Non-Cochrane · intervention · PM41580743
The effect of pharmacological and non-pharmacological interventions on pain control after orthodontic treatment: a systematic review and network meta-analysis.
Dong Xiaoran, Qu Hao, Ning Xiangyi, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-07733-9
Findings
Population Orthodontic patients undergoing initial pain-inducing orthodontic procedures (separator placement, initial archwire insertion, first aligner activation)
31 findings
| Acetaminophen post | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -6.97 [-29.09, 14.99] Moderate Downgraded: risk of bias, imprecision 36 studies · 2322 participants |
| Acetaminophen post | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -15.36 [-44.36, 13.59] Moderate Downgraded: risk of bias, imprecision 30 studies · 1995 participants |
| Acetaminophen pre | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -7.60 [-46.22, 31.17] Moderate Downgraded: risk of bias, imprecision 30 studies · 1995 participants |
| Acetaminophen pre | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -23.64 [-39.01, -8.40] Moderate Downgraded: risk of bias 36 studies · 2322 participants |
| Acetaminophen pre-post | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -27.43 [-49.95, -5.05] High 30 studies · 1995 participants |
| Acetaminophen pre-post | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -37.45 [-52.59, -22.60] High 36 studies · 2322 participants |
| Aspirin pre-post | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -29.11 [-59.53, 1.33] Moderate Downgraded: risk of bias, imprecision 30 studies · 1995 participants |
| Aspirin pre-post | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD 4.81 [-18.08, 27.40] Low Downgraded: risk of bias, imprecision 36 studies · 2322 participants |
| Attention call | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -21.86 [-64.80, 20.93] Very low Downgraded: risk of bias, imprecision 30 studies · 1995 participants |
| Chewing | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -6.88 [-18.14, 4.06] Moderate Downgraded: risk of bias, imprecision 36 studies · 2322 participants |
| Chewing | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -13.01 [-28.75, 2.58] Moderate Downgraded: risk of bias, imprecision 30 studies · 1995 participants |
| Etoricoxib pre-post | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -55.90 [-73.75, -38.22] Moderate Downgraded: risk of bias 36 studies · 2322 participants |
| Etoricoxib pre-post | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -43.21 [-71.67, -14.84] Moderate Downgraded: risk of bias 30 studies · 1995 participants |
| Ibuprofen post | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -17.61 [-33.53, -1.49] Moderate Downgraded: risk of bias 30 studies · 1995 participants |
| Ibuprofen post | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -9.10 [-19.06, 0.87] Moderate Downgraded: risk of bias, imprecision 36 studies · 2322 participants |
| Ibuprofen pre | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -17.40 [-27.66, -7.05] Moderate Downgraded: risk of bias 36 studies · 2322 participants |
| Ibuprofen pre | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -2.55 [-26.29, 21.39] Moderate Downgraded: risk of bias, imprecision 30 studies · 1995 participants |
| Ibuprofen pre-post | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -30.06 [-49.48, -11.02] Moderate Downgraded: risk of bias 36 studies · 2322 participants |
| Ibuprofen pre-post | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -19.63 [-50.71, 11.47] Moderate Downgraded: risk of bias, imprecision 30 studies · 1995 participants |
| LLLT | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -9.85 [-14.48, -5.28] High 36 studies · 2322 participants |
| LLLT | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -13.85 [-21.26, -6.21] High 30 studies · 1995 participants |
| Naproxen pre | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -30.74 [-54.94, -6.73] Very low Downgraded: risk of bias, imprecision 36 studies · 2322 participants |
| Naproxen pre | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -11.39 [-44.04, 21.42] Very low Downgraded: risk of bias, imprecision 30 studies · 1995 participants |
| Naproxen pre-post | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -33.50 [-63.91, -2.96] Low Downgraded: risk of bias 30 studies · 1995 participants |
| Naproxen pre-post | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -44.09 [-66.05, -22.31] Low Downgraded: risk of bias 36 studies · 2322 participants |
| Structured call | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -11.16 [-29.26, 6.83] Very low Downgraded: risk of bias, imprecision 36 studies · 2322 participants |
| Structured call | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -15.20 [-45.04, 14.82] Very low Downgraded: risk of bias, imprecision 30 studies · 1995 participants |
| TEAS | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -7.01 [-21.31, 7.55] Low Downgraded: risk of bias, imprecision 36 studies · 2322 participants |
| TEAS | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -6.12 [-27.29, 15.14] Low Downgraded: risk of bias, imprecision 30 studies · 1995 participants |
| Vibration | Placebo | Pain intensity (VAS 0-100 mm) at 24 h 24 h | MD -9.26 [-18.69, 0.24] Low Downgraded: risk of bias, imprecision 36 studies · 2322 participants |
| Vibration | Placebo | Pain intensity (VAS 0-100 mm) at 48 h 48 h | MD -20.51 [-37.74, -3.01] Moderate Downgraded: risk of bias 30 studies · 1995 participants |
Included primary studies 68
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Katchooi 2018 Effect of supplemental vibration on orthodontic treatment with aligners: A randomized trial. PMID:29501108 | 2018 | 2 other reviews | not stated | not extracted yet |
| Al-Hanbali 2024 The effectiveness of low-level laser therapy and low-intensity pulsed ultrasound in reducing pain induced by orthodontic separation: a… PMID:38308275 | 2024 | 1 other review | not stated | not extracted yet |
| Ghaffar 2022 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Ghaffar 2022 Effect of low-level laser therapy on the time needed for leveling and alignment of mandibular anterior crowding. PMID:35344012 | 2022 | 1 other review | not stated | not extracted yet |
| Gupta 2014 Controlling pain during orthodontic fixed appliance therapy with non-steroidal anti-inflammatory drugs (NSAID): a randomized,… PMID:25355194 | 2014 | 1 other review | not stated | not extracted yet |
| Guram 2018 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Guram 2018 Evaluation of Low-Level Laser Therapy on Orthodontic Tooth Movement: A Randomized Control Study. PMID:29599594 | 2018 | 1 other review | not stated | not extracted yet |
| Katchooi 2018 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Kaur 2019 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Martins 2019 Low-level laser therapy (830 nm) on orthodontic pain: blinded randomized clinical trial. PMID:29998356 | 2019 | 1 other review | not stated | not extracted yet |
| Miles 2012 The effects of a vibrational appliance on tooth movement and patient discomfort: a prospective randomised clinical trial. PMID:23304970 | 2012 | 1 other review | not stated | not extracted yet |
| Najaf 2015 Comparison of the effects of preemptive acetaminophen, ibuprofen, and meloxicam on pain after separator placement: a randomized clinical… PMID:26467790 | 2015 | 1 other review | not stated | not extracted yet |
| Nik 2016 Acetaminophen Versus Liquefied Ibuprofen for Control of Pain During Separation in Orthodontic Patients: A Randomized Triple Blinded… PMID:27424011 | 2016 | 1 other review | not stated | not extracted yet |
| Polat 2005 (pain control with fixed appliances) Pain control during fixed orthodontic appliance therapy. PMID:15825785 | 2005 | 1 other review | not stated | not extracted yet |
| Qamruddin 2017 Effects of low-level laser irradiation on the rate of orthodontic tooth movement and associated pain with self-ligating brackets. PMID:29103440 | 2017 | 1 other review | not stated | not extracted yet |
| Roth 1986 Effect of transcutaneous electrical nerve stimulation for controlling pain associated with orthodontic tooth movement. PMID:3488674 | 1986 | 1 other review | not stated | not extracted yet |
| Salmassian 2009 Comparison of the efficacy of ibuprofen and acetaminophen in controlling pain after orthodontic tooth movement. PMID:19361739 | 2009 | 1 other review | not stated | not extracted yet |
| Ahrari 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Ahrari 2024 Low-level laser therapy and laser acupuncture therapy for pain relief after initial archwire placement : A randomized clinical trial. PMID:38683401 | 2024 | this review only | not stated | not extracted yet |
| Al-Hanbali 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Alansari 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Almallah 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Almallah 2016 Evaluation of Low Level Laser Therapy on Pain Perception Following Orthodontic Elastomeric Separation: A Randomized Controlled Trial. PMID:28050498 | 2016 | this review only | not stated | not extracted yet |
| Almallah Hasan 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Almallah Hasan 2020 Assessment of a single versus double application of low-level laser therapy in pain reduction following orthodontic elastomeric… PMID:32307932 | 2020 | this review only | not stated | not extracted yet |
| Azizi 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Azizi 2024 Comparative efficacy of pharmaceutical (Ibuprofen) and non-pharmaceutical (photobiomodulation, and chewing gum) interventions for pain… PMID:39317795 | 2024 | this review only | not stated | not extracted yet |
| Bartlett 2005 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Bartlett 2005 The influence of a structured telephone call on orthodontic pain and anxiety. PMID:16214624 | 2005 | this review only | not stated | not extracted yet |
| Celebi 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Celebi 2021 Effectiveness of low-level laser therapy and chewing gum in reducing orthodontic pain: A randomized controlled trial. PMID:34556585 | 2021 | this review only | not stated | not extracted yet |
| Celebi 2022 Mechanical Vibration and Chewing Gum Methods in Orthodontic Pain Relief. PMID:35788438 | 2022 | this review only | not stated | not extracted yet |
| Çelebi 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Elshehaby 2025 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Elshehaby 2025 Acupressure versus NSAID for relief of orthodontic pain : A randomized controlled clinical trial. PMID:37395765 | 2025 | this review only | not stated | not extracted yet |
| Eslamian 2014 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Eslamian 2014 The effect of 810-nm low-level laser therapy on pain caused by orthodontic elastomeric separators. PMID:23334785 | 2014 | this review only | not stated | not extracted yet |
| Farzanegan 2012 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Farzanegan 2012 Pain reduction after initial archwire placement in orthodontic patients: a randomized clinical trial. PMID:22284284 | 2012 | this review only | not stated | not extracted yet |
| Gupta 2014 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Hasan 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Hasan 2020 Low-level laser therapy effectiveness in reducing initial orthodontic archwire placement pain in premolars extraction cases: a… PMID:32690001 | 2020 | this review only | not stated | not extracted yet |
| Kaur 2019 Application of photodynamic oxidation to the disinfection of tapwater, seawater, and sewage contaminated with poliovirus. PMID:201951 | 1977 | this review only | not stated | not extracted yet |
| Kaya 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kaya 2021 Effects of ibuprofen and low-level laser therapy on orthodontic pain by means of the analysis of interleukin 1-beta and substance P levels… PMID:33097977 | 2021 | this review only | not stated | not extracted yet |
| Kim 2013 Effect of frequent laser irradiation on orthodontic pain. A single-blind randomized clinical trial. PMID:23241006 | 2013 | this review only | not stated | not extracted yet |
| Kohli 2011 Cryptococcosis in systemic lupus erythematosus: a series of six cases. PMID:20118161 | 2010 | this review only | not stated | not extracted yet |
| Kohli 2011 Effectiveness of piroxicam and ibuprofen premedication on orthodontic patients' pain experiences. PMID:21644837 | 2011 | this review only | not stated | not extracted yet |
| Martins 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Miles 2012 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mirhashemi 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mirhashemi 2021 Efficacy of Photobiomodulation Therapy for Orthodontic Pain Control Following the Placement of Elastomeric Separators: A Randomized… PMID:34084734 | 2021 | this review only | not stated | not extracted yet |
| Najaf 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Owayda 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Owayda 2022 The efficacy of low-level laser therapy versus paracetamol-caffeine in controlling orthodontic separation pain and changes in the… PMID:35110003 | 2022 | this review only | not stated | not extracted yet |
| Polat 2005 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Polat 2005 (preoperative ibuprofen and naproxen) Effects of preoperative ibuprofen and naproxen sodium on orthodontic pain. PMID:16279825 | 2005 | this review only | not stated | not extracted yet |
| Prasad 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Prasad 2019 Low-Level Laser Therapy: A Noninvasive Method of Relieving Postactivation Orthodontic Pain-A Randomized Controlled Clinical Trial. PMID:31198342 | 2019 | this review only | not stated | not extracted yet |
| Qamruddin 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Qamruddin 2016 Effect of a single dose of low-level laser therapy on spontaneous and chewing pain caused by elastomeric separators. PMID:26718379 | 2016 | this review only | not stated | not extracted yet |
| Qamruddin 2017 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Qamruddin 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Qamruddin 2018 Effects of single-dose, low-level laser therapy on pain associated with the initial stage of fixed orthodontic treatment: A randomized… PMID:29564218 | 2018 | this review only | not stated | not extracted yet |
| Ren 2020 Low-level laser-aided orthodontic treatment of periodontally compromised patients: a randomised controlled trial. PMID:31833004 | 2020 | this review only | not stated | not extracted yet |
| Salmassian 2009 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Stein 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Stein 2015 Pain reduced by low-level laser therapy during use of orthodontic separators in early mixed dentition. PMID:26272170 | 2015 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Orthodontic patients undergoing initial pain-inducing procedures (separator placement, initial archwire insertion, first aligner activation); no age, sex or ethnicity restriction | Orthodontic patients (n=2,430 in 37 RCTs) after separator placement, initial archwire placement or first aligner activation |
| Intervention | Pharmacological and non-pharmacological interventions: acetaminophen (pre, post, pre-post), aspirin pre-post, attention call, chewing, etoricoxib pre-post, ibuprofen (post, pre, pre-post), LLLT, naproxen (pre, pre-post), structured call, TEAS, vibration | 15 interventions at 24 h (acetaminophen (post, pre, pre-post), aspirin pre-post, chewing, etoricoxib pre-post, ibuprofen (post, pre, pre-post), LLLT, naproxen (pre, pre-post), structured call, TEAS, vibration) and 16 at 48 h (adds attention call); LLLT n=21 trials, chewing n=4, vibration n=4, TEAS n=2, structured call n=2, ibuprofen post n=6, ibuprofen pre n=4 |
| Comparison | Placebo / routine care without additional intervention | Placebo (reference) |
| Outcomes | Pain intensity on VAS at 24 h and 48 h | VAS pain at 24 h (36 RCTs, n=2,322) and at 48 h (30 RCTs, n=1,995) |
| Study designs | Prospective randomized controlled trials | 37 RCTs |
| Timing | 24 h and 48 h after the procedure | 24 h and 48 h |