Orthodontic bracket bonding techniques and adhesion failures: A systematic review and meta-analysis

Area of Science:

• Orthodontics
• Dental Materials Science
• Clinical Research Methodology

Background:

• Orthodontic bracket bonding is crucial for treatment success.
• Direct and indirect bonding techniques are commonly used.
• Understanding bonding failure rates is essential for clinical decision-making.

Purpose of the Study:

• To systematically compare the bonding failures between indirect and direct orthodontic bracket bonding techniques.
• To answer whether the indirect technique reduces bonding failures compared to the direct technique over time in permanent teeth.

Main Methods:

• Systematic review of randomized clinical trials comparing indirect and direct bracket bonding.
• Searched databases included Cochrane Library, LILACS, BBO, PubMed, Scopus, and Web of Science.
• Assessed study quality using the Cochrane risk of bias tool and evidence quality with GRADE.

Main Results:

• Seven studies were included in the meta-analysis.
• No significant difference in bonding failures between techniques from 0-6 months (RR = 0.59).
• Direct bonding showed a lower failure rate at 12-15 months (RR = 1.44), with high-quality evidence.

Conclusions:

• Direct bracket bonding technique demonstrates a lower failure rate in the long term (12-15 months) compared to the indirect technique.
• The high quality of evidence supports the superiority of direct bonding for long-term adhesion.
• Clinical practice may benefit from considering direct bonding for improved bracket retention.