Efficacy of Piroxicam and Tramadol for Relieving Pain Associated with Therapeutic Dental Extractions followed by Immediate Archwire Loading during Orthodontic Treatment: A Cross-Over Randomized Clinical Trial

Abstract

Objectives: Extraction of premolars and archwire loading during orthodontic treatment is associated with postoperative pain that affects the patient’s quality of life and acceptability for the treatment. Prompt management of post-operative pain can improve patient’s compliance and confidence in the dental profession. Material and Methods: The present split-mouth double-blinded randomized clinical trial was conducted on 30 patients undergoing bilateral maxillary first premolar extraction followed by archwire placement for orthodontic treatment. Patients were administered either of the two drugs, tramadol or piroxicam, and their pain levels were recorded by visual analog scale at 2-hours (h), 4-h, and 6-h intervals. The same protocol was repeated for extraction of the contralateral premolar 1 week later, and the patients were provided with the other drug not received during the first extraction, followed by an assessment of the pain levels. Results: The pain levels were significantly higher (P < 0.01) at 2 h in the patients taking piroxicam as compared to 4-h and 6-h intervals. There was a significant rise in pain at the 4- and 6-h intervals compared to the 2-h interval following the administration of tramadol. The pain levels were significantly higher (P < 0.01) in the piroxicam group at the 2-h and 4-h intervals as compared to patients in the tramadol group. On the contrary, when considering the pain levels at the 6-h intervals, the pain levels were found to be significantly lower for patients administered with piroxicam. Conclusion: The use of piroxicam for the management of pain following the extraction and archwire placement during orthodontic treatment is more beneficial than the use of tramadol due to the sustenance of its effect over a prolonged duration of time.