Bayesian Network Meta-analysis Of The Effects Of Nonpharmacologic Interventions Relieving Orthodontic Pain On The Acceleration Of Orthodontic Tooth Movement

Orthodontic pain is related to systemic immune responses caused by orthodontic treatment.Most patients may suffer from different degrees of discomfort and pain during orthodontic treatment.Orthodontic pain has a negative impact on patients'compliance,oral health and quality of life.To alleviate the orthodontic pain,scholars put forward many methods,such as drug analgesic therapy(like opioid drugs,non-steroidal anti-inflammatory drugs,paracetamol,local anesthesia,etc.),acupuncture therapy,low intensity laser therapy,vibration therapy,percutaneous electrical stimulation therapy,chewing gum and bite training,psychological counseling and behavior management.Right now,non-steroidal anti-inflammatory drugs are "gold standard" for pain relief in orthodontic patients.However,except for acetaminophen and meroxicam,other non-steroidal anti-inflammatory drugs can inhibit tooth movement.Studies have shown that low intensity laser therapy,light-emitting diode photobiomodulation,vibration therapy,chewing gum and chewing bite training can effectively reduce orthodontic pain and these methods may have a role in promoting the movement of orthodontic teeth,but there is controversial that these methods can accelerate orthodontic movement.The acceleration of tooth movement by these methods has not yet been confirmed.Objective:This study was aimed to summarise published randomized controlled trials(RCTs)or clinical controlled trials(CCTs)that assess the effects of nonpharmacologic interventions which can relieve orthodontic pain on the acceleration of orthodontic tooth movement(OTM)with Bayesian network meta-analysis.The adjunctive interventions include low intensity laser therapy,light-emitting diode photobiomodulation,vibration therapy.The aim is to provide evidence support for clinicians to effectively alleviate or prevent orthodontic pain in orthodontic patients and provide reference for clinical practice.Materials and Methods:Searched systematical randomized controlled clinical trials(RCTs)or clinical controlled trials(CCTs)from Medline(Pubmed),EMBASE,The Cochrane Oral Health Group's Trials Register,the China National Knowledge Infrastructure Database(CNKI),China Biology Medicine disc,and Wanfang Database,and several major journal of orthodontics(to the November 2018).At the same time,the relevant grey literature website was searched as supplement.According to the pre-established inclusion and exclusion criteria,the intervention measures were screened as randomized controlled trials of low-intensity laser therapy,LED photobiomodulation therapy and vibration therapy,and were included in the final statistical analysis.The tooth movement distance was used as the outcome index of the study.The quality of each included study was assessed separately according to the Downs and Black checklist.Finally,RevMan 5.4,Statal4.0,R program with gemtc-gui-0.14.3 were applied to process and visualize the data in general meta-analysis and Bayesian network meta-analysis.Results:In this study,a total of 1,248 relevant literatures were retrieved,21 of which met the inclusion criteria.The quality scores of the included studies ranged from 16-19,all studies were rated as median risk of bias.The results of general meta-analysis showed that LLLT accelerate tooth movement in a variety of interventions at 3-4 weeks and 6-8 weeks,and its MD(95%CI)was 0.46(0.21,0.72).and P<0.0001 and 0.6(0.15,1.05),P<0·0001,respectively.Network meta-analysis results showed that compared with control intervention,vibration therapy,LLLT and LED photobiomodulation therapy accelerate tooth movement,and its MD(95%CI)was 0.80(-0.14,11.71),0.42(0.14,0.69),0.54(-0.37,1.48).Compared with LLLT,vibration therapy accelerate tooth movement[0.39(-0.60,1.34)].Compared with LED photobiomodulation therapy,vibration therapy accelerate tooth movement[0.54(-0.37,1.48)].Compared with LED photobiomodulation therapy,LLLT inhibit tooth movement[-0.12(-1.09,0.83)].According to rank probability,vibration therapy is the most possible(62%)as the most effective way to promote tooth movement.Conclusions:(1)Among the many interventions to alleviate orthodontic pain,low-intensity laser therapy may promote tooth movement.(2)The nonpharmacologic interventions(LLLT,LED photobiomodulation therapy and vibration therapy)which can relieve orthodontic pain may accelerate orthodontic tooth movement.Vibration therapy may the most effective way to accelerate orthodontic tooth movement.On account of the great heterogeneity of the literatures,more high-quality literatures are essential.