Assessing the Efficacy of Various Pain Management Methods in Orthodontic Debonding: A Randomized Clinical Trial

Orthodontic treatment improves smiles and confidence, but pain during procedures often leads to high dropout rates, making effective pain management essential. Debonding, which marks the completion of treatment, can be particularly painful. Although advanced pain relief methods such as analgesics, local anesthesia, ultrasound techniques, transcutaneous electrical nerve stimulation, and nitrous oxide sedation are available, they are often costly, time-consuming, and may affect patient compliance. In contrast, simple and cost-effective techniques like finger pressure, elastomeric wafers, stress relief, and vibration anesthesia offer practical alternatives to reduce pain and enhance patient satisfaction. However, there is limited literature comparing the effectiveness of these methods.

To evaluate the pain experienced during orthodontic debonding using finger pressure, elastomeric wafers, stress relief, and vibration anesthesia, and to assess the effectiveness of these pain control methods with respect to age and gender variations.

The descriptive cross-sectional study adhered to Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines, involving 140 (61 males and 79 females) orthodontic patients aged 18-30 years, who had undergone fixed orthodontic treatment with 0.022" x 0.028" slot McLaughlin, Bennett, and Trevisi (MBT) prescription metal brackets were randomly divided into four groups. A single debonding plier is used, employing elastomeric wafer, finger pressure, stress relief, and vibration anesthesia methods. Visual Analog Scale (VAS) scores were recorded after debonding. Statistical data was analysed using IBM SPSS Statistics for Windows, Version 20 (Released 2012; IBM Corp., Armonk, New York, United States).

Upper jaw pain scores differed significantly among groups, favouring the elastomeric wafer group (p<0.001) with a low score. Vibration anesthesia group resulted in higher mean pain scores, particularly in the upper regions (p<0.001). In the lower jaw, the elastomeric wafer group had lower mean pain scores, with no significant difference from finger pressure group (p=0.514). Overall, the elastomeric wafer group demonstrated significantly lower mean pain scores, with no gender-based differences observed.

Elastomeric wafer and finger pressure methods were effective in orthodontic pain management during debonding, along with a stress relief method to a certain level. Vibration anesthesia method is comparatively less effective for pain reliving method while debonding, particularly in anterior regions. The study found no gender differences in the pain scores across all groups.