A colagem indireta de braquetes reduz as falhas de adesão durante o tratamento ortodôntico em comparação com a colagem direta? Revisão sistemática e metanálise

Abstract

This systematic review aimed to compare the longevity of adhesion of orthodontic brackets bonded by the indirect technique compared to the direct technique. A systematic search for randomized clinical trials comparing the two bracket bonding techniques for orthodontic treatment was carried out following a search strategy developed from the research question based on the acronym PICO: The indirect bonding of orthodontic brackets on permanent teeth is superior direct bonding with regard to the adhesion of brackets over time? The databases used were Cochrane Library, LILACS, BBO, PubMed, Scopus and Web Of Science. Additional research in the gray literature was carried out through Google Scholar. The Cochrane risk of bias tool was used to assess the quality of the studies and GRADE (Grading of Recommendations Assessment, Development and Evaluation) for the quality of the evidence. Meta-analyzes were performed in studies considered to be at low risk of bias or undefined bias. 3096 articles were identified, of which seven studies were included in the systematic review and meta-analysis. The meta-analysis was carried out with subgroups, defined according to the periods of follow-up (zero to six months and 12 to 15 months). In the period from 0 to 6 months, the two bracket bonding techniques were similar with regard to adhesion failures (RR = 0.59; 95% CI 0.10-3.62; p = 0.00001; I2 = 92%); in the 12-to-15-month period, the direct bonding technique proved to be superior to the indirect technique (RR = 1.44; 95% CI 1.05 - 1.99; p = 0.41; I2 = 0%).

The quality of the evidence was classified as low in the period of 0-6 months of follow- up, and high in the period of 12-15 months. Based on the absence of heterogeneity and the high quality of evidence, it is concluded that the direct bracket bonding technique has a lower failure rate than the indirect technique in the period of 12-15 months.