It is perhaps understandable, and even inevitable, that in every clinical discipline, individual clinician bias and florid anecdotal “evidence” periodically combine to create a widespread but flawed understanding of scientific reality. Orthodontic history is littered with such episodes, as is extravagantly and abundantly illustrated by our current tendency to enthusiastically accept certain unsupported claims about the relative merits of recent incarnations of self-ligating brackets (as contrasted with their traditional counterparts). For this reason, our specialty owes a debt of gratitude to the 10 authors who responded to those claims and prepared the “Readers’ forum” article in the August 2010 issue of the AJO-DO (Marshall SD, Currier GF, Hatch NE, Huang GJ, Nah HD, Owens SE, Shroff B, Southard TE, Suri L, Turpin DL. Ask us. Self-ligating bracket claims. Am J Orthod Dentofacial Orthop 2010;138:128-31).
Although now retired, I was an avid advocate for self-ligating brackets throughout my long career, adopting their use for the first time in the early 1970s with the advent of Ormco’s Edgelock system. In those days, adherents to the new design generally claimed only 3 chief advantages: reduced chair-time because of speedier ligation, the assurance of full seating and engagement of the archwires in bracket slots (the doors would either close or they wouldn’t), and the likelihood of enhanced patient comfort due to the rounded design of the bracket and the absence of scratchy ligature “pigtails.”
Practitioners of that era, like their predecessors, were acutely aware of potential problems relating to binding and friction at the archwire/bracket-slot interface, but few if any claims were made then that self-ligating brackets provided much relief from those problems. This was undoubtedly a result, at least in part, of the infinitely more limited metallurgic options then available to us in archwire formulations. More importantly, however, we understood that orthodontic pioneers of prior generations had long previously learned to overcome binding issues during the leveling stage of treatment and did so by a method far more elegant and efficient than any solution that has evolved since, even to this day: multi-looped archwires. Admittedly, this was during an era when highly developed wire-bending skills by orthodontic practitioners were taken for granted. What wouldn’t have occurred to any of us back then, or subsequently, for that matter, is any notion that the advent of these bracket designs would somehow alter the fundamentals of diagnosis. The “Readers’ forum” article touched on this issue by referencing counterintuitive claims of stable arch expansion as a direct byproduct of new bracket design concepts. Such claims, reflected in both a variety of “scientific” lecture presentations and concomitant advertising assertions by manufacturers that fewer dental extractions are thereby now required, would surely have been greeted with considerable skepticism back then.
By subjecting the entire range of claims of the so-called benefits of current self-ligating systems to the cold light of objective analysis, these authors have done our specialty a great service that will, I hope, limit such claims in the future to those that are intellectually and scientifically sustainable.