Treatment Efficiency with Self-Ligating Brackets: The Clinical Evidence Nikolaos Pandis and Peter G. Miles Self-ligating brackets have seen a great reemergence mainly as a result of the introduction of purportedly more efficient appliances as well as the marketing efforts of orthodontic companies to promote innovative products and differentiate themselves in the marketplace. The Speed bracket (Strite Industries, Ltd, Cambridge, Ontario), introduced in the early 1980s, was the first viable product, whereas now almost all major orthodontic companies offer a self-ligating bracket to their customers. Several capabilities/advan- tages over conventional brackets have been attributed to the self-ligating appliances without the accompanied evidence to support the claims. In this article, we will cover the available evidence in the orthodontic literature that deals with the clinical efficiency of the self-ligating brackets. (Semin Orthod 2010;16:258-265.) © 2010 Elsevier Inc. All rights reserved. H arradine 1 reported that the first self-ligat- ing bracket was described by Stolzenberg in 1935, and although several designs were in- troduced in the following decades, the first self- ligating bracket to become commonly used was the SPEED appliance in the early 1980s (Strite Industries, Ltd, Cambridge, Ontario, Canada). 2 During the decade that followed, other orth- odontic companies introduced self-ligating ap- pliances and today, all major orthodontic com- panies include a self-ligating appliance in their product catalog. The popularity of the Damon (Ormco, Glendora, CA) and the In-Ovation-R (GAC, Bohemia, NY) brackets, has been a pos- sible factor in many manufacturers introducing similar systems in an effort to be up to date with current trends. True or perceived product dif- ferentiation is a key marketing parameter for product success in a competitive environment, and companies have strong incentives to intro- duce appliances that differentiate them in the marketplace. In this article, we will review the available evidence as it relates the treatment efficiency of the self-ligating appliances. The main industry claims in favor of self- ligating brackets and in relation to treatment efficiency are the following: ● self-ligating brackets reduce appointment du- ration; and ● self-ligating brackets reduce treatment time. Questions that should be posed are: how do the aforementioned claims measure up with the sci- entific evidence? Do self-ligating brackets deliver what they promise for the patient and the clini- cian? Do they really outperform conventional brackets? Interpretation of Trial Results Before proceeding with answering the individual questions, a few comments on the quality of evidence is in order. The quality of scientific evidence ranges from case reports and opinions at the lower level to randomized controlled trials (RCTs) at the highest level with all other de- signs, such as retrospective and nonrandomized prospective studies falling in between. RCTs are considered the gold standard for clinical trial designs because they possess characteristics, such as randomization, allocation concealment, Private Practice, Corfu, Greece; Department of Orthodontics, University of Queensland Dental School, Queensland, Australia. Address correspondence to Nikolaos Pandis DDS, 29 P. Zafiro- poulou Street, Corfu 49100, Greece. E-mail: npandis@yahoo.com © 2010 Elsevier Inc. All rights reserved. 1073-8746/10/1604-0$30.00/0 doi:10.1053/j.sodo.2010.06.004 258 Seminars in Orthodontics, Vol 16, No 4 (December), 2010: pp 258-265