Pain Control During Braces Removal Using Transcutaneous Electrical Nerve Stimulation and High-Frequency Vibration

This clinical study aims to evaluate and compare the effectiveness and cost-effectiveness of TENS (Dental Pain Eraser) and high-frequency vibration (SureSmile® VPro™) in reducing discomfort during orthodontic bracket removal, improving patient satisfaction, and optimizing efficiency. The study includes a control group, and results are intended to provide evidence-based guidance for orthodontists to enhance the patient experience during debonding procedures.

Participants will be individuals who have completed fixed orthodontic treatment and are scheduled for bracket removal. Before the procedure, their baseline dental anxiety will be assessed. The assigned intervention will be applied either immediately before (TENS) or during (vibration) the bracket removal session. Participants' experiences of pain and satisfaction will be monitored throughout the procedure. Sex and baseline anxiety will be considered in the analysis to evaluate their influence on outcomes. A cost-effectiveness analysis will be performed to determine the most efficient method among the interventions.

The research will be conducted in a standardized clinical setting, adhering to established bracket removal protocols to ensure participant safety and minimize variability. The procedures will be performed by the same operator following consistent techniques.

This study is designed to generate practical insights into pain management during orthodontic debonding, focusing on participant comfort, satisfaction, and procedural efficiency, without compromising the quality of care. The findings may guide future clinical recommendations and improve patient-centered orthodontic practice.

Inclusion criteria

• Patients scheduled for fixed orthodontic appliance removal.
• Permanent dentition present, including both anterior and posterior teeth.
• Age between 15-35 years.
• Ability to provide informed consent and comply with study procedures.
• General health adequate for routine orthodontic care.
• No history of regular or recent medication intake within the preceding 24 hours, including painkillers, corticosteroids, or anti-flu drugs.

Exclusion criteria

• Patients with craniofacial anomalies, systemic conditions affecting pain perception, or taking medications influencing nociception.
• Teeth with extensive restorations or prostheses that prevent standard bracket debonding.
• Patients with known allergy or contraindication to TENS or vibration devices.
• Pregnant women.
• Active periodontal disease, including gingival recession or tooth mobility exceeding Grade I.
• Excessive gingival overgrowth that may impede debonding or influence study outcomes.