The aims of this study were to investigate the initial time at which pain occurs after insertion of two initial wires of different sizes, the duration of the pain, the areas affected within the mouth, the level of self-medication, the effect of this pain on daily life, and whether gender is important in the perception of pain. The study group consisted of 109 patients (52 boys, 57 girls) with a mean chronological age of 13.6 years for boys and 14.7 years for girls. Insertion of either a 0.014 or 0.016 inch wire was by random selection. Following insertion of the archwires, a questionnaire comprising a total of 49 questions was given to the patients. They described the time of initial pain in the first question, answered the next 24 questions as 'yes' or 'no', and used a visual analogue scale for the final 24 questions. No significant differences were found in terms of gender, in the perception period of initial pain as regards the areas affected within the mouth or the effect of pain on daily living when the 0.014 and 0.016 inch wire groups were compared at 6 hours, 1, 2, 3, 4, 5, 6 and 7 days. At 24 hours, which was found to be statistically significant, more pain relief was used in the 0.014 inch archwire group. The results show that in both groups, initial pain was perceived at 2 hours, peaked at 24 hours and had decreased by day 3.

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BackgroundRadiographic examination is considered ‘justified’ only when detection of a condition that would change the mechanisms and timing of treatment is possible. Radiographic safety guidelines have restricted the indication of lateral cephalometric radiographs (LCRs) to presence of distinct skeletal Class II or Class III. However, they are taken routinely in clinical practice and considered to be part of the ‘gold’ standard for orthodontic diagnosis. Therefore, the aim of this study was to test the null hypothesis that lateral cephalometric radiograph (LCR) evaluation would not alter the extraction/non-extraction decision in orthodontic treatment planning of skeletal Class I patients.Materials and methodsIntraoral and extraoral photographs, dental casts and extraoral radiographs of 60 skeletal Class I patients were prepared digitally for assessment using a presentation software. One experienced (EO) and inexperienced orthodontist (IO) was asked to decide on extraction or non-extraction on a Likert-type linear scale for treatment planning. This procedure was repeated 4 weeks later with a mixed order of patients and the LCRs being omitted. Kappa, Weighted Kappa (WK) and McNemar scores were computed to test decision consistency and Bland-Altman plots together with 95% limits of agreement were used to determine measurement accuracy and presence of systematic bias.ResultsBoth EO (WK = 0.67) and IO (WK = 0.64) had good level of decision agreement with and without LCR evaluation. EO did not present a shift towards extraction nor non-extraction with LCR evaluation (McNemar = 0.999) whereas IO showed a tendency to extraction (McNemar = 0.07) with LCR data. Including LCR evaluation created a systematic inconsistency between EO and IO (Line of equality = 0.8, Confidence interval = 0.307-0.707).ConclusionsLateral cephalometric radiograph evaluation did not influence the extraction decision in treatment planning of skeletal Class I patients. Reconsidering the necessity of lateral cephalograms in orthodontic treatment of skeletal Class I patients may reduce the amount of ionizing radiation. Key words: Lateral cephalometric radiograph, extraction, treatment planning, skeletal Class I.

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