Pain and Discomfort Associated with Fixed Orthodontic Appliances and Clear AlignerTherapy: A Narrative Review

Abstract

Background: Pain and discomfort often occur during orthodontic treatment. Understanding and addressing them can improve patient care and outcomes. Objectives: This review provides a comprehensive analysis of the profiles of pain and discomfort associated with fixed orthodontic (FA) appliances and clear aligners (CA), along with their management protocols. Methods: A literature search on orthodontic pain and discomfort used PubMed, Google Scholar, and the Saudi Digital Library. The study assessed articles published from 2015 to 2025. This review
summarizes research from randomized controlled trials, prospective clinical studies, systematic reviews, and meta-analyses on orthodontic pain and discomfort, with a focus on pain management strategies associated with CA and FA treatments. Results: FA patients experienced pain and discomfort more frequently than CA patients. After activation of the orthodontic appliance, the pain intensity became severe between 24 and 48 h and gradually decreased over the next week. Patients undergoing treatment with CA showed lower pain prevalence and intensity than the FA patients. Similarly, fewer functional difficulties were noted among CA patients compared to FA patients. Drugs such as ibuprofen, naproxen, and acetaminophen effectively reduced pain at 2, 6, and 24 h after appliance activation. Etoricoxib demonstrated prolonged pain relief for up to 96 h. Non-pharmacological methods such as low-level laser therapy, topical analgesics, and behavioral interventions were able to reduce orthodontic
treatment pain. Conclusion: Both CA and FA orthodontic treatments caused temporary pain and discomfort. However, pain caused by CA therapy is less severe than that caused by FA orthodontic treatment. Orthodontic pain management using pharmacological and non-pharmacological strategies is effective in improving patient comfort
and treatment acceptance.