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Systematic review
Dental and skeletal changes associated with
the Damon system philosophical approach
Hye Jin Nam, Carlos Flores-Mir, Paul W. Major, Giseon Heo, Justin Kim, Manuel O. Lagravère
Available online: 29 August 2019 School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta,
ECHA 5-524, 11405, 87th avenue, Edmonton, Alberta T6G 1C9, Canada
Correspondence:
Manuel O. Lagravère, School of Dentistry, Faculty of Medicine and Dentistry,
University of Alberta, ECHA 5-524, 11405, 87th avenue, Edmonton,
Alberta T6G 1C9, Canada.
manuel@ualberta.ca
Keywords Summary
Damon
Brackets Objective > To compare the skeletal and dentoalveolar changes produced by the Damon system's
Self-ligating treatment philosophy to traditional orthodontic treatment techniques.
Expansion Materials and Methods > An electronic search in four major databases was completed: Cochrane,
Transverse Dimension PubMed, EMBASE, and Google Beta Scholar on October 5th, 2018. Randomized controlled trials,
prospective and retrospective controlled clinical trials were included in this systematic review. The
quality assessment of individual studies was done using two different tools: The Cochrane Risk of
Bias Assessment Tool (RTCs) and The Methodological Index for Non-Randomized Studies (MINORS)
(non-RCTs).
Results > Seven studies were included for this qualitative analysis. Six studies compared the
Damon system to various types of conventional (non self-ligating bracket) system as a comparison
group. One study used a quad helix as a comparison for a few months before a full bonding
appointment with conventional brackets. The majority of studies found an increase in maxillary
inter-canine, inter-premolar, and intermolar distance after the treatment in both the Damon and
comparison groups. Yet, all studies concluded that there is no significant difference in the final
transverse dimension between the two groups. One study also found that the transverse expan-
sion was achieved mainly by tipping movement of posterior dentition, and a decrease in the
posterior buccal bone area was evident in both groups after treatment.
Conclusion > There is not enough evidence to support the claim that the Damon system allows
additional arch expansion with better tipping control than with traditional techniques.
621
Introduction to the conventional bracket and the use of ligating ties, it has
Any tooth movement has dynamic effects on bone and soft been claimed that a passive self-ligating bracket, like the
tissue structures surrounding it. With increase force levels, an Damon one, allows a wire to slide through the brackets with
avascular area in the PDL, also known as a hyalinized area, can a lower resistance to sliding resulting in faster level and align-
slow down the tooth movement, and also may increase the risk ment of teeth [2,3]. This philosophical approach also involves
of root resorption and the amount of pain due to chemicals the use of the term "optimal force zone'' which implies that the
released from the ischemic area. If continuous excessive ortho- force applied to teeth should generate an optimal pressure to
dontic force is applied to teeth, it can occlude and cut off blood allow uninterrupted vascular supply to the tooth and its sur-
supply to the periodontal ligament (PDL), and therefore, could rounding system [2,3]. In addition to suggested benefits listed
cause necrosis of the compressed area. Therefore, use of light above, this philosophy argues that the light force produced by
continuous forces are suggested to be critical in achieving the system allows the connective tissue and alveolar bone to
desired movements in orthodontics while minimizing the follow tooth movement, and therefore, more expansion of
unwanted side effects [1]. maxillary arch can be achieved. Also, the applied force is so
The Damon appliance system is one of the multiple self-ligating light that the pressure from lips can minimize unwanted tipping
bracket systems that have been increasingly used by orthodont- of incisors during alignment stage. These two claims suggest
ists. This philosophical approach claims to have many benefits that the need for extraction is reduced when using the Damon
over conventional bracket systems, including less force applied System as additional arch perimeter can be safely gained [2].
on the teeth, reduced amount of pain experienced by patients, The Damon's proposed clinical benefits are heavily marketed to
and higher treatment efficiency [2,3]. The Damon bracket is both orthodontists and patients without high quality evidence.
advertised as "a nearly friction-free'' system [2]. Thus, compared Currently, there is no systemic review on the potential benefits
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Systematic review
of the Damon System over more traditional orthodontic orthodontists to attain maxillary expansion without some of
bracket/archwire system management. In 2011, a limited criti- the negative associated side effects commonly seen in the rapid
cal review on the Damon system was published [4]. Acknowl- expansion appliance such as a tipping movement of posterior
edging their limited search strategy, they concluded that other teeth.
than a possible reduced chair-side time for orthodontists, many
of its claims such as lower pain experience, higher efficiency of
treatment, and better stability after expansion were not clearly Materials and methods
supported by the available literature. Protocol and registration
This review will focus on one of many benefits suggested by the The PROSPERO website was accessed on March 17, 2017, and no
Damon system, which is that a stable clinically meaningful systemic review on the Damon system was registered. A
expansion can be done negating the need for rapid palatal proposal for the systematic review was registered on March
expansion appliances. If this claim is true, it may allow 29, 2017 (registration #: CRD42017059758).
Figure 1
PRISMA Flow Chart for Literature Search.
623
Systematic review
TABLE I
Characteristics of included studies.
Study group Study design Treatment group Sample (size and Records used for Pretreatment Clinical Characteristics
and year (A, B, vs C) a mean age) analysis
Atik and Ciger RCT A: Quad helix and A: 17 patients Cephalometric, Moderate max/mand crowding, Class I
2014 [12] conventional (14,5 1.2 yrs) Posteroanterior MO with
B: Damon 3MX B: 16 patients radiographs, and maxillary constriction
bracket (14.8 1.0 yrs) dental casts Maxillary crowding (mm):
Group A: 3.5 (2.4–6.0), Group B: 3.5
(2.4–6.2)
Mandibular crowding (mm):
Group A: 3.4 (2.3–4.6), Group B: 3.9
(2.3–5.5)
Atik et al., Prospe-ctive A: Self-ligating A: 15 patients Cephalometric, Moderate max/mand crowding, Class I
2016 [13] Clinical Trial (Nexus) (14.4 1.5 yrs) Posteroanterior MO, non-extraction treatment
B: Conventional B: 15 patients radiographs, and Maxillary crowding (mm):
C: Passive self- (14.4 1.6 yrs) dental casts Group A: 4.0 (0.77), Group B: 3.1 (0.74),
ligating bracket C: 16 patients Group C: 3.9 (1.12)
(14.8 1.0 yrs) Mandibular crowding (mm):
Group A: 4.1 (0.99), Group B: 3.2 (1.12),
Group C: 3.8 (0.93)
Cattaneo et al., RCT A: Damon A: 21 patients Dental casts and Class I, II, and mild Class III MO, non-
2011 [16] B: In-Ovation (16.0 5.7 yrs) CBCT extraction treatment
(active self- B: 20 patients
ligating brackets) (15.0 3.3 yrs)
Fleming et al., RCT A: Damon Q A: 32 patients Cephalometric Any type of MO with maxillary crowding
2013 [14] B: In-Ovation C (18.9 2.9 yrs) radiographs and <6 mm, non-extraction treatment
C: Ovation B: 32 patients dental casts Maxillary crowding (mm):
(conventional) (22.5 8.5 yrs) Group A: 2.3 (2.64), Group B: 2.59 (1.99),
C: 32 patients Group C: 2.56 (2.22)
(18.6 3.4 yrs)
Shook et al., Retrospe-ctive A:Conventional A: 45 patients Digital models Any type of MO, non-extraction
2014 [15] study B: Damon (15.0 3.5 yrs) treatment
B: 39 patients Maxillary crowding (mm):
(15.3 4.1 yrs) Group A: 1.69 (4.17), Group B: 2.41
(3.09),
Tecco et al., Prospe-ctive A:Conventional A: 20 patients Dental casts Any type of MO with low mand plane
2009 [18] Clinical Trial B: Self-ligating B: 20 patients angle, normal OB, mild crowding
(Damon-3MX, Mean age 15.8 yrs
Ormo) (range 14 to 30 yrs)
Vajaria et al., Retrospe-ctive A: Damon A: 27 patients Cephalometric Class I MO with
2011 [17] study B: Conventional B: 16 patients radiographs and maxillary constriction
A mean age not listed dental casts
GRADE, the overall quality of evidence supporting this out- Only one study found a greater maxillary incisor proclination in a
come is moderate (table VI). Damon treatment group [17]. According to GRADE, the overall
quality of evidence supporting this outcome is low (table VI).
Changes in inclination of anterior teeth
4 out of 7 included studies compared the axial inclination of Comparison between the treatment groups
anterior teeth before and after the treatment (table III). The All studies concluded that there is no significant difference in the
majority of studies showed a proclination of maxillary incisor final transverse dimension between the Damon and the con-
teeth after the treatment in all treatment groups [12–14]. In the ventional bracket system (table VIII). Yet, there were some
Damon group, the average proclination of maxillary incisor minor differences between included studies. Atik and Ciger
(based on U1-SN8) was 3.50 5.528, while in their comparison found a greater increase in maxillary molar inclination in the
groups, the average proclination was 3.13 4.318 (table VII). Damon treatment group [12]. Also, Vajaria et al. found a greater
625
TABLE II
Characteristics of included studies.
Study group and year Treatment group Treatment sequence (Archwire progression protocol)
(A, B, vs C)
Atik and Ciger A: Quad helix and conventional Group A: Quad helix used until lingual cusps of max first molars contacts with
2014 [12] B: Damon 3MX bracket buccal cusps of mand first molars. Then, a sequence of Ormco 0.014 Cu-NiTi, 0.018
Cu-NiTi, 0.014 0.025 Cu-NiTi, 0.017 0.025 Cu-NiTi, 0.017 0.025 SS, and
0.019 0.025 SS archwires were used.
Group B: A sequence of Damon arch form 0.014 Cu-NiTi, 0.018 Cu-NiTi,
0.014 0.025 Cu-NiTi, 0.017 0.025 Cu-NiTi, 0.017 0.025 SS, and 0.019 0.025
SS archwires were used.
Atik et al., A: Self-ligating (Nexus) All groups were treated with a sequence of Damon arch form 0.014 Cu-NiTi, 0.018
2016 [13] B: Conventional Cu-NiTi, 0.014 0.025 Cu-NiTi, 0.017 0.025 Cu-NiTi, 0.017 0.025 SS, and
C: Passive self-ligating bracket 0.019 0.025 SS archwires.
Cattaneo et al., A: Damon Group A: Archwire selection based on the Damon Work-book protocol
2011 [16] B: In-Ovation (active self-ligating Group B: Treatment protocol based on GAC recommendation
brackets)
Fleming et al., A: Damon Q All groups were treated with a sequence of Damon arch form 0.013 Cu-NiTi, 0.014
2013 [14] B: In-Ovation C Cu-NiTi, 0.014 0.025 Cu-NiTi, 0.018 0.025 Cu-NiTi, and 0.019 0.025 SS
C: Ovation (conventional) archwires.
Shook et al., A:Conventional Group A: A sequence of 0.014 Cu-NiTi, 0.018 Cu-NiTi, 0.018 0.025 SS OrthoForm
2014 [15] B: Damon III Ovoid arch forms (3 M Unitek) were customized to arch shape
Group B: A sequence of Damon arch form 0.014 Cu-NiTi to 0.018 0.025 Cu-NiTi
archwires were used
Tecco et al., A:Conventional Group A: A sequence of 3 M Unitek 0.016 Cu-NiTi followed by 0.019 0.025 Cu-
2009 [18] B: Self-ligating (Damon-3MX, Ormo) NiTi (OrthoForm II), non-specified rectangular archwires were used
Group B: A sequence of Ormco 0.014 Cu-NiTi, 0.016 Cu-NiTi, 0.016 0.025 Cu-NiTi,
and non-specified rectangular archwires were used
Vajaria et al., A: Damon Group A: A sequence of Damon arch form 0.012 to 0.014 Cu-NiTi, 0.016 Cu-NiTi,
2011 [17] B: Conventional 0.014 0.025 Cu-NiTi, 0.018 0.025 Cu-NiTi, and 0.019 0.025 SS or TMA
archwires were used.
Group B: A sequence of Ormo 0.013 Cu-Niti, 0.014 Cu-Niti, Highland Metals 0.016
Cu-Niti, Oscar 0.016 SS, Rocky Mountain 0.016 0.022 SS archwires were
customized to arch shape
TABLE III
Qualitative and quantitative summary of the individual study results (Skeletal and dental changes within the group).
Study group Treatment group Records time Main Statistically Significant Findings (Changes within the group from T0-T1)
and year (A, B, vs C) point
Atik and Ciger A: Quad helix and T0: before tx Group A
2014 [12] Conventional bracket T1: after tx Decrease in OJ ( 1.05 1.37 mm), Increase in intercanine (2.02 1.67 mm), interfirst
B: Damon 3MX (13.2-15.3 premolar (5.72 1.70 mm), intersecond premolar (5.04 2.15 mm), intermolar (3.83
bracket months) 1.57 mm) widths
Increase in max incisor proclination (U1-SN8: 1.95 4.648)
Group B
Decrease in OJ ( 1.16 1.77 mm), Increase in intercanine (2.53 2.16 mm), interfirst
premolar (5.06 2.41 mm), intersecond premolar (4.90 2.55 mm), intermolar (3.43
1.80 mm) widths
Increase in max incisor proclination (U1-SN8: 3.68 3.648)
Atik et al., A: Self-ligating T0: before tx Group A
2016 [13] (Nexus) T1: after tx Increase in intercanine (2.03 1.33 mm), interfirst premolar (4.03 1.53 mm),
B: Conventional (13.2–14.6 intersecond premolar (3.52 1.21 mm), intermolar (2.34 1.14 mm) widths
C: Passive self- months) Increase in max incisor proclination (U1-SN8: 4.00 4.428)
ligating bracket
(Damon)
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Systematic review
TABLE III (Continued).
Study group Treatment group Records time Main Statistically Significant Findings (Changes within the group from T0-T1)
and year (A, B, vs C) point
Group B
Increase in intercanine (2.02 W 0.95 mm), interfirst premolar (4.05 W 1.75 mm),
intersecond premolar (3.23 W 0.94 mm), intermolar (2.61 W 2.13 mm) widths
Increase in max incisor proclination (U1-SN-: 3.06 W 2.44-)
Group C
Increase in intercanine (2.53 W 2.16 mm), interfirst premolar (5.07 W 2.41 mm),
intersecond premolar (4.9 W 2.55 mm), intermolar (3.43 W 1.80 mm) widths
Increase in max incisor proclination (U1-SN-: 3.68 W 3.64-)
Cattaneo A: Damon T0: before tx Group A
et al., 2011 B: In-Ovation (active T1: after tx Increase in intercanine (1.4 W 1.7 mm), interfirst premolar (4.3 W 1.6 mm), intersecond
[16] self-ligating (21.1–22.4 premolar (4.0 W 1.9 mm), intermolar (1.9 W 1.2 mm) widths
brackets) months) Increase in buccal inclination of first premolar (11.7 W 9.7-)
Increase in buccal inclination of second premolar (13.5 W 8.1-)
Group B
Increase in intercanine (0.7 W 1.7 mm), interfirst premolar (4.5 W 1.6 mm), intersecond
premolar (3.3 W 1.8 mm), intermolar (1.3 W 1.3 mm) widths
Increase in buccal inclination of first premolar (11.8 W 12.4-)
Increase in buccal inclination of second premolar (13.0 W 9.1-)
Fleming et al., A: Damon Q T0: before tx Group A
2013 [14] B: In-Ovation C T1: after tx Increase in intercanine (1.97 W 2.16 mm), interfirst premolar (4.51 W 2.68 mm),
C: Ovation (Minimum of intersecond premolar (3.96 W 2.51 mm), intermolar (1.22 W 2.26 mm) widths
(conventional) 8.5 months) Increase in max incisor proclination (1.12 W 3.88-)
Group B
Increase in intercanine (1.78 W 2.21 mm), interfirst premolar (3.75 W 2.31 mm),
intersecond premolar (3.78 W 1.91 mm), intermolar (1.82 W 1.59 mm) widths
Increase in max incisor proclination (3.25 W 6.89-)
Group C
Increase in intercanine (0.88 W 2.18 mm), interfirst premolar (3.7 W 3.19 mm),
intersecond premolar (3.59 W 2.80 mm), intermolar (1.41 W 2.08 mm) widths
Increase in max incisor proclination (2.84 W 5.68-)
Shook et al., A:Conventional T0: before tx Group A
2014 [15] B: Damon T1: after tx No significant difference in intercanine (0.10 mm) and intermolar (0.53 mm) width
(Mean of 25.6
months)
Group B
No significant difference in intercanine (S0.29 mm) and intermolar (0.86 mm) width
Tecco et al., A:Conventional T0: before tx Group A
2009 [18] B: Self-ligating T1: 12 months Increase in intercanine (2.6 W 2.4 mm), interfirst premolar (4.3 W 2.1 mm), intersecond
(Damon-3MX, Ormo) into tx premolar (4.1 W 2.1 mm), intermolar (2.4 W 2.0 mm) widths
Group B
Increase in intercanine (3.3 W 2.6 mm), interfirst premolar (4.4 W 2.5 mm), intersecond
premolar (4.2 W1.8 mm), intermolar (2.3 W 1.5 mm) widths
Vajaria et al., A: Damon T0: before tx Group A
2011 [17] B: Conventional T1: after tx (not Increase in intercanine (1.74 W 3.44 mm), interfirst premolar (2.87 W 3.03 mm),
specified) intersecond premolar (2.77 W 3.19 mm), intermolar (2.79 W 1.60 mm) widths
Increase in max incisor proclination (U1-SN-: 3.13 W 8.05-)
Group B
Increase in intercanine (1.72 W 2.72 mm), interfirst premolar (3.44 W 1.80 mm),
intersecond premolar (2.87 W 2.41 mm), intermolar (0.60 W 2.42 mm) widths
Increase in max incisor proclination (U1-SN-: 3.50 W 5.22-)
627
TABLE IV
Averaged Dental Expansion (Maxillary intercanine distance in mm).
Atik and Ciger 2014 [12] 2.02 1.67 2.79 2.53 2.16 4.67
Atik et al., 2016 [13] 2.03 1.33 1.77 2.53 2.16 4.67
Atik et al., 2016 [13] 2.02 0.95 0.90
Cattaneo et al., 2011 [16] 0.70 1.70 2.89 1.40 1.70 2.89
Fleming et al., 2013 [14] 1.78 2.21 4.88 1.97 2.16 4.67
Fleming et al., 2013 [14] 0.88 2.18 4.75
Tecco et al., 2009 [18] 2.60 2.40 5.76 3.30 2.60 6.76
Vajaria et al., 2011 [17] 1.72 2.72 7.40 1.74 3.44 11.83
Average 1.72 1.97 3.89 2.25 2.43 5.91
*Shook et al., 2014 [15] was not included since the STDEV was not reported with the average value.
TABLE V
Averaged Dental Expansion (Maxillary intermolar distance in mm).
Atik and Ciger 2014 [12] 3.83 1.57 2.46 3.43 1.80 3.24
Atik et al., 2016 [13] 2.34 1.14 1.30 3.43 1.80 3.24
Atik et al., 2016 [13] 2.61 2.13 4.54
Cattaneo et al., 2011 [16 1.30 1.30 1.69 1.90 1.20 1.44
Fleming et al., 2013 [14] 1.82 1.59 2.53 1.22 2.26 5.11
Fleming et al., 2013 [14] 1.41 2.08 4.33
Tecco et al., 2009 [18] 2.40 2.00 4.00 2.30 1.50 2.25
Vajaria et al., 2011 [17] 0.60 2.42 5.86 2.79 1.60 2.56
Average 2.04 1.83 3.34 2.51 1.72 2.97
*Shook et al., 2014 [15] was not included since the STDEV was not reported with the average value.
TABLE VI
GRADE's summary of findings for randomized controlled trials. Dental Changes Associated with the Damon System Compared to a
Conventional Bracket System or an Expansion Appliance. A qualitative descriptive analysis of the results was performed; meta-analysis
was not performed due to differences in methodology.
Population: Patients with any type of malocclusion with maxillary arch crowding, Intervention Orthodontic treatment following the Damon system philosophy, Comparison: Orthodontic
treatment using any conventional bracket/archwire system or any type of maxillary expansion appliance, Outcome: Maxillary dental and skeletal changes.
Maxillary Intercanine Distance assessed with: Dental casts, PA ceph, CBCT follow up: mean 14.3 months 3 RCTs 67 in Damon group *
101 in comparison group Moderatea
Maxillary Intermolar Distance assessed with: Dental casts, PA ceph, CBCT follow up: mean 14.3 months 3 RCTs 67 in Damon group *
101 in comparison group Moderatea
Maxillary Incisor Proclination assessed with: Cephalometric Radiograph follow up: mean 10.9 months 2 RCTs 48 in Damon group **
81 in comparison group Lowa,b
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is
substantially different
Low certainty: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
a
Need bigger sample size. Total number of participants is less than 400.
b
One out of two studies have unclear risk of bias.
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Systematic review
TABLE VII
Averaged Maxillary Intercanine Proclination (Based on U1-SN, unit in-).
Atik and Ciger 2014 [12] 1.95 4.64 21.53 3.68 3.64 13.25
Atik et al., 2016 [13] 4.00 4.42 19.54 3.68 3.64 13.25
Atik et al., 2016 [13] 3.06 2.44 5.95
Vajaria et al., 2011 [17] 3.50 5.22 27.25 3.13 8.05 64.80
Average 3.13 4.31 18.57 3.50 5.52 30.43
* Fleming et al., 2013 [14] was not included since reference plane was not specified.
increase in maxillary intermolar width after treatment in the study was assessed as a low risk of bias. Two other RCT studies
Damon group [17]. However, all other measurements (maxillary were assessed as an unclear risk of bias since the detailed
intercanine, interfirst premolar, and intersecond premolar process of allocation was not clearly stated in the methods
widths) showed no significant difference between groups [17]. section.
MINORS was used to analyse prospective clinical trials and
Risk of bias of included studies retrospective cohort studies included in this review (table IX).
Cochrane bias tool was used to analyse three randomized Two studies were assessed as a medium risk of bias. Two
controlled trials (RCT) included in this study (figure 2). One remaining studies were assessed as a high risk of bias mainly
TABLE VIII
Qualitative summary of the individual study results. (Skeletal and dental changes between the group).
Study group and year Treatment group Records time point Statistically Significant Findings (Changes between
(A, B, vs C) the group from T0 –T1)
Atik and Ciger 2014 [12] A: Quad helix and T0: before tx No difference between groups in transverse
Conventional bracket T1: after tx (13.2–15.3 months) dimension
B: Damon 3MX bracket Greater increase in max molar inclination in group B
Atik et al., 2016 [13] A: Self-ligating T0: before tx No difference between groups in transverse
B: Conventional T1: after tx dimension
C: Passive self-ligating (13.2–14.6 months)
bracket
Cattaneo et al., 2011 [16] A: Damon T0: before tx No significant difference in inter-premolar bucco-
B: In-Ovation (active self- T1: after tx lingual inclination between two groups
ligating brackets) (21.1–22.4 months) Bone area decrease 20% in Damon, 14% in In-
Ovation group
Fleming et al., 2013 [14] A: Damon Q T0: before tx No significant difference in transverse dimension,
B: In-Ovation C T1: after tx incisal and molar inclination between three groups
C: Ovation (conventional) (Minimum of 8.5 months)
Shook et al., 2014 [15] A:Conventional T0: before tx No difference between groups in transverse
B: Damon T1: after tx dimension
(Mean of 25.6 months)
Tecco et al., 2009 [18] A:Conventional T0: before tx No difference between groups in transverse
B: Self-ligating (Damon- T1: 12 months into tx dimension
3MX, Ormo)
Vajaria et al., 2011 [17] A: Damon T0: before tx No difference between groups in transverse
B: Conventional T1: after tx (not specified) dimension
Greater increase in maxillary intermolar width in
group A
629
Figure 2
Cochrane Bias Tool Summary Chart. The plus sign indicates a low risk of bias. The question mark indicates unclear risk of bias. The
minus sign indicates a high risk of bias.
630
Systematic review
due to inadequate reporting of characteristics of treatment
equivalence statistical Score
Adequate Total
Score 0 (not reported), 1 (reported but inadequate), or 2 (reported and adequate). The ideal total score is 16 for non-comparative studies and 24 for comparative studies. Total score of 24 indicates a low risk of bias. A score between 20–
20
20
18
17
analyses groups.
Discussion
The Damon system, one of the perceived leading self-ligating
2
2
bracket systems, has been widely used by many orthodontists.
of groups
Prospective An adequate Contemporary Baseline
Some clinicians may see less of a need for extraction with the
Damon system because of its claim that a light force and a low
2
0
follow-up
2
of the study
endpoint
pletion of treatment (table III). However, one study did not find a
significant increase in maxillary intercanine and intermolar
0
the study
cases were finished with copper Niti archwires [15]. Also, even
in a conventional treatment group, their final few archwires
2
low pressure from the Damon archwire system and the resting
patients
Tecco et al.,
2014
2009
2011
Systematic review
References
[1] Proffit WR, Fields HW. The biologic basis of [10] Basciftci FA, Akin M, Ileri Z, Bayram S. Long- [17] Vajaria R, BeGole E, Kusnoto B, Galang MT,
orthodontic therapy. In: Contemporary Ortho- term stability of dentoalveolar, skeletal, and Obrez A. Evaluation of incisor position and
dontics. 2nd ed. St Louis MI: C.V. Mosby Co; soft tissue changes after non-extraction treat- dental transverse dimensional change using
1993p. 266–88. ment with a self-ligating system. Korean J the Damon system. Angle Orthod 2011;81:
[2] Damon D. Damon system: the workbook. Orthod 2014;44:119–27. 647–652.
Orange, CA: Ormco; 2004. [11] Scott P, DiBiase AT, Sherriff M, Cobourne MT. [18] Tecco S, Tetèe S, Perillo L, Chimenti C, Festa
[3] Damon DH. The Damon low-friction bracket: Alignment efficiency of Damon3 self-ligating F. Maxillary arch width changes during ortho-
a biologically compatible straight-wire sys- and conventional orthodontic bracket sys- dontic treatment with fixed self-ligating and
tem. J Clin Orthod 1998;32:670–80. tems: a randomized clinical trial. Am J Orthod traditional straight-wire appliances. World J
[4] Wright N, Modarai F, Cobourne MT, DiBiase Dentofacial Orthop 2008;134:470 [e1-e8]. Orthod 2009;10:290–4.
AT. Do you do Damon®? What is the current [12] Atik E, Ciğer S. An assessment of conven- [19] Barron TW, Bogdan F. A practical treatment
evidence base underlying the philosophy of tional and self-ligating brackets in Class I max- objective: alveolar bone modeling with a
this appliance system?. J Orthod 2011;38: illary constriction patients. Angle Orthod fixed continuous-arch appliance. Clinical
222–230. 2014;84:615–22. Impressions 2017;20:1–18.
[5] Higgins JP, Altman DG, Gøtzsche PC, et al. The [13] Atik E, Akarsu-Guven B, Kocaderell I, Ciger S. [20] Sun Z, Smith T, Kortam S, Kim DG, Tee BC,
Cochrane Collaboration's tool for assessing Evaluation of maxillary arch dimensional and Fields H. Effect of bone thickness on alveolar
risk of bias in randomised trials. BMJ inclination changes with self-ligating and con- bone-height measurements from cone-beam
2011;343:d5928. ventional brackets using broad archwires. Am computed tomography images. Am J Orthod
[6] Slim K, Nini E, Forestier D, Kwiatkowski F, J Orthod Dentofacial Orthop 2016;149:830–7. Dentofacial Orthop 2011;139:e117–27.
Panis Y, Chipponi J. Methodological index for [14] Fleming PS, Lee RT, Marinho V, Johal A. [21] Leung CC, Palomo L, Griffith R, Hans MG.
non-randomized studies (MINORS): develop- Comparison of maxillary arch dimensional Accuracy and reliability of cone-beam com-
ment and validation of a new instrument. ANZ changes with passive and active self-ligation puted tomography for measuring alveolar
J Surg 2003;73:712–6. and conventional brackets in the permanent bone height and detecting bony dehiscences
[7] Yu YL, Tang GH, Gong FF, Chen LL, Qian YF. A dentition: a multicenter, randomized con- and fenestractions. Am J Orthod Dentofacial
comparison of rapid palatal expansion and trolled trial. Am J Orthod Dentofacial Orthop Orthop 2010;137:109–19.
Damon appliance on non-extraction correc- 2013;144:185–93. [22] Ballanti F, Lione R, Fanucci E, Franchi L,
tion of dental crowding. Shanghai Kou Qiang [15] Shook C, Kim S, Burnheimer J. Maxillary arch Baccetti T, Cozza P. Immediate and post-
Yi Xue 2008;17:237–42. width and buccal corridor changes with Damon retention effects of rapid maxillary expansion
[8] Fleming PS, Lee RT, Mcdonald T, Pandis N, and conventional brackets: a retrospective ana- investigated by computed tomography in
Johal A. The timing of significant arch dimen- lysis. Angle Orthod 2016;86:655–60. growing patients. Angle Orthod 2009;79:24–
sional changes with fixed orthodontic appli- [16] Cattaneo PM, Treccani M, Carlsson K, et al. 9.
ances: data from a multicenter randomized Transversal maxillary dento-alveolar changes [23] Reitan K. Tissue reaction as related to the age
controlled trial. J Dent 2014;42:1–6. in patients treated with active and passive factor. Dent Rec 1954;74:271–9.
[9] Atik E, Taner T. Stability comparison of two self-ligating brackets: a randomized clinical [24] Goz G. The age dependence of the tissue
different dentoalveolar expansion treatment trial using CBCT-scans and digital models. reaction in tooth movements. Fortschr Kiefer-
protocols. Dental Press J Orthod 2017;22:74–82. Orthod Craniofac Res 2011;14:223–33. orthop 1990;51:4–7.
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