The efficacy and effectiveness of customized CAD/CAM brackets in fixed orthodontic treatment: a systematic review and meta-analysis.

BACKGROUND

Recent advancements in computer-aided design and computer-aided manufacturing (CAD/CAM) technology have led to the development of customized brackets for personalized treatment.

OBJECTIVE

Comparing customized CAD/CAM brackets for their efficacy and effectiveness in orthodontic patients using systematic review and meta-analysis of the literature.

SEARCH METHODS

A comprehensive search was conducted in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to June 2024, with no language or date restrictions.

SELECTION CRITERIA

Studies that complied with PICO (population, intervention, comparison, outcome) questions were included, and the Cochrane Risk of Bias 2.0 and Newcastle-Ottawa Scale tools were used to assess the risk of bias in the included studies.

DATA COLLECTION AND ANALYSIS

Using custom piloted forms, relevant data was retrieved from the included studies. Then a random-effects inverse variance meta-analysis was used to pool the results. The primary outcome was the effectiveness of orthodontic treatment measured by the American Board of Orthodontics cast-radiographic examination (ABO-CRE). Secondary outcomes were overall treatment time and mean number of appointments for CAD/CAM and conventional brackets.

RESULTS

Six studies were included in our final review and meta-analysis. Based on the results of meta-analysis, no significant differences between CAD/CAM and conventional brackets for ABO-CRE score (Mean Difference (MD) = -0.49, Confidence Interval (CI)95% = -4.67, 3.68; P = .82) or number of appointments (MD = -1.88, CI95% = -5.91, 2.16; P = .36) could be found. However, significantly shorter overall treatment time for CAD/CAM brackets were reported (MD = -4.07, CI95% = -7.16, -0.99; P = .010).

CONCLUSIONS

The findings of our meta-analysis indicate that both bracket types perform comparably in terms of treatment results and the number of clinical appointments required during treatment. Nevertheless, a distinct advantage of CAD/CAM brackets emerged concerning overall treatment duration. Notably, patients using CAD/CAM brackets experienced an average treatment period reduction of approximately 4 months, a clinically significant result.

REGISTRATION

The protocol for this systematic review was registered at PROSPERO with the ID CRD42024605257.