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Research Article: Self-ligation shortens chair time and compounds savings, with external bracket hygiene compared to conventional ligation

Systematic review with meta-analysis of RCTs

JC Voudouris - S Suri -B Tompson - JD Voudouris - C Schismenos - J Poulos

Astract

Objective: To test if there are significant evidence-based differences in effectiveness between self-ligation (SL) and conventional-ligation (CL) brackets.

Materials and Methods: Popular clinical claims of SL were identified through a literature overview of PubMed, EMBASE, Cochrane Library, and Web of Science for the period 1965-2017. Additional hand searching of the references from retrieved articles was completed. The articles containing the inclusion criteria were qualitatively analyzed using the Cochrane risk of bias tool, and one other scale. Applicable RCTs were statistically analyzed with weighted means calculations and forest plots. RCT data that could not be synthesized with one other RCT at this time were reserved for discussion.

Results: The inclusion criteria were satisfied by a total of ten RCT studies, six of which were matched for meta-analysis of three popular clinical claims. Space closure rate, reduced incisor proclination, and the rate of mandibular alignment for SL compared to CL were not statistically significant with confidence intervals of 95%. The remaining four RCTs were collectively analyzed and found no statistically significant difference in discomfort between SL and CL.

Conclusion: The null hypothesis that there are no differences between SL and CL, was not rejected due to statistically insignificant results. Additional active SL studies, and well-designed RCTs for MA are needed that includes overall treatment time. SL chair time efficiency was consistently higher versus CL.

self-ligation

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