Periodontal conditions in orthodontic patients using direct and indirect bracket bonding techniques: A randomized study

The aim of this study was comparing two orthodontic bracket bonding techniques (direct and indirect), with regard to the following variables: plaque index; gingival index, evaluation of gingival crevicular fluid, and white spots on tooth enamel. Seventeen patients were randomly selected (10 men and 7 women) with a mean age of 15.8 years, and these were subjected to comprehensive orthodontic treatment (braces), totaling a sample size of 260 teeth examined. The experimental model used was the split-mouth technique, in each patient, the maxillary brackets in one hemi-arch were bonded by the direct, and in the other by the indirect technique, the same occurring in the mandibular arch. Assessments were performed in the following time intervals: pre-bonding, one, three and six months after initial placement of the brackets. The data were subjected to statistical analysis by the Kruskal-Wallys test (Dunn's post-test) to assess the intra-group evolution of the variables. The Wilcoxon test was used for comparison between groups. The brackets bonded to teeth by the direct technique showed a higher number of surfaces with the presence of bacterial plaque and bleeding, when compared with the indirect technique, in time intervals of 3 and 6 months. For measurement of fluid, direct bonding showed increased index in 3-month evaluation. The occurrence of white spots showed no statistical difference between groups. As conclusion, indirect technique shows less oral health impairment with a lower incidence of plaque accumulation, bleeding and fluid.