A Clinical Trial on the Failure Rates of Metallic and Ceramic Orthodontic Brackets

January 12, 2024 updated by: Andrea Scribante, University of Pavia

A 12-months Evaluation of the Failure Rates of Stainless Steel and Ceramic Brackets in Orthodontic Fixed Therapy: a Clinical Trial.

The aim of this study is to assess if there are significant differences in the failure rate of stainless steel and ceramic brackets. For this study, patients will be enrolled and divided into two groups, according to the type of brackets (stainless steel or ceramic) used for orthodontic treatment. Failure rates will be recorded every month for 12 months and survival analysis will be performed, together with skeletal and space analysis.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This clinical trial aims to investigate if there are differences in the failure rates of stainless steel and ceramic orthodontic brackets. Patients willing to start orthodontic fixed therapy and recruited for the study will be asked to sign the informed consent. Parents will sign the consent for underage patients. After that, patients will be divided into two groups:

  • Group MET: stainless steel brackets will be bonded on the vestibular surfaces of teeth.
  • Group CER: ceramic brackets will be bonded on the vestibular surfaces of teeth. The following sequence of archwires will be adopted for the first six months: 0.012-in Niti, 0.014-in Niti, 0.016-in NiTi, 0.018 SS Australian, 0.020 SS Australian, 0.017X0.025-in NiTi, 0.019X0.025-in SS. The failure rates of the brackets will be recorded each month for 12 months. Each failed bracket will be recorded once. For each patient, pre-treatment lateral cephalometric radiograph and study models will be used to measure ANB angle, Wits, Skeletal Class, dento-alveolar discrepancy and Little Index at the beginning of the treatment. Bond failures will be recorded together with the archwire engaged at the moment of the failure.

Sample size Sample size was calculated with the following assumptions: ability to detect a clinically relevant difference of 4.935% in the failure rates (primary outcome) of the two groups with an alfa = 0.05 and power = 80%. The assumptions were based on findings of a previous study with an expected value of 12.08% for the first group at the end of 12 months of therapy. Therefore, 800 brackets (40 patients) per group were required for the study.

Statistical analysis Statistical analysis will be conducted with R software (R version 3.1.3, R Development Core Team, R Foundation for Statistical Computing, Wien, Austria). Fisher exact test will be performed to evaluate the differences between the failure rates of the two groups, between anterior and posterior sites and between upper and lower arches. Kaplan-Meier survival analysis of the bond failures will be performed among the 12 months of the study. Linear regressions will be calculated to assess the effects on bond failure of the skeletal and dental variables collected before the bonding procedure. Significance for all statistical tests will be predetermined at P<0.05.

Study Type

Interventional

Enrollment (Actual)

80

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Italy
    • Lombardy
      • Pavia, Lombardy, Italy, 27100
        • Unit of Orthodontics and Pediatric Dentistry - Section of Dentistry - Department of Clinical, Surgical, Diagnostic and Pediatrics - University of Pavia

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • patients willing to begin fixed multibracket therapy with metallic or ceramic brackets;
  • full permanent dentition;
  • enamel integrity, absence of traumatic or carious lesions, no pretreatment procedure performed with chemical agents;
  • no previous orthodontic treatment with fixed vestibular appliances.

Exclusion Criteria:

  • patients suffering from systemic diseases;
  • patients taking medications that could alter periodontal conditions (NSAIDS, steroids, etc.);
  • patients with low compliance;
  • patients unable to give informed consent;
  • presence of congenital enamel defects;
  • extractions for orthodontic reasons;
  • oral/orthognathic surgery.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Groups MET
Patients from this group will undergo orthodontic fixed treatment with stainless steel brackets.
Other: Fixed orthodontic treatment with stainless steel brackets
Orthophosphoric acid 37% acid (Gerhò Etchant gel 37%, Gerhò spa, Terlano, Italy) will be applied for 30 s for the etching of the vestibular surfaces of teeth. The, after rinsing and drying, a thin layer of Transbond XT Light Cure Adhesive Primer (3M Unitek, Monrovia, CA, USA) will be applied and then cured for 10 s with a LED unit. At last, Transbond XT Light Cure Adhesive Paste (3M Unitek) will be applied on the base of stainless steel brackets (Queen Series Low Profile Brackets MBT 0.022", Aestetika, Terni, TR, Italy); brackets will be applied on the vestibular surfaces of teeth with a light pressure and the extra paste will be removed. Curing will be performed with the LED unit at 2 mm distant from the enamel-bracket interface for 40 s, 10 s per each surface (mesial, distal, gingival and occlusal). The following sequence of archwires will be adopted for the first six months: 0.012-in Niti, 0.014-in Niti, 0.016-in NiTi, 0.018 SS, 0.020 SS, 0.017X0.025-in NiTi, 0.019X0.025-in SS.
Active Comparator: Group CER
Patients from this group will undergo orthodontic fixed treatment with ceramic brackets.
Other: Fixed orthodontic treatment with ceramic brackets
Orthophosphoric acid 37% acid (Gerhò Etchant gel 37%, Gerhò spa, Terlano, Italy) will be applied for 30 s for the etching of the vestibular surfaces of teeth. The, after rinsing and drying, a thin layer of Transbond XT Light Cure Adhesive Primer (3M Unitek, Monrovia, CA, USA) will be applied and then cured for 10 s with a LED unit. At last, Transbond XT Light Cure Adhesive Paste (3M Unitek) will be applied on the base of ceramic brackets; brackets (Super Clear Series Brackets MBT 0.022", Aestetika, Terni, TR, Italy) will be applied on the vestibular surfaces of teeth with a light pressure and the extra paste is removed. Curing will be performed with the LED unit at 2 mm distant from the enamel-bracket interface for 40 s, 10 s per each surface (mesial, distal, gingival and occlusal). Then, the following sequence of archwires will be adopted for the first six months: 0.012-in Niti, 0.014-in Niti, 0.016-in NiTi, 0.018 SS, 0.020 SS, 0.017X0.025-in NiTi, 0.019X0.025-in SS

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Failure rates of metallic and ceramic brackets.
Time Frame: Among the 12 months of the study.
Each month, failed brackets will be recorded. Per each tooth, failure will be recorded once.
Among the 12 months of the study.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Failure rates of metallic and ceramic brackets per sites and sides.
Time Frame: Among the 12 months of the study.
Failures will be divided in "anterior" for brackets failed on incisors and canines, and "posterior" for premolar brackets. Failure will be recorded per dental arch ("upper" and "lower") and per archwire (.014-in NiTi, .016-in NiTi, .017X0.25-in NiTi, .019X.025-in SS). Per each tooth, failure will be recorded once.
Among the 12 months of the study.
ANB angle
Time Frame: Before the beginning of the orthodontic treatment.
ANB angle will be calculated using the pre-treatment lateral cephalometric radiograph.
Before the beginning of the orthodontic treatment.
Wits Index
Time Frame: Before the beginning of the orthodontic treatment.
Wits Index will be calculated using the pre-treatment lateral cephalometric radiograph.
Before the beginning of the orthodontic treatment.
Skeletal Class
Time Frame: Before the beginning of the orthodontic treatment.
Skeletal Class will be assessed using ANB angle and Wits Index will be calculated using the pre-treatment lateral cephalometric radiograph.
Before the beginning of the orthodontic treatment.
Dento-alveolar discrepancy
Time Frame: Before the beginning of the orthodontic treatment.
Dento-alveolar discrepancy will be calculated using the pre-treatment study models.
Before the beginning of the orthodontic treatment.
Little Index
Time Frame: Before the beginning of the orthodontic treatment.
Little Index will be calculated using the pre-treatment study models.
Before the beginning of the orthodontic treatment.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Pavia

Investigators

  • Principal Investigator: Andrea Scribante, DDS, PhD, University of Pavia

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 9, 2021

Primary Completion (Actual)

May 4, 2023

Study Completion (Actual)

May 8, 2023

Study Registration Dates

First Submitted

November 10, 2021

First Submitted That Met QC Criteria

December 3, 2021

First Posted (Actual)

December 9, 2021

Study Record Updates

Last Update Posted (Estimated)

January 17, 2024

Last Update Submitted That Met QC Criteria

January 12, 2024

Last Verified

January 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2021-METCERORTO

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Data will be available upon motivated request to Principal Investigator

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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