Impact of treament with orthodontic aligners on the oral health-related quality of life.

BACKGROUND: There is an increasing interest in information on the effects of orthodontic aligners on the oral health-related quality of life (OHRQoL) of people. AIM: To compare the impact of orthodontic aligners versus conventional fixed appliances on OHRQoL, using a validated tool and controlling for sociodemographic and clinical variables. METHOD: Sixty-one individuals participated in this study. Group 1 (G1) consisted of 33 individuals under treatment with orthodontic aligners and Group 2 (G2) comprised 28 individuals under treatment with conventional fixed appliances. OHRQoL was evaluated with the Oral Health Impact Profile (OHIP-14) in which 14 items are distributed across seven dimensions: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. The higher the score, the more negative is the perception of the individual regarding his/her OHRQoL. Descriptive statistics, Mann-Whitney test, and Poisson regression were performed. Effect Size (ES) and Minimal Clinically Important Difference (MCID) were also determined. RESULTS: Participants' mean age was 30.69 years. Individuals in G1 had a significantly lower score for physical pain and the total score of OHIP-14 compared to individuals in G2 (p < 0.05). The ES was large (ES = 0.74) for physical pain and moderate (ES = 0.46) for the total score. The ES was moderate for physical disability (ES = 0.50). The difference between groups for physical pain (1.30) and for physical disability (0.90) was greater than the MCID (0.87 and 0.88, respectively). Poisson regression showed that G2 individuals showed a score for physical pain 1.39 times higher than those of G1 in the adjusted model (OR = 1.39, [1.03-1.89], p = 0.031). CONCLUSION: Those under treatment with orthodontic aligners have a more positive perception of OHRQoL compared to those wearing fixed appliances.

Comparative analysis of periodontal pain and quality of life in patients with fixed multibracket appliances and aligners (Invisalign®): longitudinal clinical study.

BACKGROUNDS: The aim of this longitudinal clinical study is to analyse and compare according to location, degree and type, the pain presented by patients during their first year of treatment, as well as the quality of oral life after the placement of two types of orthodontic appliances: conventional brackets and removable Invisalign ® aligners. METHODS: The sample consisted of 140 patients grouped into 2 study groups of 70 patients each. The first group (brackets group- BG), with fixed multibracket appliances, using the MBT technique and a 0.022" slot. The second group (invisaling group- IG), in treatment with removable aligners (IG), using the Invisalign ® system. They were providen with a questionnare where they had to record the degree (mild, moderate or intense), the type and location of the pain monthly during the first year of treatment. The second form was the Spanish version of the OHIP-14, oral quality of life questionnaire, which was provided the twelfth month after the start of treatment. RESULTS: In both groups, we found that the most frequent location of pain occurred during the first phase: mandibular for the IG group and maxillary in the BG group. Throughout the whole analysis, the intensity was mild-moderate with lower values in the conventional brackets' group. The BG group reported acute pain while the IG group reported sensitive pain during the first month; later both reported sensitive pain. CONCLUSIONS: There are differences in terms of periodontal pain in its degree, location, and type according to the different orthodontic techniques used. TRIAL REGISTRATION: The study was approved by the bioethics committee of the University of Salamanca (USAL_20/516).

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.

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.

Homenagem ao Prof. Dr. Learreta / Tribute to Prof. Dr. Learreta / Homenaje al Prof. Dr. Learreta

Preito de gratidão ao Professor Dr. Jorge Alfonso Learreta. Nascido em Buenos Aires, Argentina, em 11/12/1949. Cursou Odontologia aos 17 anos. Seus conhecimentos em Histologia o fez ganhar uma bolsa de estudos para a França. Aqui estudou com cirurgiões renomados e voltou para Argentina. Especializou-se em Ortodontia e Ortopedia funcional em 1971. Tinha uma ampla rede de amigos e mestres em diversas partes do mundo. Começou a investir em tecnologia para estudar a ATM no início dos anos 90. Especializou-se em estudo das imagens e já em 1994, possuía casos com RNM antes e depois dos tratamentos, algo que veio a se tornar o padrão-ouro da sua filosofia. Homem estudioso, conhecedor de vasta literatura e de inteligência indescritível com grande poder de observação e raciocínio, vivenciou diversos problemas na Odontologia com soluções simples e geniais. O prof. Learreta é a definição de uma pessoa a frente de seu tempo que deixa um legado na odontologia da dor orofacial e seus ensinamentos foram além da neurofisiologia da ATM.

I offer gratitude to Professor Dr. Jorge Alfonso Learreta. Born in Buenos Aires, Argentina, on 12/11/1949. He studied Dentistry at the age of 17. His knowledge in Histology earned him a scholarship to France. Here he studied with renowned surgeons and returned to Argentina. He specialized in Orthodontics and Functional Orthopedics in 1971. He had a wide network of friends and teachers in different parts of the world. He began investing in technology to study the TMJ in the early 90s. He specialized in studying images and in 1994, he had cases with MRI before and after treatments, something that became the gold standard of his philosophy . A studious man, knowledgeable about vast literature and indescribable intelligence with great power of observation and reasoning, he experienced several problems in Dentistry with simple and ingenious solutions. The prof. Learreta is the definition of a person ahead of his time who leaves a legacy in orofacial pain dentistry and his teachings went beyond the neurophysiology of TMJ.

Ofrezco agradecimiento al Profesor Dr. Jorge Alfonso Learreta. Nacido en Buenos Aires, Argentina, el 11/12/1949. Estudió Odontología a los 17 años. Sus conocimientos en Histología le valieron una beca para Francia. Aquí estudió con reconocidos cirujanos y regresó a la Argentina. Se especializó en Ortodoncia y Ortopedia Funcional en 1971. Contaba con una amplia red de amigos y profesores en diferentes partes del mundo. Comenzó a invertir en tecnología para estudiar la ATM a principios de los 90. Se especializó en el estudio de imágenes y en 1994 tuvo casos con resonancia magnética antes y después de los tratamientos, algo que se convirtió en el estándar de oro de su filosofía. Hombre estudioso, conocedor de vasta literatura e inteligencia indescriptible con gran poder de observación y razonamiento, experimentó varios problemas en Odontología con soluciones simples e ingeniosas. El prof. Learreta es la definición de una persona adelantada a su tiempo que deja un legado en la odontología del dolor orofacial y sus enseñanzas fueron más allá de la neurofisiología de la ATM.

Effect of obesity on tooth movement using an orthodontic device and changes in inflammatory cytokines, periodontal tissues, and orofacial pain.

OBJECTIVE: This study aimed to investigate the effect of obesity prospectively on tooth movement via an orthodontic device and changes in inflammatory cytokines, periodontal tissues, and orofacial pain. SUBJECTS AND METHODS: Prospective design in which data was gathered at baseline T0, 1 hour, 24 hours, and 1 week after the application of fixed orthodontic appliances. The total sample size was 60 participants aged between 12 to 18 years and divided into 2 groups based on the inclusion and exclusion criteria. Anthropometrical estimation was made using a bioimpedance meter. A clinical assessment was performed before the application of fixed appliance bonding (T0) one hour after bonding (T1), after 24 hours (T2), and finally after one week (T3). At T0 little irregularity index was assessed, gingival crevicular fluid (GCF) was collected and periodontal examination including probing depth (PD), gingival bleeding (GB), and the presence or absence of calculus were measured. Orofacial pain was assessed at three levels: 1 hours, 24 hours, and 1 week after application of fixed orthodontics using a visual analog scale. For inter-group comparison, Mann-Whitney and t-tests were used and for interphase, comparison cluster analysis was performed. The level of significance was p<0.05. RESULTS: The participants in obese groups were significantly higher in terms of weight, BMI, WHR, FM, and BF than in the non-obese group (p<0.05). Obese participants had significantly more PD 4-5 mm (0.64±0.23 mm) and significantly higher BoP than non-obese participants (0.13±0.10 mm). Little's irregularity index at T0 and T3 showed no significant difference among obese and non-obese participants. The inflammatory cytokines level of IL-ß was higher in the obese group compared to non-obese groups. CONCLUSIONS: The intensity of orofacial pain was higher in obese participants after 24 hours along with high levels of IL-ß pro-inflammatory cytokines before and during orthodontic treatment. No difference was noted in tooth movement in both obese and non-obese during orthodontic treatment in the first week.

Pain profile during orthodontic levelling and alignment with fixed appliances reported in randomized trials: a systematic review with meta-analyses.

OBJECTIVE: To assess the pain profile of patients in the levelling/alignment phase of orthodontic treatment, as reported from randomized clinical trials. MATERIALS AND METHODS: Five databases were searched in September 2022 for randomized clinical trials assessing pain during levelling/alignment with a visual analogue scale (VAS). After duplicate study selection, data extraction, and risk-of-bias assessment, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression, and certainty analyses. RESULTS: A total of 37 randomized trials including 2277 patients (40.3% male; mean age 17.5 years) were identified. Data indicated quick pain initiation after insertion of orthodontic appliances (n = 6; average = 12.4 mm VAS), a quick increase to a peak at day 1 (n = 29; average = 42.4 mm), and gradually daily decrease the first week until its end (n = 23; average = 9.0 mm). Every second patient reported analgesic use at least once this week (n = 8; 54.5%), with peak analgesic use at 6 h post-insertion (n = 2; 62.3%). Patients reported reduced pain in the evening compared to morning (n = 3; MD = - 3.0 mm; 95%CI = - 5.3, - 0.6; P = 0.01) and increased pain during chewing (n = 2; MD = 19.2 mm; 95% CI = 7.9, 30.4; P < 0.001) or occlusion of the back teeth (n = 2; MD = 12.4 mm; 95% CI = 1.4, 23.4; P = 0.3), while non-consistent effects were seen for patient age, sex, irregularity, or analgesic use. Subgroup analyses indicated increased pain among extraction cases and during treatment of the lower (rather than the upper) arch, while certainty around estimates was moderate to high. CONCLUSIONS: Evidence indicated a specific pain profile during orthodontic levelling/alignment, without signs of consistent patient-related influencing factors.

Quality assessment of online information on orthodontic Web sites in the United States.

INTRODUCTION: The objective of this study was to assess the quality of online information on orthodontic treatment provided by orthodontic Web sites in the United States and investigate their claims. METHODS: Three hundred and one American orthodontic Web sites were identified after an advanced Google search. Data collection included: the location of the clinic, treatment options offered, quality-of-information assessment using the DISCERN tool, and finally, claims when promoting 1 treatment option against another, as well as the presence of information on relapse risk and retention needs. RESULTS: All Web sites belonged to private clinics, with more than half (60.5%) in a single location. Invisalign (Align Technology, Santa Clara, Calif) was the most commonly promoted treatment option (94%), followed by the full fixed appliance (FFA) (92%). The mean DISCERN total score was poor (36.78 out of 80.00), whereas the mean reliability (questions 1-8) and quality-of-information (questions 9-15) scores were 17.06 out of 40.00 and 16.85 out of 35.00, respectively. Almost one-third (28%) of the Web sites compared aligners to FFA, whereas 25% claimed that aligners are less painful than FFA, faster than FFA (14%), or give better results than FFA (1%). Almost half of the Web sites (47%) failed to display information on relapse risk and retention needs after orthodontic treatment (41%). The Web sites that displayed such info had higher DISCERN total scores (P <0.001). CONCLUSIONS: Invisalign seems to be the treatment modality most commonly mentioned online. According to DISCERN, U.S. orthodontic Web sites display poor or fair quality information. On many Web sites, aligner treatment was compared with FFA, with some stating that aligners cause less pain than FFA or are more efficient/faster than FFA. Moreover, almost half of the American orthodontic Web sites failed to display information on the relapse risk or retention need. Display of such information can be an indicator of better-quality Web sites. There is ample room for improvement in the online information American orthodontists provide to potential patients.

The effect of alpha binaural beat music on orthodontic pain after initial archwire placement: A randomized controlled trial.

OBJECTIVE: The objective of this article was to evaluate the effect of alpha binaural beat music on pain level after initial placement of a maxillary fixed appliance, compared to music without binaural beats (placebo) and no music (control). METHODS: 60 patients undergoing maxillary fixed orthodontic appliance and initial archwire placement were randomly allocated into the three aforementioned groups. The pain level experienced was monitored for the following seven days, using the short-form McGill pain questionnaire (SF-MPQ). RESULTS / DESCRIPTORS: Intensity of both sensory and psychological aspects of pain reduced significantly in the binaural beat music (BBM) group, compared to the control, after the 5th day. Statistically significant lower affective and total pain scores were also found on day 6 for the placebo group, compared to the control. Present Pain Intensity (PPI): Statistically significant lower scores were found between the BBM group and the control group from days 3 to 7. Statistically significant lower scores were also found between the placebo and the control groups on days 4, 5 and 6. Visual Analog Scale (VAS): Compared to the control group, the placebo group had a lower VAS score on day 4, and the BBM group had lower scores on days 6 and 7. CONCLUSIONS: There was a significant reduction of pain demonstrated in the BBM group, compared to the control, toward the end of the first week of treatment. There was no difference in reported pain between the BBM and placebo groups for any of the scores.

THE USE OF DENTAL PATIENT-REPORTED OUTCOMES AMONG RANDOMIZED CONTROLLED TRIALS IN ORTHODONTICS: A METHODOLOGICAL STUDY.

OBJECTIVE: To identify and summarize the use and characteristics of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs) within randomized controlled trials (RCTs) published in 5 leading orthodontic journals. METHODS: A manual search was conducted to identify intervention (therapeutic or preventive) related RCTs published in selected journals between 2015 and 2021. Two authors extracted the characteristics of each included trial, as well as all outcomes and outcome measures used in these trials independently and in duplicate. Thereafter, the use of dPROs and dPROMs was identified and summarized. We classified all dPROs into 2 general types (oral health-related quality of life [OHRQoL] and others) and dPROMs into 3 categories (single-item questionnaires, generic multiple-item questionnaires, and specific multiple-item questionnaires). We also identified whether these dPROMs assessed 4 dimensions of OHRQoL (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact). RESULTS: From 4631 examined articles, a total of 315 RCTs were included, of which 76 (24.1%) used dPROs and dPROMs. Eight different dPROs (OHRQoL, patients' satisfaction with treatment, difficulty, compliance, preference, efficacy, duration, and unwanted events) and 34 different dPROMs (including 13 single-item questionnaires, 7 generic multiple-item questionnaires, and 14 specific multiple-item questionnaires) were identified in these trials. OHRQoL was the most commonly used dPRO (n = 71; 93.4%), followed by patients' satisfaction with treatment (n = 10; 13.2%), patient-reported difficulty (n = 5; 6.6%), and patient-reported compliance (n = 4, 5.3%). The 4 most frequently used dPROMs were pain measured with 10 mm Visual Analogue Scale (n = 20; 24.1%), pain measured with Numerical Rating Scale (n = 11; 13.3%), the Feldmann's Questionnaire (2007) (n = 6; 7.2%), and the Oral Health Impact Profile 14 (n = 5; 6.0%). CONCLUSION: Only about one-fourth of RCTs published in leading orthodontic journals can reflect patients' perspectives. OHRQoL was the most commonly used dPRO in these trials. Substantial heterogeneity exists among dPROMs used for OHRQoL assessment. Efforts are needed from researchers, reviewers, editors and other stakeholders to promote the wide and standardized use of dPROs in orthodontic research.

Sugar-free chewing gum versus conventional analgesic drugs for pain relief with fixed orthodontic appliances. A systematic review and meta-analysis.

OBJECTIVE: To compare the effect of chewing sugar-free gum towards alleviating self-reported orthodontic treatment (OT) pain compared with conventional analgesic drugs (CADs). SEARCH SOURCES: An unrestricted search of indexed databases and manual searching was performed up to September 2021. DATA SELECTION: Randomised controlled trials (RCTs) comparing the impact of chewing gum and CADs on relieving self-reported orthodontic pain were included. DATA EXTRACTION: Data screening, extraction and risk of bias (RoB) assessment were performed by two authors. Meta-analyses were performed using a random-effects model. The quality of available evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS: Nine RCTs were included. Eight RCTs used the Visual Analogue Scale for self-reported pain assessment, while one RCT used the Numeric Rating Scale. Five RCTs had a high RoB and four RCTs had a moderate RoB. Power analysis for sample size estimation was performed in six RCTs. Separate meta-analyses were performed by pooling quantitative data from five RCTs that compared self-reported orthodontic pain between chewing gum and ibuprofen groups for the following timepoints: baseline; immediately; 2 hours; 6 hours; bedtime; 24 hours; 2 days; 3 days; 5 days; and 7 days after the placement of orthodontic appliances. None of the timepoints individually indicated a difference in self-reported pain scores between chewing sugar-free gum and ibuprofen groups. The overall level of evidence was very low. CONCLUSION: Chewing sugar-free gum is a potentially useful alternative to CADs towards pain alleviation during fixed OT.

Extração atípica de incisivo em caso de protrusão excessiva anteroinferior ­ relato de caso / Atypical incisor extraction in case of excessive anteroinferior protrusion ­ case report

Resumo O tratamento ortodôntico com extrações atípicas, quando bem planejado e conduzido, é uma excelente abordagem terapêutica. Esse estudo objetivou apresentar um caso clínico de retratamento ortodôntico em paciente adulto com aparatologia fixa em ambos os arcos e extração do dente 31, e discutir os limites de aceitação do organismo às movimentações ortodônticas. Paciente de 23 anos, vindo de um tratamento ortodôntico anterior, compareceu à clínica da Escola de Especialização Profissional da ABO/MA com relato de dor na região dos incisivos inferiores e queixa estética. Identificou-se a presença de problema periodontal por excesso de vestibularização dos incisivos inferiores. O tratamento ortodôntico adotado corrigiu a vestibularização excessiva dos incisivos inferiores, eliminando as queixas do paciente, e restabelecendo o overjet e overbite ideais, além de manter as relações oclusais de Classe I bilateral. Concluiu-se, neste caso, que a extração de um incisivo foi uma alternativa eficaz para correção da vestibularização excessiva dos incisivos inferiores.(AU)

Abstract Orthodontic treatment with atypical extractions, when well planned and conducted, is an excellent therapeutic approach. This study aimed to present a clinical case of orthodontic retreatment in an adult patient with fixed appliance in both arches and extraction of tooth 31, and discuss the limits of the body's acceptance to orthodontic movements. A 23-year-old patient, coming from a previous orthodontic treatment, attended the clinic of the Professional Specialization School of ABO/MA with a report of pain in the region of the mandibular incisors and aesthetic complaint. The presence of periodontal problem due to excessive buccalization of the mandibular incisors was identified. The orthodontic treatment adopted corrected the excessive buccalization of the mandibular incisors, eliminating the patient's complaints, and restoring the ideal overjet and overbite, in addition to maintaining bilateral Class I occlusal relationships. It was concluded that, in this case, the extraction of an incisor was an effective alternative for the correction of excessive buccalization of the mandibular incisors.(AU)

Malaysian Patients' Expectations of Orthodontic Treatment in Indian Dental Care Set up: A Questionnaire Survey.

Materials and Methods: A cross-sectional study was conducted on 349 Malaysian patients (182 females and 167 males) aged 18-30 years. A questionnaire consisting of ten items developed by Sawyers and Newton was administered to the patients who visited the department of Orthodontics seeking orthodontic treatment. Outcome measures. Descriptive analysis of the responses and comparison of male and female expectations. Results: Most of the patients expected only a check-up/diagnosis/discussion at their initial appointment, anticipated a fixed type of orthodontic treatment, did not prefer extraction/removal of their teeth, thought the treatment to be painful, and can restrict what they could eat or drink. Positive expectations from the patient included better tooth alignment, enhanced smile, improved confidence, and advancement in professional career. At the same time, nearly half of the patients' assumed speech/mastication does not get affected during the treatment. Moreover, very few patients believed it would be easier to eat/speak/keep their teeth clean after the treatment. Compared to males, more females had significantly anticipated fixed types of orthodontic treatment, thinking the treatment to be painful and restrictive in terms of what they could eat or drink. Most of the females were unsure about the length of the orthodontic treatment and had significantly higher expectations concerning career improvement. Conclusions: To meet the varied expectations of each of the patients, effective communication between the orthodontist and the patient is essential.

Effects of high-frequency near infrared laser irradiation on experimental tooth movement-induced pain in rats.

Discomfort and dull pain are known side effects of orthodontic treatment. Pain is expected to be reduced by near-infrared (NIR) lasers; however, the mechanism underlying effects of short-pulse NIR lasers in the oral and maxillofacial area remains unclear. This study aimed to examine the effects of high-frequency NIR diode laser irradiation on pain during experimental tooth movement (ETM) on 120 J. NIR laser with 910 nm wavelength, 45 W maximum output power, 300 mW average output power, and 200 ns pulse width (Lumix 2; (Lumix 2; Fisioline, Verduno CN, Italy) was used for the experiment. A nickel-titanium-closed coil was used to apply a 50-gf force between the maxillary left-side first molar and incisor in 7-week-old Sprague-Dawley rats (280-300 g) to induce ETM. We measured facial-grooming frequency and vacuous chewing movement (VCM) period between laser-irradiation and ETM groups. We performed immunofluorescent histochemistry analysis to quantify levels of Iba-1, astrocytes, and c-fos protein-like immunoreactivity (Fos-IR) in the trigeminal spinal nucleus caudalis (Vc). Compared with the ETM group, the laser irradiation group had significantly decreased facial-grooming frequency (P = 0.0036), VCM period (P = 0.043), Fos-IR (P = 0.0028), Iba-1 levels (P = 0.0069), and glial fibrillary acidic protein (GFAP) levels (P = 0.0071). High-frequency NIR diode laser irradiation appears to have significant analgesic effects on ETM-induced pain, which involve inhibiting neuronal activity, microglia, and astrocytes, and it inhibits c-fos, Iba-1, and GFAP expression, reducing ETM-induced pain in rats. High-frequency NIR diode laser application could be applied to reduce pain during orthodontic tooth movement.

Effect of ibuprofen and low-intensity pulsed ultrasound on the reduction of pain after initial archwire placement: a double-blind randomized clinical trial / Efecto del ibuprofeno y el ultrasonido pulsado de baja intensidad en la reducción del dolor después de la colocación inicial del arco de ortodoncia: un ensayo clínico aleatorizado doble ciego

Objective: This study aimed to compare the effect of ibuprofen and low intensity pulsed ultrasound (LIPUS) on the reduction of pain after the placement of initial archwire in orthodontic patients. Material and Methods: This double-blind clinical trial study was carried out on 60 female candidates for fixed orthodontic treatment referring to the Orthodontic Department of School of Dentistry in Mashhad University of Medical Sciences, Mashhad, Iran, during 2015-2016. The subjects were divided into four groups of ibuprofen, LIPUS, placebo, and mock LIPUS. A questionnaire and a rectangular and flexible cubic silicone were given to each patient to record the severity of pain based on the visual analog scale at specified time points (i.e., 2 h, 6 h, at bedtime, 2nd, 3rd, and 7th days after archwire placement) when biting the silicone block with the anterior and posterior teeth and without biting at all. Repeated measures analysis of variance was used in order to compare the pain severity at different time points. Results: The comparison of pain severity at various time points showed that the highest and lowest mean scores of pain were reported at bedtime and seven days after the intervention (p<0.001). In each of the three conditions (i.e., biting the silicone block with the anterior and posterior teeth and without biting the teeth) at six time points (i.e., 2 h, 6 h, at bedtime, 2nd, 3rd, and 7th days following archwire placement), no significant difference was observed in the severity of pain (p>0.05). Conclusion: In conclusion, LIPUS (with a frequency of 1 MHz and an intensity of 100 mW) and ibuprofen have no significant effects on reduction of the pain severity at different time points and various conditions in orthodontic patients.

Objetivo: Este estudio tuvo como objetivo comparar el efecto del ibuprofeno y el ultrasonido pulsado de baja intensidad (LIPUS) en la reducción del dolor después de la colocación del arco inicial en pacientes de ortodoncia. Material y Métodos: Este estudio de ensayo clínico doble ciego se llevó a cabo en 60 candidatas a tratamiento de ortodoncia fija referidas al Departamento de Ortodoncia de la Facultad de Odontología de la Universidad de Ciencias Médicas de Mashhad, Mashhad, Irán, durante 2015-2016. Los sujetos se dividieron en cuatro grupos: ibuprofeno, LIPUS, placebo y LIPUS simulado. Se entregó un cuestionario y un bloque de silicona cúbica rectangular y flexible a cada paciente para registrar la intensidad del dolor según la escala analógica visual en puntos de tiempo específicos (es decir, 2 h, 6 h, hora de acostarse, 2do, 3er y 7mo día después de la colocación del arco) al morder el bloque de silicona con los dientes anteriores y posteriores, y sin morder en absoluto. Se utilizó el análisis de varianza de medidas repetidas para comparar la intensidad del dolor en diferentes momentos.Resultados: La comparación de la intensidad del dolor en varios puntos de tiempo mostró que las puntuaciones medias de dolor más altas y más bajas se informaron a la hora de acostarse y siete días después de la intervención (p<0,001). En cada una de las tres condiciones (es decir, al morder el bloque de silicona con los dientes anteriores y posteriores, y sin morder) en seis momentos (2 h, 6 h, antes de acostarse 2do, 3er y 7mo día después de la colocación del arco), no se observó diferencia significativa en la severidad del dolor (p>0.05).Conclusión: En conclusión, LIPUS (con una frecuencia de 1 MHz y una intensidad de 100 mW) y el ibuprofeno no tienen efectos significativos en la reducción de la severidad del dolor en diferentes puntos de tiempo y diversas condiciones en pacientes de ortodoncia.

A randomized controlled trial to evaluate the effectiveness of different methods on pain management during orthodontic debonding.

BACKGROUND: Orthodontic treatment procedures like separator placement, archwire placement, orthodontic force application, miniscrew placement and debonding procedure usually involve pain and discomfort. Pain perception and methods to reduce pain during debonding in regard to gender and different locations of oral cavity is still a poorly documented issue in orthodontics. The aim of this study was to evaluate the effectiveness of different methods on pain management during debonding and its association with gender and location. MATERIALS AND METHODS: One hundred and forty orthodontic patients in the stage of debonding were randomly assigned into four groups according to different methods used during debonding; Group A: Medication group (Paracetamol given 1 h before debonding), Group B: Finger pressure group, Group C: Stress relief group and Group D: Control group. A visual analog scale (VAS) was used to assess the pain intensity just after debonding for each sextant. RESULTS: Among 140 participants, 61 (43.57%) were males and 79 (56.43%) were females. Differences in VAS score in different areas of oral cavity among all groups were found to be significant (p < 0.05). Total VAS score was greater in control group (16.67) followed by stress relief group (13.33) and finger pressure group (10) and least in medication group (8.33). The VAS score was higher in the upper front and lower front sextants in all the groups. Females reported higher VAS score and in upper front sextant, it showed significant difference (p = 0.018). On comparison, total VAS scores were statistically significant difference in medication-stress relief arm pair (p = 0.009), medication-control arm pair (p < 0.001) and finger pressure-control arm pair (0.002). The total VAS score comparison between medication-finger pressure arm was not significant (p = 0.172). CONCLUSIONS: Pain perceived during debonding varies in different areas of oral cavity among all the groups. Anterior area of oral cavity and female seems to be more sensitive to pain. Use of finger pressure can be used effectively for pain management during debonding.

Aplicación del láser de baja potencia para el alivio del dolor en pacientes con tratamiento ortodóncico / Application of low power laser for pain relief in patients with orthodontic treatment

Introducción: El dolor es el principal síntoma que refieren los pacientes después de la colocación y activación de los aparatos ortodóncicos. Objetivo: Evaluar la efectividad del láser de baja potencia en el alivio del dolor en pacientes con tratamiento de ortodoncia. Métodos: Se realizó un estudio cuasiexperimental de intervención terapéutica en 30 pacientes que se encontraban en los inicios de la fase de distalización de los caninos superiores (previa extracción de los primeros premolares de la misma arcada), los cuales fueron atendidos en el Servicio de Ortodoncia del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero a diciembre de 2020. A tal efecto, se conformaron 2 grupos de forma aleatoria, por el orden de llegada, de 15 integrantes cada uno: el de estudio, que fue tratado con láser de baja potencia, y el de control, que recibió paracetamol como analgésico habitual. Para la validación estadística de la información se emplearon el porcentaje y la prueba de la T de Student para muestras independientes, con 95 % de confiabilidad. Resultados: Existieron diferencias significativas en cuanto a la remisión de la intensidad del dolor, pues el síntoma estuvo ausente o en grado leve en todos los integrantes del grupo de estudio luego de tres sesiones terapéuticas (p=0,00), mientras que solo 13,3 % de los pacientes del grupo de control se ubicaron en estas dos categorías. Conclusiones: Se demostró que la terapia alternativa con láser fue más efectiva para paliar el dolor que el paracetamol.

Introduction: The pain is the main symptom that patients refer after placing and activation of the orthodontic appliances. Objective: To evaluate the effectiveness of the low power laser for pain relief in patients with orthodontics treatment. Methods: A quasi-experiment study of therapeutic intervention was carried out in 30 patients that were in the beginnings of the distancing phase of the upper canine teeth (previous extraction of the same arch first premolars), who were assisted in the Orthodontics Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from January to December, 2020. To such an effect, 2 groups were conformed at random, by arrival order, of 15 members each one: the study group that was treated with low power laser, and the control group that received paracetamol as usual analgesic. For the statistical validation of the information the percentage and the Student´s t test were used for independent samples, with 95% of confidence. Results: There were significant differences as for the remission of pain intensity, because absence of this symptom or light pain was observed in all the members of the study group after three therapeutic sessions (p=0.00) while just 13.3 % of the control group patients was located in these two categories. Conclusions: It was demonstrated that the alternative therapy with laser was more effective to palliate the pain than the paracetamol.

Is catastrophising associated with pain perception in early phase of orthodontic treatment? A cohort study.

BACKGROUND AND OBJECTIVES: This study aimed to investigate the association between pain perception and catastrophising at the beginning of orthodontic treatment; and the association between pain during orthodontic treatment and demographic, clinical and other psychological factors. METHODS: A cohort study with 44 patients (28.9 ± 15.05 years old; 25 females and 19 males) under orthodontic treatment with fixed appliances had their pain perception evaluated through a visual analogue scale at baseline (before activation), 6 h, 24 h, 2nd day, 3rd day, 5th day and 7th day after activation. The scores at each evaluation period after the first (T1), second (T2) and third (T3) appointments were compared by analysis of variance. A multivariate Poisson regression analysis verified the association between pain perception and Pain Catastrophising Scale (PCS); and demographic (age, gender), clinical (tooth crowding, tooth loss, analgesic intake and archwire characteristics) and other psychological (dental anxiety and previous negative dental experiences) independent variables (p < .05). RESULTS: Catastrophising (RR = 1.03, 95%CI 1.01-1.05, p = .0001) showed a weak risk of pain perception at T1. The peak of pain occurred 24 h after activation at T1, T2 and T3. Significant higher scores were observed at T1 in comparison to T2 (FT1,T2  = 11.82, p = .005) and T3 (FT1,T3  = 5.09, p = .03). Wire diameter, tooth crowding and single-arch treatment were found as risk factors for pain. Patients without tooth loss had half of the risk of pain perception, while analgesics intake and older patients were also found with a weak protective association. Dental anxiety and negative dental experience were not associated with pain perception. CONCLUSION: Catastrophising has a mild influence on pain perception and only after the first orthodontic activation. Patients with tooth losses, tooth crowding and using thicker archwires are more likely to report pain after orthodontic activations.

A double-blinded randomized clinical trial of pain perception during orthodontic treatment / Ensaio clínico randomizado duplo cego de percepção da dor durante tratamento ortodôntico

Introduction: Orthodontic movement can cause painful symptoms, especially in the early stages of treatment. Objective: This study aimed to compare the performance of chewing gum and ibuprofen in pain control during the initial period of orthodontic treatment. Material and method: A randomized blind clinical trial, with an allocation ratio of 1:1, was developed with patients aged ≥18 years old. The sample size was established considering a significance level of 5% and test power of 80%, resulting in a minimum of 30 volunteers per group (n=90). Participants were paired regarding sex, age, the severity of malocclusion, defined by the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN), and crowding, determined by Little's irregularity index. The sample was randomly allocated to three groups: Group I (control) placebo; Group II chewing gum; and Group III Ibuprofen. Pain perception was evaluated by the Visual Analog Scale (VAS) in the first 24, 36, and 48 hours after activation of the orthodontic appliance. The data were analyzed by generalized linear models for repeated measures in time. Result: No statistically significant difference (p>0.05) was observed among the groups for the methods of pain therapy evaluated in 24, 36, and 48 hours post-activation. Conclusion: There was no difference among the method used for pain control during the orthodontic treatment.

Introdução: A movimentação ortodôntica pode causar sintomatologia dolorosa, principalmente nas fases iniciais do tratamento. Objetivo: Este estudo teve como objetivo comparar o desempenho da goma de mascar e do ibuprofeno no controle da dor durante o período inicial do tratamento ortodôntico. Material e método: Foi desenvolvido um ensaio clínico randomizado cego, com razão de alocação de 1:1, com pacientes com idade ≥ 18 anos. O tamanho da amostra foi estabelecido considerando um nível de significância de 5% e poder do teste de 80%, resultando em um mínimo de 30 voluntários por grupo (n=90). Os participantes foram pareados quanto ao sexo, idade, gravidade da má oclusão, definida pelo Componente de Saúde Bucal (DHC) do Índice de Necessidade de Tratamento Ortodôntico (IOTN), e apinhamento, determinado pelo índice de irregularidade de Little. A amostra foi distribuída aleatoriamente em três grupos: Grupo I (controle) placebo; Goma de mascar Grupo II; e Grupo III Ibuprofeno. A percepção da dor foi avaliada pela Escala Visual Analógica (EVA) nas primeiras 24, 36 e 48 horas após a ativação do aparelho ortodôntico. Os dados foram analisados por modelos lineares generalizados para medidas repetidas no tempo. Resultado Não foi observada diferença estatisticamente significativa (p>0.05) entre os grupos para os métodos de terapia da dor avaliados em 24, 36 e 48 horas pós-ativação. Conclusão: Não houve diferença entre o método utilizado para controle da dor durante o tratamento ortodôntico.

Auriculotherapy used to manage orthodontic pain: a randomized controlled pilot study.

INTRODUCTION: Several methods are commonly used to decrease orthodontic pain, but versatile tools and standardized protocols are still lacking. OBJECTIVE: In response to the need for alternatives to conventional analgesic methods, this study evaluates the analgesic effects of auriculotherapy (AT) during the first three months of fixed orthodontic treatment. METHODS: A sample of 36 subjects was selected, with patients randomly allocated into two homogeneous groups, Study Group (SG) and Control Group (CG), depending on the application/non-application of AT. Patients rated their pain scores monthly from 0 to 10, on visual analogue scales (VAS) at the time of bonding (T0) and again at two appliance adjustments (T1 and T2). At each of these treatment phases, VAS was applied in six different time moments (TM): immediately before, immediately after, after 4 hours, after 8 hours, after 24 hours, and after 72h hours. Descriptive statistical analysis, a Student's t-test, and a Chi-square test were applied to the collected data (statistical significance for p< 0.05). RESULTS: SG patients reported lower pain levels than CG patients, both at T0, T1 and T2. Moreover, average pain intensity values were lower in the SG for all TM analyzed, with the t-test significant (p< 0.05) for most TMs. CONCLUSION: AT was effective in the pain treatment of patients with fixed orthodontic appliances. Further studies are needed with a sham control group to confirm the validity of these results.

Consideraciones diagnósticas para la exodoncia de primeros molares permanentes severamente afectados por la Hipomineralización de Molares e Incisivos / Considerações diagnósticas para a exodontia de primeiros molares permanentes severamente afetados pela Hipomineralização de Molares e Incisivos / Diagnostic considerations for extraction of first permanent molars severely affected by Molar-Incisor Hypomineralization

Resumen La Hipomineralización de Molares e Incisivos (HMI) es un defecto de desarrollo del esmalte de origen multifactorial que afecta de uno a cuatro primeros molares permanentes y frecuentemente está asociada con incisivos permanentes. Clínicamente se caracteriza por presentar opacidades demarcadas de color blanco-crema y/o amarillo-café. En casos severos puede haber dolor, fracturas posteruptivas, lesiones de caries dental y/o restauraciones atípicas. Entre las opciones de tratamiento se encuentran restauraciones temporales con cemento de ionómero de vidrio, restauraciones en resina compuesta, coronas, restauraciones indirectas y exodoncia. El objetivo de este caso es analizar las consideraciones diagnósticas de la exodoncia de primeros molares permanentes severamente afectados por la HMI. Paciente de sexo femenino, 9 años de edad, patrón esquelético Clase I, maloclusión Clase I bilateral e HMI severa. Para el tratamiento se optó por realizar la exodoncia de los cuatro primeros molares permanentes bajo anestesia general. Luego de 10 meses, se observa que los segundos molares permanentes están clínicamente sanos y presentan inclinaciones y posiciones favorables para el cierre espontáneo del espacio. Se concluye que la exodoncia de primeros molares permanentes severamente afectados por la HMI es una estrategia que mejora el pronóstico del paciente y para realizarla, se requiere trabajar en conjunto con el ortodoncista para diagnosticar y planear individualmente cada caso.

Resumo A Hipomineralização de Molares e Incisivos (HMI) é um defeito de desenvolvimento do esmalte, de origem multifatorial que afecta de um a quatro primeiros molares permanentes e frequentemente está associada aos incisivos permanentes. Clinicamente se caracteriza como opacidades demarcadas de coloração branco-creme e/ou amarelo-café. Em casos severos pode haver dor, fraturas pós-irruptivas, lesões de cárie dentária e restaurações atípicas. Dentre as opções de tratamento estão as restaurações temporárias com cimento de ionômero de vidro, restaurações em resina composta, coroas, restaurações indiretas e a exodontia. Esta última opção permite que o segundo molar permanente se reposicione espontaneamente desde que realizada a tempo, portanto, é considerada uma alternativa viável e custo-efetiva. O objetivo deste caso foi analisar as considerações diagnósticas de exodontia de primeiros molares permanentes severamente afetados pela HMI. Paciente do sexo feminino, 9 anos de idade, padrão esquelético Classe I, maloclusão Classe I bilateral e HMI severa. Para o tratamento, optou-se por realizar a exodontia dos quatro primeiros molares permanentes sob anestesia geral. Após 10 meses, se observa que os segundos molares permanentes estão clinicamente saudáveis e apresentam inclinações e posicionamentos favoráveis para o fechamento espontâneo do espaço. Conclui-se que a exodontia de primeiros molares permanentes melhora o prognóstico do paciente e para realizá-la requer um trabalho em conjunto com o ortodontista para diagnosticas e planejar individualmente cada caso.

Abstract Molar and Incisor Hypomineralization (MIH) is an enamel development defect of multifactorial origin that affects one-to-four permanent first molars and is frequently associated with permanent incisors. Clinically it is characterized by demarcated white-cream and/ or yellow-brown opacities. In severe cases, there may be tooth pain, posteruptive fractures, dental caries lesions, and/ or atypical restorations. Treatment options include temporary restorations with glass ionomer cement, restorations with composite resin, crowns, indirect restorations, and tooth extraction. When extractions are performed at the right time, it allows the spontaneous replacement of the second permanent molar, therefore, it is considered a viable and cost/effective treatment. The objective of this case report is to analyze the diagnostic considerations for the extraction of first permanent molars severely affected by MIH. Female patient, 9 years old, Class I skeletal pattern, Class I malocclusion, and severe MIH. For the treatment, it was decided to perform the extraction of the first four permanent molars under general anesthesia. After 10 months, it is observed that the second permanent molars are clinically healthy and have favorable inclinations and positions for spontaneous closure of the space. It is concluded that the extraction of first permanent molars severely affected by MIH is a strategy that improves the patient's prognosis and to carry out, it is necessary to work together with the orthodontist to diagnose and plan each case individually.