Self-ligating brackets (SLBs) are not new conceptually, having been pioneered in the 1930s. They have undergone a revival over the past 30 years with a variety of new appliances being developed. A host of advantages over conventional appliance systems have been claimed typically relating to reduced frictional resistance.1–4
The most compelling potential advantages attributed to SLBs are a reduction in overall treatment time5,6 and less associated subjective discomfort.7 Other purported improvements include more efficient chairside manipulation8 and promotion of periodontal health due to poorer biohostability. Preliminary retrospective research has pointed to a definite advantage, with a reduction in overall treatment time of 4 to 7 months and a similar decrease in required appointments.5,6 Consequently, the use of SLBs has increased exponentially; over 42% of American practitioners surveyed reported using at least one system in 2008.9 This figure was just 8.7% in 2002.10 Retrospective research may be confounded by a variety of factors including operator enthusiasm, different appointment intervals and archwire sequences, and multiple operators.
However, prospective research relating to SLBs has emerged in recent years. The purpose of this systematic review is to evaluate the clinically significant effects of SLBs on orthodontic treatment with respect to the quality of scientific evidence and the methodology of those reports. An understanding of clinical evidence on the impact of SLBs on orthodontic treatment would inform the orthodontist’s decisions in relation to their choice of fixed appliance system.