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Accuracy of 3D-printed customized orthodontic bracket: A systematic review and meta-analysis of in vitro studies
Rashad I Shaadouh1, Mohammad Y Hajeer2, Mohammad Khursheed Alam3
1Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, Syria.
Background:
Dimensional accuracy of orthodontic bracket slots critically influences the bracket's performance and the quality of treatment outcomes. Conventional brackets frequently show dimensional deviations from the basic bracket manufacturing standards. 3D-printing technology may make it possible to manufacture high-precision custom brackets.
Objective:
This systematic review aimed to critically evaluate the available evidence regarding the accuracy of orthodontic 3D-printed brackets and their compliance with the international standard Deutsche Industrie Norm DIN 13971-2. Secondarily, it sought to compare their accuracy to traditionally manufactured brackets.
Methods:
An electronic search of available literature across six electronic databases up to April 14, 2025, was conducted by two reviewers. Eligibility criteria were adopted based on the PICOS structure and in vitro studies were included. The QUIN tool was used to assess the risk of bias. The following data were extracted from all accepted articles: customized bracket material, printing technology, apparatus of measurement, key outcomes (printing trueness, geometric accuracy, dimensional accuracy of bracket slot, surface Integrity).
Results:
Six in vitro studies were included in this systematic review. The pooled estimate of mean slot height showed that the slot heights of 0.022 in 3D-printed brackets tend to be slightly oversized compared to the nominal value (0.566mm) which was within the tolerance limits of DIN 13971-2. 3D-printed brackets exhibited statistically superior dimensional accuracy compared to conventional metal (SMD=-3.07), ceramic (SMD=-1.82), and self-ligating brackets (SMD=-6.09). However, their surface roughness was generally higher. The accuracy, geometric fidelity, and surface integrity were highly influenced by printing technology and materials used.
Conclusions:
3D-printed orthodontic brackets exhibit clinically acceptable dimensional accuracy of the bracket slot that can surpass conventional brackets. Optimal printing results depend critically on selecting appropriate printing techniques and applying stringent post-processing protocols.
Registration:
PROSPERO database (CRD420251165769).
