Clinical effects with customized brackets and CAD/CAM technology: a prospective controlled study

Abstract

Objective Nowadays, CAD/CAM technologies enrich orthodontics in several ways. While they are commonly used for diagnoses and treatment planning, they can also be applied to create individualized bracket systems. The purpose of this prospective quasi-randomized study was to evaluate the clinical efficiency of a customized bracket system and its comparison with directly bonded conventional self-ligating bracket treatment. Materials and methods Altogether 38 patients were separated into two groups, treated either with direct bonded self-ligating brackets (Damon, Ormco, USA) or with indirect bonded customized CAD/CAM brackets (Insignia™, Ormco, USA). Overall treatment time, number of treatment appointments, number of lost or repositioned brackets, number of arch wires and wire bends, Little Irregularity Index, cephalometric analyses and ABO scores were compared. Superimpositions of the virtual set-ups and the treatment results of the CAD/CAM group were performed to evaluate the clinical realization of the treatment planning. Results No differences between both treatment groups were found concerning overall treatment time, number of appointments and number of archwire bends. Bonding failures occurred more often using the CAD/CAM system. Indirectly bonded brackets did not have to be repositioned as often as directly bonded brackets. Treatment results with both systems were similar concerning their effects on the reduction of ABO scores. The number of used archwires was higher in the CAD/CAM group. Treatment with both systems led to further proclination of the incisors. Proclination in the lower jaw was greater than proclination in the upper jaw, and there was a statistically significant difference between the two treatment systems. Comparing the treatment results with the virtual set-ups, mesial positions were met best, followed by vertical positions. Transversal positions showed the greatest discrepancies. Concerning angles, values of angulation showed greatest accordance to the virtual set-up, while values of inclinations showed greatest discrepancies. Conclusion In comparison with a direct bonded self-ligating bracket system the use of indirect bonded customized CAD/CAM brackets showed only minor influence on treatment efficiency and treatment outcomes. Transversal expansion, deep bite correction, expression of torque and anchorage loss remain challenges in the treatment with straight-wire appliances. Trial registration DRKS, DRKS00024350. Registered 15 February 2021, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024350.

Efficacy of CAD/CAM Technology in Interventions Implemented in Orthodontics: A Scoping Review of Clinical Trials

“…Reading the full text resulted in the exclusion of 5 additional trials. Finally, 8 CTs [ 5 , 11 – 17 ] were included in this scoping review ( Figure 1 ).…”

“…Three CTs were randomized single-blind, controlled, and with parallel design [ 11 , 12 , 17 ]. Three CTs were randomized unblinded, controlled, and with parallel design [ 14 – 16 ], one CT was randomized unblinded, controlled, and with split-mouth design [ 13 ], and one CT was quasi-randomized, controlled, with parallel design [ 5 ]. One CT compared 4 groups [ 14 ], 2 CTs compared 3 groups [ 11 , 12 ], and 5 CTs compared 2 groups [ 5 , 13 , 15 – 17 ].…”

“…These experiments evaluated different interventions in orthodontics. Four studies compared the computer-aided indirect bonding method versus the traditional direct bonding of orthodontic brackets [ 5 , 13 , 15 , 16 ]. Three studies compared CAD/CAM retainers with other types of retainers [ 12 , 14 , 17 ], and one CT compared CAD/CAM group with multistranded stainless steel wires versus stainless steel Ortho-FlexTech wires group (traditional group) and Lab group with multistranded stainless steel wires [ 11 ].…”

“…In contrast with a direct bonded self-ligating bracket system, the utilization of indirect bonded customized CAD/CAM brackets presented just a slight effect on treatment efficacy. Besides, after therapy, the ABO score in both interventions was diminished, without significant differences [ 5 ]. Likewise, an indirect bonding self-ligating standard system showed a similar quality of therapy in comparison with the CAD/CAM customized bracket system, and the final ABO score was similar [ 15 ].…”

“…Regarding fixed purposes, CAD/CAM technology may promote the accuracy of bracket placement, considering that its location significantly influences treatment effects [ 4 ]. Some fully individualized bracket systems incorporate virtual configurations to assume treatment outcomes, taking into account individual tooth surface and morphology, and custom archwires [ 5 ]. Furthermore, patients treated with CAD/CAM orthodontic systems, in a retrospective study, required fewer appointments for archwire changes; besides, the treatment time was shorter and presented an inferior American Board of Orthodontics (ABO) score [ 6 ].…”