| Background: Orthodontic pain and discomfort is felt by almost all patients during orthodontic treatment.Orthodontic pain refers to the discomfort,dull pain and hypersensitivity of affected teeth,while the discomfort of soft tissue during orthodontic treatment is defined as orthodontic discomfort.Orthodontic pain is caused by periodontal inflammation and local inflammatory products acting on sensory endings under the action of orthodontic force.But orthodontic discomfort are caused by stimulation of the orthodontic appliance.Orthodontic pain and discomfort are affected by a number of comprehensive factors,such as severity of crowding and type of appliance.In turn,orthodontic pain and discomfort can also affect the patients’ social psychology and behavior.Therefore,it is of great significance to research on the pain and discomfort of different orthodontic appliances,which may help patients and doctors choose orthodontic appliances.Objective: Self-ligating appliance and clear aligner are the conventional choices for orthodontic treatment in China.In the past,scholars often used paper questionnaires to study the differences of orthodontic pain between fixed orthodontic appliance and clear aligner,which mainly focused on the regularity of pain.This study used digital questionnaire to study the differences between fixed orthodontic appliance and clear aligner in age,sex,ICON index,pain pattern,soft tissue discomfort and analgesic use,so as to provide more scientific and effective evidence for dentists and orthodontic patients while making clinical decisions.Methods: Orthodontic patients were selected from the Department of Orthodontics,Stomatological Hospital,from September 1,2020 to August 31,2021.According to the inclusion and exclusion criteria,these patients conducted a paired design by age,gender,ICON index.Finally,80 patients were selected.Among them,40 patients（12 males and28 females）were treated with AO metal self-ligating fixed appliance as self-ligating appliance group and the other 40 patients（11 males and 29 females）were treated with Invisalign aligner as the clear aligner group.Digital questionnaire was used to investigate the general data of the patients.We made statistics to the VAS score of pain and the analgesic usage of the subjects in the resting state and at the moment of contact of front teeth at 2nd hours,4th hours,1st day,2nd days,3rd days,4th days,5th days,6th days and 7th days.The discomfort of oral soft tissue investigated at 1st day,3rd days and 7th days are also recorded.The results were analyzed by SPSS22.0.Results: 1.The mean age of the self-ligating appliance group was 23.5 years old,and that of the clear aligner group was 24.6 years old.There were no significant statistically differences between the self-ligating appliance group and the clear aligner group in gender,age,ICON index（P>0.05）.The VAS score of patients with different ICON index had statistical significance（P<0.05）.2.In resting state,the pain intensity in the first 5 days was below moderate in both groups,but the pain intensity in the self-ligating appliance group was higher than that in the clear aligner group（P<0.05）.There was no significant difference in the pain degree between the two groups at 2nd hours,5th days,6th days and 7th days（P>0.05）,and the pain degree in the above period was low in both two groups.When the incisors contacted,the pain intensity of self-ligating appliance group was significantly higher than that of clear aligner group after 4th hours（P<0.05）.Also,the pain degree in both groups was higher than that in resting state（P<0.05）.3.The pain pattern showed a trend of increasing at first and then decreasing.Only a few patients felt pain after 2nd hours,whose pain level was mild.It showed that the pain was obvious from 4th hours to 3rd days after treatment,and the pain degree was moderate.In addition,the intensity of pain with both appliances peaked at 1st day.4.There were less likely to cause oral soft tissue discomfort in both self-ligating fixed appliance group and clear aligner group.The labial discomfort of the self-ligating fixed appliance group increased within 3rd days and gradually decreased after 7th days.However,the clear aligner seemed to have less probability of causing the labial discomfort and had no significant correlation with time.Furthermore,there was no significant difference between the self-ligating fixed appliance group and the clear aligner group in palatal discomfort within 3rd days（P>0.05）,but the incidence of palatal discomfort at 7th days in the clear aligner group was higher than that in the self-ligating fixed appliance group（P<0.05）.Moreover,the degree of tongue discomfort was mild in both two groups,also there was no statistical significance between the two groups（P>0.05）.5.Patients using self-ligating appliance（15.8%）were more likely to take analgesics than those using clear aligner（2.4%）（P<0.05）.Most patients in the clear aligner group chose to take analgesics at 4th hours after treatment,whereas the other group patients often took analgesics in 1st day.Conclusion: 1.Orthodontic pain is not affected by gender,but is affected by ICON index.The higher the ICON index,the higher the pain degree is.2.The clear aligner demonstrates a slighter pain comparing with self-ligating fixed appliance.When incisors are contact,the orthodontic pain degree becomes higher than that in the resting state in both self-ligating appliance group and clear aligner group.3.There are mild pain in self-ligating appliance group and clear aligner group at first 2nd hours.The intensity increases at first and then decreases in the first week.The peak of pain intensity comes in 1st day after treatment and gradually decreases until disappearing after 5th days.4.The two appliances are not easy to cause tongue discomfort.Compared with clear aligner,self-ligating appliance can easily cause labial discomfort.Patients with clear aligner are more likely to report palatal discomfort at 7th days than those with self-ligating appliance.5.Patients with the self-ligating fixed orthodontic appliance take analgesics more frequently than those with clear aligner.Nevertheless,the frequency of analgesic use in patients of both two groups is low.Patients with clear aligner use analgesics earlier than that with self-ligating appliance. |
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