Prevalence and type of pain during conventional and self-ligating orthodontic treatment

Eur J Orthod. 2009 Aug;31(4):380-4. doi: 10.1093/ejo/cjp003. Epub 2009 May 22.


This study investigated the prevalence and type of pain experienced during orthodontic treatment in 30 subjects (12 males, 18 females, aged 12-18 years) with crowding. Fifteen patients were treated with conventional brackets (Victory Series) and 15 with self-ligating brackets (Damon SL II). The first archwire for all patients was a 0.014 inch nickel-titanium (NiTi) archwire with a force of approximately 100 g. Conventional brackets were ligated with elastomeric modules. A visual analogue scale (VAS) was used daily to assess the intensity of pain; the use of pain medication was also reported in a specially designed daybook for a total period of 3 months. Pearson's chi-square was used to investigate the difference between groups in the frequency of pain experience, its nature, and the use of analgesia. Non-parametric statistics (Mann-Whitney U-test) were computed to compare pain intensity between the groups. To investigate reported pain assessments, Friedman's two-way analysis of variance was used and the differences were estimated using Wilcoxon's signed-rank test. The results showed that pain was reported for a period of 9 days after archwire insertion. Patients treated with self-ligating brackets reported the highest pain intensity on the day following placement of the first archwire (VAS mean = 42.6), while those treated with conventional brackets experienced the greatest pain intensity at placement of the first archwire (VAS mean = 52) and after the second orthodontic appointment (VAS mean = 59.6). Analgesics were used by 16.5 per cent of patients treated with self-ligating brackets and by 10 per cent of those treated with conventional brackets, most often during the first 2 days after archwire placement. Patients treated with conventional brackets reported significantly more 'constant' pain than those treated with self-ligating brackets who complained of 'chewing/biting' pain. Pain appears to be common during orthodontic treatment but perhaps less intense when self-ligating brackets are used, although no difference was observed in the use of analgesics between those treated with self-ligating or conventional brackets. There were no reports of pain after 7-9 days in either group.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Analgesics / administration & dosage
  • Analgesics / therapeutic use
  • Child
  • Dental Alloys
  • Elastomers
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Malocclusion / therapy
  • Mastication / physiology
  • Medical Records
  • Nickel
  • Orthodontic Appliance Design*
  • Orthodontic Brackets*
  • Orthodontic Wires*
  • Pain / classification
  • Pain / drug therapy
  • Pain / etiology*
  • Pain Measurement
  • Stainless Steel
  • Stress, Mechanical
  • Time Factors
  • Titanium


  • Analgesics
  • Dental Alloys
  • Elastomers
  • titanium nickelide
  • Stainless Steel
  • Nickel
  • Titanium