Abstract：
BACKGROUND: Pain is an unpleasant experience and annoying sensation. To control this pain during orthodontic separation, different pharmacological and non-pharmacological methods have been used.
OBJECTIVE: This systematic review and meta-analysis aimed to critically assess the evidence of the effectiveness of pharmacological and non-pharmacological methods in reducing pain induced by orthodontic separation.
METHODS: An electronic search was conducted using the following databases: PubMed® (Medline), Scopus®, EMBASE®, Web of ScienceTM, Google ScholarTM, ProQuest, and Cochrane Central Register of controlled trials (CENTRAL) searching for the studies published between January 2012 and April 2023.
METHODS: Only randomized controlled trials (RCTs) were included, each experimental group included patients who received elastomeric separators and one kind of pharmacological or non-pharmacological interventions for pain reduction during the separation stage.
METHODS: Cochrane\'s risk of bias tool (RoB2 tool) was applied. The Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach was used to evaluate the strength of the evidence.
RESULTS: Thirty-one studies (RCTs) were included in this systematic review. Nineteen of them were appropriate for quantitative synthesis and used VAS for pain assessment. Meta-analysis showed that low-level laser therapy (LLLT) was an effective approach for pain relief after separators placement with standard mean difference of 13.79 mm (95% confidence interval (CI): -15.64, -11.94) at 6 h and 23.34 mm at 24 h (95% CI: -25.91, -20.77). LLLT was also effective when applied in split-mouth and the standard mean difference was 8.9 mm at 6 h (95% CI: -12.86, -3.33) and 17.15 mm at 24 h (95% CI: -30.12, -4.17). Ibuprofen had a pain control effect at 6 h and at 24 h compared with the placebo group. The standard mean difference was 14.37 mm (95% CI: -20.54, -8.19) and 20.46 mm (95% CI: -27.79, -13.13), respectively. There was no difference in pain control between ibuprofen and acetaminophen. Naproxen had lower visual analog scale scores in pain perception at 6 h and the standard mean difference was 7.03 mm (95% CI: -12.67, -1.40).
CONCLUSIONS: The application of LLLT decreased the pain induced by the separation during the first day of teeth separation; the pain reduction showed an increase from 6 h to the end of the 24 h. However, the evidence is weak to moderate. The analgesics reduced the pain compared to placebo; this pain reduction had shown an increase from 6 h to the end of the 24 h. The strength of the evidence is moderate. Naproxen gel effectively reduced the pain compared to placebo; the evidence in this regard is moderate. Naproxen gel effectively reduced the pain compared to placebo, but it was less effective than the oral intake of non-steroidal anti-inflammatory drugs. However, the evidence in this regard is moderate.
BACKGROUND: This systematic review was registered with PROSPERO (CRD42022335553) during the first stages of its conduction.
OBJECTIVE: This systematic review and meta-analysis aimed to critically assess the evidence of the effectiveness of pharmacological and non-pharmacological methods in reducing pain induced by orthodontic separation.
METHODS: An electronic search was conducted using the following databases: PubMed® (Medline), Scopus®, EMBASE®, Web of ScienceTM, Google ScholarTM, ProQuest, and Cochrane Central Register of controlled trials (CENTRAL) searching for the studies published between January 2012 and April 2023.
METHODS: Only randomized controlled trials (RCTs) were included, each experimental group included patients who received elastomeric separators and one kind of pharmacological or non-pharmacological interventions for pain reduction during the separation stage.
METHODS: Cochrane\'s risk of bias tool (RoB2 tool) was applied. The Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach was used to evaluate the strength of the evidence.
RESULTS: Thirty-one studies (RCTs) were included in this systematic review. Nineteen of them were appropriate for quantitative synthesis and used VAS for pain assessment. Meta-analysis showed that low-level laser therapy (LLLT) was an effective approach for pain relief after separators placement with standard mean difference of 13.79 mm (95% confidence interval (CI): -15.64, -11.94) at 6 h and 23.34 mm at 24 h (95% CI: -25.91, -20.77). LLLT was also effective when applied in split-mouth and the standard mean difference was 8.9 mm at 6 h (95% CI: -12.86, -3.33) and 17.15 mm at 24 h (95% CI: -30.12, -4.17). Ibuprofen had a pain control effect at 6 h and at 24 h compared with the placebo group. The standard mean difference was 14.37 mm (95% CI: -20.54, -8.19) and 20.46 mm (95% CI: -27.79, -13.13), respectively. There was no difference in pain control between ibuprofen and acetaminophen. Naproxen had lower visual analog scale scores in pain perception at 6 h and the standard mean difference was 7.03 mm (95% CI: -12.67, -1.40).
CONCLUSIONS: The application of LLLT decreased the pain induced by the separation during the first day of teeth separation; the pain reduction showed an increase from 6 h to the end of the 24 h. However, the evidence is weak to moderate. The analgesics reduced the pain compared to placebo; this pain reduction had shown an increase from 6 h to the end of the 24 h. The strength of the evidence is moderate. Naproxen gel effectively reduced the pain compared to placebo; the evidence in this regard is moderate. Naproxen gel effectively reduced the pain compared to placebo, but it was less effective than the oral intake of non-steroidal anti-inflammatory drugs. However, the evidence in this regard is moderate.
BACKGROUND: This systematic review was registered with PROSPERO (CRD42022335553) during the first stages of its conduction.
摘要：
背景：疼痛是一种不愉快的经历和烦人的感觉。为了控制正畸分离过程中的疼痛，已经使用了不同的药理学和非药理学方法。
目的：本系统综述和荟萃分析旨在严格评估药理学和非药理学方法在减轻正畸分离引起的疼痛方面的有效性的证据。
方法：使用以下数据库进行电子搜索：PubMed®（Medline），Scopus®,EMBASE®,WebofScienceTM,谷歌奖学金，ProQuest,和Cochrane中央对照试验注册中心（CENTRAL）搜索2012年1月至2023年4月之间发表的研究。
方法：仅纳入随机对照试验，每个实验组包括在分离阶段接受弹性隔离物和一种药物或非药物干预以减轻疼痛的患者.
方法：应用Cochrane的偏倚风险工具（RoB2工具）。建议评估的分级，发展,使用评估[等级]方法来评估证据的强度。
结果：本系统综述包括31项研究（RCT）。其中19例适用于定量合成，并使用VAS进行疼痛评估。Meta分析显示，低水平激光治疗（LLLT）是一种有效的缓解隔离物放置后疼痛的方法，6h的标准平均差为13.79mm（95％置信区间（CI）：-15.64，-11.94），24h的标准平均差为23.34mm（95％CI：-25.91，-20.77）。LLLT在裂口应用时也有效，标准平均差在6小时为8.9mm（95％CI：-12.86，-3.33），在24小时为17.15mm（95％CI：-30.12，-4.17）。与安慰剂组相比，布洛芬在6h和24h具有疼痛控制作用。标准平均差为14.37mm（95％CI：-20.54，-8.19）和20.46mm（95％CI：-27.79，-13.13），分别。布洛芬和对乙酰氨基酚在疼痛控制方面没有差异。萘普生在6h时的疼痛感知视觉模拟评分较低，标准平均差异为7.03mm（95％CI：-12.67，-1.40）。
结论：在牙齿分离的第一天，LLLT的应用减轻了由分离引起的疼痛；疼痛减轻显示从6小时到24小时结束的增加。但是，证据是弱到中等的。与安慰剂相比，镇痛药减轻了疼痛；这种疼痛减轻已显示出从6小时到24小时结束的增加。证据的强度是中等的。与安慰剂相比，萘普生凝胶有效减轻了疼痛；这方面的证据是适度的。与安慰剂相比，萘普生凝胶有效减轻疼痛，但效果不如口服非甾体类抗炎药。然而,这方面的证据是温和的。
背景：该系统综述在其传导的第一阶段向PROSPERO（CRD42022335553）注册。
目的：本系统综述和荟萃分析旨在严格评估药理学和非药理学方法在减轻正畸分离引起的疼痛方面的有效性的证据。
方法：使用以下数据库进行电子搜索：PubMed®（Medline），Scopus®,EMBASE®,WebofScienceTM,谷歌奖学金，ProQuest,和Cochrane中央对照试验注册中心（CENTRAL）搜索2012年1月至2023年4月之间发表的研究。
方法：仅纳入随机对照试验，每个实验组包括在分离阶段接受弹性隔离物和一种药物或非药物干预以减轻疼痛的患者.
方法：应用Cochrane的偏倚风险工具（RoB2工具）。建议评估的分级，发展,使用评估[等级]方法来评估证据的强度。
结果：本系统综述包括31项研究（RCT）。其中19例适用于定量合成，并使用VAS进行疼痛评估。Meta分析显示，低水平激光治疗（LLLT）是一种有效的缓解隔离物放置后疼痛的方法，6h的标准平均差为13.79mm（95％置信区间（CI）：-15.64，-11.94），24h的标准平均差为23.34mm（95％CI：-25.91，-20.77）。LLLT在裂口应用时也有效，标准平均差在6小时为8.9mm（95％CI：-12.86，-3.33），在24小时为17.15mm（95％CI：-30.12，-4.17）。与安慰剂组相比，布洛芬在6h和24h具有疼痛控制作用。标准平均差为14.37mm（95％CI：-20.54，-8.19）和20.46mm（95％CI：-27.79，-13.13），分别。布洛芬和对乙酰氨基酚在疼痛控制方面没有差异。萘普生在6h时的疼痛感知视觉模拟评分较低，标准平均差异为7.03mm（95％CI：-12.67，-1.40）。
结论：在牙齿分离的第一天，LLLT的应用减轻了由分离引起的疼痛；疼痛减轻显示从6小时到24小时结束的增加。但是，证据是弱到中等的。与安慰剂相比，镇痛药减轻了疼痛；这种疼痛减轻已显示出从6小时到24小时结束的增加。证据的强度是中等的。与安慰剂相比，萘普生凝胶有效减轻了疼痛；这方面的证据是适度的。与安慰剂相比，萘普生凝胶有效减轻疼痛，但效果不如口服非甾体类抗炎药。然而,这方面的证据是温和的。
背景：该系统综述在其传导的第一阶段向PROSPERO（CRD42022335553）注册。
