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Title Self-Ligating Appliances May Increase Efficiency of Initial Alignment
Clinical Question For a patient undergoing comprehensive orthodontic treatment with fixed appliances, do self-ligating appliances, compared to conventional appliances, increase efficiency of initial alignment?
Clinical Bottom Line For a patient undergoing comprehensive orthodontic treatment with fixed appliances, self-ligating appliances may increase efficiency of initial alignment compared to conventional appliances. This is supported by two randomized control trials (RCTs) in a systematic review and network meta-analysis which indicated that efficiency of mandibular alignment favored self-ligating brackets compared to conventional appliances. Self-ligating brackets are available from various brands and in various bracket prescriptions, making them easily accessible to orthodontists, and are likely to be accepted by the average orthodontic patient.
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) 34629309Maizeray/20211,702 patients in 30 RCT and 9 SMD studiesSystematic Review and Network Meta-Analysis
Key resultsOut of the 39 total studies, two RCTs, Scott (2008) and Reddy (2014), with a combined total of 108 participants, were used to compare mandibular alignment efficiency between self-ligating brackets (SLBs) and conventional brackets (CBs). In comparing passive self-ligating brackets (PSLBs) and CBs, alignment was faster with PSLBs (MD -1.58, 95% CI). In comparing active self-ligating brackets (ASLBs) and CBs, alignment was faster with ASLBs (MD -2.55, 95% CI). In comparing ASLBs and PSLBs, alignment was faster with ASLBs (MD -0.93, 95% CI).
Evidence Search (self-ligating brackets) AND (conventional brackets) AND (efficiency) AND (initial alignment)
Comments on
The Evidence
Maizeray’s systematic review and network meta-analysis included 30 RCTs and 9 SMDs. Two of the included RCTs, Scott (2008) and Reddy (2014), were used to compare the outcomes of mandibular alignment efficiency between PSLBs and CBs, between ASLBs and CBs, and between ASLBs and PSLBs. Both RCTs were considered at low risk of bias. Considering only two RCTs were used in these comparisons, future research in this area could further strengthen the conclusions.
Applicability For orthodontists, knowing if a particular bracket type has an impact on the efficiency of initial alignment could benefit the orthodontist and patient alike. Based on Maizeray’s article, there may be some benefit in using self-ligating brackets to increase efficiency of initial alignment; however, other confounding factors, such as the slot size, wire size, and extractions may play a role. Adverse effects, such as degree of root resorption, should also be considered. Furthermore, greater efficiency of initial alignment may not imply shorter treatment time.
Specialty/Discipline (Orthodontics)
Keywords Orthodontics, Self-Ligating Brackets, Conventional Brackets, Initial Alignment
ID# 3465
Date of submission: 11/12/2021spacer
E-mail millerd8@livemail.uthscsa.edu
Author Dakota Miller, DDS
Co-author(s) Madison Hauritz, DDS
Co-author(s) e-mail hauritz@livemail.uthscsa.edu
Faculty mentor/Co-author Dr. Ravikumar Anthony
Faculty mentor/Co-author e-mail anthonyr@uthscsa.edu
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