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Title Customized Orthodontic Brackets Appear to Have No Impact on Treatment Duration
Clinical Question In patients undergoing orthodontic treatment with fixed appliances, can custom brackets reduce orthodontic treatment duration when compared with non-customized (conventional) brackets?
Clinical Bottom Line More clinical research is needed to evaluate the impact of customized brackets on treatment time. The results vary widely between published articles. However, based on the limited number and hierarchy of studies currently published, customized orthodontic brackets appear to have no impact on treatment duration.
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) 28742420Penning/2017147 Fixed orthodontic patientsRandomized Controlled Trial
Key resultsOf the 174 patients who completed the treatment, 89 were in the non-customized group and 85 were in the customized group, with an average treatment time of 1.24± 0.37 years and 1.29± 0.35 years respectively. A higher pretreatment weighted peer assessment ratio (PAR) and the orthodontist treating the case both had a significant effect on the treatment duration (P<0.05) . The bracket system used (customized vs. non-customized) did not have a significant effect on the treatment duration.
#2) 26672713Brown/201596 Fixed orthodontic patientsRetrospective cohort study
Key resultsThree groups were evaluated retrospectively: customized fixed appliances, and non-customized bonded either directly or indirectly. Treatment outcome was judged based on ABO Cast- Radiograph Evaluation scores between the three groups and showed no statistical difference in the effectiveness of the three treatment modalities. However, patients treated with customized fixed appliances showed a statistically significant shorter treatment time (13.8± 3.4 months) when compared to the other groups (21.9± 5.0 and 16.9± 4.1 months, respectively) (P<0.05).
#3) 23660822Weber/201346 Fixed orthodontic patientsRetrospective cohort study
Key resultsThe group of patients treated with customized (n= 35) brackets showed a statistically significant reduction in the treatment time, with an average treatment time of 14.23 months (SD=5.02) when compared to the non-customized group (n=11) treatment time of 22.91 months (SD=4.35). The average reduction in the number of appointments was 7 in the customized brackets. Both groups had no statistical difference in the severity of the malocclusion before the start of the treatment (based on age-adjusted Peer Assessment Rating)
Evidence Search ("Orthodontics"[MeSH Terms] AND ("Brackets"[All Fields] AND "Customized"[All Fields] NOT "Iingual"[All Fields]). ("Orthodontic"[All Fields] AND "CAD/CAM"[All Fields]) NOT "Lingual"[All Fields]). "Brackets"[All Fields] AND ("Customized"[All Fields] OR CAD/CAM"[All Fields] OR ("Insignia"[All Fields]). ("Orthodontic"[All Fields] AND "Customized"[All Fields]) AND ("Treatment Duration"[All Fields] AND "efficiency"[All Fields]).
Comments on
The Evidence
Validity: The randomized clinical trial is classified higher on the evidence level hierarchy and represents a larger study sample (with almost equal number of cases in each group) as compared to either retrospective study. Blinding in such an intervention is impossible since each system can be identified easily by the orthodontist providing the treatment. All three studies had a clear inclusion and exclusion criteria. Also, each study had a way of quantifying the difficulty of the case at the initial stage and distributing the difficult cases equally between the groups; this is important as the difficulty of the case increases the treatment duration. Perspective: The invention of customized brackets was based on the idea that brackets designed specifically for the patient will reduce the need for detailing bends that compensate for normal anatomical variation between patients and bracket positioning errors introduced by the orthodontist. This in turn will lead to reduction in treatment time and number of clinical appointments and provide nearly ideal finishing results. The two retrospective studies support this idea by reporting shorter treatment duration and fewer clinical appointments. However, the randomized clinical trial showed no true difference between the customized and non-customized brackets. More clinical research is needed evaluate the efficiency of the customized brackets.
Applicability Both customized and non-customized brackets can lead to the same quality of treatment. Treatment time reduction in orthodontics is always desirable as it can decrease the side effects associated with orthodontic treatment, which include and are not limited to higher caries risk. It is important to keep in mind that customized brackets are currently more financially costly for the patient.
Specialty/Discipline (Orthodontics)
Keywords orthodontics, customized brackets, CAD/CAM, treatment duration, efficiency
ID# 3303
Date of submission: 11/28/2017spacer
E-mail alotaibia@livemail.uthscsa.edu
Author Ahmed Alotaibi
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