Clinical Evaluation of Pain Control Methods in Patients Undergoing Combined Orthodontic and Restorative Dental Treatments
European Journal of Prosthodontics and Restorative Dentistry (2026) 34(2s), 89–99
KeywordsOrthodontic pain; Postoperative sensitivity; Pain management; Restorative dentistry; Multidisciplinary dental care
AuthorsAbstractPain is a frequent clinical issue of clinical interest in patients who have combined orthodontic and restorative dental procedures. Application of orthodontic force and restorative treatments including adhesive bonding as well as the placement of composite stimulate different but overlapping inflammatory and neurophysiological mechanisms, which may result in discomfort accumulation with prolonged treatment. Multidisciplinary cases pain management needs therefore an integrated and mechanism-based approach. The review consolidates the current evidence on the biological nature of the orthodontic and restorative pain, appraises pharmacological therapies encompassing nonsteroidal anti-inflammatory drugs and combinations of these therapies, and extends to the non-pharmacological therapies which include photobiomodulation, mechanical stimulation, and technique-sensitive restorative techniques. Existing evidence indicates that multimodal pain management guidelines, involving the integration of preventive therapeutic interventions and selective pharmacotherapeutic interventions, are a more effective approach towards maximising patient comfort without losing the effectiveness of treatment. Nevertheless, the problem of heterogeneity of the study design, the short-term outcome measurement and scanty data on combined-treatment protocols is still a major drawback. It is proposed to employ a structured and patient-centred decision-making algorithm that involves the assessment of risks, optimisation of the procedures, and focused analgesia to reduce the cumulative inflammatory load and increase adherence. Research is advised to rely on standardised methods and combined clinical studies on multidisciplinary care in the future. 1. Introduction Pain has become one of the most common adverse experiences in dental practice and one of the most important predictors of patient satisfaction, compliance, and success of overall treatment outcomes. In modern dentistry, the need to provide multidisciplinary treatment, particularly the fusion of orthodontic care with restorative care, has grown significantly. Adult patients who desire aesthetic and functional rehabilitation may need orthodontic alignment before the restorative correction, placement of an implant, veneers fabrication, or full-mouth rehabilitation. Although this approach is clinically beneficial, it exposes patients to a variety of sources of nociceptive stimulation during prolonged periods of time. Orthodontic pain mainly correlates with the use of mechanical force on the teeth, which leads to the compression of the periodontal ligament, ischemia, the release of inflammatory mediators and sensitisation of nerves. It is always clinically observed that the highest level of pain occurs during the first 24-48 hours after arch wire placement or activation. A multicentre randomised controlled trial comparing chewing gum and ibuprofen demonstrated that orthodontic pain is significant enough to necessitate structured analgesic strategies, underscoring its clinical importance in routine orthodontic care¹. •••••••••••••••••••••••••••••••• ejprd.org- Published by Riset Publishing Services LLC.
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