Effectiveness of different debonding techniques and adjunctive methods on pain and discomfort perception during debonding fixed orthodontic appliances: a systematic review

Abstract

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.

Effect of experimental orthodontic pain on gray and white matter functional connectivity

“…2,3 It is thought that pain signals arising in the mandible are transmitted to the limbic system, hippocampus and somatosensory cortex via the trigeminal ganglion, trigeminal caudate nucleus and pathways ascending from the thalamus. 4 In a previous study in this laboratory, 5 compared to healthy controls, the amplitude of low-frequency fluctuation (ALFF) was significantly increased in the left insula and right supplementary motor area, and decreased in the right angular gyrus, left precuneus, and superior frontal gyrus in patients with orthodontic pain. Furthermore, the gray matter (GM) functional connectivity (FC) between the left precuneus and left middle temporal gyrus was found to be negatively correlated with scores of pain intensity.…”

Skausmas Ir Diskomfortas Ortodontinio Gydymo Breketų Sistema Metu

“…Skausmas apibūdinamas kaip nemalonus fizinis ir emocinis pojūtis, kylantis dėl galimo arba esamo audinių pažeidimo [1]. Diskomfortas gali būti apibūdinamas kaip nemalonus pojūtis, kuris ortodontinio gydymo metu pasireiškia burnos ertmės suvaržymu, minkštųjų audinių tempimu, gleivinės spaudimu, liežuvio padėties pasikeitimu ar dantų maudimu [2].…”

“…Diskomfortas gali būti apibūdinamas kaip nemalonus pojūtis, kuris ortodontinio gydymo metu pasireiškia burnos ertmės suvaržymu, minkštųjų audinių tempimu, gleivinės spaudimu, liežuvio padėties pasikeitimu ar dantų maudimu [2]. Skausmo ir diskomforto suvokimas yra subjektyvus ir gali priklausyti nuo psichosocialinių aplinkybių ar individualių paciento savybių, amžiaus, lyties, emocinės būklės ir skausmo slenksčio, todėl šiuos pojūčius sunku ištirti [1,3]. Skausmas yra viena iš ortodontinio gydymo baimių ir viena pagrindinių priežasčių, dėl kurių pacientai linkę mažiau bendradarbiauti su gydytoju, atidėlioti vizitus arba nutraukti gydymą [4,5].…”

“…pacientų [6]. Šis skausmas yra periodonto spaudimo, išemijos, uždegimo ir edemos rezultatas [1,7]. Ortodontinis dantų judėjimas sukelia uždegimines periodonto bei danties pulpos reakcijas, skatinančias įvairių biocheminių mediatorių, sukeliančių skausmą, išsiskyrimą.…”

“…Ortodontinio gydymo metu stebimi kraujotakos pokyčiai -padidėja kraujyje cirkuliuojančių leukotrienų, prostaglandinų, citokinų, bradikininų, P substancijos, histamino, dopamino ir serotonino kiekis. Veikiant ortodontinėms jėgoms, šie mediatoriai lemia hiperalgezinį periodonto atsaką [1,4]. Ortodontinės jėgos aktyvuoja juntamuosius periodonto audinių receptorius, kuriais skausminis impulsas toliau plinta tiek periferine, tiek centrine nervų sistema [6].…”