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Transversal changes, space closure, and efficiency of conventional and self-ligating appliances

A quantitative systematic review

Transversale Veränderungen, Lückenschluss und Wirksamkeit von selbstligierenden vs. konventionellen Brackets

Ein quantitatives systematisches Review

Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie volume 79, pages 1–10 (2018)Cite this article

Abstract

Objective

Self-ligating brackets (SLBs) were compared to conventional brackets (CBs) regarding their effectiveness on transversal changes and space closure, as well as the efficiency of alignment and treatment time.

Methods

All previously published randomized controlled clinical trials (RCTs) dealing with SLBs and CBs were searched via electronic databases, e.g., MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. In addition, relevant journals were searched manually. Data extraction was performed independently by two reviewers and assessment of the risk of bias was executed using Cochrane Collaboration’s tool. Discrepancies were resolved by discussion with a third reviewer. Meta-analyses were conducted using Review Manager (version 5.3).

Results

A total of 976 patients in 17 RCTs were included in the study, of which 11 could be produced quantitatively and 2 showed a low risk of bias. Meta-analyses were found to favor CB for mandibular intercanine width expansion, while passive SLBs were more effective in posterior expansion. Moreover, CBs had an apparent advantage during short treatment periods. However, SLBs and CBs did not differ in closing spaces.

Conclusions

Based on current clinical evidence obtained from RCTs, SLBs do not show clinical superiority compared to CBs in expanding transversal dimensions, space closure, or orthodontic efficiency. Further high-level studies involving randomized, controlled, clinical trials are warranted to confirm these results.

Zusammenfassung

Ziel

Selbstligierende Brackets (SLBs) und konventionelle Brackets (CBs) wurden hinsichtlich transversaler Expansion Lückenschluss, Nivellierungseffizienz und Behandlungszeit verglichen.

Methoden

In klinischen Datenbanken (MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, Chinese Biomedical Literature Database, China National Knowledge Infrastructure) wurde nach sämtlichen bisher publizierten randomisierten, kontrollierten klinischen Studien (RCTs) zu SLBSs und CBs gesucht. Zudem wurden relevante Periodika händisch durchgesehen. Die Daten wurden von 2 Reviewern unabhängig extrahiert, das Bias-Risiko wurde mit dem entsprechenden Cochrane-Collaboration-Tool ermittelt und Diskrepanzen wurden mit einem dritten Reviewer bis zur Konsensfindung diskutiert. Die Metaanalysen wurden mit der Software RevMan (Version 5.3) durchgeführt.

Ergebnisse

Insgesamt 976 Patienten aus 17 RCTs wurden in die Studie aufgenommen, 11 RCTs eigneten sich für die quantitative Synthese, wobei bei zwei Studien ein geringes Bias-Risiko bestand. Metaanalysen zeigten, dass CBs hinsichtlich der Erweiterung der intercaninen Distanz im Unterkiefer überlegen waren. Passive SLBs dagegen waren effektiver bei der Expansion im Molarenbereich. Zudem zeigten sich CBs offensichtlich / scheinbar vorteilhaft bei kurzen Behandlungszeiten. Beim Lückenschluss unterschieden sich SLBs und CBs nicht.

Schlussfolgerungen

Auf der Basis der aktuell verfügbaren klinischen Evidenz aus RCTs zeigten SLBs im Vergleich zu CBs keine klinische Überlegenheit hinsichtlich transversaler Expansion, Lückenschluss bzw. kieferorthopädischer Effizienz. Zur Bestätigung dieser Ergebnisse bedarf es weiterer qualitativ hochwertiger Forschung einschließlich randomisierter, kontrollierter klinischer Studien.

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References

  1. Atik E, Clger S (2014) An assessment of conventional and self-ligating brackets in Class I maxillary constriction patients. Angle Orthod 84:615–622

    Article  PubMed  Google Scholar 

  2. Burrow SJ (2010) Canine retraction rate with self-ligating brackets vs conventional edgewise brackets. Angle Orthod 80:626–633

    Article  Google Scholar 

  3. Celar A, Schedberger M, Dorfler P, Bertl M (2013) Systematic review on self-ligating vs. conventional brackets: initial pain, number of visits, treatment time. J Orofac Orthop 74:40–51

    Article  PubMed  Google Scholar 

  4. Chen SSH, Greenlee GM, Kim JE, Smith CL, Huang GJ (2010) Systematic review of self-ligating brackets. Am J Orthod Dentofac Orthop 137:726.e1–726.e18

    Google Scholar 

  5. DiBiase AT, Nasr IH, Scott PP, Cobourne MT (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 Dentofac Orthop 139:111–116

    Article  Google Scholar 

  6. Ehsanl S, Mandich MA, El-Bialy TH, Flores-Mir C (2009) Frictional resistance in self-ligating orthodontic brackets and conventionally ligated brackets. A systematic review. Angle Orthod 79:592–601

    Google Scholar 

  7. Fleming PS, DiBiase AT, Sarri G, Lee RT (2009) Comparison of mandibular arch changes during alignment and leveling with 2 preadjusted edgewise appliances. Am J Orthod Dentofac Orthop 136:340–347

    Article  Google Scholar 

  8. Fleming PS, DiBiase AT, Sarri G, Lee RT (2009) Efficiency of mandibular arch alignment with 2 preadjusted edgewise appliances. Am J Orthod Dentofac Orthop 135:597–602

    Article  Google Scholar 

  9. Fleming PS, DiBases AT, Lee RT (2010) Randomized clinical trial of orthodontic treatment efficiency with self-ligating and conventional fixed orthodontic appliances. Am J Orthod Dentofac Orthop 137:738–742

    Article  Google Scholar 

  10. Fleming PS, Johal A (2010) Self-ligating brackets in orthodontics: a systematic review. Angle Orthod 80:575–584

    Article  PubMed  Google Scholar 

  11. Fleming PS, Lee RT, Marinho V, Johal A (2013) Comparison of maxillary arch dimensional changes with passive and active self-ligation and conventional brackets in the permanent dentition: a multicenter, randomized controlled trial. Am J Orthod Dentofac Orthop 144:185–193

    Article  Google Scholar 

  12. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ, GRADE Working Group (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926

    Article  PubMed  PubMed Central  Google Scholar 

  13. Higgins JPT, Altman DG (2008) Assessing risk of bias. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions. Wiley, Chichester, pp 8.1–8.44

    Chapter  Google Scholar 

  14. Johansson K, Lundstrom F (2012) Orthodontic treatment efficiency with self-ligating and conventional edgewise twin brackets: a prospective randomized clinical trial. Angle Orthod 85:929–934

    Article  Google Scholar 

  15. Jongsma MA, van der Mei HC, Atema-Smit J, Busscher HJ, Ren Y (2014) In vivo biofilm formation on stainless steel bonded retainers during different oral health-care regimens. Int J Oral Sci 69:1–7

    Google Scholar 

  16. Monini AC, Jnior GG, Martins RP, Vianna AP (2014) Canine retraction and anchorage loss self-ligating versus conventional brackets in a randomized split-mouth study. Angle Orthod 84:846–852

    Article  Google Scholar 

  17. Mezomo M, Lima ES, Menezes LM et al (2011) Maxillary canine retraction with self-ligating and conventional brackets: a randomized clinical trial. Angle Orthod 81:292–297

    Article  PubMed  Google Scholar 

  18. Miles PG (2009) Self-ligating brackets in orthodontics: do they deliver what they claim? Aust Dent J 54:9–11

    Article  PubMed  Google Scholar 

  19. Miles P, Weyant R (2010) Porcelain brackets during initial alignment: are self-ligating cosmetic brackets more efficient? Aust Dent J 26:21–26

    Google Scholar 

  20. Nucera R, Giudice AL, Matarese G, Artemisia A, Bramanti E, Crupi P, Cordasco G (2013) Analysis of the characteristics of slot design affecting resistance to sliding during active archwire configurations. Prog Orthod 14:35

    Article  PubMed  PubMed Central  Google Scholar 

  21. Pandis N, Polychronopoulou A, Eliades T (2007) Self-ligating vs conventional brackets in the treatment of mandibular crowding a prospective clinical trial of treatment duration and dental effects. Am J Orthod Dentofac Orthop 132:208–215

    Article  Google Scholar 

  22. Pandis N, Polychronopoulou A, Kataros C, Eliades T (2011) Comparative assessment of conventional and self-ligating appliances on the effect of mandibular intermolar distance in adolescent nonextraction patients: a single-center randomized controlled trial. Am J Orthod Dentofac Orthop 140:e99–e105

    Article  Google Scholar 

  23. Pandis N, Fleming PS, Spineli LM, Salanti G (2014) Initial orthodontic alignment effectiveness with self-ligating and conventional appliances: a network meta-analysis in practice. Am J Orthod Dentofac Orthop 145:152–163

    Article  Google Scholar 

  24. Rinchuse DJ, Miles PG (2007) Self-ligating brackets: present and future. Am J Orthod Dentofac Orthop 132:216–222

    Article  Google Scholar 

  25. Scott P, DiBiase AT, Sherriff M, Cobourne MT (2008) Alignment efficiency of Damon3 self-ligating and conventional orthodontic bracket systems: a randomized clinical trial. Am J Orthod Dentofac Orthop 134:470.e1–470.e8

    Google Scholar 

  26. Songra G, Clover M, Atack NE, Ewings P, Sherriff M, Sandy JR, Ireland AJ (2014) Comparative assessment of alignment efficiency and space closure of active and passive self-ligating vs conventional appliance in adolescents: a single-center randomized controlled trial. Am J Orthod Dentofac Orthop 145:569–578

    Article  Google Scholar 

  27. Stolzenberg J (1935) The Russell attachment and its improved advantages. Int J Orthod Dent Child 2:837–840

    Article  Google Scholar 

  28. Wong H, Collins Tinsley D, Sandler J, Benson P (2013) Does the bracket-ligature combination affect the amount of orthodontic space closure over three months? A randomized controlled trial. J Orthod 40:155–162

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wahab RM, Idris H, Yacob H, Ariffin SH (2011) Comparison of self- and conventional-ligating brackets in the alignment stage. Eur J Orthod 34:176–181

    Article  PubMed  Google Scholar 

  30. Yang X, Su N, Shi Z, Xiang Z, He Y, Han X, Bai D (2016) Effects of self-ligating brackets on oral hygiene and discomfort: a systematic review and meta-analysis of randomized controlled clinical trials. Int J Dent Hyg 15:16–22

    Article  PubMed  Google Scholar 

  31. Zhou B, Wang J, Stein EM, Zhang Z, Nishiyama KK, Zhang CA, Nickolas TL, Shane E, Guo XE (2014) Bone density microarchitecture and stiffness in Caucasian and Caribbean Hispanic postmenopausal American women. Bone Res 16:1–9

    Google Scholar 

  32. Zhou Q, Ul Haq AA, Tian L, Chen X, Huang K, Zhou Y (2015) Canine retraction and anchorage loss self-ligating versus conventional brackets: a systematic review and meta-analysis. BMC Oral Health 15:136

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China

    Xianrui Yang, Chaoran Xue, Yiruo He, Mengyuan Zhao, Mengqi Luo & Peiqi Wang

  2. Department Chair, Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 3rd Section of Renmin South Road, Chengdu, 610041, Sichuan, China

    Ding Bai

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Yang, X., Xue, C., He, Y. et al. Transversal changes, space closure, and efficiency of conventional and self-ligating appliances. J Orofac Orthop 79, 1–10 (2018). https://doi.org/10.1007/s00056-017-0110-4

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  • DOI: https://doi.org/10.1007/s00056-017-0110-4

Keywords

  • Transversal changes
  • Orthodontic efficiency
  • Conventional brackets
  • Self-ligating bracket
  • Meta-analysis

Schlüsselwörter

  • Transversale Veränderungen
  • kieferorthopädische Effizienz
  • konventionelle Brackets
  • selbstligierende Brackets
  • Metaanalyse