Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign^®aligners during the first week of orthodontic treatment

Abstract

ObjectiveThis study was performed to compare the perception of pain between patients treated with passive self-ligating fixed appliances and those treated with Invisalign aligners.MethodsThis prospective study conducted in Saudi Arabia used an estimated sample of 64 patients from a private dental clinic. After obtaining written informed consent, the patients were divided into two groups; one group (n = 32) was treated using passive self-ligating fixed appliances and the other group (n = 32) using Invisalign® aligners. Immediately after fitting the appliances, the patients' perception of pain was evaluated through a close-ended and coded self-administrated questionnaire by using a visual analog scale (VAS). Their responses were recorded at 4 hours, 24 hours, day 3, and day 7. Mann-Whitney U-test, Kruskal-Wallis test, and Pearson's chi-square test were performed for statistical analysis.ResultsA lower percentage of patients treated with Invisalign aligners reported pain than did patients treated with passive self-ligating fixed appliances, and these differences were statistically significant (p = 0.001). Similarly, the mean VAS score for the Invisalign group was significantly lower than that for the passive self-ligating fixed appliance group at different intervals during the first week of treatment. The intensity of pain with both appliances peaked at 24 hours (mean VAS score, 3.87) and was lowest (mean VAS score, 1.62) on day 7.ConclusionsDuring the first week of orthodontic treatment, patients treated with Invisalign aligners reported lower pain than did those treated with passive self-ligating fixed appliances.

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

“…Among all included studies [2, 10-13, 20, 25], pain scores were obtained 24 h after the beginning of treatment, and four included articles reported higher pain levels for fixed appliances during this period. However, only one investigation [10] found a statistically significant difference. Two others studies [2,11] only reported a significant difference on day 3 and on day 4.…”

“…The mean age of the control group (group with fixed appliances) ranged between 23.56 [10] and 28.6 [11], but four studies [2,12,13,25] did not report this information. A homogeneity was observed due the type of aligner used in all studies (Invisalign aligner); however, different types of fixed appliances were used as a control group, such as Edgewise [20], Damon Q (Ormco, Orange, CA) [10,25] (Ormco, Glendora, CA), Speed [25] (Strite Industries Ltd., Ontario, Canada), Radiance (American Orthodontics, Sheboygan, WI) in the maxillary arch, and Alexander (American Orthodontics, Sheboygan, WI) in the mandibular arch [2]. One study just reported a use of a straight-wire appliance from GAC or Ormco [12], and two studies did not report any information [11,13].…”

“…In five studies [2,10,20,25,26], a VAS was used as a method for evaluating pain level, one study used a questionnaire at the end of treatment [13], and two studies used both methods [11,12].…”

“…Reasons related to increased RoB included confusing information (description of the malocclusion, method of pain evaluation, and follow-up time). Only one [10] study presented a low RoB and four [11,12,20,25] showed a moderate RoB ( Table 6). The major reason for this grading was related to the use of analgesics and this information was not properly reported (use or not).…”

“…Removable appliances produce intermittent forces, which allow the tissues to reorganize before compressive forces are reapplied [9]. Regarding studies that have evaluated pain levels with clear aligners compared to fixed appliances, some studies have found positive [2,10,11] or negativ e [12] results related to clear aligners.…”