Umar Hussain, Alessandra Campobasso, Muhammad Noman, Shamsul Alam, Rida Mujeeb, Sofia Shehzad and Spyridon N. Papageorgiou
What did the authors aim to do in this study?
The primary objective of this systemic review was to compare the periodontal effects of elastomeric and steel ligatures used for orthodontic fixed appliances.
How did the authors evaluate?
In this study, various studies on patients undergoing orthodontic treatment with fixed labial appliances that are ligated either with elastomeric or stainless steel ligatures were included. The primary outcome in these studies were Pocket Probing Depth (PPD), while secondary outcomes included Plaque Index (PI), Gingival Bleeding Index (GBI) or Gingival Index (GI), total bacterial count, and Streptococcus mutans counts. Apart from these, comparative clinical studies (both randomized and nonrandomized) on humans were also included.
Two authors independently conducted a search of seven databases (MEDLINE via PubMed, Scopus, Web of Science, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Virtual Health Library), using appropriate search terms, without any restrictions for publication year, language, or type.
What did the authors find?
A total of 11 studies with 354 patients were included in this study. No statistically significant differences were seen for plaque index, gingival index, probing pocket depth, or Streptococcus mutans counts. Elastomeric ligatures were associated with moderately increased total bacterial load. Confidence in these estimates was low in all instances due to the inclusion of non-randomized studies with high risk of bias.
What did the authors conclude?
Existing low quality evidence indicates that ligature method does not seem to influence the periodontal health during fixed treatment.
In comparison with the two, the elastomeric ligatures are associated with a moderate increase of bacterial load.
What do we think about it?
In any orthodontic treatment, the method of ligation plays a very important role in how efficient the treatment outcome is going to be. In clinical practice, the choice of ligatures is based on patient preference, esthetic demands, logistic reasons related to appliance interval, or differential clinical performance due to the material's own characteristics. The most commonly used type of ligatures include the stainless steel & the elastomeric ligatures. Although any component of the fixed appliance therapy is associated with increased bacterial accumulation, which may alter the oral ecosystem towards pathogenic colonization, and increase the risk of caries, periodontal inflammation, and enamel demineralization, the elastomeric modules are considered to provide a greater bacterial retention & have a negative effect on oral hygiene. Although this study culminates the effect of each ligature type on the periodontal health, it has few limitations such as, the inclusion of non randomized studies, inclusion of studies which have very limited sizes. Inspite of these, the study gives a clear view on the effect, different ligatures have on the periodontal health.
Hussain, U., Campobasso, A., Noman, M. et al. Influence of elastomeric and steel ligatures on periodontal health during fixed appliance orthodontic treatment: a systematic review and meta-analysis. Prog Orthod. 25, 24 (2024).
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