The evaluation of the effects of the preoperative and postoperative non-steroidal antiinflammatory analgesics on the pain induced by orthodontic tooth movement and inflammatory mediator levels

Despite the improvements in fixed orthodontic treatment procedures over the years, pain during treatment is still a major problem that the patients face. The aim of this double blind, randomized, controlled clinical study is to comperatively evaluate the effects preoperative/postoperative ibuprofen and acetaminophen use after bracket bonding and to investigate the effect of these drugs on the prostaglandin E2 level in the crevicular fluid. Furthermore, the association between the clinical pain findings and the amount of prostaglandin E2 release will be investigated.Forty-six patients (31 girls, 15 boys; mean age: 14.5±2.00 years) were included in our study. The patients were split into preoperative/postoperative ibuprofen, preoperative/postoperative acetaminophen and preoperative/postoperative placebo groups. The pain levels were measured before the placement of appliances, after the placement of appliances, at the 1st day, 2nd day, 3rd day and 7th day on the visual analogue scale and the crevicular fluid samples were collected simultaneously in order to explore the prostaglandin E2 levels. Prostaglandin E2 levels were determined with ELISA test. The results were evaluated with Wilcoxon signed ranks test and Kruskal Wallis test.Three patients who did not agree to the study terms were excluded from the study and a total of 45 patients were evaluated. The pain at 1st day after bonding was found to be statistically significant, and remained at higher levels during 2nd and 3rd days, then decreased at day 7 to baseline values (p<0.0011). In the ibuprofen group the pain levels did not show statistically significant differences, while in the acetaminophen group significant differences were seen at the 1st and 2nd days. The prostaglandin E2 levels did not show a statistically significant difference with time in the groups (p>0.0011). There were no statistically significant differences between the 3 groups in the pain and prostaglandin E2 levels (p>0.003). There was not a statistically significant correlation between pain and prostaglandin E2 levels (p>0.05). The pain seen during fixed orthodontic treatment is not a neglectible issue. In this study, the pain relief provided by ibuprofen and acetaminophen were found similar to placebo to reduce the pain. Analgesic use did not affect prostaglandin E2 levels during orthodontic tooth movement.