{"title":"被动自结扎、主动自结扎和传统支架中时间分层的微生物定植：一项系统综述和荟萃分析。","authors":"Gowri Sankar Singaraju, Shibitha Balakrishnan, Harneet Kaur, Prasad Mandava","doi":"10.1016/j.ejwf.2025.07.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Fixed orthodontic appliances can increase microbial colonization and periodontal inflammation. Bracket design-particularly the presence or absence of elastomeric ligatures-may influence this risk.</p><p><strong>Objectives: </strong>To compare microbial and periodontal outcomes among passive self-ligating brackets, active self-ligating brackets, and conventional brackets during orthodontic treatment.</p><p><strong>Materials and methods: </strong>A systematic search of PubMed, Scopus, Google Scholar, Cochrane Library, and ScienceDirect was conducted up to 24<sup>th</sup> August 2024 following a predefined PICOS strategy. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools. Meta-analyses were performed for time-stratified microbial counts (Streptococcus mutans, Lactobacillus) and periodontal parameters (plaque index [PI], gingival index [GI], probing pocket depth [PPD]) using RevMan 5.0. Evidence quality was assessed via GRADE and Swedish Agency for Health Technology Assessment (SBU) criteria.</p><p><strong>Results: </strong>Fifteen studies contributed data to the systematic review, of which six were included in the meta-analysis (751 patients, 1227 brackets) across different microbial and periodontal parameters. Passive Metal Self-Ligating Brackets (PMSLB) demonstrated modest but consistent microbial benefits over Conventional Metal Brackets (CMB), especially at 0-3 months (MD = -0.50; 95% CI: -1.04 to -0.04; low-certainty). Reductions in Lactobacillus and other microbes were observed but not statistically significant (moderate certainty). Active Metal Self-Ligating Brackets (AMSLB) showed intermediate outcomes (low certainty). Periodontal improvements were noted in select studies but lacked consistency and had high heterogeneity (very low certainty).</p><p><strong>Conclusion: </strong>PMSLB offer modest microbial advantages over CMB in early treatment phases. AMSLB performed better than CMB but were less consistent than PMSLB. Due to limited evidence, further well-designed RCTs are required.</p>","PeriodicalId":43456,"journal":{"name":"Journal of the World Federation of Orthodontists","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Time-stratified microbial colonization in passive self-ligating, active self-ligating, and conventional brackets: A systematic review and meta-analysis.\",\"authors\":\"Gowri Sankar Singaraju, Shibitha Balakrishnan, Harneet Kaur, Prasad Mandava\",\"doi\":\"10.1016/j.ejwf.2025.07.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Fixed orthodontic appliances can increase microbial colonization and periodontal inflammation. Bracket design-particularly the presence or absence of elastomeric ligatures-may influence this risk.</p><p><strong>Objectives: </strong>To compare microbial and periodontal outcomes among passive self-ligating brackets, active self-ligating brackets, and conventional brackets during orthodontic treatment.</p><p><strong>Materials and methods: </strong>A systematic search of PubMed, Scopus, Google Scholar, Cochrane Library, and ScienceDirect was conducted up to 24<sup>th</sup> August 2024 following a predefined PICOS strategy. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools. Meta-analyses were performed for time-stratified microbial counts (Streptococcus mutans, Lactobacillus) and periodontal parameters (plaque index [PI], gingival index [GI], probing pocket depth [PPD]) using RevMan 5.0. Evidence quality was assessed via GRADE and Swedish Agency for Health Technology Assessment (SBU) criteria.</p><p><strong>Results: </strong>Fifteen studies contributed data to the systematic review, of which six were included in the meta-analysis (751 patients, 1227 brackets) across different microbial and periodontal parameters. Passive Metal Self-Ligating Brackets (PMSLB) demonstrated modest but consistent microbial benefits over Conventional Metal Brackets (CMB), especially at 0-3 months (MD = -0.50; 95% CI: -1.04 to -0.04; low-certainty). Reductions in Lactobacillus and other microbes were observed but not statistically significant (moderate certainty). Active Metal Self-Ligating Brackets (AMSLB) showed intermediate outcomes (low certainty). Periodontal improvements were noted in select studies but lacked consistency and had high heterogeneity (very low certainty).</p><p><strong>Conclusion: </strong>PMSLB offer modest microbial advantages over CMB in early treatment phases. AMSLB performed better than CMB but were less consistent than PMSLB. Due to limited evidence, further well-designed RCTs are required.</p>\",\"PeriodicalId\":43456,\"journal\":{\"name\":\"Journal of the World Federation of Orthodontists\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the World Federation of Orthodontists\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ejwf.2025.07.003\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the World Federation of Orthodontists","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.ejwf.2025.07.003","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
Time-stratified microbial colonization in passive self-ligating, active self-ligating, and conventional brackets: A systematic review and meta-analysis.
Background: Fixed orthodontic appliances can increase microbial colonization and periodontal inflammation. Bracket design-particularly the presence or absence of elastomeric ligatures-may influence this risk.
Objectives: To compare microbial and periodontal outcomes among passive self-ligating brackets, active self-ligating brackets, and conventional brackets during orthodontic treatment.
Materials and methods: A systematic search of PubMed, Scopus, Google Scholar, Cochrane Library, and ScienceDirect was conducted up to 24th August 2024 following a predefined PICOS strategy. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools. Meta-analyses were performed for time-stratified microbial counts (Streptococcus mutans, Lactobacillus) and periodontal parameters (plaque index [PI], gingival index [GI], probing pocket depth [PPD]) using RevMan 5.0. Evidence quality was assessed via GRADE and Swedish Agency for Health Technology Assessment (SBU) criteria.
Results: Fifteen studies contributed data to the systematic review, of which six were included in the meta-analysis (751 patients, 1227 brackets) across different microbial and periodontal parameters. Passive Metal Self-Ligating Brackets (PMSLB) demonstrated modest but consistent microbial benefits over Conventional Metal Brackets (CMB), especially at 0-3 months (MD = -0.50; 95% CI: -1.04 to -0.04; low-certainty). Reductions in Lactobacillus and other microbes were observed but not statistically significant (moderate certainty). Active Metal Self-Ligating Brackets (AMSLB) showed intermediate outcomes (low certainty). Periodontal improvements were noted in select studies but lacked consistency and had high heterogeneity (very low certainty).
Conclusion: PMSLB offer modest microbial advantages over CMB in early treatment phases. AMSLB performed better than CMB but were less consistent than PMSLB. Due to limited evidence, further well-designed RCTs are required.
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