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Table 7 Grading system according to GRADEpro

From: Pain level between clear aligners and fixed appliances: a systematic review

Clear aligners compared to fixed appliances for pain
Certainty assessment Summary of findings
No. of participants (studies) followed up Risk of bias Inconsistency Indirectness Imprecision Publication bias Overall certainty of evidence Study event rates (%) Relative effect (95% CI) Anticipated absolute effects
With fixed appliances With clear aligners Risk with fixed appliances Risk difference with clear aligners
1st, 3rd, and 7th day (follow up: mean 1 days; assessed with VAS scale)
 336 (5 non-randomized studies) Seriousa Seriousa Not serious Very seriousb All plausible residual confounding would reduce the demonstrated effect dose response gradient low 181 participants 155 participants Not estimable Low
0 per 1.000  
2nd, 4th, 5th, and 6th day (follow up: mean 1 days; assessed with VAS score)
 234 (3 non-randomized studies) Seriousa Seriousa Not serious Very serious All plausible residual confounding would reduce the demonstrated effect dose response gradient low 110 participants 124 participants Not estimable Low
0 per 1.000  
14th day (follow up: mean 1 days; assessed with VAS score)
 119 (2 non-randomized studies) Serious c Serious c Not serious Very seriousb All plausible residual confounding would reduce the demonstrated effect dose response gradient low 67 participants 52 participants Not estimable Low
0 per 1.000  
21st, 22nd, 23rd, 36th, and 37th day (follow up: mean 1 days; assessed with VAS score)
 93 (1 non-randomized study) Not serious Very seriousd Not serious Very seriousb All plausible residual confounding would reduce the demonstrated effect dose response gradient low 55 participants 38 participants Not estimable Low
0 per 1.000  
24th, 25th, 26th, 27th, 35th, 38th, 39th 40th, and 41st day (follow up: mean 1 days; assessed with VAS score)
 93 (1 non-randomized study) Not serious Very seriousd Not serious Very seriousb All plausible residual confounding would reduce the demonstrated effect dose response gradient low 55 participants 38 participants Not estimable Low
0 per 1.000  
Baseline (follow up: mean 1 days; assessed with VAS SCORE)
 223 (3 non-randomized studies) Seriousa Seriousa,c Not serious Very serious b All plausible residual confounding would reduce the demonstrated effect dose response gradient low 121 participants 102 participants Not estimable Low
0 per 1.000  
Baseline, 1st, 2nd, 14th, 30th, 33rd, 34th, 60th, 61st, 62nd, 63rd, and 64th day (follow up: mean 1 days; assessed with VAS score)
 41 (1 RCT) Not serious Not serious Not serious Very seriousb All plausible residual confounding would reduce the demonstrated effect dose response gradient high 18 participants 23 participants Not estimable Low
0 per 1.000  
3rd, 4th, 5th, 6th, 7th, 31st, and 32nd day (follow up: mean 1 days; assessed with VAS score)
 41 (1 RCT) Not serious Not serious Not serious Very seriousb All plausible residual confounding would reduce the demonstrated effect dose response gradient high 18 participants 23 participants Not estimable Low
0 per 1.000  
  1. CI confidence interval
  2. aThis will down grade because one article was classified with a serious RoB
  3. bThis will downgrade because the use of analgesic was not properly described and it may mask the real pain reported by the patients
  4. cThis will downgrade because two articles were classified with moderate RoB
  5. dThis will downgrade because one article as classified with a moderate RoB