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

Area of Science:

• Orthodontics
• Dental Pain Management
• Biomaterials in Dentistry

Background:

• Pain is a significant factor influencing patient satisfaction and compliance in orthodontic treatment.
• Clear aligners offer an aesthetic alternative to traditional fixed appliances, but their impact on patient-reported pain requires thorough investigation.

Purpose of the Study:

• To compare pain levels experienced by patients undergoing orthodontic treatment with clear aligners versus fixed appliances.
• To synthesize current evidence on the differences in pain perception between these two orthodontic modalities.

Main Methods:

• A comprehensive electronic literature search was conducted across multiple databases until February 2019.
• Included studies were comparative, assessing pain between clear aligners and fixed appliances, with risk of bias and evidence levels evaluated.
• Seven studies, including one randomized clinical trial, were included; meta-analysis was precluded by heterogeneity.

Main Results:

• Most studies indicated lower initial pain with Invisalign compared to conventional fixed appliances.
• These pain differences were not sustained beyond the initial days of treatment.
• No comparable evidence was found for other clear aligner brands.

Conclusions:

• Orthodontic patients treated with Invisalign may experience reduced pain during the initial days compared to fixed appliances.
• Pain levels become comparable between the two methods after the initial phase and up to three months.
• While pain is a consideration, treatment predictability and outcomes are paramount, especially given the transient nature of pain differences.