Comparing the effectiveness profile of pharmacological interventions used for orthodontic pain relief: an arm-based multilevel network meta-analysis of longitudinal data

Satpal Sandhu, Hans-Peter Piepho, Harpreet S Khehra

Research output: Contribution to journalArticle (Academic Journal)peer-review

6 Citations (Scopus)
247 Downloads (Pure)


Background and objectives: To compare the effectiveness profile of various analgesics used for orthodontic pain relief over a 1-week time period by conducting a longitudinal network meta analysis (NMA).

Search methods: The MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases were searched till 31st December 2015 to identify the relevant studies. Additional studies were identified by hand searching journals and reference lists. Unpublished literature was also searched.

Selection criteria: Eligible studies were randomized-controlled trials (RCTs) evaluating the effectiveness of pharmacological interventions for pain relief after placement of separator or initial aligning arch wire.

Data collection and analysis: Pain intensity data at 2, 6, 12, 24, 36, 48, 72, 96, and 168 hours was collected. In addition, data were also extracted for potential covariates (age, sex, and procedure). A covariate-adjusted arm-based multilevel random coefficient model was used for evidence synthesis.

Results: Fifteen RCTs (1341 participants; male/females 595, 44.6%/746 55.4%; mean age 17.3 years, SD 4.1) were included. A total of 11 nodes (Acetaminophen, Aspirin, Etoricoxib, Flurbiprofen, Ibuprofen, Lumiracoxib, Meloxicam, Naproxen, Piroxicam, Placebo, and Control) were identified out of which five nodes (Placebo, Ibuprofen, Naproxen, Acetaminophen, and Aspirin) had subnodes (based on timing of administration). Compared to Control, Placebo, Flurbiprofen, Lumiracoxib, and Meloxicam were not significantly effective. Etoricoxib (most effective) and Piroxicam (second most effective) were effective over a long period which lasted up to 96 and 72 hours, respectively. Ibuprofen, Acetaminophen, Naproxen, and Aspirin were effective at 6, 12, and 24 hours. The effectiveness of these analgesics was significantly influenced by the timing of administration. Assessment of heterogeneity, transitivity, inconsistency, and publication bias revealed no major threat to the NMA derived estimates.

Conclusion: Compared to the Control, Placebo was least effective whereas Etoricoxib was the most effective analgesic in reducing orthodontic pain. Administration timing has significant influence on the effectiveness profile of analgesics routinely used for managing orthodontic pain.
Original languageEnglish
Pages (from-to)601-614
Number of pages14
JournalEuropean Journal of Orthodontics
Issue number6
Early online date15 Feb 2017
Publication statusPublished - Dec 2017


  • aspirin
  • pharmacotherapy
  • acetaminophen
  • analgesics
  • heterogeneity
  • bone wires
  • flurbiprofen
  • ibuprofen
  • naproxen
  • pain
  • piroxicam
  • publication bias
  • time factors
  • arm
  • meloxicam
  • lumiracoxib
  • etoricoxib
  • network meta-analysis


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