Systematic review on self-ligating vs. conventional brackets: initial pain, number of visits, treatment time

  • A.G. Čelar
  • M. Schedlberger
  • P. Dörfler
  • M.H. Bertl
Original article

Abstract

Objective

Meta-analysis of differences between conventional and self-ligating brackets concerning pain during tooth movement, number of patient visits, total treatment duration, and ligation times.

Materials and methods

Online search in Medline, Embase, and Central focused on randomized clinical trials and controlled clinical studies published between 1996 and 2012.

Results

Four studies on pain met our inclusion criteria, two on the number of appointments, two on overall treatment time but none on ligation times. Pain levels did not differ significantly between patients treated with conventional or self-ligating brackets after 4 h, 24 h, 3 and 7 days. The number of appointments and total treatment times revealed no significant differences between self-ligating and conventional brackets.

Conclusion

The lack of significant overall effects apparent in this meta-analysis contradicts evidence-based statements on the advantages of self-ligating brackets over conventional ones regarding discomfort during initial orthodontic therapy, number of appointments, and total treatment time. Due to the limited number of studies included, further randomized controlled clinical trials are required to deliver more data and to substantiate evidence-based conclusions on differences between the two bracket types considering orthodontic pain, number of visits, treatment, and ligation times.

Keywords

Systematic review Meta-analysis Self-ligating bracket Number of appointments Treatment time Orthodontic pain 

Systematisches Review über ligaturfreie und konventionelle Brackets: initiale Schmerzen, Anzahl der Behandlungstermine, Therapiedauer

Zusammenfassung

Fragestellung

Metaanalyse zu Unterschieden zwischen selbstligierenden und konventionellen Brackets hinsichtlich der Schmerzen bei Zahnbewegung, Behandlungsfrequenz, Behandlungsdauer und Ligationszeit.

Material und Methode

Onlinesuche in Medline, Embase und Central nach randomisierten klinischen und kontrollierten klinischen Studien der Jahre 1996–2012.

Ergebnisse

Den Einschlusskriterien entsprachen vier Schmerzstudien, zwei über die Anzahl an Behandlungsterminen, zwei zur Gesamttherapiedauer, aber keine Publikationen zur Dauer des Ein- und Ausligierens. Bei den Schmerzangaben nach 4 h, 24 h, 3 Tagen und 7 Tagen festsitzender Kieferorthopädie bestanden keine signifikanten Unterschiede zwischen selbstligierenden und konventionellen Brackets. Die Metaanalyse zeigte auch bei der Terminfrequenz und Gesamtbehandlungsdauer keine signifikant unterschiedlichen Gesamteffekte zwischen beiden Bracketarten.

Schlussfolgerung

Das Fehlen signifikanter Gesamteffekte in der Metaanalyse erlaubt keine evidenzbasierten Aussagen, dass selbstligierende Brackets geringere Schmerzen in der ersten Behandlungswoche, weniger Behandlungstermine oder kürzere Gesamtbehandlungsdauern bewirkten. Aufgrund der geringen Zahl brauchbarer Arbeiten bedarf es weiterer randomisierter, kontrollierter Studien, um mehr Daten und damit substanzielle, evidenzbasierte Konklusionen über Unterschiede zwischen selbstligierenden und konventionellen Brackets hinsichtlich Schmerz und zeitlicher Aspekte zu erlangen.

Schlüsselwörter

Systematisches Review Metaanalyse Selbstligierende Brackets Anzahl von Terminen Behandlungszeit Kieferorthopädisch bedingte Schmerzen 

Notes

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

References

  1. 1.
    Abramoff MD, Magalhaes PJ, Ram SJ (2004) Image processing with ImageJ. Biophoton Int 11:36–42Google Scholar
  2. 2.
    Bartzela T, Turp JC, Motschall E et al (2009) Medication effects on the rate of orthodontic tooth movement: a systematic literature review. Am J Orthod Dentofacial Orthop 135:16–26PubMedCrossRefGoogle Scholar
  3. 3.
    Berger J, Byloff FK (2001) The clinical efficiency of self-ligated brackets. J Clin Orthod 35:304–308PubMedGoogle Scholar
  4. 4.
    Bergius M, Berggren U, Kiliaridis S (2002) Experience of pain during an orthodontic procedure. Eur J Oral Sci 110:92–98PubMedCrossRefGoogle Scholar
  5. 5.
    Chen SS, Greenlee GM, Kim JE et al (2010) Systematic review of self-ligating brackets. Am J Orthod Dentofacial Orthop 137:726. e1–e726. e18 (discussion 726–727)PubMedCrossRefGoogle Scholar
  6. 6.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRefGoogle Scholar
  7. 7.
    DiBiase AT, Nasr IH, Scott P et al (2011) Duration of treatment and occlusal outcome using Damon3 self-ligated and conventional orthodontic bracket systems in extraction patients: a prospective randomized clinical trial. Am J Orthod Dentofacial Orthop 139:e111–e116PubMedCrossRefGoogle Scholar
  8. 8.
    Doll GM, Zentner A, Klages U et al (2000) Relationship between patient discomfort, appliance acceptance and compliance in orthodontic therapy. J Orofac Orthop 61:398–413PubMedCrossRefGoogle Scholar
  9. 9.
    Eberting JJ, Straja SR, Tuncay OC (2001) Treatment time, outcome, and patient satisfaction comparisons of Damon and conventional brackets. Clin Orthod Res 4:228–234PubMedCrossRefGoogle Scholar
  10. 10.
    Eltz M, Ibel G (2007) Passive und aktive selbstligierende Brackets im klinischen Alltag. Kieferorthopädie 21:203–210Google Scholar
  11. 11.
    Fernandes LM, Ogaard B, Skoglund L (1998) Pain and discomfort experienced after placement of a conventional or a superelastic NiTi aligning archwire. A randomized clinical trial. J Orofac Orthop 59:331–339PubMedCrossRefGoogle Scholar
  12. 12.
    Fleming PS, DiBiase AT, Lee RT (2010) Randomized clinical trial of orthodontic treatment efficiency with self-ligating and conventional fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 137:738–742PubMedCrossRefGoogle Scholar
  13. 13.
    Fleming PS, Dibiase AT, Sarri G et al (2009) Pain experience during initial alignment with a self-ligating and a conventional fixed orthodontic appliance system. A randomized controlled clinical trial. Angle Orthod 79:46–50PubMedCrossRefGoogle Scholar
  14. 14.
    Fleming PS, Johal A (2010) Self-ligating brackets in orthodontics. A systematic review. Angle Orthod 80:575–584PubMedCrossRefGoogle Scholar
  15. 15.
    Fuck LM, Wilmes B, Gürler G et al (2007) Frictional behavior of self ligating brackets in comparison to conventional brackets. Inf Orthod Kieferorthop 39:6–17CrossRefGoogle Scholar
  16. 16.
    Hamilton R, Goonewardene MS, Murray K (2008) Comparison of active self-ligating brackets and conventional pre-adjusted brackets. Aust Orthod J 24:102–109PubMedGoogle Scholar
  17. 17.
    Harradine NW (2001) Self-ligating brackets and treatment efficiency. Clin Orthod Res 4:220–227PubMedCrossRefGoogle Scholar
  18. 18.
    Harradine NW (2003) Self-ligating brackets: where are we now? J Orthod 30:262–273PubMedCrossRefGoogle Scholar
  19. 19.
    Higgins JPT, Green S, Collaboration C (2008) Cochrane handbook for systematic reviews of interventions. Wiley Online LibraryGoogle Scholar
  20. 20.
    Jäger A, Braumann B, Kim C et al (2001) Skeletal and dental effects of maxillary protraction in patients with angle class III malocclusion. A meta-analysis. J Orofac Orthop 62:275–284PubMedCrossRefGoogle Scholar
  21. 21.
    Jiang LQ, Dai J, Liu JL (2009) Comparative study on pain experience with fixed orthodontic treatment of Damon 3Mx™ self-ligating and conventional Mbt™ appliance. J Xi’an Jiaotong University (Medical Sciences) 30:648–650Google Scholar
  22. 22.
    Kaklamanos EG, Athanasiou AE (2011) Systematic review of self-ligating brackets. Am J Orthod Dentofacial Orthop 139:145–146 (author reply 146–147)PubMedCrossRefGoogle Scholar
  23. 23.
    Krishnan V (2007) Orthodontic pain: from causes to management — a review. Eur J Orthod 29:170–179PubMedCrossRefGoogle Scholar
  24. 24.
    McNamara JAJ, Bagramian RA (1999) Prospective survey of percutaneous injuries in orthodontic assistants. Am J Orthod Dentofacial Orthop 115:72–76PubMedCrossRefGoogle Scholar
  25. 25.
    Miles P, Weyant R (2010) Porcelain brackets during initial alignment: are self-ligating cosmetic brackets more efficient? Aust Orthod J 26:21–26PubMedGoogle Scholar
  26. 26.
    Miles PG, Weyant RJ, Rustveld L (2006) A clinical trial of Damon 2 vs conventional twin brackets during initial alignment. Angle Orthod 76:480–485PubMedGoogle Scholar
  27. 27.
    Paduano S, Cioffi I, Iodice G et al (2008) Time efficiency of self-ligating vs conventional brackets in orthodontics: effect of appliances and ligating systems. Prog Orthod 9:74–80PubMedGoogle Scholar
  28. 28.
    Pandis N, Polychronopoulou A, Eliades T (2006) Failure rate of self-ligating and edgewise brackets bonded with conventional acid etching and a self-etching primer: a prospective in vivo study. Angle Orthod 76:119–122PubMedGoogle Scholar
  29. 29.
    Pizzoni L, Ravnholt G, Melsen B (1998) Frictional forces related to self-ligating brackets. Eur J Orthod 20:283–291PubMedCrossRefGoogle Scholar
  30. 30.
    Pramanik K, Das U, Adhikari B et al (2008) RhCl3-assisted C–H and C–S bond scissions: isomeric self-association of organorhodium(III) thiolato complex. synthesis, structure, and electrochemistry. Inorg Chem 47:429–438PubMedCrossRefGoogle Scholar
  31. 31.
    Pringle AM, Petrie A, Cunningham SJ et al (2009) Prospective randomized clinical trial to compare pain levels associated with 2 orthodontic fixed bracket systems. Am J Orthod Dentofacial Orthop 136:160–167PubMedCrossRefGoogle Scholar
  32. 32.
    Read-Ward GE, Jones SP, Davies EH (1997) A comparison of self-ligating and conventional orthodontic bracket systems. Br J Orthod 24:309–317PubMedCrossRefGoogle Scholar
  33. 33.
    Rinchuse DJ, Miles PG (2007) Self-ligating brackets: present and future. Am J Orthod Dentofacial Orthop 132:216–222PubMedCrossRefGoogle Scholar
  34. 34.
    Scheurer PA, Firestone AR, Burgin WB (1996) Perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod 18:349–357PubMedGoogle Scholar
  35. 35.
    Scott P, Sherriff M, Dibiase AT et al (2008) Perception of discomfort during initial orthodontic tooth alignment using a self-ligating or conventional bracket system: a randomized clinical trial. Eur J Orthod 30:227–232PubMedCrossRefGoogle Scholar
  36. 36.
    Sergl HG, Klages U, Zentner A (1998) Pain and discomfort during orthodontic treatment: causative factors and effects on compliance. Am J Orthod Dentofacial Orthop 114:684–691PubMedCrossRefGoogle Scholar
  37. 37.
    Shivapuja PK, Berger J (1994) A comparative study of conventional ligation and self-ligation bracket systems. Am J Orthod Dentofacial Orthop 106:472–480PubMedCrossRefGoogle Scholar
  38. 38.
    Tecco S, D’Attilio M, Tete S et al (2009) Prevalence and type of pain during conventional and self-ligating orthodontic treatment. Eur J Orthod 31:380–384PubMedCrossRefGoogle Scholar
  39. 39.
    Thomas S, Sherriff M, Birnie D (1998) A comparative in vitro study of the frictional characteristics of two types of self-ligating brackets and two types of pre-adjusted edgewise brackets tied with elastomeric ligatures. Eur J Orthod 20:589–596PubMedCrossRefGoogle Scholar
  40. 40.
    Thorstenson GA, Kusy RP (2002) Comparison of resistance to sliding between different self-ligating brackets with second-order angulation in the dry and saliva states. Am J Orthod Dentofacial Orthop 121:472–482PubMedCrossRefGoogle Scholar
  41. 41.
    Turnbull NR, Birnie DJ (2007) Treatment efficiency of conventional vs self-ligating brackets: effects of archwire size and material. Am J Orthod Dentofacial Orthop 131:395–399PubMedCrossRefGoogle Scholar
  42. 42.
    Ukra A, Bennani F, Farella M (2011) Psychological aspects of orthodontics in clinical practice. Part one: treatment-specific variables. Prog Orthod 12:143–148PubMedCrossRefGoogle Scholar
  43. 43.
    Van Leeuwen EJ, Kuijpers-Jagtman AM, Von den Hoff JW et al (2010) Rate of orthodontic tooth movement after changing the force magnitude: an experimental study in beagle dogs. Orthod Craniofac Res 13:238–245CrossRefGoogle Scholar
  44. 44.
    Xiaoting L, Yin T, Yangxi C (2010) Interventions for pain during fixed orthodontic appliance therapy. A systematic review. Angle Orthod 80:925–932PubMedCrossRefGoogle Scholar
  45. 45.
    Yamaguchi M, Takizawa T, Nakajima R et al (2009) The Damon system and release of substance P in gingival crevicular fluid during orthodontic tooth movement in adults. World J Orthod 10:141–146PubMedGoogle Scholar
  46. 46.
    Yorita R, Sameshima GT (2007) A comparison of self-ligating and conventional orthodontic bracket systems. IADR 85th General Session and Exhibition, Abstract 1918Google Scholar
  47. 47.
    Zhu YL (2009) Tolerance comparison between patients with self-ligating brackets and conventional straight wire brackets during initial alignment. J Clin Rehab Tissue Eng Res 13:4893–4896Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • A.G. Čelar
    • 1
  • M. Schedlberger
    • 1
  • P. Dörfler
    • 1
  • M.H. Bertl
    • 1
  1. 1.Division of OrthodonticsBernhard Gottlieb University Clinic of Dentistry, Medical University of ViennaViennaAustria

Personalised recommendations