Introduction: The objective of this study was to investigate the effect of prior engagement of tooth with orthodontic appliance on postextraction pain among orthodontic patients.

Methods: In this randomized clinical trial, 44 patients, who needed bilateral extractions of first premolars in upper arches, were recruited. Patients were divided into two groups based on the timing of extractions. Group A needed extractions before alignment, while Group B needed extractions for retraction of anterior teeth. Group A was sent for extractions first, while Group B went for orthodontic bonding and banding procedures for orthodontic treatment. After series of aligning wires (0.014, 0.016, 17 × 25, 19 × 25 heat-activated NiTi and 19 × 25 SS), patients from Group B were sent for extractions. For pain assessment, an 11-point numerical rating scale (NRS) was given to record pain intensity at 2, 4, 8, 12, and then 24 h after extraction for the next 7 days. A nonparametric Mann–Whitney U test was used to compare the level of pain perception between males and females and between groups.

Results: Females in Group A reported greater pain (p < 0.05) at 2, 4, 8, 12, and 24 h, 2nd and 3rd day after extraction, while there was no gender dimorphism in Group B. Group A reported more pain at 2, 4, 8, and 12 h after extractions when compared with Group B (p < 0.05).

Conclusions: Early engagement of teeth with orthodontic appliances may potentially reduce postextraction pain in patients.