Cochrane · intervention · CD005516

Enamel etching for bonding fixed orthodontic braces

Hu, H, Li, C, Li, F, et al. · Cochrane Database of Systematic Reviews · 2013 · Cochrane Library

Oral Health Orthodontics2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

9

current version

GRADE rated

1

No studies

4

Included studies

13

as reported

No studies 4 · 44.4%Ungraded 4 · 44.4%Very low 0 · 0%Low 1 · 11.1%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Participants, both children and adults, with fixed orthodontic brackets attached to their incisors, canines and premolars; excluded individuals with a cleft lip or palate or both, or with other craniofacial deformities/syndromes, and those with hypoplastic or fluorotic teeth	417 participants with 7184 teeth/brackets; age ranged from 11 to 36 years, most participants were teenagers
Intervention	Any kind of etching materials and techniques used in the intervention group (e.g. self etching primers)	Self etching primers (n=11); Transbond Plus SEP (n=10); Ideal 1 SEP (n=1); Transbond Plus SEP as index arm in SEP-versus-SEP comparisons (n=2)
Comparison	Different etching materials, times and acid concentrations, or an alternative etching technique in the control group	Conventional etchants (n=11); 37% phosphoric acid (n=11); Clearfil Protect Bond SEP (n=1); First Step SEP (n=1)
Outcomes	Primary: bond failure rate of braces (rate at which braces fall off the teeth during treatment). Secondary: presence or absence of decay (decalcification) associated with or around the etching field; participant satisfaction; cost of treatment	Bond failure rate (n=12); presence or absence of decay (decalcification) (n=2)
Study designs	Randomized controlled trials (RCTs) comparing different etching materials or different etching techniques, including split-mouth trials using quadrants (even if contralateral quadrants receive the same intervention) but not those randomizing individual teeth or using alternate teeth	Split-mouth design (n=10); parallel design (n=3); five studies (split-mouth n=3, parallel n=2) pooled in the meta-analysis
Timing	Not specified	Follow-up ranged from 5 to 37 months

Search date: 2013-03. Databases: Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; WHO International Clinical Trials Registry Platform; National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov); Chinese Biomedical Literature…

Questions and results

Current version only

Different etching materials (phosphoric acid, polyacrylic acid, maleic acid, etc.), acid concentrations or etching times vs An alternative etching material, concentration or etching time

Population: Children and adults with fixed orthodontic brackets bonded to incisors, canines and premolars

CD005516.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	We identified no eligible trial that examined the effects of conventional etchants with respect to different etching concentrations or etching times for the bonding of fixed orthodontic appliances. No eligible RCTs…	NR	No studies

Self etching primers (one-step etchant and primer system) vs Conventional etchants (two-step etch and prime method using 37% phosphoric acid)

Population: Children and adults with fixed orthodontic brackets bonded to incisors, canines and premolars

CD005516.PUB2 (current) · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Bond failure rate 5 to 37 months same question in other reviews	RR 1.14 [0.75, 1.73] 27 [-49, 143] more per 1000	5 studies · 221 participants	Low Downgraded: risk of bias, imprecision
Damage to the teeth same question in other reviews	Damage to the teeth: No studies assessed this outcome.	NR	No studies
Cost of treatment same question in other reviews	Cost of treatment: No studies assessed this outcome.	NR	No studies
Participant satisfaction same question in other reviews	Participant satisfaction: No studies assessed this outcome.	NR	No studies
Decay (decalcification) associated with or around the etching field same question in other reviews	Decay (decalcification) associated with or around the etching field: Only one study (Ghiz 2009) assessed this outcome but data were reported at the tooth level rather than at the participant level and therefore was not…	1 study · 25 participants	Ungraded

Transbond Plus self etching primer (3M Unitek) vs Clearfil Protect Bond self etching primer (Kuraray Medical)

Population: Children and adults with fixed orthodontic brackets bonded to incisors, canines and premolars

CD005516.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Bond failure rate same question in other reviews	Self etching primers versus self etching primers: Two split-mouth studies compared two different SEPs (Noble 2006; Paschos 2009). The failure rates were reported at tooth level rather than at participant level. We…	1 study	Ungraded
Decay (decalcification) associated with or around the etching field same question in other reviews	Decalcification outcomes in Paschos 2009 were reported at tooth level rather than at participant level; the evidence was insufficient to conclude whether or not there is a difference in decalcification between the…	1 study	Ungraded

Transbond Plus self etching primer (3M Unitek) vs First Step self etching primer (Reliance Orthodontic Products)

Population: Children and adults with fixed orthodontic brackets bonded to incisors, canines and premolars

CD005516.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Bond failure rate same question in other reviews	Noble 2006 (split-mouth) compared Transbond Plus versus First Step SEP; the bond failure rate was reported at tooth level rather than at participant level and was not amenable to analysis; the evidence was insufficient…	1 study	Ungraded

Different dental etchants (phosphoric acid, polyacrylic acid, maleic acid, etc.) vs An alternative dental etchant

Population: Children and adults with fixed orthodontic brackets bonded to incisors, canines and premolars

CD005516 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR At least 1 year	no estimate extracted	NR	No studies

Self etching primer (one-step etchant-and-primer technique) vs Conventional etchants (conventional multiprocedural etch-and-prime technique)

Population: Children and adults with fixed orthodontic brackets bonded to incisors, canines and premolars

CD005516 · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Cost and duration of treatment At least 1 year	no estimate extracted	NR	No studies
Patient satisfaction (how patients feel about their teeth at the end of active treatment) At least 1 year	no estimate extracted	NR	No studies
Bond failure rate (rate at which brackets fall off the teeth during treatment) At least 1 year	no estimate extracted	NR	No studies
Damage to the teeth (irreversible enamel decalcification) [harm] At least 1 year	no estimate extracted	NR	No studies
Decay (decalcification) associated with or around the etching field At least 1 year	no estimate extracted	NR	No studies