Pain Perception Associated with Mini-Implants and Interventions for Pain Management: A Cross-Sectional Questionnaire-Based Survey

Patient's Perspective on Miniscrews During Orthodontic Treatment-A Systematic Review With Meta-Analysis

During orthodontic treatment, undesirable reciprocal forces are generated during tooth movement, which explains the use of anchorage strategies to minimise their harmful effects through intra and/or extraoral appliances. Miniscrews are intraoral devices used for temporary skeletal anchorage. Miniscrews are small-sized intraoral devices used for temporary skeletal anchorage and are easy to place and remove. However, some studies refer to adverse effects such as inflammation, pain, and discomfort. This systematic review aims to synthesise the available evidence on the use of miniscrews during orthodontic treatment from the patient's perspective. The literature search was conducted using various databases MedLine through PubMed, Cochrane Library, Web of Science Core Collection, and EMBASE. A search was also carried out in the grey literature. The search terms used were "Orthodontic Anchorage Procedures," "mini-implant," "Mini Dental Implant," "Miniscrew," and "microimplant." Cochrane risk of bias tools was used to assess the quality of included studies. Patients tend to overestimate the pain inherent in this procedure. The insertion of micro implants is more accepted than the tooth extraction procedure, with less postoperative pain reported. The location, surgical technique, and type of anaesthesia used in the placement of miniscrews influence levels of discomfort. Additionally, the execution of a good surgical technique and the clinician's communication skills are factors that influence patient satisfaction and positive perception. The most frequent outcome reported is pain and discomfort, which varies depending on its location (less with mini interradicular screws than with extra-alveolar screws). Most patients are satisfied or very satisfied with this application.

Patient experiences and discomfort associated with mid-palatal temporary skeletal anchorage devices

BACKGROUND

Mid-palatal placement of temporary skeletal anchorage devices (TSADs) has become increasingly popular among clinicians due to high success rates, low associated risk and streamlining and enhanced customization of associated supra-structures. There is however limited patient data in relation to associated experiences and impacts.

METHODS

A survey of patients undergoing mid-palatal TSAD insertion was undertaken using a 27-item bespoke questionnaire. Questionnaires were sent using both electronic and surface mail with a 3-month period allowed for response. Pain experience; the use of analgesia; requirement for additional visits; impacts on hygiene, speech, eating, and hobbies; and social impacts were assessed. Reponses involved the use of a Visual Analogue Scale as well as binary information.

RESULTS

Overall, 152 responses were obtained with 87.5% describing experience of TSAD insertion either "as expected" or "better". Procedural pain was reported as mild in 62.5%. Local post-operative pain was scored as moderate in 21.1%. Some functional impairment was reported with 63.2% attributing difficulty with speech and 67.8% difficulty with eating due to the implant. However, these functional impairments were generally considered mild (by 68.1% and 60.2%, respectively) and most were very likely to recommend this treatment to others, with 65.1% (n = 99) scoring 8 or above out of 10.

CONCLUSIONS

Appreciable levels of pain, discomfort and functional impairment were noted with the use of mid-palatal TSADs. However, any unpleasant experiences were generally regarded as mild with most highly likely to recommend mid-palatal TSADs to prospective patients.

What is the most effective method for reducing pain during debonding procedures? A systematic review

OBJECTIVE

This study aimed to investigate the most effective methods in controlling pain during debonding procedures.

MATERIAL AND METHODS

Electronic searches in published and unpublished studies were performed. Restricted to the English language and publication date up to 23/3/2024, the searches in published literature covered the following databases: MEDLINE, PubMed, EMBASE, Tripe, Web of Science, Scopus and PubMed Central. However, unpublished literature was searched at ClinicalTrials.gov, National Research Register, and ProQuest Dissertations and Theses. Lists of all eligible studies were checked for further scrutiny. Risk of bias for randomized and non-randomized control trials was assessed using ROB2 and ROBINS Cochrane tools.

RESULTS

Thirteen RCTs and two non-RCTs were included. All the reviewed articles studied the pain during debonding events and included 886 patients aged between 12-65. They used different scales such as VAS, NRS, Wong-Baker faces, and others scales. Two studies have shown that the lift-off plier causes less pain than other pliers when comparing different types of dental instruments. However, when comparing different adjunctive techniques, two studies have found that using a wafer causes less pain, while two studies have reported no significant difference between methods and one study has found that using finger pressure causes less pain. In addition, three separate studies have found that utilizing an ultrasonic device, as well as a thermal device and laser radiation, can lead to lower pain scores. Furthermore, two studies have demonstrated that using medication has a positive impact on reducing pain.

CONCLUSIONS

According to reported evidence, applying finger pressure is more effective in relieving pain in the anterior teeth, while wafer biting is more effective in the posterior teeth. Pain-relieving medications like paracetamol or ibuprofen can also effectively reduce debonding pain. Promising procedures, such as using diode or Er-YAG lasers, and thermal devices, may also be effective, but further studies are needed to confirm their efficacy. The protocol of this systematic review was registered with the PROSPERO International Database under ID number CRD42024529190. This review follows the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the instructions provided in the Cochrane Handbook.

Usage and Preferences of Orthodontic Mini-Implants Among Romanian Practitioners: A Survey Study

Background/Objectives: Dental malocclusions are highly prevalent worldwide, negatively impacting patients' quality of life and leading to complex, often costly, orthodontic treatments. In Romania, the economic status of patients and the limited public funding for orthodontic care significantly influence treatment accessibility and choices. Advanced technologies, such as mini-implants (MIs), offer improved anchorage and treatment efficiency but are often underutilized due to financial constraints and variability in clinical training. In this context, there are limited data regarding the use and preferences of MI among orthodontists in Romania. This study aims to explore the characteristics, preferences, and challenges of Romanian orthodontists in their use of MI systems. Methods: A survey was conducted between June and September 2024, targeting orthodontists across Romania. The questionnaire, distributed via social media platforms, consisted of 24 items addressing professional experience, MI system preferences, insertion methods, and complications. Statistical analyses were conducted using IBM SPSS Statistics 25. Fisher's Exact Test and Pearson's Chi-Square Test were employed to evaluate relationships between categorical variables. When appropriate, logistic binomial univariable regression models were applied to predict key dependent variables (e.g., MI placement zones, MI experience, and MI complications) based on independent variables such as specific MI system usage and frequency of MI usage. A significance threshold of α = 0.05 was used for all tests. Results: Out of 105 participants, 85.7% reported using mini-implants (MIs) in their orthodontic practice, with the Dual Top and Benefit systems being the most frequently used (60% and 43.3%, respectively). The interradicular area was the most common placement site (60%), while the palatal and retromolar regions showed significant correlations with the Benefit system (p = 0.008). Practitioners with more than 10 years of experience reported a significantly higher frequency of MI use (p = 0.001), with frequent use being observed in 60.9% of these practitioners. Complications were common, with MI mobility reported by 92.2% and soft tissue damage by 57.8%. The midpalatal area was significantly associated with higher complication rates compared to other sites (p < 0.001). The success rates of MI usage ranged from 76% to 100% in 57.8% of respondents, with higher success rates being associated with infrazygomatic placements (p < 0.05). Conclusions: MI usage is prevalent among Romanian orthodontists, with experienced practitioners utilizing them more frequently. Despite high success rates, common complications highlight the need for improved insertion techniques and post-operative care. Further research and training are recommended to optimize MI application and reduce complication rates.

Effects of posterior intrusion using skeletal anchorage on treating anterior open bite: A systematic review and meta-analysis

Background

Posterior intrusion with skeletal anchorage is one of the effective methods in the treatment of anterior open bite. Knowing the effects of posterior intrusion, the amount of possible molar intrusion using skeletal anchorage, and its impact on clinical and cephalometric indicators can help the clinician choose the optimal treatment method, especially in borderline surgical cases.

Methods

In this systematic review, a series of articles were collected through a systematic search in databases, and the titles and summaries of all these articles were reviewed. After removing the irrelevant articles, the full texts of the related articles were read carefully, and their validity was evaluated. Only RCTs and observational studies that complied with PICO questions were included. The Cochrane Risk of Bias 2.0 (RoB 2), ROBINS-I, and GRADE were used to assess the risk of bias in the included studies. The relevant information on selected articles was extracted, and a meta-analysis was performed with Review Manager 5.4 software.

Results

The meta-analysis revealed a significant average molar intrusion of 2.89 mm using temporary anchorage devices (TADs). A subgroup analysis showed that miniplates achieved greater intrusion (3.29 mm) compared to miniscrews (2.25 mm) (P=0.03). The level of applied force did not significantly affect the degree of intrusion. Dental parameters such as overbite and overjet were notably altered, with overbite increasing by 4.81 mm and overjet decreasing by 2.06 mm on average. As for the skeletal cephalometric characteristics, SNB, ANB, and SN-Pog increased while mandibular plane angle and lower anterior facial height (LAFH) decreased, and these changes were significant. Meanwhile, SNA and palatal angle changes were not significant.

Conclusion

TADs have proved effective in achieving significant intrusion of maxillary molars, leading to marked improvements in dental and skeletal characteristics in patients with open bite malocclusion. Miniplates proved more effective in achieving greater intrusion.

Does the application of autologous injectable Platelet-Rich Fibrin (i-PRF) affect the patient's daily performance during the retraction of upper canines? A single-centre randomized split-mouth controlled trial

BACKGROUND

Previous studies have assessed different aspects concerning the applications of i-PRF in the oral cavity. However, nothing is known regarding patients' perceptions of the injection of autologous platelet-rich fibrin (i-PRF).

OBJECTIVES

To investigate patients' perceptions after injecting platelet-rich fibrin (i-PRF) in the course of retracting upper canines.

METHODS

Twenty-one patients, whose treatments required extractions of both upper first premolars, were recruited. Extraction side was randomly allocated to the intervention or control sides. After the alignment phase, i-PRF was injected twice with a one-month interval on the buccal and palatal aspects of the extraction sites (intervention side). Patients' perceptions were evaluated with two questionnaires: the first was used to assess the level of pain, discomfort, swelling, eating and swallowing difficulties as well as jaw movement restriction after 1 h (T1), 2 h (T2), 6 h (T3), 24 h (T4) and 48 h (T5) of the second injection; the second questionnaire was used to assess the acceptance of the i-PRF injection and overall satisfaction with this technique at the end of canine retraction phase. Visual Analogue Scale (VAS) was adopted for this purpose. Wilcoxon Signed Rank Test was used to compare between both sides at all time points while Friedman's Test was the selected test for detecting variables' changes over time. Post-hoc Wilcoxon Matched-Pairs Signed-Rank Tests were applied when any of the results were significant. As to the multiplicity of tests, Bonferroni Correction was implemented.

RESULTS

Pain and swelling levels were significantly higher on the experimental compared to the control sides at T1, T2, and T3 (P < 0.05), whereas they declined sharply and went back to almost normal values at T4 (after 24 h). At T5 they were 0. Discomfort and difficulty in mastication on intervention sides were significant only at T1 and T2. Pain, swelling, and chewing difficulties were significant (P < 0.001) during the 4 assessed time points. The increase was insignificant regarding swallowing difficulties and jaw movement limitations at all time intervals.

CONCLUSIONS

Injecting autologous (i-PRF) during orthodontic canine retraction is a well-perceived and well-tolerated method due to the limited discomfort which significantly diminishes 24 h afterwards.

TRIAL'S REGISTRATION

ClinicalTrials.gov (Identifier Number: NCT03399422. 16/01/2018).