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Patients' report of discomfort and pain during debonding of orthodontic brackets: a comparative study of two methods

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Abstract

To examine the level of discomfort and pain reported by patients during debonding of orthodontic metallic brackets by comparing two of the most popular methods, since discomfort can negatively influence patients' motivation to undergo orthodontic treatment. This split-mouth designed study involved 37 patients. Two methods were used for bracket removal: a lift-off debonding instrument and a ligature-cutting plier. The level of discomfort during debonding was evaluated on a scale of 0 to 4; The Adhesive Remnant Index (ARI) was taken into consideration, as well. Comparison between the methods was statistically analyzed by using the Wilcoxon signed rank and chi-squared tests (P<.05). Regarding the remnant adhesive, no significant difference was observed between the methods. Patients' reports of pain (score ≥2) were observed in 24.3% of teeth when the brackets were removed using a ligature-cutting plier, while there was a 12.8% report of pain when the lift-off instrument was employed (odds ratio [OR]=2.17, P<.001, χ(2)=17.7). Statistically significant lower scores for maxillary (P=.02) and mandibular central incisors (P=.02), maxillary lateral incisors (P=.02), mandibular canines (P=.00), and mandibular premolars (P=.00/.02) were reported when the lift-off instrument was employed. For the removal of orthodontic brackets, the lift-off instrument is better accepted by patients compared to the ligature cutting pliers, given that reports of pain are about two times lower with the former. The ARI was the same for both methods.

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... Debonding procedure should be harmless, painless and quick [8]. The pain during debonding can be minimized by various means like the use of different orthodontic instruments, laser application, analgesics, ultrasound, adjunctive procedures, thermal heating the orthodontic adhesives, or biting occlusal bite wafers at debonding [7,[9][10][11]. ...
... Previous studies fail to compare different pain management methods during debonding in regard to gender and on different locations of oral cavity using randomization, placebo and blinding [7,[9][10][11][12]. ...
... The median values of VAS score were highest in the lower front quadrant followed by upper front quadrant whereas least in upper and lower posterior region in all the groups, suggesting that anterior region of jaw is more sensitive to pain while debonding. The similar finding was reported by other studies [10,11,[27][28][29][30]. It might be due to their anatomic location and root morphology. ...
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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.
... A careless debonding technique and approach can take longer debonding time 1 , cause irreversible damage to outermost fluoride rich layer of enamel 2 and is usually more painful for the patient. 3 Many different types of fixed orthodontic brackets are available in the market but stainless steel labial brackets are mostly used because of their low cost and clinical effectiveness. 4,5 Stainless steel brackets are usually bonded to teeth with composite adhesive systems which are based on the principle of enamel etching and microretention. ...
... Discomfort of pain was evaluated by asking the patient their level of sensitivity during debonding based on score of 0 to 4 as proposed by Normando. 3 The scale is given in Table 1. ...
... Other variables that were not considered in this study but which can effect pain during debonding are mobility of the tooth at time of debonding ,tooth type, patient anxiousness at time of debonding and gender of the patient. 3,[21][22][23] CONCLUSION From this study following conclusions can be made: ...
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The aim of this study was to compare the debonding time and pain or discomfort between conventional mechanical debonding with sonic and ultrasonic debonding of stainless steel brackets. One hundred fifty brackets were debonded at the end of 2 years of comprehensive orthodontic treatment from 12 patients of both sexes of age range between 15-25 years using non probability sampling technique. Mechanical debonding of brackets was done with debonding plier using wing method. Ultrasonic and sonic scalers were used to debond the brackets engaging the bracket from incisal side. Debonding time in seconds and patient perception of pain on a scale of 0-4 was noted. One way ANOVA was used to compare these three techniques in terms of time efficiency and pain or discomfort at time of debonding. Mechanical debonding was successful in all the cases while ultrasonic and sonic debonding failed to debond the brackets in 16% and 36% of the cases respectively. Mechanical wing method debonds brackets in 1.28±0.49 seconds, ultrasonic debonding in 42.53±20.25 while sonic method debonds brackets in 70.18±22.28 seconds. More pain was felt by mechanical debonding followed by sonic and ultrasonic debonding respectively. Difference in debonding time and pain were found statistically significant between these three different techniques. It was concluded that that no single method is time efficient and at the same time least painful for the patient. Mechanical debonding was most time efficient while ultrasonic debonding was least painful.
... Orthodontic patients may experience pain not only during the phase of active treatment but also during the removal of fixed appliances [10]. Various methods to debond metallic and ceramic brackets have been described in the literature, including the use of special debonding pliers [8], ultrasound [9,10] or laser application [11,12], electrothermic debonding [13][14][15], special instruments [8,16], and the use of bonding materials presenting thermoexpandable microcapsules to facilitate debonding [17]. Despite the several techniques described, few authors have been concerned about understanding the discomfort the different debonding methods cause to orthodontic patients [10,12]. ...
... Various methods to debond metallic and ceramic brackets have been described in the literature, including the use of special debonding pliers [8], ultrasound [9,10] or laser application [11,12], electrothermic debonding [13][14][15], special instruments [8,16], and the use of bonding materials presenting thermoexpandable microcapsules to facilitate debonding [17]. Despite the several techniques described, few authors have been concerned about understanding the discomfort the different debonding methods cause to orthodontic patients [10,12]. Undoubtedly, the ideal debonding method should be harmless to the enamel and painless to the patients [18][19][20]. ...
... Furthermore, the use of the SC was the method that presented the highest discomfort for the patients. This finding corroborates with previous clinical reports [28,29], as well as the study of Normando et al. [12], which also compared quantitatively the discomfort caused by LODI and SC. However, that study [12] was limited to these two methods and did not evaluate other methods widely used by orthodontists, such as HP and BRP. ...
Article
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The aim of this clinical investigation was to compare the level of discomfort reported by patients during the removal of orthodontic metallic brackets performed with four different debonding instruments. The sample examined in this split-mouth study comprised a total of 70 patients (840 teeth). Four different methods of bracket removal were used: lift-off debonding instrument (LODI), straight cutter plier (SC), how plier (HP), and bracket removal plier (BRP). Prior to debonding with all experimental methods, the archwire was removed. Before appliance removal, each patient was instructed about the study objectives. It was explained that at the end of debonding in each quadrant, it would be necessary to assess the discomfort of the procedure using a visual analog scale (VAS). This scale was composed of a millimeter ruler scoring from 0 to 10, in which 0 = a lot of pain, 5 = moderate pain, and 10 = painless. The level of significance was predetermined at 5 % (p = 0.05), and the data were analyzed using the BioEstat 5.0 software (BioEstat, Belém, Brazil). The pain scores with SC were significantly higher than in all other methods. There were no significant differences between HP and BRP pain scores, and the LODI group showed the lowest pain scores. Statistically, significant differences were observed in the ARI between the four debonding methods. The biggest limitation of this study is that each tooth was not assessed individually. Patients reported lower levels of pain and discomfort when metallic brackets were removed with the LODI. The use of a straight cutter plier caused the highest pain and discomfort scores during debonding.
... The first study about the pain at debonding was done by Williams and Bishara, 8 who found that patients could withstand intrusive forces the most and that there was a positive correlation between tooth mobility and pain threshold. Normando et al. 9 evaluated the degree of pain during debonding with two instruments and found that the lift-off instrument led to almost two times lower levels of pain than wire cutting plier. Mangnall et al. 10 analyzed the effect of soft acrylic bite wafers and reported significantly less pain in the posterior region. ...
... There are a few articles about pain during debonding but they have some limitations. Williams and Bishara 8 did not actually debond the brackets, while Normando et al. 9 concen-trated only on the effectiveness of pliers but did not provide adequate data about the effects of personal traits and gender. On the other hand, Mangnall et al. 10 recorded the pain expectations of participants and their actual experiences during debonding, but the effects of personal traits and gender were not considered. ...
... Mangnall et al. 10 reported median VAS scores of 25.9 and 33.6 for control and wafer groups, respectively. Normando et al. 9 reported that the most frequent scores were 0 and 1 on a scale of 0 to 4, and for only 5 teeth out of 342, participants gave a score of 4 (intolerable pain). This difference could be due to biological pathways to compensate pain but it could also be the result of ''getting used to it'' by the help of past experiences stored in the cerebral cortex. ...
Article
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Objective: To determine pain during debonding and the effects of different pain control methods, gender, and personal traits on the pain experience. Materials and methods: Patients who had fixed orthodontic treatment with metal brackets, but no surgical treatment or craniofacial deformity, were included. Sixty-three patients (32 female, aged 17.2 ± 2.9 years; 31 male aged, 17.2 ± 2.5 years) were allocated to three groups (n = 21) according to the pain control method: finger pressure, elastomeric wafer, or stress relief. Pain experience for each tooth was scored on a visual analogue scale (VAS), and general responses of participants to pain were evaluated by Pain Catastrophizing Scale (PCS). Multiple linear regression analysis, the Mann Whitney U-test, and Spearman's rank correlation coefficient analysis were used to analyze the data. Results: When the VAS scores were adjusted, finger pressure caused a 47% reduction overall, 56% in lower elastomer wafer total, 59% in lower right arch, 62% in lower left, and 62% in lower anterior compared with the elastomeric wafer. In the elastomer wafer group, upper and lower anterior scores were higher than posterior scores, respectively. Females had higher VAS (lower left and anterior) and total PCS scores than males. Regardless of the pain control method, total PCS scores were correlated with total (r = .254), upper total (r = .290), right (r = .258), left (r = .244), and posterior (r = .278) VAS scores. Conclusions: The stress relief method showed no difference when compared with the other groups. Finger pressure was more effective than the elastomeric wafer in the lower jaw. Higher pain levels were recorded for the anterior regions with the elastomeric wafer. Females and pain catastrophizers gave higher VAS scores.
... Eleven articles were excluded as they did not meet the eligibility criteria because of various reasons (Supplementary Table 2). The final sample included seven studies (12,13,(20)(21)(22)(23)(24). ...
... All of the included studies except the one by Mangnall et al. (20) were single centre studies. Two studies were parallel two-arm trials (12,13), two were parallel three-arm trials (23,24), and three were split-mouth trials (12,21,22). ...
... The included studies had a total of 307 participants aged 12-60 years. The included studies were based in four continents; two were performed in Brazil (12,21), one in India (13), one in Turkey (24), one in Pakistan (23), one in the UK (20), and one in the USA (22). All of the included trials were recent, undertaken between 2010 and 2018, except for the trial by Kraut et al. (22), which dated back to 1991. ...
Article
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Background: Pain is an unpleasant side-effect that can be experienced during orthodontic procedures including debonding of fixed appliances. Pain experience can vary depending on the appliance, debonding technique, as well as adjunctive measures used. Objectives: The primary objective of this systematic review was to assess the effectiveness of different debonding techniques and adjunctive methods on pain/discomfort perception during debonding procedure (PDP) of fixed orthodontic appliances. The secondary objective was to assess the effects of anatomic location and gender on PDP of fixed orthodontic appliances. Search methods: Multiple electronic databases were searched from inception to August 2018. Reference lists of the included articles were manually screened. Selection criteria: Randomized clinical trials (RCTs) and controlled clinical trials were included. Data collection and analysis: Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers according to Cochrane guidelines, with disputes resolved by a third reviewer. Clinical heterogeneity in study design and methodology prevented quantitative synthesis of the data. Results: The search yielded 198 articles after the removal of duplicates. Seven studies were included in the final review with a total of 307 participants aged 12-60 years. Of the four studies comparing different debonding instruments of labial fixed appliances, two studies showed that the lift-off debonding instrument (LODI) produced lower PDP levels than ligature cutting pliers. Three studies compared adjunctive measures to reduce PDP of labial fixed appliances. Finger pressure and bite wafers significantly reduced PDP levels. Analgesics administration (ibuprofen + paracetamol tablets) 1 hour prior to debonding also reduced PDP. PDP was significantly higher in anterior segments and in females. Limitations: The authors acknowledge that there was clinical heterogeneity among the included studies and that the potential effect of diurnal variation on pain during debonding was not considered in any of the included trials. Conclusions and implications: There is weak evidence indicating that using the LODI may reduce PDP of labial fixed appliances. Adjunctive measures such as an intrusive force with finger pressure, bite wafers, and preoperative analgesia may further aid PDP control. Further well-designed parallel-group RCTs taking into consideration the diurnal variation in pain are required. Registration: PROSPERO (CRD42017084474). Funding: None. Conflict of interest: The authors declare that there is no conflict of interest.
... A PubMed database search revealed only six clinical studies on this topic. These studies were all performed with labial metal brackets (13)(14)(15)(16)(17)(18). The scarcity of studies in this area is conspicuous (Table 1). ...
... The scarcity of studies in this area is conspicuous (Table 1). These studies are presented chronologically (13)(14)(15)(16)(17)(18). ...
... In 2010, a split-mouth study assessed the level of discomfort and pain during debracketing (14). A total of 37 (25 female and 12 male) patients composed this study. ...
Article
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The topic of bracket removal and enamel integrity has been extensively investigated. Nevertheless, bracket removal, as far as pain and/or discomfort are concerned, is poorly delineated in the orthodontic literature, i.e., the scarcity of reports in this area is conspicuous. In fact, only six studies were retrieved upon a PubMed search. These clinical studies performed with metal brackets are presented in a chronological order in the present review. Pain and/or discomfort during bracket removal are urgently in need of additional studies. The orthodontists have to be well-informed and updated to convey all the aspects of this procedure to the patient.
... Normando et al. in their study assessed the degree of pain during debonding with two instruments and concluded that the lift-off instrument lowered the pain levels twice that by wire cutting pliers [3]. Another study conducted by Mangnall et al. evaluated the effect of soft acrylic bite wafers and found significantly lesser pain in the posterior region compared to the anterior region [16]. Conclusions of the previous studies have drawn the attention of researchers towards the direction of methods to control effects of anatomic location and personal differences in pain experience during debonding. ...
... e anatomic location of teeth and their root morphology can be held responsible for variation in pain experience in different quadrants of arch. Mangnall et al. in their study found that 39% of the patients reported maximum pain in the mandibular anterior region during debonding [16]. ...
Article
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Introduction. Patients experience various levels of discomfort during orthodontic treatment, i.e., after placement of separators, orthodontic implant placement, and archwire placement and during debonding. Various pain control methods have been developed to relive pain during debonding, i.e., finger pressure (FP), elastomeric wafer (EW), and stress relief (SR). Aim. To analyse various pain scales commonly used to determine the effect of different pain control methods during debonding of orthodontic brackets. Study Design. A comparative cross-sectional study performed on a sample of 60 patients (n � 60) including 14 males and 46 females who were ready for debonding and who were divided into three groups, i.e., finger pressure (FP), elastomeric wafer (EW), and stress relief (SR). Materials and Methods. A 100mm Visual Analog Scale (VAS) was used to record the pain intensity for each tooth. Another scale known as Pain Catastrophizing Scale (PCS) was used to evaluate the patient’s general attitude towards pain perception. *e armamentarium and operator were kept same for all the patients. Statistical analysis used was the Kruskal–Wallis test, used for intergroup and intragroup comparison of pain scores. Results. Lowest total pain score was recorded in the FP group (P � 0.043) on intergroup comparison, while on intragroup comparison, higher pain scores were recorded in lower anterior region (P � 0.02) in all three groups. *ere was no significant difference between the pain scores reported by the male and female subjects. Conclusion. FP is an effective method of pain control. And teeth in the anterior region of lower and upper arches are more sensitive to pain. In terms of cognitive-affective constructs, although the VAS has been widely used in previous studies, the PCS has been detailed to show the most reliable association with physical discomfort and emotional distress.
... Many previous studies evaluated pain during debonding, but they were frequently focused on a specific technique or method. [8][9][10][11][12][13][14] All studies were performed on metallic brackets regardless of whether they were conventional or adhesive precoated (APC) brackets. Additionally, an assessment of the published literature demonstrated that there was limited information about the level of discomfort patients experienced during ceramic bracket removal using a specially designed debonding instrument. ...
... These findings were in agreement with previous studies evaluating the effects of different debonding techniques and adjunctive procedures. 8,9,12,13 This can be explained by the gradually increasing tactile sensory threshold from the anterior to the posterior region, as stated previously. 9 ...
Article
Objectives To evaluate the effects of adhesive precoated (APC) flash-free brackets on the level of pain, amount of remnant adhesive, and removal time during the debonding procedure. Materials and Methods Thirty patients (20 female, 10 male) aged 12 to 18 years undergoing nonextraction fixed orthodontic treatment were included in this study. APC flash-free and conventional ceramic brackets were bonded with a split-mouth study design. Bracket types were randomly allocated to quadrants. During the removal of the brackets, the visual analogue scale (VAS) was used to assess the level of pain for each tooth. The adhesive remnant index (ARI) was used to determine the amount of adhesive remaining on the tooth surface. Adhesive removal times were calculated per quadrant. The data were analyzed using the Wilcoxon test for comparisons between groups. Results Pain scores were generally higher for the conventional group than for the flash-free group. There were no differences in VAS scores across most tooth types during debonding. Overall, ARI results showed more adhesive remnants in the conventional bracket group (P < .001). Except for the right maxillary quadrant, the times required to remove the adhesive were significantly longer for the flash-free brackets than the conventional brackets (P ≤ .005). Conclusions Although removal time was slightly longer for the flash-free adhesive than for the conventional adhesive, lower pain scores were generally observed for the flash-free adhesive brackets during the debonding procedure. Both time and pain differences could be considered clinically insignificant.
... Orthodontic treatment starts from the stage of initial examination till the date of de-bonding. It includes major events like extraction of few teeth, separator placement, bonding and banding, arch wire placement and activation as well as deboning (8) . So, patients are exposed to pain stimuli brushing might be impaired (11) . ...
... Figures (2,3). Overall, the level of pain intensity in females was more than in males as in Table ( 8). ...
Article
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Aims: Orthodontic treatment is known as a painful procedure among patients. They feel varying degrees of pain during orthodontic treatment from the stage of initial examination till the end of the treatment. The aims of this study are to explore pain experience among patients undergoing orthodontic treatment with the fixed appliances by comparing two different arch wires sizes. Materials and Methods: The study group consisted of 60 patients (26 males, 34 females) with a mean age of 17.6 years and 20.5 years consequently. Insertion of either 0.014 or 0.016-inch wire was by random selection of patients. Patients were asked to fill out a series of questionnaires for five consecutive days after the insertion of orthodontic initial arch wire, and after the arch wire activation for 4 hours, 6 hours, 24 hours, and till 5 days. The intensity (weak, mild, moderate, severe, and intensive) of the pain symptoms in connection with ten items (Biting on a hard/soft food, sensitive to hot or cold food/drink, mastication of food, fitting anterior and fitting posterior teeth together, cheeks, lips, and tongue pain) have been evaluated. Results: No significant differences were found between age groups, and between the two arch wire groups. Pain perception was more significant in females than in males and the pain perceived at the anterior teeth was greater than posterior teeth. Pain percentage level increased gradually till reaching the peak within 24 hours after the insertion of arch wire and retained the same level in the 2nd day, then decreased till the 5th day. Perceptions of pain by fitting anterior teeth were exactly the same within the period of the first few hours in both arch wire groups, and decreased over the following hours. Conclusion: No age discrimination was found for perception of pain in the two different arch wire groups, with no significant correlation for the time with initial pain that perceived after the insertion of two different initial arch wire sizes then the intensity of pain reduced over the time. Pain was perceived as being greater at the anterior than the posterior teeth and females experienced more pain than males.
... A few studies have assessed the level of discomfort during debonding with different instruments or biting on a soft acrylic wafer at the time of bracket removal. 3,10 Possible changes in the pain dynamic with time after debonding have been not observed. Therefore, there is little knowledge regarding the duration and the intensity of discomfort experienced during the time period after bracket removal. ...
... Orthodontic pain can be perceived during almost all treatment procedures: separator placement, initial wire engagement, banding, wearing elastics, rapid maxillary expansion and debonding. [7][8][9][10][11] It has been well documented that orthodontic pain begins 12 h after applying orthodontic force, peaks after 1 day, gradually diminishes 3-7 days thereafter and returns to baseline levels after 1 month. [12][13][14] Although orthodontic pain subsides in most patients 1 week following orthodontic treatments, 440% of adolescent patients reported orthodontic pain after 1 week, indicating the potential long duration of orthodontic pain. ...
Article
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Orthodontic pain is an inflammatory pain that is initiated by orthodontic force-induced vascular occlusion followed by a cascade of inflammatory responses, including vascular changes, the recruitment of inflammatory and immune cells, and the release of neurogenic and pro-inflammatory mediators. Ultimately, endogenous analgesic mechanisms check the inflammatory response and the sensation of pain subsides. The orthodontic pain signal, once received by periodontal sensory endings, reaches the sensory cortex for pain perception through three-order neurons: the trigeminal neuron at the trigeminal ganglia, the trigeminal nucleus caudalis at the medulla oblongata and the ventroposterior nucleus at the thalamus. Many brain areas participate in the emotion, cognition and memory of orthodontic pain, including the insular cortex, amygdala, hippocampus, locus coeruleus and hypothalamus. A built-in analgesic neural pathway-periaqueductal grey and dorsal raphe-has an important role in alleviating orthodontic pain. Currently, several treatment modalities have been applied for the relief of orthodontic pain, including pharmacological, mechanical and behavioural approaches and low-level laser therapy. The effectiveness of nonsteroidal anti-inflammatory drugs for pain relief has been validated, but its effects on tooth movement are controversial. However, more studies are needed to verify the effectiveness of other modalities. Furthermore, gene therapy is a novel, viable and promising modality for alleviating orthodontic pain in the future.International Journal of Oral Science advance online publication, 24 June 2016; doi:10.1038/ijos.2016.24.
... Furthermore, lower anteriors were reported to be most painful after debonding 22 . Normandoet al. compared two methods of debonding that is, a lift-off method and ligature cutting pliers and confirmed that lift-off method caused lesser pain to the patients during debonding 23 . ...
Article
p>Orthodontic pain, the most cited negative effect arising as a result of orthodontic force application, is a major matter of distress for clinicians and patients/parents and directly influences their compliance during the treatment. The lengthy duration of treatment along with frequent pain due to the orthodontic appliances often leads to patient burn out and has been associated with discontinuation of orthodontic treatment. It is imperative for the clinicians to identify and manage the pain experienced by their patients. It becomes duty of an orthodontist to satisfy the questions arising in the mind of patients, parents and clinicians. Various modalities for the management of orthodontic pain have been proposed over the years. The purpose of this review article is to throw a light on the various possible causes of orthodontic pain and to discuss the various management options for the orthodontic pain. Update Dent. Coll. j: 2016; 6 (1): 43-51</p
... [1][2][3][4] Orthodontic treatment starts from the stage of initial examination of the patient for malocclusion to debonding of the appliance at the end of treatment and includes major events such as extraction of few teeth, separator placement, and bonding and banding, archwire placement, and activation. [5] Therefore, the patients are exposed to pain stimuli throughout the entire procedure. Furstman and Bernick suggested that periodontal pain was caused by process of pressure, ischemia, inflammation, and edema. ...
Article
Aim: The aim of this research is to assess the patient's pain response and discomfort in patients treated with self-ligating bracket system. Objective: Patients undergoing orthodontic treatment quite often complain about pain and discomfort during various stages of orthodontic treatment, and hence, sufficient precaution should be taken to minimize them. Materials and Methods: The study was conducted on a sample size of 15 patients who were reported to the Department of Orthodontics. The patients were undergoing orthodontic treatment with self-ligating brackets. The patients were requested to complete a questionnaire about duration of treatment, pain, or discomfort experienced after regular monthly activation of brackets, duration, onset and severity of pain, difficulty in brushing or chewing food, and food accumulation between the teeth. Results: Out of 15 patients, only six patients were aware of that they are wearing self-ligation bracket while nine other patients do not know that they are wearing self-ligation bracket. Almost 80% of the patients experienced pain and discomfort after regular monthly activation of brackets, whereas 20% of the patients did not experience any pain and discomfort after regular monthly activation of brackets. Thirteen percent experienced slight pain, 47% experienced mild pain, 7% experienced moderate pain, 7% experienced severe pain, and 7% experienced very severe pain. A great majority of patients (67%) stated that the pain started few hours after activation while 13% of patients stated that the pain started few minutes after activation. Seventy-three percent of the patients stated that the pain lasted for the whole day and 7% patients stated that the pain lasted for hours. Fifty-three percent of the patients reported difficulty in brushing and chewing food while remaining 47% did not have any difficulty in brushing and chewing food. Most of the patients about 87% reported food accumulation in between the teeth. Conclusion: This study highlighted the pain and discomfort experienced by the patient during self-ligation bracket system. Pain and discomfort caused in the initial stage of fixed orthodontic treatment can be moderate to severe and might last for few days. Brushing teeth might cause mild discomfort and pain can be minimized by consuming soft food. Most of the patients undergoing self-ligating bracket system experienced pain and discomfort after regular monthly activation of brackets.
... A few studies assessed the level of discomfort during debonding with different instruments or biting on a soft acrylic wafer at the time of bracket removal. 3,10 Possible changes in pain dynamic with time following debonding have been not observed. Therefore, there is little knowledge regarding the duration and intensity of discomfort experienced during the time periods after bracket removal. ...
Article
Introduction: Our aim was to assess the possible changes in sensitivity of teeth with and without visible enamel microcracks (EMCs) up to 1 week after the removal of metal brackets. Methods: After debonding, 15 patients possessing teeth with visible EMCs and 15 subjects whose teeth were free of EMCs were enrolled in the study. For each experimental group, a control group was formed. The assessments of tooth sensitivity elicited by compressed air and cold testing were performed 5 times: just before debonding, immediately after debonding, and at 1, 3, and 7 days after debonding. Tooth sensitivity was recorded on a 100-mm visual analog scale. Results: For the patients without visible EMCs, discomfort peaked immediately after debonding and started to decrease on day 1; at 1 week after debonding, the visual analog scale scores were lower than just before debonding and immediately after debonding. For the subjects possessing teeth with visible EMCs, the pattern of sensitivity dynamic was inherently the same. However, the patients with visible EMCs showed higher visual analog scale values at each time interval. Conclusions: Debonding leads to a short-term increase in tooth sensitivity. EMCs, a form of enamel damage, do not predispose to greater sensitivity perception in relation to bracket removal.
... Comprehensive orthodontic treatment procedure includes separator placement, banding, bonding and debonding. 14 Kvam et al suggested that 95% of the patients undergoing orthodontic treatment experienced pain. 15 The main reason for discontinuing orthodontic treatment is pain. ...
... A few studies have assessed the level of discomfort during debonding with different instruments or biting on a soft acrylic wafer at the time of bracket removal. 3,10 Possible changes in the pain dynamic with time after debonding have been not observed. Therefore, there is little knowledge regarding the duration and the intensity of discomfort experienced during the time period after bracket removal. ...
Article
Introduction: Our aim was to assess the possible changes in sensitivity of teeth with and without visible enamel microcracks (EMCs) up to 1 week after the removal of metal brackets. Methods: After debonding, 15 patients possessing teeth with visible EMCs and 15 subjects whose teeth were free of EMCs were enrolled in the study. For each experimental group, a control group was formed. The assessments of tooth sensitivity elicited by compressed air and cold testing were performed 5 times: just before debonding, immediately after debonding, and at 1, 3, and 7 days after debonding. Tooth sensitivity was recorded on a 100-mm visual analog scale. Results: For the patients without visible EMCs, discomfort peaked immediately after debonding and started to decrease on day 1; at 1 week after debonding, the visual analog scale scores were lower than just before debonding and immediately after debonding. For the subjects possessing teeth with visible EMCs, the pattern of sensitivity dynamic was inherently the same. However, the patients with visible EMCs showed higher visual analog scale values at each time interval. Conclusions: Debonding leads to a short-term increase in tooth sensitivity. EMCs, a form of enamel damage, do not predispose to greater sensitivity perception in relation to bracket removal. (Am J Orthod Dentofacial Orthop 2017;151:284-91)
... e process of ceramic bracket removal produces lots of inconveniences even though exceptional aesthetically. It may be associated with tie wing failure, enamel fracture, pain, and irritation during the process of bracket removal [18,19]. us, the time required for debonding may be varied. ...
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Materials and methods: A total of 80 human premolars were included in this study. The samples were first arranged following a standard protocol for bracketing and then debonded using the ultrasonic scaler (US), debonding plier (DP), ligature cutter (LC), and thermal method (TM). Depending on the technique applied for debonding, the specimens were randomly divided into four groups with 20 samples, each keeping a 1 : 1 ratio. During the debonding process, the time taken for each bracket removal was recorded using a stopwatch. To assess the difference in mean time required for debonding among the four techniques, one-way ANOVA test was applied along with Tukey's HSD to compare the two methods. Results: The time range and the mean time required for the four techniques analyzed show that the DP method has the highest range of time needed for debonding with 0.97-2.56 seconds, while LC methods have the least time range taking 0.46 to 1.79 seconds. TM's mean time to debond is the highest at 1.5880 seconds. LC method has the lowest mean debonding time of 0.9880 seconds. The one-way ANOVA test has shown the mean debonding time required by the four techniques to be significantly different (p < 0.001). Tukey's HSD multiple comparisons also show that the mean time to debond using the LC method is substantially less than the other three methods (p < 0.001). Conclusion: The mean debonding time for the TM was substantially the highest, followed by the US and DP. Debonding with the LC technique required the least time. This study shows some limelight towards the effectiveness of the LC method as it is the least time-consuming technique.
... The location of the tooth has an impact on the degree of pain, 25 being the debonding of incisors more painful than that of posterior teeth. 15,21 This phenomenon may be related with the tactile sensory threshold, since this threshold is about 1 gram in the anterior portion of the dentition in normal subjects and gradually increases toward the posterior segment, ranging from 5 to 10 gram. 21 This finding is consistent with the study by Williams and Bishara 12 (1992), who noted that gender difference has little influence on pain. ...
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Objective The aim of this study was to evaluate patients’ pain levels during four different debonding procedures. The null hypothesis was that the pain perception of the patients undergoing four different debonding applications was not statistically significant different. Material and Methods One hundred and twenty orthodontic patients who underwent orthodontic debonding were included in this study. The patients were randomly divided into 4 groups according to technique used in the patients. Debonding groups were as follows: Group 1) Conventional debonding group, Group 2) Medication group (acetaminophen was given 1 hour before debonding), Group 3) Soft bite wax group, and Group 4) Soft acrylic bite wafer group. The patients’ levels of anxiety and fear of pain were evaluated before debonding, and Numerical Rating Scale (NRS) was applied to evaluate their pain perception during debonding. Mann-Whitney U and Kruskal–Wallis tests were used to evaluate non-normally distributed data. Categorical data analysis were carried by chi-square and McNemar tests. The significance level was set at p<0.05. Results Anxiety scores of the patients were not statistically significant between both genders and debonding groups. In the quadrants in which the patients were perceived, the highest pain level was in the left side of the mandible. The teeth in which the highest pain level was perceived were the lower left and upper right lateral incisors. Although there was no statistically significant difference among the pain scores of the patients in each group, quadrant scores of female patients showed significant differences, being the lowest scores in the soft bite wax group. Conclusions Majority of the patients had no fear of pain before debonding. Pain levels of the patients in the conventional debonding group were not significantly different from those of the other groups, except quadrant scores of females in the soft bite wax group. The null hypothesis was accepted.
... Manufacturemade pliers apply force in a precise direction and therefore are capable of debonding brackets consistently at the bracket-adhesive interface, limiting the enamel damage [20]. From the patients' perspective, LODI was considered the least discomforting among other debonding methods [21,22]. Also, brackets were found to be less distorted and considered for recycling when debonded by the LODI [23]. ...
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Background: To introduce an orthodontic bracket debonding device capable of measuring debonding force clinically by a novel sensor mechanism MATERIALS AND METHOD: A prototype orthodontic debonding device was constructed utilizing a lift-off debonding instrument (LODI) and force-sensitive resistor (FSR). For data interpretation, the force sensor was equipped with a microcontroller and C++ programming software running on a computer. Ninety-nine (99) 0.022-in. conventional metallic brackets were bonded to premolar teeth in vitro by a single clinician applying the same adhesive and bonding technique. For validation, the mean debonding force measured by the prototype debonding device (n = 30) and the universal testing machine (n = 30) was compared. Both intra- and inter-examiner reliability tests were done by holding and operating the device in a standardized manner. Following debonding by the prototype device, the bracket failure pattern was evaluated (n = 30) by adhesive remnant index (ARI) under the stereomicroscope at × 30 magnification. Statistical analysis included independent samples t test for validation and intraclass correlation coefficient (ICC) with a 95% confidence interval for both intra- and inter-examiner reliability. Results: Mean orthodontic bracket debonding force measured by the prototype device (9.36 ± 1.65 N) and the universal testing machine (10.43 ± 2.71 N) was not significantly different (p < 0.05). The prototype device exhibited excellent intra- [ICC (3, 1) = 0.942] and inter-examiner reliability [ICC (2, 1) = 0.921] and was able to debond brackets mostly at the bracket-adhesive interface. Limitation: Due to adjusting the position and mechanism of the force sensor, the device had to be held in a modified standardized position. Conclusion: A novel method of measuring in vivo orthodontic bracket debonding force has been introduced which proved to be validated, reliable, and safe in terms of enamel damage.
... Manufacturemade pliers apply force in a precise direction and therefore are capable of debonding brackets consistently at the bracket-adhesive interface, limiting the enamel damage [20]. From the patients' perspective, LODI was considered the least discomforting among other debonding methods [21,22]. Also, brackets were found to be less distorted and considered for recycling when debonded by the LODI [23]. ...
Article
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Background: To introduce an orthodontic bracket debonding device capable of measuring debonding force clinically by a novel sensor mechanism
... It is obvious from the literature that pain can be felt during almost all orthodontic procedures: from placement of separator, banding, arch wire insertion and activation using elastics, orthopedic forces, rapid maxillary expansion and debonding procedures [6][7][8][9][10]. ...
Article
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Patients wearing orthodontic appliances experience varying degrees of pain and discomfort during the course of orthodontic therapy. Pain is one of the main factors responsible for the rejection of orthodontic treatments. Pain control is, therefore, crucial for both patients and orthodontists. In this review, an attempt is made to summarize the information regarding pain associated with orthodontic treatment, and to address questions orthodontists and patients or their parents may ask from the clinical point of view. Also, current orthodontic pain management procedures are presented. Data collection was performed by three reviewers independently. Using evidences found in the literature, an understanding of the causes as well as an overview of recent management procedures used in reducing orthodontic pain is provided. During orthodontic treatment, pain prevention and management should be given priority because heightened uncertainty in patients and parents can create a negative impact of emotional and confidence levels on the patient-parent-orthodontists.
... 5 Even though ceramic brackets are esthetically superior, debonding of ceramic brackets presents various challenges like bracket tie wing failure, enamel fracture, pain and discomfort to the patient during debonding. 6,7 Enamel fracture is of great concern clinically, as it can lead to poor esthetics, need for further restoration and can affect long-term prognosis of the affected tooth. Bracket tie wing failure during treatment results in more clinical time spent to remove the bracket by grinding it with a diamond bur. ...
Article
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The purpose of this 2 part literature review is to evaluate various debonding techniques for orthodontic ceramic bracket removal and their clinical applications.In part 1, and studies on mechanical and ultrasonic debonding techniques have been reviewed. Mechanical debonding (use of diamond burs, special pliers) is most widely applicable in clinical practice. Use of recommended pliers by manufacturers is key to minimize bracket failure modes as these pliers are designed specifically for the brackets. Ultrasonic debonding is advantageous in minimizing bracket failure but requires greater time to debond ceramic brackets than mechanical debonding and it may be uncomfortable to the patient due to longer duration of use. Studies on electrothermal and Laser debonding have been reviewed in part 2 of the literature review.
... [2][3][4] It is also reported Original Article the stage of initial examination till the date of deboning which includes major events like extraction of few teeth, separator placement, bonding and banding, arch wire placement and activation as well as deboning. 8 So patients are exposed to pain stimuli throughout the orthodontic treatment. Being responsible clinician orthodontists should know the painful effects of the each of the procedure and know the measures to mitigate pos-procedural pain. ...
Article
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Background: Orthodontic treatment is taken as a painful procedure by most of the patients. The pain can be experienced during different procedures like separator placement, banding, bonding, extraction as well as arch wire activation and debonding. There are very few studies done on the anticipated pain and pain experienced among mentioned orthodontic procedures. Objectives: To compare the anticipated pain and pain experience among the patients going for comprehensive orthodontic treatment. Methods: Total 45 patients going for comprehensive orthodontic therapy are enrolled into the study. They are given a 100mm Visual Analogue Scale (VAS) for pain. The anticipated pain as well as perceived pain after different orthodontic procedures are recorded on the VAS by patients and returned back to orthodontic office. The data are analyzed by SPSS 16.00 software by paired and independent t-test for the statistical significance. Results: The result showed that there is significant difference between the anticipated pain before orthodontic treatment and the pain experienced following orthodontic treatment. It also showed that perception of pain between two sexes is significantly different. The comparison of anticipated pain among male and female does not show any significant difference, however the pain felt after separator placement as well as after orthodontic bonding is significantly different in two sexes. Conclusion: The level of anticipated pain before orthodontic treatment is higher than the real pain experienced after orthodontic procedures. So it is better to counsel and explain the patients about the orthodontic treatment and procedures.
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Objective: Pain is a problem during bracket removal, and more comfortable treatment is needed. This study examined the association of pain with the removal force required for ceramic brackets, compared with metal and plastic brackets, to determine which removal method resulted in less pain and discomfort. Methodology: 81 subjects (mean age, 25.1 years; 25 males and 56 females) were enrolled, from whom 1,235 brackets (407 ceramic, 432 plastic, and 396 metal) were removed. Measured teeth were distinguished at six segments. Pain was measured with a visual analogue scale (VAS) during the removal of each bracket. An additional grip was placed on the grips of debonding pliers with right-angled beaks; a mini loading cell sensor pinched by the grips was used to measure removal force during debonding. VAS and force values were statistically analyzed. The Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferroni correction were performed for multiple comparisons; multiple regression analysis was also performed. Results: Forces in the upper and lower anterior segments were significantly smaller (p<0.05) than those in the other segments. Pain tended to be greater in the upper and lower anterior segments than in the posterior segments. In all segments, the removal force was greater for metal brackets than for plastic or ceramic brackets. Ceramic brackets caused significantly greater pain than plastic brackets for the upper and lower anterior segments. Debonding force was involved in the brackets, following adjustments for pain, upper left segment, age, and sex. Conclusions: Pain and discomfort are likely to occur during bracket debonding.
Article
Objectives: The goal of this work was to biomechanically analyze several different methods of bracket debonding and compare the strain they induce in the periodontal ligament (PDL). Methods: The CT dataset of an anatomical specimen was divided into four segmental models of the mandible. Each model covered one tooth (32, 42, 44, and 47). One of these teeth (32) was characterized by marked loss of periodontal attachment. After suitable finite-element models were generated, material properties were defined as nonlinear for PDL and anisotropic for the alveolar bone. This was followed by simulating four bracket debonding techniques: frontal and lateral torquing, bracket-wing compression, and shear stress applied with specially designed pliers. Results: The greatest strain was measured at the periodontally compromised tooth site 32 in response to frontal and lateral torquing. Both techniques also resulted in great strain around the other three teeth. Strain was markedly lower with the shear technique and virtually negligible with the compression technique. All simulated tooth sites confirmed the PDL-sparing effect of bracket-wing compression. Conclusion: The severity of PDL strain during orthodontic bracket removal depends on the debonding method used. The technique of compressing the bracket wings appears to trigger the smallest effect on PDL. Clinical studies should be undertaken to confirm these findings.
Article
OBJECTIVES: Until now, it is not clear if various procedures of bracket debonding differ with regard to their risk of enamel fracture. Therefore, the objective of the present study was to compare these procedures biomechanically for assessing the risk of complications. MATERIALS AND METHODS: An anisotropic finite element method (FEM) model of the mandibular bone including periodontal ligament, enamel, dentin, and an orthodontic bracket was created. The morphology based on the CT data of an anatomical specimen. Typical loading conditions were defined for each method of bracket debonding (compression, shearing off, twisting off). Shortly before the adhesive's break, the induced stress in enamel, periodontal ligament, and in the alveolar bone was measured. The statistical analysis of the obtained values was performed in SPSS 19.0. RESULTS: Relatively high stresses occurred in the enamel using frontal torque (max. 44.18 MPa). With shearing off, the stresses were also high (max. 41.96 MPa), and additionally high loads occurred on the alveolar bone as well (max. 11.79 MPa). Moderate maximum values in enamel and alveolar bone appeared during the compression of the bracket wings (max. 37.12 MPa) and during debonding by lateral torque (max. 35.18 MPa). CONCLUSIONS: The present simulation results indicate that the risk of enamel fracture may depend on the individual debonding procedure. Further clinical trials are necessary to confirm that. CLINICAL RELEVANCE: For patients with prior periodontal disease or loosened teeth, a debonding procedure by compression of the bracket wings is recommended, since here the load for the periodontal structures of the tooth is lowest. see: NumBioLab http://www.kfo-forschung.de
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