Indirect bonding of Orthodontic brackets: a comparison of positional accuracy between software vs. stone model driven techniques

Background: Many orthodontic clinicians consider indirect bonding of orthodontic brackets as a method of achieving greater accuracy and effectiveness in orthodontic treatment. Currently, few features of our world have escaped the influence of technology. The indirect system of orthodontic bonding offers an example of technology’s power through a computer-driven system that enables customized bracket placement that optimizes esthetics, accuracy, precision and efficiency. The purpose of this study was to compare the positional accuracy and reliability between traditional and computer-generated indirect bonding techniques. Methods: A total of 210 brackets (STEP metal brackets with slot size .022x.028) were placed using a four quadrants, split-mouth randomized controlled trial (RCT) research design. Of the 210 brackets, 105 were placed on indirect stone model set-ups and scanned using an iTero scanner to capture 3D bracket positioning data, while the remaining 105 brackets were positioned using the newly developed software Maestro 3D Ortho Studio. All the brackets were then transferred to the patient’s dentition and scanned using an iTero optical scanner to capture the final 3D bracket positioning on the teeth. The positional accuracy between traditional stone model and software-driven indirect bonding methods was compared by digitally superimposing initial and final bracket positions. Differences in bracket positioning were measured using customized software. Tukey’s HSD was employed to compare measurement data with the pre-determined acceptable ranges of +/- 0.5 mm linearly in the Mesial-Distal, Buccal-Lingual and Occluso-Gindival dimensions. Results: Overall, the measurements showed a smaller mean deviation for the software-driven indirect bonding in the bucco-lingual, mesio-distal, and occluso-gingival dimensions but neither the computer-generated indirect bonding nor the traditional methods possessed a gap of 0.5 mm or greater linearly. Conclusions: Both indirect bonding methods are accurate within the specified acceptable boundaries of +/- 0.5 mm linearly