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Odontoestomatología
Print version ISSN 0797-0374On-line version ISSN 1688-9339
Odontoestomatología vol.23 no.38 Montevideo 2021 Epub Sep 30, 2021
https://doi.org/10.22592/ode2021n37e302
Update
Evidence-based comparison of self-ligating and conventional brackets
¹
http://orcid.org/0000-0002-5207-6977
¹
http://orcid.org/0000-0003-2956-9455
¹Facultad de Odontología, Universidad de Chile, Santiago, Chile. gahempel@uc.cl
²Departamento del Niño y Ortopedia Dento Maxilar. Facultad de Odontología, Universidad de Chile, Santiago, Chile
Self-ligating brackets include a locking mechanism that holds the archwire in the bracket slot. They were created primarily to create a lower friction system, allowing for more efficient sliding mechanics and reducing treatment time.
Objective:
This review aims to present all the information available on different self-ligating devices, whether active or passive, in a structured and organized way. This paper sets out to compare their qualities with each other and with conventional devices.
Method:
A search was conducted in PubMed and Epistemonikos, regardless of language or year of publication.
Results:
Comparisons were made of both active and passive self-ligating brackets and self-ligating brackets with conventional brackets in different clinical situations.
Conclusions
No statistically significant difference was found in most clinical situations, except for torque expression, where conventional brackets have a more significant advantage.
Keywords: Orthodontic brackets; Self-ligating brackets; Conventional brackets
Los brackets de autoligado son aquellos que incorporan un mecanismo de cierre que mantiene el arco en el interior de la ranura del bracket. Fueron creados principalmente para crear un sistema de menor fricción, permitiendo una mecánica de deslizamiento más eficiente y disminuir el tiempo de tratamiento.
Objetivo:
El objetivo de esta revisión es presentar de manera más estructurada y ordenada toda la información disponible respecto de los distintos aparatos de autoligado, ya sea activo o pasivo, comparando las cualidades entre sí y con los aparatos convencionales.
Método:
Se realizó una búsqueda mediante PubMed y Epistemonikos, sin importar idioma o año de publicación.
Resultados:
Se establecieron comparaciones tanto de brackets de autoligado activos con pasivos, como de brackets de autoligado con brackets convencionales en distintas situaciones clínicas.
Conclusiones:
Para la gran mayoría de situaciones clínicas, no existe una diferencia estadísticamente significativa, a excepción de la expresión de torque, en donde los brackets convencionales tienen una mayor ventaja.
Palabras clave: Brackets de ortodoncia; Brackets de autoligado; Brackets convencionales
Os braquetes autoligáveis são aqueles que incorporam um mecanismo de fechamento que mantém o fio dentro da ranhura do braquete. Eles foram criados principalmente para criar um sistema de menor atrito, permitindo uma mecânica de deslizamento mais eficiente e reduzindo o tempo de tratamento.
Objetivo:
O objetivo desta revisão é apresentar de forma mais estruturada e ordenada todas as informações disponíveis sobre os diferentes dispositivos autoligáveis, sejam eles ativos ou passivos, comparando as qualidades entre si e com os dispositivos convencionais.
Método:
A busca foi realizada usando PubMed e Epistemonikos, independentemente do idioma ou ano de publicação.
Resultados:
Foram comparadas braquetes autoligáveis ativos e passivos e braquetes autoligáveis convencionais em diferentes situações clínicas.
Conclusões:
Para a grande maioria das situações clínicas, não há diferença estatisticamente significativa, exceto para a expressão do torque, onde os braquetes convencionais apresentam maior vantagem.
Palavras-chave: aparelho ortodôntico; aparelho autoligável; aparelho convencional
Introduction
The term self-ligating refers to brackets that include a locking method, either a clip, cap, or gate mechanism that holds the archwire inside the bracket slot1-3.They were designed to eliminate metallic and elastomeric ligatures, based on the concept that this system would create a lower friction environment, allowing for more efficient sliding mechanics that could reduce treatment time4. They can be classified into passive and active according to the locking mechanism in place5,6. In an active system, the ligation clip exerts pressure on the archwire, unlike the passive system, where the locking mechanism transforms the slot into a tube5.
The concept of self-ligating brackets appeared in 1935, with the Russell appliance described by Dr. Stolzenberg7, as an attempt to improve clinical efficiency by reducing ligation time8,9. Several new self-ligating appliances have been developed in recent decades. Their creators claim that they are more efficient than traditional methods. Other existing appliances have been modified to adapt to the requirements of clinicians and patients10.
Many properties have been proposed for any ligation system. Harradine states that a ligation system should be secure and firm, ensure full bracket engagement of the archwire, show low friction between bracket and archwire, allow for high friction when required, demand little clinical time, allow easy attachment of auxiliary elements, help maintain good oral hygiene, and finally, be comfortable for the patient11.
The main advantage of self-ligating brackets is the low friction during tooth movement, allowing teeth to slide more easily over the archwire and clinicians to use lower forces11.
A review of the literature reveals a large number and diversity of studies with contradictory results. This creates confusion among orthodontists as to the actual usefulness of this type of bracket in clinical practice.
This review aims to present all the information available on different self-ligating devices, whether active or passive, in a structured and organized way. This paper sets out to compare their qualities with each other and with conventional devices. The most relevant clinical considerations will also be discussed.
Methodology
The literature review was conducted in PubMed MEDLINE and Epistemonikos. The term self-ligating brackets has been used in 518 papers. An additional 30 studies identified through other sources were added. Clinical trials, meta-analyses, randomized clinical trials, and systematic reviews comparing self-ligating brackets with each other or with conventional brackets in different clinical situations were included. The papers were not filtered according to the year of publication. Narrative reviews were not considered, nor were papers without a full text. We also did not consider papers that combined self-ligating brackets with other types of appliances, nor studies of lingual self-ligating brackets. Studies that appered in both search sources and studies unrelated to the topic were also eliminated. In the end, 96 studies were included.
The results are divided into two areas to organize the information collected. First, different passive and active self-ligating brackets at different stages of treatment are compared. Then, different clinical aspects of self-ligating and conventional brackets are compared. In each area, both clinical and in vitro studies will be presented first, followed by a reference to the systematic reviews that have studied the same clinical aspects.
Development
Passive vs. active self-ligating brackets
The results were organized into the following treatment elements:
Friction
In vitro studies have shown that passive self-ligating brackets have less friction than active self-ligating brackets; therefore, sliding mechanics improve with passive brackets. However, bracket design must also be considered12,13.
Alignment and leveling
One study compared the time required to align moderate maxillary anterior crowding and found no difference when correcting the initial crowding14. A systematic review with meta-analysis concludes that active self-ligating brackets appear to be more efficient for initial alignment6.
Torque expression
Active self-ligating brackets would be more effective in torque expression than passive self-ligating brackets15). Other studies conclude, however, that the influence of the ligature or the active or passive closure mechanism is minimal and that the size of the slot is much more important for torque expression5. Systematic reviews in this regard show a slight difference in torque expression between active and passive self-ligating brackets16.
Self-ligating vs. conventional brackets
The differences between active and passive self-ligating brackets and conventional brackets will also be expressed according to the following clinical elements.
Friction
Studies, mainly experimental, show various results, ranging from significantly lower friction to a significant increase in friction17,18. Henao and Robert’s in vitro study compares both types of self-ligating brackets with conventional brackets. Using three different archwires, they detected a significantly lower difference regarding friction in passive self-ligating brackets with 0.014-inch archwires19. In a similar study, Burrow concludes that friction and reversible elastic wire deformation (binding) was higher in conventional brackets when using elastomeric ligatures. Sliding resistance was lower in passive self-ligating brackets20. Costa et al. obtained similar results: they observed a reduction in friction in passive self-ligating brackets21. A systematic review concludes that passive and active self-ligating brackets only produce less friction when low diameter round archwires are used on previously aligned dental arches. However, in severe malocclusions, there is insufficient evidence to ensure that there is less friction when using rectangular archwires22.
Alignment and leveling
Some studies, mainly laboratory studies, show that self-ligating systems produce significantly greater tooth movement at this stage due to their low friction23. However, other studies show that similar results can be obtained by using conventional brackets with moderate-strength metal ligatures24. Conversely, other studies conclude that neither self-ligating system is more efficient in reducing crowding25,26.Ong et al. obtained similar results when comparing passive self-ligating brackets with conventional brackets. They added that the ligation method is only one factor that can influence this stage of treatment27. In contrast, Scott et al. and Abdul et al. report that conventional brackets would be more efficient in the first four months when compared to passive self-ligating brackets28,29. Pandis et al. studied the behavior of passive self-ligating brackets with conventional brackets according to the degree of crowding: greater or less than 5 mm. They found no significant difference in severe crowding, but passive self-ligating brackets were more efficient in moderate crowding30. Conventional brackets proved to be the most efficient in controlling and correcting rotations, followed by active self-ligating brackets and passive self-ligating brackets31. Systematic reviews32,33 point out a controversy regarding initial alignment in extraction orthodontics. However, in non-extraction cases, the values and duration of the alignment phase and the changes in incisor position and inclination were almost identical in patients treated with both systems32. The efficiency of orthodontic alignment has shown little difference between the different types of fixed appliances33.
Anchorage loss
Anchorage loss in conventional and passive self-ligating brackets was compared. The authors found no difference in anchorage loss between the two groups34. Similar results were obtained in several studies comparing self-ligating brackets with conventional brackets35-39. Systematic reviews conclude that both conventional and self-ligating brackets showed the same anchorage loss40 and that no evidence suggests a significant difference between conventional and self-ligating brackets41.
Space closure
Studies show that self-ligating brackets exhibit no advantages in this phase24, and the same rate of canine retraction is observed when comparing both self-ligating systems with conventional brackets35-38. We compared passive self-ligating brackets with conventional brackets with metal ligatures. Regarding the range of mass space closure, there were no significant differences in the number of millimeters by which spaces closed per month42,43,44. Burrow obtained different results when comparing a passive self-ligating bracket with a conventional bracket, as conventional brackets achieved better space closure45. Systematic reviews32,33,46 on this subject show no significant difference. Regarding en-masse retraction of incisors and canines, it is concluded that the use of self-ligating brackets does not improve space closure compared with conventional braces32. Space closure rate efficiency has shown little difference between the different types of fixed appliances33. Therefore, self-ligating brackets are not clinically superior to conventional brackets46.
Torque expression
Conventional brackets show better torque control than self-ligating brackets as the latter cannot press the archwire into the slot fully47. However, another study comparing conventional brackets with passive self-ligating brackets concluded that the latter appear to be equally effective in applying torque to the upper incisors compared to conventional brackets in extraction or non-extraction cases48. Systematic reviews on this topic conclude that conventional brackets express torque better than self-ligating brackets16.
Transversal changes
It has been proposed that self-ligating brackets have a more significant effect on transversal changes than conventional brackets49,50. However, studies found no differences in the dimensional changes of the maxillary arch or changes in the inclination of incisors and molars in any type of bracket when using transversely wider archwires49,50. Buccal bone modeling using passive or active self-ligating brackets could not be confirmed either51. Other studies comparing conventional brackets with passive self-ligating brackets found no significant differences in the transversal dimension in the maxillary arch or in any periodontal clinical parameters52,53,54. The only significant difference was that passive self-ligating brackets showed a greater buccal inclination of the upper molars than conventional brackets52. Other types of studies have found different results when comparing passive self-ligating brackets with conventional brackets: the most significant transversal movement occurs in the premolar area in both techniques and is significantly greater with passive self-ligating brackets55,56. In the same study, inter-canine distance increased significantly with conventional braces compared to self-ligating brackets55. In similar studies, the passive self-ligation group showed a greater increase in intermolar and inter-canine width56,57,58.
Systematic reviews show no evidence of self-ligating brackets being more efficient than conventional brackets in transversal expansion46. The dimensional arch changes observed with self-ligating and conventional brackets appear to be similar, with comparable levels of inter-canine expansion33.
Root resorption
In vitro studies have shown a reduction in the force exerted by active self-ligating brackets compared with conventional brackets with metal and elastomeric ligatures, concluding that this may reduce adverse effects such as root resorption associated with high force levels59. However, randomized clinical trials show that root resorption does not depend on the brackets used28,60,61. A systematic review suggests that self-ligating brackets do not outperform conventional brackets in reducing external apical root resorption in upper lateral incisors and mandibular central and lateral incisors62. However, self-ligating brackets may have an advantage in protecting the upper central incisor, which has yet to be confirmed by higher-quality studies62. Another review mentions inconclusive results in the clinical management of root resorption63.
Clinical time
Studies comparing the time required to position and remove ligatures in conventional metal and ceramic brackets, and in active and passive self-ligating brackets have shown that an average of 8 minutes per arch is required for metal ligatures. For elastic ligatures, this takes 2.3 minutes, and for self-ligating brackets, only 0.7 minutes64. Other studies conclude that passive self-ligating appliances provide a faster and more efficient system of archwire replacement, reporting clinical time savings of approximately 1.5 minutes per patient65. In contrast, Harradine found that this time reduction in a passive self-ligating system was small and of little clinical relevance66. A review concludes that both types of self-ligating brackets appear to have a significant advantage regarding clinical time67.
Checkup frequency
The locking mechanism of self-ligating brackets is not subject to biological degradation, as with elastomeric ligatures. Therefore, it would be possible to increase the time between checkups64. Regarding the number of appointments needed to complete the treatment, some studies indicate that patients passive self-ligating brackets required between four and seven fewer appointments than those with conventional braces4,66. In contrast, other studies comparing active or passive self-ligating brackets with conventional brackets found that self-ligating systems do not reduce the number of checkups68,69,70. One review shows no reduction in the number of appointments compared to conventional brackets32. Another states that no relevant conclusions can be drawn given the few studies included71.
Total treatment time
Some authors report that cases treated with passive self-ligating appliances ended, on average, between 4 and 6 months earlier than conventional ones4,66. Other studies comparing active self-ligating brackets with conventional brackets show that treatment was completed, on average, 5.7 months earlier than cases treated with conventional braces72. However, the decrease in months of treatment is not statistically significant34. However, other studies show that active or passive self-ligating appliances do not reduce treatment time compared to conventional appliances68,70. One review shows no decrease in total treatment time compared with conventional braces31. At the same time, another indicates that it is impossible to draw conclusions on the differences between the two types of brackets given the limited number of studies included71.
Patient comfort
When evaluating patient discomfort with passive self-ligating brackets and conventional brackets, no differences were found in the seven days after inserting the 0.014-inch Cu Nitti archwire73. Rahman et al. reached the same conclusion, as they found no significant differences in pain74.
When comparing the pain experience in patients treated with an active self-ligating system with conventional appliances, no differences were found between the two groups with an initial 0.016-inch NiTi archwire. However, when evaluating the pain associated with removing NiTi 0.019x0.025-inch archwires and inserting SS 0.019x0.025-inch archwires, the self-ligating group reported more significant perceived pain75. Similar results were obtained when comparing passive self-ligating brackets with conventional brackets when inserting or removing rectangular archwires: patients with self-ligating brackets experienced more pain76. Another study reports differences when comparing passive self-ligating brackets with conventional brackets in initial stages with a 0.014-inch NiTiCu archwire. The authors found less pain in the group treated with self-ligating brackets77,78, as did Pringle et al.79.However, when the archwire diameter was increased to 0.016x0.025 inch, the pain increased with self-ligating appliances77,78. Other studies found no evidence of a difference in pain intensity when comparing self-ligating brackets with conventional brackets when evaluated after 4 hours, 24 hours, 3 days, 1 week and 1 month80.
Regarding bracket appearance, patients preferred conventional brackets77. Regarding the contact between the brackets and the lips, the patients with self-ligating brackets reported greater discomfort77.
Systematic reviews report greater discomfort with self-ligating brackets, although the differences are neither statistically nor clinically significant32,33,81. Other reviews do not reach conclusions on this issue due to the few studies included71.
Hygiene and halitosis
Some studies have shown that self-ligating appliances had a higher accumulation of periodontal pathogens21,82,83. However, other studies show no differences, so bracket design does not seem to have a major influence on biofilm accumulation or the presence of periodontal pathogens in subgingival plaque or gingival inflammation84,85,86,87,88. Therefore, self-ligating brackets do not differ regarding Streptococcus mutans or Lactobacillus colonization compared to conventional braces88,89,90 and would have no advantage over conventional brackets regarding periodontal status and halitosis91. In contrast, a study indicates that self-ligating brackets exhibit less biofilm retention, better periodontal parameters, and less halitosis compared with brackets with elastomeric ligatures92,93.
Some systematic reviews conclude that self-ligating metal brackets accumulate less Streptococcus mutans biofilm than conventional metal brackets. However, they suggest that these findings should be interpreted jointly with individual patient characteristics, such as hygiene and eating habits94. Other results show that self-ligating brackets do not outperform conventional brackets in promoting better oral health81 and others show that there is no evidence of a potential influence of bracket design (conventional or self-ligating) on colony formation and adhesion of Streptococcus mutans1,95. Regarding halitosis, reviews found that selfligating brackets controlled malodor better than conventional brackets96.
Discussion
This review shows a wide variety of results and conclusions regarding passive and active self-ligating brackets, and conventional brackets. Therefore, it is important to organize all the available information for clinical decision-making based on current evidence.
Regarding the studies of self-ligating brackets, their validity seems questionable. Several elements must be considered when reading these types of articles. As Rinchuse et al. point out, many of these studies are performed in vitro, so they fail to simulate the patient’s biological response, and others focus on only part of the treatment. In addition, tooth movement range is much greater than clinical movement8. Additionally, brackets have many different sizes, making it difficult to compare them with conventional brackets8. Many of these studies focus on different size archwires, so it is difficult to draw clear conclusions by unifying all the criteria.
Clinical studies show contradictory results when evaluating the differences between passive and active self-ligating brackets concerning alignment and leveling. The only systematic review consulted concludes that active self-ligating brackets would be more efficient in the alignment stage. However, the authors add that more studies are required to confirm these results since their review considered only three studies, and the differences found were not statistically significant6,14. Regarding friction, they conclude that passive self-ligating brackets would have certain advantages. However, these are in vitro studies, so results must be analyzed cautiously and considering the comments above12,13. The same applies when comparing these studies in terms of torque expression. One systematic review shows a small silght in torque expression5,15,16.
When grouping the data between active and passive self-ligating brackets with conventional brackets, we detected contradictory results when comparing various clinical studies at different treatment stages and with clinical considerations. Regarding friction, a single systematic review concludes that self-ligating brackets would produce less friction with round archwires of smaller caliber in an ideally aligned dental arch. However, this clinical situation occurs in very few cases17-22.
Regarding orthodontic treatment stages, there are no significant differences in alignment and leveling between the different types of fixed appliances23-33. When evaluating anchorage loss and space closure, no significant evidence showed any difference between the different types of brackets24,32-46. Regarding torque expression, conventional brackets have better results than self-ligating brackets16,47,48. Finally, when analyzing transversal expansion, there is no evidence of the superiority of self-ligating brackets33,46,49-57.
Further contradictory results appear in the various clinical studies evaluating other clinical considerations of self-ligating and conventional brackets. Regarding root resorption, only one in vitro study indicates the possible root protective effect of self-ligating appliances due to the amount of force exerted in relation to their conventional counterpart. However, clinical studies show similar results regarding root volume loss in both types of brackets, and systematic reviews conclude that a system cannot be considered superior to the other28,59-63.
Only one study found a reduction in clinical activity time with self-ligation brackets, which would be of little clinical relevance. Finally, the systematic reviews mention that self-ligating appliances seem to have a significant advantage regarding chair time. However, it remains to be seen whether this difference is clinically relevant64-67.
As the self-ligating systems have the advantage that the locking mechanism is free of biological degradation, the checkup interval can be increased. However, when reviewing the literature on checkup frequency, the results are mixed, and the systematic reviews generally show no reduction in the number of appointments compared to conventional brackets4,32,64,66,68-71.
Regarding total treatment time, some authors report a decrease in the cases treated with self-ligating brackets; others say that this reduction is not significant. One study even reports a longer time for self-ligating brackets4,31,33,60,62-64. However, systematic reviews show no decrease in total treatment time compared with conventional devices4,32,34,66,68-72.
As for comfort, patients experience greater discomfort with self-ligating brackets, but this is not statistically significant32,33,71,73-81. Finally, reviews and clinical studies are also contradictory when analyzing hygiene levels. Some find no differences, and others state that self-ligating brackets accumulate less Streptococcus mutans biofilm, so the issue is far from clear 1,21,81-96.
Conclusions
After reviewing the available literature on self-ligating brackets, we can draw the following conclusions:
- Regarding alignment, leveling, friction, space closure, anchorage loss, transversal changes, root resorption, checkup frequency, duration of treatment, patient comfort, and hygiene, and halitosis, the results show no significant differences between self-ligating or conventional brackets, and further studies are required to support their clinical relevance.
- As for chair time, there is no evidence suggesting that self-ligating brackets significantly decrease clinical time compared to conventional brackets.
- The main disadvantage of the self-ligating system compared with conventional brackets is that torque expression is more problematic.
- Many external factors related to tooth movement cannot be controlled, but they can affect the comparison between self-ligating and conventional brackets.
- In vitro studies show different results than clinical studies.
REFERENCES
1. do Nascimento LEAG, de Souza MMG, Azevedo ARP, Maia LC. Are self-ligating brackets related to less formation of Streptococcus mutans colonies? A systematic review. Dental Press J Orthod. 2014;19(1):60-8. [ Links ]
2. Pandis N, Bourauel C, Eliades T. Changes in the stiffness of the ligating mechanism in retrieved active self-ligating brackets. Am J Orthod Dentofacial Orthop. 2007;132(6):834-7. [ Links ]
3. Gandini P, Orsi L, Sfondrini MF, Scribante A. Opening and closure forces of sliding mechanisms of different self-ligating brackets. J Appl Oral Sci. 2013;21(3):231-4. [ Links ]
4. Eberting JJ, Straja SR, Tuncay OC. Treatment time, outcome, and patient satisfaction comparisons of Damon and conventional brackets. Orthod Craniofacial Res. 2001;4(4):228-34. [ Links ]
5. Brauchlia LM, Steineckb M, Wichelhausc A. Active and passive self-ligation: A myth? Part 1: Torque control. Angle Orthod. 2012;82(4):663-9. [ Links ]
6. Yang X, He Y, Chen T, Zhao M, Yan Y, Wang H, et al. Differences between active and passive self-ligating brackets for orthodontic treatment. Systematic review and meta-analysis based on randomized clinical trials. J Orofac Orthop. 2017;78(2):121-8. [ Links ]
7. Stolzenberg J. The Russell attachment and its improved advantages. International Journal of Orthodontia and Dentistry for Children 1935;21:837-40. [ Links ]
8. Rinchuse DJ, Miles PG. Self-ligating brackets: present and future. Am J Orthod Dentofacial Orthop. 2007 Aug;132(2):216-22. [ Links ]
9. Cacciafesta V, Sfondrini MF, Ricciardi A, Scribante A, Klersy C, Auricchio F. Evaluation of friction of stainless steel and esthetic self-ligating brackets in various bracket-archwire combinations. Am J Orthod Dentofacial Orthop. 2003;124(4):395-402. [ Links ]
10. Meeran NA. Self-ligating brackets: an update. J Clin Orthod. 2012;46(4):235-41 [ Links ]
11. Harradine N. The History and Development of Self-Ligating Brackets. Semin Orthod. 2008;14(1):5-18. [ Links ]
12. Thorstenson GA, Kusy RP. Comparison of resistance to sliding between different self-ligating brackets with second-order angulation in the dry and saliva states. Am J Orthod Dentofacial Orthop. 2002 May;121(5):472-82 [ Links ]
13. Chung M, Nikolai RJ, Kim KB, Oliver DR. Third-order torque and self-ligating orthodontic bracket-type effects on sliding friction. Angle Orthod. 2009;79(3):551-7. [ Links ]
14. Pandis N, Polychronopoulou A, Eliades T. Active or passive self-ligating brackets? A randomized controlled trial of comparative efficiency in resolving maxillary anterior crowding in adolescents. Am J Orthod Dentofacial Orthop. 2010;137(1):12.e1-12.e6. [ Links ]
15. Badawi HM, Toogood RW, Carey JPR, Heo G, Major PW. Torque expression of self-ligating brackets. Am J Orthod Dentofacial Orthop. 2008;133(5):721-8. [ Links ]
16. Al-Thomali Y, Mohamed RN, Basha S. Torque expression in self-ligating orthodontic brackets and conventionally ligated brackets: A systematic review. J Clin Exp Dent. 2017;9(1):e123-8. [ Links ]
17. Tecco S, Festa F, Caputi S, Traini T, Di Iorio D, D'Attilio M. Friction of conventional and self-ligating brackets using a 10 bracket model. Angle Orthod. 2005;75(6):1041-5. [ Links ]
18. Fuck L-M, Wilmes B, Gürler G, Hönscheid R, Drescher D. Friktionsverhalten selbstligierender und konventioneller Bracketsysteme. Informationen aus Orthod Kieferorthopädie. 2007;39(1):6-17 [ Links ]
19. Henao SP, Kusy RP. Evaluation of the frictional resistance of conventional and self-ligating bracket designs using standardized archwires and dental typodonts. Angle Orthod. 2004;74(2):202-11. [ Links ]
20. Burrow SJ. Friction and resistance to sliding in orthodontics: A critical review. Am J Orthod Dentofacial Orthop. 2009;135(4):442-7. [ Links ]
21. Araujo RC, Bichara LM, De Araujo AM, Normando D. Debris and friction of self-ligating and conventional orthodontic brackets after clinical use. Angle Orthod. 2015;85(4):673-7. [ Links ]
22. Ehsani S, Mandich MA, El-Bialy TH, Flores-Mir C. Frictional resistance in self-ligating orthodontic brackets and conventionally ligated brackets a systematic review. Angle Orthod. 2009;79(3):592-601. [ Links ]
23. Kim TK, Kim KD, Baek SH. Comparison of frictional forces during the initial leveling stage in various combinations of self-ligating brackets and archwires with a custom-designed typodont system. Am J Orthod Dentofacial Orthop. 2008;133(2):187.e15-187.e24. [ Links ]
24. Ludwig B, Bister D, Baumgaertel S. Self-Ligating Brackets in Orthodontics. Angle Orthodontist 2010;80: 575-584 [ Links ]
25. Miles PG. SmartClip versus conventional twin brackets for initial alignment: is there a difference? Aust Orthod J.2005;21(2):123-7. [ Links ]
26. Fleming PS, DiBiase AT, Sarri G, Lee RT. Efficiency of mandibular arch alignment with 2 preadjusted edgewise appliances. Am J Orthod Dentofacial Orthop 2009;135: 597-602. [ Links ]
27. Ong E, McCallum H, Griffin MP, Ho C. Efficiency of self-ligating vs conventionally ligated brackets during initial alignment. Am J Orthod Dentofacial Orthop. 2010;138(2):138.e1-138.e7. [ Links ]
28. Scott P, Dibiase AT, Sherriff M, Cobourne MT. Alignment efficiency of Damon3 self-ligating and conventional orthodontic bracket systems: A randomized clinical trial. Am J Orthod Dentofacial Orthop. 2008 Oct; 134 (4): 471-478. [ Links ]
29. Megat R, Idris H, Yacob H, Zainal SH. Comparison of self- and conventional-ligating brackets in the alignment stage. Eur J Orthod. 2012;34(2):176-181. [ Links ]
30. Pandis N, Polychronopoulou A, Eliades T. Self-ligating vs conventional brackets in the treatment of mandibular crowding: A prospective clinical trial of treatment duration and dental effects. Am J Orthod Dentofacial Orthop.2007;132(2):208-215. [ Links ]
31. Pesce RE, Uribe F, Janakiraman N, Neace WP, Peterson DR, Nanda R. Evaluation of rotational control and forces generated during first-order archwire deflections: A comparison of self-ligating and conventional brackets. Eur J Orthod. 2014;36(3):245-254. [ Links ]
32. Dehbi H, Azaroual MF, Zaoui F, Halimi A, Benyahia H. Therapeutic efficacy of self-ligating brackets: A systematic review. Int Orthod. 2017;15(3):297-311. [ Links ]
33. Fleming PS, Johal A. Self-ligating brackets in orthodontics a systematic review. Angle Orthod. 2010;80(3):575-584. [ Links ]
34. Machibya FM, Bao X, Zhao L, Hu M. Treatment time, outcome, and anchorage loss comparisons of self-ligating and conventional brackets. Angle Orthod. 2013;83(2):280-285. [ Links ]
35. da Costa Monini A, Júnior LGG, Vianna AP, Martins RP. A comparison of lower canine retraction and loss of anchorage between conventional and self-ligating brackets: a single-center randomized split-mouth controlled trial. Clin Oral Investig. 2017;21(4):1047-1053. [ Links ]
36. da Costa Monini A, Gandini LG, Martins RP, Vianna AP. Canine retraction and anchorage loss: Self-ligating versus conventional brackets in a randomized split-mouth study. Angle Orthod. 2014;84(5):846-852. [ Links ]
37. Monini A da C, Gandini LG, Vianna AP, Martins RP, Jacob HB. Tooth movement rate and anchorage lost during canine retraction: A maxillary and mandibular comparison. Angle Orthod. 2019;89(4):559-565. [ Links ]
38. Mezomo M, de Lima ES, de Menezes LM, Weissheimer A, Allgayer S. Maxillary canine retraction with self-ligating and conventional brackets: A randomized clinical trial. Angle Orthod. 2011;81(2):292-297. [ Links ]
39. de Almeida MR, Herrero F, Fattal A, Davoody AR, Nanda R, Uribe F. A comparative anchorage control study between conventional and self-ligating bracket systems using differential moments. Angle Orthod.2013;83(6):937-942. [ Links ]
40. Zhou Q, ul Haq AAA, Tian L, Chen X, Huang K, Zhou Y. Canine retraction and anchorage loss self-ligating versus conventional brackets: A systematic review and meta-analysis. BMC Oral Health. 2015; 136(15):1-9. [ Links ]
41. Malik DES, Fida M, Afzal E, Irfan S. Comparison of anchorage loss between conventional and self-ligating brackets during canine retraction - A systematic review and meta-analysis. Int Orthod. 2020;18(1):41-53. [ Links ]
42. Miles PG. Self-ligating vs conventional twin brackets during en-masse space closure with sliding mechanics. Am J Orthod Dentofacial Orthop. 2007;132(2):223-225. [ Links ]
43. Songra G, Clover M, Atack NE, Ewings P, Sherriff M, Sandy JR, et al. Comparative assessment ofalignment efficiency and space closure of active and passive self-ligating vs conventional appliances in adolescents: A single-center randomized controlled trial. Am J Orthod Dentofacial Orthop2014;145(5):569-578. [ Links ]
44. Wong H, Collins J, Tinsley D, Sandler J, Benson P . Does the bracket-ligature combination affect the amount of orthodontic space closure over three months? A randomized controlled trial. J Orthod 2013; 40: 155-162 [ Links ]
45. Burrow SJ. Canine retraction rate with self-ligating brackets vs conventional edgewise brackets. Angle Orthod. 2010;80(4):626-633. [ Links ]
46. Yang X, Xue C, El Y, Zhao M, Luo M, Wang P, et al. Transversal changes , space closure , and efficiency of conventional and self-ligating appliances: A quantitative systematic review. J Orofac Orthop. 2017;79(1):1-10 [ Links ]
47. Dalstra M, Eriksen H, Bergamini C, Melsen B. Actual versus theoretical torsional play in conventional and self-ligating bracket systems. J Orthod. 2015;42(2):103-113. [ Links ]
48. Pandis N, Strigou S, Eliades T. Maxillary incisor torque with conventional and self-ligating brackets : a prospective clinical trial. Orthod Craniofac Res. 2006; 9(4): 193-198. [ Links ]
49. Atik E, Akarsu-Guven B, Kocadereli I, Ciger S. Evaluation of maxillary arch dimensional and inclination changes with self-ligating and conventional brackets using broad archwires. Am J Orthod Dentofacial Orthop.2016;149(6):830-837. [ Links ]
50. de Almeida MR, Futagami C, Castro AC, Pedron PV, de Lima R. Dentoalveolar mandibular changes with self-ligating versus conventional bracket systems: A CBCT and dental cast study. Dental Press J Orthod. 2015;20(3):50-57. [ Links ]
51. Cattaneo PM, Treccani M, Carlsson K, Thorgeirsson T, Myrda A, Cevidanes LHS, et al. Transversal maxillary dento-alveolar changes in patients treated with active and passive self-ligating brackets: A randomized clinical trial using CBCT-scans and digital models. Orthod Craniofacial Res. 2011;14(4):222-233. [ Links ]
52. Atik E, Ciger S. An assessment of conventional and self-ligating brackets in Class i maxillary constriction patients. Angle Orthod. 2014;84(4):615-622. [ Links ]
53. Fleming PS, Lee RT, McDonald T, Pandis N, Johal A. The timing of significant arch dimensional changes with fixed orthodontic appliances: data from a multicenter randomised controlled trial. J Dent 2014;42:1-6 [ Links ]
54. Pandis N, Polychronopoulou A, Katsaros C, Eliades T. Comparative assessment of conventional and self-ligating appliances on the effect of mandibular intermolar distance in adolescent nonextraction patients: a single-center randomized controlled trial. Am J Orthod Dentofacial Orthop. 2011;140(3):e99-e105. [ Links ]
55. Mateu ME, Benítez-Rogé S, Iglesias M, Calabrese D, Lumi M, Solla M, et al.Increased interpremolar development with self-ligating orthodontics. A prospective randomized clinical trial. Acta Odontol Latinoam. 2018;31(2):104-109. [ Links ]
56. Bashir R, Sonar S, Batra P, Srivastava A, Singla A. Comparison of transverse maxillary dental arch width changes with self-ligating and conventional brackets in patients requiring premolar extraction - A randomised clinical trial. Int Orthod. 2019;17(4):687-692. [ Links ]
57. Pandis N, Polychronopoulou A, Makou M, Eliades T. Mandibular dental arch changes associated with treatment of crowding using self-ligating and conventional brackets. Eur J Orthod. 2010;32(3):248-253. [ Links ]
58. Fleming PS, DiBiase AT, Sarri G, Lee RT. Comparison of mandibular arch changes during alignment and leveling with 2 preadjusted edgewise appliances. Am J Orthod Dentofacial Orthop. 2009;136(3):340-7. [ Links ]
59. Berger JL. The influence of the SPEED bracket's self-ligating design on force levels in tooth movement: a comparative in vitro study. Am J Orthod Dentofacial Orthop. 1990;97(3):219-228. [ Links ]
60. Pandis N, Nasika M, Polychronopoulou A, Eliades T. External apical root resorption in patients treated with conventional and self-ligating brackets. Am J Orthod Dentofacial Orthop. 2008;134(5):646-651. [ Links ]
61. Aras I, Unal I, Huniler G, Aras A. Root resorption due to orthodontic treatment using self-ligating and conventional brackets: A cone-beam computed tomography study. J Orofac Orthop. 2018;79(3):181-190. [ Links ]
62. Yi J, Li M, Li Y, Li X, Zhao Z. Root resorption during orthodontic treatment with self-ligating or conventional brackets: a systematic review and meta-analysis. BMC Oral Health. 2016;16(1):1-8. [ Links ]
63. Weltman B, Vig KWL, Fields HW, Shanker S, Kaizar EE. Root resorption associated with orthodontic tooth movement: a systematic review. Am J Orthod Dentofacial Orthop. 2010;137(4):462-476. [ Links ]
64. Shivapuja PK, Berger J. A comparative study of conventional ligation and self-ligation bracket systems. Am J Orthod Dentofacial Orthop. 1994;106(5):472-480. [ Links ]
65. Turnbull NR, Birnie DJ. Treatment efficiency of conventional vs self-ligating brackets: effects of archwire size and material. Am J Orthod Dentofacial Orthop. 2007;131(3):395-399. [ Links ]
66. Harradine NW. Self-ligating brackets and treatment efficiency. Clin Orthod Res. 2001;4(4):220-227. [ Links ]
67. Chen SSH, Greenlee GM, Kim JE, Smith CL, Huang GJ. Systematic review of self-ligating brackets. Am J Orthod Dentofacial Orthop. 2010;137(6):726.e1-726.e18. [ Links ]
68. Johansson K, Lundström F. Orthodontic treatment efficiency with self-ligating and conventional edgewise twin brackets: a prospective randomized clinical trial. Angle Orthod. 2012;82(5):929-934. [ Links ]
69. O'Dywer L, Littlewood SJ, Rahman S, Spencer RJ, Barber SK, Russell JS. A multi-center randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: Part 1: Treatment efficiency. Angle Orthod. 2016;86(1):142-8. [ Links ]
70. Fleming PS, DiBiase AT, Lee RT. Randomized clinical trial of orthodontic treatment efficiency with self-ligating and conventional fixed orthodontic appliances. Am J Orthod Dentofacial Orthop. 2010;137(6):738-42. [ Links ]
71. Celar AG, Schedlberger M, Dörfler P, Bertl MH. Systematic review on self-ligating vs conventional brackets: initial pain, number of visits, treatment time. J Orofac Orthop.2013;74(1):40-51. [ Links ]
72. Alpern MC. Gaining Control with Self-Ligation. Semin Orthod. 2008;14(1):73-86. [ Links ]
73. Scott P, Sherriff M, Dibiase AT, Cobourne MT. Perception of discomfort during initial orthodontic tooth alignment using a self-ligating or conventional bracket system: A randomized clinical trial. Eur J Orthod.2008;30(3):227-232. [ Links ]
74. Rahman S, Spencer RJ, Littlewood SJ, O'Dywer L, Barber SK, Russell JS. A multicenter randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: Part 2: Pain perception. Angle Orthod. 2016 Jan;86(1):149-56. [ Links ]
75. Fleming PS, Dibiase AT, Sarri G, Lee RT. Pain experience during initial alignment with a self-ligating and a conventional fixed orthodontic appliance system. A randomized controlled clinical trial. Angle Orthod. 2009;79(1):46-50. [ Links ]
76. Bertl MH, Onodera K, Celar AG. A prospective randomized split-mouth study on pain experience during chairside archwire manipulation in self-ligating and conventional brackets. Angle Orthod. 2013 Mar;83(2):292-7. [ Links ]
77. Miles PG, Weyant RJ, Rustveld L. A clinical trial of Damon 2 vs conventional twin brackets during initial alignment. Angle Orthod. 2006;76(3):480-485. [ Links ]
78. Tecco S, D´Attilio M, Tetè S, Festa F. Prevalence and type of pain during conventional and self-ligating orthodontic treatment. Eur J Orthod. 2009;31(4):380-384. [ Links ]
79. Pringle AM, Petrie A, Cunningham SJ, McKnight M. Prospective randomized clinical trial to compare pain levels associated with 2 orthodontic fixed bracket systems. Am J Orthod Dentofacial Orthop. 2009 Aug;136(2):160-7. [ Links ]
80. Lai TT, Chiou JY, Lai TC, Chen T, Wang HY, Li CH, Chen MH. Perceived pain for orthodontic patients with conventional brackets or self-ligating brackets over 1 month period: A single-center, randomized controlled clinical trial. J Formos Med Assoc. 2020 Jan;119(1 Pt 2):282-289. [ Links ]
81. Yang X, Su N, Shi Z, Xiang Z, He Y, Han X, et al. Effects of self-ligating brackets on oral hygiene and discomfort: a systematic review and meta-analysis of randomized controlled clinical trials. Int J Dent Hyg. 2017;15(1): 16-22. [ Links ]
82. Pithon MM, dos Santos RL, Nascimento LE, Ayres AO, Alviano D, Bolognese AM. Do self-ligating brackets favor greater bacterial aggregation? Braz J Oral Sci. 2011;10(3):208-212. [ Links ]
83. Bergamo AZN, Nelson-Filho P, Andrucioli MCD, do Nascimento C, Pedrazzi V, Matsumoto MAN. Microbial complexes levels in conventional and self-ligating brackets. Clin Oral Investig. 2017;21(4):1037-1046. [ Links ]
84. Pejda S, Varga ML, Milosevic SA, Mestrovic S, Slaj M, Repic D, et al. Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment. Angle Orthod. 2013;83(1):133-139. [ Links ]
85. Cardoso Mde A, Saraiva PP, Maltagliati LÁ, Rhoden FK, Costa CC, Normando D, Capelozza Filho L. Alterations in plaque accumulation and gingival inflammation promoted by treatment with self-ligating and conventional orthodontic brackets. Dental Press J Orthod. 2015;20(2):35-41. [ Links ]
86. Baka ZM, Basciftci FA, Arslan U. Effects of 2 bracket and ligation types on plaque retention: a quantitative microbiologic analysis with real-time polymerase chain reaction. Am J Orthod Dentofacial Orthop. 2013;144(2):260-7. [ Links ]
87. Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T. Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating brackets. Orthod Craniofac Res. 2008;11(4):211-5. [ Links ]
88. Pandis N, Papaioannou W, Kontou E, Nakou M, Makou M, Eliades T. Salivary Streptococcus mutans levels in patients with conventional and self-ligating brackets. Eur J Orthod. 2010;32(1):94-9 [ Links ]
89. do Nascimento LEAG, Pithon MM, dos Santos RL, Ayres AO, Alviano DS, Nojima LI, et al. Colonization of Streptococcus mutans on esthetic brackets: self-ligating vs conventional. Am J Orthod Dentofacial Orthop. 2013;143(4):72-77. [ Links ]
90. Uzuner FD, Kaygisiz E, Cankaya ZT. Effect of the bracket types on microbial colonization and periodontal status. Angle Orthod. 2014;84(6):1062-7. [ Links ]
91. Kaygisiz E, Uzuner FD, Yuksel S, Taner L, Çulhaoglu R, Sezgin Y, et al. Effects of self-ligating and conventional brackets on halitosis and periodontal conditions. Angle Orthod. 2015;85(3):468-473. [ Links ]
92. Pellegrini P, Sauerwein R, Finlayson T, McLeod J, Covell DA, Maier T, et al. Plaque retention by self-ligating vs elastomeric orthodontic brackets: quantitative comparison of oral bacteria and detection with adenosine triphosphate-driven bioluminescence. Am J Orthod Dentofacial Orthop. 2009;135(4):426-427. [ Links ]
93. Nalçaci R, Özat Y, Çokakoglu S, Türkkahraman H, Önal S, Kaya S. Effect of bracket type on halitosis, periodontal status, and microbial colonization. Angle Orthod. 2014;84(3):479-85. [ Links ]
94. Longoni J, Lopes B, Freires I, Dutra K, Franco A, Parnahos L. Self-ligating versus conventional metallic brackets on Streptococcus mutans retention: A systematic review. Eur J Dent. 2017;11(4):537-547. [ Links ]
95. Arnold S, Koletsi D, Patcas R, Eliades T. The effect of bracket ligation on the periodontal status of adolescents undergoing orthodontic treatment. A systematic review and meta-analysis. J Dent. 2016;54:13-24. [ Links ]
96. Huang J, Li CY, Jiang JH. Effects of fixed orthodontic brackets on oral malodor: A systematic review and meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Medicine (Baltimore). 2018;97(14):1-6. [ Links ]
Authorship contribution 1. Conception and design of study 2. Acquisition of data 3. Data analysis 4. Discussion of results 5. Drafting of the manuscript 6. Approval of the final version of the manuscript. GHS participated in 1, 2, 3, 4, 5, 6. MISY participated in 1, 2, 3, 4, 5, 6. VVA participated in 1, 2, 3, 4, 5, 6. ADM participated in 1, 2, 3, 4, 5, 6.
Received: October 22, 2020; Accepted: April 27, 2021
Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons
