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Is there any difference between conventional, passive and active self-ligating brackets? A systematic review and
Raphaëlle Maizeray1, Delphine Wagner1, François Lefebvre2
1Sous-section d'Orthopédie dento-faciale, Faculté de Chirurgie Dentaire, Université de Strasbourg, 8, rue Ste-Élisabeth, 67000 Strasbourg, France.
This network meta-analysis found few significant differences between conventional (CBs), passive self-ligating (PSLBs), and active self-ligating (ASLBs) orthodontic brackets. While ASLBs offered faster archwire ligation and PSLBs showed some advantages in incisor positioning, most claims by bracket manufacturers were not supported.
Area of Science:
- Orthodontics and Dental Biomaterials
Background:
- Self-ligating brackets (SLBs) are designed to simplify orthodontic procedures and potentially improve treatment outcomes compared to conventional brackets (CBs).
- Passive (PSLBs) and active (ASLBs) self-ligating systems differ in their mechanisms for holding the archwire, leading to varied clinical claims.
- A comprehensive comparison using network meta-analysis is needed to evaluate the evidence for treatment efficiency across these bracket types.
Purpose of the Study:
- To conduct a network meta-analysis comparing treatment efficiency between conventional brackets (CBs), passive self-ligating brackets (PSLBs), and active self-ligating brackets (ASLBs).
- To evaluate key orthodontic variables including treatment duration, alignment rate, arch dimensional changes, incisor position, and patient-reported outcomes.
Main Methods:
- Systematic electronic search of PubMed, Web of Science, and Cochrane Library databases up to January 2019.
- Inclusion of randomized controlled trials (RCTs) and split-mouth design studies (SMDs) only.
- Network meta-analysis combining data from 30 RCTs and 9 SMDs, evaluating 85 comparisons across multiple clinical variables.
Main Results:
- Only 16 out of 85 comparisons showed statistically significant differences.
- Active self-ligating brackets (ASLBs) demonstrated faster archwire ligation/unligation compared to CBs.
- Passive self-ligating brackets (PSLBs) showed reduced maxillary incisor proclination and less bleeding on probing compared to CBs in non-extraction cases.
- Alignment was approximately 10 days faster with ASLBs versus PSLBs, though overall treatment duration was not significantly different.
- Greater incisor proclination (IMPA) was observed with CBs compared to both ASLBs and PSLBs in extraction cases.
Conclusions:
- The majority of evaluated variables showed no significant differences between CBs, PSLBs, and ASLBs.
- Key differences included faster archwire manipulation with ASLBs and increased discomfort with PSLBs during wire insertion/removal compared to CBs.
- The clinical benefits of self-ligating brackets, particularly regarding treatment efficiency claims, are largely unsubstantiated by the current evidence base.
