Systematic review of self-ligating brackets.
BACKGROUND
Self-ligating brackets have been gaining popularity over the past several decades. Various advantages for these systems have been claimed. The purposes of this systematic review were to identify and review the orthodontic literature with regard to the efficiency, effectiveness, and stability of treatment with self-ligating brackets compared with conventional brackets.


METHODS
An electronic search in 4 data bases was performed from 1966 to 2009, with supplemental hand searching of the references of retrieved articles. Quality assessment of the included articles was performed. Data were extracted by using custom forms, and weighted mean differences were calculated.


RESULTS
Sixteen studies met the inclusion criteria, including 2 randomized controlled trials with low risk of bias, 10 cohort studies with moderate risk of bias, and 4 cross-sectional studies with moderate to high risk of bias. Self-ligation appears to have a significant advantage with regard to chair time, based on several cross-sectional studies. Analyses also showed a small, but statistically significant, difference in mandibular incisor proclination (1.5 degrees less in self-ligating systems). No other differences in treatment time and occlusal characteristics after treatment were found between the 2 systems. No studies on long-term stability of treatment were identified.


CONCLUSIONS
Despite claims about the advantages of self-ligating brackets, evidence is generally lacking. Shortened chair time and slightly less incisor proclination appear to be the only significant advantages of self-ligating systems over conventional systems that are supported by the current evidence.
Chen
Stephanie Shih-Hsuan
SS
Department of Orthodontics, University of Washington, Seattle, 98195-7446, USA.
Greenlee
Geoffrey Michael
GM
Kim
Jihyun-Elizabeth
JE
Smith
Craig L
CL
Huang
Greg J
GJ
D004868:Equipment Failure; D006801:Humans; D007180:Incisor / Q000502:physiology; D016382:Orthodontic Appliance Design; D016910:Orthodontic Brackets; D019516:Orthodontic Space Closure / Q000295:instrumentation; D013997:Time Factors