Advancements In Customized Orthodontic Brackets Using Cad/Cam Technology

Abstract

Introduction: Customized fixed appliances designed with CAD/CAM aim to individualize bracket prescription, base morphology, and transfer jigs to improve placement accuracy and treatment efficiency compared with conventional stock brackets. Evidence from recent clinical studies and systematic reviews is growing but heterogeneous.

Materials and Methods: We conducted a multicenter, prospective cohort study comparing CAD/CAM-customized brackets (3D-printed ceramic or custom-base metal) with conventional preadjusted appliances in adolescents and adults requiring comprehensive treatment. Primary outcomes were bracket placement accuracy (linear/angular error vs digital setup) and chairside efficiency; secondary outcomes included early bond failure, number of repositionings, appointment count, and patient-reported outcomes (PROs).

Results: Among 220 patients (110 per group), customized brackets reduced linear placement error (0.18 ± 0.11 mm vs 0.32 ± 0.17 mm), angular error (2.1° ± 1.4° vs 3.6° ± 2.2°), and repositionings (0.3 ± 0.7 vs 1.2 ± 1.6 per patient). Median treatment time decreased by 3.2 months with fewer visits (−3.8 appointments). Early bond-failure rates were similar (4.9% vs 5.6%). Patients reported higher comfort and satisfaction with customized transfer trays during bonding.

Conclusion: Within the limits of this study, CAD/CAM-customized brackets improve placement accuracy and chairside efficiency and can shorten overall treatment with no increase in early bond failure. Broader RCTs are warranted to confirm magnitude of benefit and identify subgroups that benefit most.