Evaluation of the accuracy of digital indirect bonding vs. conventional systems: a randomized clinical trial

Objectives: To compare the accuracy and chair time of self-ligating brackets using direct bonding, traditional indirect bonding (IB), and computer-aided design/computer-aided manufacturing (CAD/CAM) IB techniques after orthodontic leveling and alignment. Materials and Methods: Forty-five patients were randomly assigned to three bonding groups (G1 [n = 15], G2 [n = 15], and G3 [n = 15]). Evaluation after the alignment and leveling phases used two parameters of the objective grading system of the American Board of Orthodontics for root parallelism and posterior marginal ridges, assessed using panoramic radiographies (PR I and PR II), a digital model, and a plaster model. Blinding was only applied for outcome assessment. No serious harm was observed except for gingivitis associated with plaque accumulation. Results: Although G3 showed better numerical results, they were not statistically significant in the radiographic or model evaluations (P > .001). Mean chair time was significantly shorter in G3 (1.1 +/- 11.8 min) vs. G1 (56.7 +/- 7.3 min) and G2 (52.8 +/- 8.3 min; P < .001). Conclusions: The CAD/CAM IB system for self-ligating brackets was as effective as conventional methods, with a shorter chair time.