ORTHO 252 1-15

Ó 2017 CEO

A review of the literature Published by / Édité par Elsevier Masson SAS

All rights reserved / Tous droits réservés

rature
Revue de la litte

Therapeutic efficacy of self-ligating

brackets: A systematic review

the
Efficacite
rapeutique des attaches

matique
autoligaturantes : revue syste

Hasnaa Dehbi*, Mohamed Faouzi Azaroual, Fatima Zaoui, Abdelali Halimi, Hicham Benyahia

Service d’orthop
edie dentofaciale, facult
e de m
edecine dentaire, Mohamed V university, avenue

Allal el Fassi, rue Mohammed Jazouli, cit
e Al Irfane, BP 6212, Rabat, Morocco

Available online: XXX / Disponible en ligne : XXX

Summary
sume
Re

Introduction: Over the last few years, the use of self-ligating Introduction: Durant ces dernieres  annees
l’utilisation des
brackets in orthodontics has progressed considerably. These brackets autoligaturants s’est largement developp

dans la
ee
systems have been the subject of numerous studies with good pratique orthodontique. Ces systemes  ont fait l’objet de nom-
levels of evidence making it possible to evaluate their efficacy

breuses etudes de haut niveau de preuve qui ont permis
and efficiency compared to conventional brackets. The aim of

d’evaluer leur efficacite
et leur efficience par rapport aux
this study was to evaluate the therapeutic efficacy of self-ligat- brackets classiques. L’objectif de cette etude


est d’evaluer
ing brackets by means of a systematic review of the scientific l’efficacite
therapeutique

des brackets autoligaturants à tra-
literature.

vers une revue systematique

de la litterature scientifique.
Materials and methods: A systematic study was undertaken in

Materiel

et methode:

Une etude

systematique a et
e
entre-
the form of a recent search of the electronic Pubmed database, prise à travers une recherche recente
sur la base de donnees

oriented by the use of several keywords combined by Boolean

electroniques Pubmed. Cette recherche a et
e
orientee
par
operators relating to the therapeutic efficacy of self-ligating l’utilisation de plusieurs mots cles,
combines
par des
brackets through the study of tooth alignment, space closure,

operateurs

booleens, en rapport avec l’efficacite
therapeu-

expansion, treatment duration and degree of discomfort. The tique des attaches autoligaturantes à travers l’etude
de
search was limited to randomized controlled studies, and two l’alignement dentaire, de la fermeture d’espace, de l’expan-
independent readers identified studies corresponding to the sion, de la duree
de traitement et du degre
d’inconfort. La
selection criteria. recherche a et
e
limitee

aux essais control ^ es

randomises,
et


deux lecteurs independants

ont retenu les etudes

repondant

aux criteres

de selection.
Results and discussion: The chosen articles comprised 20 ran-

Resultats et discussion: Les articles retenus ont consiste
en
domized controlled trials. The studies analyzed revealed the 20 essais control ^ es

randomises.
Les etudes
analysees
ont
absence of significant differences between the two types of sys- montre
l’
tem on the basis of the clinical criteria adopted, thereby refuting absence de difference
significative entre les deux types de
the hypothesis of the superiority of self-ligating brackets over 
systemes sur la base des criteres 

cliniques etudi
ce qui
es,
conventional systems.

refuterait

la superiorit e
des brackets autoligaturants sur les
brackets conventionnels.
Ó 2017 CEO. Published by Elsevier Masson SAS. All rights Ó 2017 CEO. Édité par Elsevier Masson SAS. Tous droits
reserved réservés

* Correspondence and reprints / Correspondance et tire
s à part :

Hasnaa Dehbi, Service d’orthop
edie dentofaciale, facult
e de m
edecine dentaire,
Mohamed V university, avenue Allal el Fassi, rue Mohammed Jazouli, cit
e Al Irfane,
BP 6212, Rabat, Morocco.
e-mail address / Adresse e-mail : dehbihasnaa@gmail.com (Hasnaa Dehbi)

International Orthodontics 2017 ; X : 1-15 1

http://dx.doi.org/10.1016/j.ortho.2017.06.009
ORTHO 252 1-15

Hasnaa Dehbi et al.

Key-words
s
Mots-cle
·· Self-ligating brackets.
Efficacy.
·· Brackets autoligaturants.
Efficacite
.
·· Friction.
Orthodontics.
·· Friction.
Orthodontie.
· Systematic review. · Revue syste
matique.

Introduction Introduction

In the last few years, the orthodontics market has shown On a assiste
ces dernie res anne
es à un grand inte
re
^ t du
considerable interest in self-ligating brackets, which do away marche
orthodontique pour les brackets autoligaturants,
with the need for metallic or elastomeric ligatures since they boı̂tiers s’affranchissant de toutes ligatures me
talliques et/ou
possess a clip that opens and closes the attachment system.
lastome
e
riques par la pre
sence d’un clapet solidaire de
l’attache qui ouvre et ferme ce syste me.
Two types of bracket can be distinguished (fig. 1): Deux types de boı̂tiers sont à distinguer (fig. 1) :
— active self-ligating brackets: the clip is in contact with the — les brackets autoligaturants actifs : le clapet entre en
archwire and exerts a slight pressure that allows control of contact avec l’arc en assurant une le
ge
 re pression qui est
movements in the three planes of space (e.g. In-OvationÒ, à l’origine de la maı̂trise des mouvements dans les trois plans
SpeedÒ) [1]; de l’espace. (ex. In-OvationÒ, SpeedÒ) [1] ;
— passive self-ligating brackets: the clip does not interfere — les brackets autoligaturants passifs : le clapet n’interfe re
with the bracket slot, leading to reduced friction (e.g. pas avec la lumie re du bracket, entraı̂nant ainsi une moindre
DamonÒ, Smart-ClipÒ, CarriereÒ) [1]. friction (ex. DamonÒ, Smart-ClipÒ, Carrie reÒ) [1].
Since their arrival on the market, these systems have been Depuis leur apparition, ces syste mes ont fait l’objet de nom-
subjected to numerous studies, which have led to several breuses e
tudes, qui ont permis de leur associer plusieurs
advantages being attributed to them compared with conven- avantages par rapport aux brackets conventionnels. Le
tional brackets. The main alleged benefit is a reduction in be
ne
fice majeur serait la re
duction des forces de friction,
friction, meaning that on a clinical level there is less favorisant sur le plan clinique une moindre re
sistance au

[(Fig._1)TD$IG]

Fig. 1: Different types of self-ligating brackets.

a: active.
b: passive.

rents types de boı̂tiers autoligaturants.
Fig. 1 : Diffe
a : actif.
b : passif.

2 International Orthodontics 2017 ; X : 1-15

ORTHO 252 1-15

Therapeutic efficacy of self-ligating brackets: A systematic review

the
Efficacite
rapeutique des attaches autoligaturantes : revue syste

matique

resistance to sliding, thus greater efficacy and efficiency dur-
ing alignment, space closure and expansion, and also advan-
tages linked to patient comfort and a reduction in total treat-
ment time.
The aim of this study was to confirm or refute the hypothesis of
the therapeutic efficacy of self-ligating brackets through a
systematic review of articles with a good level of evidence
and in terms of several clinical criteria.
glissement, une efficacite
et une efficience lors des phases
d’alignement, de fermeture d’espace et d’expansion, en plus
des avantages lie
s à l’ame
lioration du confort des patients et

duction de la dure
à la re
e totale du traitement.
L’objectif de cette e
tude est de chercher à travers une revue
syste
matique de la litte
rature de haut niveau de preuve scien-
tifique, à confirmer ou infirmer l’efficacite
the

rapeutique des
brackets autoligaturants sur plusieurs crite res cliniques.

Materials and methods
riel et me

Mate
thode

Search strategy
gie de recherche

Strate

A systematic review was carried out by means of electronic Une revue syste
matique a e
te

re
alise

e, à travers une consul-
consultation of the PubMed database. The search was directed tation e
lectronique de la base de donne
es PubMed. La
using several specific keywords combined by means of recherche a e
te

oriente

e par l’utilisation de plusieurs mots cle
s
Boolean operators (Self-ligat*, conventional, bracket*, treat- spe
cifiques combine
s à l’aide d’ope
rateurs boole
ens (Self-
ment time, alignment, dental arch, discomfort, retraction) in ligat*, conventional, bracket*, treatment time, alignment, den-
order to evaluate the efficacy of these systems during the tal arch, discomfort, retraction) afin d’e
valuer l’efficacite

de
treatment phases of alignment, space closure (retraction) ces syste mes lors des phases the
rapeutiques d’alignement
and arch expansion, and also to assess patient comfort and dentaire, de fermeture des espaces (re
traction), et d’expan-
total treatment duration. No limits were imposed concerning sion d’arcade, et e
galement d’e
valuer le confort des patients
publication date or language. et la dure
e totale du traitement. Aucune restriction de date de
publication ou de langue n’a e
te

impose
e.
The selected articles had to answer the PICO question: do self- Les articles se
lectionne
s devaient re
pondre à la question
ligating brackets improve treatment efficacy compared to con- PICO de recherche : les brackets autoligaturants ame
lio-
ventional brackets? rent-ils l’efficacite
du traitement par rapport aux brackets
conventionnels ?
— participants: patients wearing fixed orthodontic appliances — participants : patients portant un appareillage orthodon-
with a continuous archwire, treated by means of self-ligating or tique fixe avec arc continu, traite
s par des brackets vestibu-
conventional vestibular brackets; laires autoligaturants ou conventionnels ;
— interventions: treatment by fixed orthodontic appliances — interventions : traitement par appareillage orthodontique
including self-ligating brackets; fixe incluant des brackets autoligaturants ;
— comparison: treatment using conventional brackets; — comparaison : traitement par brackets conventionnels ;
— outcome: comparison between conventional and self-ligat- — outcome (re
sultats) : comparaison de l’efficacite
the

rapeu-
ing brackets in terms of therapeutic efficacy on the basis of tique entre brackets conventionnels et autoligaturants en se
five clinical criteria: tooth alignment, retraction, degree of basant sur cinq crite res cliniques : l’alignement dentaire, la
expansion, duration of treatment and patient discomfort. re
traction, le degre
d’expansion, la dure
e du traitement et
l’inconfort des patients.

Inclusion and exclusion criteria res d’inclusion et d’exclusion

Crite

Inclusion criteria were based on two parameters:
— outcome measurements: only studies answering the ques-
tion above were included;
— study design: only randomized controlled clinical trials
with a high level of scientific evidence and a low or moderate
bias were included.
Exclusion criteria concerned in vitro studies, studies on an
articulator, systematic reviews, animal studies and microbio-
logical studies.
Les criteres d’inclusion reposent sur deux parame tres :
— les crite res de jugement : seules sont incluses les e
tudes

pondant à la question de recherche ;
re
— le design de l’e
tude : seuls sont inclus les essais cliniques
contro^ le

s randomise
s caracte
rise

s par leur haut niveau de
preuve scientifique et leur biais faible à moyen.
Les crite res d’exclusion concernent les e
tudes in vitro, les

tudes sur typodont, les revues syste
e
matiques, les e
tudes
sur les animaux, et les e
tudes microbiologiques.

International Orthodontics 2017 ; X : 1-15 3

ORTHO 252 1-15

Hasnaa Dehbi et al.

Results and discussion
sultats et discussion

Re

One hundred twenty-eight articles were identified in the first Au total, 128 articles ont e
te
de
nombre
s durant le premier
stage of research. Of these 128 potentially relevant articles, 22 stade de la recherche. Sur ces 128 articles potentiellement
were selected on the basis of their titles and summaries. After pertinents, 22 ont e
te

inclus apre s lecture des titres et des
reading of the full articles, one was eliminated because of the
sume
re
s. Apre s lecture des articles complets, 1 article a e
te


use of segmented archwires [2] and a second because it did exclu en raison de l’utilisation d’arcs segmente
s [2] et un autre
not correspond to the pre-established research question [3] article a e
te

exclu du fait de l’absence de conformite
avec la
(fig. 2). question de recherche pre
e
tablie [3] (fig. 2).
Finally, 20 randomized controlled trials were included. These Finalement, 20 essais contro ^ le

s randomise
s sont inclus. Les
have been summarized and classified by subject and date of travaux ont e
te

re
sume
s et classe
s par the me et date de
publication. The selected articles are presented in the Tables publication. Les Tableaux I–V pre
sentent les articles
I–V: se
lectionne
s :
— 4 articles study the efficacy of tooth alignment (Table I); — 4 articles se re
fe
rent à l’e

tude de l’efficacite
de l’alignement
dentaire (Tableau I) ;
— 4 articles study space closure or retraction (Table II); — 4 articles se re
ferent à l’e
tude de la fermeture d’espace ou
de la re
traction (Tableau II) ;
— 3 articles concern the evaluation of arch expansion (Table — 3 articles concernent l’e
valuation de l’expansion d’arcade
III); (Tableau III) ;
— 4 articles assess the overall duration of treatment (Table — 4 articles appre
cient la dure
e de traitement globale
IV); (Tableau IV) ;
— 5 articles assess patient comfort (Table V). — 5 articles appre
cient le confort des patients (Tableau V).

Efficacy of alignment
de l’alignement

Efficacite

Improvements in the efficacy of tooth alignment due to self- L’ame
lioration de l’efficacite

ligating brackets have been explained by a reduction in fric-
tional forces at the bracket/archwire interface that optimizes
the effects of the orthodontic forces applied, thereby improv-
ing tooth movement. This reduction is additional to the strong,
durable retention of the archwire by the bracket clip compared
with conventional systems.

de l’alignement dentaire par les
brackets autoligaturants a e
te

explique

e par la re

duction des
forces de friction au niveau de l’interface bracket/arc, optimi-
sant ainsi l’effet de la force orthodontique applique
e, ce qui
permet d’ame
liorer le de

placement dentaire. Cette re
duction
s’ajoute à l’action du verrouillage ferme et robuste de l’arc par
le clapet du bracket en comparaison avec les boı̂tiers
conventionnels.

[(Fig._2)TD$IG]

Fig. 2: Flow chart.

Fig. 2 : Diagramme de flux.

4 International Orthodontics 2017 ; X : 1-15

ORTHO 252 1-15

Therapeutic efficacy of self-ligating brackets: A systematic review

the
Efficacite
rapeutique des attaches autoligaturantes : revue syste

matique

Table I Tableau I
List of studies evaluating the efficacy of tooth alignment.
tudes e
Liste des e
valuant l’efficacite

de l’alignement dentaire.

Author / Auteur

Study protocol / Protocole des etudes

Results / Resultats
Celikoglu et al. [7] Comparison between BC (metallic ligatures)
de
Alignment duration (P = NS) / Duree
2015 and self-ligating brackets (Smart-ClipÒ) / l’alignement (p = NS)


Comparaison entre BC (ligatures metalliques) Buccal tipping of incisors (P = NS) /
et autoligaturants (Smart-ClipÒ) Vestibuloversion incisive (p = NS)
Cases without extractions: crowding (LII): BC (5.38 W 3.37) Smart-ClipÒ (5.25 W 4.77) /
mean = 7 mm / Cas sans extractions : BC (5,38  W 3,37) Smart-ClipÒ(5,25  W 4,77)
encombrement (LII) : moyenne = 7 mm
Archwire sequence: heat-treated NiTi (0.01400


for 8 weeks, 0.01600 for 16 weeks) / Sequence
arcs : NiTi thermique (0,01400 pendant
8 semaines, 0,01600 pendant 16 semaines)
Songra et al. [4] Comparison between BC (DENTSPLY GACÒ

Alignment duration: (P = 0.001) / Duree
2014 with elastomeric ligatures) and self-ligating d’alignement : (p = 0,001)
brackets (Damon 3MXÒ, In-Ovation RÒ) / DamonÒ (422 W 124d) > In-OvationÒ
Comparaison entre BC (DENTSPLY (399 W 107d) > BC (251 W 107d) /
GACÒavec ligatures elastom


eriques) et DamonÒ(422 W 124j) > In-
autoligaturants (Damon 3MXÒ, In-Ovation RÒ) OvationÒ(399 W 107j) > BC (251 W 107j)
Cases with extractions: crowding (LII): Passive closure of extraction spaces (P = NS) /
mean = 8 mm / Cas d’extractions : Fermeture passive d’espace d’extractions
encombrement (LII) : moyenne = 8 mm (p = NS)
Archwire sequence: copper NiTi (0.01400 ,
0.01800 ), SS (0.016  0.02200 ,


0.019  0.02500 ) / Sequence arcs : copper
NiTi (0,01400 , 0,01800 ), SS (0,016  0,02200 ,
0,019  0,02500 )
Reddy et al. [6] Comparison between BC (elastomeric and Alignment duration: (P < 0.01) / Duree

2014 metallic ligatures) and self-ligating brackets d’alignement : (p < 0,01)
(Smart-ClipÒ, In-Ovation RÒ) / Comparaison BC + elastomeric ligatures (176 W 11d) > BC


entre BC (ligatures elastom

eriques, + metallic ligatures (175 W 9d) > In-Ovation R


metalliques) et autoligaturants (Smart-ClipÒ, (152 W 10d) > Smart-ClipÒ: (143 W 7d) / BC
In-Ovation RÒ)

+ ligature elastom

eriques (176 W 11j) > BC
Cases with extractions: Crowding (LII):

+ ligature metalliques (175 W 9j) > In-Ovation R
mean = 6 mm / Cas d’extractions : (152 W 10j) > Smart-ClipÒ : (143 W 7j)
encombrement (LII) : moyenne = 6 mm Passive closure of extraction spaces: (P < 0.01) /
Archwire sequence: Copper NiTi (0.01400 , Fermeture passive d’espace d’extraction :
0.01600 , 0.016  0.02200 ), SS (p < 0,01)


(0.016  0.02200 ) / Sequence arcs : Copper Elastomerics: (2 mm) < metallics: (2.1 mm) < In-
NiTi (0,01400 , 0,01600 , 0,016  0,02200 ), SS OvationÒ: (3.5 mm) < Smart-ClipÒ: (3.9 mm) /
(0,016  0,02200 )

Elastomeriques

: (2 mm) < metalliques :
(2,1 mm) < In-OvationÒ : (3,5 mm) < Smart-
ClipÒ : (3,9 mm)
Buccal tipping of incisors: (P < 0.01)
elastomerics (4.40 ) > metallics (4.39 ) > In-
Ovation (2.78 ) > Smart-Clip (1.85 ) /
Vestibuloversion incisive : (p < 0,01)


elastom

eriques

(4,40  ) > metalliques (4,39  )
> In-Ovation (2,78  ) > Smart-Clip (1,85  )

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ORTHO 252 1-15

Hasnaa Dehbi et al.

Table I Tableau I
List of studies evaluating the efficacy of tooth alignment.
tudes e
Liste des e
valuant l’efficacite

de l’alignement dentaire.
(following) (suite)

Author / Auteur

Study protocol / Protocole des etudes

Results / Resultats
Fleming et al. [8] Comparison between BC (VictoryÒ) and self-
de
Alignment duration (P = NS) / Duree
2009 ligating brackets (Smart-ClipÒ) / l’alignement (p = NS)
Comparaison entre BC (VictoryÒ) et Smart-ClipÒ (253 W 39d), VictoryÒ (247 W 37d) /
autoligaturants (Smart-ClipÒ) Smart-ClipÒ(253 W 39j), VictoryÒ(247 W 37j)
Cases without extractions: crowding (LII): Buccal tipping of incisors (P = NS) /
mean = 2 mm / Cas sans extractions : Vestibuloversion incisive (p = NS)
encombrement (LII) : moyenne = 2 mm Smart-ClipÒ (4.41 W 3), (1.46 mm W 0.9);
Archwire sequence: NiTi (0.01600 , VictoryÒ (4.32 W 4), (1.36 mm W 1.35) / Smart-
0.017  0.02500 , 0.019  0.02500 ), SS ClipÒ(4,41  W 3), (1,46 mm W 0,9) ;


(0.019  0.02500 ) / Sequence arcs : NiTi VictoryÒ(4,32  W 4), (1,36 mm W 1,35)
(0,01600 , 0,017  0,02500 , 0,019  0,02500 ), SS
(0,019  0,02500 )
Scott et al. [5] Comparison between BC (elastomeric
de
Alignment duration (P = NS) / Duree
2008 ligatures) and self-ligating brackets l’alignement (p = NS)
(Damon3Ò) / Comparaison entre BC (ligatures BC (243 W 82d), DamonÒ (253 W 63d) / BC


elastom

eriques) et autoligaturants (Damon3Ò) (243 W 82j), DamonÒ(253 W 63j)
Cases with extractions: crowding (LII): Buccal tipping of incisors (IMPA): (P = NS) /
mean = 5 and 12 mm / Cas d’extractions : Vestibuloversion incisive (IMPA) : (p = NS)
encombrement (LII) : moyenne = 5 et 12 mm BC (93.3 W 5) DamonÒ (92 W 7) / BC
Archwire sequence: Copper NiTi (0.01400 , (93,3  W 5) DamonÒ(92  W 7)
0.014  0.02500 , 0.018  0.02500 ) SS


(0.019  0.02500 ) / Sequence : Copper NiTi
(0,01400 , 0,014  0,02500 , 0,018  0,02500 ) SS
(0,019  0,02500 )
BC: conventional brackets; LII: Little Irregularity Index; NiTi: Nickel Titanium; NS: non-significant; SS: stainless steel.
BC : brackets conventionnels ; LII : Little Irregularity Index ; NiTi : Nickel Titane ; NS : non significatif ; SS : stainless steel.

In clinical terms, increased efficacy of dental alignment
de l’alignement dentaire permet

Sur le plan clinique, l’efficacite
reduces the time required for correction of tooth irregularities. de re
duire la dure

e ne
cessaire à l’atte
nuation des irre
gularite

s
The alignment is performed by correcting incisor tilt by dentaires. Cet alignement se fait en contro ^ lant les axes incisifs
reducing flaring and vestibular positioning, and by passive par la re
duction des vestibuloversions et vestibulopositions,
closure of extraction spaces thanks to the distal migration of ainsi que par la fermeture passive des espaces d’extractions
teeth (fig. 3). par la migration distale des dents (fig. 3).
The results obtained in studies of the efficacy of tooth align- Les re
sultats obtenus lors de l’e
tude de l’efficacite
de l’aligne-
ment are contradictory. In the situation of treatment with ment dentaire ont e
te

contradictoires. En effet, en cas de
extractions, Songra et al. concluded that conventional brack- traitement avec extractions, Songra et al. ont conclu que les
ets significantly reduced alignment time by 42% compared brackets conventionnels re
duisent significativement la dure
e
with self-ligating brackets [4], whereas Scott et al. noted a non- d’alignement de 42 % par rapport aux brackets autoligatu-
significant difference of 4% [5]. Concerning passive closure of rants [4], alors que Scott et al. ont trouve
une diffe
rence non
extraction spaces and incisor angle correction, studies have significative de 4 % [5]. Quant à la fermeture passive des
shown that the two types of bracket produce similar results, espaces d’extractions et à l’inclinaison incisive, les e
tudes
although the conventional brackets give rise to more buccal ont montre
que les deux types d’attaches ont des valeurs
tipping of incisors than the self-ligating systems [4,5]. similaires, bien que les brackets conventionnels entraı̂nent
plus de vestibuloversion incisive par rapport aux autoligatur-
ants [4,5].
These results were put in perspective by the study of Reddy et Ces re
sultats ont e
te

mis en perspective par l’e
tude de Reddy
al., who showed that self-ligating brackets offered statistically et al. qui ont montre
que les attaches autoligaturantes sont
significant advantages over conventional types in terms of plus avantageuses par rapport aux conventionnelles, aussi
alignment duration, control of the incisal axes and extraction bien en termes de dure
e d’alignement, de contro ^ le des axes

6 International Orthodontics 2017 ; X : 1-15

ORTHO 252 1-15

Therapeutic efficacy of self-ligating brackets: A systematic review

the
Efficacite
rapeutique des attaches autoligaturantes : revue syste

matique

Table II Tableau II
List of studies evaluating the efficacy of space closure Liste des e
tudes e

valuant l’efficacite

de la fermeture d’espace
(retraction).
traction).
(re

Author / Auteur Intervention / Intervention

Results / Resultats
Monini et al. [13] Comparison between BC (OvationÒ) and self-

Retraction rate: (P = NS) / Taux de retraction :
2016 ligating brackets (In-Ovation RÒ) / (p = NS)
Comparaison BC (OvationÒ) et OvationÒ (0.6 mm/month) > In-Ovation RÒ
autoligaturants (In-Ovation RÒ) (0.5 mm/month) / OvationÒ(0,6 mm/mois) > In-
Lower canine retraction on 0.02000 SS with Ovation RÒ(0,5 mm/mois)


closed NiTi spring / Retraction canine Retraction distance: (P = NS) OvationÒ


inferieure sur 0,02000 SS avec ressort ferme
en (7.5 mm) > In-Ovation RÒ (7.2 mm) / Quantite

NiTi

de retraction : (p = NS) OvationÒ(7,5 mm) > In-
Ò
Ovation R (7,2 mm)

de retraction
Retraction time: (P = NS) / Duree
:
(p = NS)
OvationÒ (13.6 months) < In-Ovation RÒ
(13.9 months) / OvationÒ(13,6 mois) < In-
Ovation RÒ(13,9 mois)
Monini et al. [14] Comparison between BC (OvationÒ) and self-

Retraction rate: (P = NS) / Taux de retraction :
2014 ligating brackets (In-Ovation RÒ) / (p = NS)
Comparaison entre BC (OvationÒ) et OvationÒ (0.72 mm/month) > In-OvationÒ
autoligaturants (In-Ovation RÒ) (0.71 mm/month) / OvationÒ(0,72 mm/mois)
Lower canine retraction on 0.02000 SS with > In-OvationÒ(0,71 mm/mois)


closed NiTi spring / Retraction canine Retraction distance: (P = NS) OvationÒ


superieure sur 0,02000 SS avec ressort ferme
(6.97 mm) > In-OvationÒ (6.92 mm) / Quantite

en NiTi

de retraction : (p = NS) OvationÒ(6,97 mm) > In-
Ò
Ovation (6,92 mm)

de retraction
Retraction time: (P = NS) / Duree
:
(p = NS)
OvationÒ (10.70 months) < In-OvationÒ
(10.86 months) / OvationÒ(10,70 mois) < In-
OvationÒ(10,86 mois)
Songra et al. [4] Comparison between BC (elastomeric Total active closure of extraction spaces:
2014 ligatures) and self-ligating brackets (Damon (P = NS) / Fermeture active et totale d’espace
3MXÒ, In-Ovation RÒ) / Comparaison entre d’extraction : (p = NS)


BC (ligatures elastom

eriques) et
autoligaturants (Damon 3MXÒ, In-Ovation RÒ)
Incisor and canine retraction on
0.019  0.02500 SS with NiTi spring /


Retraction incisivocanine sur 0,019  0,02500
SS avec ressort NiTi
Wong et al. [16] Comparison between BC (elastomeric Retraction distance: (P = NS) / Quantite
de
2013 ligatures, super-slickÒ) and self-ligating

retraction : (p = NS)
brackets (Damon 3MXÒ) / Comparaison entre Elastomeric ligatures (3.0 mm W 1.2) >


BC (ligatures elastom

eriques, Super-slickÒ) et Super-slickÒ (3.0 mm W 1.1) > DamonÒ
Ò
autoligaturants (Damon 3MX )

(2.7 mm W 1.2) / Ligatures elastom

eriques
Incisor and canine retraction on (3,0 mm W 1,2) > Super-
0.019  0.02500 SS with NiTi spring / slickÒ(3,0 mm W 1,1) > DamonÒ(2,7 mm W 1,2)


Retraction incisivocanine sur 0,019  0,02500
SS avec ressort NiTi

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Hasnaa Dehbi et al.

Table II Tableau II
List of studies evaluating the efficacy of space closure Liste des e
tudes e
valuant l’efficacite

de la fermeture d’espace
(retraction). (following)
traction). (suite)
(re

Author / Auteur Intervention / Intervention

Results / Resultats
Mezomo et al. [15] Comparison between BC (GeminiÒ with

Retraction rate: (P = NS) / Taux de retraction :
2011 elastomeric ligatures) and self-ligating (p = NS)
brackets (Smart-ClipÒ) / Comparaison entre GeminiÒ (0.84 mm/month) < Smart-ClipÒ
BC (GeminiÒavec ligatures elastom



eriques) et (0.90 mm/month) / GeminiÒ(0,84 mm/mois)
autoligaturants (Smart-ClipÒ) < Smart-ClipÒ(0,90 mm/mois)
Incisor and canine retraction on 0.01800 SS by Retraction distance: (P = NS) GeminiÒ


elastomeric power chains / Retraction canine (2.53 mm) < Smart-ClipÒ (2.68 mm) / Quantite

maxillaire sur 0,01800 SS par chaıˆnettes

de retraction : (p = NS) GeminiÒ(2,53 mm)


elastom

eriques < Smart-ClipÒ(2,68 mm)
Canine rotation: (P = 0.03) GeminiÒ (12.27 )
> Smart-ClipÒ (9.15 ) / Rotation de la canine :
(p = 0,03) GeminiÒ(12,27  ) > Smart-
ClipÒ(9,15  )
BC: conventional brackets; NS: non-significant; SS: stainless steel; NiTi: Nickel Titanium.
BC : brackets conventionnels ; NS : non significatif ; SS : stainless steel ; NiTi : Nickel Titan.

[(Fig._3)TD$IG]

Fig. 3: Tooth movements during alignment.

a and b: occlusal views.
c and d: anteroposterior views.

placements dentaires au cours de l’alignement.
Fig. 3 : Les de
a et b : vues occlusales.

roposte
c et d : vues ante
rieures.

8 International Orthodontics 2017 ; X : 1-15

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Therapeutic efficacy of self-ligating brackets: A systematic review

the
Efficacite
Table III
List of studies evaluating the efficacy of arch expansion.
Author / Auteur

Study protocol / Protocole des etudes
Celikoglu et al. [7] Comparison between BC (metallic
2015 ligatures) and self-ligating brackets
(Smart-ClipÒ) / Comparaison entre BC


(ligatures metalliques) et autoligaturants
(Smart-ClipÒ)
Cases without extractions: crowding (LII):
mean = 7 mm / Cas sans extractions :
encombrement (LII) : moyenne = 7 mm
Archwire sequence: heat-treated NiTi
(0.01400 for 8 weeks, 0.01600 for 16


weeks) / Sequence arcs : NiTi thermique
(0,01400 pendant 8 semaines, 0,01600
pendant 16 semaines)
Mandibular expansion / Expansion
mandibulaire
Fleming et al. [17] Comparison between BC (ovation with
2013 elastomeric ligatures) and self-ligating
brackets (Damon QÒ, In-ovation CÒ) /
Comparaison entre BC (ovation avec


ligatures elastom

eriques) et
autoligaturants (Damon QÒ, In-ovation
C Ò)
Cases without extractions: crowding
mean = 2 mm / Cas sans extractions :
encombrement : moyenne = 2 mm
Archwire sequence (DamonÒ): Copper
NiTi (0.01300 , 0.01400 , 0.014  0.02500 ,
0.018  0.02500 ); SS (0.019  0.02500 ) /


Sequence d’arc (DamonÒ) : Copper NiTi
(0,01300 , 0,01400 , 0,014  0,02500 ,
0,018  0,02500 ) ; SS (0,019  0,02500 )
Maxillary expansion / Expansion
maxillaire
Pandis et al. [18] Comparison between BC (GACÒ) and
2011 self-ligating brackets (Damon MXÒ) /
Comparaison entre BC (GACÒ) et
autoligaturants (Damon MXÒ)
Cases without extractions: Crowding (LII):
mean = 4 mm / Cas sans extraction :
Encombrement (LII) : moyenne = 4 mm
Archwire sequence (DamonÒ): Copper
NiTi (0.014, 0.014  0.025), SS


(0.016  0.025) / Sequence d’arc
(DamonÒ) : Copper NiTi (0,014,
0,014  0,025), SS (0,016  0,025)
Mandibular expansion / Expansion
mandibulaire
International Orthodontics 2017 ; X : 1-15

rapeutique des attaches autoligaturantes : revue syste

matique
Tableau III

tudes e
Liste des e
valuant l’efficacite

de l’expansion d’arcade.


Results / Resultats
Intercanine width: (P = NS) / Largeur intercanine : (p = NS)
BC (start: 0.59 W 1.23 mm. end: 0.68 W 1.48 mm) > Smart-


Clip (start: 0.87 W 1.31; end: 0.88 W 1.47) / BC (debut :
0,59 W 1,23 mm, fin : 0,68 W 1,48 mm) > Smart-Clip (debut
:
0,87 W 1,31 ; fin : 0,88 W 1,47)
Intermolar width: (P = NS) / Largeur intermolaire : (p = NS)
BC (start: 0.35 W 1.43 mm. end: 0.61 W 1.15 mm) > Smart-
Clip (start: 0.29 W 1.02 mm; end: 0.51 W 0.92 mm) / BC


(debut : 0,35 W 1,43 mm, fin : 0,61 W 1,15 mm) > Smart-Clip


(debut : 0,29 W 1,02 mm ; fin : 0,51 W 0,92 mm)
Intercanine width: (P = NS) / Largeur intercanine : (p = NS)
DamonÒ (1.97 W 2.16 mm) > In-OvationÒ
(1.78 W 2.21 mm) > OvationÒ (0.88 W 2.18 mm) /
DamonÒ(1,97 W 2,16 mm) > In-
OvationÒ(1,78 W 2,21 mm) > OvationÒ(0,88 W 2,18 mm)
Width between 1st premolars: (P = NS) / Largeur
 premolaire
interpremiere
: (p = NS)
DamonÒ (4.51 W 2.68 mm) > In-OvationÒ
(3.75 W 2.31 mm) > OvationÒ (3.7 W 3.19 mm) /
DamonÒ(4,51 W 2,68 mm) > In-
OvationÒ(3,75 W 2,31 mm) > OvationÒ(3,7 W 3,19 mm)
Width between 2nd premolars: (P = NS) / Largeur

interdeuxieme

premolaire : (p = NS)
DamonÒ (3.96 W 2.51 mm) > In-OvationÒ
(3.78 W 1.91 mm) > OvationÒ (3.59 W 2.8 mm) /
DamonÒ(3,96 W 2,51 mm) > In-
OvationÒ(3,78 W 1,91 mm) > OvationÒ(3,59 W 2,8 mm)
Intermolar width: (P = NS) / Largeur intermolaire : (p = NS)
In-OvationÒ (1.82 W 1.59) > OvationÒ (1.41 W 2.08)
> DamonÒ (1.22 W 2.26) / In-OvationÒ(1,82 W 1,59)
> OvationÒ(1,41 W 2,08) > DamonÒ(1,22 W 2,26)
Intercanine width: (P = NS) / Largeur intercanine : (p = NS)
BC (2.1 W 1.2 mm) > Damon MXÒ (1.4 W 0.8 mm) / BC
(2,1 W 1,2 mm) > Damon MXÒ(1,4 W 0,8 mm)
Intermolar width: (P = NS) / Largeur intermolaire : (p = NS)
BC (1.5 W 0.9 mm) < Damon MXÒ (1.9 W 1.3 mm) / BC
(1,5 W 0,9 mm) < Damon MXÒ(1,9 W 1,3 mm)
9
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Table III Tableau III

List of studies evaluating the efficacy of arch expansion.
tudes e
Liste des e
valuant l’efficacite

de l’expansion d’arcade.
(following) (suite)

Author / Auteur

Study protocol / Protocole des etudes

Results / Resultats
Fleming et al. [8] Comparison between BC (VictoryÒ) and Intercanine width: (P = NS) / Largeur intercanine : (p = NS)
2009 self-ligating brackets (Smart-ClipÒ) / VictoryÒ (1.17 mm) > Smart-ClipÒ (0.85 mm) /
Ò
Comparaison entre BC (Victory ) et VictoryÒ(1,17 mm) > Smart-ClipÒ(0,85 mm)
autoligaturants (Smart-ClipÒ) Width between 1st premolars: (P = NS) / Largeur
Cases without extractions: crowding (LII):  premolaire
interpremiere
: (p = NS)
mean = 2 mm / Cas sans extraction : VictoryÒ (1.46 mm) > Smart-ClipÒ (0.37 mm) /
encombrement (LII) : moyenne = 2 mm VictoryÒ(1,46 mm) > Smart-ClipÒ(0,37 mm)
Archwire sequence: NiTi (0.01600 , Width between 2nd premolars: (P = NS) / Largeur
0.017  0.02500 , 0.019  0.02500 ), SS 
interdeuxieme

premolaire : (p = NS)


(0.019  0.02500 ) / Sequence d’arc : NiTi VictoryÒ (1.73 mm) > Smart-ClipÒ (1.34 mm) /
(0,01600 , 0,017  0,02500 , VictoryÒ(1,73 mm) > Smart-ClipÒ(1,34 mm)
0,019  0,02500 ), SS (0,019  0,02500 ) Intermolar width: (P = 0.009) VictoryÒ (0.5 mm) < SmartclipÒ
Mandibular expansion / Expansion (1.41 mm) / Largeur intermolaire : (p = 0,009)
mandibulaire VictoryÒ(0,5 mm) < Smart-ClipÒ(1,41 mm)
BC: conventional brackets; LII: Little Irregularity Index; NS: non-significant; SS: stainless steel.
BC : brackets conventionnels ; LII : Little Irregularity index ; NS : non significatif ; SS : stainless steel.

space closure [6]. The differences between these studies can incisifs et de fermeture des espaces d’extractions, avec des
perhaps be explained by the varying natures of the protocols
sultats statistiquement significatifs [6]. La diffe
re
rence entre
adopted (disparities in patient selection, severity of the initial ces e
tudes peut e ^tre explique

e par l’absence d’homoge
ne

ite


malocclusion, archwire sequence, etc.). des protocoles adopte
s (disparite

dans la se
lection des
patients, se
ve
rite

de la malocclusion initiale, se

quences d’arcs

es. . .).
utilise
For treatments without extractions the values and duration of Pour les traitements sans extractions, les valeurs de la dure
e
alignment and the changes in incisor position and inclination de l’alignement et les changements d’axe et de position inci-
were virtually identical in patients treated with self-ligating or sifs sont presque identiques chez les porteurs de brackets
conventional brackets [7,8] (Table I). autoligaturants et conventionnels [7,8] (Tableau I).

Space closure or retraction
traction

Fermeture d’espace ou re

Several in vitro studies have reported a reduction in friction Plusieurs e
tudes in vitro ont rapporte
une re
duction des forces
forces in self-ligating systems compared with conventional de friction par les autoligaturants par rapport aux convention-
brackets during tooth movements [9–12]; this is alleged to nels lors des de
placements dentaires [9–12] ; ceci serait à l’ori-
lead to an optimization of the phases of canine distalization gine d’une optimisation des phases de recul canin et de fer-
and space closure using sliding mechanics. meture des espaces en technique de glissement.
Canine retraction, which is a very important stage in treatment Trois e
tudes ont e
value
la re

traction canine, qui constitue une
using sliding mechanics, has been evaluated in three studies. phase tre s importante en technique de glissement. Ainsi en
In 2016 and 2014, Monini et al. studied respectively mandib- 2016 et 2014, Monini et al. ont e
tudie
respectivement la
ular and maxillary canine retraction [13,14]; they did not find re
traction canine mandibulaire et maxillaire [13,14] ; ils n’ont
any significant influence of the bracket type on the magnitude pas trouve
d’influence significative du type de brackets sur
and duration of retraction. These results complement those of l’ame
lioration du taux, de la quantite
et de la dure
e de la
Mezomo et al. who also assessed mandibular canine rotation re
traction. Ces re
sultats s’ajoutent à ceux de Mezomo et al.
[15]: this seems to be better controlled by self-ligating brack- qui ont e
value

e
galement la rotation canine mandibulaire [15] :
ets, with a statistically significant difference. However, the celle-ci semble e ^tre mieux contro ^ le

e par les brackets autoli-
existence of only one study on this topic and the use of elas- gaturants avec une diffe
rence statistiquement significative.
tomeric ligatures associated with conventional brackets dur- Cependant, la pre
sence d’une seule e
tude sur ce sujet et
ing retraction limit the interest of this result. l’utilisation des ligatures e
lastome
riques pour les porteurs de
brackets conventionnels lors de la re
traction, limitent l’inte

re
^t
de ce re
sultat.

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Therapeutic efficacy of self-ligating brackets: A systematic review

the
Efficacite
rapeutique des attaches autoligaturantes : revue syste

matique

Table IV Tableau IV
List of studies evaluating treatment duration.
tudes e
Liste des e
valuant la dure

e de traitement.

Author / Auteur Intervention / Intervention

Results / Resultats
O’Dywer et al. [19] Comparison between BC (3MÒ) and self-ligating

Treatment duration: (P = NS) / La duree
2016 brackets (Smart-ClipÒ) / Comparaison entre BC de traitement : (p = NS)
(3MÒ) et autoligaturants (Smart-ClipÒ) BC (25.80 months) > Smart-ClipÒ
Archwire sequence BC: NiTi (0.02400 , 0.01800 , (25.12) / BC (25,80 mois) > Smart-
0.019  0.02500 ), SS (0.019  0.02500 ). Self-ligating: ClipÒ(25,12)
NiTi (0.01400 , 0.016  0.02500 , 0.019  0.02500 ), SS Number of appointments: (P = NS) /


(0.019  0.02500 ) / Sequences d’arcs BC : NiTi Nombre de visites : (p = NS)
(0,02400 , 0,01800 , 0,019  0,02500 ), SS BC (20.37) > Smart-ClipÒ (19.97) / BC
(0,019  0,02500 ). Autoligaturants : NiTi (0,01400 , (20,37 visites) > Smart-
0,016  0,02500 , 0,019  0,02500 ), SS (0,019  0,02500 ) ClipÒ(19,97 visites)
Treatment with and without extractions / Traitement
avec et sans extractions
Johansson et al. [20] Comparison between BC (Gemini brandÒ) and self-

Treatment duration: (P = NS) / La duree
2012 ligating brackets (Time2Ò) / Comparaison entre BC de traitement : (p = NS)
(Gemini brandÒ) et autoligaturants (Time2Ò) GeminiÒ (18.2 W 6.56 months) < Time2Ò
Archwire sequence: 0.01400 NiTi, 0.020  0.02000 heat- (20.4 W 5.97) /


treated NiTi, 0.019  0.02500 SS / Sequence d’arcs : GeminiÒ(18,2 W 6,56 mois) <
0,01400 NiTi, 0,020  0,02000 NiTi thermique, Time2Ò(20,4 W 5,97)
0,019  0,02500 SS Number of appointments: (P = NS) /
Treatment with and without extractions / Traitement Nombre de visites : (p = NS)
avec et sans extractions GeminiÒ (14.1 W 5.41) < Time2Ò
(15.5 W 4.90) / GeminiÒ(14,1 W 5,41)
< Time2Ò(15,5 W 4,90)
DiBiase et al. [21] Comparison between BC (elastomeric ligatures) and

Treatment duration: (P = NS) / La duree
2010 self-ligating brackets: (DamonÒ) / Comparaison entre de traitement : (p = NS)


BC (ligatures elastom

eriques) et autoligaturants : BC (23.00 W 4.86 months) < DamonÒ
(DamonÒ) (24.48 W 6.72 months) / BC
Treatment with extractions: Crowding (LII): (23,00 W 4,86 mois) <
mean = between 5 and 12 mm / Cas d’extractions : DamonÒ(24,48 W 6,72 mois)
encombrement (LII) : moyenne = entre 5 et 12 mm Number of appointments: (P = NS) /
Archwire sequence: Copper NiTi (0.01400 , Nombre de visites : (p = NS)
0.014  0.02500 , 0.018  0.02500 ), SS BC (14.48 W 3.53) > DamonÒ


(0.019  0.02500 ) / Sequence d’arcs : Copper NiTi (14.22 W 2.64) / BC (14,48 W 3,53)
(0,01400 , 0,014  0,02500 , 0,018  0,02500 ), SS > DamonÒ(14,22 W 2,64)
(0,019  0,02500 )
Fleming et al. [22] Comparison between BC (VictoryÒ) and self-ligating

Treatment duration: (P = NS) / La duree
2010 brackets: (Smart-ClipÒ) / Comparaison entre BC de traitement : (p = NS)
(VictoryÒ) et autoligaturants (Smart-ClipÒ) BC (18.32 months) < Smart-ClipÒ (21.41
Treatment with and without extractions / TTT avec et months) / BC (18,32 mois) < Smart-
sans extractions ClipÒ(21,41 mois)
Archwire sequence: NiTi (0.01600 , 0.017  0.02500 , Number of appointments: (P = NS) /


0.019  0.02500 ), SS (0.019  0.02500 ) / Sequence Nombre de visites : (p = NS)
d’arcs : NiTi (0,01600 , 0,017  0,02500 , 0,019  0,02500 ), BC (15.7) < Smart-ClipÒ (17.7) / BC
SS (0,019  0,02500 ) (15,7) < Smart-ClipÒ(17,7)
BC: conventional brackets; NiTi: Nickel Titanium; NS: non-significant; SS: stainless steel; LII: Little Irregularity Index.
BC : brackets conventionnels ; NiTi : Nickel Titane ; NS : non significatif ; SS : stainless steel ; LII : Little Irregularity Index.

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Hasnaa Dehbi et al.

Table V Tableau V
List of studies evaluating the degree of discomfort.
tudes e
Liste des e
valuant le degre

d’inconfort.

Author / Auteur Intervention / Intervention

Results / Resultats
Rahman et al. [23] Comparison between BC (VictoryÒ) and self-ligating Degree of discomfort: (P = NS) Smart-
2016 brackets (Smart-ClipÒ) / Comparaison entre BC ClipÒ > BC / Degre
d’inconfort : (p = NS)
(VictoryÒ) et autoligaturants (Smart-ClipÒ) Smart-ClipÒ > BC
The perception of pain is carried out through a
questionnaire VAS / La perception de la douleur

à travers un questionnaire VAS
effectuee
Othman et al. [24] Comparison between BCa (VictoryÒ) and self-ligating Degree of discomfort: (P = NS) / Degre

2014 brackets (In-Ovation R, Damon 3MXÒ) / d’inconfort : (p = NS)
Comparaison entre BC (VictoryÒ) et autoligaturants DamonÒ > In-OvationÒ > BC /
(In-Ovation R, Damon 3MXÒ) DamonÒ > In-OvationÒ > BC
Evaluation through a questionnaire (the Oral Health
Impact Profile) / Evaluation à travers un questionnaire
(the Oral Health Impact Profile)
Bertl et al. [27] Comparison between BC (elastomeric ligatures) and Insertion: (P = 0.031) Smart-ClipÒ > BC /
2013 self-ligating brackets (smart-ClipÒ) / Comparaison Insertion : (p = 0,031) Smart-ClipÒ > BC


entre BC (ligatures elastom

eriques) et autoligaturants Removal: (P = 0.027) Smart-ClipÒ > BC /
(smart-ClipÒ)

Desinsertion : (p = 0,027) Smart-
Treatment without extractions / TTT sans extractions ClipÒ > BC
The degree of discomfort is evaluated on a scale
(insertion/removal of archwires): NiTi (0.01600 ,
0.014  0.02500 ) acier (0.018  0.02500 ) TMA
(0.017  0.02500 ) Blue Elgiloy (0.016  0.02200 ) / Le
degre
d’inconfort est evalu

e
sur une echelle

(insertion/


desinsertion des arcs) : NiTi (0,01600 , 0,014  0,02500 )
acier (0,018  0,02500 ) TMA (0,017  0,02500 ) Blue
Elgiloy (0,016  0,02200 )
Flemming et al. [25] Comparison between BC (VictoryÒ) and self-ligating Degree of discomfort: (P = NS) / Degre

2009 brackets (Smart-ClipÒ) / Comparaison entre BC d’inconfort : (p = NS)
(VictoryÒ) et autoligaturants (Smart-ClipÒ) Smart-ClipÒ (score: 46.81 W 24.41 at
Treatment without extractions / TTT sans extractions 4 H) > VictoryÒ (46.43 W 24.07) / Smart-
Painful experience is evaluated through a ClipÒ(score : 46,81 W 24,41 à 4 H) >
questionnaire (VAS) after 4, 24, 72 H and 7 days, and VictoryÒ(46,43 W 24,07)
during insertion/removal of an archwire Removal: (P = 0.001) and insertion of


0.019  0.02500 NiTi and SS / Experience archwires (P = 0.013): Smart-


douloureuse est evalu
par un questionnaire (VAS)
ee ClipÒ > VictoryÒ / Desinsertion

:
 4, 24, 72 H et 7 jour, et lors de l’insertion
apres (p = 0,001) et insertion d’arcs (p = 0,013) :


desinsertion d’un arc 0,019  0,02500 NiTi et Acier Smart-ClipÒ > VictoryÒ
Scott et al. [26] Comparison between BC (elastomeric ligatures) and Degree of discomfort: (P = NS) / Degre

2008 self-ligating brackets (Damon3Ò) / Comparaison d’inconfort : (p = NS)


entre BC (ligatures elastom

eriques) et autoligaturants DamonÒ (score: 63.67 W 23.18 at 4 H)
(Damon3Ò) > BC (60.11 W 23.3) / DamonÒ(score :
Treatment with extractions: crowding: mean between 63,67 W 23,18 à 4 H) > BC (60,11 W 23,3)
5 and 12 mm / Cas d’extractions : encombrement :
moyenne = entre 5 et 12 mm
Degree of discomfort evaluated on a scale (VAS) /
Degre
d’inconfort evalu

e
sur une echelle

(VAS)
BC: conventional brackets; VAS: Verbal Rating Scale; NS: non-significant; NiTi: Nickel Titanium; TMA: Titane Molybden Alloy; SS: stainless steel; H: hour.
BC : brackets conventionnels ; VAS : Verbal Rating Scale ; NS : non significatif ; NiTi : Nickel Titanium ; TMA : Titane Molybden Alloy ; SS : stainless steel ; H : heure.

12 International Orthodontics 2017 ; X : 1-15

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Therapeutic efficacy of self-ligating brackets: A systematic review

the
Efficacite
rapeutique des attaches autoligaturantes : revue syste

matique

As for mass retraction of incisors and canines, all authors
agree that the use of self-ligating brackets has very little
influence on the improvement of space closure compared with
conventional types [4,16] (Table II).

traction incisivocanine « en masse », les auteurs
Quant à la re
s’accordent à dire que les brackets autoligaturants ont une
influence tres limite
e dans l’ame
lioration de la fermeture
d’espace par rapport aux conventionnels [4,16] (Tableau II).

Expansion Expansion

Other supposed advantages of self-ligating brackets are the Parmi les avantages suppose
s des brackets autoligaturants,
correction of dental crowding without extractions, distaliza- on peut citer la correction de l’encombrement dentaire sans
tion of molars and reproximation, all with stable results over extractions, la distalisation des molaires ou la re
duction
time. This can be done through expansion to change arch ame
laire, tout en assurant un re
sultat stable dans le temps.
dimensions, particularly the intermolar distance, where the Ceci peut e ^tre obtenu gra
^ce à des changements dimensionnels
long-term stability of results is better than for intercanine d’arcade, à travers une expansion inte
ressant particulie
rement
width. la distance intermolaire caracte
rise
e par sa stabilite
à long
terme par opposition à celle de la largeur intercanine.
Four studies have been noted in this systematic review. Quatre e
tudes ont e
te

recense
es dans cette revue syste
ma-
Evaluation of the intercanine width shows results that are tique. L’e
valuation de la largeur intercanine a rapporte
des
practically identical for the two orthodontic systems, with valeurs presque identiques pour les deux appareillages ortho-
results that are not statistically significant [7,8,17,18]. The dontiques avec des re
sultats statistiquement non significatifs
same is true for the evaluation of intermolar width [7,17,18], [7,8,17,18]. La me ^me constatation est valable pour
with the exception of the study by Fleming et al. who noted that
valuation de la largeur intermolaire [7,17,18], à l’exception
l’e
the self-ligating systems increased this width significantly, by de l’e
tude de Fleming et al. qui ont constate
que les autoliga-
0.91 mm compared with conventional brackets [8] (Table III). turants augmentent significativement cette largeur de 0,91 mm
However, the author stressed the need for further prospective par rapport aux conventionnels [8] (Tableau III). Toutefois,
research in order to obtain definite proof of these results. l’auteur insiste sur la ne
cessite
de poursuivre la recherche
prospective afin de prouver de
finitivement ces constatations.
What emerges from these studies is that increases in inter- Il ressort de ces e
tudes que l’augmentation des largeurs inter-
canine and intermolar widths do not differ significantly canine et intermolaire n’est pas significativement diffe
rente
depending on the type of bracket used, and that self-ligating selon le type de bracket utilise
, et que les brackets autoliga-
brackets are not more effective than conventional types in turants ne sont pas plus efficaces que les conventionnels en
terms of expansion. termes d’expansion.

Treatment duration
e de traitement

Dure

The selected studies did not reveal any reduction in overall
tudes se
Les e
lectionne

es n’ont pas objective
de diffe

rence en
treatment time and number of appointments compared with
duction de la dure
ce qui concerne la re
e totale du traitement et
conventional systems [19–22] (Table IV). le nombre de visites par rapport aux conventionnels [19–22]
(Tableau IV).

Degree of comfort
de confort

Degre

The improvement in patient comfort supposedly provided by
self-ligating brackets has been called into question by this
systematic review. The studies evaluating problems caused by
discomfort and pain during different stages of orthodontic
treatment report that the degree of discomfort is greater with
self-ligating brackets, though with statistically non-significant
differences [23–26] (Table V). Othman et al. [24] explain this
discomfort as being due to the shape of the self-ligating brack-
ets studied (Damon 3MXÒ), which possess sharp angles and
edges (less rounded than on new generations) at the origin of
mucosal lesions.
Concerning pain at the time of insertion or removal of rigid
archwires, the difference is statistically significant. The self-
L’ame
lioration du degre
de confort pre
sume
e par les brackets
autoligaturants a e
te

remise en question dans cette revue
syste
matique. Ainsi, les e
tudes e
valuant l’inconfort en rapport
avec les ge ^nes et les douleurs lie
es aux diffe
rentes phases du
traitement orthodontique ont rapporte
que le degre
d’inconfort
est plus important avec l’utilisation des brackets autoligatu-
rants avec une diffe
rence statistiquement non significative
[23–26] (Tableau V). En effet, Othman et al. [24] ont explique

cet inconfort par la forme des brackets autoligaturants e
tudie

s
(Damon 3MXÒ) caracte
rise

s par des angles et des bords aigus
(moins arrondis que les nouvelles ge
ne

rations) et qui seraient
à l’origine de blessures muqueuses.
Pour ce qui concerne des douleurs accompagnant l’insertion
et la de
sinsertion des arcs rigides, la diffe
rence est

International Orthodontics 2017 ; X : 1-15 13

ORTHO 252 1-15

Hasnaa Dehbi et al.

ligating brackets used in the study (Smart-ClipÒ) necessitate a
specific procedure with special pliers to insert and remove
archwires using the bracket as a support, which leads to
discomfort for patients [25,27].
statistiquement significative. En effet, les brackets autoligatu-
rants concerne
s dans l’e
tude (Smart-ClipÒ) ne
cessitent un
proce
de

particulier à l’aide d’une pince spe
ciale pour inse

rer
et de
sinse
rer les arcs en s’appuyant sur le bracket, ce qui
serait à l’origine d’inconfort pour les patients [25,27].

Conclusion Conclusion

In the light of the studies included in this systematic review it À la lumie re des e
tudes se
lectionne
es dans cette revue
can be concluded that self-ligating brackets do not offer any syste
matique, on peut conclure que les boı̂tiers autoligaturants
special advantages over conventional types in terms of thera- n’offrent pas d’avantages particuliers par rapport aux conven-
peutic efficacy and efficiency. However, it is difficult to make tionnels en termes d’efficacite
et d’efficience the
rapeutiques.
a final judgment. Each of the two systems can continue to Toutefois, il est difficile de porter un jugement de
finitif. Chacun
attract supporters. des deux syste mes peut encore garder ses adeptes.
Other controlled clinical trials, with protocols better adapted D’autres e
tudes cliniques contro ^ le

es, avec des protocoles
to the chosen clinical criteria, are necessary in order to eval- mieux adapte
s aux crite res cliniques e
tudie

s, sont ne
cessaires
uate objectively the two systems, which continue to evolve pour e
valuer objectivement ces deux syste mes, qui continuent
every day in the light of results provided by such research.
voluer chaque jour à la lumie
à e re de ces travaux de recherche.

Disclosure of interest
claration de liens d’inte

De
re
^ts

The authors declare that they have no competing interest.
clarent ne pas avoir de liens d’inte
Les auteurs de
re
^ ts.

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