Self-Ligating Brackets Do Not
Self-Ligating Brackets Do Not
Self-Ligating Brackets Do Not
increase treatment
efficiency
CONTAINS
INTRODUCTION.
CHAIR-SIDE EFFICIENCY AND EASE OF USE.
EFFICIENCY OF TREATMENT.
EFFICIENCY OF ARCH ALIGNMENT.
RATES OF SPACE CLOSURE AND CANINE
RETRACTION.
OVERALL TREATMENT DURATION.
CONCLUSIONS.
REFERENCES.
INTRODUCTION
The Oxford English Dictionary defines efficiency as
achieving maximum productivity with minimum
wasted effort or expense.
Orthodontic pioneers have continuously sought
methods of enhancing treatment efficiency by
attempting to reduce the duration of orthodontic
treatment and the length of orthodontic
appointments.
Although mean treatment times of 1 to 2 years are
now typical, the drive to reduce orthodontic
treatment duration persists.
EFFICIENCY OF TREATMENT
Early research examining the relationship between selfligating brackets and overall treatment time was observational.
These studies were invariably compromised by the compelling
possibilities of selection bias, observer bias, and confounding,
including susceptibility to uncontrolled factors such as varying
operator experience and preference, differing archwires and
sequences, and inconsistent appointment intervals.
EFFICIENCY OF ARCH
ALIGNMENT
A number of prospective studies have investigated the
efficiency of initial orthodontic alignment over periods up
to 20 weeks.
The results from these trials have consistently indicated
that despite their associated costs, self-ligating brackets
might offer no advantage with respect to treatment
efficiency (Table II).
RATES OF SPACE
CLOSURE AND CANINE
RETRACTION
Rates of space closure and canine retraction were first investigated
OVERALL TREATMENT
DURATION
Recently, a large retrospective study29 and
several randomized controlled trials30-32
investigating the duration of orthodontic
treatment in its entirety have been published.
The prospective studies were based in
hospital or public health care a total of 192
participants (Table III). Findings from the 3
prospective studies indicate that treatment
with selfligating brackets does not result in
shorter treatment times.
CONCLUSIONS
In total, 9 randomized controlled trials have been cited in this
summary. There are also 2 published systematic reviews on selfligating brackets.
It is, therefore, reasonable to assert that the question of whether
self-ligating brackets improve treatment efficiency has been
particularly well researched in the context of orthodontic evidence.
Furthermore, the consistency of the findings from these prospective
studies is remarkable, with none finding that self-ligating brackets
translate into enhanced efficiency, during either 1 phase of
treatment or overall therapy.
Therefore, despite the preliminary findings from retrospective
studies, the contention that self-ligating brackets do not improve
treatment efficiency is compelling, highlighting the divergence
between retrospective research and clinical reality.
The efficiency of a course of orthodontic treatment is based on a
complex interaction of parameters including appliance type,
compliance, biologic age, and bone remodeling, with biologic
processes as the ultimate arbiter dictating the maximum speed of
the process.
REFRENCE
1. Stolzenberg J. The Russell attachment and its improved
advantages. Int J Orthod Dent Child 1935;21:837-40.
2. Turbill EA, Richmond S, Wright JL. The time-factor in
orthodontics what influences the duration of treatments in
the National Health Service practices? Community Dent Oral
Epidemiol 2001;29:62-72.
3. Richmond S, Andrews M. Orthodontic treatment standards
in Norway. Eur J Orthod 1993;15:7-15.
4. Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid
orthodontics with alveolar reshaping: two case reports of
decrowding. Int J Periodontics Restorative Dent 2001;21:919.
5. AcceleDent. Available at:
http://acceledent.com/images/uploads/
AcceleDent1Increases1the1Rate1of1Orthodontic1Tooth1
MovementResults1of1a1RCT1Final1for1Print1November
11412011. Accessed July 5, 2012