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Computer-aided indirect bonding versus traditional direct bonding of orthodontic brackets: bonding accuracy and
Izabela Czolgosz1, Paolo M Cattaneo2, Malgorzata Sowinska3
1Ludwik Rydygier Collegium Medicum in Bydgoszcz. Department of Maxillofacial Orthopaedics and Orthodontics, Nicolaus Copernicus University, Jagiellońska 13-15 Street, 85-067 Bydgoszcz, Poland.
Objectives:
The aims of this randomized controlled trial were to compare the accuracy of computer-aided indirect bonding with conventional direct bonding, and to evaluate bracket survival.
Methods:
Consecutive patients were randomly allocated to two groups (blocks of four, online generated sequence) using a split-mouth design with a computer-aided indirect and a direct bonding method: group 1 (upper right and lower left quadrants: computer-aided indirect bonding; upper left and lower right quadrants: direct bonding) or group 2 (opposite situation). Modified ABO-OGS scores were calculated at the end of treatment. Bracket bonding failures, as well as bracket rebondings and finishing bends because of inaccurate bracket positioning were recorded at every visit. The primary outcome was bracket placement accuracy. The secondary outcome was bracket survival. Outcome assessment was blinded. To compare bracket placement accuracy, paired t-tests were used together with linear mixed models. For the survival analysis, a piecewise Cox model was used.
Results:
Thirty-seven patients were randomized to group 1 or group 2. Twenty-seven patients were analyzed for bracket survival, and 26 for ABO-OGS scores. There was no significant difference (P = 0.76, 95% CI: -1.18, 0.87) in mean modified ABO-OGS scores between both methods. Among the brackets bonded with computer-aided indirect bonding, 66 brackets (27%) needed rebonding or finishing bends because of inaccurate positioning. Fifty-six brackets bonded with direct bonding (23%) were rebonded or required finishing bends because of inaccurate bracket positioning. The bonding method did not appear to significantly influence the proportion of teeth needing rebonding/wire bending because of inaccurate bracket positioning. A total of 44 out of 532 brackets got debonded throughout treatment: 22 debonded brackets were totalized with each bonding method (8.3%). There was no statistically significant difference in survival between both bonding techniques. The hazard ratio (HR) computer-aided indirect bonding to direct bonding during the first year was estimated at 1.15 (P = 0.67, 95% CI: 0.61, 2.17). After the first year, the HR indirect to direct was estimated at 0.46 (P = 0.38, 95% CI: 0.09, 2.53). No harm was observed.
Conclusions:
There were no statistically significant differences in bonding accuracy and in bracket survival between computer-aided indirect and direct bonding methods.
Registration:
This trial was retrospectively registered on ClinicalTrials.gov (University of Aarhus Protocol Record 10101).
Protocol:
The protocol was not published before trial commencement.