{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:46Z","timestamp":1783491526384,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oral Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dentofacial malocclusion is a global public health concern and the third most prevalent oral condition after caries and periodontal disease. This systematic review evaluated the impact of bracket slot size (0.018 vs. 0.022-inch) on clinical efficacy (quality of finishing), tooth movement efficiency (treatment duration and alignment speed), and biosafety in patients treated with fixed orthodontic appliances.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>Randomized clinical trials were identified through comprehensive searches in PubMed, Cochrane Library, Scielo, Scopus, Web of Science, Embase, and Google Scholar up to January 2026. Studies comparing 0.018- and 0.022-inch slot brackets and reporting clinical effectiveness, efficiency, or biosafety outcomes were included. Risk of bias was assessed using RoB 2.0, and certainty of evidence was evaluated with the GRADE approach. Due to clinical and methodological heterogeneity among included studies, a statistically and clinically meaningful meta-analysis was not feasible, and results were synthesized narratively, incorporating a structured critical appraisal of the available evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 835 records screened, nine RCTs met the inclusion criteria. No significant clinical differences were observed between bracket slot sizes regarding overall treatment duration, leveling efficiency, or final treatment quality. Although the 0.018-inch system required one fewer visit to complete alignment, this difference lacked clinical relevance. No significant differences in biological risks were identified. Higher comfort and improved quality of life were reported with 0.022-inch low-friction systems. Evidence certainty was low to very low for most outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Based on current evidence, no clinically relevant differences exist between 0.018- and 0.022-inch slot brackets across most evaluated orthodontic outcomes. The overall certainty of evidence is low, and findings should be interpreted with caution. This review provides a structured critical appraisal of the available data, which may assist clinicians in making evidence-based decisions regarding bracket selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42024509885<\/jats:ext-link>\n                      , PROSPERO CRD42024509885.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/froh.2026.1862036","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:57:11Z","timestamp":1783490231000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical effectiveness of 0.018-inch vs. 0.022-inch bracket slot size in fixed orthodontic treatment: a systematic review and critical appraisal of the evidence"],"prefix":"10.3389","volume":"7","author":[{"given":"Franz Tito","family":"Coronel-Zubiate","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, Universidad Nacional Toribio Rodr\u00edguez de Mendoza de Amazonas","place":["Chachapoyas, Peru"]},{"name":"Postgraduate School, Universidad Nacional Toribio Rodr\u00edguez de Mendoza de Amazonas","place":["Chachapoyas, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heber Isac","family":"Arbildo-Vega","sequence":"additional","affiliation":[{"name":"Postgraduate School, Universidad Nacional Toribio Rodr\u00edguez de Mendoza de Amazonas","place":["Chachapoyas, Peru"]},{"name":"Faculty of Dentistry, Dentistry School, Universidad San Mart\u00edn de Porres","place":["Chiclayo, Peru"]},{"name":"Faculty of Human Medicine, Human Medicine School, Universidad San Mart\u00edn de Porres","place":["Chiclayo, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredy Hugo","family":"Cruzado-Oliva","sequence":"additional","affiliation":[{"name":"Faculty of Stomatology, Stomatology School, Universidad Nacional de Trujillo","place":["Trujillo, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rub\u00e9n","family":"Aguirre-Ipenza","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Universidad Continental","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hern\u00e1n","family":"V\u00e1squez-Rodrigo","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Dentistry School, Universidad San Mart\u00edn de Porres","place":["Chiclayo, Peru"]},{"name":"Faculty of Health Sciences, Dentistry School, Universidad Norbert Wiener","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Antonieta","family":"Luj\u00e1n-Valencia","sequence":"additional","affiliation":[{"name":"Postgraduate School, Universidad Cat\u00f3lica de Santa Mar\u00eda","place":["Arequipa, Peru"]},{"name":"Faculty of Dentistry, Dentistry School, Universidad Cat\u00f3lica de Santa Mar\u00eda","place":["Arequipa, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan Manuel","family":"Meza-M\u00e1laga","sequence":"additional","affiliation":[{"name":"Postgraduate School, Universidad Cat\u00f3lica de Santa Mar\u00eda","place":["Arequipa, Peru"]},{"name":"Faculty of Dentistry, Dentistry School, Universidad Cat\u00f3lica de Santa Mar\u00eda","place":["Arequipa, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Luj\u00e1n-Urviola","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Andina N\u00e9stor C\u00e1ceres Vel\u00e1squez University","place":["Juliaca, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Alberto","family":"Farje-Gallardo","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Universidad Nacional 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