Comparative Analgesic Efficacy of Diclofenac and Ketoprofen Transdermal Patches Versus Ibuprofen Tablets for Pain Control After Initial Archwire Placement in Orthodontic Patients: A Randomized Clinical Trial.

OBJECTIVES

This study compared the analgesic efficacy of diclofenac and ketoprofen transdermal patches versus ibuprofen tablets for pain control following initial archwire placement in orthodontic patients.

MATERIALS AND

METHODS

In this randomized clinical trial, 60 patients (aged 15-30 years) undergoing fixed orthodontic treatment (0.022-inch MBT brackets and 0.014-inch nickel-titanium archwires on both arches) were assigned via stratified permuted block randomization (1:1:1 ratio) to three groups (n = 20 each): 30-mg ketoprofen transdermal patches every 12 h, 15-mg diclofenac transdermal patches every 12 h, or 400-mg ibuprofen tablets every 8 h for 1 day. Pain severity was assessed using the numeric rating scale (NRS; 0-10) at baseline (immediately postplacement), 2 and 6 h, bedtime, 24 and 48 h, and 3 and 7 days. Data were analyzed by the generalized estimating equation (GEE) and the Kruskal-Wallis, Bonferroni, chi-square, and Fisher's exact tests (α = 0.05).

RESULTS

The pain score was the lowest in the ketoprofen group, followed by the ibuprofen group, and then the diclofenac group, but the difference was not significant (p > 0.05). The pain score initially increased after archwire placement to 6 h (from 0 pain in all groups to 2.50 ± 1.64, 3.90 ± 1.25, and 3.45 ± 1.82, respectively, in ketoprofen, diclofenac, and ibuprofen groups). It subsequently decreased until bedtime, increased again at 24 h, and then followed a descending trend from 48 h to 7 days. The trend of change in the pain score over time was not significantly different among the three groups (p = 0.657). Age (p = 0.757) and gender (p = 0.153) of patients did not affect their perceived pain.

CONCLUSION

Considering the comparable analgesic efficacy of ibuprofen and the tested transdermal patches, diclofenac and ketoprofen patches may be used as an alternative to ibuprofen tablets for efficient pain control after initial archwire placement.

TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20190915044771N2.