Pain level between clear aligners and fixed appliances: a systematic review

Paula Coutinho Cardoso, Daybelis Gonzalez Espinosa, Paulo Mecenas, Carlos Flores-Mir, David Normando, Paula Coutinho Cardoso, Daybelis Gonzalez Espinosa, Paulo Mecenas, Carlos Flores-Mir, David Normando

Abstract

Objectives: To assess if there is any difference in pain levels between orthodontic treatment with clear aligners or fixed appliances.

Materials and methods: An electronic search was completed in PubMed, The Cochrane Database, Web of Science, Scopus, Lilacs, Google Scholar, Clinical Trials, and OpenGrey databases without any restrictions until February 2019. All comparative study types contrasting pain levels between clear aligners and fixed appliances were included. The risk of bias (RoB) was assessed using the Newcastle-Ottawa Scale, ROBINS-I-Tool, or ROB 2.0 according to the study design. The level of evidence was assessed through the GRADE tool.

Results: After removal of duplicates, exclusion by title and abstract, and reading the full text, only seven articles were included. Five were prospective non-randomized clinical trials (CCT), one was a cross-sectional study, and one was a randomized clinical trial (RCT). Two studies presented a high RoB, three a moderate RoB, and two a low RoB (including the RCT). A meta-analysis was not performed because of clinical, statistical, and methodological heterogeneity. Most of the studies found that pain levels in patients treated with Invisalign were lower than those treated with conventional fixed appliances during the first days of treatment. Differences disappeared thereafter. No evidence was identified for other brands of clear aligners.

Conclusions: Based on a moderate level of certainty, orthodontic patients treated with Invisalign appear to feel lower levels of pain than those treated with fixed appliances during the first few days of treatment. Thereafter (up to 3 months), differences were not noted. Malocclusion complexity level among included studies was mild. Pain is one of many considerations and predictability and technical outcome are more important, mainly considering that the difference does not seem to occur after the first months of the orthodontic treatment.

Keywords: Invisalign; Malocclusion; Orthodontic appliances; Pain.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Diagram with number of records at each stage of the review according to PRISMA statement

References

    1. Bergius M, Kiliaridis S, Berggren U. Pain in orthodontics a review and discussion of the literature. J Orofac Orthop. 2000;62(2):125–137. doi: 10.1007/BF01300354.
    1. White DW, Julien KC, Jacob H, Campbell PM, Buschang PH. Discomfort associated with Invisalign and traditional brackets: a randomized , prospective trial. Angle Orthod. 2017;87(6):801–808. doi: 10.2319/091416-687.1.
    1. Kazancı F, Aydoğan C, Alkan Ö. Patients’ and parents’ concerns and decisions about orthodontic treatment. Korean J Orthod. 2016;46(1):20–26. doi: 10.4041/kjod.2016.46.1.20.
    1. Al-Omiri MK, Abu Alhaija ES. Factors affecting patient satisfaction after orthodontic treatment. Angle Orthod. 2006;76(3):422–431.
    1. Haynes S. Discontinuation of orthodontic relative to patient age Orthodontic. J Dent. 1967;2(4):138–142. doi: 10.1016/0300-5712(74)90041-4.
    1. Jones M, Chan C. The pain and discomfort experienced during orthodntic treatment: a randomized controlled clinical trial of two intial aligning arch wires. Am J Orthod Dentofacial Orthop. 1992;102(4):373–381. doi: 10.1016/0889-5406(92)70054-E.
    1. Ngan P, Kess B, Wilson S. Perception of discomfort by patients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop. 1989;96(1):47–53. doi: 10.1016/0889-5406(89)90228-X.
    1. Scheurer PA, Firestone AR, Burgin WB. Perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod. 1996;18(4):349–357. doi: 10.1093/ejo/18.4.349.
    1. Thilander B, Rygh P, Reitan K. Tissue reactions in orthodontics.: Elsevier, Philadelphia, PA; 2005. 247-286 p.
    1. Almasoud NN. Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign ® aligners during the first week of orthodontic treatment. Korean J Orthod. 2018;48(5):326–332. doi: 10.4041/kjod.2018.48.5.326.
    1. Miller KB, McGorray SP, Womack R, Quintero C, Perelmuter M, Gibson J, et al. A comparison of treatment impacts between Invisalign aligner and fixed appliance therapy during the first week of treatment. Am J Orthod Dentofacial Orthop. 2007;131(3):302.e1–302.e9. doi: 10.1016/j.ajodo.2006.05.031.
    1. Shalish M, Cooper-kazaz R, Ivgi I, Canetti L, Tsur B, Bachar E, et al. Adult patients’ adjustability to orthodontic appliances. Part I : a comparison between Labial, Lingual, and Invisalign ™. Eur J Orthod. 2012;34(6):724–730. doi: 10.1093/ejo/cjr086.
    1. Flores-Mir C, Brandelli J, Pacheco-Pereira C. Patient satisfaction and quality of life status after 2 treatment modalities: Invisalign and conventional fixed appliances. Am J Orthod Dentofacial Orthop. 2018;154(5):639–644. doi: 10.1016/j.ajodo.2018.01.013.
    1. Galan-lopez L. A systematic review of the accuracy and efficiency of dental movements with Invisalign. Korean J Orthod. 2019;49(3):140–149. doi: 10.4041/kjod.2019.49.3.140.
    1. Papadimitriou A, Mousoulea S, Gkantidis N, Kloukos D. Clinical effectiveness of Invisalign® orthodontic treatment: a systematic review. Prog Orthod. 2018;19(1):37. doi: 10.1186/s40510-018-0235-z.
    1. Ke Y, Zhu Y, Zhu M. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. 2019;19(1):24. doi: 10.1186/s12903-018-0695-z.
    1. Zheng M, Liu R, Ni Z, Yu Z. Efficiency, effectiveness and treatment stability of clear aligners: a systematic review and meta-analysis. Orthodo Craniofacial Res. 2017;20(3):127–133. doi: 10.1111/ocr.12177.
    1. Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Periodontal health during clear aligners treatment: a systematic review. Eur J Orthod. 2015;37(5):539–543. doi: 10.1093/ejo/cju083.
    1. Azaripour A, Weusmann J, Mahmoodi B, Peppas D, Gerhold-Ay A, Van Noorden CJF, et al. Braces versus Invisalign ® : gingival parameters and patients ’ satisfaction during treatment : a cross-sectional study. BMC Oral Health. 2015;15(1):69. doi: 10.1186/s12903-015-0060-4.
    1. Fujiyama K, Honjo T, Suzuki M, Matsuoka S, Deguchi T. Analysis of pain level in cases treated with Invisalign aligner : comparison with fixed edgewise appliance therapy. Prog Orthod. 2014;15(1):64. doi: 10.1186/s40510-014-0064-7.
    1. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2014.
    1. Sterne JAC, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I : a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919–i491i. doi: 10.1136/bmj.i4919.
    1. Higgins JPT, Sterne JACJS, Page MJ, Hróbjartsson A, Boutron I, Reeves B, et al. A revised tool for assessing risk of bias in randomized trials. Cochrane Database Syst Rev. 2016;10(suppl 1):29–31.
    1. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–406. doi: 10.1016/j.jclinepi.2010.07.015.
    1. Masi-damois C. Comparaison de la perception de la douleur entre le traitement orthodontique avec Invisalign® et le traitement avec fils et boîtiers fixes. 2015.
    1. Tufekcia E, Lucchese A, Gherlone E. Prevalence of white-spot lesions before and during orthodontic treatment with fixed appliances. Eur J Orthod. 2013;35(5):664–668. doi: 10.1093/ejo/cjs070.
    1. Pacheco-Pereira C, Brandelli J, Flores-Mir C. Patient satisfaction and quality of life changes after Invisalign treatment. Am J Orthod Dentofacial Orthop. 2018;153(6):834–841. doi: 10.1016/j.ajodo.2017.10.023.
    1. Djeu G, Shelton C, Maganzini A. Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system. Am J Orthod Dentofacial Orthop. 2005;128(3):292–298. doi: 10.1016/j.ajodo.2005.06.002.
    1. Zachrisson S, Zachrisson BU. Gingival condition associated with orthodontic treatment. Angle Orthod. 1972;42(1):26–34.
    1. Bergius M, Berggren U, Kiliaridis S. Experience of pain during an orthodontic procedure. Eur J Oral Sci. 2002;110(2):92–98. doi: 10.1034/j.1600-0722.2002.11193.x.
    1. Krukemeyer AM, Arruda AO, Inglehart MR. Pain and orthodontic treatment patient experiences and provider assessments. Angle Orthod. 2009;79(6):1175–1181. doi: 10.2319/121308-632R.1.
    1. Oliver RG, Knapman YM. Attitudes to orthodontic treatment. Br J Orthod. 2019;12(4):179–188. doi: 10.1179/bjo.12.4.179.
    1. Patel V. Non-completion of active orthodontic treatment. Br J Orthod. 2019;19(1):47–54. doi: 10.1179/bjo.19.1.47.
    1. Lew KK. Attitudes and perceptions of adults towards orthodontic treatment in an Asian community. J Community Dent Oral Epidemiol. 1993;21(1):31–35. doi: 10.1111/j.1600-0528.1993.tb00715.x.
    1. Jones ML. An investigation into the initial discomfort caused by placement of an archwire. Eur J Orthod. 1984;6(1):48–54. doi: 10.1093/ejo/6.1.48.
    1. Erdinç AME, Dinçer B. Perception of pain during orthodontic treatment with fixed appliances. Eur J Orthod. 2004;26(1):79–85. doi: 10.1093/ejo/26.1.79.
    1. Furstman L, Bernick S. Clinical considerations of the periodontium. Am J Orthod Dentofacial Orthop. 1970;61(2):138–155. doi: 10.1016/0002-9416(72)90092-9.
    1. Dray A. Inflammatory mediators of pain. Br J Anaesthesia. 1995;75(2):125–131. doi: 10.1093/bja/75.2.125.
    1. Grieve WG, III, Johnson GK, Moore RN, Reinhardt RA, Dubois LM. Levels in gingival crevicular fluid during human orthodontic tooth movement. Am J Orthod Dentofacial Orthop. 1994;105(4):369–374. doi: 10.1016/S0889-5406(94)70131-8.
    1. Oliveira CMD, Sheiham A. Orthodontic treatment and its impact on oral health-related quality of life in Brazilian adolescents. J Orthod. 2004;31(1):20–27. doi: 10.1179/146531204225011364.
    1. Krishnan V. Orthodontic pain: from causes to management--a review. Eur J Orthod. 2007;29(2):170–179. doi: 10.1093/ejo/cjl081.
    1. Doll GM, Zentner A, Klages U, Sergl HG. Relationship between patient discomfort, appliance acceptance and compliance in orthodontic therapy. J Orofacial Orthop. 2000;61(6):398–413. doi: 10.1007/PL00001908.
    1. Bos A, Hoogstraten J, Prahl-andersen B. Attitudes towards orthodontic treatment : a comparison of treated and untreated subjects. Eur J Orthod. 2005;27(2):148–154. doi: 10.1093/ejo/cjh071.
    1. Burstone CJ, Goldberg AJ. Beta titanium: a new orthodontic alloy. 1980;77(2):121-32.
    1. Kapila S, Sachdeva RJAJoO, Orthopedics D. Mechanical properties and clinical applications of orthodontic wires. 1989;96(2):100-9.
    1. Evans TJW, Jones ML, Newcombe RGJAjoo, orthopedics d. Clinical comparison and performance perspective of three aligning arch wires. 1998;114(1):32-9.
    1. Gravina MA, Brunharo IHVP, Canavarro C, Elias CN, Quintão CCAJDpjoo. Mechanical properties of NiTi and CuNiTi shape-memory wires used in orthodontic treatment. Part 1: stress-strain tests. 2013;18(4):35-42.
    1. Papageorgiou S, Konstantinidis I, Papadopoulou K, Jäger A, Bourauel CJO, research c. A systematic review and meta-analysis of experimental clinical evidence on initial aligning archwires and archwire sequences. 2014;17(4):197-215.
    1. Sergl HG, Klages U, Zentner A. Pain and discomfort during orthodontic treatment: causative factors and effects on compliance. Am J Orthod Dentofacial Orthop. 1998;114(6):684–691. doi: 10.1016/S0889-5406(98)70201-X.
    1. Opree A, Kress M. Involvement of the proinflammatory cytokines tumor necrosis factor-a, IL-1b, and IL-6 but not IL-8 in the development of heat hyperalgesia: effects on heat-evoked calcitonin gene-related peptide release from rat skin. J Neurosci. 2000;20(16):6289–6293. doi: 10.1523/JNEUROSCI.20-16-06289.2000.
    1. Polat Ö. Pain and discomfort after orthodontic appointments. Semin Orthod. 2007;13(4):292–300. doi: 10.1053/j.sodo.2007.08.010.
    1. Abdelrahman RS, Al-Nimri KS, Al Maaitah EF. Pain experience during initial alignment with three types of nickel-titanium archwires: a prospective clinical trial. Angle Orthod. 2015;85(6):1021–1026. doi: 10.2319/071614-498.1.
    1. Da Costa E, Blagitz M, Normando A. Impact of catastrophizing on pain during orthodontic treatment. Dental Press J Ortho. 2019.
    1. Brown DF, Moerenhout RG. The pain experience and psychological adjustment to orthodontic treatment of preadolescents, adolescents, and adults. Am J Orthod Dentofacial Orthop. 1991;100(4):349–356. doi: 10.1016/0889-5406(91)70073-6.
    1. Salgado K, Normando A, Brandão G. Factors associated with pain perception in the initial phase of orthodontic alignment: a cohort study.: Federal University of Pará; 2018.
    1. Sun L. Relationship between the severity of malocclusion and oral health related quality of life : a systematic review and meta-analysis. Oral Health Prev Dent. 2017;15(6):503–518.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir