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Table 2 Summary of the included studies

From: Effectiveness, efficiency and adverse effects of using direct or indirect bonding technique in orthodontic patients: a systematic review and meta-analysis

Study Study design Observation period Participants Intervention
(Indirect bonding adhesives)
(Direct bonding adhesives)
Outcomes Indirect Direct
Aguirre 1982 [24] RCT (split-mouth) 3 months Sex: not specified
Age: patients from graduate practice
Inclusion criteria: receiving the orthodontic appliance
Brackets: Ormco standard, with a mesh pad
Endur (self-curing)
(Lab adhesive: Sugar Daddy
Tray: Citricon silicone impression material)
Not specified Bracket placement accuracy refer to the original data
Working time (min, mean ± SD) LS: 29.8 ± 0.8
CS: 23.7 ± 1.1
T: 53. 5
42.0 ± 0.9
Bond failure rate 4/98 (4.10%) 5/94 (5.30%)
Dalessandri 2012 [12] RCT (split-mouth) 2 years and 6 months ±4 months Sex: male 13, female 17
Age: 11.2–12.8 years
Inclusion criteria: attending an orthodontics department of a university and undergoing fixed orthodontic treatment (Victory braces, Low Profile series, MBT prescription, 0.022-in. slot, power arm on canines, 3 M Unitek); no presence of systemic or local (caries, periodontal pockets, mucosal alterations) pathologies; no need for surgical or extended restorative adjunctive procedures; no enamel development alterations; no dietary restrictions or intolerances
Brackets: Victory braces, Low Profile series, MBT prescription, 0.022-in. slot, power arm on canines
3 M Unitek (light-cured)
(Lab adhesive: removable adhesive (Vinavil, Vinavil SpA)
Tray: a first bracket transfer matrix in a soft material (Copyplast 0.5 mm, Scheu Dental GmbH) was prepared with a pressure molding machine (Biostar VI, Scheu Dental Technology).
and a second transfer matrix with a 1-mm thick Duran (Scheu Dental GmbH) foil was developed)
3 M Unitek (light-cured) Oral hygiene status (number of new caries) 2 2
Oral hygiene status (plaque accumulation index) 0.97 ± 0.29 1.71 ± 0.97
Oral hygiene status (number of new white spots) 8 21
Hodge 2004 [7] RCT (split-mouth) Not specified Sex: not specified
Age: not specified
Inclusion criteria: requiring full treatment with preadjusted
edgewise appliances in both arches
Brackets: not specified
Not specified Not specified Bracket placement accuracy (bracket placement errors; mm/°, mean ± SD) V: −0.20 ± 0.08
H: −0.05 ± 0.10
A: 0.02 ± 0.05
V: −0.27 ± 0.46
H: −0.11 ± 0.30
A: 0.08 ± 0.14
Huang 2016 [28] RCT Not specified Sex: male 12, female 33
Age:15–30 years
Inclusion criterion: requiring fixed orthodontic appliance therapy; with good oral hygiene; no periodontal diseases, caries, fluorosis, cracked-teeth, and partially erupted cases etc., heights of clinical crowns were similar
Brackets: Damon3MX self-ligating brackets (Ormco, US)
3 M Unitek Sondhi™ Rapid-set (3 M, US)
(Lab adhesive: 3 M Unitek Transbond™ XT (3 M, US) (light-cured)
Tray: using translucent soft silicone to make the soft layer and rigid tray refinement)
3 M Unitek Transbond™ XT (3 M, US) (light-cured) Working time (min, mean) LS: 56.4
CS: 34.13
T: 90.53
T: 43.5
Thiyagarajah 2006 [25] RCT (split-mouth) 12 months Sex: not specified
Age: 12–15 (mean13.6) years
Inclusion criteria: requiring orthodontic treatment with full upper and lower pre-adjusted edgewise appliances; no caries, large restorations, fluorosis, hypoplasia or abnormalities of crown morphology
Brackets: MBT™ Versatile+ Bracket System
Transbond TM XT (light-cured)
(Lab adhesive: 3 M Unitek laboratory adhesive;
Tray: 0.45 mm Drufolen WTM transparent tray)
Transbond TM XT (light-cured) Bond failure rate 6/279 (2.15%) 8/274 (2.92%)
Vijayakumar 2014 [26] RCT (split-mouth) 6 months Sex: male 12, female 18
Age: 15–28 (mean 21.73) years
Inclusion criteria: requiring fixed orthodontic appliance therapy; with full complement of tooth and good oral hygiene; no deep-bite, crowns and veneers, and partially erupted cases
Brackets: MBT −022 brackets
Transbond XT (light cure adhesive)
(Lab adhesive: Transbond XT light cure adhesive;
Tray: constructed using soft clear thermo-plastic
sheet of 2 mm thickness in a bio-star machine)
Transbond XT (light-cured) Bond failure rate 23/262 (8.78%) 27/256 (10.55%)
Yıldırım 2018 [27] RCT Direct bonding: 12.0 ± 3.1 months; indirect bonding: 11.4 ± 2.4 months Sex: male 7, female 23
Age: Direct: 11.7–19.2 (14.6 ± 2.4) years; indirect: 11.4–21(16.7 ± 5.1) years
Inclusion criterion: complete permanent dentition, including second molars with bilateral Angle Class I molar and canine relationships, no previous orthodontic treatment, no skeletal discrepancy, mild or moderate crowding
Brackets: 0.018-in slot stainless steel Roth prescription Empower 2 self-ligating brackets and 0.018-in Non Convertible LP direct bond molar tubes, American Orthodontics, Sheboygan, Wis
Transbond Supreme LV Low Viscosity Light Cure Adhesive; 3 M Unitek (light-cured)
(Lab adhesive: Transbond Plus Color Change Adhesive;
Tray: 2-layer transfer tray prepared using translucent soft silicone [Memosil 2; Heraeus Kulzer] and thermoformed rigid Essix plastic [Raintree Essix, New Orleans, La])
Transbond Plus Color Change Adhesive;
3 M Unitek
Working time (min, mean ± SD) LS: 45.54 ± 4.33
CS: 26.51 ± 3.33
T: 72.05 ± 5.2
T: 53.02 ± 4.72
Oral hygiene status (plaque accumulation index; median ± interquartile range) 11.67 ± 16.66 5 ± 10.00
Oral hygiene status (white spot lesions formation; median ± interquartile range) 0.00 ± 0.08 0.00 ± 0.16
Bond failure rate 45/420
Zachrisson 1978 [18] RCT (split-mouth) 6 months Sex: male14, female 28
Age: 11–15 (13 ± 1.5) years
Inclusion criteria: at least 4 permanent teeth in a quadrant
Bracket: metal brackets with mesh-backed bases
Edur (self-curing)
(Lab adhesive: Sugar Daddy;
Tray: Optosil, silicone putty impression material)
Oral hygiene status (number of gingival index score) 0:24
Oral hygiene status (number of plaque index score along bracket) 0:658
Oral hygiene status (number of plaque index score along gingiva) 0:517
Bond failure rate 9/104
  1. RCT randomized controlled trial, LS laboratorial stage, CS clinical stage, T total, V vertical, H horizontal, A angular