Validating the pre-placement of orthodontic separators for atraumatic extractions: a split-mouth randomised trial

Introduction Atraumatic extraction techniques aim to minimise tissue injury, preserve alveolar bone, and reduce post-operative discomfort. Although periotomes and physics forceps are effective, they require additional armamentarium. This study evaluated orthodontic separators as a simple, low-cost adjunct for atraumatic premolar extraction in orthodontic patients.Methodology A split-mouth randomised clinical trial was conducted in 20 patients requiring four premolar extractions (80 sites). In each arch, one premolar received separators and the contralateral premolar served as control. Elastomeric separators were placed five days before extraction. Outcomes included extraction time, intra-operative complications, wound healing using Landry's index on post-operative days (PODs) three, five, and seven, and pain using a visual analogue scale on PODs one, three, and five. Statistical analysis used one-way ANOVA, Friedman test, and Mann-Whitney U test.Results Extraction time was significantly shorter in the separator group, with a paired difference of 5.90 seconds (p = 0.03). Two root fractures with buccal cortical involvement occurred only in controls. Healing scores were better in the separator group on POD three and POD seven. Pain scores were lower at separator sites on POD three (p <0.01).Conclusion Pre-extraction orthodontic separators reduce operative time, complications, pain, and enhance early wound healing.