A systematic review and meta‐analysis of experimental clinical evidence on initial aligning archwires and archwire sequences

Papageorgiou, Spyridon N.; Konstantinidis, Ioannis; Papadopoulou, Konstantina; Jäger, Andreas; Bourauel, Christoph

doi:10.1111/ocr.12048

Cited by 31 publications

(20 citation statements)

References 82 publications

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“…The types of archwires should be taken in account since they have differences in some mechanical properties such as low elasticity module and coefficient of attrition, high resilience, flexibility and elastic recovery, and biocompatibility that are important characteristics to stimulate the adequate tissue response [44][45][46]. A laboratory study demonstrates that nickel-titanium archwire with addition of copper (CuNiTi) presented less favorable biologically deactivation loads compared to the other thermoactivated NiTi [47] which is consistent with a systematic review and meta-analyses [48] that found that patients treated with CuNiTi archwires presented greater levels of pain in the Likert scale than those patients treated with NiTi.…”

Section: Discussionsupporting

confidence: 78%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 78%

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

et al. 2020

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“…There has been some focus on pain associated with self-ligating versus conventional brackets during initial alignment, but little evidence exists of clinically significant differences between these designs 7 8 9 16 17 , although the process of archwire insertion and removal can be more painful when using 3M Smartclip TM self-ligating brackets 16 17 . In terms of aligning archwires, martensitic-active copper nickel-titanium has been associated with greater pain intensity compared with martensitic-stabilized 18 19 and superelastic nickel-titanium has a significantly higher peak pain when compared to multistrand stainless steel 20 ; however, the effects of nickel-titanium type appears to be marginal in other studies 4 20 and overall, more evidence is needed 21 22 . Low-level laser therapy has also been described as a non-thermal biostimulatory pain-relieving adjunct to fixed appliance treatment 23 24 25 26 27 28 29 and whilst showing some promise, current evidence remains weak 30 31 .…”

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confidence: 96%

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

Woodhouse

DiBiase

Papageorgiou

et al. 2015

Sci Rep

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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.

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“…First of all, the GRADE quality was very low to low, mainly because of small samples and inconsistency. Additionally, the dental arch dimensions are not directly relevant to the type of fixed appliances, as the influence of specific treatment mechanics and of the archwire properties might act as a confounder. Indeed, two trials included were problematic in this aspect.…”

Section: Discussionmentioning

confidence: 99%

“…As the outcome of fixed appliance therapy is bound to be affected by the bracket , the wire , and their interaction , a random‐effects model according to DerSimonian and Laird was deemed appropriate to incorporate this variability .…”

Section: Methodsmentioning

confidence: 99%

“…KHATTAB et al (31) used prefabricated wires for the labial group but individualized wires for the lingual group. On the other hand, SOLDANOVA et al (37) used wire sequences that differed in the material, size, and cross-section between the lingual and labial groups, which can affect the results (7) and introduce bias. The prominent premolar offset incorporated in the lingual wire, together with the small interbracket distance in the anterior region, might be responsible for the increased intercanine width (31).…”

Section: Oral Discomfortmentioning

confidence: 99%

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Lingual vs. labial fixed orthodontic appliances: systematic review and meta‐analysis of treatment effects

Papageorgiou

Gölz

Jäger

et al. 2016

European J Oral Sciences

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The aim of this systematic review was to compare the therapeutic and adverse effects of lingual and labial orthodontic fixed appliances from clinical trials on human patients in an evidence-based manner. Randomized and prospective non-randomized clinical trials comparing lingual and labial appliances were included. Risk of bias within and across studies was assessed using the Cochrane tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random-effects metaanalyses were conducted, followed by subgroup and sensitivity analyses. Six electronic databases were searched from inception to July 2015, without limitations. A total of 13 papers pertaining to 11 clinical trials were included with a total of 407 (34% male/66% female) patients. Compared with labial appliances, lingual appliances were associated with increased overall oral discomfort, increased speech impediment (measured using auditory analysis), worse speech performance assessed by laypersons, increased eating difficulty, and decreased intermolar width. On the other hand, lingual appliances were associated with increased intercanine width and significantly decreased anchorage loss of the maxillary first molar during space closure. Based on existing trials, there is insufficient evidence to make robust recommendations for lingual fixed orthodontic appliances regarding their therapeutic or adverse effects, as the quality of evidence was low. AbstractAim of this systematic review was to compare the therapeutic and adverse effects of lingual and labial orthodontic fixed appliances from clinical trials on human patients in an evidence-based manner.Randomized and prospective non-randomized clinical trials comparing lingual and labial appliances were included. Risk of bias within and across studies was assessed with the Cochrane tool and the GRADE approach. Random-effects meta-analyses were conducted, followed by subgroup and sensitivity analyses. Six electronic databases were searched from inception to July 2015 without limitations. A total of 13 papers pertaining to 11 clinical trials were included with a total of 407 (119 male / 228 female) patients. Lingual appliances were associated with increased overall oral discomfort compared to labial appliances, increased speech impediment (measured with auditory analysis), worse speech performance assessed by laypersons, increased eating difficulty, and decreased intermolar width. On the other side, lingual appliances were associated with increased intercanine width and significantly decreased anchorage loss of the maxillary first molar during space closure. Based on existing trials, there is insufficient evidence to make robust recommendations for lingual fixed orthodontic appliances regarding their therapeutic or adverse effects, as the quality of evidence was low.Registration: PROSPERO (CRD42015024596)

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A systematic review and meta‐analysis of experimental clinical evidence on initial aligning archwires and archwire sequences

Cited by 31 publications

References 82 publications

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

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

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

Lingual vs. labial fixed orthodontic appliances: systematic review and meta‐analysis of treatment effects

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