Semester

Spring

Date of Graduation

2022

Document Type

Thesis

Degree Type

MS

College

School of Dentistry

Department

Orthodontics

Committee Chair

Peter Ngan

Committee Co-Chair

Khaled Alsharif

Committee Member

Khaled Alsharif

Committee Member

Chris Martin

Abstract

Background and Objectives:

Self-ligating brackets have risen in popularity in clinical orthodontics, but many claims made by their manufacturers have been made without substantial evidence. Any differences among the bracket types are very small when consulting new peer reviewed literature testing their differences. Nevertheless, self-ligating brackets are still purported to be able to increase the dental transverse dimension more effectively than conventional brackets. In 2018, Yang et al. performed a systematic review on the transversal changes, space closure, and efficiency of conventional and self-ligating appliances. Since then, there were several clinical trials published in the literature comparing the mandibular arch dimensional changes between these two types of brackets. The purpose of this systematic review was to include the new studies to give more practical advice on bracket selection in contemporary orthodontic practice.

Methods: This systematic review was conducted similarly to the Yang et al (2018) systematic review. An extensive systematic search of the most recent literature published after December 2016 to April 2022 was carried out to compare passive self-ligating brackets with conventional brackets in treating the transverse dental dimension. Randomized controlled trials only were included after systematically hand searching the PubMed literature database with the search terms: “passive” “self-ligating” “brackets” “conventional” “transverse” “orthodontics” respectively. Each article that met inclusion criteria was reviewed by a statistician to confirm heterogeneity and for potential meta-analyses.

Results: Out of 19 papers initially screened by abstract, 11 were included in this systematic review, with 6 being new articles having been published in the last 5 years. 2 were included with 4 articles were included in a previously published meta-analysis review to synthesize their results. Meta-analyses showed that passive self-ligating brackets increased intermolar width more than conventional brackets (0.59mm; p = 0.0008), while conventional preadjusted brackets increased intercanine width more than passive self-ligating brackets (0.42mm; p = 0.007)

Conclusions: The systematic review found 6 studies out of 19 to be included in a qualitative systematic review. From these six, 2 were included in a meta-analysis including 4 studies used in the previous systematic review. Passive self-ligating brackets expanded the mandibular intermolar width slightly more than conventional brackets, and conventional preadjusted brackets expanded intercanine width slightly more than passive self-ligating brackets, both being statistically significant respectively. High heterogeneity in the intercanine measurements calls these results into question. The difference in width increases between the bracket types were deemed not clinically significant. Future research should standardize arch forms and wire sequences to further differentiate between the two bracket types.

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