{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:48:22Z","timestamp":1790880502517,"version":"4.1.0"},"reference-count":58,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objectives:<\/jats:title>\n To compare the failure pattern of four different bracket types and to assess its effect on treatment duration.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n A total of 78 white patients (28 male, 50 female) with a mean age of 12.6 years were included in this retrospective cohort study and treated for a mean period of 30.6 months. The patients were treated in a private practice with stainless steel conventionally ligated brackets, ceramic conventionally ligated brackets, stainless steel self-ligating brackets, or nickel-free self-ligating brackets. The loss of at least one bracket during the course of treatment was analyzed with Cox proportional hazards survival analyses and generalized linear regression.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The overall bracket failure rate at the tooth level was 14.1% (217 brackets), with significant differences according to tooth type (between 8.0%\u201323.4%) and bracket type (between 11.2%\u201320.0%). After taking confounders into account, patients treated with ceramic brackets lost more brackets (hazard ratio = 1.62; 95% confidence interval = 1.14\u20132.29;\n P<\/jats:italic>\n = .007) than patients with stainless steel brackets. On average, treatment time increased by 0.6 months (95% confidence interval = 0.21\u20131.05;\n P<\/jats:italic>\n = .004) for each additional failed bracket.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Bracket failure was more often observed with ceramic brackets and was associated with increased treatment duration.<\/jats:p>\n <\/jats:sec>","DOI":"10.2319\/081817-559.1","type":"journal-article","created":{"date-parts":[[2018,2,2]],"date-time":"2018-02-02T13:03:50Z","timestamp":1517576630000},"page":"338-347","source":"Crossref","is-referenced-by-count":50,"title":["Failure patterns of different bracket systems and their influence on treatment duration: A retrospective cohort study"],"prefix":"10.2319","volume":"88","author":[{"given":"Dimitrios","family":"Stasinopoulos","sequence":"first","affiliation":[{"name":"Doctoral Candidate, Department of Oral Technology, School of Dentistry, University of Bonn, Bonn, Germany"},{"name":"Private Practice, Bergheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyridon N.","family":"Papageorgiou","sequence":"additional","affiliation":[{"name":"Senior Teaching and Research Assistant, Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Kirsch","sequence":"additional","affiliation":[{"name":"Private Practice, Bergheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Daratsianos","sequence":"additional","affiliation":[{"name":"Assistant Professor, Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"J\u00e4ger","sequence":"additional","affiliation":[{"name":"Professor, Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Bourauel","sequence":"additional","affiliation":[{"name":"Private Practice, Bergheim, Germany"},{"name":"Professor, Endowed Chair of Oral Technology, School of Dentistry, University of Bonn, Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-88-3-338-b01","series-title":"Am J Orthod Dentofacial Orthop","first-page":"7439","article-title":"An evaluation of factors affecting duration of orthodontic treatment","volume":"115","author":"Beckwith, \n FR,","year":"1999","unstructured":"Beckwith, \n FR, \n \n \n Ackerman \n RJ, \n \n \n Cobb \n CM, \n \n \n Tira \n DE. \n \n \n An evaluation of factors affecting duration of orthodontic treatment. Am J Orthod Dentofacial Orthop. 1999;115:7439\u20137447."},{"key":"i0003-3219-88-3-338-b02","series-title":"Am J Orthod Dentofacial Orthop","first-page":"293","article-title":"Predictors for class II treatment duration","volume":"127","author":"Popowich \n K,","year":"2005","unstructured":"Popowich \n K, \n \n \n Nebbe \n B, \n \n \n Heo \n G, \n \n \n Glover \n KE, \n \n \n Major \n PW. \n \n \n Predictors for class II treatment duration. Am J Orthod Dentofacial Orthop. 2005;127:293\u2013300."},{"key":"i0003-3219-88-3-338-b03","series-title":"Am J Orthod Dentofacial Orthop","first-page":"230","article-title":"Factors influencing treatment time in orthodontic patients","volume":"129","author":"Skidmore \n KJ,","year":"2006","unstructured":"Skidmore \n KJ, \n \n \n Brook \n KJ, \n \n \n Thomson \n WM, \n \n \n Harding \n WJ. \n \n \n Factors influencing treatment time in orthodontic patients. Am J Orthod Dentofacial Orthop. 2006;129:230\u2013238."},{"key":"i0003-3219-88-3-338-b04","series-title":"Eur J Orthod","first-page":"386","article-title":"Factors affecting the duration of orthodontic treatment: a systematic review","volume":"30","author":"Mavreas \n D,","year":"2008","unstructured":"Mavreas \n D, \n \n \n Athanasiou \n AE. \n \n \n Factors affecting the duration of orthodontic treatment: a systematic review. Eur J Orthod. 2008;30:386\u2013395."},{"key":"i0003-3219-88-3-338-b05","series-title":"Korean J Orthod","first-page":"401","article-title":"Outcome assessment of comprehensive fixed appliance treatment: a systematic review with meta-analysis and methodological overview of studies using the American Board of Orthodontists Objective Grading System","volume":"47","author":"Papageorgiou \n SN,","unstructured":"Papageorgiou \n SN, \n \n \n H\u00f6chli \n D, \n \n \n Eliades \n T. \n \n \n Outcome assessment of comprehensive fixed appliance treatment: a systematic review with meta-analysis and methodological overview of studies using the American Board of Orthodontists Objective Grading System. Korean J Orthod. 47:401\u2013413."},{"key":"i0003-3219-88-3-338-b06","series-title":"Clin Oral Investig","first-page":"1849","article-title":"Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients","volume":"20","author":"Li \n X,","year":"2016","unstructured":"Li \n X, \n \n \n Xu \n ZR, \n \n \n Tang \n N, \n \n et al. \n Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients. Clin Oral Investig. 2016;20:1849\u20131859."},{"key":"i0003-3219-88-3-338-b07","series-title":"Am J Orthod Dentofacial Orthop","first-page":"649","article-title":"Accidental debondings: buccal vs fully individualized lingual multibracket appliances","volume":"145","author":"Ziebura \n T,","year":"2014","unstructured":"Ziebura \n T, \n \n \n Hohoff \n A, \n \n \n Flieger \n S, \n \n \n Stamm \n T. \n \n \n Accidental debondings: buccal vs fully individualized lingual multibracket appliances. Am J Orthod Dentofacial Orthop. 2014;145:649\u2013654."},{"key":"i0003-3219-88-3-338-b08","series-title":"Angle Orthod","first-page":"142","article-title":"A multi-center randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: part 1: treatment efficiency","volume":"86","author":"O'Dywer \n L,","year":"2016","unstructured":"O'Dywer \n L, \n \n \n Littlewood \n SJ, \n \n \n Rahman \n S, \n \n \n Spencer \n RJ, \n \n \n Barber \n SK, \n \n \n Russell \n JS. \n \n \n A multi-center randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: part 1: treatment efficiency. Angle Orthod. 2016;86:142\u2013148."},{"key":"i0003-3219-88-3-338-b09","series-title":"Cochrane Database Syst Rev","article-title":"Surgical adjunctive procedures for accelerating orthodontic treatment","volume":"6","author":"Fleming \n PS,","year":"2015","unstructured":"Fleming \n PS, \n \n \n Fedorowicz \n Z, \n \n \n Johal \n A, \n \n \n El-Angbawi \n A, \n \n \n Pandis \n N. \n \n \n Surgical adjunctive procedures for accelerating orthodontic treatment. Cochrane Database Syst Rev. 2015;6:CD010572."},{"key":"i0003-3219-88-3-338-b10","series-title":"Eur J Orthod","first-page":"350","article-title":"Clinical effects of pre-adjusted edgewise orthodontic brackets: a systematic review and meta-analysis","volume":"36","author":"Papageorgiou \n SN,","year":"2014","unstructured":"Papageorgiou \n SN, \n \n \n Konstantinidis \n I, \n \n \n Papadopoulou \n K, \n \n \n J\u00e4ger \n A, \n \n \n Bourauel \n C. \n \n \n Clinical effects of pre-adjusted edgewise orthodontic brackets: a systematic review and meta-analysis. Eur J Orthod. 2014;36:350\u2013363."},{"key":"i0003-3219-88-3-338-b11","series-title":"Am J Orthod Dentofacial Orthop","first-page":"534","article-title":"Bond failure patterns in vivo","volume":"123","author":"Linklater \n RA,","year":"2003","unstructured":"Linklater \n RA, \n \n \n Gordon \n PH. \n \n \n Bond failure patterns in vivo. Am J Orthod Dentofacial Orthop. 2003;123:534\u2013539."},{"key":"i0003-3219-88-3-338-b12","series-title":"Eur J Orthod","first-page":"13","article-title":"The inappropriateness of conventional orthodontic bond strength assessment protocols","volume":"22","author":"Eliades \n T,","year":"2000","unstructured":"Eliades \n T, \n \n \n Brantley \n WA. \n \n \n The inappropriateness of conventional orthodontic bond strength assessment protocols. Eur J Orthod. 2000;22:13\u201323."},{"key":"i0003-3219-88-3-338-b13","series-title":"Eur J Orthod","first-page":"203","article-title":"5-year clinical review of bond failure with a no-mix adhesive (Right On)","volume":"16","author":"Millett \n DT,","year":"1994","unstructured":"Millett \n DT, \n \n \n Gordon \n PH. A\n \n \n 5-year clinical review of bond failure with a no-mix adhesive (Right On). Eur J Orthod. 1994;16:203\u2013211."},{"key":"i0003-3219-88-3-338-b14","series-title":"Br J Orthod","first-page":"283","article-title":"Clinical performance of orthodontic brackets and adhesive systems: a randomized clinical trial","volume":"25","author":"Sunna \n S,","year":"1998","unstructured":"Sunna \n S, \n \n \n Rock \n WP. \n \n \n Clinical performance of orthodontic brackets and adhesive systems: a randomized clinical trial. Br J Orthod. 1998;25:283\u2013287."},{"key":"i0003-3219-88-3-338-b15","series-title":"Am J Orthod Dentofacial Orthop","first-page":"547","article-title":"A clinical trial comparing the failure rates of two orthodontic bonding systems","volume":"110","author":"Trimpeneers \n LM,","year":"1996","unstructured":"Trimpeneers \n LM, \n \n \n Dermaut \n LR. \n \n \n A clinical trial comparing the failure rates of two orthodontic bonding systems. Am J Orthod Dentofacial Orthop. 1996;110:547\u2013550."},{"key":"i0003-3219-88-3-338-b16","series-title":"Orthod Craniofac Res","first-page":"161","article-title":"Clinical bond failure of pre-coated and operator-coated orthodontic brackets","volume":"5","author":"Kula \n K,","year":"2002","unstructured":"Kula \n K, \n \n \n Schreiner \n R, \n \n \n Brown \n J, \n \n \n Glaros \n A. \n \n \n Clinical bond failure of pre-coated and operator-coated orthodontic brackets. Orthod Craniofac Res. 2002;5:161\u2013165."},{"key":"i0003-3219-88-3-338-b17","series-title":"Arch Oral Biol","first-page":"383","article-title":"Structural variations in the surface zone of human tooth enamel observed by scanning electron microscopy","volume":"27","author":"Whitakker \n DK.","year":"1982","unstructured":"Whitakker \n DK. \n \n \n Structural variations in the surface zone of human tooth enamel observed by scanning electron microscopy. Arch Oral Biol. 1982;27:383\u2013392."},{"key":"i0003-3219-88-3-338-b18","series-title":"Am J Orthod","first-page":"173","article-title":"A post-treatment evaluation of direct bonding in orthodontics","volume":"71","author":"Zachrisson \n BU.","year":"1977","unstructured":"Zachrisson \n BU. \n \n \n A post-treatment evaluation of direct bonding in orthodontics. Am J Orthod. 1977;71:173\u2013189."},{"key":"i0003-3219-88-3-338-b19","series-title":"J Clin Diagn Res","first-page":"1495","article-title":"The shear bond strengths of metal and ceramic brackets: an in-vitro comparative study","volume":"7","author":"Reddy \n YG,","year":"2013","unstructured":"Reddy \n YG, \n \n \n Sharma \n R, \n \n \n Singh \n A, \n \n \n Agrawal \n V, \n \n \n Agrawal \n V, \n \n \n Chaturvedi \n S. \n \n \n The shear bond strengths of metal and ceramic brackets: an in-vitro comparative study. J Clin Diagn Res. 2013;7:1495\u20131497."},{"key":"i0003-3219-88-3-338-b20","series-title":"Am J Orthod Dentofacial Orthop","first-page":"132","article-title":"Microbial attack of orthodontic adhesives","volume":"108","author":"Matasa \n CG.","year":"1995","unstructured":"Matasa \n CG. \n \n \n Microbial attack of orthodontic adhesives. Am J Orthod Dentofacial Orthop. 1995;108:132\u2013141."},{"key":"i0003-3219-88-3-338-b21","series-title":"Am J Orthod Dentofacial Orthop","first-page":"456","article-title":"Extraction frequencies at a university orthodontic clinic in the 21st century: demographic and diagnostic factors affecting the likelihood of extraction","volume":"151","author":"Jackson \n TH,","year":"2017","unstructured":"Jackson \n TH, \n \n \n Guez \n C, \n \n \n Lin \n FC, \n \n \n Proffit \n WR, \n \n \n Ko \n CC. \n \n \n Extraction frequencies at a university orthodontic clinic in the 21st century: demographic and diagnostic factors affecting the likelihood of extraction. Am J Orthod Dentofacial Orthop. 2017;151:456\u2013462."},{"key":"i0003-3219-88-3-338-b22","series-title":"Eur J Orthod","first-page":"109","article-title":"Extractions, retention and stability: the search for orthodontic truth","volume":"39","author":"Peck \n S.","year":"2017","unstructured":"Peck \n S. \n \n \n Extractions, retention and stability: the search for orthodontic truth. Eur J Orthod. 2017;39:109\u2013115."},{"key":"i0003-3219-88-3-338-b23","series-title":"Angle Orthod","first-page":"329","article-title":"Influence of supplemental written information on adolescent anxiety, motivation and compliance in early orthodontic treatment","volume":"80","author":"Wright \n NS,","year":"2010","unstructured":"Wright \n NS, \n \n \n Fleming \n PS, \n \n \n Sharma \n PK, \n \n \n Battagel \n J. \n \n \n Influence of supplemental written information on adolescent anxiety, motivation and compliance in early orthodontic treatment. Angle Orthod. 2010;80:329\u2013335."},{"key":"i0003-3219-88-3-338-b24","series-title":"Am J Orthod Dentofacial Orthop","first-page":"319","article-title":"The clinical use of Activa self-ligating brackets","volume":"109","author":"Harradine \n NW,","year":"1996","unstructured":"Harradine \n NW, \n \n \n Birnie \n DJ. \n \n \n The clinical use of Activa self-ligating brackets. Am J Orthod Dentofacial Orthop. 1996;109:319\u2013328."},{"key":"i0003-3219-88-3-338-b25","series-title":"Am J Orthod Dentofacial Orthop","first-page":"638","article-title":"Numeric modeling of torque capabilities of self-ligating and conventional brackets","volume":"136","author":"Huang \n Y,","year":"2009","unstructured":"Huang \n Y, \n \n \n Keilig \n L, \n \n \n Rahimi \n A, \n \n et al. \n Numeric modeling of torque capabilities of self-ligating and conventional brackets. Am J Orthod Dentofacial Orthop. 2009;136:638\u2013643."},{"key":"i0003-3219-88-3-338-b26","series-title":"Am J Orthod Dentofacial Orthop","first-page":"834","article-title":"Changes in the stiffness of the ligating mechanism in retrieved active self-ligating brackets","volume":"132","author":"Pandis \n N,","year":"2007","unstructured":"Pandis \n N, \n \n \n Bourauel \n C, \n \n \n Eliades \n T. \n \n \n Changes in the stiffness of the ligating mechanism in retrieved active self-ligating brackets. Am J Orthod Dentofacial Orthop. 2007;132:834\u2013837."},{"key":"i0003-3219-88-3-338-b27","series-title":"J Clin Epidemiol","first-page":"1512","article-title":"Basic study design influences the results of orthodontic clinical investigations","volume":"68","author":"Papageorgiou \n SN,","year":"2015","unstructured":"Papageorgiou \n SN, \n \n \n Xavier \n GM, \n \n \n Cobourne \n MT. \n \n \n Basic study design influences the results of orthodontic clinical investigations. J Clin Epidemiol. 2015;68:1512\u20131522."},{"key":"i0003-3219-88-3-338-b28","series-title":"J Dent","first-page":"1195","article-title":"Publication of statistically significant research findings in prosthodontics & implant dentistry in the context of other dental specialties","volume":"43","author":"Papageorgiou \n SN,","year":"2015","unstructured":"Papageorgiou \n SN, \n \n \n Kloukos \n D, \n \n \n Petridis \n H, \n \n \n Pandis \n N. \n \n \n Publication of statistically significant research findings in prosthodontics & implant dentistry in the context of other dental specialties. J Dent. 2015;43:1195\u20131202."},{"key":"i0003-3219-88-3-338-b29","series-title":"Eur J Orthod","first-page":"98","article-title":"Bias from historical control groups used in orthodontic research: a meta-epidemiological study","volume":"39","author":"Papageorgiou \n SN,","year":"2017","unstructured":"Papageorgiou \n SN, \n \n \n Koretsi \n V, \n \n \n J\u00e4ger \n A. \n \n \n Bias from historical control groups used in orthodontic research: a meta-epidemiological study. Eur J Orthod. 2017;39:98\u2013105."},{"key":"i0003-3219-88-3-338-b01","series-title":"Am J Orthod Dentofacial Orthop","first-page":"7439","article-title":"An evaluation of factors affecting duration of orthodontic treatment","volume":"115","author":"Beckwith, \n FR,","year":"1999","unstructured":"Beckwith, \n FR, \n \n \n Ackerman \n RJ, \n \n \n Cobb \n CM, \n \n \n Tira \n DE. \n \n \n An evaluation of factors affecting duration of orthodontic treatment. 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Korean J Orthod. 47:401\u2013413."},{"key":"i0003-3219-88-3-338-b06","series-title":"Clin Oral Investig","first-page":"1849","article-title":"Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients","volume":"20","author":"Li \n X,","year":"2016","unstructured":"Li \n X, \n \n \n Xu \n ZR, \n \n \n Tang \n N, \n \n et al. \n Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients. Clin Oral Investig. 2016;20:1849\u20131859."},{"key":"i0003-3219-88-3-338-b07","series-title":"Am J Orthod Dentofacial Orthop","first-page":"649","article-title":"Accidental debondings: buccal vs fully individualized lingual multibracket appliances","volume":"145","author":"Ziebura \n T,","year":"2014","unstructured":"Ziebura \n T, \n \n \n Hohoff \n A, \n \n \n Flieger \n S, \n \n \n Stamm \n T. \n \n \n Accidental debondings: buccal vs fully individualized lingual multibracket appliances. Am J Orthod Dentofacial Orthop. 2014;145:649\u2013654."},{"key":"i0003-3219-88-3-338-b08","series-title":"Angle Orthod","first-page":"142","article-title":"A multi-center randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: part 1: treatment efficiency","volume":"86","author":"O'Dywer \n L,","year":"2016","unstructured":"O'Dywer \n L, \n \n \n Littlewood \n SJ, \n \n \n Rahman \n S, \n \n \n Spencer \n RJ, \n \n \n Barber \n SK, \n \n \n Russell \n JS. \n \n \n A multi-center randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: part 1: treatment efficiency. Angle Orthod. 2016;86:142\u2013148."},{"key":"i0003-3219-88-3-338-b09","series-title":"Cochrane Database Syst Rev","article-title":"Surgical adjunctive procedures for accelerating orthodontic treatment","volume":"6","author":"Fleming \n PS,","year":"2015","unstructured":"Fleming \n PS, \n \n \n Fedorowicz \n Z, \n \n \n Johal \n A, \n \n \n El-Angbawi \n A, \n \n \n Pandis \n N. \n \n \n Surgical adjunctive procedures for accelerating orthodontic treatment. Cochrane Database Syst Rev. 2015;6:CD010572."},{"key":"i0003-3219-88-3-338-b10","series-title":"Eur J Orthod","first-page":"350","article-title":"Clinical effects of pre-adjusted edgewise orthodontic brackets: a systematic review and meta-analysis","volume":"36","author":"Papageorgiou \n SN,","year":"2014","unstructured":"Papageorgiou \n SN, \n \n \n Konstantinidis \n I, \n \n \n Papadopoulou \n K, \n \n \n J\u00e4ger \n A, \n \n \n Bourauel \n C. \n \n \n Clinical effects of pre-adjusted edgewise orthodontic brackets: a systematic review and meta-analysis. Eur J Orthod. 2014;36:350\u2013363."},{"key":"i0003-3219-88-3-338-b11","series-title":"Am J Orthod Dentofacial Orthop","first-page":"534","article-title":"Bond failure patterns in vivo","volume":"123","author":"Linklater \n RA,","year":"2003","unstructured":"Linklater \n RA, \n \n \n Gordon \n PH. \n \n \n Bond failure patterns in vivo. 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