AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO025310330
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ORIGINAL RESEARCH ARTICLE

Effectiveness of treatments for pain caused by orthodontic elastomeric separator placement: A systematic review and network meta-analysis of randomized controlled trials

Yuhan Shao1 ,  Dong Li2 ,  Lili Xiang2 ,  Chaoxiong Zhang2 ,  Chuanhua Yang2*
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1 State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
2 Department of General Surgery, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
EJMO, 025310330 https://doi.org/10.36922/EJMO025310330
Received: 29 July 2025 | Revised: 18 August 2025 | Accepted: 19 August 2025 | Published online: 23 December 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Orthodontic separators often cause significant discomfort, prompting the need to assess both pharmacological and non-pharmacological strategies for effective pain management during treatment.

Objective: This study aims to evaluate the efficacy of pharmacological and non-pharmacological interventions in controlling pain resulting from orthodontic elastomeric separator placement, through a systematic review and network meta-analysis of randomized controlled trials (RCTs).

Methods: A comprehensive search was conducted across PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases to identify RCTs published from 2000 up to November 2024. Included studies assessed various pain relief methods, such as low-level laser therapy (LLLT), ibuprofen, acetaminophen, benzocaine, and low-level pulsed ultrasound (LLPU), in patients receiving orthodontic elastomeric separators. Two independent reviewers conducted data extraction and evaluated study quality using the Cochrane risk of bias tool. A network meta-analysis was performed to compare and rank the effectiveness of the interventions using surface under the cumulative ranking curve (SUCRA) values, while the strength of the evidence was appraised with Confidence in Network Meta-Analysis.

Results: A total of 33 trials involving 2,216 participants were analyzed. At the 6-h mark following separator placement, benzocaine demonstrated the greatest pain relief (SUCRA 72.3%), with both LLLT and ibuprofen also showing notable effectiveness. After 24 h, LLPU ranked highest in pain reduction (SUCRA 83.2%), followed by acetaminophen and LLLT. Every treatment provided significant analgesic effects compared to placebo; nonetheless, the quality of evidence varied across interventions. Confidence levels were rated very low for benzocaine and LLPU, whereas LLLT received a high confidence score.

Conclusion: Both medication-based and non-medication approaches—especially LLLT—are effective in alleviating pain following separator placement. The effectiveness of benzocaine and LLPU requires further investigation. These results support tailored pain management plans and highlight the importance of studying combination therapies to improve outcomes in orthodontic treatment.

Keywords
Orthodontic pain
Network meta-analysis
Low-level laser therapy
Pharmacological interventions
Complementary pain management
Elastomeric separators
Funding
None.
Conflict of interest
The authors declare that there are no conflicts of interest related to this study. No financial or non-financial relationships exist that could have influenced the results or their interpretation.
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