Diclofenac and Ketoprofen Patches Effective Alternatives to Ibuprofen for Orthodontic Pain: Study

In order to systematically compare these two very different modes of drug administration, a parallel group randomized clinical trial with a precise allocation strategy was used. For the study, 60 orthodontic patients aged between 15 and 30 years, who underwent fixed orthodontics with 0.022-inch MBT brackets, were recruited. In order to provide the same initial trigger of pain, all the subjects wore exactly the same size of 0.014-inch nickel-titanium archwires on their upper and lower dental arches. Patients were randomly assigned into three groups, using the stratified permuted block design in a 1:1:1 ratio.

The first group was allocated to receive a ketoprofen transdermal patch in a dosage of 30 mg per 12 hours; the second one received the diclofenac transdermal patch at a dosage of 15 mg per 12 hours; while the third one was given the standard oral ibuprofen tablets at a dosage of 400 mg every 8 hours, for one whole day. Pain levels were measured using NRS from 0 to 10 over a prolonged period of time from baseline to 2, 6, before sleep, 24, 48 hours, 3 and 7 days.

Key findings:

• Pain score was recorded as 0 among all 60 patients immediately after placement, but increased to 2.50 ± 1.64 among those in the ketoprofen patch, 3.90 ± 1.25 among those in the diclofenac patch, and 3.45 ± 1.82 among those in the oral ibuprofen group after 6 hours.
• While numerical values of pain scores in the ketoprofen patch, the oral ibuprofen, and diclofenac patch groups decreased sequentially, the difference between the means was statistically insignificant (p > 0.05).
• There was a marginal reduction in pain scores across the study groups at bedtime, an increase in pain scores at the 24-hour point, and a consistently decreasing trend until day 7 with no difference between the groups over time (p = 0.657).
• Statistical analysis showed that age (p = 0.757) and sex (p = 0.153) of the subjects had no independent effect on pain scores.

Given the fact that the use of transdermal patches and oral tablets is equally effective means that there is an excellent opportunity to increase patient compliance during the early stages of orthodontic care which may be considered as difficult due to a lot of pain experienced by a patient. The discomfort associated with the placement of the arch wire is considered to be one of the most important causes why patients skip their appointments and ask their dentist to remove the brackets before time. Besides, young patients often find it hard to take medications orally every eight hours because of their inconvenient schedule. Moreover, for those patients that experience gastric problems such as reflux, using this pain medication is quite convenient.

Reference:

Babaee Hemmati, Yasamin, and Amirhossein Toghrolian. "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." Pain Research & Management, vol. 2026, no. 1, 2026, pp. e9922008.