Influence of anxiety levels on pain perception during orthodontic Copper–Nickel–Titanium archwire changes at different time intervals: A randomized clinical trial

Objectives: To evaluate the intensity and duration of painful symptoms reported during the Copper–Nickel–Titanium (NiTi) archwire changes and the influence of anxiety levels on pain perception. Material and Methods: Forty-five patients treated with fixed appliances and the same sequence of leveling archwires were divided into 3 groups with different time spans for archwire changes stipulated at 28, 56, and 84 days. They received a visual analog scale (VAS) at different times: T0, before the procedure; T1, immediately after the procedure; T2, 8h after the procedure; T3 24 h after the procedure; and every 24 h daily from T4 to T9 for each archwire change. A dental anxiety scale was presented at T0. Data were compared using t -tests. Results: The highest values were reported at T3 (3.01 ± 2.58), T2 (2.65 ± 2.40), T2 (3.01 ± 2.69) and T2 (1.77 ± 1.66), in the 4-week Group, T3 (4.61 ± 3.06), T2 (2.55 ± 1.83), T2 (3.46 ± 2.89) and T2 (2.20 ± 2.17) in the 8-week Group, and, T3 (4.74 ± 2.65), T2 (3.04 ± 2.23), T2 (4.01 ± 2.57), and T3 (2.51 ± 2.29) in the 12-week Group. 17 patients were classified as having low anxiety and 25 as moderate anxiety. Conclusion: Pain perception initiates shortly after archwire insertion and peaks within 24 h across all protocols, with the 0.014” Copper-NiTi wire eliciting the highest intensity. Furthermore, higher anxiety levels are associated with increased pain perception over prolonged archwire replacement intervals.