Evaluation of the Failure Rate and Clinical Efficacy of Orthodontic Brackets Indirect Bonding with Computer-Aided Transfer Jig System: An In Vivo Study

This study aimed to evaluate the failure rates and relevant factors of bonded orthodontic brackets with a computer-aided design and manufacturing (CAD/CAM)-based 3D-printed indirect bonding jig system (IDBS) using 2531 natural teeth selected from 99 orthodontic patients. Ceramic self-ligating brackets and metal tubes were used in this study. Proportion analysis was used to calculate the total bracket re-bonding rate and respective proportions of bonding failure and position error. Crossover frequency analysis was used to analyze the total bracket re-bonding, bonding failure, and position error rates in different tooth positions of the maxilla and mandible. Multiple linear regression analysis was used to evaluate the association between dependent variables (age, sex, treatment stage, skeletal divergence, and tooth position) and the bracket bonding failure rate. Pearson's Chi-square test was used to test the difference between the maxilla and mandible for each variable. The total bracket re-bonding rate was 22.64%, and the bonding failure rate and position error rates accounted for 15.09% and 7.55%, respectively. The bonding failure rate was higher in the mandibular teeth than in the maxillary teeth (p < 0.05). Anterior teeth had a higher position error rate, and mandibular anterior teeth had a higher bonding failure rate. The accuracy of IDBS was higher in the premolars and molars. Sex, age, and treatment stage were affected by IDBS. Patients with hyperdivergent skeletal patterns had higher rates of bracket bonding failure. The results of this study can provide practical guidelines for placing brackets with 3D-printed IDBS on the entire dentition to ensure the precision and accuracy of their use during orthodontic treatments.