Self-ligating vs conventional brackets as perceived by orthodontists

Public perception of the advertised claims of Damon® appliance system in Saudi Arabia: a cross-sectional survey-based study

INTRODUCTION

The clinical validity of self-ligating brackets' advertised claims, such as those for the Damon® appliance system, has been explored, but public awareness remains underexamined. This study assessed Saudi public perceptions of these claims.

MATERIALS AND METHODS

A web-based survey distributed via social media evaluated perceptions of Damon system claims, including treatment efficiency, patient discomfort, oral hygiene maintenance, and treatment esthetic results. Participants were also asked to outline their perception of Damon's appliance cost. Responses were ranked on a Likert scale and analyzed using the Chi-square test with Bonferroni corrections.

RESULTS

Of 918 adults, 11% were familiar with the Damon system. Among Damon appliance-aware respondents, 64.4% believed it was superior to traditional braces. Around 56.4% thought it required fewer visits, and 49.5% believed treatment time was shorter, though many were neutral or uncertain. Regarding tooth extraction needs, 43.6% agreed it required lower needs, while 48.5% believed it causes less discomfort. About 46.5% agreed it was easier to maintain oral hygiene, and 54.5% thought it provided better esthetic results. Notably, 52.5% mistakenly believed it was cheaper than traditional braces. However, no major association was found between socio-demographics and Damon appliance knowledge, but females were more likely to perceive it as superior (P = .012).

CONCLUSIONS

This study highlighted the dissimilarities between public perception and scientific evidence regarding the Damon system. These mixed findings suggest a need for guidelines in orthodontic advertising to prevent potential misinformation. Providing the public with reliable, evidence-based information is crucial for supporting informed decision-making in orthodontic care.

Self-Ligating Versus Conventional Brackets: A Narrative Review

Orthodontic treatment has seen remarkable progress, particularly in bracket technology, enhancing efficiency, comfort, and oral hygiene. Self-ligating brackets (SLBs) have emerged as an alternative to conventional brackets (CBs), with claims of lower friction, shorter treatment time, better periodontal health, and reduced chairside visits. However, clinical studies yield mixed results, sparking ongoing debate. This narrative review examines the differences between SLBs and CBs in biomechanics, treatment duration, patient comfort, periodontal health, clinical efficiency, cost-effectiveness, and long-term stability based on recent research. The findings suggest that while SLBs offer certain benefits, they do not significantly surpass CBs in key treatment outcomes.

Perception

Introduction

Orthodontists' perception of bracket techniques plays a significant role in planning, allowing critical evaluation of the patient's facial aesthetics.

Objective

To compare the perception of Peruvian orthodontists regarding treatments with self-ligating and conventional brackets.

Methods

A questionnaire was applied to 168 orthodontic specialists (53% men, average professional experience 9 years) to evaluate preferences for treatment phases, benefits of patient consultation according to the type of bracket, experience with self-ligating brackets, and demographic and clinical characteristics (sex, years of experience, volume of care and length of experience). The Kruskal-Wallis Test and Chi-square test were used with P < 0.05.

Results

The total preference for self-ligating brackets (48.9%) was higher than conventional brackets (18.8%). Self-ligating brackets were preferred in most treatment phases (46.4%-63.7%) but not in completion and finishing, in which conventional brackets were preferred. Most orthodontists preferred self-ligating brackets (40.5%-60.7%) over conventional brackets (4.2%-14.3%) due to patient comfort, oral hygiene, and total treatment and appointment time control, but not the cost. The orthodontists reported SLB having mastered their technique in <10 cases (59.5%), the experience of <2 years (45.2%), applying control times of 4-9 weeks (78.6%), and feeling comfortable with their use (89.3%). Preferences were not associated with sex (P > 0.05) but rather with years of professional experience (P < 0.05).

Conclusions

Peruvian orthodontists preferred self-ligating brackets over conventional brackets in most treatment phases associated with user comfort and oral hygiene management and treatment/control time, and professional experience. However, some factors, such as cost-effectiveness, counteracted this preference.

Incisors' bone height and inclination changes after orthodontic treatment with a self-ligating passive system

Background

This study aimed to evaluate changes in the alveolar buccal bone height of maxillary and mandibular incisors after orthodontic treatment with a self-ligating passive system and to assess the correlation between bone height and incisor inclination.

Material and Methods

Pre (T1) and post-treatment (T2) cone-beam computed tomography images of patients treated with the Damon 3MX appliance system were measured to quantify the alveolar buccal bone height of the maxillary incisors. The incisor's inclination was measured in digital models. Paired t-test was used to evaluate the changes between T1 and T2, and Pearson's coefficient was used to test the correlation.

Results

All teeth presented statistically significant alveolar buccal bone loss at T2. A statistically significant buccal inclination was observed only for the lower left lateral incisors. There was no correlation between bone height changes and incisor inclination.

Conclusions

Orthodontic treatment with a self-ligating passive system showed changes in alveolar height, but these changes were not correlated with incisor inclination. Key words:Passive self-ligating brackets, orthodontics, corrective, treatment outcome, alveolar bone loss.

An Evaluation of Microbial Flora, Alkaline Phosphatase and IL-8 Levels in GCF of Orthodontic Patients with Self-Ligating and Conventional Brackets

PURPOSE

To compare the microbial flora, alkaline phosphatase (ALP) and interleukin-8 (IL-8) levels during orthodontic treatment with self-ligating brackets versus conventional brackets.

PATIENTS AND METHODS

Forty patients were included in this study and distributed equally between two groups. One group received conventional edgewise brackets while the other group received DAMON self-ligating brackets. Periodontal parameters were recorded and biochemical and microbial analyses were conducted before bonding (baseline), and 14, 30, and 45 days after bonding. Paired t-test was performed to estimate the intergroup differences from the baseline at the various time points; unpaired t-test was used for intragroup comparisons.

RESULTS

A significantly higher prevalence of gram-negative as well as gram-positive microorganisms was found in the group with conventional brackets than that with self-ligating brackets. Alkaline phosphatase (ALP) activity and interleukin-8 (IL-8) levels were significantly higher in the gingival crevicular fluid of the group with conventional brackets than that with self-ligating brackets.

CONCLUSION

The conventional bracket-ligature technique exhibited an increase in IL-8 levels, ALP activity, and microbial colonization compared with that of the self-ligature technique. Accordingly, self-ligating brackets are recommended in orthodontic patients to improve periodontal health and minimize damage outcomes of periodontal tissue interventions.

The Influence of Friction on Design of the Type of Bracket and Its Relation to OHRQoL in Patients Who Use Multi-Bracket Appliances: A Randomized Clinical Trial

Background and objectives: The aim of this study was to evaluate the influence of friction on design of the type of bracket, patients’ perception of pain and the impact on their oral health-related quality of life. Materials and Methods: A randomized clinical trial was carried out with 90 patients (62.2% women and 37.8% men) with three kinds of fixed multi-bracket appliances: Conventional (GC), fixed multi-bracket low friction (GS) and self-ligating (GA). The VAS (Visual Analogue Scale) was used to determine pain during the first seven days of treatment at different points in time. The patients were also given the OHIP-14 (Oral Health Impact Profile) questionnaire to analyse their oral health-related quality of life (OHRQoL) after the first 30 days of treatment. The ANOVA test was used for the analysis of the variables and the post hoc Bonferroni test for the comparison between groups. Results: Maximum pain was observed between one and two days after the start of treatment. The GC group showed the greatest degree of pain, with maximum values (4.5 ± 2.0) at 24 h. The self-ligation brackets show lower impact on patients’ oral health-related quality of life (0.8 ± 2.2, p < 0.01). Conclusions: Friction in the type of bracket influences pain and the Oral Health-Related Quality of Life of patients who use multi-bracket fixed orthodontics.

Extraction of premolars for orthodontic reasons on the decline? A cross-sectional survey of BOS members

OBJECTIVE

To obtain the opinion of British Orthodontic Society (BOS) members in relation to possible patterns of prescription of orthodontic extractions over the past 5-10 years and to relate any changes identified to treatment objectives, facial and smile aesthetics, and treatment strategies and adjuncts.

DESIGN

Cross-sectional questionnaire.

SETTING

On-line survey of BOS members.

METHODS

A 14-item on-line questionnaire was sent to orthodontic practitioners for completion. The questionnaire covered demographics, possible changes in frequency of prescribed extractions with specific information concerning the effect of patient age, and the influence of other factors including alternative approaches to space creation, evolving treatment mechanics, smile and facial aesthetics, and retention protocols.

RESULTS

Two hundred and eight responses were obtained with 95.6% (n = 199) reporting reduced extraction prescription over the last 5-10 years. Overall, 29.9% and 35.5% felt that their threshold for extractions had increased by more than 2 mm in adolescents and adults, respectively. Facial (n = 145; 69.7%) and smile (n = 127; 61.1%) aesthetics, and increased use of inter-proximal reduction (n =  102; 49%) were the factors most frequently reported as having either a moderate or major influence on this trend. Based on ordinal logistical regression analyses, no significant relationship was found between threshold for extractions and work setting (P =  0.675; O.R. 0.51; 95% CI: 0.39, 1.85) or level of orthodontic experience (P =  0.15; O.R. 1.02; 95% CI: 0.15, 1.05), although a higher threshold for extractions was more likely among users of conventional than self-ligating brackets (P =  0.001; O.R. 4.74; 95% CI: 1.95, 11.5).

CONCLUSIONS

A reduced tendency to prescribe orthodontic extractions over the past 5-10 years among British Orthodontic Society members was identified. Comparative clinical research exploring the relative merits of extraction and non-extraction approaches could be timely.

Ceramic brackets and low friction : A possible synergy in patients requiring multiple MRI scanning

AIM

To investigate any advantages of low friction biomechanics in orthodontic patients with fixed appliances without producing metal artifacts during magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Frictional resistance generated by bracket-wire-ligature systems was analyzed via an experimental model that reproduced upper canine misalignment. Each sample was tested 10 consecutive times in a dry state; a total of 160 tests were carried out. We documented the frictional forces generated by a 0.012- and 0.014-inch superelastic nickel-titanium wire (SENT) with ceramic self-ligating brackets (SLB) with metal insert and ceramic monocrystalline brackets with nonconventional elastic ligatures (NCEL) in conjunction with various degrees of canine misalignment (1.5, 3.0, 4.5, and 6.0 mm). Comparisons between the frictional forces released by the two different bracket-wire-ligature systems were made by conducting 3-way analysis of variance (ANOVA) with Tukey HSD pairwise test (P < 0.005).

RESULTS

We observed no clinically relevant difference between the frictional forces released by ceramic SLB and ceramic brackets in conjunction with a 0.012- and 0.014-inch SENT. Statistically significant differences were apparent with a 0.012-inch SENT at 4.5 and 6.0 mm of canine misalignment, where the SLB revealed higher frictional forces.

CONCLUSIONS

Ceramic brackets with NCEL revealed frictional forces similar to those generated in conjunction with ceramic SLB, thereby helping to avoid metal artifacts in case of expected necessary MRI during orthodontic treatment with fixed appliances.

Differences of treatment outcomes between self-ligating brackets with microimplant and headgear anchorages in adults with bimaxillary protrusion

INTRODUCTION

Our aim was to determine differences between the outcomes of treatment using microimplant anchorage compared with headgear anchorage in adult patients with bimaxillary protrusion treated with self-ligating brackets.

METHODS

Thirty-one adult orthodontic patients (13 men, 18 women; age, 25.87 ± 3.37 years) who were diagnosed with bimaxillary protrusion were selected. All patients were treated with self-ligating brackets and maximum anchorage after extraction of 4 first premolars. Group 1 received microimplant anchorage, and group 2 received headgear. Lateral cephalometric radiographs were obtained before and after treatment. Differences in the skeletal and dental parameters between and within groups were analyzed.

RESULTS

No significant difference was observed in the mean treatment times between the groups (21.93 ± 3.10 vs 23.88 ± 2.68 months). There was no significant difference in skeletal measurements before or after treatment in patients who received microimplant anchorage. Patients who received headgear anchorage had an increase of the mandibular plane angle. The microimplant anchorage group had greater anterior tooth retraction and less maxillary molar mesialization than did the headgear group.

CONCLUSIONS

In both the anteroposterior and vertical directions, microimplant anchorage achieved better control than did the traditional headgear appliance during the treatment of bimaxillary protrusion.

Frictional resistance of self-ligating versus conventional brackets in different bracket-archwire-angle combinations

Objective

To compare the influence of archwire material (NiTi, beta-Ti and stainless steel) and brackets design (self-ligating and conventional) on the frictional force resistance.

Material and Methods

Two types of brackets (self-ligating brackets - Smartclip, 3M/Unitek - and conventional brackets - Gemini, 3M/Unitek) with three (0, 5, and 10 degrees) slot angulation attached with elastomeric ligatures (TP Orthodontics) were tested. All brackets were tested with archwire 0.019"x0.025" nickel-titanium, beta-titanium, and stainless steel (Unitek/3M). The mechanical testing was performed with a universal testing machine eMIC DL 10000 (eMIC Co, Brazil). The wires were pulled from the bracket slots at a cross-head speed of 3 mm/min until 2 mm displacement.

Results

Self-ligating brackets produced significantly lower friction values compared with those of conventional brackets. Frictional force resistance values were directly proportional to the increase in the bracket/ wire angulation. With regard to conventional brackets, stainless steel wires had the lowest friction force values, followed by nickel-titanium and beta-titanium ones. With regard to self-ligating brackets, the nickel-titanium wires had the lowest friction values, significantly lower than those of other materials.

Conclusion

even at different angulations, the self-ligating brackets showed significantly lower friction force values than the conventional brackets. Combined with nickel-titanium wires, the self-ligating brackets exhibit much lower friction, possibly due to the contact between nickel-titanium clips and wires of the same material.

Geometric morphometric evaluations of a randomized prospective split-mouth study on modes of ligation and reverse-curve mechanics

OBJECTIVES

To evaluate tooth position after six and 9 months of orthodontics with conventional brackets on one side of the dentition and ligature-less brackets on the other.

SETTING AND SAMPLE POPULATION

Orthodontic Division, Vienna Medical University. Twenty patients aged 22.5 ± 5.7 years, symmetrical malocclusion and arch form, no premolar extraction.

MATERIAL AND METHODS

Prospective split-mouth study, 0.022-inch SmartClip self-ligating brackets assigned randomly to the left or right dentition, conventional 0.018-inch brackets on the other side. 52 dental landmarks, digitized on plaster casts, represented dental arches at baseline (t0), 6 months and 9 months (t1, t2). During t0-t1, we used 0.016 and 0.014 x 0.025 inch superelastic wires, during t1-t2 connected reverse-curve hemiarch wires: 0.017 x 0.025 inch ß-titanium on the ligature-less side, and 0.016 x 0.022 inch Elgiloy multiloop wires on conventional brackets. Morphometric analyses were used to assess differences in dental arch shapes.

RESULTS

Neither initial alignment nor the reverse-curve phase showed statistically significant differences between ligature-less and conventional brackets in moving teeth.

CONCLUSION

Morphometric shape analyses corroborated current evidence that self-ligating brackets were no more effective than conventional brackets with steel ligatures after 6-month initial alignment. From months 6-9 treatment with ß-titanium reverse-curve wires on 0.022-inch ligature-less brackets resulted in similar tooth positions as accomplished by Elgiloy multiloop wires on 0.018-inch steel-ligature-tied brackets.

The timing of significant arch dimensional changes with fixed orthodontic appliances: data from a multicenter randomised controlled trial

OBJECTIVES

To identify the timing of significant arch dimensional increases during orthodontic alignment involving round and rectangular nickel-titanium (NiTi) wires and rectangular stainless steel (SS). A secondary aim was to compare the timing of changes occurring with conventional and self-ligating fixed appliance systems.

METHODS

In this non-primary publication, additional data from a multicenter randomised trial initially involving 96 patients, aged 16 years and above, were analysed. The main pre-specified outcome measures were the magnitude and timing of maxillary intercanine, interpremolar, and intermolar dimensions. Each participant underwent alignment with a standard Damon (Ormco, Orange, CA) wire sequence for a minimum of 34 weeks. Blinding of clinicians and patients was not possible; however, outcome assessors and data analysts were kept blind to the appliance type during data analysis.

RESULTS

Complete data were obtained from 71 subjects. Significant arch dimensional changes were observed relatively early in treatment. In particular, changes in maxillary inter-first and second premolar dimensions occurred after alignment with an 0.014in. NiTi wire (P<0.05). No statistical differences in transverse dimensions were found between rectangular NiTi and working SS wires for each transverse dimension (P>0.05). Bracket type had no significant effect on the timing of the transverse dimensional changes.

CONCLUSIONS

Arch dimensional changes were found to occur relatively early in treatment, irrespective of the appliance type. Nickel-titanium wires may have a more profound effect on transverse dimensions than previously believed.

CLINICAL SIGNIFICANCE

On the basis of this research orthodontic expansion may occur relatively early in treatment. Nickel-titanium wires may have a more profound effect on transverse dimensions than previously believed.

Treatment time, outcome, and anchorage loss comparisons of self-ligating and conventional brackets

OBJECTIVE

To compare the treatment time, outcome, and anchorage loss among orthodontic patients treated by self-ligating brackets (SLBs) and conventional brackets (CBs).

MATERIALS AND METHODS

A retrospective cohort study compared 34 patients (SLB group) treated by SmartClip brackets (3M Unitek, Monrovia, Calif) to 35 patients (CB group) treated by conventional preadjusted Victory series brackets (3M Unitek) and ligated by stainless steel wire ligatures. Pretreatment (T1) and posttreatment (T2) lateral cephalograms were traced and analyzed using Pancherz sagittal-occlusion analysis to obtain skeletal and dental changes in the maxilla and the mandible. The dental cast models were assessed by the Peer Assessment Rating (PAR) Index for the treatment outcomes.

RESULTS

The mean treatment time for SLBs (19.19 months) did not show a statistically significant difference from 21.25 months of CBs; the treatment time and pretreatment PAR scores were strongly correlated. There was no difference in anchorage loss between the SLB and CB groups. There were significant dental and skeletal changes among adolescent orthodontic patients regardless of the bracket used. The lingual inclination of the mandibular incisors in the CB group was 3.62° more than in the SLB group (P < .01).

CONCLUSIONS

The treatment time and anchorage loss are not influenced by the type of bracket used. There are significant dental and skeletal changes among adolescent orthodontic patients regardless of the bracket used. There is significantly greater lingual inclination of mandibular incisors in the CB group than in the SLB group.