Transversal maxillary dento-alveolar changes in patients treated with active and passive self-ligating brackets: a randomized clinical trial using CBCT-scans and digital models

Abstract

Objective: To assess transversal tooth movements and buccal bone modeling of maxillary lateral segments achieved with active or passive self-ligating bracket systems in a randomized clinical trial.

Materials and methods: Sixty-four patients, with Class I, II, and mild Class III malocclusions, were randomly assigned to treatment with passive (Damon 3 MX) or active (In-Ovation R) SLBs. Impressions and cone-beam CT-scans were taken before (T0) and after treatment (T1). Displacement of maxillary canines, premolars and molars, and buccal alveolar bone modeling were blindly assessed.

Results: Twenty-one patients in the Damon and 20 in the In-Ovation group completed treatment according to the prescribed protocol. Eight Damon and 10 In-Ovation patients were excluded as the treatment approach had to be changed because of deviation from the recommended initial plan, while three Damon and two In-Ovation patients did not complete the treatment. Transversal expansion of the upper arch was achieved by buccal tipping in all but one patient in each group. No statistical significant difference in inter-premolar bucco-lingual inclination was found between the two groups from T0 to T1. The bone area buccal to the 2nd premolar decreased on average of 20% in the Damon and 14% in the In-Ovation group. Only few patients exhibited widening of the alveolar process.

Conclusion: The anticipated translation and buccal bone modeling using active or passive SLBs could not be confirmed. Because of the large interindividual variation, a patient-specific analysis seems to be mandatory as individual factors like pre-treatment teeth inclination and occlusion influenced the treatment outcome of the individual patients.