Comparison of pain, anxiety, and oral health-related quality of life in orthodontic treatment using traditional, self-ligating, and clear aligner systems.

Background/purpose: The choice of orthodontic appliance can profoundly influence the patient experience. While conventional, self-ligating, and clear aligner systems are widely used, direct comparisons of their effects on patient comfort and well-being remain limited. This prospective study compared changes in pain, anxiety, and oral health-related quality of life (OHRQoL) among adult patients treated with these three modalities during the critical first month of orthodontic treatment. Materials and methods: Ninety-seven adult participants were allocated to traditional, self-ligating, or Invisalign groups, ensuring comparable case complexity across treatments. Pain (VAS), anxiety (GAD-7), and OHRQoL (OHIP-14) were evaluated at baseline (T0), one week (T1), and one month (T2). Changes over time were analyzed using Generalized Estimating Equations (GEE) to account for within-subject correlations and to compare temporal trends among treatment groups. Results: At T1, the Invisalign group reported significantly lower pain levels (VAS: 2.95) than the traditional (5.20) and self-ligating (4.85) groups. Similarly, the decline in OHRQoL was substantially less pronounced in the Invisalign group, primarily due to significantly smaller impacts on the functional limitation and physical pain subdomains (p < 0.001). Anxiety levels decreased similarly across all groups over time. Conclusion: Clear aligners are associated with a notably more comfortable adaptation period, producing less pain and functional disruption than both traditional and self-ligating fixed appliances. These findings provide robust, domain-specific evidence to support shared decision-making, enabling clinicians to better manage patient expectations and tailor treatment choices to individual preferences.