Assessment of pain perception between clear aligners and fixed appliances: A review

AbstractIntroductionAccording to the International Association for the Study of Pain (IASP), pain is an unpleasant sensory and emotional experience linked to actual or potential tissue damage. In orthodontics, pain commonly results from compression of the periodontal ligament (PDL). Burstone (1964) identified two types of pain: immediate pain from initial PDL compression and delayed pain, or PDL hyperalgesia, occurring hours later. Pain intensity is commonly assessed using tools like the Visual Analogue Scale (VAS).AimTo evaluate the pain perception between clear aligners and fixed appliances.ObjectivesTo compare the pain perception between clear aligners and fixed appliancesMethodsA review of systematic reviews was conducted per PRISMA 2020 and Cochrane guidelines (PROSPERO: CRD42022302515). Four systematic reviews were included from an initial pool of 312 studies. Pain was assessed using validated tools like the Visual Analogue Scale (VAS).ResultsClear aligner patients consistently reported lower pain levels, especially in the first few days of treatment, with less analgesic use and better quality of life. Fixed appliance users experienced more pain, particularly within 24-72 hours of appliance activation. One study reported initially higher pain with aligners, which decreased over time.DiscussionPain perception varies by appliance type, age, and individual sensitivity. Clear aligners exert less mechanical stress, possibly reducing inflammation and discomfort. However, heterogeneity in study design and lack of standardization limit the strength of conclusions.ConclusionClear aligners are associated with lower pain perception than fixed appliances in early treatment stages. Further well-designed RCTs are needed to confirm these findings across diverse populations.