Comparison of Three Orthodontic Separators for Pain, Plaque, and Tooth Separation

Separation of teeth prior to molar banding is an essential step in fixed orthodontic treatment. Orthodontic separators are used to create sufficient interproximal space to allow proper placement of bands. However, separator placement is commonly associated with pain, discomfort, and changes in oral hygiene practices, which may lead to plaque accumulation and negatively impact patients' quality of life.

Various types of orthodontic separators are available, including elastomeric separators, spring-type separators such as Kesling separators, and customized separators such as ligature tie wire separators. Elastomeric separators are widely used due to ease of placement; however, they may cause significant pain and are prone to dislodgement. Kesling separators are effective in tight contact areas but may cause gingival irritation and are relatively difficult to handle. Tie wire separators, which can be fabricated chairside, may offer a cost-effective and practical alternative, especially in cases with tight interproximal contacts.

This randomized controlled trial aims to compare three types of orthodontic separators-elastomeric, Kesling, and customized tie wire separators-in terms of:

Amount of separation achieved Pain perception using a visual analogue scale (VAS) Plaque accumulation measured using the Silness and Loe plaque index Impact on patients' quality of life assessed through structured interviews

A total of 144 participants requiring fixed orthodontic treatment with molar banding will be randomly allocated into three groups. Separators will be placed on the mesial and distal surfaces of maxillary first molars. Clinical parameters will be assessed after 48-72 hours.

Quantitative data will be analyzed using appropriate statistical tests, including one-way ANOVA and Chi-square tests. Additionally, qualitative data from patient interviews will be analyzed using thematic analysis to explore the impact of separator placement on daily life, including functional, emotional, and social aspects.

The results of this study will help determine the most effective separator with minimal discomfort and adverse effects, thereby improving patient compliance and overall orthodontic treatment experience.

Inclusion criteria

• Patients requiring fixed orthodontic appliance therapy with maxillary first molar banding
• Age between 12 and 25 years
• Good oral hygiene (Plaque Index score 0-1)
• Good general oral health
• No previous orthodontic treatment
• No history of dental extractions
• Presence of tight interproximal contacts at the site of separator placement (no spacing)

Exclusion criteria

• Presence of interproximal restorations
• Presence of interproximal caries
• Missing maxillary second premolar, first molar, or second molar
• Unerupted maxillary second molars
• Systemic diseases affecting oral health (e.g., diabetes mellitus)
• Regular use of medications affecting pain perception (e.g., analgesics, corticosteroids)
• Loss of separators before follow-up appointment
• Failure to return within 72 hours for evaluation