Comparative efficacy of ibuprofen and low-level laser therapy on pain intensity after elastomeric separator placement: A systematic review and network meta-analysis.

BACKGROUND

This research aimed to assess the efficacy of ibuprofen and low-level laser therapy (LLLT) in pain reduction following the placement of elastomeric separators, utilizing a network meta-analysis (NMA) to synthesize data from relevant randomized controlled trials (RCTs). Our objective was to determine the most effective method for pain management in orthodontic patients.

METHODS

This study was registered with International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42025640519). A comprehensive literature search was conducted across various databases up to January 19, 2025, to identify RCTs evaluating the impact of ibuprofen and LLLT on pain intensity following orthodontic separator placement. The quality of the included studies was assessed using the Cochrane risk-of-bias tool. A NMA was performed to combine direct and indirect comparisons, ranking the interventions based on their effectiveness in alleviating pain at 6 hours and 24 hours after orthodontic separator placement.

RESULTS

Twenty-three studies with 1007 participants were included in the NMA. Both ibuprofen and LLLT demonstrated significantly greater reductions in pain intensity compared to control or placebo groups at all assessed time points. For ibuprofen, pain reduction was observed at 6-hour with a mean difference (MD) of -1.93 and a 95% confidence interval (CI) of -2.93 to -0.93, and at 24-hour with an MD of -1.63 (95% CI: -2.58 to -0.68). For LLLT, the MD at 6-hour was -1.46 (95% CI: -2.28 to -0.64), and at 24-hour, the MD was -1.84 (95% CI: -2.52 to -1.16). Ibuprofen showed greater effectiveness in reducing pain intensity at 6-hour, with a surface under the cumulative ranking curve (SUCRA) of 88.4, whereas LLLT demonstrated more sustained reduction at 24-hour, with a SUCRA of 81.8.

CONCLUSION

This NMA provides evidence that both ibuprofen and LLLT are effective in reducing pain following elastomeric separator placement. Ibuprofen offers more immediate pain reduction, whereas LLLT offers more sustained effects over 24-hour. These findings suggest that a time-dependent, multimodal approach may be beneficial for optimizing orthodontic pain management. To further validate these findings and establish standardized clinical protocols, more high-quality randomized clinical trials are needed, particularly those involving direct, head-to-head comparisons between ibuprofen and LLLT.