MalocclusionNCT06133296
Anxiety, Pain, and Quality of Life in Orthodontic Treatment
A study testing Conventional fixed treatment and Clear aligner treatment in people with Malocclusion and Pain, run by Yuzuncu Yil University at 1 site in Turkey (Türkiye).
Trial summary
This study was evaluated anxiety, pain, and oral health-related quality of life in individuals treated with conventional fixed appliances (Group A) and clear aligners (Group B) for moderate malocclusion during the initial phase of orthodontic treatment Read more about this study
- Who is it for?
- Ages 17 to 28 yearsHealthy volunteers can take part
- Conditions the study is for
- Malocclusion, Pain, Anxiety
- What is being tested?
- Conventional fixed treatment and Clear aligner treatment
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 Mar 2021to 1 Mar 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 17 to 28 years
- All sexes
- Healthy volunteers accepted
- Child, Adult
Who may be able to join
- Individuals who had not received orthodontic treatment before,
- Angle class I malocclusion,
- 4-6 mm arc length disperancy in both dental arches,
- Permanent dentition period,
- Missing or impacted teeth,
- No smoker,
- No alcohol drinker.
Who cannot join
- Individuals who underwent extraction fixed orthodontic treatment,
- Radiologically observed alveolar bone loss,
- Missing or impacted teeth,
- systemic disease,
- Using of drugs or analgesics.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Comparison of Anxiety, Pain, and Quality of Life in Individuals With Moderate Malocclusion Between Conventional Fixed Treatment and Invisalign: a Randomized Clinical Trial
This study was evaluated anxiety, pain, and oral health-related quality of life in individuals treated with conventional fixed appliances (Group A) and clear aligners (Group B) for moderate malocclusion during the initial phase of orthodontic treatment
Read the detailed description
Clear aligner treatment is becoming increasingly popular among orthodontic treatment option. With this treatment method, which was introduced the literature at the beginning of the 20th century, approximately four million individuals in 2019 and over twelve million individuals have already been treated today. In addition, the number of commercial companies worldwide producing transparent plaque has reached twenty-seven, indicating that these figures will increase rapidly. Although there are debates about the effectiveness of the treatment, the increase in living standards and the improvement of the quality of life of individuals relative to conventional fixed orthodontic treatment have increased interest in clear aligner treatment.
The World Health Organization has multidimensional definitions of the concepts of "quality of life" and "health," and their common point is that they emphasize the importance of the psychological and social status of individuals in recent years. Quality of life is affected by dentofacial problems caused by malocclusions, as well as the psychosocial state of individuals during orthodontic treatment. Oral health-related quality of life was defined as "the absence of physical and psychological problems in terms of oral health and self-confidence associated with the maxillofacial region," and the importance of self-confidence and psychosocial status that could affect quality of life was emphasized. The presence of pain and anxiety before and at the beginning of orthodontic treatment are among the factors affecting oral health-related quality of life.
Pain is an emotional state frequently encountered by individuals undergoing orthodontic treatment, leading to cooperation problems and even causing them to give up treatment. In studies comparing the pain levels of individuals treated with conventional fixed orthodontic appliances and clear aligners, individuals treated with clear aligners felt less pain in the first few days, but there was no significant difference in pain levels in later periods of treatment.
The importance of malocclusion type and arc length disperancy has been emphasized in studies comparing conventional fixed therapy and clear plating therapy in terms of pain and quality of life. Considering that the concepts of anxiety, pain, and quality of life are interrelated by each other, there are limited studies in which both treatment methods are evaluated in terms of these factors in a particular malocclusion. The current study aims to compare anxiety and pain values observed in the initial phase of orthodontic treatment and oral health-related quality of life among individuals with moderate malocclusion treated with conventional fixed orthodontic appliances and clear aligners. Our null hypothesis (H0) is that there is no difference in anxiety, pain, or oral health-related quality of life between individuals treated with conventional fixed orthodontic appliances and clear aligners.
- Conditions
- Malocclusion, Pain, Anxiety, Quality of Life
- Being tested
- Conventional fixed treatment, Clear aligner treatment
- Keywords
- clear aligner, Anxiety, Pain, Quality of Life
- Medical subject headings
- Malocclusion, Pain, Anxiety Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Conventional fixed treatmentOther
Roth brackets (.018; Gemini Roth System, 3M Unitek, USA) were used for the fixed orthodontic attachment
Clear aligner treatmentOther
After the clear aligners came from the manufacturer (Align Technology, Santa Clara, CA), the compatibility of the guide aligner with each patient's mouth was checked for attachments
| Study group | Role | What they receive |
|---|---|---|
| Group A (Conventional fixed treatment) | Active comparator | Roth brackets (.018; Gemini Roth System, 3M Unitek, USA) were used for the fixed orthodontic attachment. Tooth surfaces were etched with 35% gel phosphoric acid for 30 seconds and then washed with water for 15 seconds. A primer was applied to the etching surface with the manufacturer's applicator. After an adhesive was applied to the bases of the brackets, the brackets were placed in their appropriate positions. Afterward, LED was irradiated for 20 seconds and 5 seconds for each surface. For leveling after bonding, .012 nickel titanium archwires (3M Unitek Monrovia, CA, USA) were tied with an elastic ligature. Receives: Other: Conventional fixed treatment |
| Group B (Clear aligner treatment) | Active comparator | Clear aligners were ordered after the recordings were evaluated in the Clincheck program, and the final treatment plan was created. After the clear aligners came from the manufacturer (Align Technology, Santa Clara, CA), the compatibility of the guide aligner with each patient's mouth was checked for attachments. The enamel surfaces on which the attachments will be applied were etching with the same method as in Group A. After an adhesive was condensed into the attachment spaces inside the guide plate, the guide aligner was placed in the correct position in the mouth, and each attachment was applied from the buccal surface with an LED light device for 20 seconds. After the guide plate was removed, the composite residues around the attachments were cleaned, and the first treatment aligner was applied. The individuals were informed that they should use their clear aligner continuously, except during meals, and replace them after 10 days. Receives: Other: Clear aligner treatment |
What is being measured
The primary outcome is the main question the study is designed to answer.
VAS
Visual Analogue Scale (VAS) was used to measure the individuals' pain levels. VAS is a scale that ranges pain severity from 0 to 10. (0= no pain, 10= severe pain)
Measured: 0 hour, 2 hours, 6 hours, 1st day, 3rd day, 7th day, 14th day, 21st day.
OHIP-14
The Oral Health Impact Profile-14 (OHIP-14) questionnaires were used to measure quality of life in our study. The OHIP-14 questionnaire consists of seven domains and 14 questions, including those related to functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, and disability. The individuals were asked to answer each question as follows: 0: never, 1: very little, 2: sometimes, 3: quite often, and 4: often. After the results were collected separately for each of the seven subgroups, they were added together to calculate the actual results. High scores obtained on the OHIP-14 questionnaire indicate that quality of life was adversely affected.
Measured: Baseline, 10th day, 20th day
OHRQoL-UK
The Oral Health-Related Quality of Life-United Kingdom (OHRQoL-UK) questionnaires were used to measure quality of life in our study. In the OHRQoL-UK questionnaire, 16 questions were asked in four categories: symptom (two questions), physical condition (five questions), psychological condition (five questions), and social situation (four questions).Answers scored according to the Likert scale were given 1 point for very bad influence, 2 for bad influence, 3 for no effect, 4 for good effect, and 5 for very good effect. The scores ranged from 16 to 80. A high score indicates a good quality of life for oral and dental health, whereas a low score indicates a poor quality of life for oral and dental health.
Measured: Baseline, 10th day, 20th day
Secondary outcomes (1)
Anxiety
The Spielberger State and Trait Anxiety Inventory (STAI) survey was applied. It includes 40 questions that measure state anxiety (STAI-S, 20) and trait anxiety (STAI-T, 20). The answer categories for the questions varied according to the nature of the problem (e.g., 1: No, 2: slightly, 3: multiple, and 4: always) in the form of a four-point scale.
Measured: Before treatment, baseline, 10th day, and 20th day.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Nov 2023
- Study start1 Mar 2021
- Primary completion1 Mar 2023
- Study completion1 Mar 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for MalocclusionStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 60 participants (actual)
Sponsor and investigators
- Lead sponsor
- Yuzuncu Yil University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Murat Tunca, Yuzuncu Yil University
- Investigators
- Murat Tunca, PhD, DDS, Principal investigator, Yuzuncu Yil UniversityYesim Kaya, PhD, DDS, Study chair, Ankara Yildirim Beyazıt UniversityYasemin Tunca, PhD, DDS, Study chair, Yuzuncu Yil UniversitySiddik Keskin, PhD, DDS, Study chair, Yuzuncu Yil University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06133296
- Sponsor's protocol ID
- 2021/02-08
- Status last verified
- Nov 2023
- First submitted
- 9 Nov 2023
- Last updated
- 15 Nov 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Alfawal AMH, Burhan AS, Mahmoud G, Ajaj MA, Nawaya FR, Hanafi I. The impact of non-extraction orthodontic treatment on oral health-related quality of life: clear aligners versus fixed appliances-a randomized controlled trial. Eur J Orthod. 2022 Dec 1;44(6):595-602. doi: 10.1093/ejo/cjac012.
PubMed 35395075Flores-Mir C, Brandelli J, Pacheco-Pereira C. Patient satisfaction and quality of life status after 2 treatment modalities: Invisalign and conventional fixed appliances. Am J Orthod Dentofacial Orthop. 2018 Nov;154(5):639-644. doi: 10.1016/j.ajodo.2018.01.013.
PubMed 30384934Tunca Y, Kaya Y, Tunca M, Keskin S. Comparison of anxiety, pain, and quality of life in individuals with mild or moderate malocclusion between conventional fixed orthodontic treatment versus Invisalign: a randomised clinical trial. BMC Oral Health. 2024 May 17;24(1):576. doi: 10.1186/s12903-024-04335-1.
PubMed 38760747
Study at a glance
From the registry record, last updated by the sponsor on 15 Nov 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of Anxiety, Pain, and Quality of Life in Individuals With Moderate Malocclusion Between Conventional Fixed Treatment and Invisalign: a Randomized Clinical Trial
- ClinicalTrials.gov ID
- NCT06133296
- Acronym / sponsor ID
- 2021/02-08
- Conditions
- Malocclusion, Pain, Anxiety, Quality of Life
- Keywords
- clear aligner, Anxiety, Pain, Quality of Life
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 60 participants (actual)
- Lead sponsor
- Yuzuncu Yil UniversityUniversity, hospital or other
- Study start
- 1 Mar 2021 (actual)
- Primary completion
- 1 Mar 2023 (actual)
- Study completion
- 1 Mar 2023 (actual)
- First posted
- 15 Nov 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study was evaluated anxiety, pain, and oral health-related quality of life in individuals treated with conventional fixed appliances (Group A) and clear aligners (Group B) for moderate malocclusion during the initial phase of orthodontic treatment
Detailed description
Clear aligner treatment is becoming increasingly popular among orthodontic treatment option. With this treatment method, which was introduced the literature at the beginning of the 20th century, approximately four million individuals in 2019 and over twelve million individuals have already been treated today. In addition, the number of commercial companies worldwide producing transparent plaque has reached twenty-seven, indicating that these figures will increase rapidly. Although there are debates about the effectiveness of the treatment, the increase in living standards and the improvement of the quality of life of individuals relative to conventional fixed orthodontic treatment have increased interest in clear aligner treatment.
The World Health Organization has multidimensional definitions of the concepts of "quality of life" and "health," and their common point is that they emphasize the importance of the psychological and social status of individuals in recent years. Quality of life is affected by dentofacial problems caused by malocclusions, as well as the psychosocial state of individuals during orthodontic treatment. Oral health-related quality of life was defined as "the absence of physical and psychological problems in terms of oral health and self-confidence associated with the maxillofacial region," and the importance of self-confidence and psychosocial status that could affect quality of life was emphasized. The presence of pain and anxiety before and at the beginning of orthodontic treatment are among the factors affecting oral health-related quality of life.
Pain is an emotional state frequently encountered by individuals undergoing orthodontic treatment, leading to cooperation problems and even causing them to give up treatment. In studies comparing the pain levels of individuals treated with conventional fixed orthodontic appliances and clear aligners, individuals treated with clear aligners felt less pain in the first few days, but there was no significant difference in pain levels in later periods of treatment.
The importance of malocclusion type and arc length disperancy has been emphasized in studies comparing conventional fixed therapy and clear plating therapy in terms of pain and quality of life. Considering that the concepts of anxiety, pain, and quality of life are interrelated by each other, there are limited studies in which both treatment methods are evaluated in terms of these factors in a particular malocclusion. The current study aims to compare anxiety and pain values observed in the initial phase of orthodontic treatment and oral health-related quality of life among individuals with moderate malocclusion treated with conventional fixed orthodontic appliances and clear aligners. Our null hypothesis (H0) is that there is no difference in anxiety, pain, or oral health-related quality of life between individuals treated with conventional fixed orthodontic appliances and clear aligners.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Group A (Conventional fixed treatment) | Active comparator | Other: Conventional fixed treatmentRoth brackets (.018; Gemini Roth System, 3M Unitek, USA) were used for the fixed orthodontic attachment. Tooth surfaces were etched with 35% gel phosphoric acid for 30 seconds and then washed with water for 15 seconds. A primer was applied to the etching surface with the manufacturer's applicator. After an adhesive was applied to the bases of the brackets, the brackets were placed in their appropriate positions. Afterward, LED was irradiated for 20 seconds and 5 seconds for each surface. For leveling after bonding, .012 nickel titanium archwires (3M Unitek Monrovia, CA, USA) were tied with an elastic ligature. |
| Group B (Clear aligner treatment) | Active comparator | Other: Clear aligner treatmentClear aligners were ordered after the recordings were evaluated in the Clincheck program, and the final treatment plan was created. After the clear aligners came from the manufacturer (Align Technology, Santa Clara, CA), the compatibility of the guide aligner with each patient's mouth was checked for attachments. The enamel surfaces on which the attachments will be applied were etching with the same method as in Group A. After an adhesive was condensed into the attachment spaces inside the guide plate, the guide aligner was placed in the correct position in the mouth, and each attachment was applied from the buccal surface with an LED light device for 20 seconds. After the guide plate was removed, the composite residues around the attachments were cleaned, and the first treatment aligner was applied. The individuals were informed that they should use their clear aligner continuously, except during meals, and replace them after 10 days. |
Who may qualify
- Ages
- 17 to 28 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult
Key inclusion criteria (7 listed)
- Individuals who had not received orthodontic treatment before,
- Angle class I malocclusion,
- 4-6 mm arc length disperancy in both dental arches,
- Permanent dentition period,
- Missing or impacted teeth,
Key exclusion criteria (5 listed)
- Individuals who underwent extraction fixed orthodontic treatment,
- Radiologically observed alveolar bone loss,
- Missing or impacted teeth,
- systemic disease,
- Using of drugs or analgesics.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Conventional fixed treatmentRoth brackets (.018; Gemini Roth System, 3M Unitek, USA) were used for the fixed orthodontic attachment | Other | Group A (Conventional fixed treatment) |
| Clear aligner treatmentAfter the clear aligners came from the manufacturer (Align Technology, Santa Clara, CA), the compatibility of the guide aligner with each patient's mouth was checked for attachments | Other | Group B (Clear aligner treatment) |
Primary outcome
VAS
Time frame: 0 hour, 2 hours, 6 hours, 1st day, 3rd day, 7th day, 14th day, 21st day.
Visual Analogue Scale (VAS) was used to measure the individuals' pain levels. VAS is a scale that ranges pain severity from 0 to 10. (0= no pain, 10= severe pain)
OHIP-14
Time frame: Baseline, 10th day, 20th day
The Oral Health Impact Profile-14 (OHIP-14) questionnaires were used to measure quality of life in our study. The OHIP-14 questionnaire consists of seven domains and 14 questions, including those related to functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, and disability. The individuals were asked to answer each question as follows: 0: never, 1: very little, 2: sometimes, 3: quite often, and 4: often. After the results were collected separately for each of the seven subgroups, they were added together to calculate the actual results. High scores obtained on the OHIP-14 questionnaire indicate that quality of life was adversely affected.
OHRQoL-UK
Time frame: Baseline, 10th day, 20th day
The Oral Health-Related Quality of Life-United Kingdom (OHRQoL-UK) questionnaires were used to measure quality of life in our study. In the OHRQoL-UK questionnaire, 16 questions were asked in four categories: symptom (two questions), physical condition (five questions), psychological condition (five questions), and social situation (four questions).Answers scored according to the Likert scale were given 1 point for very bad influence, 2 for bad influence, 3 for no effect, 4 for good effect, and 5 for very good effect. The scores ranged from 16 to 80. A high score indicates a good quality of life for oral and dental health, whereas a low score indicates a poor quality of life for oral and dental health.
1 secondary outcome
Anxiety
Time frame: Before treatment, baseline, 10th day, and 20th day.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Nov 2023.
- Background: PubMed 35395075Alfawal AMH, Burhan AS, Mahmoud G, Ajaj MA, Nawaya FR, Hanafi I. The impact of non-extraction orthodontic treatment on oral health-related quality of life: clear aligners versus fixed appliances-a randomized controlled trial. Eur J Orthod. 2022 Dec 1;44(6):595-602. doi: 10.1093/ejo/cjac012.
- Background: PubMed 30384934Flores-Mir C, Brandelli J, Pacheco-Pereira C. Patient satisfaction and quality of life status after 2 treatment modalities: Invisalign and conventional fixed appliances. Am J Orthod Dentofacial Orthop. 2018 Nov;154(5):639-644. doi: 10.1016/j.ajodo.2018.01.013.
- Derived from this study: PubMed 38760747Tunca Y, Kaya Y, Tunca M, Keskin S. Comparison of anxiety, pain, and quality of life in individuals with mild or moderate malocclusion between conventional fixed orthodontic treatment versus Invisalign: a randomised clinical trial. BMC Oral Health. 2024 May 17;24(1):576. doi: 10.1186/s12903-024-04335-1.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Murat Tunca, PhD, DDS principal investigator
Yuzuncu Yil University
Yesim Kaya, PhD, DDS study chair
Ankara Yildirim Beyazıt University
Yasemin Tunca, PhD, DDS study chair
Yuzuncu Yil University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Conventional fixed treatment and Clear aligner treatment in people with Malocclusion and Pain, run by Yuzuncu Yil University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 15 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
VAS (time frame: 0 hour, 2 hours, 6 hours, 1st day, 3rd day, 7th day, 14th day, 21st day.). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06133296, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Nov 2023.