Title	Active Self-Ligating Brackets Are More Efficient and Effective Than Passive Self-Ligating Brackets
Clinical Question	In patients undergoing orthodontic treatment via a self-ligating system, do active clips offer greater efficacy and efficiency compared to passive clips?
Clinical Bottom Line	In patients undergoing orthodontic treatment via a self-ligating system, active self-ligating brackets (ASLB) offer increased efficacy and efficiency compared to passive self-ligating brackets (PSLB). This claim is supported by 2 individual systematic reviews and meta-analyses that show a statistically significant difference between ASLB and PSLB, indicating that an ASLB provided superior results during initial alignment.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 28224175 Xianrui Yang/2017 205 patients in 8 RCT (randomized control trial) studies Systematic review with meta-analysis Key results Yang’s study favored ASLB over PSLB for initial alignment time (MD: -10.24, 95% CI). 34629309 Raphaëlle Maizeray/2021 1,702 patients in 30 RCT and 9 SMD (standard mean difference) studies Systematic review with meta-analysis Key results Notable findings included that a 0.014 NiTi arch wire was quicker to untie and ligate from ASLB brackets compared to conventional brackets with an assistant (MD -101.10, 95% CI) and without an assistant (MD -130.20, 95% CI). More pain resulted from the insertion and removal of a 0.019 x 0.025 SS wire from PSLB brackets compared to conventional brackets (MD 18.28, 95% CI and MD 18.13, 95% CI respectively). Finally, alignment was 10 days faster with ASLB than with PSLB (MD -10.07, 95% CI).
Evidence Search	active AND passive OR self ligating brackets
Comments on The Evidence	Validity: Both Yang and Maizeray’s systematic review and meta-analyses included relevant studies that followed PRISMA guidelines. The review conducted by Yang involved the manual and electronic search of 5 databases without language limitations. Of the 8 RCT studies selected, 3 had a low risk of bias, 4 had unclear risk of bias, and 1 had a high risk of bias. Confounding factors, limitations in the size of the studies, and risk of bias called for additional research. Maizeray’s systematic review and meta-analysis surveyed 3 databases in addition to the references, bibliographies, and table of contents from 3 major orthodontic journals. The analysis comprised of 30 RCTs and 9 SMDs of which only 4 studies presented a high risk of bias, 8 had a moderate risk of bias, and 23 showed a low risk of bias. Although the studies were supported by high quality data, future investigations may be required to assess variables such as bracket brand and width.
Applicability	The 10 days of quicker alignment and faster insertion and removal of wire associated with ASLB would save time for both the orthodontist and the patient. Additionally, the efficacy of ASLB would result in improved esthetics and patient satisfaction. The costs for a patient who chooses PSLB over ASLB would include increased wear time and increased chair time during appointments.
Specialty	(Orthodontics)
Keywords	Orthodontics, Active brackets, Passive brackets, Self-ligating brackets
ID#	3491
Date of submission	09/19/2022
E-mail	patels22@livemail.uthscsa.edu
Author	Shivani K Patel
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Dr. Callegari
Faculty mentor e-mail	callegari@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