Self-ligating bracket

One of the most significant differences from conventional dental braces is the absence of elastic ligature (bands or ties). Self-ligating braces typically are smaller and more aesthetic since a metal door is required to hold wires in place. They also tend to stand off the teeth further toward the lips and cheeks. Proponents of self-ligating brackets say that patients with self-ligating brackets have better oral hygiene than patients with conventional brackets. The hygiene is related to the use of Elastic Ligature which serves as another factor for having plaque being retained. A systematic review and a meta-analysis study done by Yang et al. in 2016 [4] stated that self-ligating brackets do not outperform conventional brackets in reliving discomfort or promoting oral health in clinic. Another systematic review published by Do Nascimento et al.[5] stated that there is no evidence for a possible influence of the design of the brackets (conventional or self-ligating) over colony formation and adhesion of Streptococcus mutans.

A systematic review and meta-analysis done in a study by Arnold et al.[6] in 2016 stated that differences in the periodontal status of adolescents undergoing orthodontic treatment with either conventional or self-ligating brackets were detected were non-significant. Therefore, there is no difference between using self-ligating bracket and conventional bracket in patients with periodontal problems.

A systematic review published by Chen et al.[7] in 2010 stated that 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. On the other hand, a study published by Papageorgiou et al. stated that their analysis showed treatment time being longer when self ligated orthodontic brackets are used compared to conventional orthodontic brackets.[8]

A systematic review done by Ehsani et al. in 2009,[9] stated that self-ligating brackets produce lower friction when coupled with small round archwires in the absence of tipping and/or torque in an ideally aligned arch. However, sufficient evidence was not found to claim that with large rectangular wires, in the presence of tipping and/or torque and in arches with considerable malocclusion, self-ligating brackets produce lower friction compared with conventional brackets. Other studies also agree that round wires produce less friction than the rectangular wires. They also stated that most of the evaluated studies agreed that friction of both self-ligated and conventional brackets increased as the archwire size increased. However, a study done by Pizzoni et al.[10] stated that self-ligating brackets had a markedly lower friction than conventional brackets at all angulations.

A study published by Pacheco et al.[12] stated that when tested with rectangular wires, active self-ligating brackets showed significantly higher friction than passive self-ligating brackets, with results statistically similar to conventional brackets using same caliber archwires. These results were agreed upon by another study published in 2010 by Stefanos et al.[13] which stated that Passive self-ligating brackets have lower static and kinetic frictional resistance than do active self-ligating brackets with 0.019 × 0.025-in stainless steel wire.