The Effectiveness of Calcium Versus Ibuprofen in Reducing Pain Following Orthodontic Elastic Separator Placement: A Trible-Blind Randomized Controlled Trial

Abstract

Orthodontic pain following separator placement is a common clinical problem that may negatively affect patient comfort and adherence to treatment. In spite of that ibuprofen is widely prescribed for orthodontic pain relieve due to its scientifically proven analgesic efficiency, its possible gastrointestinal and systemic side effects have increased interest in finding safer alternatives, such as calcium supplementation. This study aimed to compare the analgesic effectiveness of calcium supplementation with ibuprofen in reducing orthodontic pain. A triple-blinded randomized controlled trial was done including 78 orthodontic participants aged 18–28 years, who were allocated into three equal groups: Ibuprofen (400 mg), Calcium (350 mg), and Placebo. Psychological status was estimated using the Hospital Anxiety and Depression Scale (HADS). Pain intensity was estimated using the Visual Analogue Scale (VAS) at different time points: two hours, six hours, bedtime on the day of separator placement, and at two, three, and seven days post-procedure. Statistical analysis was completed using non-parametric tests, including Kruskal–Wallis, Mann –Whitney U, and Spearman correlation. The ibuprofen group showed the greatest reduction in pain intensity, with highly significant differences compared to both the calcium and placebo groups (p < 0.001). Calcium supplementation showed low but statistically significant reduction in pain beginning at bedtime (p = 0.009); however, pain scores did not differ significantly from those of the placebo group at most time points. Adverse side effects were told more frequently in the ibuprofen group (19.2%) compared with the calcium (3.8%) and placebo (7.7%) groups. In conclusion, ibuprofen remains the most effective analgesic for orthodontic pain management. Nevertheless, calcium supplementation may represent a safer alternative for patients who are unable to tolerate non-steroidal anti-inflammatory drugs.