## 5 Strengths and Limitations of the Systematic Review  
The present review has several strengths. It included an a priori and registered protocol, a comprehensive literature search strategy, and strict eligibility criteria. Efforts were made to compile the maximum amount of available information, and the use of recommended tools was utilized to critically appraise the risk of bias in individual studies and assess the quality of available evidence. Some limitations should be considered before finalizing whether a bite wafer is a practical choice in place of CADs after the placement and/or adjustment of fixed orthodontic appliances, such as whether the meta-analyses included only a limited number of studies with inconsistent methodologies. For example, a variation was observed in patients' ages as studies included adolescent and adult patients. Moreover, it has been documented that pain perception differs depending on an individual's age and growth status [42; 43], which may have impacted the noted results. In addition, variability was noted regarding the analgesic drug dosages and consumption intervals, as well as the bite wafer use intervals and duration. Further, [PERSON] et al. [41] reported that the bite wafer was made in the laboratory due to the difficulty of obtaining this type of industrial product in Belgium. In addition, the material used was less flexible than an industrial product. Also, orthodontic pain was generated by different orthodontic archives (such as 0.014-inch and 0.016-inch nickel-titanium archives and/or 0.014-inch copper-nickel-titanium (Niti)). These orthodontic appliances and auxiliaries may lead to dissimilar force magnitudes and tissue reactions during orthodontic force application [44; 45], which may influence a person's pain perception and reaction to pain management methods like pharmacological and non-pharmacol interventions. Furthermore, the participants' malocclusion status ranged from mild to severe crowding, and it could be speculated that patients with moderate crowding mighthave undergone heavier orthodontic forces after orthodontic archive placement compared to patients with mild crowding, which may impact the resultant pain perception. However, additional studies are required for the latter consideration. In addition, gender dissimilarities have been noted concerning pain perception and tolerance [46]; thus, studies including female patients might have been subjected to selection bias. Nevertheless, based on the presently available evidence, it is challenging to recognize the optimal protocol for bite wafer usage and/or analgesic consumption after fixed orthodontic appliance placement and to draw conclusions regarding the long-term success of bite wafer as a pain management protocol during fixed OT. It is of merit to note that four RCTs [2; 20; 21; 40] had a high RoB and three RCTs [4; 9; 41] had a moderate RoB. The absence of blinding absence of researchers and participants, the inclusion of only female patients in two RCTs, and the shortage of blinding for outcome estimation are considered the major causes that raised the probable biases in the RCTs included. Because of the character of the studies (bite wafer and consumption of analgesics), one can contest the blinding of the study participants. Hence, the authors suppose that participants consuming analgesics might experience reduced self-perceived pain levels due to a placebo effect. Also, power analysis for sample size estimation was performed in three [4; 20; 41] of seven RCTs. This warrants a warning in interpreting their statistical results due to the probability of Type II errors. In three RCTs [9; 20; 21], adjustments were made for multiple testing when comparing intervention with control groups, such as [PERSON]'s test. The authors of the present systematic review perceive that \(p\)-values in all included RCTs should have been modified utilizing multiplicity correction for accounting for the multiple group comparisons among several timepoints.