Clinical effects with customized brackets and CAD/CAM technology: a prospective controlled study.

Area of Science:

• Orthodontics
• Biomaterials
• Dental Technology

Background:

• Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) technologies are increasingly integrated into orthodontics.
• These technologies enable the creation of patient-specific, customized bracket systems.
• The clinical efficiency of customized CAD/CAM brackets compared to conventional systems requires thorough evaluation.

Purpose of the Study:

• To prospectively evaluate the clinical efficiency of an indirect bonded customized CAD/CAM bracket system.
• To compare the outcomes of customized CAD/CAM brackets with directly bonded conventional self-ligating brackets.

Main Methods:

• A prospective quasi-randomized study involving 38 patients divided into two groups.
• Group 1: Directly bonded conventional self-ligating brackets (Damon).
• Group 2: Indirectly bonded customized CAD/CAM brackets (Insignia™).
• Comparison of treatment time, appointments, bracket failures, archwire usage, irregularity index, cephalometric analyses, and ABO scores.
• Virtual setup superimpositions for the CAD/CAM group to assess treatment plan realization.

Main Results:

• No significant differences were observed in overall treatment time, number of appointments, or archwire bends between the groups.
• CAD/CAM systems experienced more bonding failures, but indirectly bonded brackets required fewer repositioning interventions.
• Both systems yielded similar reductions in ABO scores; however, the CAD/CAM group used more archwires.
• Incisor proclination was observed in both groups, with greater proclination in the lower jaw and a statistically significant difference between systems.
• Virtual setup comparisons showed best accuracy in mesial and vertical positions, with greatest discrepancies in transversal positions and inclinations.

Conclusions:

• Indirectly bonded customized CAD/CAM brackets demonstrate minor influence on overall orthodontic treatment efficiency and outcomes compared to direct bonded self-ligating brackets.
• Challenges persist in achieving precise transversal expansion, deep bite correction, torque expression, and anchorage control with straight-wire appliances.
• The study is registered under DRKS00024350.