Journal of Contemporary Orthodontics

Official Publication of Indian Orthodontic Society


Geojan, Misra, Joshi, and Vishnupriya: Invisible Orthodontics: Ceramic appliance vs Lingual appliance -A patient perception survey


Introduction

Orthodontic treatment has evolved significantly in recent years with the introduction of invisible orthodontic appliances, which aim to provide effective teeth alignment while minimizing the impact on patients' daily lives. Two popular options are fixed lingual metal brackets and fixed buccal aesthetic/ceramic brackets.1, 2, 3 This study aimed to analyse variations in patients' perceptions of oral health, aesthetic acceptance, pain perception, and comfort levels after undergoing orthodontic treatment with these two types of invisible orthodontic appliances.

Materials and Methods

A comparative survey was conducted to assess patient perceptions after the initial levelling and alignment phase of their orthodontic treatment. The survey was created using Google Forms and was distributed to 25 patients who received ceramic (labially treated) brackets and 25 patients who received lingual (lingually treated) brackets. The survey included questions related to comfort level, pain perception, speech impediments, quality of life, aesthetic perception, oral hygiene maintenance, and difficulties with food consumption. Descriptive statistics was obtained from google form. The chi square test was used to investigate significant difference between groups. The whole set of data was entered into MS Excel prior to statistical analysis (P-value 0.05 was regarded as statistically significant). To better understand the statistically significant difference, all findings are presented in tabular and graphical formats.

Results

Table 1

Statistical data on all the measured parameters in survey (In Percentage)

Parameters

Ceramic Group

Lingual Group

None

Mild

Moderate

High

None

Mild

Moderate

High

Comfort level

8

40

52

16

0

16

68

16

Pain

4

36

44

14

72

20

4

4

Difficulty in speech

o

32

52

16

0

12

44

44

Aesthetics

4

36

44

16

72

20

4

4

Food

4

20

40

36

4

28

52

16

Oral hygiene maintenance

4

24

44

44

4

44

44

8

Quality of life

8

20

60

12

4

24

48

24

Statistical analysis

Graph 1

Impact of treatment modality on problem with comfort level

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/af74f4d0-2678-4ce7-b8d6-f7c8ac0bfd8fimage1.png

Graph 2

Impact of treatment modality on pain perception

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/af74f4d0-2678-4ce7-b8d6-f7c8ac0bfd8fimage2.png

Graph 3

Impact of treatment modality on difficulty in speech

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/af74f4d0-2678-4ce7-b8d6-f7c8ac0bfd8fimage3.png

Graph 4

Impact of treatment modality on aesthetic

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/af74f4d0-2678-4ce7-b8d6-f7c8ac0bfd8fimage4.png

Graph 5

Impact of treatment modality on difficulty in having food

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/af74f4d0-2678-4ce7-b8d6-f7c8ac0bfd8fimage5.png

Graph 6

Impact of treatment modality on oral hygiene maintainance

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/af74f4d0-2678-4ce7-b8d6-f7c8ac0bfd8fimage6.png

Graph 7

Impact of treatment modality on quality of life

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/af74f4d0-2678-4ce7-b8d6-f7c8ac0bfd8fimage7.png

The provided table and graphs presents statistical data on various measured parameters in two groups: the Ceramic Group and the Lingual Group, with percentages across different levels of severity (None, Mild, Moderate, High).

Key Observations

The Lingual Group generally experiences higher levels of pain and difficulty in speech compared to the Ceramic Group.

Discussion

In a comprehensive study comparing the experiences of patients treated with ceramic brackets versus lingual brackets in orthodontic therapy, several key findings emerged7. Notably, patients undergoing treatment with ceramic brackets reported significantly higher levels of comfort and considerably decreased pain perception compared to their counterparts with lingual brackets, as indicated by a p-value of 0.001. This suggests that ceramic brackets may offer a more comfortable and less painful orthodontic experience for patients.

Furthermore, the study revealed that patients with ceramic brackets experienced much less speech impairment and reported a higher quality of life throughout their orthodontic therapy journey. These outcomes underscore the potential advantages of ceramic brackets in terms of speech and overall well-being during treatment.

Aesthetic considerations also played a significant role in the study's findings. Patients with ceramic brackets were found to have considerably higher aesthetic ratings (p=0.001) compared to those with lingual brackets. Notably, a striking 72% of patients with lingual brackets reported no impact on aesthetics, while only 4% of ceramic bracket patients made the same observation. This suggests that ceramic brackets may be a preferred choice for individuals who prioritize the aesthetic aspects of their orthodontic treatment. 4, 5, 6, 7

However, when it came to oral hygiene maintenance, there was no statistically significant difference between ceramic and lingual brackets (p=0.238), indicating that both types of brackets can be equally manageable in terms of maintaining oral hygiene. 8

Lastly, in terms of difficulties with food consumption, the study found no significant disparity between patients with ceramic and lingual brackets (p=0.448). This suggests that neither type of bracket significantly impedes a patient's ability to consume food comfortably. 9, 10, 11, 12, 13

Conclusion

In summary, this study highlights the advantages of ceramic brackets over lingual brackets in terms of comfort, pain perception, speech impediment, quality of life, and aesthetic perception. However, both types of brackets appear to be equally effective in terms of oral hygiene maintenance and food consumption. These findings provide valuable insights for both orthodontic practitioners and patients when considering the choice of bracket type for orthodontic treatment.14, 15, 16, 17

Source of Funding

None.

Conflict of Interest

None.

References

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MD Rosvall HW Fields J Ziuchkovski SF Rosenstiel WM Johnston Attractiveness, acceptability, and value of orthodontic appliancesAm J Orthod Dentofac Orthop200913532767

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K Fujita New orthodontic treatment with lingual bracket and mushroom arch wire applianceAm J Orthod197976665775

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JPT Higgins S Green Cochrane handbook for systematic reviews of interventions version 5.1.02011https://handbook-5-1.cochrane.org/

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A Liberati DG Altman J Tetzlaff C Gotzsche Mulrow PC Ioannidis M Clarke The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaborationJ Clin Epidemiol2009627134

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SN Papageorgiou L Keilig I Hasan C Bourauel Effect of material variation on the biomechanical behaviour of orthodontic fixed appliances: a finite element analysisEur J Orthod20153833007

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SN Papageorgiou E Antonoglou Tsiranidou J Deschner A Jager Choice of effect measure for meta-analyses of dichotomous outcomes influenced the identified heterogeneity and direction of small-study effectsJ Clin Epidemiol201568553441

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SN Papageorgion Meta-analysis for orthodontists: Part I How to choose effect measure and statistical modelJ Orthod201441432736

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H Long U Pyakurel L Liao F Jian J Xue N Ye Comparison of adverse effects between lingual and labial orthodontic treatmentAngle Orthod2013836106673

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S Geron N Shpac S Kandos M Davidovitch AD Vardimon Anchorage loss - a multifactorial responseAngle Orthod20037367307

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L Kula Ye KS Papageorgiou SN Konstantinidis K Papadopoulou C Bourauel Clinical effects of pre-adjusted edgewise orthodontic brackets: a systematic review and meta-analysisWorld J Orthod2006735063

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SN Papageorgiou PK Konstantinidis A Jager C Bourauel A systematic review and meta-analysis of experimental clinical evidence on initial aligning archwires and archwire sequencesOrthod Craniofac Res2014174197215

13 

I Mistakidis H Katib G Vasilakos D Kloukos N Gkantidis Clinical outcomes of lingual orthodontic treatment: a systematic reviewEur J Orthod201538544758

14 

SN Papageorgiou GM Xavier MT Cobourne Basic study design influences the results of orthodontic clinical investigationsJ Clin Epidemiol20156812151222

15 

O Guyatt Gh TP Schunemann A Knottnerus GRADE guidelines: a new series of articles in theJ Clin Epidemiol20116443802

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L Shamseer D Clarke M Moher D Ghersi A Liberati M Petticrew Group Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanationBMJ20153497647

17 

CS Higgins JP Thompson A simple method for converting an odds ratio to effect size for use in meta-analysisStat Med20001922153958



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Article History

Received : 07-10-2023

Accepted : 07-12-2023


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https://doi.org/10.18231/j.jco.2023.051


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