Does the pain experienced during orthodontic treatment and bracket removal depend on the architecture of the bracket or debonding method?

Background: The fear of pain during the various stages of orthodontic treatment with fixed appliances is a common concern of patients. Therefore, the present research aimed to thoroughly investigate the impact of bracket architecture on pain perception during active treatment, debonding, and adhesive removal.

Materials: One hundred consecutive patients who completed treatment with one of two bracket systems (2-slot brackets with an integral base or conventional twin brackets with foil mesh) were included in this prospective cohort study. Participants were asked to evaluate the level of pain encountered throughout their orthodontic treatment with the fixed appliances and during bracket and adhesive removal, utilizing a 0-10 numerical rating scale. Two different methods of bracket removal (bracket debonding pliers and Lift-Off Debonding Instrument) and adhesive removal (adhesive removal pliers and rotary instrument) were tested.

Results: Our study found moderate and comparable levels of pain during active treatment in both groups (4.4 ± 1.6 in the 2-slot group and 3.9 ± 1.9 in the Twin group). Debonding of brackets with integral base caused more discomfort compared to conventional twin brackets and using bracket removal pliers elicited more pain sensations than when Lift-Off Debonding Instrument were employed. Patients are likely to prefer adhesive removal methods involving rotary instruments despite the sound and vibrations produced by contra-angle handpiece.

Limitations: The lack of randomization in patient grouping introduces an increased risk of bias.

Conclusions: The results of the present study suggest that the bracket architecture, particularly the construction of the bracket base, affects the level of discomfort experienced during debonding.

Trial registration: ClinicalTrials.gov, NCT06324162, Registered 20 March 2024-Retrospectively registered, https://clinicaltrials.gov/study/NCT06324162.