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.