ORIGINAL ARTICLE

Self-ligating vs conventional brackets

in the treatment of mandibular crowding:
A prospective clinical trial of treatment
duration and dental effects
Nikolaos Pandis,a Argy Polychronopoulou,b and Theodore Eliadesc
Corfu, Athens, and Thessaloniki, Greece

Introduction: The aim of this study was to investigate the duration of mandibular-crowding alleviation with
self-ligating brackets compared with conventional appliances and the accompanying dental effects.
Methods: Fifty-four subjects were selected from a pool of patients satisfying the following inclusion criteria:
nonextraction treatment in the mandibular or maxillary arches; eruption of all mandibular teeth; no spaces in
the mandibular arch; irregularity index greater than 2 in the mandibular arch; and no therapeutic intervention
planned with any extraoral or intraoral appliance. The patients were randomly assigned to 2 groups: 1 group
received treatment with a self-ligating bracket (Damon 2, Ormco, Glendora, Calif) and the other with a
conventional edgewise appliance (Microarch, GAC, Central Islip, NY), both with 0.022-in slots. The
irregularity index of the mandibular arch was normalized between the groups, and the time to alignment was
estimated in days. Treatment duration was assessed by data modeling with the Cox proportional hazard
regression. Lateral cephalometric radiographs were used to assess the alteration of mandibular incisor
position before and after alignment. Measurements of intercanine and intermolar widths were also made on
dental casts to determine changes associated with correction. Results and Conclusions: Overall, no
difference in the time required to correct mandibular crowding with Damon 2 and conventional brackets was
observed. For moderate crowding (irregularity index ⬍5), however, the self-ligating group had 2.7 times
faster correction. This difference was marginally insignificant for subjects with irregularity index scores
greater than 5. Greater crowding prolonged treatment by an additional 20% for each irregularity index unit.
Increases in intercanine and intermolar widths associated with crowding correction regardless of bracket
group were noted. The self-ligating group showed a statistically greater intermolar width increase than the
conventional group. Also, an alignment-induced increase in the proclination of the mandibular incisors was
observed for both bracket groups, but no difference was found between Damon 2 and conventional brackets
for this parameter. (Am J Orthod Dentofacial Orthop 2007;132:208-15)

S
elf-ligating brackets were introduced in this spe-
cialty in a first form some decades ago; Harra-
dine1 reported that the concept of self-ligation is
as old as that of the edgewise bracket. Nonetheless, in
the past 2 decades, there has been a boost in the
manufacturing and release of self-ligating appliances
with active or passive ligation modes.
The basic advantages of these brackets involve the
elimination of certain utilities or materials such as
a
elastomeric modules along with the process or tools
associated with their application. This brings several
favorable features to treatment, including the elimina-
tion of potential cross-contamination with elastic liga-
tures, consistently full engagement without the unde-
sirable force relaxation of elastomeric modules,
supposed reduced risk for enamel decalcification from
the elimination of the retentive site for plaque accumu-
lation, hypothetically reduced friction in sliding me-
chanics, and assumed low-magnitude forces resulting

b
Private practice, Corfu, Greece.
in fewer side effects.2-9 Moreover, during the past
Assistant professor, Department of Community and Preventive Dentistry,
School of Dentistry, University of Athens, Athens, Greece. decade, the initial clinical handling difficulties associ-
c
Associate professor, Department of Orthodontics, School of Dentistry, Aris- ated with their use have been overcome, and the
totle University of Thessaloniki, Thessaloniki, Greece.
Reprint requests to: Theodore Eliades, 57 Agnoston Hiroon St, Nea Ionia
application of these appliances has been significantly
GR-14231, Greece; e-mail, teliades@ath.forthnet.gr. simplified.
Submitted, November 2005; revised and accepted, January 2006. However, most advantages of self-ligation remain
0889-5406/$32.00
Copyright © 2007 by the American Association of Orthodontists. largely presumptive. For example, enamel decalcifica-
doi:10.1016/j.ajodo.2006.01.030 tion rates around self-ligating appliances are unknown,
208
American Journal of Orthodontics and Dentofacial Orthopedics Pandis, Polychronopoulou, and Eliades 209
Volume 132, Number 2

Table I. Demographics and clinical characteristics of sample

Total Conventional Self-ligating
(n ⫽ 54) (n ⫽ 27) (n ⫽ 27)
Variable mean or % SD mean or % SD mean or % SD P value*

Age (y) 13.70 1.38 13.92 1.43 13.48 1.31 NS

Sex (%)
Male 20.37 25.93 14.81 NS
Female 79.63 74.07 85.19
Crowding (irregularity index) 5.43 2.27 5.37 2.41 5.50 2.16 NS
Crowding (%)
Moderate 52.00 52.00 52.00 NS
Severe 48.00 48.00 48.00
Angle class (%)
I 59.26 66.67 51.85 NS†
II 37.04 33.33 40.74
III 3.70 0.00 7.41

NS, Not significant.

*P value for comparison of group means by t test or differences in proportions by chi-square test.
†
Investigation of the significance for Angle classification variable relates to differences in distribution of Classes I, II, and III in bracket groups
and not to the actual percentages of these classifications.

friction variants have not been explored systematically
in clinical setups,10 and root resorption has not been
found to vary between self-ligating and conventional
brackets.11 Whereas ligation, especially with stainless
steel ligatures, might increase friction, the effect of this
variable remains unknown in vivo.3-7 A clinical trial
demonstrated that the use of archwires with different
surface roughnesses and, consequently different fric-
tion variants, in vitro was not accompanied by different
tooth movement rates.12 This effect probably relates to
various clinical variables that cannot be simulated in
currently available laboratory configurations, including
the following.
1. The rate of sliding movement has typically been
chosen arbitrarily, resulting in a nonstandardized
parameter that makes comparison of the results
from various studies impossible. Nonetheless, when
a standard rate is chosen, fundamental discrepan-
cies between the clinical situation and the research
environment arise. Therefore, the use of movement
rates described by simple first-order kinetics is
inappropriate.10
2. Kusy and Whitley13 noted a dependence of friction
on the velocity at which the surfaces slide past each
other, an effect that has not been considered in
related research.
3. Observations of the structure and morphology of
retrieved nickel-titanium (Ni-Ti) archwires pro-
vided proof of calcified protein integuments, a
variable not incorporated into in-vitro studies.14
Thus, the efficacy of treatment with these appli-
ances relative to conventional brackets requires
further study.
The purpose of this study was compare the time
required to complete the alignment of crowded man-
dibular anterior teeth (canine to canine) with a conven-
tional edgewise and self-ligating brackets. Addition-
ally, the effects of alleviation of crowding on
mandibular incisor inclination and intercanine and in-
termolar widths were investigated cephalometrically
and through dental cast analysis, respectively.
MATERIAL AND METHODS
Fifty-four subjects were included in the study. They
were selected from a large pool of patients based on the
following inclusion criteria: nonextraction treatment on
the mandibular or maxillary arches, eruption of all
mandibular teeth, no spaces in the mandibular arch,
mandibular irregularity index greater than 2; and no
therapeutic intervention planned involving intermaxil-
lary or other intraoral or extraoral appliances including
elastics, lip bumpers, maxillary expansion appliances,
or headgear. The demographics of these subjects are
listed in Table I. Complete records were obtained
including cephalometric and panoramic radiographs
taken with the same machine (Orthophos 10, Sirona
Dental Systems, GmbH, Bensheim, Germany) by the
same operator (N.P.); digital extraoral and intraoral
photographs and plaster models were prepared from
alginate impressions.
The conventional edgewise group was bonded with
the Roth prescription, 0.0.22-in slot (Microarch, GAC,
Central Islip, NY), and the self-ligating group received
the low-incisor torque version of the Damon 2, 0.022-in
slot, appliance (Ormco, Glendora, Calif). The mandib-
ular incisor torque values for these brackets are listed
210 Pandis, Polychronopoulou, and Eliades
by their manufacturers as –1° for the conventional and
– 6° for the self-ligating. All first and second molars
(when present) were bonded with bondable tubes.
Bracket bonding, archwire placement, and treatment
were performed by the same clinician (N.P.) who has
received training for, and routinely uses, both appliance
systems.
The amount of crowding of the mandibular anterior
dentition was assessed by using Little’s irregularity in-
dex.15 Measurements were made on the initial casts by the
same clinician using a fine-tip digital caliper (Digimatic
NTD12-6”C, Mitutoyo Corp, Kanagawa, Japan), and all
values were entered automatically into an Excel spread-
sheet by using the IT-012U input tool (Microsoft, Red-
mond, Wash) interfaced with the caliper. Similarly, the
irregularity index values of patients were recorded and
normalized in each bracket group to investigate the effect
of bracket type on treatment duration at various crowding
levels.
The archwire sequence for the conventional group
was in most cases 0.016-in copper-Ni-Ti (Cu-Ni-Ti)
35°C (Ormco) ligated mainly with elastics, followed by
a 0.020-in medium Sentalloy archwire (GAC) ligated
with elastics. To correct rotations, elastics were often
placed in figure-8 form.
In the self-ligating group, the archwire sequence
involved a 0.014-in Cu-Ni-Ti Damon (Ormco) and
0.014 ⫻ 0.025-in Cu-Ni-Ti Damon (Ormco). The
difference in archwire sequence was due to the mech-
anotherapeutical scheme suggested by the relevant
guidelines in the Damon 2 bracket manual.16
The date (T1) that the each patient was bonded
was recorded, and all patients were followed
monthly. Complete alleviation of crowding was
judged clinically by the same practitioner. Upon
visual inspection of correction of proximal contacts,
the patient was considered complete, and the align-
ment date (T2) was determined and recorded on the
spreadsheet. Only the alignment of the 6 mandibular
anterior teeth was evaluated. In other words, a patient was
considered to have reached T2 if the 6 mandibular anterior
teeth were aligned, regardless of possible irregularities in
the posterior segments. The time to alignment (T2 – T1)
for each patient was calculated in days. At T2, a cepha-
lometric radiograph, an alginate impression for model
construction, and digital photographs of the mandibular
arch were taken, and treatment was resumed in both
arches.
Changes in intercanine and intermolar widths were
recorded from dental casts taken at T1 and T2. Mea-
surements, made with a digital caliper (Mitutoyo),
included the distance of the cusp tips in the canines and
the central groove in the molars.
American Journal of Orthodontics and Dentofacial Orthopedics
August 2007
Table II. Mean treatment time to alignment by bracket
system and severity of crowding
Mean time to
n alignment (days) SD P value*
Bracket
Conventional 27 114.51 46.44
Self-ligating 27 91.03 31.94 NS (.06)
Crowding
Moderate 28 89.46 31.46 ⬍.05
Severe 26 117.11 46.05
NS, Not significant.
*P value based on log-rank test for equality of survivor functions.
Lateral cephalograms were traced by the same
person (N.P.), and mandibular incisor position and
inclination were assessed for all patients by using the
following angular measurements at T1 and T2:
mandibular incisor to mandibular plane, mandibular
incisor to nasion-Point B line, and mandibular inci-
sor to Point A-pogonion line.
To assess intraexaminer reliability, 8 plaster models
and 8 cephalometric radiographs were randomly se-
lected from records. The cephalometric radiographs
were retraced, and the measurements of the cephalo-
metric variables were repeated; in the dental casts, the
intercanine and intermolar widths were remeasured.
The reproducibility of the measurements was investi-
gated with paired t tests for each variable. The analysis
showed no statistical significance between the first and
second measurements (P ⫽ .002).
Statistical analysis
Demographic, clinical, and cephalometric charac-
teristics were investigated with conventional descrip-
tive statistics. Comparisons between the 2 appliance
groups were conducted with the t test or the chi-square
test, depending on the characteristic’s nature (numeri-
cal or categorical). Treatment duration—the time re-
quired to resolve crowding—in both appliance groups
was investigated with statistical methods for survival
analysis, whereas alignment rate ratios for appliance
type and crowding level were studied with the Cox
proportional hazard regression. All analyses were con-
ducted with the Stata 8 statistical package (StataCorp,
College Station, Tex).
RESULTS
Table I gives the demographic variables of the
groups including age, sex, and irregularity index. Angle
classification distribution showed no difference be-
tween the 2 groups; there was no discrimination with
respect to age, sex, and irregularity index between the
American Journal of Orthodontics and Dentofacial Orthopedics Pandis, Polychronopoulou, and Eliades 211
Volume 132, Number 2

Table III. Alignment rate ratios (times faster) derived from Cox proportional hazard regression
Predictor (bracket) Hazard ratio (times faster) P value

Model I, all patients Conventional Baseline NS

Self-ligating 1.68
Model II, patients with severe crowding Conventional Baseline NS
Self-ligating 1.37
Model III, patients with moderate crowding Conventional Baseline ⬍.05
Self-ligating 2.7

NS, Not significant.

Table IV. Intercanine and intermolar width changes induced by alignment per bracket group
Total Conventional Self-ligating
Model measurement (n ⫽ 54) mean SD (n ⫽ 27) mean SD (n ⫽ 27) mean SD P value*†

Initial intercanine width (mm) 25.39 1.75 25.01 1.49 25.78 1.92 NS
Final intercanine width (mm) 26.72 1.32 26.59 1.30 26.86 1.36 NS
Initial intermolar width (mm) 44.21 2.54 44.21 2.53 44.21 2.60 NS
Final intermolar width (mm) 45.44 2.41 44.64 2.74 46.25 1.72 ⬍.05

NS, Not significant.

*P value for comparison of group means by t test.
†
Significance denotation applies to raw comparison (conventional vs self-ligating) of bracket systems only. Column comparisons (initial vs final
widths) indicated that, overall, statistically significant difference was found between initial and final total widths (paired t test, P ⬍.01).

Table V. Mandibular incisor inclination changes induced by alignment per bracket group
Total Conventional Self-ligating
Measurement (°) (n ⫽ 54) mean SD (n ⫽ 27) mean SD (n ⫽ 27) mean SD P value*†

Initial L1-MP 94.70 6.98 95.66 5.95 93.70 7.88 NS

Final L1-MP 101.50 8.10 101.88 7.51 101.11 8.78 NS
Initial L1-NB 25.74 6.10 26.00 5.44 25.48 6.80 NS
Final L1-NB 32.77 6.80 32.37 6.34 33.18 7.33 NS
Initial L1-A-Pog 24.09 5.10 25.22 4.50 22.96 5.48 NS
Final L1-A-Pog 31.59 5.33 32.11 4.50 31.07 5.34 NS

L1-MP, Mandibular incisor to mandibular plane; L1-NB, mandibular incisor to nasion-Point B line; L1-A-Pog, mandibular incisor to Point
A-pogonion line; NS, Not significant.
*P value for comparison of group means by t test.
†
Significance denotation applies to raw comparison (conventional vs self-ligating) of bracket systems only. Column comparisons (initial vs final
angles) indicated that, overall, statistically significant difference was found for initial and final total inclination of mandibular incisor (paired t test,
P ⬍.001).

2 samples, thus validating the random assignment of
appliances to each group.
In Table II, the results of treatment time to align-
ment are shown for the bracket groups. A marginal lack
of statistical significance was shown for the self-
ligating group, whereas crowding was shown to statis-
tically alter treatment time. This prompted further data
analysis by hazard ratios shown in Table III; this
indicated that analysis of data by irregularity index
seemed to produce a higher alignment rate for the
self-ligating group. Specifically, patients with moderate
crowding (irregularity index ⬍5) were finished 2.7
times faster than those treated with conventional brack-
ets (P ⬍.05). Severe crowding showed a similar but
less powerful tendency; treatment time was 1.37 times
faster compared with conventional brackets, but this
effect did not reach statistical significance.
In Table IV, intercanine and intermolar width
changes are shown, suggesting that the correction of
crowding in both cases produced a small but statis-
tically significant expansion in the mandibular arch.
Intercanine width seemed to show no change be-
tween bracket groups, whereas intermolar width
increased about 2 mm in the self-ligating group
compared with 0.5 for the conventional bracket
group (P ⬍.05).
Table V lists the results of the assessment of mandib-
ular incisor position in response to alleviation of crowd-
212 Pandis, Polychronopoulou, and Eliades
Fig 1. Occlusal views of mandibular arches with low (⬍5) and high (⬎5) irregularity index valves
treated with Damon 2 brackets.
ing. Treatment resulted in an overall significant proclina-
tion of the mandibular incisors regardless of bracket type,
whereas no difference for incisor position between bracket
groups was identified.
Representative intraoral photographs of treatment
of a low (⬍5) and a high (⬎5) irregularity index
mandibular arch treated with the Damon 2 bracket
are shown in Figure 1. The corresponding pictures of
a subject with mandibular crowding treated with a
conventional appliance are shown in Figure 2. In
Figure 3, the variation of treatment time with the
severity of crowding is shown: the pattern seen
initially for prolonged alleviation of severe relative
to moderate crowding continued during the full term
of treatment.
DISCUSSION
Mandibular crowding was selected as a model for
examining the efficiency of brackets because correction
of this discrepancy largely depends on the “free play”
or clearance of the archwire inside the slot walls.
Although canine retraction with sliding mechanics is
the basic scenario when free play is the dominant
mechanotherapy, this model has some fundamental
difficulties when a research design is considered. These
include the necessity for adjustment of the rate of
movement between the 2 groups, the requirement for
estimation of the pre- and postmovement condition, and
the assessment of the relative efficiency of the appli-
American Journal of Orthodontics and Dentofacial Orthopedics
August 2007
ances. On the other hand, alleviation of crowding is a
treatment process in which both initial and final stages
can be quantitatively determined with the irregularity
index, and measurements can be made regardless of
tooth inclinations or rotations, as opposed to retracting
canines, where these 2 parameters can interfere with the
assessment of crown spatial orientation.
The results of this study suggest that, overall,
Damon 2 brackets are not more efficient in terms of
treatment time required to resolve severe anterior man-
dibular crowding than conventional appliances. How-
ever, moderate crowding was alleviated about 2.7 times
faster with Damon 2 brackets than with conventional
appliances. This difference might be because of the
substantially greater free play of the self-ligating appli-
ances, an effect that facilitates undisturbed labial move-
ment of the crown. In contrast, elastomeric modules or
steel ligatures act as obstacles because of the stress they
exert on the wire adjacent to the bracket sides, preclud-
ing free sliding of the wire into the slot walls and
adversely affecting movement rate. This advantage of
self-ligation over conventional ligation is eliminated
when crowding exceeds a certain amount and space in
the arch is restricted. In the latter case, the relative
efficiency of the bracket system seems to be of limited
use because of difficulties that are beyond the capabil-
ities of mechanotherapeutical configurations. Likewise,
we found a positive effect of the severity of crowding
on treatment duration, which was about 20% longer for
American Journal of Orthodontics and Dentofacial Orthopedics Pandis, Polychronopoulou, and Eliades 213
Volume 132, Number 2

Fig 2. Occlusal views of mandibular arches with low (⬍5) and high (⬎5) irregularity index valves
treated with conventional brackets.

Fig 3. Graph of variations of treatment duration with severity of crowding. Y-axis gives proportion
of patients still in treatment (not aligned) at different times (days on x-axis). By drawing line
perpendicular to x-axis at given time value, proportion of patients not completed for each crowding
group (moderate or severe) is extrapolated from corresponding value given in y-axis. Note
persistence of alignment completion pattern through entire treatment period: severe crowding has
higher percentage of incomplete patients compared with moderate crowding at any treatment time.

each additional irregularity index unit (hazard ratio for no difference in the crowding alleviation stage at
1 unit of irregularity index increase: 0.81, P ⬍.05, data predetermined times with conventional and self-ligat-
not shown). ing SmartClip brackets (3M Unitek, Monrovia, Calif)17
Our findings agree with previous trials that found or conventional and self-ligating Damon 2 brackets.18
214 Pandis, Polychronopoulou, and Eliades
In a similar study, Torres et al19 reported no difference
in treatment duration between Damon 2 and Synergy
brackets (Rocky Mountain Orthodontics, Denver,
Colo) with a maxillary, split-mouth setup.
It is strikingly surprising that self-ligating brackets
have been advocated and marketed long before the
publication of any clinical trials investigating their
efficiency by independent sources. Anecdotal evidence
and case series exhibitions do not substantiate the
effectiveness of a biomedical material or a new tech-
nique, and it seems that more clinical studies are
required in the mainly laboratory-based assessments of
orthodontic materials and techniques.
A decade after the introduction of self-ligating
brackets, the literature lists just a handful of clinical
studies, of which even fewer satisfy the criteria of a
prospective and randomized clinical trial. Most were
conducted with treatment records of more than 1 practi-
tioner or questionnaires filled out by patients. Moreover,
even the few comparative trials available involve various
malocclusions treated with many methods and modalities,
thus precluding a means to isolate confounding variables.
This is because various treatment auxiliaries and utilities
such as intermaxillary elastics, treatment variability such
as extractions, and extraoral appliances introduce vari-
ables that, if not carefully weighted in both populations,
can distort the results.20,21 Our study involved a thor-
ough screening of patients with strict inclusion criteria;
this improved the reliability of the outcome. Moreover,
the same clinician, who has been trained and routinely
uses both techniques, treated all patients, and a pro-
spective model was used rather than recording the
treatment variables from records or questionnaires. In
addition, the drop-out rate of this study was nonexist-
ent. This is important in clinical trials because patient
drop-out rates distort the assumption of equal effect on
both treatment groups, since exclusion of patients from
the study might show a preference connected with the
process or the result itself.22
Retrospective studies include the possibility of
outcome bias, because the treatment results are known
before assignment of the bracket type to the patient
groups. Data collection in these studies relies on the
accuracy of treatment records, whereas a trial including
more than 1 practice to collect enough patients has the
additional complicating factors of interoperative vari-
ability in materials handling and clinical management.
In contrast to various anecdotal evidence, our find-
ings suggest that both brackets alleviate crowding by
similar mechanisms that involve mandibular incisor
proclination and mild expansion of the dental arches.
The former seemed unaffected by the difference be-
tween the torque-prescribed values of the 2 appliances,
American Journal of Orthodontics and Dentofacial Orthopedics
August 2007
probably because of the relatively greater buccolingual
proclination induced by lack of space. On the other
hand, the use of preformed Ni-Ti archwires precludes
the operator’s absolute control over the dimensions of
the dental arch. Although the overall expansion of the
mandibular arch of the subjects in this trial was found
to be relatively small, the intermolar width gained in
the self-ligating group was 1.5 mm greater than that for
the conventional-appliance group. Expansion with pre-
formed arches of 0.5 to 1 mm might be negligible and
could be a spontaneous effect of treatment. However,
traditional assumptions on the intentional “develop-
ment of the arch,” which means substantially expand-
ing the buccal segments, have been found to be highly
unpredictable.23 The reported dental effects also par-
tially agree with a recent report that evaluated dental-
arch dimensions of nonextraction patients treated with
conventional or self-ligating appliances.24 The results
of that study showed that posttreatment maxillary and
mandibular arch widths increased significantly in the
Damon 2 bracket group.
Additional aspects of treatment with self-ligating
brackets include the necessity of the clinician’s famil-
iarity with the new materials and uses, the patient’s
potential discomfort, and the probably higher failure
rates of these appliances because of their greater
thickness. Although the former might be a concern, the
latter—that the thick bracket induces larger moments
during mastication and might result in debonding— has
not been proven valid.25
CONCLUSIONS
The results of this clinical trial suggest the follow-
ing conclusions.
1. There was no difference in the time required to correct
mandibular crowding between self-ligating Damon 2
and conventional edgewise brackets. However, when
moderate and severe crowding were examined sepa-
rately, self-ligating brackets corrected moderate
crowding (irregularity index ⬍5) 2.7 times faster than
conventional appliances. This difference was insignif-
icant for subjects with severe crowding (irregularity
index ⬎5).
2. Overall, greater crowding prolonged treatment by
20% per irregularity index unit, regardless of bracket
type used.
3. Overall increases in intercanine and inermolar
widths were associated with crowding correction in
both bracket groups; Damon 2 brackets resulted in
statistically greater intermolar width increases than
conventional appliances.
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 132, Number 2
4. There was an overall increase in the proclination of
the mandibular incisors associated with crowding
correction in both bracket groups; no difference
was identified between Damon 2 and conventional
brackets for this parameter.
REFERENCES
1. Harradine HNW. Self-ligating brackets: where are we now?
J Orthod 2003;30:262-73.
2. Khambay B, Millett D, McHugh S. Evaluation of methods of
archwire ligation on frictional resistance. Eur J Orthod 2004;26:
327-32.
3. 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;124:395-402.
4. Griffiths HS, Sherriff M, Ireland AJ. Resistance to sliding with
3 types of elastomeric modules. Am J Orthod Dentofacial Orthop
2005;127:670-5.
5. Thomas S, Sherriff M, Birnie D. A comparative in vitro study of
the frictional characteristics of two types of self-ligating brackets
and two types of pre-adjusted edgewise brackets tied with
elastomeric ligatures. Eur J Orthod 1998;20:589-96.
6. Hain M, Dhopatkar A, Rock P. The effect of ligation method on
friction in sliding mechanics. Am J Orthod Dentofacial Orthop
2003;123:416-22.
7. Pizzoni L, Ravnholt G, Melsen B. Frictional forces related to
self-ligating brackets. Eur J Orthod 1998;20:283-91.
8. Shivapuja PK, Berger J. A comparative study of conventional
ligation and self-ligation bracket systems. Am J Orthod Dento-
facial Orthop 1994;106:472-80.
9. Sims AP, Waters NE, Birnie DJ, Pethybridge RJ. A comparison
of the forces required to produce tooth movement in vitro using
two self-ligating brackets and a pre-adjusted bracket employing
two types of ligation. Eur J Orthod 1993;15:377-85.
10. Eliades T, Brantley WA, Eliades G. Orthodontic brackets. In:
Brantley WA, Eliades T, editors. Orthodontic materials: scien-
tific and clinical aspects. Stuttgart: Thieme; 2001. p. 143-72.
11. Blake M, Woodside DG, Pharoah MJ. A radiographic compari-
son of apical root resorption after orthodontic treatment with the
edgewise and Speed appliances. Am J Orthod Dentofacial
Orthop 1995;108:76-84.
Pandis, Polychronopoulou, and Eliades 215
12. Kula K, Phillips C, Gibilaro A, Proffit WR. Effect of ion
implantation of TMA archwires on the rate of orthodontic sliding
space closure. Am J Orthod Dentofacial Orthop 1998;114:577-80.
13. Kusy RP, Whitley JQ. Effects of sliding velocity on the coeffi-
cients of friction in a model orthodontic system. Dent Mater
1989;5:235-40.
14. Eliades T, Eliades G, Athanasiou AE, Bradley TG. Surface
characterization of retrieved NiTi orthodontic archwires. Eur
J Orthod 2000;22:317-26
15. Little RM. The irregularity index: a quantitative score of man-
dibular anterior alignment. Am J Orthod 1975;68:554-63.
16. System archwire sequence in Damon system. The workbook. 2nd
ed. Ormco 2002:7-8.
17. Miles PG. Smartclip versus conventional twin brackets for initial
alignment: is there a difference. Aust Orthod J 2005;21:123-7.
18. Miles PG, Weyant RJ, Rustveld L. A clinical trial of Damon 2 vs.
conventional twin brackets during initial alignment. Angle
Orthod 2006;76:480-5.
19. Torres CB, Cabrilla MCP, Quintanilla DS. Comparative asses-
ment of the effectiveness of dental alignment between low
friction conventional ligated and self-closing brackets on the
maxillary arch in 18 patients. Proceedings of the European
Orthodontic Society; 2005; Amsterdam. London: European
Orthodontic Society; 2005. p. 294.
20. Harradine NW. Self-ligating brackets and treatment efficiency.
Clin Orthod Res 2001;4:220-7.
21. Eberting JJ, Straja SR, Tuncay OC. Treatment time, outcome,
and patient satisfaction comparisons of Damon and conventional
brackets. Clin Orthod Res 2001;4:228-34.
22. Brunnete D. Critical thinking. Chicago: Quintessence; 2001. p.
135.
23. Sandstrom RA, Klapper L, Papaconstantinou S. Expansion of the
lower arch concurrent with rapid maxillary expansion. Am J
Orthod Dentofacial Orthop 1988;94:296-302.
24. Menendez M, Alarcon JA, Travesi A, Palma JC. Evaluation of
dental arch width and form changes after orthodontic treatment
with the Damon system. Proceedings of the International Orth-
odontic Conference; 2005; Paris. Chicago: Quintessence; 2005.
p. 445.
25. Pandis N, Polychronopoulou A, Eliades T. Failure rate of
self-ligating and edgewise brackets bonded with conventional
and a self-etching primer: a prospective in vivo study. Angle
Orthod 2006;76:119-22.