Australian Dental Journal 2009; 54: 9–11

REVIEW
doi: 10.1111/j.1834-7819.2008.01081.x

Self-ligating brackets in orthodontics: do they deliver what

they claim?
PG Miles*
*Private Orthodontic Practice, Caloundra, Queensland.

ABSTRACT
Self-ligating brackets have enjoyed recent popularity in the orthodontic marketplace with various claims made including
faster ligation, lower friction, faster treatment, less pain, waking up the tongue, and fewer appointments. Although various
designs of self-ligating brackets have been available for many years they have only recently surged in popularity on the back
of these claims but what evidence is there to support these claims? This review article examines the current available
evidence regarding treatment duration, influence on archform, and the speed of tying and untying self-ligating brackets
compared with conventional brackets and methods of ligation.
Key words: Self-ligating, orthodontics.
(Accepted for publication 29 May 2008.)

than conventional brackets tied with modules.4–6

INTRODUCTION
Damon described the clinical use of his Damon brackets
Self-ligating (SL) brackets are becoming more common and proposed that this low friction is a major factor in
in the orthodontic marketplace with many manufac- enabling more efficient treatment.7 However, the
turers offering one form or another. Some SL brackets assumption has been made that along with low friction
are promoted on the premise that elimination of in vitro, comes more rapid alignment and a reduction in
ligatures reduces friction and allows for better sliding treatment time in the clinical setting. One of the first
mechanics. If true, SL brackets could reduce the clinical studies on treatment efficiency found a mean
treatment time.1 Self-ligating brackets are not new with reduction of four months in treatment time and four
the ‘Russell Lock’ edgewise attachment being described visits during active treatment.3 Another clinical study in
in 1935.2 More recently, other designs have appeared three practices found an average reduction in treatment
including the Speed bracket in 1980, the Time bracket time of six months and seven visits for Damon SL cases
in 1994, the Damon SL bracket in 1996, the TwinLock compared to conventional ligation.1 These reports
bracket in 1998, and the Damon 2 and In-Ovation support a view of clinically significant improvements
brackets in 2000.3 The popularity and marketing of in treatment efficiency with SL brackets. However,
some of the self-ligating brackets has led other compa- these studies are not clear as to what techniques were
nies to introduce similar systems in an effort to be up used or which variables were controlled. Retrospective
with the current trends. In 2008, all major orthodontic studies such as these are potentially biased as there
companies now offer some form of self-ligating appli- are many uncontrolled factors which may affect the
ance. Claims by manufacturers in their advertising outcome. These include greater experience, differing
literature range from faster ligation, lower friction, archwires, altered wire sequences, changes in treat-
faster treatment, less pain, and fewer appointments but ment mechanics, and modified appointment intervals.
what evidence exists to support these claims? Observer bias may inadvertently affect the outcome as
the practitioner may unknowingly be doing ‘‘a bit
more’’ due to enthusiasm with the new product. These
Is orthodontic treatment faster with self-ligating
other variables may have played a major role in
brackets?
reducing treatment duration. For these reasons, a
Several papers have reported that in the laboratory prospective study with randomized or consecutive
setting self-ligating brackets demonstrate lower friction assignment is preferred.
ª 2009 Australian Dental Association 9
PG Miles

The first published prospective clinical trial com- torque control and demonstrated that the molars tipped
pared a Smart-Clip self-ligating bracket with a buccally 4. This supports the possibility that molar
conventional bracket in the mandibular arch and expansion observed with SL brackets is related to
examined the initial reduction in crowding over the rolling or tipping of the molars rather than bodily
first 20 weeks of treatment.8 This study used identical movement. This expansion in the order of 1–2 mm
wire sequences and found no difference between the is negligible and could be a spontaneous effect of
two bracket types. In a similar study comparing the treatment. Such small changes in molar expansion only
Damon 2 bracket and conventional brackets, again result in an additional 0.3 to 0.6 mm in arch perimeter
no difference was found in the clinical ability to align which is clinically insignificant.15
the teeth.9 Another prospective trial comparing
Damon and conventional brackets found no signifi-
Are self-ligating brackets faster to tie and untie?
cant difference in severely crowded cases but a small
difference in favour of the Damon bracket in the Self-ligating brackets were initially introduced to
moderately crowded cases.10 However, this study reduce the time of ligation, particularly at a time when
used different wire sequences for each bracket type elastic modules did not exist and only steel ligatures
and the thicker rectangular wires used in the Damon were available. In one study comparing four types of SL
cases could explain the more rapid alignment brackets with steel ligatures and elastic modules, SL
achieved than the round wires used in the conven- brackets saved 10–12 minutes per patient compared
tional brackets. with tying steel ligatures and 2–3 minutes compared
Other prospective evidence is starting to emerge such with modules, the Speed bracket being the fastest.16
as a recent abstract presented at the International Another study of treatment efficiency found an average
Association for Dental Research in 2007 which found time saving from a reduction in archwire place-
no difference in total treatment time between conven- ment ⁄ removal of 24 seconds per arch.3 Other studies
tional edgewise (27.3 ± 6.6 months) and self-ligating have supported the improved speed of archwire changes
(28.0 ± 4.7 months) brackets.11 Another recent paper when using SL brackets.4,17 These modest time savings,
also found no difference in initial alignment between however, represent only a small fraction of the actual
the Damon 3 bracket and a conventional bracket.12 The chair time during an orthodontic treatment visit. It
only published study so far to evaluate the rate of space would therefore be up to the individual practitioner to
closure in extraction cases also found no difference in determine if this is a significant contribution to the
the rate of tooth movement between a self-ligating efficiency of their practice.
bracket and conventional brackets tied with steel
ligatures.13
CONCLUSIONS
The current prospective evidence regarding duration of
Do self-ligating brackets result in wider arches?
treatment indicates that no clinically significant differ-
Claims have been made that self-ligating brackets can ence exists between conventional brackets and self-
‘‘waken the tongue’’ resulting in broader archforms ligating brackets. Self-ligating brackets have similar
than conventional brackets. Research examining the effects on archform to conventional brackets. Self-
effect of self-ligating brackets on archform has found ligating brackets offer modest time savings when tying
that conventional and self ligating brackets resolve and untying compared with conventional brackets but
crowding in a similar manner.10 The lower incisors the time saving varies with the particular design of the
proclined and slight expansion (1.6 mm) of the dental SL bracket used. Currently, the evidence is limited and
arches in the molar region occurred. However, the more prospective clinical trials using identical wire
wires used were not of the same shape for the two sequences and mechanics are required.
bracket systems with the Damon 0.014 · 0.025’’
Copper NiTi wire having a wider archform and being
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10 ª 2009 Australian Dental Association
 Self-ligating brackets

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11. Yorita R, Sameshima GT. Comparison of self-ligating and con- Address for correspondence:
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2007:86. Abstract 1918.
Private Orthodontic Practice
12. Scott P, DiBiase AT, Sherriff M, Cobourne MT. Alignment effi- 10 Mayes Avenue
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Dentofacial Orthop 2008;134:470.e1–470.e8. Email: [email protected]

ª 2009 Australian Dental Association 11