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Electronic searches in published and unpublished studies were performed.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 However, unpublished literature was searched at ClinicalTrials.gov, National Research Register, and ProQuest Dissertations and Theses.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.