Initial Archwire Research Articles

Effectiveness of Pre-and Post-Archwire Insertion Acetaminophen Vs. Non-Pharmacologic Management of Pain During Orthodontic Tooth Movement

Introduction: Some patients undergoing orthodontic treatment perceive discomfort at levels that may negatively impact their feelings about their treatment and decrease their compliance. The purpose of this investigation was to study the effectiveness of either pre- or post-archwire insertion acetaminophen versus a placebo or telephone call in controlling discomfort. Materials/Methods: A total of 120 patients, aged 12 to 18 years, undergoing fixed comprehensive orthodontic treatment were ran - domly assigned to one of six experimental groups: (1) 600 mg acetaminophen pre-treatment, 600 mg acetaminophen post-treatment; (2) lactose placebo pre-treatment, 600 mg acetaminophen post-treatment; (3) 600 mg acetaminophen pre-treatment, lactose placebo post-treatment; (4) lactose placebo pre-treatment and post-treatment; (5) courtesy phone call pre-treatment, courtesy phone call post- treatment; (6) no courtesy phone call pre-treatment or post-treatment. Medication group subjects were instructed to take the oral medications at prescribed time intervals before and after initial archwire insertion. The patient's level of discomfort was assessed using a 100mm visual analogue scale (VAS) approximately 1 hour prior to initial archwire placement and at 3, 7, 19, 24, 31, and 48 hours after archwire placement. Results: The peak level of mild to moderate discomfort occurred 19 hours after archwire placement and the differences in VAS scores between the six groups and gender were not statistically significant. Conclusions: All of the interventions were equally effective in controlling the pain following initial orthodontic appliance placement, indicating a relatively low level of pain.

Pain and Discomfort Associated With Initial Alignment with Three Different Archwires-A Clinical Study

6; pain is known to be influenced by psychological, sociocultural, and environmental factors, making objective evaluation difficult. The experience of pain is measured indirectly, and the visual analog scale (VAS) is the most reliable method of measuring pain perception. 7-10 Nonlinear relationships have been shown between pain experienced after initial archwire placement and archwire material and age; social class; degree of force applied; dental arch relationships; and dental crowding. 11-15 It is not surprising that the use of preemptive and postoperative analgesia has been shown to reduce pain scores. 8 The present study is intended to test whether any significant difference in the pain and discomfort experience could be found during initial alignment with three initial archwires ,i.e. 0.0175 multisranded stainless steel archwire, 0.018 Cu-Niti and 0.018 Niti. Ideally, archwires are designed to move teeth with light and continuous forces. Such force reduces the potential for patient discomfort, tissue hyalinization and undermining resorption. When force is applied, the archwire should behave elastically over a period of weeks to months. Keeping these wire characteristics in mind, research work was pursued by orthodontists. AIMS AND OBJECTIVES: 1 To investigate the amount of pain and discomfort experienced by the patient during the alignment phase of treatment.

No reliable evidence to guide initial arch wire choice for fixed appliance therapy

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase databases were searched. Conference proceedings and abstracts from the British Orthodontic Conference European Orthodontic Conference and the International Association for Dental Research were also searched together with the reference lists of identified studies. Study authors were contacted for additional information. Randomised controlled trials of initial arch wire involving participants with upper and/or lower full arch fixed orthodontic appliances were included. Study selection, data extraction and risk of bias assessment were carried out independently by at least two reviewers. Nine RCTs with 571 participants were included in this review. All trials were at high risk of bias. All trials had at least one potentially confounding factor (such as bracket type, slot size, ligation method, extraction of teeth) which is likely to have influenced the outcome and was not controlled in the trial. None of the trials reported the important adverse outcome of root resorption. The comparisons were made between:Multistrand stainless steel initial arch wires compared to superelastic nickel titanium (NiTi) initial arch wires. There were four trials in this group, with different comparisons and outcomes reported at different times. No meta-analysis was possible. There is insufficient evidence from these trials to determine whether or not there is a difference in either rate of alignment or pain between stainless steel and NiTi initial arch wires.Conventional (stabilised) NiTi initial arch wires compared to superelastic NiTi initial arch wires. There were two trials in this group, one reporting the outcome of alignment over six months and the other reporting pain over one week. There is insufficient evidence from these trials to determine whether or not there is any difference between conventional (stabilised) and superelastic NiTi initial arch wires with regard to either alignment or pain.Single-strand superelastic NiTi initial arch wires compared to other NiTi (coaxial, copper NiTi (CuNiTi) or thermoelastic) initial arch wires. The three trials in this comparison each compared a different product against single-strand superelastic NiTi. There is very weak unreliable evidence, based on one very small study (n = 24) at high risk of bias, that coaxial superelastic NiTi may produce greater tooth movement over 12 weeks, but no information on associated pain or root resorption. This result should be interpreted with caution until further research evidence is available. There is insufficient evidence to determine whether or not there is a difference between either thermoelastic or CuNiTi and superelastic NiTi initial arch wires. There is no reliable evidence from the trials included in this review that any specific initial arch wire material is better or worse than another with regard to speed of alignment or pain. There is no evidence at all about the effect of initial arch wire materials on the important adverse effect of root resorption. Further well-designed and conducted, adequately-powered RCTs are required to determine whether the performance of initial arch wire materials as demonstrated in the laboratory, makes a clinically important difference to the alignment of teeth in the initial stage of orthodontic treatment in patients.

Assessment of pain experience in adults and children after bracket bonding and initial archwire insertion

Ninety five percent of orthodontic patients routinely report pain, due to alterations in the periodontal ligament and surrounding soft tissues, with intensity and prevalence varying according to age. This study aimed to assess toothache and buccal mucosal pain in adults and children during two initial phases of the orthodontic treatment. The intensity of toothache and buccal mucosal pain reported by 20 patients, 10 children (11-13 years) and 10 adults (18-37 years) was recorded with the aid of a Visual Analog Scale (VAS), during 14 days--7 days with bonded brackets only and 7 days with the initial archwire inserted. There was no significant difference in pain intensity among adults and children. After bracket bonding, 50% of the children and 70% of the adults reported pain. 70% of both groups reported pain after initial archwire insertion. While adults reported constant, low intensity, buccal mucosal pain, the children showed great variation of pain intensity, but with a trend towards decreasing pain during the assessment period. After initial archwire insertion the peaks of toothache intensity and prevalence occurred 24 hours in children and 48 hours in adults. In general, children reported pain less frequently than adults did, though with greater intensity.

Initial arch wires for tooth alignment during orthodontic treatment with fixed appliances

Initial arch wires are the first arch wires to be inserted into the fixed appliance at the beginning of orthodontic treatment and are used mainly for the alignment of teeth by correcting crowding and rotations. With a number of different types of orthodontic arch wires available for initial tooth alignment, it is important to understand which wire is most efficient, as well as which wires cause the least amount of root resorption and pain during the initial aligning stage of treatment. This is an update of the review 'Initial arch wires for alignment of crooked teeth with fixed orthodontic braces' first published in the Cochrane Database of Systematic Reviews 2010, Issue 4. To assess the effects of initial arch wires for alignment of teeth with fixed orthodontic braces in relation to alignment speed, root resorption and pain intensity. We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 2 August 2012), CENTRAL (The Cochrane Library 2012, Issue 7), MEDLINE via OVID (1950 to 2 August 2012) and EMBASE via OVID (1980 to 2 August 2012). We also searched the reference lists of relevant articles. There was no restriction with regard to publication status or language of publication. We contacted all authors of included studies to identify additional studies. We included randomised controlled trials (RCTs) of initial arch wires to align teeth with fixed orthodontic braces. Only studies involving participants with upper and/or lower full arch fixed orthodontic appliances were included. Two review authors were responsible for study selection, validity assessment and data extraction. All disagreements were resolved by discussion amongst the review team. Corresponding authors of included studies were contacted to obtain missing information. Nine RCTs with 571 participants were included in this review. All trials were at high risk of bias and a number of methodological limitations were identified. All trials had at least one potentially confounding factor (such as bracket type, slot size, ligation method, extraction of teeth) which is likely to have influenced the outcome and was not controlled in the trial. None of the trials reported the important adverse outcome of root resorption.Three groups of comparisons were made.(1) Multistrand stainless steel initial arch wires compared to superelastic nickel titanium (NiTi) initial arch wires. There were four trials in this group, with different comparisons and outcomes reported at different times. No meta-analysis was possible. There is insufficient evidence from these trials to determine whether or not there is a difference in either rate of alignment or pain between stainless steel and NiTi initial arch wires.(2) Conventional (stabilised) NiTi initial arch wires compared to superelastic NiTi initial arch wires. There were two trials in this group, one reporting the outcome of alignment over 6 months and the other reporting pain over 1 week. There is insufficient evidence from these trials to determine whether or not there is any difference between conventional (stabilised) and superelastic NiTi initial arch wires with regard to either alignment or pain.(3) Single-strand superelastic NiTi initial arch wires compared to other NiTi (coaxial, copper NiTi (CuNiTi) or thermoelastic) initial arch wires. The three trials in this comparison each compared a different product against single-strand superelastic NiTi. There is very weak unreliable evidence, based on one very small study (n = 24) at high risk of bias, that coaxial superelastic NiTi may produce greater tooth movement over 12 weeks, but no information on associated pain or root resorption. This result should be interpreted with caution until further research evidence is available. There is insufficient evidence to determine whether or not there is a difference between either thermoelastic or CuNiTi and superelastic NiTi initial arch wires. There is no reliable evidence from the trials included in this review that any specific initial arch wire material is better or worse than another with regard to speed of alignment or pain. There is no evidence at all about the effect of initial arch wire materials on the important adverse effect of root resorption. Further well-designed and conducted, adequately-powered, RCTs are required to determine whether the performance of initial arch wire materials as demonstrated in the laboratory, makes a clinically important difference to the alignment of teeth in the initial stage of orthodontic treatment in patients.

Regional odontodysplasia: Orthodontic treatment and transplantation of premolars

Regional odontodysplasia is a rare and unique dental anomaly involving both dentitions, but mostly the teeth of 1 quadrant. This report describes the combined surgical and orthodontic treatment of a boy with regional odontodysplasia. The mandibular right central and lateral incisors and the canine (as well as the deciduous predecessors) were affected. In a 2-step procedure, the maxillary right and left second premolars were autotransplanted to the affected area. The extraction sites in the maxilla were closed, and a good functional occlusion was established.

Cognitive Behavioral Therapy for Orthodontic Pain Control

The objective of this study was to evaluate the efficacy of cognitive behavioral therapy intervention for patients who experienced pain during orthodontic treatment. The baseline characteristics were assessed via questionnaires and oral examinations. Four hundred and fifty eligible individuals were recruited and randomized by computer-generated block randomization into three groups: cognitive behavioral therapy intervention (n = 150), ibuprofen intervention (n = 150), and no intervention (control; n = 150). Primary outcomes were the change from baseline in pain intensity measured with 100-mm Visual Analog Scale (VAS) scores at 1, 2, 3, 7, 14, and 30 days after initial archwire placement. Outcomes assessment was blinded and followed the intention-to-treat principle. One hundred forty-three (95.30%), 145 (96.70%), and 141 (94.00%) individuals in the cognitive behavioral therapy, the ibuprofen, and the control groups, respectively, completed the one-month follow-up evaluations. Those in the cognitive behavioral therapy group showed a greater decrease in mean VAS scores than did those in the control group over the previous five time-points (p < 0.001). Cognitive behavioral therapy was shown to be effective in pain control during the initial stage of orthodontic treatment. The study registration number was ChiCTR-TRC-00000556.

Pain reduction after initial archwire placement in orthodontic patients: A randomized clinical trial

The aim of this study was to compare the efficacy of ibuprofen, viscoelastic bite wafers, and chewing gum in reducing orthodontic pain. This randomized clinical trial included 50 girls between the ages of 13 and 18 years classified into 5 groups of 10 each: placebo, ibuprofen (400 mg), chewing gum, soft viscoelastic wafer, and hard viscoelastic wafer. The patients in each group received 1 method immediately after placement of the initial archwires and every 8 hours if they experienced pain. Pain perception was recorded by the patients while chewing, biting, fitting front teeth, and fitting posterior teeth at 2 hours, 6 hours, bedtime, 24 hours, 2 days, 3 days, and 7 days after archwire placement, using a visual analog scale. Analysis of variance (ANOVA) and Tukey tests were used for data analysis. There were significant differences in pain perception of chewing function between the placebo group and the chewing-gum group at 24 hours and 7 days, and between the placebo group and the hard-viscoelastic group on the day 7 (P <0.05). Also, there were significant differences between the placebo group and the soft-viscoelastic group, and between the placebo group and the hard-viscoelastic group in pain severity when fitting posterior teeth at 6 hours (P <0.05). At other times and with other functions, no significant differences were recorded. Both chewing gum and viscoelastic bite wafers are effective for pain reduction in orthodontic patients and can be recommended as suitable substitutes for ibuprofen.

Pain intensity and control with fixed orthodontic appliance therapy (A clinical comparative study on Iraqi sample)

The purpose of this prospective, randomized clinical trial was to investigate the level and intensity of patientspain and discomfort, and to compare between the use of Bite Wafer and Paracetamol in reducing pain and discomfort associated with initial orthodontic tooth movement in both adolescents and adults. Sample: 110 subjects with two age groups, 52 adolescents with age range from 12 to less than 18 years and 58 adults with age range 18-24 years, successfully completing the study. For each subject fixed orthodontic appliance (Roth 0.022) was bonded and round 0.014 NiTi arch wire was ligated with elastic ligature. The subjects in the Bite Wafer group were instructed to chew on it whenever they feel pain for the next 7 days, and document the time and effectiveness of it in the questionnaire. The Paracetamol group subjects instructed to use Paracetamol 500mg to relive pain and record times and effectiveness of its use in questionnaire. Results: The peak of pain was occurred in the first day and declined gradually till totally disappeared at the sixth day after initial arch wire placement. A marked reduction of pain intensity was noticed in both adolescents and adults groups, using Bite Wafer, from the first to the sixth day which is much higher than Paracetamol group especially in adolescents. No gender differences (P>0.05) was noticed in this study. Conclusion: Although both Bite Wafer and Paracetamol reduced pain gradually, Bite Wafer reduced pain more obviously and safely in comparison to Paracetamol especially in adolescents.

Load deflection characteristics and force level of nickel titanium initial archwires

To investigate and compare the characteristics of commonly used types of traditional and heat-activated initial archwire by plotting their load/deflection graphs and quantifying three suitable parameters describing the discharge plateau phase. Forty-eight archwires (22 nickel titanium [NiTi] and 26 heat-activated) of cross-sectional diameter ranging from 0.010 to 0.016 inch were obtained from seven different manufacturers. A modified three-point wire-bending test was performed on three analogous samples of each type of archwire at a constant temperature (37.0°C). For each resulting load/deflection curve, the plateau section was isolated, along with the mean value of the average plateau force, the plateau length, and the plateau slope for each type of wire obtained. Statistically significant differences were found between almost all wires for the three parameters considered. Statistically significant differences were also found between traditional and heat-activated archwires, the latter of which generated longer plateaus and lighter average forces. The increase in average force seen with increasing diameter tended to be rather stable, although some differences were noted between traditional and heat-activated wires. Although great variation was seen in the plateau behavior, heat-activated versions appear to generate lighter forces over greater deflection plateaus. On average, the increase in plateau force was roughly 50% when the diameter was increased by 0.002 inch (from 0.012 to 0.014 and from 0.014 to 0.016 inch) and about 150% when the diameter was increased by 0.004 inch (from 0.012 to 0.016), with differences between traditional and heat-activated wires noted in this case.

Salivary Alpha-Amylase Activity: A Possible Indicator of Pain-Induced Stress in Orthodontic Patients

Pain, a common experience reported by orthodontic patients, has its intensity assessed with the help of subjective scales, which have a limited and disputable value. Such unpleasant experience, which may raise stress levels, is reflected by an increase in the salivary concentration of alpha-amylase. Assess the correlation between the salivary levels of alpha-amylase and pain intensity reported by patients during orthodontic treatment. Twenty male patients (11-37 years of age) were assessed daily, before treatment, after bracket bonding, and after initial arch wire insertion. Saliva was sampled for alpha-amylase analysis, and pain intensity was measured with the visual analog scale. There was no correlation between alpha-amylase concentrations in the saliva and pain intensity, although the patients had a significant and progressive increase of alpha-amylase levels during the assessment period. The findings may reflect the psychological stress caused by the presence and activation of the fixed appliance.

Self-reported pain associated with the use of intermaxillary elastics compared to pain experienced after initial archwire placement

To evaluate the pain during the use of intermaxillary elastics and to compare it with that of initial archwire placement. Sixteen orthodontic patients who underwent initial bonding (7 girls, 13 boys; mean age 16.75 ± 2.61 years) and 19 patients who would be using intermaxillary elastics for the first time (13 girls, 7 boys; mean age 16.21 ± 3.01 years) were enrolled in this prospective study. A visual analog scale form was given to each patient to measure the pain levels, and these were measured by the same investigator using a digital caliper. Data were evaluated using Mann Whitney U-test. The pain started to increase 2 hours after the application of elastics. The highest levels were achieved at the sixth hour and the same night. The pain levels started to decrease at day 2. Although the pain levels of the elastic group started to decrease after the second day, the pain levels of the initial bonding group were still significantly high. Intermaxillary elastics cause similar amounts of pain compared with initial archwire placement, but the pain of the elastics did not last as long as the pain felt after initial bonding.

Treatment of pain after initial archwire placement: A noninferiority randomized clinical trial comparing over-the-counter analgesics and bite-wafer use

Pain is a major concern of patients before orthodontic treatment. Currently, the most frequently recommended treatments for pain after archwire placement or appliance adjustment are over-the-counter (OTC) analgesics. Although the overuse of OTC medications and their potential side effects are concerns, particularly for children, no study to date has investigated a nonpharmacologic option for pain management as an alternative for these analgesics. A parallel 2-group stratified block randomized clinical trial was designed to assess the pain response of adolescents during the first week after initial archwire placement. The subjects were randomly assigned to 1 of 2 pain management groups: bite wafer (BW) or OTC analgesics. Pain levels were reported on a numerical rating scale. The intensity and unpleasantness of the pain were also assessed. Data were collected at 8 times over a 7-day period. A general linear mixed model with heterogeneous compound symmetry covariance matrix was fitted separately for each outcome. Estimates from the mixed model were used to test a noninferiority hypothesis that the BW group, on average, was not inferior with respect to pain management to the OTC group. The patterns of pain level, intensity, and unpleasantness over time were similar for the 2 groups (P >0.33). Pain management for the BW group as indicated by pain level, intensity, and unpleasantness was not inferior to that of the OTC group (P >0.39). In adolescents, the BW is a nonpharmacologic option for pain management after orthodontic procedures that is at least as effective as OTC analgesics.

Evaluation of preemptive valdecoxib therapy on initial archwire placement discomfort in adults.

The purpose of this randomized, double-blinded, placebo-controlled prospective clinical trial was to compare the efficacy of preemptive and postoperative administration of valdecoxib in reducing discomfort caused by initial archwire placement in adults. A total of 56 orthodontic patients aged 18-54 years who were to begin treatment were randomly assigned to one of three groups: (1) placebo, (2) those who received preemptive valdecoxib 40 mg at least 30 minutes before initial archwire placement, or (3) those who received postoperative valdecoxib 40 mg two hours after initial archwire placement. Patients in the active treatment groups also received continuous valdecoxib therapy for an additional 48 hours. Discomfort levels were recorded on a visual analog scale at zero, two, six, 24, and 48 hours after initial archwire placement. At baseline, no significant differences were detected between the three groups. In the preemptive valdecoxib group, there was no significant increase (P > .05) in discomfort from baseline at any time point. The placebo and postoperative valdecoxib groups showed significant (P < .05) increases in discomfort after six hours, with the peak discomfort at 24 hours. The postoperative group showed a tendency toward decreased discomfort over time, but the changes were not significantly different from the placebo or the preemptive group. Preemptive analgesia with nonsteroidal anti-inflammatory drugs may be an approach to prevent discomfort associated with initial archwire placement in healthy adults.

The effect of ibuprofen on the level of discomfort inpatients undergoing orthodontic treatment

Studies have shown that patients undergoing orthodontic tooth movement can experience varying degrees of discomfort. The objective of this study was to determine whether nonsteroidal antiinflammatory agents, such as aspirin or ibuprofen, which inhibit prostaglandin synthesis through acetylation and inactivation of the enzyme cyclooxygenase, can suppress orthodontic discomfort by inhibiting the inflammatory response normally observed after orthodontic adjustments. A total of 77 patients were included in a double-blind, randomized, parallel, placebo-controlled, single-dose, analgesic efficacy evaluation of ibuprofen and aspirin. Patients were divided into three groups. Group A received one dose of the drug ibuprofen (400 mg), group B received aspirin (650 mg), and group C received a placebo (beta-lactose). The level of discomfort was assessed using a visual analogue scale at 2, 6, and 24 hours and 2, 3, and 7 days after the insertion of either orthodontic separators or an initial arch wire. A repeated measures analysis of variance and post hoc studentized range statistics showed that the placebo group had significantly more discomfort than either the ibuprofen or the aspirin group at all the time intervals tested. In addition, ibuprofen produced significantly less discomfort than aspirin at the 6 and 24-hour and 2-day time phase after separator placement; and 2 and 6 hours and 2, 3, and 7 days after arch wire placement. These results support a recommendation for ibuprofen as a preferred analgesic in the treatment of discomfort because of postorthodontic adjustments.

The pain and discomfort experienced during orthodntic treatment: A randomized controlled clinical trial of two intial aligning arch wires

A randomized controlled clinical trial was performed to compare the nature, prevalence, intensity, and duration of pain related to the use of a relatively recently developed superelastic arch wire and a more traditional multistranded steel arch wire. Other factors likely to influence the pain experience were also investigated. Forty-three subjects participated in the study, the pain response being assessed by each of the visual analogue scales, the questionnaires, and an analgesic consumption record. In 18 of the 43 subjects a standardized preliminary dental extraction procedure was used as a control. Subsequent to the random allocation of an initial arch wire in 43 patients, 22 of them underwent a second arch wire in the opposing arch, the wire again being determined by random allocation. It was found that the prevalence, intensity, and duration of pain after the insertion of the two types of wire was similar but much greater than in the postextraction control phase. The pain score peaked on the morning after the placement of the arch wire, lasting typically for 5 to 6 days. The pain and discomfort experienced after the insertion of the second arch wire was similar to that of the first, no conditioning response being evident. Overall a diurnal variation was found with a tendency to an increase in pain in the evenings and nights, although this did not greatly affect sleep. The pain response was found to be highly and consistently subjective, not related to the dental arch, crowding, sex, or social class; however, a statistically significant association was found between the age and the pain experienced.