There has been a paradigm shift within orthodontics in the use of lingual fixed appliances compared with the use of labial fixed appliances on the basis of perceived benefits and acceptance by patients.
Methods: A matched case-control prospective longitudinal study of adult patients treated in the Orthodontic Department, Prince Philip Dental Hospital, Hong Kong. Group A consisted of 30 patients treated with lingual orthodontic appliances. Group B consisted of 30 patients treated with labial orthodontic appliances. Data were collected at five different time points using questionnaire: pre-treatment; one week after the placement of the fixed appliance, and then at 1-month, 3-months, and 6-months thereafter. The questionnaire consisted of 15 items, in which 11 items were rated on a visual analogue scale.
Results: Patients' experience of pain decreased over the study period (p < 0.001); Those treated with lingual appliances reported significantly greater pain experience than those treated with labial appliances with respect to tongue pain (p < 0.001). However, those treated with labial appliances reported experiencing significantly more lip pain (p < 0.01), cheek pain (p < 0.001), and gum pain (p < 0.05). Patients treated with lingual appliances reported experiencing pain earlier on than those treated with labial appliances (p < 0.05). Both groups reported the pain level to be the same throughout the day (p > 0.05). There was no significant difference in reported disturbance of sleep or analgesic consumption between the two groups (p > 0.05).
Conclusion: Patients treated with both labial and lingual orthodontic appliances experienced pain during treatment, but this decreased over the treatment period. Patients treated with lingual appliances experienced more tongue pain whereas those treated with labial appliances experienced more lip, cheek and gum pain. Patients treated with lingual appliance reported experiencing pain earlier on than those treated with labial appliances.