Split-mouth clinical trial evaluating pain perception in orthodontic patients using four types of separators: An <i>in viv</i> o study

Objectives: The objectives needs to include the study aims to evaluate the pain associated with four different types of separators at 4 hours, 24 hours, and on the 5 th day, and to compare the pain levels among the four types. Materials and Methods: Four different types of separators were placed in each quadrant of 54 patients receiving fixed orthodontic treatment, and each quadrant was divided into four groups. In group I, kesling separators were placed, while groups II, III, and IV were given elastomeric, brass wire, and kansal separators, respectively. Pain perception was evaluated after 4 hours, 24 hours, and on the 5 th day using the numerical pain rating scale (NPRS). The NPRS is a 0–10 scale where patients verbally rate their pain, with 0 being no pain and 10 being the worst pain. Results: Kansal separators consistently produced the highest pain scores across all time intervals, while kesling separators resulted in the least discomfort. At 4 hours post-placement, the highest mean pain score was observed in the kansal group (7.52 ± 1.57) and the lowest in the kesling group (6.69 ± 1.31), with a statistically significant difference ( P = 0.028). At 24 hours, pain remained highest for kansal separators (7.24 ± 1.63), though the differences were not statistically significant ( P = 0.152). By the 5 th day, overall pain levels had decreased, but kansal separators still recorded the highest pain (6.91 ± 1.54), while kesling recorded the lowest (6.00 ± 1.08), showing a significant difference ( P = 0.012). Conclusion: The type of separator has a significant impact on pain perception. Rigid separators, such as kansal and brass wire, induced higher pain, especially in the initial hours, while flexible separators, such as kesling, caused minimal discomfort. kesling separators may be preferred in patients with low pain tolerance to improve comfort and compliance.