This audit highlights a need for increased training at undergraduate and postgraduate levels to update practitioners about contemporary retention practice. Better communication is required from orthodontists to GDPs to ensure that on discharge the dentist is aware of the retainer type and retention regime.
Summary
Background
Pain is an unpleasant side-effect that can be experienced during orthodontic procedures including debonding of fixed appliances. Pain experience can vary depending on the appliance, debonding technique, as well as adjunctive measures used.
Objectives
The primary objective of this systematic review was to assess the effectiveness of different debonding techniques and adjunctive methods on pain/discomfort perception during debonding procedure (PDP) of fixed orthodontic appliances. The secondary objective was to assess the effects of anatomic location and gender on PDP of fixed orthodontic appliances.
Search methods
Multiple electronic databases were searched from inception to August 2018. Reference lists of the included articles were manually screened.
Selection criteria
Randomized clinical trials (RCTs) and controlled clinical trials were included.
Data collection and analysis
Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers according to Cochrane guidelines, with disputes resolved by a third reviewer. Clinical heterogeneity in study design and methodology prevented quantitative synthesis of the data.
Results
The search yielded 198 articles after the removal of duplicates. Seven studies were included in the final review with a total of 307 participants aged 12–60 years. Of the four studies comparing different debonding instruments of labial fixed appliances, two studies showed that the lift-off debonding instrument (LODI) produced lower PDP levels than ligature cutting pliers. Three studies compared adjunctive measures to reduce PDP of labial fixed appliances. Finger pressure and bite wafers significantly reduced PDP levels. Analgesics administration (ibuprofen + paracetamol tablets) 1 hour prior to debonding also reduced PDP. PDP was significantly higher in anterior segments and in females.
Limitations
The authors acknowledge that there was clinical heterogeneity among the included studies and that the potential effect of diurnal variation on pain during debonding was not considered in any of the included trials.
Conclusions and implications
There is weak evidence indicating that using the LODI may reduce PDP of labial fixed appliances. Adjunctive measures such as an intrusive force with finger pressure, bite wafers, and preoperative analgesia may further aid PDP control. Further well-designed parallel-group RCTs taking into consideration the diurnal variation in pain are required.
Registration
PROSPERO (CRD42017084474).
Funding
None.
Conflict of Interest
The authors declare that there is no conflict of interest.
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