ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Direct and Indirect Bonding of Orthodontic Brackets Display No Difference in Bond Failure Rate
Clinical Question In patients undergoing orthodontic treatment, does indirect bonding of orthodontic brackets have lower bond failure rates compared to direct bonding?
Clinical Bottom Line There was no difference in bond failure rate between direct and indirect bonding of orthodontic brackets.
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) 18068590Deahl/2007 Patients undergoing orthodontic treatment lasting at least one year, with full fixed appliances on both the upper and lower arches.Other
Key resultsNo difference in bond failure rate was found between direct and indirect bonding of orthodontic brackets (P= 0.225). Samples were collected from 11 orthodontists examining 29,963 brackets in 1,368 patients. 5 orthodontists used direct bonding methods with 772 patients. 6 orthodontists used indirect bonding on 596 patients.
#2) 16926313Thiyagarajah/2006Adolescent patients undergoing orthodontic treatment lasting at least one year, with full fixed appliances on both the upper and lower arches.Randomized Controlled Trial
Key resultsNo significant difference in the bond failure rate was found between direct and indirect bonding of orthodontic brackets (P=0.565). 33 patients aged 12-15 were randomly assigned to two different groups for a split mouth study.
Evidence Search "indirect" AND "Direct" AND "bonding" AND "Bracket"
Comments on
The Evidence
Deahl, et al sampled multiple orthodontists, covering a large sample size of patients. Since there was no oversight in the selection criteria, the exact similarity between patient groups is unknown. There was adequate follow up of the patients. Patient compliance and completion was not an issue since the treatment was at the patients’ expense. Thiyagarajah, et al used a single blinded randomized split mouth study in order to eliminate the operator error and bias. They had similar groups at the start of the trial. They had a 32 of the 33 initial patients complete the study. There was adequate follow up of the patients. There appears to be no recall bias with the patients.
Applicability Both studies conclude that direct and indirect bonding methods display equal bond failure rates in patients receiving orthodontic treatment. Since there are no adverse effects, the only limiting factor is the practitioner’s familiarity with either method. Practitioners using an unfamiliar method should expect to see a higher failure rate initially. This rate should then decrease as they gain more experience with that particular technique.
Specialty/Discipline (Orthodontics)
Keywords Orthodontic brackets, direct bonding, indirect bonding
ID# 2685
Date of submission: 03/28/2014spacer
E-mail mayberryd@livemail.uthscsa.edu
Author Derick Mayberry
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Clarence C. Bryk, DDS, MS
Faculty mentor/Co-author e-mail brykc@uthscsa.edu
Basic Science Rationale
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