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

Abstract

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.

Impact of clear aligner therapy on tooth pain and masticatory muscle soreness

“…Deformation of aligners has been reported as the primary cause of this pain and discomfort 13 . The results of the available studies are generally in agreement with each other, suggesting that CAT causes slightly less pain and discomfort than fixed appliances during the first few days of treatment, whilst differences seem to be negligible later in treatment 15 …”

“…Orthodontic pain associated with clear aligner therapy (CAT) has been investigated in several studies. CAT appears to follow an analogous pattern of pain progression compared to fixed orthodontic appliances in terms of peaking at 24 hours and trending towards baseline levels after 7 days 12‐15 . Deformation of aligners has been reported as the primary cause of this pain and discomfort 13 .…”

“…CAT appears to follow an analogous pattern of pain progression compared to fixed orthodontic appliances in terms of peaking at 24 hours and trending towards baseline levels after 7 days. [12][13][14][15] Deformation of aligners has been reported as the primary cause of this pain and discomfort. 13 The results of the available studies are generally in agreement with each other, suggesting that CAT causes slightly less pain and discomfort than fixed appliances during the first few days of treatment, whilst differences seem to be negligible later in treatment.…”

“…13 The results of the available studies are generally in agreement with each other, suggesting that CAT causes slightly less pain and discomfort than fixed appliances during the first few days of treatment, whilst differences seem to be negligible later in treatment. 15 The response of masticatory muscle to orthodontic treatment has been investigated in several studies. Patients undergoing orthodontic treatment with fixed edgewise appliances may adapt by avoiding tooth contact to reduce tooth pain related to orthodontic treatment Also, occlusal interferences generated during treatment could trigger an avoidance behaviour.…”

Relationship between oral health impacts and personality profiles among orthodontic patients treated with Invisalign clear aligners

“…In this context, previous studies reported positive changes and high satisfaction with Invisalign treatment especially with eating, chewing and appearance 19,36,37 . Invisalign treatment was associated with better satisfaction, better oral health related quality of life, and less negative impacts on oral health than fixed orthodontics [12][13][14][15][16]19,20,37,38 . They were associated with less disruption to eating and chewing and were rated as more satisfactory than fixed appliances 16 .…”