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Title Self-ligating Brackets Lead To Less Plaque Accumulation Compared To Elastomeric Ring-Ligated Orthodontic Brackets
Clinical Question Do self-ligating brackets lead to reduced plaque accumulation compared to elastomeric ring ligated orthodontic brackets in patients undergoing orthodontic treatment?
Clinical Bottom Line Self-Ligating brackets lead to less plaque accumulation as well as reduced bacterial counts within the plaque compared to elastomeric ring ligated orthodontic brackets. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19361723Pellegrini/200918 orthodontic patients that are between ages of 11-17 (only 14 completed the study).Split Mouth Control Trial.
Key resultsData gathered from culture specimens one week after bonding demonstrated that total bacterial plaque load and oral streptococci count was lower for teeth bonded with self-ligating brackets (mean for total bacteria =2x10^6, mean for oral streptococci = 0.7x10^6) compared to teeth bonded with elastomeric brackets (mean for total bacteria = 5 x 10^6, mean for oral streptococci = 2x10^6). This trend was also observed for total bacteria plaque load and oral streptocci count from culture specimens after five weeks (Total bacterial mean: 2x10^6 self-ligating brackets vs. 3x10^6 for elastomeric brackets. Oral Streptococci mean: 0.5x10^6 for self-ligating brackets vs. 2x10^6 for elastomeric brackets). The results from culture from both recall intervals (week 1 and week 5) are considered clinically significant (p<0.05). These results are further supported from data gathered via ATP bioluminescence, where more patients demonstrated clinically significantly less total bacteria (p=0.028) count and oral streptococci count (p=0.007) surrounding self-ligating brackets compared to elastomeric brackets. The data gathered from week five via ATP bioluminescence revealed a greater total bacteria count surrounding elastomeric brackets compared to self-ligating brackets, but the results were not clinically significant (p = 0.074). For oral streptococci count gathered at week five via ATP bioluminescence, there was clinical significantly less oral streptococci count surrounding self-ligating bracket compared to elastomeric brackets (p = 0.025).
Evidence Search Search "Orthodontic Brackets"[Mesh] AND "Dental Plaque"[Mesh] Limits: Randomized Controlled Trial Search "Orthodontic Brackets"[Mesh] AND "Dental Plaque"[Mesh] Limits: Meta-AnalysisSearch "Orthodontic Brackets"[Mesh] AND "Dental Plaque"[Mesh] Limits: Systematic ReviewsSearch "Orthodontic Brackets"[Mesh] AND "Dental Plaque"[Mesh]
Comments on
The Evidence
This was a randomized control (split mouth) trial. Groups were made similar before the study began in which all teeth involved received the same prophylactic treatment. The completion rate was 77.78% (14 out of 18 patients completed the study). The follow up and compliance were both adequate, but the study cannot be considered double blind. The study utilized a randomized split mouth design, and the doctor employed a standardized technique to collect specimens. The patients were all treated the same (same tooth brush, tooth paste and oral hygiene instructions). Due to the standardized nature of the study, recall bias is unlikely. Competing interests were not detected.
Applicability This evidence is very applicable to virtually any dental office offering orthodontic services with an interest in plaque reduction and preventing white spot lesions in teenagers.
Specialty/Discipline (Orthodontics)
Keywords Orthodontic Brackets, Dental Plaque
ID# 558
Date of submission: 03/31/2010spacer
E-mail chenk@livemail.uthscsa.edu
Author Kat Shao
Co-author(s) e-mail
Faculty mentor/Co-author Peter T. Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail GAKUNGA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Shahad Abudawood (San Antonio, TX) on 07/14/2011
I agree with Dr. Jeff Shao, this scientific article is the most updated and has the highest rank on the hierarchy of evidence based dentistry currently available.
by Jeff Shao (San Antonio, TX) on 07/12/2011
This article is still up to date and has the highest rank on the hierarchy of evidence based dentistry. Randomized Controlled Trial.

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