Comparison of the failure rate, bonding time and ARI score of two orthodontic bonding systems: Self-Ech Primer and Conventional Eching Primer: A systematic review and meta-analysis

Summary Objective This study aimed to evaluate the failure incidence of brackets with at least six months follow-up between self-etch primer and conventional etch/primer, as well as to investigate the clinical duration of the bonding process and the amount of adhesive remnant index (ARI). Methods Electronic search was conducted in databases including PubMed, Scopus, Web of Science, ProQuest, ClinicalTrials.gov, and ICTRP (International Clinical Trials Registry Platform). The electronic search targeted only randomized clinical trials and was limited from January 2000 to June 2021. Delphi list is used to evaluate the risk of bias and Stata Version14.2 software was used. This systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and recorded on the Ethics Committee of Research Institute of Dental Sciences, SBMU (IR.SBMU.DRC.REC.1398.240). Results Out of 2288 extracted studies, 30 of them entered the full-text evaluation process. According to the inclusion criteria, 15 studies entered this systematic review. Containing 607 participants and 10,563 brackets/teeth. All the included studies were of randomized clinical trials (RCT) design with either parallel or split-mouth design. Comparing the two groups, the risk difference effect (RD) = 0.007 CI 95% (−0.004,0.018) indicated a neglectable difference in the risk of bracket failure during treatment between the two groups. The index I2 = 53.9% indicated moderate heterogeneity in the results. Furthermore, the P-value = 0.007 indicated statistical insignificance between the two interventions in terms of failure rate. The clinical duration of bonding time analysis were equal to SMD _Cohen = −2.67 CI95% (−3.49, −1.85), which indicated a statistically significant reduction in clinical process time, using the self-etch primer. Data synthesis for adhesive remnant index could not be conducted due to heterogeneity among included studies. Conclusions There was no difference between the self-etch primer and conventional etch/primer in bracket debonding at a medium level of evidence, However, there was statistically significant reduction in clinical bonding time using self-etch primer.