Self-ligating Bracket Systems Research Articles

Comparison of Initial Stress and Displacement On Vertically Displaced Canines Using Conventional Bracket System and Self-Ligating Bracket System – A Finite Element Study

Aim: This study aimed to assess and compare the initial stress and displacement in vertically displaced canines using finite element analysis. Both conventional and self-ligating bracket systems were evaluated at displacement heights of 2, 4, and 6 mm. Methods: Six finite element models of maxillary dentitions with canines vertically displaced by 2, 4, and 6 mm were developed using specialized software. Continuous archwire techniques were applied in both the conventional system with 0.022" × 0.028" slot MBT brackets (3M Unitek™) and the self-ligating system with 0.022" × 0.028" slot passive self-ligating brackets (DAMON Q by ORMCO), both utilizing a 0.014-inch CuNiTi archwire. The study calculated canine displacement, reactionary effects on adjacent teeth (lateral incisors and first premolars), and compressive and tensile stresses along the X, Y, and Z axes at 12 specific points. Results: The self-ligating bracket system demonstrated greater extrusion of the canine compared to the conventional bracket system, with the most significant movement observed in the 2-mm model, followed by the 4-mm and 6-mm models. Reactionary effects on adjacent teeth included intrusion and tipping away from the canine, most pronounced in the 2-mm model. Compressive and tensile stresses were higher in the conventional bracket system and decreased with increased displacement. Conclusion: For vertically displaced canines, using a continuous archwire with a self-ligating bracket system is more advantageous than a conventional bracket system, as it results in greater canine movement and less stress on adjacent teeth. However, its effectiveness diminishes with increased displacement height due to resistance caused by higher contact angles and decreased wire expression.

Comparative Efficacy of Self-ligating Bracket Systems versus Conventional Bracket Systems in Orthodontic Treatment: A Systematic Review

Abstract This systematic review aimed to compare the efficacy of self-ligating bracket (SLB) systems with conventional bracket systems in orthodontic treatment. A comprehensive search of electronic databases was conducted to identify relevant studies published up to 11. Inclusion criteria encompassed comparative studies evaluating orthodontic treatment outcomes between SLB and conventional bracket systems. Data extraction and quality assessment were performed independently by two reviewers. Key outcome measures included treatment duration, complications, patient-reported outcomes and clinical effectiveness. A total of 11 studies met the inclusion criteria and were included in the systematic review. Findings indicated comparable treatment durations between SLB and conventional bracket systems, with significant differences in complication rates. Patient-reported outcomes suggested more levels of comfort and satisfaction with SLB systems. In addition, clinical effectiveness measures, such as tooth alignment and occlusal outcomes, showed significant discrepancies in favour of SLB systems. However, there was variability amongst studies regarding specific clinical parameters assessed. Based on the findings of this systematic review, SLB systems demonstrate comparable efficacy to conventional bracket systems in orthodontic treatment. While both SLB systems exhibit lesser treatment durations, complication rates and patient-reported outcomes, further research is warranted to elucidate potential differences in specific clinical parameters and long-term treatment outcomes.

Comparative Analysis of Displacements and Stress Produced by Square and Rectangular Bracket Slot With Incremental Torque: A Finite Element Analysis Study.

This study aimed to perform a comparative analysis of stresses and displacements with incremental torque on the maxillary incisors and surrounding cortical bone using conventional metal brackets with rectangular slots and passive self-ligating brackets with square slots using finite element analysis (FEA). An in vitro FEA study was conducted, in which a three-dimensional (3D) model of the maxilla was built using ANSYS softwareversion 18 (ANSYS Inc., Canonsburg, PA). The conventional McLaughlin, Bennet, and Trevisi (MBT) bracket (3M Unitek, Monrovia, CA) of 0.022 × 0.028-inch slot with a 0.019 × 0.025-inch rectangular stainless steel (SS) archwire (model 1) was compared with the Pitts 21™ self-ligating bracket system (OC Orthodontics, McMinnville, OR) of 0.021 x 0.21-inch slot with a 0.020 × 0.020-inch square SS archwire (model 2) at incremental torques of 5°, 10°, 15°, and 20°. The von Mises stress was evaluated at the maxillary incisors and surrounding cortical bone. The torque moment, tipping angle, and displacement of the maxillary incisors were also measured and compared between the bracket systems. The highest torque expression of 13.8 N-mm was observed in model 2, compared to a torque expression of 10.68 N-mm in model 1. The torque expression increased in both models from 0°to 20°. There was a play of 6.2°at 20°torquein model 2, whereas it was 9.32°​​​​​​​play in model 1. The torque expressions were better for the lateral incisors than for the central incisors. Increased incremental torque was associated with increased proclination of the incisors, and this movement was more pronounced for the central incisor and model 1. Furthermore, it was revealed that the stresses on the cortical bone and teeth were higher in model 2 than in model 1. It was concluded that the Pitts 21™ passive self-ligating system produced better torque expression and less play with square SS archwire compared to conventional brackets with rectangular SS archwire.

A Review on Damon Self- Ligating Brackets

Self-ligating bracket systems are accepted more by orthodontists nowadays. This is because of their superior quality, improved reliability and ease of use. However, it might also be related to claims of superior function made by the manufacturers of these appliances. In particular, the Damon appliance system claims to offer significant advantages to both orthodontist and patient over conventional-ligation and other forms of self-ligated appliances. We have reviewed present literature relating to use of the Damon appliance system. There is some evidence to suggest this appliance may lead to reductions in chairside time for the orthodontist, particularly those experienced with this system, in comparison to conventional-ligation. There is no high quality evidence that treatment with the Damon appliance takes place more quickly or gives a superior occlusal or aesthetic result. The best available evidence would suggest there is no difference in treatment outcome or time, at least in extraction cases. There is no evidence that treatment with the Damon appliance is more stable. Claims relating to improved clinical performance of the Damon appliance system are currently being made to orthodontists and patients that are not substantiated in the scientific literature.

Comparison of Pain Levels on Patients Undergoing Fixed Orthodontic Treatment with 2 Different Self-Ligating Bracket Systems.

Comparison of pain levels of patients treated with 2 different passive self-ligating bracket systems right after initial archwire placement. A total of 34 patients with mild crowding were allocated randomly to 2 groups to be treated using 2 different self-ligating brackets. 0.014 inch copper nitinol and 0.014 inch superelastic nitinol archwires were selected as the initial archwire for Damon Q and SmartClip SL3 systems respectively. Seven page questionnaires that consisted of 3 visual analogue scales were handled to patients to mark their pain levels while chewing, biting with anterior teeth, and biting with posterior teeth at 2nd hour, 6th hour, 2nd day, 3rd day, and 7th day time intervals. Pain scores were measured manually using a ruler and noted. The SmartClip group reported less pain at the 2nd and the 6th hours while chewing. Pain levels were the highest at the 6th h and the 2nd day for the Damon Q and SmartClip SL3 groups respectively. The SmartClip group reported more pain for the first two days, and after the 2nd day, pain scores were very similar to the Damon group. No statistically significant differences were reported between the groups. The highest pain sensation was reported for the 2nd day and decreased toward the 7th day. The SmartClip SL3 group reported lower pain scores in the first two days, but the levels were equaled on the 2nd day and after.

Self-Ligating Bracket Systems: A Comprehensive Review.

Currently, ligature-free bracket technologies, including self-ligating brackets (SLBs), are all the rage in orthodontics. Self-ligating mechanisms have been shown to be more effective and less time-consuming inorthodontic treatment than traditional appliances due to their enhanced frictional properties. Crucial to the success of the multi-band/bracket method is the transmission of forces and moments from the bracket to the archwire. Advances in bracket design and ligation techniques are constantly being made to better distribute loads and increase the efficiency of leveling.

Passive Self-Ligating Bracket Systems: A Scoping Review of Their Claims Regarding Efficiency and Effectiveness in Orthodontic Treatment

Passive self-ligating bracket systems (PSLBs), such as the Damon® system (Ormco, US) and SmartClip (3M Unitek®, US) claim advantages over other types of brackets regarding efficiency and effectiveness. However, some studies have questioned their qualities, particularly during the alignment stage, in arch development, and regarding stability of results. This article aims to conduct a scoping review from the past decade’s literature (2013–2023) regarding these assertions about PSLBs. A comprehensive search was performed on several databases. With at least one comparison between PSLBs and the other two bracket types, the inclusion criteria were restricted to English-written randomized controlled trials and split-mouth design studies involving patients receiving orthodontic treatment using PSLB, active self-ligating bracket systems (ASLBs), or conventional/traditional bracket systems (CBs). After screening and manual analysis of the selected studies, only 39 were chosen for the review. Most of the efficiency and effectiveness results from research conducted in the past ten years did not indicate any appreciable differences between the three different types of brackets; therefore, the evidence on whether PSLB is better than CBs and ASLBs is equivocal. Further research is necessary to understand the distinctions between passive self-ligating and other bracket systems and establish the optimal utilization of each system in clinical settings.

Effects of Low-Level Laser Therapy and Bracket Systems on Root Resorption during Orthodontic Treatment: A Randomized Clinical Trial.

This study aimed to assess the outcomes of low-level laser therapy (LLLT) with the conventional bracket (CB) and self-ligating (SL) bracket systems on root resorption (RR) during orthodontic treatment. A total of 32 patients were included in this randomized clinical trial. All the patients were randomly divided into four individual groups (SLL: self-ligating laser, CBL: conventional bracket laser, SLNL: self-ligating non-laser, CBNL: conventional bracket non-laser). RR was measured from the cone-beam computed tomography (CBCT) radiographs which were taken at two stages of the orthodontic treatment: pre-treatment (T1) and after leveling and alignment stage (T2). Wilcoxon rank test for the comparison was conducted to compare the RR at T1 and T2 stages within each group and showed a significant difference (p < 0.05) for various variables. Mann Whitney test compared the RR in laser and non-laser groups irrespective of the bracket systems and exhibited no significant differences except the left lateral incisor. Moreover, CB and SL groups showed no significant difference in RR among any tooth. Kruskal Wallis test was performed to compare the RR among all groups which presented no significant differences. LLLT and bracket systems have no consequences on RR until the leveling and alignment stage of orthodontic treatment.

Influence of Different Orthodontic Brackets on Cytokine and Cortisol Profile

Background and Objectives: Orthodontic tooth movement (OTM) requires bone remodeling resulting from complex processes of aseptic inflammation. Recent studies have confirmed close interaction between the immune and skeletal systems. In addition, various orthodontic appliances including fixed systems affect the sublingual microbial composition, and the likelihood of developing inflammatory reactions of the gums is high, especially early in the treatment period. It is known that these systems have both positive and negative effects on the humoral and cellular immune responses. The main aim of the study was to evaluate the influence of self-ligating and conventional brackets on the salivary concentrations of cytokines (IL-6, osteoprotegerin (OPG), TNF-alpha, and IFN-gamma) and cortisol as a marker of stress. Materials and Methods: Forty patients were analyzed at baseline (T0) and 2 months (T2) after fixing self-ligating (Ormco Damond Q) and conventional brackets (Ormco Mini Diamond). Salivary cytokine and cortisol concentrations were evaluated by commercial ELISA kits. Results: Outcomes of our study showed that after two months of treatment with either of these brackets, IFN-gamma and IL-6 levels did not change. However, TNF-alpha decreased with self-ligating brackets (13.36 to 8.32, p = 0.002). The self-ligating bracket system also affects OPG concentration and cortisol levels 2 months after orthodontic activation. The level of OPG in the group of self-ligating brackets decreased significantly (8.55 to 2.72, p = 0.003). Cortisol concentration was significantly higher in the self-ligation group (25.72 to 48.45, p = 0.001) due to the effect of sustained strength movements. Conclusions: Thus, the use of self-ligating and conventional brackets has a different effect on the concentration of cortisol and cytokines (OPG and TNF-alpha) in saliva 2 months after their fixation. Further longitudinal studies are necessary to explore why OPG levels are decreased in case of self-ligating cases and how OPG levels are related to clinical improvement.

Conventional and self-ligating lingual orthodontic treatment outcomes in Class I nonextraction patients: A comparative study with the American Board of Orthodontics Objective Grading System

This study aimed to assess and compare the duration and outcomes of orthodontic treatment with conventional and self-ligating lingual fixed appliances with the American Board of Orthodontics (ABO) Objective Grading System. Thirty consecutive patients with a complete dentition and Angle Class I malocclusion treated with a conventional lingual bracket system (STb; Ormco, Glendora, Calif) or self-ligating lingual bracket system (GC Experience-L; GC Orthodontics, Breckerfeld, Germany) were included. The occlusal outcome was assessed with the ABO instrument. The treatment duration and ABO scores of the 2 groups were recorded. Statistical analyses were evaluated using independent-sample t tests. The conventional group had a mean treatment time of 2.10 ± 0.69 years, and the self-ligating group had a treatment duration of 1.68 ± 0.48 years (P>0.05). The mean posttreatment ABO scores in the conventional group were 20.23 ± 5.13, and the mean posttreatment ABO scores in the self-ligating group were 21.00 ± 5.66. No difference was found between the groups regarding the criteria of ABO (P>0.05). The highest scores were given in the assessment of buccolingual inclinations in both conventional and self-ligating lingual bracket groups. The design of the lingual appliances used in this study did not influence the treatment duration and the total ABO scores in treating patients with a Class I relationship in this sample. Both types of lingual brackets were especially deficient in correcting buccolingual inclinations. The strengths were their ability to close spaces and correct anterior rotations and overjet regardless of the bracket types.

Effect of Two Self-Ligating Bracket Systems on Mechanical and Biological Evaluation of Tooth Movement (Randomized Clinical Study)

Effect of Two Self-Ligating Bracket Systems on Mechanical and Biological Evaluation of Tooth Movement (Randomized Clinical Study)

Deflection of tandem archwire in a specific self-ligating metal bracket system: an in vitro study.

The aim of this study was to quantify the force exerted by tandem archwires in a specific system of passive self-ligating bracket. Forty-eight thermo-activated nickel-titanium orthodontic archwires were separated into four groups (n = 12): G1 - two .014" + .014" round archwires; G2 - two .014" + .016" round archwires; G3 - .014" x .025" rectangular archwire; and. G4 - .016" x .022" rectangular archwire. Brackets were fixed onto teeth 1.5 to 2.5 using a device that represented the upper teeth, maintaining an interbracket distance of 6.0 mm. The deflection tests were performed using the structure representative of tooth 1.1 as support on the Instron testing machine at a speed of 2.0 mm/min. The archwires were evaluated at deflections of 0.5 mm, 1.0 mm, and 1.5 mm. The data were analyzed by a generalized linear model, considering values at different deflections as repeated measurements in the same experimental unit (α = 0.5%). At 0.5 mm, higher forces were observed in G2 and G3, which did not differ significantly (p > 0.05). The lowest force was observed in G4 (p < 0.05). At 1.0 mm and 1.5 mm, the highest force was observed in G3, followed by G4 and G2 (p < 0.05). The lowest force was observed in G1 (p < 0.05). In general, tandem archwires (same or different calibers) in a specific passive self-ligating bracket exerted lower force when compared with rectangular archwires.

The Evolution of Self-Ligating Brackets in Orthodontics

Orthodontic treatment has significantly evolved with the introduction of self-ligating brackets, revolutionizing the use of fixed appliances. These brackets, first conceptualized in the early 1900s and gaining popularity in the 1970s, have undergone substantial design improvements, enhancing treatment efficiency and patient comfort. Self-ligating brackets, characterized by an internal mechanism like a sliding door or clip, eliminate the need for external ligatures, thus reducing friction and facilitating more precise tooth movement. This design not only improves patient comfort through easier hygiene maintenance but also potentially accelerates treatment progress. Despite these advantages, the clinical significance of self-ligating brackets, particularly in reducing treatment times, remains a subject of debate. Factors such as case complexity and the orthodontist’s skill play a crucial role in determining treatment outcomes. Furthermore, the higher initial cost of these brackets poses economic considerations for both practitioners and patients. Recent advancements have led to a diversity of self-ligating bracket systems, each with unique features focusing on low friction mechanics, torque control, or ease of use. Orthodontists now have the flexibility to choose systems aligning with their treatment philosophies and patient needs. Continuous research is essential to enhance our understanding of their biomechanics, long-term results, and comparative effectiveness. The ongoing development of self-ligating brackets represents a commitment to balancing treatment efficiency, patient comfort, and cost-effectiveness in orthodontic care.

Comparative Evaluation of Two Bracket Systems' Bond Strength: Conventional and Self-Ligating.

Adhesion remains a key element in dentistry, whether approached in prosthetics, odontology, or orthodontics. It is a continuously researched aspect, as improved materials and adhesive methods keep emerging in the market. No orthodontic treatment can be effective without the proper adhesion strength of the bonded elements on the teeth. The objective of this research, in the broad context of self-ligating versus conventional brackets, was to compare active and passive self-ligating systems with a conventional one by conducting an in vitro study on human-extracted premolars. Shear bond strength tests were executed by means of an advanced materials-testing machine that generated maximum load and tensile strength values. The data obtained underwent statistical analysis with a statistical threshold of p < 0.05. The results regarding the statistical significance were acquired when comparing the passive self-ligating system with the active self-ligating and conventional systems (load-at-maximum-load mean 204.9, SD 91.09, and p < 0.05). In this study, the passive self-ligating bracket system appears to present increased shear bond strength.

An Umbrella Review of Systematic Reviews With or Without Meta-Analysis Assessing Treatment Outcomes and Efficiency of Self-Ligating Brackets

Introduction Self-ligating bracket systems are popular and seem to demonstrate lesser friction, allowing tooth movement without exerting unwanted forces on surrounding structures. This umbrella review aimed to compare self-ligating and conventional bracket systems for treatment efficiency. Methods An electronic search in 8 databases was performed for literature published between January 1, 1990, and October 1, 2021, with manual hand-searching of references of retrieved articles. Quality assessment was performed using the risk of bias in a systematic tool by 2 independent reviewers. Data were extracted using a prepiloted form (Joanna Briggs Institute) for evidence synthesis. Corrected covered area was calculated to quantify study overlaps across systematic reviews with or without meta-analysis. Results 605 articles were retrieved, of which 16 were selected. Most included studies had a low risk of bias, except for 6 that showed an unclear risk of bias. Data analysis revealed a reduction in lower incisor proclination, bacterial accumulation, and oral malodor using self-ligating appliances. Conclusions Self-ligating systems reduce mandibular incisor proclination, bacterial accumulation, external apical root resorption, chairside time, and oral malodor. No other differences could be demonstrated in comparison with conventional appliance systems.

A COMPARATIVE EVALUATION OF EXTERNAL APICAL ROOT RESORPTION IN PATIENTS TREATED WITH DAMON BRACKET SYSTEM AND CONVENTIONALMBT BRACKET SYSTEM- A RETROSPECTIVE STUDY

Background: Resorption of the external apical root is a common iatrogenic side effect of orthodontic therapy (EARR). The loss of cementum and dentine is caused by root resorption, which can be a normal or pathologic process. A complicated combination of individual biology and mechanical forces is assumed to be the cause. Aims &amp;Objectives: The purpose of this research was to assess the degree of external apical root resorption (EARR) in patients treated with the Damon self-ligating bracket system to those treated with the conventional MBT bracket system. Methods: For the study, twenty patients were divided into two groups. Ten patients were treated with MBT equipment in Group I. Damon self-ligating appliances were used to treat ten patients in Group 2. The Levander and Malmgren scores were used to assess root resorption on periapical radiographs of the maxillary incisors at the completion of orthodontic therapy. The chi-square test was used to compare root resorption between groups. Results: There was no significant difference in the degree of root resorption between the two groups, according to the findings. Conclusion: Non-extraction therapy with Damon self-ligating or standard preadjusted equipment resulted in similar root resorption, according to the findings.

Clinical effects with customized brackets and CAD/CAM technology: a prospective controlled study

ObjectiveNowadays, CAD/CAM technologies enrich orthodontics in several ways. While they are commonly used for diagnoses and treatment planning, they can also be applied to create individualized bracket systems. The purpose of this prospective quasi-randomized study was to evaluate the clinical efficiency of a customized bracket system and its comparison with directly bonded conventional self-ligating bracket treatment.Materials and methodsAltogether 38 patients were separated into two groups, treated either with direct bonded self-ligating brackets (Damon, Ormco, USA) or with indirect bonded customized CAD/CAM brackets (Insignia™, Ormco, USA). Overall treatment time, number of treatment appointments, number of lost or repositioned brackets, number of arch wires and wire bends, Little Irregularity Index, cephalometric analyses and ABO scores were compared. Superimpositions of the virtual set-ups and the treatment results of the CAD/CAM group were performed to evaluate the clinical realization of the treatment planning.ResultsNo differences between both treatment groups were found concerning overall treatment time, number of appointments and number of archwire bends. Bonding failures occurred more often using the CAD/CAM system. Indirectly bonded brackets did not have to be repositioned as often as directly bonded brackets. Treatment results with both systems were similar concerning their effects on the reduction of ABO scores. The number of used archwires was higher in the CAD/CAM group. Treatment with both systems led to further proclination of the incisors. Proclination in the lower jaw was greater than proclination in the upper jaw, and there was a statistically significant difference between the two treatment systems. Comparing the treatment results with the virtual set-ups, mesial positions were met best, followed by vertical positions. Transversal positions showed the greatest discrepancies. Concerning angles, values of angulation showed greatest accordance to the virtual set-up, while values of inclinations showed greatest discrepancies.ConclusionIn comparison with a direct bonded self-ligating bracket system the use of indirect bonded customized CAD/CAM brackets showed only minor influence on treatment efficiency and treatment outcomes. Transversal expansion, deep bite correction, expression of torque and anchorage loss remain challenges in the treatment with straight-wire appliances.Trial registration DRKS, DRKS00024350. Registered 15 February 2021, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024350.

Evaluation of the Effect of Different Bracket Systems on External Apical Root Resorption Using Cone-Beam Computed Tomography.

The aim of this study was to evaluate the external apical root resorption (EARR) developed in the maxillary and mandibular teeth of patients undergoing orthodontic treatment with conventional and self-ligating bracket systems. Cone-beam computed tomography images of patients treated with self-ligating and conventional bracket systems, which were taken at the beginning and end of treatment, were evaluated. The teeth where EARR developed during the treatment period were identified. EARR was evaluated as yes or no. A P value of < .05 was considered statistically significant. Of a total of 300 patients (68.7% female, 31.3% male), 20% were treated with the self-ligating bracket system, while 80% were treated with the conventional bracket system. EARR occurred in 8.3% (n = 25) of the patients after treatment. A statistically significant difference was found when the effect of age, gender, and treatment duration on the incidence of EARR was evaluated. The incidence of EARR was higher in the age group of 18-30 years than in the age group of 12-17 years. Similarly, it was found to be higher in men than in women and higher in the group with a treatment duration of 33-49 months than in the group with a treatment duration of 8-32 months. Treatment duration has been observed to affect the incidence of EARR in patients undergoing fixed orthodontic treatment, and the incidence of EARR increases with increased treatment duration. Furthermore, it has been concluded that EARR during orthodontic treatment is influenced by age and gender. There is no difference between self-ligating and conventional bracket systems in terms of EARR.

Diagnosis, treatment planning &amp; management of patient undergoing orthodontic therapy with blunderbuss canal’s in relation to multiple teeth by endo- ortho interdisciplinary approach using PRF &amp; MTA

Diagnosis, treatment planning &amp; management of patient undergoing orthodontic therapy with blunderbuss canal’s in relation to one or multiple tooth requires a precise scientific approach based on sound principles. Interdisciplinary therapy integrates individual disciplines to function as a comprehensive unit providing consistent and predictable treatment results. A thorough logical diagnostic approach and treatment planning must be executed by each member of endodontic-orthodontic team when an esthetic and healthy makeover of a patient’s dentition is planned. Precise communication is important to provide patients with desired results. This case report presents one such approach for diagnosis, treatment planning &amp; management of patient undergoing orthodontic therapy with blunderbuss canal’s in relation to one or multiple tooth. After careful clinical and radiographic evaluation, the patient was diagnosed with Angle’s Class I malocclusion with spacing in maxillary and mandibular arch, and blunderbuss canal’s irt 35 &amp; 45. The treatment consisted of initial endodontic approach by starting treatment irt 35 and 45, followed by fixed orthodontic approach using passive self-ligating bracket system and by-passing the endodontically treated tooth. Regular follow-up to observe apexogenesis and continuous evaluation of the case is being done.

An Instrument for Seating Orthodontic Archwires

Full engagement of orthodontic archwires to permit gate closure in self-ligating brackets can be challenging in both the initial stages of alignment with crowded or rotated teeth and also during the later treatment stages with use of heavy rectangular wires. A handy, reliable tool has been developed to ensure complete seating of any archwire in slots of both conventional and self-ligating bracket (SLB) systems to overcome this problem.