PATIENT-REPORTED OUTCOMES OF PAIN AND DISCOMFORT IN CLEAR ALIGNERS VERSUS FIXED APPLIANCES: A QUESTIONNAIRE-BASED REVIEW

Abstract

Background: Orthodontic appliances are associated with varying degrees of pain and discomfort, which can significantly affect patient adherence and satisfaction. With the growing use of clear aligners (CAs) as an alternative to traditional fixed appliances (FAs), there is increasing interest in comparing these modalities from the patient's perspective.

Objectives: This systematic review aims to compare patient-reported outcomes (PROs), specifically pain, discomfort, and oral health-related quality of life (OHRQoL), between individuals treated with CAs and those with fixed appliances.

Methods: A comprehensive literature search was performed across PubMed, Scopus, Web of Science, and Google Scholar. Studies published between 2000 and 2024 were screened using predefined inclusion and exclusion criteria. Eligible studies included randomized controlled trials, prospective cohort studies, cross-sectional surveys, and meta-analyses that reported on patient discomfort, pain perception, or OHRQoL using validated patient-reported outcome measures (PROMs). Data were extracted and qualitatively synthesized, and quality was assessed using the Cochrane Risk of Bias tool for randomized studies and the Newcastle-Ottawa Scale for observational studies. A total of 27 studies were included in the final synthesis according to PRISMA guidelines.

Results: Clear aligners were associated with significantly lower pain intensity, faster adaptation, and reduced use of analgesics compared to fixed appliances. Multiple studies also reported better periodontal outcomes and higher OHRQoL scores in aligner-treated patients. Fixed appliance users more frequently reported sharp or throbbing pain and experienced greater difficulty with chewing, speaking, and maintaining oral hygiene. The findings were consistent across a broad range of study designs and populations.

Conclusion: Clear aligners offer a distinct advantage in patient comfort and quality of life during orthodontic treatment. These findings highlight the importance of integrating patient-reported outcomes into treatment planning. While fixed appliances remain essential in complex cases, CAs may be the preferred option for patients prioritizing comfort and periodontal health.