ONLINE ONLY

Efficiency of self-ligating vs conventionally

ligated brackets during initial alignment
Emily Ong,a Hugh McCallum,b Mark P. Griffin,c and Christopher Hod
Brisbane and Herston, Queensland, Australia

Introduction: The aim of this study was to compare the efficiency of self-ligating (SL) and conventionally
ligated (CL) brackets during the first 20 weeks of extraction treatment. Methods: Study models of 50 consec-
utive patients who had premolar extractions in the maxillary and/or mandibular arch, 0.022 3 0.028-in slot
brackets, and similar archwire sequences were examined. Forty-four arches received SL Damon 3MX
brackets (Ormco, Glendora, Calif), and 40 arches received either CL Victory Series (3M Unitek, Monrovia,
Calif) or Mini-Diamond (Ormco) brackets. The models were evaluated for anterior arch alignment, extraction
spaces, and arch dimensions at pretreatment (T0), 10 weeks (T1), and 20 weeks (T2). Results: There were no
significant differences between the SL and CL groups at 20 weeks in irregularity scores (mandibular arch,
P 5 0.54; maxillary arch, P 5 0.81). There were no significant differences in passive extraction space closures
between the SL and CL groups (mandibular arch, T0-T2, P 5 0.85; maxillary arch, T0-T2, P 5 0.33). Mandibular
intercanine widths increased from T0 to T2: 1.96 and 2.86 mm in the SL and CL groups, respectively. This was not
significant between the groups (P 5 0.31). Logistic regression did not show a difference between the SL and CL
bracket groups. Conclusions: SL brackets were no more efficient than CL brackets in anterior alignment or
passive extraction space closure during the first 20 weeks of treatment. Ligation technique is only one of
many factors that can influence the efficiency of treatment. Similar changes in arch dimensions occurred,
irrespective of bracket type, that might be attributed to the archform of the archwires. (Am J Orthod
Dentofacial Orthop 2010;138:138.e1-138.e7)

highlighted the limitations of in-vitro studies.3 In partic-

B
racket designs have undergone continual modifi-
cations since fixed appliances were first used in
orthodontics. The quest to improve treatment
efficiency has culminated in many modern edgewise
appliances. Recently, the promotion of self-ligating
(SL) brackets has incited much controversy. Advocates
claim that low-friction SL brackets coupled with light
forces enhance the rate of tooth movement and decrease
treatment time. Other advantages include decreased
appointment times, improved oral hygiene, increased
patient acceptance, and superior treatment results.1,2
Most claims of SL brackets have been extrapolated
from in-vitro studies. A recent systematic review
a
Postgraduate student, Discipline of Orthodontics, School of Dentistry,
University of Queensland, Brisbane, Queensland, Australia.
b
Senior Dental Specialist (Orthodontics), Royal Children’s Hospital, Herston,
Queensland, Australia.
c
Research fellow, School of Population Health, University of Queensland,
Herston, Queensland, Australia.
d
Associate professor, Discipline of Orthodontics, School of Dentistry, Univer-
sity of Queensland, Brisbane, Queensland, Australia.
The authors report no commercial, proprietary, or financial interest in the prod-
ucts or companies described in this article.
Reprint requests to: Christopher Ho, University of Queensland, School of Den-
tistry, 200 Turbot St, Brisbane, QLD 4000, Australia; e-mail, Christopher_Ho@
health.qld.gov.au.
Submitted, October 2009; revised and accepted, January 2010.
0889-5406/$36.00
Copyright Ó 2010 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2010.03.020
ular, studies that demonstrate reduced friction in SL
brackets compared with conventionally ligated (CL)
brackets have been coupled with small-diameter wires
in well-aligned arches with no tip and torque.4-9 In-
vitro studies are limited because they cannot compre-
hensively simulate a clinical scenario. Many variables
can influence the amount of friction generated in a fixed
appliance system. These include archwire and bracket
composition,10 archwire dimension,11 bracket slot
dimension and design, interbracket distance, deflection
of the archwire,12 and biologic factors such as saliva11
and perturbations.13 Therefore, it is questionable
whether the use of SL brackets translates into clinical
benefits such as decreased resistance to sliding, faster
tooth movement, and increased treatment efficiency.
Several in-vivo studies have compared the
efficiency of SL and CL brackets during various stages
of treatment with conflicting results. These studies
measured treatment efficiency in terms of total treat-
ment times, numbers of appointments, and tooth move-
ment during initial alignment and active space closure.
Early retrospective studies reported up to 6 months’
reduction in total treatment time and 7 fewer appoint-
ments with SL brackets.2,14 Subsequent well-designed
retrospective and prospective studies reported no signif-
icant differences during initial alignment or active space
closure with various SL and CL brackets.15-20
138.e1
138.e2 Ong et al
Miles et al15 and Miles17 postulated that SL brackets
might provide a measurable benefit in extraction
patients. Additionally, Scott et al19 suggested that SL
brackets might encourage passive space closure during
initial alignment. There is a relative lack of evidence
comparing the efficiency of SL and CL brackets in
extraction patients because most studies have investi-
gated mixed samples. Only 2 clinical trials have
compared SL and CL brackets solely in extraction
patients.16,19 One study investigated the initial
alignment phase and reported no difference between
SL and CL brackets.19 Neither clinical trial investigated
the efficiency of passive space closure during alignment.
If there is a measurable advantage of SL brackets, then it
should be most apparent during alignment and space
closure when the bracket slides along the archwire. In
this study, passive space closure was defined as the ex-
traction space closure during alignment without active
space-closing mechanics. The amount of passive space
closure varies greatly between patients, but this param-
eter has not been investigated before. If the use of SL
brackets could achieve greater passive space closure,
there would be less extraction space to close actively.
This could reduce the overall treatment time. Further-
more, this might minimize the detrimental effects of ac-
tive force application such as root resorption.
In this study, we aimed to determine whether there
are significant differences in the efficiency of anterior
tooth alignment and the amount of passive space closure
between SL and CL brackets. Concomitant changes in
arch dimensions were also compared between the SL
and CL bracket groups.
MATERIAL AND METHODS
Ethical approval was obtained from the Dental Sci-
ences and Research Ethics Committee of the University
of Queensland School of Dentistry and the Royal Child-
ren’s Hospital and Health Services District Ethics Com-
mittee. Study models of 50 consecutive patients who
received comprehensive full fixed appliance treatment
with 0.022 3 0.028-in slot brackets at the School of
Dentistry, University of Queensland and the Royal
Children’s Hospital were examined.
The dental school patients were treated by postgrad-
uate students under the supervision of an experienced
orthodontist. Royal Children’s Hospital patients were
treated by an experienced orthodontist (H.M. or C.H.).
Patient records were included if they satisfied the
following inclusion criteria: (1) treatment began
between 10 and 18 years of age; (2) treatment included
bilateral mandibular or maxillary extractions followed
by fixed appliance therapy; (3) intraoral photos and
American Journal of Orthodontics and Dentofacial Orthopedics
August 2010
study models were available at pretreatment (T0), 10
weeks (T1), and 20 weeks (T2) postbonding; (4)
treatment included 0.022 3 0.028-in slot brackets (SL
brackets, Damon 3MX, Ormco, Glendora, Calif; or
CL brackets, Victory Series, 3M Unitek, Monrovia,
Calif, or Mini-Diamond, Ormco); (5) treatment began
with an initial archwire of 0.014-in copper-nickel-
titanium (Damon archform, Ormco), followed by
0.014 3 0.025-in copper-nickel-titanium (Damon arch-
form, Ormco)21; (6) the patients were reviewed every 5
weeks; and (7) the first archwire was left in place until
the teeth were passively engaged in all bracket slots
before proceeding to the second archwire.
The following exclusion criteria were applied: treat-
ment with nonsymmetrical extractions, no impacted or
unerupted permanent teeth anterior to the first molars
in the arch that received extractions, treatment with
removable appliances or rapid maxillary expansion
appliances, and incomplete records at a time point.
Fifty patients (20 male, 30 female) fulfilled the
inclusion criteria.
Pretreatment characteristics were recorded includ-
ing the patient’s age bonding, sex, mandibular and max-
illary crowding, irregularity index, extraction space,
intercanine width, intermolar width, and arch depth.
All study models were evaluated by using Little’s
irregularity index22 to quantify the alignment of the 6
anterior teeth. Crowding was calculated as the differ-
ence between the sum of tooth widths and arch circum-
ference taken from the line of best fit, through the
contact points mesial to the first molars, on a photocopy
of the patient’s occlusal archform.
Extraction space was measured from the closest
points on the adjacent teeth before extraction. The
mesiodistal widths of the teeth to be extracted were
not used because they were often displaced from the
archform; this decreased the extraction space to be
closed. Similarly, extraction spaces at T1 and T2
were measured from the closest points on the crowns
of the teeth on either side of the extraction space. The
contact points were not used because many teeth were
rotated.
Intercanine widths were measured from the cusp
tips of the canines. Measurements were not taken
from the gingival margin because the quality of the gin-
gival impression was inconsistent. Intermolar widths
were measured from the central and mesial occlusal
pits of the mandibular and maxillary first molars
because this area of the impression was clearer than
the cusps. Arch depth was measured as the perpendicu-
lar distance from a line drawn through the mesial
contact points of the first molars to the labial surfaces
of the central incisors.
American Journal of Orthodontics and Dentofacial Orthopedics Ong et al 138.e3
Volume 138, Number 2

Wax was applied to cover the brackets on each Table I. Sample sizes at T0, T1, and T2
model before measurement. An identification number Mandibular arch Maxillary arch
was assigned to each model. Therefore, the researcher
(E.O.) was blinded to patient name, time point, and SL CL SL CL
bracket type during data collection to minimize system- T0 19 18 25 22
atic error. The study models were measured with elec- T1 19 18 25 22
tronic calipers with sharpened tips that were accurate T2 19 14 25 16
to 0.01 mm (Mitutoyo, Tokyo, Japan). All model mea-
surements were made by the principal researcher (E.O.).
The average differences between the measurements
Statistical analysis were 0.07 6 0.52 mm for the irregularity index and
0.06 6 0.33 mm for extraction space.
The difference in irregularity scores was used to
Fifty patients (20 male, 30 female) fulfilled the in-
determine the sample size. Based on a previous study,
clusion criteria. This gave a total of 84 arches; 44 arches
a clinically significant difference of 0.98 mm in irregu-
were treated with SL brackets and 40 arches with CL
larity score, at a power of 80% and a level of signifi-
brackets. In the CL sample, 18 arches received Mini-
cance of 0.05, would require a minimum of 17
Diamond brackets. The numbers of arches included in
patients per treatment group.19 In the final sample of
the statistical analysis for each bracket group at T0,
50 patients, 44 arches were treated with SL brackets
T1, and T2 are summarized in Table I. No SL arches
and 40 arches with CL brackets.
were excluded. Six CL maxillary arches were excluded
Statistical analysis was performed by using Mini-
from analysis at T2 because 5 models were missing, and
tab software (release 15, Minitab, State College, Pa)
1 patient received a different archwire sequence. Four
and SAS software (version 9.2, SAS Institute, Cary,
mandibular arches were also excluded at T2 because
NC). The mandibular and maxillary arches were
of missing models.
analyzed separately. Descriptive statistics were calcu-
The mean irregularity index scores decreased in
lated, and the data were checked for normality.
both bracket groups over time (Table II). Both groups
Two-sample t tests were performed at T0, T1, and
had greater decreases in irregularity during the first 10
T2 to compare the bracket groups for irregularity
weeks of treatment compared with the subsequent 10
scores, residual extraction spaces, intercanine widths,
weeks.
intermolar widths, and arch depths. The amounts of
Over 20 weeks, the mean irregularity scores in the
passive extraction space closure from T0 to T1, T1
SL group decreased from 10.88 to 2.84 mm in the man-
to T2, and T0 to T2 for each bracket group were
dibular arch, and from 11.98 to 4.37 mm in the maxil-
also calculated and compared by using 2-sample
lary arch. Scores in the CL group decreased from
t tests. A chi-square goodness-of-fit test was used to
12.52 to 2.45 mm in the mandibular arch, and from
determine whether the male-to-female ratio was
12.53 to 4.16 mm in the maxillary arch.
significantly different between the bracket groups.
There were no statistically significant differences
Logistic regression was also used to determine
between the treatment groups at T1 or T2 in the mandi-
whether there was a difference between the SL and
ble (T1, P 5 0.81; T2, P 5 0.54) or the maxilla (T1,
CL bracket groups. Regression coefficients and confi-
P 5 0.87; T2, P 5 0.81).
dence intervals were calculated for each variable (age,
For passive extraction space closure, the residual ex-
sex, irregularity index, intercanine width, intermolar
traction spaces were measured, and the left and right
width, and arch depth) for both arches. Multiple impu-
sides were averaged for each patient. The mean residual
tation was used to account for missing data.
extraction spaces for each bracket group at T1 and T2
Intraexaminer reliability was assessed by remeasur-
were then calculated (Table II). There were no significant
ing 20 subjects at least 4 weeks after the original
differences in residual extraction spaces between the
measurements. A t test was performed to compare the
groups at T1 or T2 in the mandible (T1, P 5 0.35; T2,
first and second measurements.
P 5 0.99) or the maxilla (T1, P 5 0.37; T2, P 5 0.44).
Overall space closure from T0 to T2 was similar in
RESULTS both arches. The differences were less than 1 mm and
Intraexaminer reliability was high. There were no not statistically significant.
statistically significant differences between the first The mean changes in arch dimensions from T0 to T2
and second measurements for irregularity index were calculated for each arch (Table III). There were no
(P 5 0.51) and extraction space closure (P 5 0.38). statistically significant differences between the groups
138.e4 Ong et al American Journal of Orthodontics and Dentofacial Orthopedics
August 2010

Table II. Descriptive statistics for the irregularity index and mean extraction space (2-sample t test)
Mandibular arch Maxillary arch

SL mean (SD) CL mean (SD) P value SL mean (SD) CL mean (SD) P value

Irregularity index, T0 10.88 (4.72) 12.52 (5.26) 0.33 11.98 (5.55) 12.53 (7.2) 0.78
Mean extraction space, T0 7.74 (0.75) 7.78 (0.96) 0.84 7.98 (1.92) 8.12 (1.17) 0.67
Irregularity index, T1 4.38 (3.63) 4.12 (2.87) 0.81 5.44 (3.72) 5.64 (4.46) 0.87
Mean extraction space, T1 5.45 (1.43) 4.98 (1.56) 0.35 5.51 (1.74) 5.04 (1.73) 0.37
Irregularity index, T2 2.84 (1.86) 2.45 (1.72) 0.54 4.37 (2.69) 4.16 (2.59) 0.81
Mean extraction space, T2 4.02 (1.78) 4.03 (1.65) 0.99 4.30 (2.13) 3.83 (1.76) 0.44

Table III. Mean changes in arch dimensions (T0-T2) in millimeters (2-sample t test)
Mandibular arch Maxillary arch

SL mean (SD) CL mean (SD) P value SL mean (SD) CL mean (SD) P value

Intercanine width 1.96 (1.78) 2.86 (2.80) 0.31 2.83 (2.49) 3.40 (4.12) 0.63
Intermolar width 1.44 (1.54) 1.34 (2.10) 0.88 0.25 (2.08) 0.14 (1.87) 0.87
Arch depth 1.69 (2.63) 1.08 (1.03) 0.61 2.42 (3.99) 1.37 (2.87) 0.33

for any changes in arch dimensions in either arch. In DISCUSSION

both groups, mandibular intercanine widths increased
(P 5 0.31), intermolar widths decreased (P 5 0.88),
and arch depths decreased (P 5 0.61). In the maxillary
arch, intercanine widths increased (P 5 0.63), intermo-
lar widths increased (P 5 0.87), and arch depths
decreased (P 5 0.33).
The changes were greatest in mandibular and max-
illary intercanine widths. Mandibular intercanine
widths increased from T0 to T2: 1.96 and 2.86 mm in
the SL and CL groups, respectively. Maxillary interca-
nine widths increased from T0 to T2: 2.83 and 3.4
mm in the SL and CL groups, respectively.
Logistic regression was used to determine whether
there was a difference between the SL and CL bracket
groups. Multiple imputation was used to account for
the small amount of missing data at T2. The following
variables were tested at 0, 10, and 20 weeks: age, sex,
irregularity index, intercanine width, intermolar width,
and arch depth.
Regression coefficients and confidence intervals
were calculated for each variable in both arches
(Tables IV and V). The confidence intervals also
included the variance because of missing data.
All regression coefficients were close to zero, except
sex and intermolar width at T2, which also had large
confidence intervals. No variable was significantly asso-
ciated with the probability of reduction in irregularity in
either arch. Arch depth at T2 had borderline significance
for the maxillary arch but was not considered highly
significant (particularly because of the multiple compar-
isons in this study).
Studies have demonstrated that SL brackets gener-
ate significantly lower levels of in-vitro friction than
do CL brackets.4-9,23 This has led to the promotion of
SL brackets on the assumption that decreased friction
leads to enhanced clinical efficiency. However, our
study concurs with the growing body of evidence that
there is no statistically significant difference in
treatment efficiency between SL and CL brackets
during initial alignment. Our study demonstrated that
Damon 3MX SL brackets were no more efficient than
Victory Series and Mini-Diamond CL brackets in
anterior alignment or passive extraction space closure
during the first 20 weeks of orthodontic treatment.
Early clinical studies by Eberting et al2 and Harra-
dine14 reported decreased total treatment times and
fewer appointments for patients treated with Damon
SL brackets. However, these retrospective studies
were both potentially subject to bias. The effect of con-
founding factors might have been considerable because
the selection criteria were not well detailed, the pretreat-
ment characteristics of the sample were not tested for
equivalence,2 and clinical variables such as archwire se-
quences were different in each bracket group.14
Subsequent well-designed retrospective and
prospective clinical studies reported no significant
differences in treatment efficiency between SL and
CL brackets during initial alignment15,17-20 and active
space closure.16 Most of these studies evaluated the
alignment efficiency of the mandibular anterior arch
because rotations, irregularity, and small interbracket
distances are typically encountered in this region.
American Journal of Orthodontics and Dentofacial Orthopedics Ong et al 138.e5
Volume 138, Number 2

Table IV. Logistic regression for the mandibular arch

Parameter Estimate of regression coefficient 95% CI P value

Age 0.09 0.80 0.61 0.80

Sex 1.55 4.18 1.07 0.25
Irregularity index, T0 0.20 0.27 0.68 0.40
Intercanine width, T0 0.71 1.67 0.24 0.14
Intermolar width, T0 0.74 0.38 1.85 0.19
Arch depth, T0 0.35 0.24 0.93 0.25
Extraction space, T0 0.17 1.98 1.63 0.85
Irregularity index, T1 0.20 0.90 0.49 0.56
Extraction space, T1 0.56 1.93 0.81 0.42
Irregularity index, T2 0.35 1.44 0.73 0.52
Intercanine width, T2 0.53 0.53 1.60 0.32
Intermolar width, T2 1.10 2.70 0.49 0.17
Arch depth, T2 0.09 0.73 0.90 0.83
Extraction space, T2 0.49 0.65 1.63 0.40

Table V. Logistic regression for the maxillary arch

Parameter Estimate of regression coefficient 95% CI P value

Age 0.30 0.92 0.32 0.34

Sex 0.35 2.09 2.79 0.78
Irregularity index, T0 0.01 0.19 0.21 0.91
Intercanine width, T0 0.08 0.29 0.46 0.66
Intermolar width, T0 0.13 0.64 0.39 0.63
Arch depth, T0 0.19 0.27 0.65 0.40
Extraction space, T0 0.21 0.73 0.31 0.42
Irregularity index, T1 0.05 0.31 0.41 0.80
Extraction space, T1 0.07 0.81 0.96 0.87
Irregularity index, T2 0.00 0.48 0.49 0.99
Intercanine width, T2 0.14 0.70 0.41 0.60
Intermolar width, T2 0.23 0.58 1.05 0.56
Arch depth, T2 0.78 1.54 0.03 0.04
Extraction space, T2 0.72 0.31 1.74 0.16

We investigated the anterior alignment of both arches
with the irregularity index.
Various authors have drawn the same conclusions
irrespective of the particular brand of SL bracket. Miles
et al15 and Miles17 did not find any significant differ-
ences when they prospectively compared Damon SL
and SmartClip (3M Unitek) SL with Victory Series
CL brackets during initial alignment. Pandis et al18
also found no difference when comparing the time to
alignment in the mandibular arch between Damon 2
(Ormco) SL and Microarch (GAC International, Bohe-
mia, NY) CL brackets. A recent large retrospective
study concluded that InOvation (GAC) SL brackets
had no measurable advantages over Victory Series CL
brackets in initial alignment time, total treatment time,
or number of appointments.20
Despite these findings, it has been suggested that SL
brackets might provide benefits for extraction patients
during initial alignment or space closure.15,17
Correspondingly, spontaneous tooth movement into
extraction spaces because of reduced friction during
alignment could be a time-saving benefit.19 Therefore,
we exclusively investigated extraction subjects during
initial orthodontic treatment to assess the efficiency of
alignment and passive extraction space closure.
Two previous studies compared SL and CL brackets
solely in extraction patients. Miles16 prospectively com-
pared 0.018-in Victory series CL brackets and Smart-
Clip SL brackets during active space closure. He
found no differences in the rate of tooth movement
between the bracket types: 1.1 mm per month with SL
brackets and 1.2 mm per month with CL brackets. These
rates are not comparable with our results because of dif-
ferent biomechanics and types of tooth movement dur-
ing these stages.
Scott et al19 conducted a randomized controlled trial
of patients having mandibular first premolar extractions.
He concluded that Damon 3MX brackets were no more
efficient during mandibular alignment than Synthesis
(Ormco) CL brackets. Those authors did not investigate
138.e6 Ong et al
the maxillary arch or passive extraction space closure.
Our study is the first to quantify the amount of tooth
movement during passive extraction space closure. We
found no difference in the amount of passive space
closure during initial alignment, in either arch, between
the bracket types.
We used the same initial archwire sequence as that
of Scott et al,19 which included 0.014-in and 0.014 3
0.025-in copper-nickel-titanium archwires in the Damon
archform. The SL group of Pandis et al18 also used the
same sequence. Similar changes in arch dimensions
were observed in all patients with these archwires
regardless of the bracket type used. Therefore, the
dimensional changes can be attributed to the Damon arch-
form. Mean mandibular intercanine widths increased,
mandibular intermolar widths decreased, and arch depths
decreased. Mandibular intercanine widths increased by
averages of 1.96 and 2.86 mm in the SL and CL groups,
respectively. Scott et al19 reported similar increases of
2.55 and 2.66 mm in SL and CL groups, respectively.
Mean maxillary intercanine widths increased by
2.83 and 3.4 mm in the SL and CL groups, respectively.
The increases in maxillary intermolar widths in both
bracket groups were negligible. Interestingly, maxillary
and mandibular intercanine widths increased despite the
extractions. This might be due to the distal movement of
the canines into the extraction spaces.19 These findings
discredit previous suggestions that premolar extractions
inevitably cause ‘‘shrinking’’ of the dental arch, in-
creased buccal corridors, and damage to smile es-
thetics.24 Furthermore, studies have shown that buccal
corridors do not influence smile esthetics.25,26
The results from this study concur with previous
studies that found no difference in the alignment of man-
dibular teeth in extraction patients with severe
irregularity.18,19 The mean irregularity scores in the
study of Scott et al19 were 12.44 mm in the CL group
and 11.23 mm in the SL group. Similarly, the patients
we investigated had severe irregularity scores. Pandis
et al18 investigated moderate and severe irregularity. They
reported no significant difference in subjects with severe
irregularity scores greater than five. Interestingly, they
found that patients with moderate irregularity, with irreg-
ularity scores between 2 and 5, were 2.7 times more likely
to align faster in the SL bracket treatment group. Differ-
ent archwire sequences were used in each bracket group
in the study of Pandis et al18; this might have been a con-
founding factor contributing to the hazard ratio.
A strength of this study was the inclusion and exclu-
sion criteria that enabled control over certain clinical
variables such as bracket composition and dimension,
archwire type and sequence, and interappointment in-
terval. Consecutive eligible patients were included to
American Journal of Orthodontics and Dentofacial Orthopedics
August 2010
minimize confounding factors. Therefore, the critical
difference between the treatment groups was the
method of ligation.
This study had several limitations. There was no
control group available to measure the natural drift of
the teeth into the extraction spaces without orthodontic
appliances. It could also be argued that extraction ther-
apy is not routinely performed with the SL bracket phi-
losophy and is not intended for this sample of patients.
Despite the strict inclusion and exclusion criteria, the
possibility of sampling bias because of the retrospective
nature of the study cannot be dismissed. Several patients
were excluded because of missing models at the various
time points, or they received an alternate archwire
sequence that reduced the power of the study at T2.
The patients were also treated by several clinicians
with various levels of experience. The 3 bracket types
used in this study had different prescription values.
It might be postulated that, as irregularity increases,
other factors negate any benefit of the reduced friction
of SL brackets. For example, the narrower bracket
design of the Damon 3MX might have increased the
contact angle and contributed to elastic binding and
notching. Future research could explore these hypothe-
ses in extraction patients, with larger sample sizes in
a prospective clinical trial.
It is not surprising that bracket type does not appear to
have a significant influence on treatment efficiency. Treat-
ment efficiency is the product of many mechanical and bi-
ologic factors. It is unlikely that any 1 factor is responsible
for the rate of tooth movement. The biology of tooth
movement is a complex and highly coordinated process
at the cellular, molecular, and genetic levels. Individual
variation undoubtedly has a fundamental underlying role
in tooth movement and treatment efficiency.
CONCLUSIONS
1. SL brackets were no more efficient than CL
brackets in anterior alignment and passive extrac-
tion space closure during the first 20 weeks of
orthodontic treatment.
2. Changes in arch dimensions were similar in the SL
and CL groups.
We thank the Australian Society of Orthodontists’
Foundation for Research and Education for providing
a grant to fund this research project.
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