages 1, 2, and 3, respectively, in EG compared to EIG and IG. A significant difference was observed in overall VAS scores between EG and IG in intensity of pain, number of days that pain lasted, and discomfort level. Only intensity of pain resulted in a significant difference between EG and EIG. Most of the causes of problem in the Invisalign cases were deformation of the tray.

Conclusions

Invisalign may offer less pain compared to the edgewise appliance during the initial stages of treatment. In the use of Invisalign, deformation of tray must be carefully checked to avoid pain and discomfort for the patients.

Randomized controlled clinical trial of oral health-related quality of life in patients wearing conventional and self-ligating brackets

OBJECTIVE

The aim of this randomized controlled clinical trial was to compare oral health-related quality of life (OHRQoL) of patients treated with conventional, active self-ligating (ASL), and passive self-ligating (PSL) brackets in different therapeutic phases.

METHODS

Sixty patients (mean age 18.3 years; 29 males and 31 females) requiring orthodontic treatment were randomly and equally assigned to receive conventional (Victory Series), ASL (In-Ovation R), or PSL (Damon 3MX) brackets. OHRQoL was measured with a self-administered modified 16-item Malaysian version of the Oral Health Impact Profile for immediate (soon after the visit) and late (just before the subsequent visit) assessments of the bonding and activation phases. Data were analyzed with the Kruskal-Wallis and chi-square tests.

RESULTS

The PSL and ASL groups showed more immediate and late impacts in the bonding phase, respectively; the conventional group was affected in both the assessments. The first activation phase had similar impacts in the groups. After the second activation, the conventional group showed more immediate impacts, whereas the PSL and ASL groups had more late impacts. The commonly affected domains were "physical disability," "functional limitation," "physical pain," and "psychological discomfort." No significant differences in the prevalence and severity of immediate and late impacts on OHRQoL of the patients were noted in any therapeutic phase.

CONCLUSIONS

No bracket system seems to ensure superior OHRQoL. This information could be useful for explaining the therapeutic phases, especially the initial one, and selecting the optimal bracket system based on the patient's preference.

Self-ligating brackets and their impact on oral health-related quality of life in Chinese adolescence patients: a longitudinal prospective study

INTRODUCTION

Although the associations between orthodontic and oral health-related quality of life (OHRQOL) have been explored, little research has been done to address the influence of brackets type on perceived OHRQOL. The aim of this study was to assess whether the levels of OHRQOL in Chinese adolescence patients were influenced by the type of brackets.

MATERIALS AND METHODS

One hundred fifty Chinese orthodontic adolescence patients completed the 14-item Oral Health Impact Profile (OHIP-14, Chinese version) at five distinct intervals: after insertion of the fixed appliance at 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4); and after treatment (T5).

RESULTS

Patients with self-ligating brackets were associated with less pain and discomfort at any intervals compared with conventional brackets, but no significant difference of overall OHIP-14 scores could be found between two groups. Moreover, in both groups, overall scores at T1 and T2 were significantly higher than the scores at any other intervals in both groups.

CONCLUSIONS

The type of orthodontic appliance did not affect oral health-related quality of life in Chinese adolescence patients.

A randomized controlled trial to assess the pain associated with the debond of orthodontic fixed appliances

Objective: To determine patient experience of pain during treatment with fixed orthodontic appliances, expectations of pain during debond and whether biting on a soft acrylic wafer during debond decreases pain experience.

Design: Multicentre randomized controlled trial.

Setting: Three UK hospital based orthodontic departments: Mid-Staffordshire NHS Foundation Trust, Birmingham Dental Hospital and University Hospital of North Staffordshire.

Materials and methods: Ninety patients were randomly allocated to either the control (n = 45) or wafer group (n = 45). A visual analogue scale-based questionnaire was completed pre-debond to determine pain experience during treatment and expectations of pain during debond. The appliances were debonded and those in the wafer group bit on a soft acrylic wafer. A second questionnaire was completed post-debond to assess the pain experienced.

Results: Biting on an acrylic wafer significantly reduced the pain experienced when debonding the posterior teeth (P≤0·05). Thirty-nine per cent found the lower anterior teeth the most painful. The expected pain was significantly greater than that actually experienced (P≤0·0001). Greater pain during treatment correlated with increased expectations and increased actually experienced pain (P≤0·0001).

Conclusions: Biting on a soft acrylic wafer during debond of the posterior teeth reduces the pain experienced. The lower anterior teeth are the most painful. The pain expected is significantly greater than actually experienced. Patients who had greater pain during treatment expected and experienced greater pain at debond.

Assessment of pain experience in adults and children after bracket bonding and initial archwire insertion

INTRODUCTION

Ninety five percent of orthodontic patients routinely report pain, due to alterations in the periodontal ligament and surrounding soft tissues, with intensity and prevalence varying according to age.

OBJECTIVE

This study aimed to assess toothache and buccal mucosal pain in adults and children during two initial phases of the orthodontic treatment.

METHODS

The intensity of toothache and buccal mucosal pain reported by 20 patients, 10 children (11-13 years) and 10 adults (18-37 years) was recorded with the aid of a Visual Analog Scale (VAS), during 14 days--7 days with bonded brackets only and 7 days with the initial archwire inserted.

RESULTS

There was no significant difference in pain intensity among adults and children. After bracket bonding, 50% of the children and 70% of the adults reported pain. 70% of both groups reported pain after initial archwire insertion. While adults reported constant, low intensity, buccal mucosal pain, the children showed great variation of pain intensity, but with a trend towards decreasing pain during the assessment period. After initial archwire insertion the peaks of toothache intensity and prevalence occurred 24 hours in children and 48 hours in adults.

CONCLUSIONS

In general, children reported pain less frequently than adults did, though with greater intensity.

A prospective longitudinal controlled assessment of pain experience and oral health-related quality of life in adolescents undergoing fixed appliance treatment

OBJECTIVE

To compare subjective pain experience and oral health-related quality of life (OH-QoL) in treated and untreated subjects over the first 3 months of fixed appliance therapy.

SETTING AND SAMPLE POPULATION

The Department of Orthodontics, School of Medicine and Dentistry. One hundred and twenty-four subjects aged between 11 and 14 years either commencing or awaiting fixed appliance treatment.

MATERIAL & METHODS

A prospective controlled longitudinal study design was applied to subjects, over a 3-month observation period, following the placement of fixed appliances. Socio-economic status, OH-QoL, pain experience and analgesic consumption were recorded on questionnaires at baseline (T0), 6 weeks (T1) and 3 months (T2).

RESULTS

Oral symptoms and functional limitation domains of OH-QoL were found to worsen, during the follow-up period, in the test group (p = 0.001 and p = 0.002, respectively). In the treated group, pain intensity declined significantly on days 3 and 2 at T1 and T2, respectively (p < 0.001). Analgesia was required during both periods in a total of 13 participants (24.5%) undergoing orthodontic treatment.

CONCLUSION

Based on this prospective controlled study, the initial stages of fixed appliance treatment results in subjective pain experience, with subsequent reduction, and a significant impact on oral symptoms and functional limitation domains of OH-QoL.

The influence of patient's motivation on reported pain during orthodontic treatment

INTRODUCTION: Patients usually experience pain during orthodontic treatment. This fact can affect cooperation and the development of treatment. Reporting pain during treatment seems to be influenced by emotional aspects such as the patient's motivation. OBJECTIVE: To assess the relationship between patient's motivation and the intensity of reported pain during two stages of treatment. METHODS: Twenty males (11-37 years old) answered a questionnaire divided into five categories regarding their motivation towards treatment. The subjects were studied for 14 days (7 days with bonded brackets and 7 days with the initial arch inserted) and the intensity of pain was evaluated on a daily basis. All the issues, including the intensity of pain, were measured through the visual analog scale (VAS). RESULTS: The VAS-associated questionnaire proved to have good temporal reliability and reasonable internal consistency, being that the "perceived severity" domain had the greatest, although not significant (p = 0.196) correlation with pain intensity. Only the question asking the patients if they thought that their teeth were too uneven showed a positive correlation with pain intensity (p = 0.048). CONCLUSION: The results seem to indicate that the five categories related to treatment motivation cannot be used to predict discomfort during treatment. In addition, patients who think their teeth are too uneven may experience more severe pain due to greater force application after insertion of the initial arch.

Initial arch wires for tooth alignment during orthodontic treatment with fixed appliances

BACKGROUND

Initial arch wires are the first arch wires to be inserted into the fixed appliance at the beginning of orthodontic treatment and are used mainly for the alignment of teeth by correcting crowding and rotations. With a number of different types of orthodontic arch wires available for initial tooth alignment, it is important to understand which wire is most efficient, as well as which wires cause the least amount of root resorption and pain during the initial aligning stage of treatment. This is an update of the review 'Initial arch wires for alignment of crooked teeth with fixed orthodontic braces' first published in the Cochrane Database of Systematic Reviews 2010, Issue 4.

OBJECTIVES

To assess the effects of initial arch wires for alignment of teeth with fixed orthodontic braces in relation to alignment speed, root resorption and pain intensity.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 2 August 2012), CENTRAL (The Cochrane Library 2012, Issue 7), MEDLINE via OVID (1950 to 2 August 2012) and EMBASE via OVID (1980 to 2 August 2012). We also searched the reference lists of relevant articles. There was no restriction with regard to publication status or language of publication. We contacted all authors of included studies to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of initial arch wires to align teeth with fixed orthodontic braces. Only studies involving participants with upper and/or lower full arch fixed orthodontic appliances were included.

DATA COLLECTION AND ANALYSIS

Two review authors were responsible for study selection, validity assessment and data extraction. All disagreements were resolved by discussion amongst the review team. Corresponding authors of included studies were contacted to obtain missing information.

MAIN RESULTS

Nine RCTs with 571 participants were included in this review. All trials were at high risk of bias and a number of methodological limitations were identified. All trials had at least one potentially confounding factor (such as bracket type, slot size, ligation method, extraction of teeth) which is likely to have influenced the outcome and was not controlled in the trial. None of the trials reported the important adverse outcome of root resorption.Three groups of comparisons were made.(1) Multistrand stainless steel initial arch wires compared to superelastic nickel titanium (NiTi) initial arch wires. There were four trials in this group, with different comparisons and outcomes reported at different times. No meta-analysis was possible. There is insufficient evidence from these trials to determine whether or not there is a difference in either rate of alignment or pain between stainless steel and NiTi initial arch wires.(2) Conventional (stabilised) NiTi initial arch wires compared to superelastic NiTi initial arch wires. There were two trials in this group, one reporting the outcome of alignment over 6 months and the other reporting pain over 1 week. There is insufficient evidence from these trials to determine whether or not there is any difference between conventional (stabilised) and superelastic NiTi initial arch wires with regard to either alignment or pain.(3) Single-strand superelastic NiTi initial arch wires compared to other NiTi (coaxial, copper NiTi (CuNiTi) or thermoelastic) initial arch wires. The three trials in this comparison each compared a different product against single-strand superelastic NiTi. There is very weak unreliable evidence, based on one very small study (n = 24) at high risk of bias, that coaxial superelastic NiTi may produce greater tooth movement over 12 weeks, but no information on associated pain or root resorption. This result should be interpreted with caution until further research evidence is available. There is insufficient evidence to determine whether or not there is a difference between either thermoelastic or CuNiTi and superelastic NiTi initial arch wires.

AUTHORS' CONCLUSIONS

There is no reliable evidence from the trials included in this review that any specific initial arch wire material is better or worse than another with regard to speed of alignment or pain. There is no evidence at all about the effect of initial arch wire materials on the important adverse effect of root resorption. Further well-designed and conducted, adequately-powered, RCTs are required to determine whether the performance of initial arch wire materials as demonstrated in the laboratory, makes a clinically important difference to the alignment of teeth in the initial stage of orthodontic treatment in patients.

Systematic review on self-ligating vs. conventional brackets: initial pain, number of visits, treatment time

OBJECTIVE

Meta-analysis of differences between conventional and self-ligating brackets concerning pain during tooth movement, number of patient visits, total treatment duration, and ligation times.

MATERIALS AND METHODS

Online search in Medline, Embase, and Central focused on randomized clinical trials and controlled clinical studies published between 1996 and 2012.

RESULTS

Four studies on pain met our inclusion criteria, two on the number of appointments, two on overall treatment time but none on ligation times. Pain levels did not differ significantly between patients treated with conventional or self-ligating brackets after 4 h, 24 h, 3 and 7 days. The number of appointments and total treatment times revealed no significant differences between self-ligating and conventional brackets.

CONCLUSION

The lack of significant overall effects apparent in this meta-analysis contradicts evidence-based statements on the advantages of self-ligating brackets over conventional ones regarding discomfort during initial orthodontic therapy, number of appointments, and total treatment time. Due to the limited number of studies included, further randomized controlled clinical trials are required to deliver more data and to substantiate evidence-based conclusions on differences between the two bracket types considering orthodontic pain, number of visits, treatment, and ligation times.