Direct vs. Indirect Bonding of Orthodontic Brackets: A Practice-Based Study

Direct and indirect bonding of orthodontic brackets has been compared primarily in the laboratory or in university clinics with a small number of cases. OBJECTIVES: We compared the clinical efficiency and bond failure prevalence of direct vs. indirect bonding in a convenience sample of 11 local private orthodontic practices. METHODS: Five offices studied direct-bonded patients, and six offices studied indirect-bonded patients. For clinical efficiency, ten of the offices recorded total treatment time and number of visits for their ten most recently completed, comprehensive patients. For failure rates, all 11 offices observed all comprehensive patients presenting in ten consecutive practice days. For each of these patients, intact and failed bonds were recorded by tooth location. RESULTS: In the retrospective study of clinical efficiency in 100 patients, there was no statistically significant difference: the 50 direct-bonded patients required a mean (+/- sd) of 750 (220) days and 22.0 (8) visits whereas indirect bonded patients took 745 (256) days(P=0.261) and 22.2 visits (P=0.878). The cross-sectional study of bond failure prevalence included 1,368 patients and 29,963 brackets. The per-patient debond prevalence was 1.44% (s.e.m. 0.14%) for direct bonding and 1.61% (s.e.m. 0.19%) for indirect bonding (P=0.777). CONCLUSION: Direct and indirect bonding in the sampled private orthodontic practices did not differ in clinical efficiency or in bond failure prevalence.