What are self-ligating braces, and are there advantages in using them?

self-ligationThe last several decades have seen an increase in popularity (and marketing) of what are called self ligating braces (brackets). Not unique to one manufacturer, self ligating braces include Empower (American Orthodontics), Damon (Ormco), Smart Clip (3M Unitek), and In-Ovation (GAC Dentsply) among many others. Basically, self ligating brackets use a permanently installed, moveable component to hold the archwire in place instead of removable elastics or steel ties.

The manufacturers of these braces have made many claims regarding the advantages of using these braces, including increased comfort during treatment, increased efficiency, shorter treatment times, and improved oral hygiene. When presented with products with such heavily marketed claims (and which are inevitably more expensive for the orthodontist and our patients), I have to examine the evidence carefully when deciding if I want to offer them to my patients here at Meadows Orthodontics. For ethical reasons, I personally try to make as many decisions as possible using an evidence-based approach. This approach certainly applies to how these braces are presented.

A recent article in the American Journal of Orthodontics and Dentofacial Orthopedics addressed the major claims to these brackets. The findings by the American Association of Orthodontists’ Council on Scientific Affairs (COSA) are very useful in determining the merits to these claims. First and foremost, the article reviews the tenants for an evidence-based orthodontics practice, and states, “Adherence to the tenants of evidence-based orthodontic practice requires that, for any orthodontic intervention applied to a patient, 3 factors must be integrated: the relevant scientific evidence, the clinicians expertise, and the patient’s needs and preferences.” (Note that manufacturers claims and marketing are not among these factors!).

Let’s take a look at what COSA determined (the complete article can be found here). “ 9 of the 14 claims regarding self ligation bracket systems have some peer-reviewed data, but the evidence does not indicate clear differences at this time for reduced friction between arch wire and bracket, reduced clinical forces, reduced treatment time, faster alignment, faster space closure, different arch dimensions, better alignment and occlusal (bite) outcomes, less patient pain, and more hygienic. Three of the 14 claims- lateral expansion leading to bone growth, lateral expansion is comparable to expansion using RPE (expander) and conventional brackets, and stability of lateral expansion long term- have no supporting peer-reviewed data currently. Only two of the 14 claims- mandibular incisor inclination, and time in “untying” the braces, were found to have significant differences.

What does this mean for an orthodontic patient of mine? First, most of these self-ligating braces are great products, and I can achieve great results by choosing to use them. But I treat the vast majority of my patients without self ligating braces, due to the fact that 1) the scientific evidence to support the “marketed” advantages of these braces is lacking, 2) I have used these braces extensively, and have found no clinical advantage for my patients (although they did finish equal to traditional braces), and 3) the vast majority of my patients do not prefer these systems, even though they are presented as an option. What it comes down to is two things: 1) Kids and teens love the color ties that are the “ligation”  in traditional braces (and that self ligation braces eliminate), and 2)  these systems are significantly more expensive, and most of my patients prefer not to pay more for a product with no real or perceived  added value. For patients with esthetic concerns, ceramic braces (traditional and self ligating) with clear ties and Invisalign are the treatment of choice for adults and older teens -you don’t need to have bright colors!

I hope this helps clarify questions that you may have had regarding this issue. I will be posting a series of articles that examine a number of orthodontic topics, and how the current scientific evidence shapes my decisions at Meadows Orthodontics.

Dan Rejman, D.D.S., M.S.

Owner, Meadows Orthodontics