Effectiveness and efficiency of indirect bonding techniques: An umbrella review with meta-analysis of the pooled findings
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Researchers |
Ziad Mohamad Alhafi, Mohammad Y. Hajeer, Mohammad Khursheed Alam, Safwan Jaber and Samer T. Jaber |
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Published in |
International Orthodontics, volume 23, issue 4, article number 101036, June 2025. |
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Abstract |
Objectives: This umbrella review aimed to critically evaluate the available evidence regarding the accuracy, bond failure rate, working and chairside time, and oral hygiene associated with the indirect bonding of orthodontic brackets. Material and methods: An electronic search was performed using the following databases: Cochrane Library, Scopus®, Web of ScienceTM, EMBASE®, PubMed®, SciELO, and LILACS. The search was for systematic reviews published between January 1968 and January 2025. There were no restrictions on language or date of publication. The process of screening, study selection, data extraction, and methodological quality assessment using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was performed by two independent authors. The most reliable evidence was identified using the Jadad decision algorithm. Data were combined and analyzed using random-effects meta-analysis. Results: Out of 66 studies eligible for assessment, 15 were selected for full-text assessment. Seven systematic reviews were included, five of which contained meta-analyses. According to the AMSTAR-2 tool, the included reviews varied in methodological quality from moderate to critically low, with four receiving the lowest rating, thus limiting the overall certainty of the available evidence. The meta-analysis of the pooled findings showed acceptable transfer accuracy for indirect bonding methods, with no significant difference compared to direct bonding. The bracket bond failure rate was also comparable in both techniques. Indirect bonding technique was associated with shorter chairside time but longer total working time. Finally, there is no reliable evidence in the current literature about oral hygiene and indirect bonding. Conclusions: Based on the available evidence from the systematic reviews, within the limitations of the available evidence, direct and indirect bonding techniques did not significantly differ in bracket placement accuracy, bonding failure rate, and oral hygiene. Indirect bonding may require less chairside time but a longer overall working time than direct bonding. Keywords: Indirect bonding, Bracket positioning, Transfer accuracy, Bond failure, Transfer trays . |
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