Bracket Transfer Accuracy with the Indirect Bonding Technique-A Systematic Review and Meta-Analysis

Purpose: To investigate the bracket transfer accuracy of the indirect bonding technique (IDB). Methods: Systematic search of the literature was conducted in PubMed MEDLINE, Web of Science, Embase, and Scopus through November 2021. Selection Criteria: In vivo and ex vivo studies investigating bracket transfer accuracy by comparing the planned and achieved bracket positions using the IDB technique were considered. Information concerning patients, samples, and applied methodology was collected. Measured mean transfer errors (MTE) for angular and linear directions were extracted. Risk of bias (RoB) in the studies was assessed using a tailored RoB tool. Meta-analysis of ex vivo studies was performed for overall linear and angular bracket transfer accuracy and for subgroup analyses by type of tray, tooth groups, jaw-related, side-related, and by assessment method. Results: A total of 16 studies met the eligibility criteria for this systematic review. The overall linear mean transfer errors (MTE) in mesiodistal, vertical and buccolingual direction were 0.08 mm (95% CI 0.05; 0.10), 0.09 mm (0.06; 0.11), 0.14 mm (0.10; 0.17), respectively. The overall angular mean transfer errors (MTE) regarding angulation, rotation, torque were 1.13 degrees (0.75; 1.52), 0.93 degrees (0.49; 1.37), and 1.11 degrees (0.68; 1.53), respectively. Silicone trays showed the highest accuracy, followed by vacuum-formed trays and 3D printed trays. Subgroup analyses between tooth groups, right and left sides, and upper and lower jaw showed minor differences. Conclusions and implications: The overall accuracy of the indirect bonding technique can be considered clinically acceptable. Future studies should address the validation of the accuracy assessment methods used.