Introduction
In this study, we evaluated the pain and discomfort experienced by orthodontic patients by comparing how they rated the pain associated with microimplant placement, tooth extraction, and gingival tissue removal in preparation for implant placement.
Methods
Fifty-six microimplants were placed in 28 consecutive orthodontic patients for anchorage reinforcement in the maxilla for en-masse retraction. For all patients, extractions of maxillary, or maxillary and mandibular, premolars had been planned. The recruited patients were randomized into 2 groups according to the timing of the extractions. In group A, at least 1 extraction was performed during the evaluation period; the extractions in group B were after the evaluations. Furthermore, all patients had 2 different surgical procedures for placement. On 1 side, the gingival tissue was removed before placement. On the contralateral side, the implant was placed transgingivally. Each patient’s perception of pain and discomfort was evaluated by a questionnaire before, immediately after, and 1 week after the intervention.
Results
The discomfort experienced during the extractions was described as very painful by 50% of the patients. It was significantly greater than during tissue removal and microimplant placement ( P <0.05). Microimplant placement produced no pain in 30% of the patients and was described as the least painful procedure ( P <0.05). Transgingival microimplant placement was significantly preferred by all patients ( P <0.05).
Conclusions
Microimplant surgery seems to be a well-accepted treatment option in orthodontic patients, with significantly lower pain levels than for tooth extractions. Furthermore, transgingival placement is clearly favored by patients who do not need tissue removed before placement.
Editor’s comment
Microimplants (also known as miniscrews, temporary anchorage devices, and skeletal anchorage) have become part of mainstream orthodontics, allowing tooth movements that were either too difficult to achieve or too time-consuming just a few years ago. Most of us place microimplants in our offices and find the procedure easy and quick, with seemingly little discomfort to our patients. However, our patients’ point of view had, until recently, scarcely been documented. This study fills this gap by examining microimplant placement from the patients’ side. Questionnaires, with the well-known numerical rating scale scoring system, were used to collect data and compare patient discomfort during and after microimplant placement. Two techniques were used in a randomized split-mouth design: on 1 side, the implant was screwed directly through the gingiva; on the other side, the gingival tissue at the placement site was first removed with a gingival punch. Both procedures were compared with first premolar extractions, which took place either before or after microimplant placement.
According to the patients, transgingival placement caused the least discomfort, and they described it mainly as pressure rather than pain. The study followed the established guidelines of randomized clinical trials, avoiding bias as much as possible, and provides evidence-based information that can be used for technique selection and patient education.
Demetrios Halazonetis
Kifissia, Greece
