Survival analysis of brackets and tubes: A twelve-month assessment

The second molar dilemma in orthodontics: to bond or not to bond?

OBJECTIVES

To compare orthodontic treatment (OT) outcome in adolescents undergoing nonextraction fixed OT with or without bonding of second molars using the score of the American Board of Orthodontics Cast Radiograph Evaluation (C-R-Eval).

MATERIALS AND METHODS

This study included healthy adolescents with skeletal Class I or mild Class II/Class III malocclusion, normal or deep overbite (OB), and mild-to-moderate dental crowding (<5 mm) who underwent nonextraction fixed OT with ("bonded" group) or without ("not-bonded" group) bonding of second molars. Patient treatment records, pre- and posttreatment digital models, lateral cephalograms, and orthopantomograms were assessed. The evaluated outcomes included leveling of the curve of Spee (COS), OB, control of incisor mandibular plane angle (IMPA), number of emergency visits (related to poking wires and/or bracket failure of the terminal molar tubes), treatment duration, and C-R-Eval. Treatment variables were compared across time points and among groups.

RESULTS

The sample included 30 patients (mean age 16.07 ± 1.80 years) in the bonded group and 32 patients (mean age 15.69 ± 1.86 years) in the not-bonded group. The mean overall C-R-Eval score was significantly higher (P < .001) in the not-bonded group (25.25 ± 3.98) than in the bonded group (17.70 ± 2.97). There were no significant differences in mean changes of COS, OB, IMPA, or treatment duration among groups. The mean number of emergency visits was significantly higher in the bonded (3.3 ± 0.6) than the not-bonded group (1.9 ± 0.4) (P < .001).

CONCLUSIONS

Bonding of second molars enhances the outcome of nonextraction fixed OT as demonstrated by the C-R-Eval without increasing treatment duration, irrespective of more emergency visits.

Evaluation of failure rate of molar tubes with a modified bonding technique: a randomized clinical trial

BACKGROUND

During orthodontic therapy, bond failure of molar tubes may delay treatment. With the high failure rate of molar tubes, alternative bonding techniques were tested to improve bond strength.

OBJECTIVES

To compare the failure rates of molar tubes bonded with conventional and alternative bonding techniques by adding a layer of compomer adhesive at the molar/tube interface.

TRIAL DESIGN

Single-centre, single-blinded, split-mouth, randomized clinical trial.

METHODS

Patients aged 12 years or older, who required fixed appliance orthodontic treatment without extraction and with no occlusal interference were eligible to participate. They were allocated randomly using a simple non-stratified split-mouth design with a 1:1 allocation ratio. Blinding was only possible for the patients and data analysts. Molar tubes bonded with the modified bonding technique had an additional layer of compomer at the occlusal molar/tube interface. The patients were followed-up for nine months. Outcome measures included the survival time of molar tubes and the number of molar tubes debonded. The bond failure of molar tubes was analyzed using Kaplan-Meier and Cox regression analysis (P < 0.05).

RESULTS

Thirty patients were recruited, randomized, and analyzed (mean age 20.33 years). The failure rate of molar tubes bonded with the modified bonding technique was 4.2 per cent and that of molar tubes bonded with the conventional bonding technique was 6.7 per cent. This difference was not statistically significant (P > 0.05). The dental arch and molar type were found to be as significant predictors for molar tube failure rate. No harm was detected during treatment.

LIMITATIONS

The effect of compomer to reduce enamel demineralization was not tested.

CONCLUSIONS AND IMPLICATIONS

The modified bonding technique did not significantly reduce the failure rate of molar tubes. The molar tubes bonded on the upper arch and second molars are more susceptible to debond.

REGISTRATION

The trial was registered with ClinicalTrials.gov on 21 May 2022 (Registration number: NCT05391386).

FUNDING

This research did not receive any funding.

Bracket Bond Failures: Incidence and Association with Different Risk Factors-A Retrospective Study

BACKGROUND

Bracket bonding failure is one of the relevant problems in fixed orthodontics therapy, which affects the total treatment and quality of treatment results. The purpose of this retrospective study was to evaluate the frequency of bracket bond failure and find out risk factors.

METHODS

A total of 101 patients with an age range of 11-56 years were included in this retrospective study and treated for a mean period of 30.2 months. Inclusion criteria were: males and females with permanent dentition and completed orthodontic treatment in both fully bonded dental arches. Risk factors were calculated using binary logistic regression analysis.

RESULTS

The overall bracket failure rate was 14.65%. The bracket failure rate was significantly higher in the younger patients' group (p = 0.003). In most cases, patients experienced bracket failures in the first month of the treatment. Most of the bracket bond failures occurred on the left lower first molar (29.1%) and were twice as common in the lower dental arch (66.98%). Patients with increased overbite had an increased likelihood of bracket loss (p = 0.042). Class II malocclusion increased the relative risk of bracket failure, while Class III decreased the rate of bracket failure, but the difference was not statistically significant (p = 0.093).

CONCLUSIONS

The bracket bond failure rate was higher in younger patients than in older patients. Brackets placed on mandibular molars and premolars had the highest failure rate. Class II was associated with an increased bracket failure rate. Increased overbite statistically significantly increases bracket failure rate.

Bonding Failures of Lingual Orthodontic Brackets: A Retrospective Study Comparing Lingual Brackets with KommonBase Extensions, to Customized Lingual Brackets

The aim of the present study was to evaluate in a clinical setting the bracket survival of lingual brackets bonded with the KommonBase system, and to compare it to the survival of a customized lingual bracket system. Two convenience samples of 13 consecutive patients treated with lingual fixed appliances with KommonBase extensions (Group 1) and 14 consecutive patients treated with customized Incognito™ lingual fixed appliances were retrospectively enrolled (Group 2). First time debondings were recorded from the files. Data were submitted to statistical analysis and a Log-rank test was used to compare the Kaplan–Meier survival curves between the two groups. Statistical significance was set as p < 0.05. Lingual brackets bonded with the KommonBase system showed a failure rate of 8%, while Incognito brackets showed a failure rate of 7.1%. The Log-rank test comparing the Kaplan–Meier survival curves revealed no statistically significant difference between the two groups (p = 0.343). Most debondings occurred during the first 6 months. Upper incisors and canines were less prone to debond than premolars and molars. In conclusion, no difference in bracket survival was observed between the KommonBase system and a customized lingual appliance.

Effects of self-ligating brackets and other factors influencing orthodontic treatment outcomes: A prospective cohort study

Objective

The purpose of this study was to evaluate the effects of self-ligating brackets (SBs) and other factors that influence orthodontic treatment outcomes.

Methods

This two-armed cohort study included consecutively treated patients in a private practice. The patients were asked to choose between SBs and conventional brackets (CBs); if any patient did not have a preference, he or she was randomly allocated to the CB or SB group. All patients were treated using an identical archwire sequence. Evaluated parameters were as follows: treatment duration, number of bracket failures, poor oral hygiene, poor elastic wear, extraction, use of orthodontic mini-implants (OMI), OMI failure, American Board of Orthodontics (ABO) Discrepancy Index (DI), arch length discrepancy, and ABO Cast-Radiograph Evaluation (CRE) score. Stepwise regression analysis was performed to generate the equation for prediction of the CRE.

Results

The final sample comprised 134 patients with an average age of 22.73 years. The average DI, CRE, and treatment duration were 21.81, 14.25, and 28.63 months, respectively. Analysis of covariance showed a significant difference in CRE between the CB and SB groups after adjusting for the effects of confounding variables. Stepwise regression analysis using four variables, namely extraction, SB use, poor elastic wear, and additional appliance use, could explain only 25.2% of the variance in the CRE.

Conclusions

Although the CRE was significantly better for CBs than for SBs, the clinical significance of this result seems to be limited. Extraction, SB use, poor elastic wear, and additional appliance use may have significant effects on treatment outcomes.

Factors influencing treatment efficiency

OBJECTIVES

The purpose of this cohort study was to evaluate the effect of self-ligating brackets (SB) and other related factors that influence orthodontic treatment time.

MATERIALS AND METHODS

This was a two-armed prospective study. Consecutively treated patients who were recruited from a private practice were enrolled and asked to choose between SB and conventional brackets (CB). If the patient did not have a preference, that patient was randomly allocated. An identical archwire sequence was used, and all patients were treated by a single orthodontist. Treatment duration, number of bracket failures, poor oral hygiene, poor elastic wear, whether or not to orthodontic mini-implants (OMI) were used, OMI failure, extraction, American Board of Orthodontics Discrepancy Index, and arch length discrepancy were measured and statistically analyzed using t-tests, correlation analysis, and analysis of covariance (ANCOVA). Stepwise regression analysis was conducted to generate an equation to predict treatment duration.

RESULTS

A total of 134 patients with an average age of 22.73 years were included. The average treatment duration was 28.63 months. ANCOVA showed no significant difference in treatment duration between CB and SB. Stepwise regression analysis could explain 64.6% of the variance in treatment duration using five variables.

CONCLUSIONS

SB did not exhibit a significant reduction in treatment time as compared with CB. Patient cooperation, extractions, and malocclusion severity had a significant impact on treatment duration.

A Retrospective Clinical Audit of Bracket Failure among Patients Undergoing Orthodontic Therapy

Objective

Bonding failure is a problem in orthodontic therapy and has been associated with orthodontic emergencies and delayed treatment time. The aim of this study is to determine the bracket failure rate among patients undergoing orthodontic therapy.

Materials and Methods

From the archives of posttreatment records, 200 total cases were selected, out of which 122 cases had detailed treatment records. Cases with incomplete records, large restorations, or enamel aberrations were excluded from the study. Descriptive statistics were applied to obtain sample characteristics, and a chi-square test was applied to compare the bracket failure between different categories.

Result

Out of the 122 samples enrolled in the study, female and male patients comprised 71% and 29%, respectively. Class I malocclusions were the most common problem (56%), followed by Class II (41%) and Class III (3%). The bracket failure rate was 3.43%, and 32% of the patients had an incidence of bracket failure. There was no significant difference in bracket failure among genders (p=0.344), malocclusion types (p=0.191), or operators (p=0.188). The maxillary left quadrant was the most common site of bracket failure, followed by the mandibular right quadrant.

Conclusion

Bracket failure is relatively uncommon. It is not affected by the gender or age of the patient or by malocclusion type. The maxillary left and mandibular right quadrants are the most common sites of bracket failure.

Analysing the potential of hydrophilic adhesive systems to optimise orthodontic bracket rebonding

Introduction

Bond failure during fixed orthodontic treatment is a frequently occurring problem. As bracket rebonding is associated with reduced shear bond strength, the aim of the present investigation is to analyse the effect of different innovative rebonding systems to identify optimised rebonding protocols for orthodontic patient care.

Methods

Metallic brackets were bonded to the frontal enamel surfaces of 240 bovine lower incisors embedded in resin bases. Teeth were randomly divided into two major experimental groups: in group 1 a hydrophilic primer (Assure™ PLUS) was compared to commonly used orthodontic adhesives (Transbond XT™, BrackFix®, Grengloo™) and a zero control. In group 2 different rebonding systems were analysed using a hydrophilic primer (Assure™ PLUS), a methyl methacrylate-consisting primer (Plastic Conditioner) and a conventional adhesive (Transbond XT™). All teeth were tested for shear bond strength according to the DIN-13990 standard, the Adhesive Remnant Index and enamel fracture rate.

Results

The hydrophilic primer enhanced shear bond strength at first bonding (Assure™ PLUS 20.29 ± 4.95 MPa vs. Transbond XT™ 18.45 ± 2.57 MPa; BrackFix® 17 ± 5.2 MPa; Grengloo™ 19.08 ± 3.19 MPa; Meron 8.7 ± 3.9 MPa) and second bonding (Assure™ PLUS 16.76 ± 3.71 MPa vs. Transbond XT™ 13.06 ± 3.19 MPa). Using Plastic Conditioner did not seem to improve shear bond strength at rebonding (13.57 ± 2.94). When enamel etching was left out, required shear bond strength could not be achieved (Plastic Conditioner + Assure™ PLUS 8.12 ± 3.34 MPa; Plastic Conditioner: 3.7 ± 1.95 MPa). Hydrophilic priming systems showed decreased ARI-scores (second bonding: 2.63) and increased enamel fracture rates (first bonding: 55%; second bonding 21,05%).

Conclusions

Based on the present study we found that rebonding strength could be compensated by the use of hydrophilic priming systems. The additional use of a methyl methacrylate-consisting primer does not seem to enhance shear bond strength. No etching approaches resulted in non-sufficient bond strength.

A Clinical Comparison of Failure Rates of Metallic and Ceramic Brackets: A Twelve-Month Study

Objective

Clinical comparison of the survival rates between stainless steel and ceramic brackets over a 12-month period.

Materials and Methods

The study involved 20 consecutive patients with diagnosed malocclusion that required two-arch fixed appliance treatment. The participants were randomly divided into two 10-member groups. Group 1 was treated with Abzil Agile (3M Unitek) stainless steel brackets; group 2 was treated with Radiance (American Orthodontics) monocrystalline ceramic brackets. All the brackets were bonded by the same operator. Over the next 12 months, all bracket failures were recorded with each appointment. The received data were processed statistically using the Mantel–Cox test, Kaplan–Meier method, and Cox hazard model.

Results

A total of 381 brackets were bonded, 195 of which were metallic brackets and 186 were ceramic ones. In the 12-month observation period, there were 14 metal (7.2%) and 2 ceramic bracket (1.1%) failures. The overall failure rate was 4.2% (n = 16). The majority of failures (14 brackets; 87.5%) occurred during the first 6 months of the experiment, 12 (83%) of which were metal brackets and 2 (100%) were ceramic brackets. The statistical analysis revealed significant differences between the groups (p < 0.05).

Conclusions

Metal brackets demonstrated significantly higher failure rates than ceramic brackets for both 6- and 12-month observation periods (p < 0.05). The 6% difference between the brackets is clinically significant as it corresponds to one additional failure within 12 months.

Debonding Shear Strength of Orthodontic Tubes Bonded to Skeletal Anchorage Miniplates with Different Agents

Introduction:

Most miniplates used for skeletal anchorage lack built-in orthodontic devices. To address this issue, orthodontists must use creative solutions, such as bonding buttons, brackets, or tubes directly to the miniplates, thus making them more versatile devices that provide a wider range of tooth movement possibilities. The purpose of the present study was to ascertain the debonding strength in Megapascals (MPa) of orthodontic accessories bonded to skeletal anchorage miniplates with different bonding agents.

Methods:

Forty specimens were divided into two equal groups by bonding agent: Group 1, resin (Transbond XT®, 3M ESPE); Group 2, cyanoacrylate (Scotchbond®, 3M ESPE). Shear strength testing was performed in an EMIC DL-2000 universal testing machine.

Results:

The results obtained were 2.28 ± 0.44 MPa for Group 1 and 4.90 ± 0.76 MPa for Group 2. The Kolmogorov-Smirnov test was used to assess the normality of data distribution. Student's t-test was used to compare means in the response variable.

Conclusion:

A statistically significant difference was observed between groups. However, both bonding agents provided strength in excess of that needed for secure orthodontic tooth movement.

Incidence of orthodontic brackets detachment during orthodontic treatment: A systematic review

OBJECTIVES

To evaluate the incidence of orthodontic brackets detachment during orthodontic treatment.

METHODS

Using electronic databases; eligible studies up to January 2018 were retrieved, independently reviewed, and screened. The Coleman Methodology Scoring System (CMS) and Cochrane Collaboration's tool were used to assess quality and risk of bias in the included studies.

RESULTS

Of the seventeen studies included in the final synthesis, thirteen were categorized as randomized clinical trials (RCTs), one prospective cohort and retrospective survey each, whereas two studies could not be categorized. The number of patients in the selected studies ranged between 19 and 153; the mean age was between 10.5 to 38.7 years, and male to female ratio was 353:495. Almost all studies had a high risk of bias, and more than half of the studies had CMS score of 70 or above. The numbers of brackets examined in the studies ranged between 361 and 3336. The incidence of brackets detachment ranged from 0.6 to 28.3%.

CONCLUSIONS

The incidence of brackets detachment during orthodontic treatment is high.

The effect of conventional versus figure-of-eight module ligation on mandibular incisor alignment: a randomised controlled trial

OBJECTIVE

To determine whether using figure-of-eight modules affects the rate of lower incisor alignment compared with conventionally tied modules.

DESIGN

Prospective randomised controlled trial.

SETTING

Orthodontic department at Queen's Hospital, Burton upon Trent, UK.

METHODS

One hundred and twenty participants were randomly allocated to conventional module or figure-of-eight module groups, stratified for extraction or non-extraction lower arch treatment. Eligibility criteria included patients who were 12-15 years of age at the start of treatment, in the permanent dentition, and had mandibular incisor irregularity of 5-10 mm (clinical observation). The primary outcome was the rate of lower incisor alignment during the first 12 weeks of orthodontic treatment. The secondary outcome was bracket failure rate. Lower labial segment alignment was measured on study models using the Little's Irregularity Index at the start (T0) of treatment, at 6 weeks (T1) and 12 weeks (T2). Case records were analysed to assess the number of bracket failures.

RESULTS

The four groups were well matched at baseline with respect to gender, age and irregularity. All patients completed the trial and data were analysed on an intention to treat basis. In both ligation groups, the lower teeth aligned significantly faster when the treatment involved extractions, for the time periods T0-T1 and T0-T2 (p < 0.05). There were no statistically significant differences between conventional module and figure-of-eight module ligation on the rate of alignment (per month) for all three-time periods. The bracket failure rate was also similar in both test groups; 4.08% for conventional and 3.21% for figure-of-eight ligation.

CONCLUSIONS

Ligation with figure-of-eight modules has no clinically significant effect on the rate of lower incisor alignment; it does not seem to hinder or quicken the alignment of teeth. There were no differences in the mean number of bracket failures per person.

A retrospective survey of the causes of bracket- and tube-bonding failures

OBJECTIVE

To investigate the causes of bonding failures of orthodontic brackets and tubes and the effect of premedicating for saliva reduction.

MATERIALS AND METHODS

Premedication with atropine sulfate was administered randomly. Failure rate of brackets and tubes placed in a group of 158 consecutive patients was evaluated after a mean period of 67 weeks after bonding.

RESULTS

The failure rate in the group without atropine sulfate premedication was 2.4%. In the group with premedication, the failure rate was 2.7%. The Cox regression analysis of these groups showed that atropine application did not lead to a reduction in bond failures. Statistically significant differences in the hazard ratio were found for the bracket regions and for the dental assistants who prepared for the bonding procedure.

CONCLUSIONS

Premedication did not lead to fewer bracket failures. The roles of the dental assistant and patient in preventing failures was relevant. A significantly higher failure rate for orthodontic appliances was found in the posterior regions.

Survival analysis of banding and bonding molar tubes in adult patients over a 12-month period: a split-mouth randomized clinical trial

This split-mouth randomized clinical trial aimed to compare the survival rate of bonding and banding molar tubes in adult orthodontic patients. Eligibility criteria included adults (aged >18 years), no active caries, restorations, or fractures in the upper and lower molars. The main outcome was any type of first-time failure in molar tubes. A computer-generated randomization scheme was used in a 1:1 ratio. The survival rate was estimated for 32 adult patients, in whom a tube was bonded to a molar tooth using composite resin on one side and a band was cemented with glass ionomer onto the same tooth in the contralateral arch. A total of 59 banded and 59 bonded molars were followed up for 12 months. Blinding was not applicable. Survival analysis including Cox regression was used at p < 0.05. The survival rate of bonded molars was not statistically different from that of banded molars (log-rank test, p = 0.97). Hazard ratio (HR) was 0.72 (95%CI, 0.38-1.31). Bonded upper molars yielded a survival rate of 81.25% (26 out of 32) compared to 71.87% (23 out of 32) for banded upper molars. The survival rate was 66.66% (18 out of 27) for banded lower molars and 59.25% for bonded lower molars (16 out of 27). The HR for lower vs. upper arch was 2.16 (95%CI, 1.18-3.98). No serious problem was observed other than gingivitis associated with plaque accumulation. In contrast to previous studies in young patients, in adults, bonding orthodontic tubes to molars is similar to molar banding. However, both procedures had a high failure rate in the lower arch.