Document Type : Original Article


Department of Orthodontics and Dentofacial Orthopaedics, Army College of Dental Sciences, Secunderabad, India


Objectives: The objective of the current study was to compare the amount of separation obtained by two various elastomeric separators, as well as the pain perception and gingival health. 
Methods: A randomized split-mouth study was performed on 60 patients receiving fixed orthodontic treatment who were put randomly in one of two separator groups (Group 1: Elastomeric separators; Group 2: Safe-T separators). At the end of the 5-day study, the amount of separation was evaluated using a feeler gauge. Qualitative and quantitative pain assessment was performed using a patient-filled VAS (visual analogue scale) score and a questionnaire. Loe and Silness gingival index was used to examine gingival health at the time of placement and removal of separators. Student t-Test was used to compare mean VAS scores and the amount of separation followed by repeated measures of ANOVA and Bonferroni’s post hoc analysis. Chi Square Test was utilized to compare gingival index scores followed by the marginal homogeneity test comparing the 1st and 5th day. Reproducibility of measurements underwent assessment using intra-class correlation coefficients. 
Results: Greater statistically significant amounts of separation (0.126 mm) was achieved by Safe-T separators than conventional elastomeric separators. Patients experienced maximum pain and discomfort with the use of conventional elastomeric separators. Amount of soft tissue injury and bleeding was greater with elastomeric separators with a mean gingival score of 3.
Conclusion: Safe-T separators separate teeth optimally with minimal injury and discomfort to soft tissues, which makes them the better choice for clinicians.


  1. Sharma SK, Barthunia N, Pandit A, Singh A. Perception of discomfort and amount of separation from two types of orthodontic separators: A Prospective Study. Int J Oral Health Med Res 2017;4(3):35-38. doi: 10.4103/jpbs.JPBS_765_20.
  2. Malagan M. Comparison between efficacy of four different types of orthodontic separators. J Clin Diagn Res 2014;8(8):41-44. doi: 10.7860/JCDR/2014/9963.4755.
  3. Flores‐Mir C. Bonded molar tubes associated with higher failure rate than molar bands. Evid Based Dent 2011;12:84. doi: 10.1038/sj.ebd.6400813.
  4. Firestone AR, Scheurer PA, Burgin WB. Patients’ anticipation of pain and pain‐related side effects, and their perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod 1999;21:387-96. doi: 10.1093/ejo/21.4.387.
  5. Ngan P, Kess B, Wilson S. Perception of discomfort by patients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:47‐53. doi: 10.1016/0889-5406(89)90228-x.
  6. Ngan P, Wilson S, Shanfeld J, Amini H. The effect of ibuprofen on the level of discomfort in patients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop 1994; 106:88‐95. doi: 10.1016/S0889- 5406(94)70025-7.
  7. Wilson S, Ngan P, Kess B. Time course of the discomfort in young patients undergoing orthodontic treatment. Pediatr Dent 1989;11:107-10. PMID: 2762180.
  8. Wilcock A, Kansal S, Singh G, Raghav P, Kumar P, Kumar A. The Kansal Separator: In Search of “A Better. Mouse Trap”. Arch Cran Oro Fac Sc 2014;2(1):100-3. doi: 10.4103/2278-0203.127552.
  9. Davidovitch M, Papanicolou S, Vardimon AD, Brosh T. Duration of elastomeric separation and effect on interproximal contact point characteristics. Am J Orthod Dentofacial Orthop 2008;133:414-22. doi: 10.1016/j.ajodo.2006.02.036
  10. Singh G. Separators in Dentistry. J Oral Hyg Health 1: e103. doi: 10.4172/2332-0702.1000e103.
  11. Tripathi T, Singh N, Rai P, Khanna N. Separation and pain perception of Elastomeric, Kesling and Kansal separators. Dent Press J Orthod 2019;24(2):42-48. doi: 10.1590/2177-6709.24.2.042-048.oar.
  12. Dragiff DA. Table clinic – Separators. J Clin Orthod 1969:3(12):664-71.
  13. Monini A, Guimaraes M, Gandini Junior L, SantosPinto L, Hebling J. Tooth separation: A risk-free procedure? Am J Orthod Dentofacial Orthop 2012;142(3):402-405. doi: 10.1016/j.ajodo.2011.06.048.
  14. Caldwell CR, Worms FW, Gatto DJ. Orthodontic and surgical intervention to arrest tooth loss secondary to subgingival elastic. Am J Orthod 1980;78:273-8. doi: 10.1016/0002-9416(80)90272-9.
  15. Tarvade Daokar S. Separators in Orthodontics: A Review. Orthod J Nepal. 2016;6(1):37-40
  16. Woodforde JM, Merskey H. Some relationships between subjective measure of pain. J Psychosom Res 1972;16:173 8. doi: 10.1016/0022-3999(72)90041-4. PMID: 1939630.
  17. Mcgann DA. Nickle titanium separating spring. J Clin Orthod 1993;25(5):315–18. PMID: 1939630.
  18. Aldrees AM. Intensity of pain due to separators in adolescent orthodontic patients. J Orthod Sci 2015;4:118-22. doi: 10.4103/2278-0203.173423.
  19. Bondemark L, Fredriksson K, Ilros S. Separation effect and perception of pain and discomfort from two types of orthodontic separators. World J Orthod 2004;5:172–6. PMID: 15615136.
  20. Scheurer PA, Firestone AR, Burgin WB. Perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod 1996;18:349–57. doi: 10.1093/ejo/18.4.349.
  21. Kumar Bapna PA, Mane PN, Ganiger CR, Pawar RL, Phaphe SA, Ahammed YA. A survey of perception of pain and discomfort with elastomeric separators in patients undergoing orthodontic treatment in Western Maharashtra region. J Oral Res Rev 2017;9:56- 61. doi: 10.4103/jorr.jorr_42_16.
  22. Al Qahtani N, Al Wakeel A, Al Zamil A, Al Turki S, Al Dawsari G, Al Jabaa A et al. Comparison of two analgesics used for pain relief after placement of orthodontic separators. Saudi Pharm J .2017;25(8):1169–1174. doi: 10.1016/j.jsps.2017.07.010.
  23. Banerjee S, Banerjee R, Shenoy U, Agarkar S, Bhattacharya S. Effect of orthodontic pain on quality of life of patients undergoing orthodontic treatment. Indian J Dent Res 2018;29:4-9. doi: 10.4103/ijdr.IJDR_113_16.
  24. Mendes D, Nascimento J, Facholli A, Casa M, Carvalho L, Sato K. Evaluation of plasticity and radiopacity of elastic separators by means of traction tests and radiography. Dent Press J Orthod. 2012;17(6):1-10. doi: 10.1590/S2176 94512012000600008.
  25. Baty DL, Storie DJ, ConFrauhonfer JA. Synthetic elastomeric chains: A literature review. Am J Orthod Dentofacial Orthop 1994;105(6):536-42. doi: 10.1016/S0889-5406(94)70137-7.
  26. Thakur VK, Kannan S, Sharma M, Kumar P, Pradhan I. Innovative use of Kesling spring separators: A clinical pearl. Int J Orthod Rehabil 2018;9:90-1. doi: 10.4103/ijor.ijor_1_18.
  27. Kumar A, Kansal S, Thareja V, Singh G, Kumar P. The biomechanics of Kansal Separator: A ‘2 in 1’self‐ secured orthodontic spring separator. J Orthod Sci 2014;3:12‐6. doi: 10.4103/2278-0203.127552.
  28. Pandis N, Walsh T, Polychronopoulou A, Katsaros C, Eliades T. Split-mouth designs in orthodontics: an overview with applications to orthodontic clinical trials. Eur J Orthod. 2013 ;35(6):783-9. doi: 10.1093/ejo/cjs108.