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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) 34629309 | Maizeray/2021 | 1,702 patients in 30 RCT and 9 SMD studies | Systematic Review and Network Meta-Analysis | | Key results | Out 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: |
11/12/2021 |
| 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 |
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 | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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