Accuracy of bracket placement by orthodontists and inexperienced dental students

Well-finished orthodontic treatment begins with accurate positioning of the brackets on the teeth.

To compare the positions of orthodontic brackets placed by experienced clinicians and inexperienced trainees.

Twenty orthodontists (13 male, 7 female) representing experienced specialists, and 20 final year dental students (10 male, 10 female) representing inexperienced trainees, were asked to bond pre-adjusted straight-wire brackets at the centres of the clinical crowns of the teeth in a Class I crowded typodont set-up. The teeth were removed from the typodont, placed in a standardised jig and photographed. The vertical, mesiodistal and angular (tip) positions of the brackets, relative to the centres of the clinical crowns, were measured with the aid of imaging software. The accuracy of bracket placement by the groups was compared.

The dental students took significantly longer than orthodontists to place the brackets (50.65 +/- 16.33 minutes vs 28.53 +/- 9.51 minutes, p < 0.001), but were more accurate than the orthodontists at positioning the brackets vertically (0.90 +/- 0.21 mm vs 1.19 +/- 0.23 mm, p < 0.001). There were no statistically significant differences between the dental students and the specialists in either the mesio-distal or the angular/tip positions of the brackets (p > 0.05). Both groups tended to bond the brackets with a distal tip. The students had slightly more right-left differences than the orthodontists. Mesio-distal errors in bracket placement were associated with rotated and displaced teeth.

Accurate direct bonding of orthodontic brackets to teeth does not appear to be related to clinical experience or specialist training.