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BMC Oral Health
Published in: BMC Oral Health 1/2023

Open Access 01-12-2023 | Aligner | Research

Comparison of pain intensity and impacts on oral health-related quality of life between orthodontic patients treated with clear aligners and fixed appliances: a systematic review and meta-analysis

Authors: Qiuying Li, Yugui Du, Kai Yang

Published in: BMC Oral Health | Issue 1/2023

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Abstract

Objective

This study aimed to compare the pain intensity and impacts on oral health-related quality of life (OHRQoL) between orthodontic patients treated with clear aligners (CAs) and fixed appliances (FAs).

Methods

A systematic search was conducted up to December 2022 using PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and Embase. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (non-RCTs) comparing pain intensity or OHRQoL between patients treated with CAs and FAs were included. The risk of bias (RoB) of individual studies was evaluated using the Cochrane RoB tool 2.0 and ROBINS-I tool for RCTs and non-RCTs, respectively. Further, meta-analyses were separately conducted for each included study using the total oral health impact profile (OHIP)-14 and visual analog scale (VAS) scores to evaluate OHRQoL and pain intensity, respectively.

Results

Overall, 12 studies (5 RCTs and 7 non-RCTs) were included in the study. Subgroup analyses conducted according to the total OHIP-14 scores revealed that patients treated with CAs had higher OHRQoL at 1 week, 1 month, and 6 months of the treatment. Meanwhile, subgroup analyses conducted according to the VAS scores revealed that pain levels were lower in the CA group only at 3 and 4 days of the treatment.

Conclusions

Patients treated with clear aligners had higher OHRQoL than those treated with fixed appliances during orthodontic treatment. However, OHRQoL appeared to be similar between the two groups at the end of the treatment. Moreover, patients treated with clear aligners experienced lesser pain than those treated with fixed appliances on the third and fourth day after the initial treatment. The difference in pain intensity between the two treatment modalities was not noted at other time points.
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Literature
1.
Feu D, de Oliveira BH, de Oliveira Almeida MA, Kiyak HA, Miguel JA. Oral health-related quality of life and orthodontic treatment seeking. Am J Orthod Dentofacial Orthop. 2010;138(2):152–9.PubMedCrossRef
2.
Mansor N, Saub R, Othman SA. Changes in the oral health-related quality of life 24 h following insertion of fixed orthodontic appliances. J Orthod Sci. 2012;1(4):98–102.PubMedPubMedCentralCrossRef
3.
Jawaid M, Qadeer TA. Assessment of the changes in the oral health related quality of life 24 hours following insertion of fixed orthodontic appliance components - An observational cross-sectional study conducted at Bahria University Medical and Dental College Karachi. J Pak Med Assoc. 2019;69(5):677–83.PubMed
4.
Zheng DH, Wang XX, Su YR, Zhao SY, Xu C, Kong C, et al. Assessing changes in quality of life using the Oral Health Impact Profile (OHIP) in patients with different classifications of malocclusion during comprehensive orthodontic treatment. BMC Oral Health. 2015;15:148.PubMedPubMedCentralCrossRef
5.
Miller KB, McGorray SP, Womack R, Quintero JC, Perelmuter M, Gibson J, et al. A comparison of treatment impacts between invisalign aligner and fixed appliance therapy during the first week of treatment. Am J Orthod Dentofacial Orthop. 2007;131(3):302.e1-9.PubMedCrossRef
6.
Karkhanechi M, Chow D, Sipkin J, Sherman D, Boylan RJ, Norman RG, et al. Periodontal status of adult patients treated with fixed buccal appliances and removable aligners over one year of active orthodontic therapy. Angle Orthod. 2013;83(1):146–51.PubMedCrossRef
7.
Gao M, Yan X, Zhao R, Shan Y, Chen Y, Jian F, et al. Comparison of pain perception, anxiety, and impacts on oral health-related quality of life between patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatment. Eur J Orthod. 2021;43(3):353–9.PubMedCrossRef
8.
Shalish M, Cooper-Kazaz R, Ivgi I, Canetti L, Tsur B, Bachar E, et al. Adult patients’ adjustability to orthodontic appliances. Part I: a comparison between Labial, Lingual, and Invisalign™. Eur J Orthod. 2012;34(6):724–30.PubMedCrossRef
9.
Zhang B, Huang X, Huo S, Zhang C, Zhao S, Cen X, et al. Effect of clear aligners on oral health-related quality of life: A systematic review. Orthod Craniofac Res. 2020;23(4):363–70.PubMedCrossRef
10.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.PubMedPubMedCentralCrossRef
11.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.PubMedCrossRef
12.
Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.PubMedPubMedCentralCrossRef
13.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.PubMedPubMedCentralCrossRef
14.
Alfawal AMH, Burhan AS, Mahmoud G, Ajaj MA, Nawaya FR, Hanafi I. The impact of non-extraction orthodontic treatment on oral health-related quality of life: clear aligners versus fixed appliances-a randomized controlled trial. Eur J Orthod. 2022;44(6):595–602.PubMedCrossRef
15.
White DW, Julien KC, Jacob H, Campbell PM, Buschang PH. Discomfort associated with Invisalign and traditional brackets: A randomized, prospective trial. Angle Orthod. 2017;87(6):801–8.PubMedPubMedCentralCrossRef
16.
Alcón S, Curto A, Alvarado M, Albaladejo A, Garcovich D, Alvarado-Lorenzo A. Comparative analysis of periodontal pain using two different orthodontic techniques, fixed multibrackets and removable aligners: A longitudinal clinical study with monthly follow-ups for 12 months. Appl Sci Basel. 2021;11(24):12013.CrossRef
17.
Almasoud NN. Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign(®) aligners during the first week of orthodontic treatment. Korean J Orthod. 2018;48(5):326–32.PubMedPubMedCentralCrossRef
18.
Antonio-Zancajo L, Montero J, Albaladejo A, Oteo-Calatayud MD, Alvarado-Lorenzo A. Pain and oral-health-related quality of life in orthodontic patients during initial therapy with conventional, low-friction, and lingual brackets and aligners (Invisalign): a prospective clinical study. J Clin Med. 2020;9(7):2088.PubMedPubMedCentralCrossRef
19.
Casteluci CEVF, Oltramari PVP, Conti PCR, Bonjardim LR, de Almeida-Pedrin RR, Fernandes TMF, et al. Evaluation of pain intensity in patients treated with aligners and conventional fixed appliances: randomized clinical trial. Orthod Craniofac Res. 2021;24(2):268–76.PubMedCrossRef
20.
Fujiyama K, Honjo T, Suzuki M, Matsuoka S, Deguchi T. Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy. Prog Orthod. 2014;15(1):64.PubMedPubMedCentralCrossRef
21.
Jaber ST, Hajeer MY, Burhan AS, Latifeh Y. The effect of treatment with clear aligners versus fixed appliances on oral health-related quality of life in patients with severe crowding: a one-year follow-up randomized controlled clinical trial. Cureus. 2022;14(5):e25472.PubMedPubMedCentral
22.
Zamora-Martínez N, Paredes-Gallardo V, García-Sanz V, Gandía-Franco JL, Tarazona-Álvarez B. Comparative study of oral health-related quality of life (OHRQL) between different types of orthodontic treatment. Medicina (Kaunas). 2021;57(7):683.PubMedPubMedCentralCrossRef
23.
Diddige R, Negi G, Kiran KVS, Chitra P. Comparison of pain levels in patients treated with 3 different orthodontic appliances – a randomized trial. Med Pharm Rep. 2020;93(1):81–8.PubMedPubMedCentral
24.
Antonio-Zancajo L, Montero J, Garcovich D, Alvarado-Lorenzo M, Albaladejo A, Alvarado-Lorenzo A. Comparative analysis of periodontal pain according to the type of precision orthodontic appliances: vestibular, lingual and aligners A prospective clinical study. Biology (Basel). 2021;10(5):379.PubMed
25.
Hua F. Increasing the value of orthodontic research through the use of dental patient-reported outcomes. J Evid Based Dent Pract. 2019;19(2):99–105.PubMedCrossRef
26.
Baseer MA, Almayah NA, Alqahtani KM, Alshaye MI, Aldhahri MM. Oral impacts experienced by orthodontic patients undergoing fixed or removable appliances therapy in Saudi Arabia: a cross-sectional study. Patient Prefer Adherence. 2021;15:2683–91.PubMedPubMedCentralCrossRef
27.
Flores-Mir C, Brandelli J, Pacheco-Pereira C. Patient satisfaction and quality of life status after 2 treatment modalities: Invisalign and conventional fixed appliances. Am J Orthod Dentofacial Orthop. 2018;154(5):639–44.PubMedCrossRef
28.
AlSeraidi M, Hansa I, Dhaval F, Ferguson DJ, Vaid NR. The effect of vestibular, lingual, and aligner appliances on the quality of life of adult patients during the initial stages of orthodontic treatment. Prog Orthod. 2021;22(1):3.PubMedPubMedCentralCrossRef
29.
da PaesSilva S, Pitchika V, Baumert U, Wehrbein H, Schwestka-Polly R, Drescher D, et al. Oral health-related quality of life in orthodontics: a cross-sectional multicentre study on patients in orthodontic treatment. Eur J Orthod. 2020;42(3):270–80.CrossRef
30.
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol. 1997;25(4):284–90.PubMedCrossRef
31.
Pakkhesal M, Naghavialhosseini A, Faali T, Khoshnevisan MH, Karimian A. Oral health-related quality of life changes during phase 1 Class II malocclusion treatment using Frankel 2 and Twin-block appliances: a short-term follow-up study. Am J Orthod Dentofacial Orthop. 2023;163(2):191–7.PubMedCrossRef
32.
Kapetanović A, Noverraz RRM, Listl S, Bergé SJ, Xi T, Schols JGJH. What is the Oral Health-related Quality of Life following Miniscrew-Assisted Rapid Palatal Expansion (MARPE)? A prospective clinical cohort study. BMC Oral Health. 2022;22(1):423.PubMedPubMedCentralCrossRef
33.
Philip BK. Parametric statistics for evaluation of the visual analog scale. Anesth Analg. 1990;71(6):710.PubMedCrossRef
34.
Alajmi S, Shaban A, Al-Azemi R. Comparison of short-term oral impacts experienced by patients treated with invisalign or conventional fixed orthodontic appliances. Med Princ Pract. 2020;29(4):382–8.PubMedCrossRef
35.
Scott P, Sherriff M, Dibiase AT, Cobourne MT. Perception of discomfort during initial orthodontic tooth alignment using a self-ligating or conventional bracket system: a randomized clinical trial. Eur J Orthod. 2008;30(3):227–32.PubMedCrossRef
36.
Brown DF, Moerenhout RG. The pain experience and psychological adjustment to orthodontic treatment of preadolescents, adolescents, and adults. Am J Orthod Dentofacial Orthop. 1991;100(4):349–56.PubMedCrossRef
37.
Johal A, Ashari AB, Alamiri N, Fleming PS, Qureshi U, Cox S, et al. Pain experience in adults undergoing treatment: A longitudinal evaluation. Angle Orthod. 2018;88(3):292–8.PubMedPubMedCentralCrossRef
38.
39.
Tecco S, D’Attilio M, Tetè S, Festa F. Prevalence and type of pain during conventional and self-ligating orthodontic treatment. Eur J Orthod. 2009;31(4):380–4.PubMedCrossRef
40.
Fleming PS, Dibiase AT, Sarri G, Lee RT. Pain experience during initial alignment with a self-ligating and a conventional fixed orthodontic appliance system. A randomized controlled clinical trial. Angle Orthod. 2009;79(1):46–50.PubMedCrossRef
41.
Rahman S, Spencer RJ, Littlewood SJ, O’Dywer L, Barber SK, Russell JS. A multicenter randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: Part 2: Pain perception. Angle Orthod. 2016;86(1):149–56.PubMedCrossRef
42.
Cardoso PC, Espinosa DG, Mecenas P, Flores-Mir C, Normando D. Pain level between clear aligners and fixed appliances: a systematic review. Prog Orthod. 2020;21(1):3.PubMedPubMedCentralCrossRef
Metadata
Title
Comparison of pain intensity and impacts on oral health-related quality of life between orthodontic patients treated with clear aligners and fixed appliances: a systematic review and meta-analysis
Authors
Qiuying Li
Yugui Du
Kai Yang
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Aligner
Published in
BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-023-03681-w

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