Review Article
Year : 2026 | Volume : 17 | Issue : 3 | Page : 1-14
Comparison of Tooth Separation Efficiency, Pain Perception, and Patient Comfort between Elastomeric and Kesling Orthodontic Separators: A Systematic Review and Meta-Analysis
Vandana Arunajhalam-1, Prabhakar Krishnan-2, Vasanthan Palanivel-3, Sabarinathan Jagannathan-2, Thangabalu Rajamuthu-4, Revathy Seetharaman-5
1-Postgraduate Resident, 2-Professor, 3-Professor and Head, 4-Assistant Professor, 5-Associate Professor, Department of Orthodontics and Dentofacial Orthopedics, Vinayaka Mission’s Sankarachariyar Dental College, Vinayaka Mission’s Research Foundation (Deemed to be University), Salem, Tamil Nadu 636308, India.
Address for Correspondence:
Dr. P. Vasanthan, MDS
Professor and Head, Department of Orthodontics and Dentofacial Orthopedics
Vinayaka Mission’s Sankarachariyar Dental College
Vinayaka Mission’s Research Foundation (Deemed to be University)
Salem, Tamil Nadu – 636308, India
Email: orthovasu@gmail.com
ABSTRACT
OBJECTIVE : To compare elastomeric and Kesling separators with respect to tooth separation efficiency, pain perception and patient discomfort.
METHODS: A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. Electronic searches of PubMed, Web of Science, Cochrane Library and LILACS were performed up to July 2026. Studies directly comparing elastomeric and Kesling separators were included. Primary outcome was tooth separation; secondary outcomes included pain & discomfort. Risk of bias was assessed using ROBINS-I/ROB-2. Random-effects meta-analyses was performed using standardized mean differences (SMDs) with 95% confidence intervals (CIs).
RESULTS: Four studies (248 participants) were included. Meta-analysis showed no significant difference in tooth separation between elastomeric and Kesling separators on Day 1 (SMD = 0.40; 95% CI: −0.80 to 1.20; p = 0.40), Day 3 (SMD = 0.37; 95% CI: −1.98 to 2.73; p = 0.76), or Day 7 (SMD = 0.43; 95% CI: −3.55 to 4.40; p = 0.84), with substantial heterogeneity (I² = 96–99%). Qualitative synthesis indicated greater early pain with elastomeric separators and better comfort with Kesling separators. Risk of bias ranged from moderate to high risk of concerns.
CONCLUSIONS: Both elastomeric and Kesling separators demonstrated comparable effectiveness in achieving tooth separation across the evaluated time points. However, considerable variability was observed among the included studies. Kesling separators were associated with lower pain perception. Therefore, the choice of separator should be individualized based on clinical requirements and patient comfort and pain tolerance.
KEYWORDS: Orthodontic separators; Elastomeric separators, Kesling separators, Tooth separation, Pain perception; Patient-centered outcomes; Systematic review; Meta-analysis.
SOURCE OF FUNDING
The authors received no specific funding for this work.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
How to cite this article: Vandana Arunajhalam, Prabhakar Krishnan, Vasanthan Palanivel, Sabarinathan Jagannathan, Thangabalu Rajamuthu, Revathy Seetharaman. Comparison of Tooth Separation Efficiency, Pain Perception, and Patient Comfort between Elastomeric and Kesling Orthodontic Separators: A Systematic Review and Meta-Analysis.
Int J Orthod Rehabil 2026; 17 (3): 1-14.
Doi: 10.56501/Intjorthodrehabil.172.ijor0116
