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
PubMed ID Author / Year Patient Group Study type (level of evidence) 18068590 Deahl/2007 Patients undergoing orthodontic treatment lasting at least one year, with full fixed appliances on both the upper and lower arches. Other Key results No 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. 16926313 Thiyagarajah/2006 Adolescent patients undergoing orthodontic treatment lasting at least one year, with full fixed appliances on both the upper and lower arches. Randomized Controlled Trial Key results No 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	(Orthodontics)
Keywords	Orthodontic brackets, direct bonding, indirect bonding
ID#	2685
Date of submission	03/28/2014
E-mail	mayberryd@livemail.uthscsa.edu
Author	Derick Mayberry
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Clarence C. Bryk, DDS, MS
Faculty mentor e-mail	brykc@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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available