Pain profile during orthodontic levelling and alignment with fixed appliances reported in randomized trials: a systematic review with meta-analyses

• Published in: Clinical oral investigations 2023-05, Vol.27 (5), p.1851-1868
• Main Authors: Inauen, Deborah Susanne, Papadopoulou, Alexandra K., Eliades, Theodore, Papageorgiou, Spyridon N.
• Format: Article
• Language: English
• Subjects: Adolescent; Analgesics; Analgesics - therapeutic use; Clinical trials; Dentistry; Female; Humans; Male; Medicine; Orthodontic Appliances, Fixed; Orthodontics; Pain; Patients; Randomized Controlled Trials as Topic; Review
• ISSN: 1436-3771; 1432-6981; 1436-3771
• DOI: 10.1007/s00784-023-04931-5

Objective To assess the pain profile of patients in the levelling/alignment phase of orthodontic treatment, as reported from randomized clinical trials. Materials and methods Five databases were searched in September 2022 for randomized clinical trials assessing pain during levelling/alignment with a visual analogue scale (VAS). After duplicate study selection, data extraction, and risk-of-bias assessment, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression, and certainty analyses. Results A total of 37 randomized trials including 2277 patients (40.3% male; mean age 17.5 years) were identified. Data indicated quick pain initiation after insertion of orthodontic appliances ( n  = 6; average = 12.4 mm VAS), a quick increase to a peak at day 1 ( n  = 29; average = 42.4 mm), and gradually daily decrease the first week until its end ( n  = 23; average = 9.0 mm). Every second patient reported analgesic use at least once this week ( n  = 8; 54.5%), with peak analgesic use at 6 h post-insertion ( n  = 2; 62.3%). Patients reported reduced pain in the evening compared to morning ( n  = 3; MD =  − 3.0 mm; 95%CI =  − 5.3, − 0.6; P  = 0.01) and increased pain during chewing ( n  = 2; MD = 19.2 mm; 95% CI = 7.9, 30.4; P