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Iran J Ortho. In Press(In Press):e90579.
Published online 2019 March 28.
doi: 10.5812/ijo.90579.
Review Article
Possible Advantages of Self-Ligating Brackets: From Claims to
Evidence, a Literature Review
Homa Farhadifard 1, Mohammad Ali Keshvad 2, Aryan Hesamarefi 2and Elahe Soltan Mohammadi 3,*
1Department of Orthodontics, School of Dentistry , Hamedan University of Medical Sciences, Hamedan, Iran
2Department of Orthodontics, Tehran University of Medical Sciences, Tehran, Iran
3Department of Orthodontics, School of Dentistry, Qom University of Medical Sciences, Qom, Iran
*Corresponding author: Assistant Professor, Orthodontic Department, School of Dentistry, of Qom University of Medical Sciences, Saheli St., Qom, Iran. Tel: +98-9123058172,
Email: elahe.mohamadi25@gmail.com
Received 2019 February 12; Accepted 2019 March 06.
Abstract
Self-ligating brackets are ligature-less brackets with the mechanical device built into them to close edgewise slot. It was claimed
that self-ligating brackets (SLBs) have advantages over conventional-ligating brackets brackets (CLBs). The most claimed advanta-
geous feature is reduced friction between the archwire and the bracket and full archwire engagement, resulting in faster alignment
and space closure. Greater arch expansion with less incisor proclination, also faster ligation, reduced number of visits and less pain
is mentioned as the beneficial features of SLBs in different articles. In this review article, we compared SLBs with CBs in aspect of
resistance to sliding, speed of archwire ligation, quality of alignment and amount of pain during treatment base on the most re-
cent articles published in literature. We concluded that although self-ligating brackets are proved to have some advantages over
conventional brackets, but more studies are needed to discard doubts about using them, routinely.
Keywords: Self-Ligating Brackets, Review, Friction, Alignment, Pain, Ligation, Engagement
1. Context
Traditionally wire or elastomeric ligatures are used to
engage the archwire in the bracket slot. These conven-
tional ligation systems have limitations with respect to
ergonomics, efficacy, discoloration, plaque accumulation,
and friction. Self-ligation has been developed to overcome
these deficits. Self-ligating brackets (SLBs) are ligature-less
brackets with the mechanical device built into them to
close edgewise slot (1).
Self-ligation is not a new concept. The first self-
ligating bracket, the Russell attachment, was introduced
by Stoltenberg in the early 1930s and during the past sev-
eral decades, interest in SLBs has been remarked (2). SLBs
are divided into 2 groups according to their mechanisms
of closure: active and passive. Active SLBs like in-ovation,
SPEED, and time, have a spring clip that stores energy to
press against the arch- wire for rotation and torque con-
trol. Passive SLBs usually have a slide that can be closed to
the slot lumen, so they exert no active force on the arch-
wire (Damon and Smart Clip) (3). It was claimed that SLBs
have advantages over conventional brackets (CB). The most
advantageous feature is reduced friction between the arch-
wire and the bracket and full archwire engagement, result-
ing in faster alignment and space closure. Greater arch ex-
pansion with less incisor proclination (4). Also, faster liga-
tion with reduced number of visits and less pain are men-
tioned as the benefits of SLBs (5).
2. Evidence Acquisition
In order to compare different allegations around
these kind of brackets we searched databases including:
PubMed, Google Scholar, Scopus and Medline. Two or-
thodontic experts reviewed articles in English language
only and those published from 2010 to 2018. Our keywords
were: “self-ligate AND orthodontic” - “ligation method AND
orthodontic “-“active self-ligated AND brackets” -“passive
self-ligated AND brackets”. Clinical trials (randomized or
non-randomized), systematic reviews and meta-analysis
on patients with no anomalies like syndrome or lip and
palate cleft and experimental in vitro studies were chosen
3. Results
In this review we compared SLBs with CBs in aspect of
resistance to sliding, speed of archwire ligation, quality
Copyright © 2019, Iranian Journal of Orthodontics. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0
International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the
original work is properly cited.
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Farhadifard H et al.
of alignment (arch expansion and incisor pro-inclination)
and amount of pain during treatment by using newest pa-
pers according to the criteria mentioned earlier.
3.1. Resistance to Sliding
Friction is defined as resistance to motion when one
surface attempts to slide over another, which has contact
with (6). It has been proposed that approximately 50%
of the force applied to slide a tooth through an archwire
is used up to overcome friction (7). There is lots of as-
sertions considering this factor in self ligating and con-
ventional brackets and sometimes contradicting conclu-
sions (8). Ehsani et al. reported that SLBs maintain lower
friction than CBs when engaged with small round arch-
wires in the absence of tipping and/or torque in an ide-
ally aligned arch. Also, they announced that as the arch-
wire size increased, friction of both self-ligated and con-
ventional brackets increased (1). Harradine concluded that
for self-ligation, lower resistance to sliding is one of 3 main
features that are increasingly supported by valid studies
(9). Thapa and Wu reported that major portion of the resis-
tance is because of the ligation forces applied to the arch-
wire and self-ligation decreases the amount of friction due
to binding but only when thin archwires are used along
with it (10). Rinchuse and Miles reported that SLBs showed
good performance in vitro with smaller wires that are used
during early stages of treatment. But when larger wires
are used (like 0.016 ×0.022 and 0.019 ×0.025 nickel- ti-
tanium), no differences were found between SLBs and CBs
(11). Pillai et al. by evaluating frictional resistance gener-
ated by conventional stainless steel, radiance ceramic, self-
ligating and composite brackets concluded that SLB has
the least friction among these four types of brackets (12).
Leite et al. also confirmed this finding in his research in
2014. According to him, SLBs had lesser frictional resis-
tance than steel or elastomeric-tied conventional brackets
(13). Other studies also found the same conclusion (8,14-
18). In an in-vitro study by Vinay K which assessed fric-
tion in different combinations of wire, bracket and lig-
ation method, it was concluded that self-ligating brack-
ets offered least friction followed by conventional stain-
less steel brackets, ceramic with metal insert bracket and
ceramic brackets (19). In spite of these articles, Pliska et
al. found that with the exception of CL monocrystalline
bracket, CBs & SLBs displayed comparable amounts of re-
sistance to sliding regardless of ligation method or bracket
slot material (20).
Saporito et al. compared the effectiveness of space clo-
sure of CBs & SLBs. No significant difference was seen in
the efficiency of space closure between the self-ligating
bracket and conventional bracket tied with stainless steel
ligatures (21).
Karim Soltani et al. compared the resistance to slid-
ing in 4 subgroups of brackets including: metallic and
clear Damon brackets and metallic and clear conventional
brackets in a wet condition resembling oral cavity environ-
ment. Statistically, there was no significant difference ob-
served between either of the subgroups in resistance to
sliding and static frictional forces meaning that neither
the type of bracket materials (clear and metal) nor their
type of ligation made any difference in resistance to slid-
ing and static friction (22).
Muguruma et al. investigated the effects of torque on
frictional properties of SLBs. He founded that in most sit-
uations, increasing the torque produced a significant in-
crease in static friction but most SLB-wire combinations at
all torques produced less friction than that of the conven-
tional bracket. Active-type SLB-wire combinations showed
higher friction than passive-type SLB-wire combinations in
most conditions (23). Huang et al. (24) and Oliver et al. (25)
also confirmed this finding.
3.2. Pain During the Treatment
The belief that treatment with SLBs is less painful may
be because of the lighter archwires that can be used with
equal effectiveness with these brackets; so forces on the
teeth are lower and also the teeth move more readily in
response to the applied forces because of decreased re-
sistance to sliding (25,26). Celar et al. in their meta-
analysis announced that there were no significant differ-
ences in perceived pain between self-ligating and conven-
tional brackets during the first week of treatment (27,28).
Fleming and Johal declared that analysis of the effect of
bracket type on pain experience confirmed that SLBs do
not have a clinically significant stance on pain experience
(29). Othman et al. found the same conclusion in their
randomized clinical trial (30). Zhou et al. found that Pa-
tients with self-ligating brackets were associated with less
pain and discomfort at any intervals compared with con-
ventional brackets but no significant difference of overall
oral health-related quality of life (OHRQoL) scores could be
found between two groups (31).
Bertl et al. in their study declared that engagement
and disengagement of rigid rectangular archwires caused
more pain with Smart Clip self-ligating brackets than con-
ventional ones (32). In a randomized clinical trial by Rah-
man et al. with the aim of comparing pain perception
between self-ligating and conventional preadjusted edge-
wise brackets, it was concluded that patients treated with
self-ligating brackets reported more pain perception but
statistically it was not significant and was higher in day 1
compared to day 3 and 5 after bonding brackets (33) which
is confirmed by the work of Scott et al. who did not report
2Iran J Ortho. In Press(In Press):e90579.
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Farhadifard H et al.
any significant differences in pain perception during ini-
tial alignment between patients who randomly were pre-
scribed by self-ligating and conventional brackets (34). Dis-
cussing active or passive self-ligating brackets Kohli and
his colleagues in 2012 stated that patients with active self-
ligating brackets experienced more pain in the first 2 days
after bonding which was significant (35).
3.3. Quality of Alignment
It is believed that with self-ligation mechanics,
lesser incisor proclination and greater arch expansion
is achieved, and so fewer extractions are required to pro-
vide space to do aligning of teeth (3). Chen et al. stated
that there was no significant difference between the
SLB and CB for intercanine and intermolar widths. For
incisor proclination, their meta-analysis indicated that
self-ligating brackets resulted in slightly lesser incisor
proclination (1.5° leser proclination with SLBs versus CBs)
(3). Prettyman et al. declared that the use of SLB and
CB does not cause differences in incisor proclination and
intercanine expansion (4). Songra et al. concluded that the
time of initial alignment was significantly shorter in the
conventional bracket than for either the active or passive
self-ligating brackets. There was no statistically significant
difference in passive, active, or total space-closure times
among the 3 brackets under investigation (36). Pandis et
al. found that use of conventional or self-ligating brackets
did not seem to be a significant indicator of mandibular
intermolar width in non-extraction patients when the
same wire sequence is used (37). Celikoglu et al. found
that bracket type has little influence on improvement in
anterior ambiguity during initial mandibular alignment
(38). Wahab and his colleagues compared the aligning
efficacy of damon self-ligating brackets and mini-diamond
conventional brackets at each appointment and showed
that in the first month of therapy CLB group lead to sig-
nificantly faster alignment compared with SLB group but
there were no significant differences in the alignment
speed between the second and third month and third and
fourth month. After four month of alignment, CLB group
showed 98 percent of alignment which was significantly
more than 67 percent of SLB group (39).
3.4. Sped of Archwire Ligation
The initial motivation of developing self-ligating
brackets was to speed up the process of archwire ligation.
Several authors have reported that self-ligating brackets
save of up to nine minutes per visit compared with wire
ligation and approximately two minutes compared with
elastomeric ligation (9). In the study of Chen et al. results
showed a mean saving of 20 seconds per arch for opening
the slides of SLB compared with removing the ligatures of
CB, but there was no significant differences between the
time needed for closing the slides of SLBs and replacing
the ligatures of CBs and self-ligation does appear to have a
significant advantage in aspect of chair time (5). Paduano
et al. revealed that SLB had significantly shorter ligation
time compared with elastomeric or stainless steel liga-
tions in both arches. He also claimed that speed of arch
wire ligation in SLB was dependent to self-ligating bracket
type (40).
4. Conclusions
As shown in a recent systematic review by Dehbi and
colleagues which evaluated the tooth alignment, space clo-
sure, treatment duration, arch expansion and patient dis-
comfort in SLB and CB systems, and found no significant
differences (41). Evidence shows that self-ligating brackets
can have little advantages over conventional ones. But as
the results of articles are contradictory, more studies are
needed to survey different aspects of these brackets, more
precisely.
Footnotes
Authors’ Contribution: Study concept and design:
Homa Farhadifard; acquisition of data: Mohammad Ali
Keshvad; drafting of the manuscript: Elahe Soltan Moham-
madi; critical revision of the manuscript for important in-
tellectual content: Aryan Hesamarefi; study supervision:
Elahe Soltan Mohammadi.
Conflicts of Interests: The authors have no conflicts of
interest to disclose.
Funding/Support: No funding support was needed.
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