Digital assessment of direct and virtual indirect bonding of orthodontic brackets: A clinical prospective cross-sectional comparative investigation.

Objective: The objective of this report is to use in orthodontic patients the methods of virtual indirect bonding and direct bonding using eye vision or loupes in order to compare their accuracy in the three dimensions of space.

Material And Methods: Brackets were directly placed by one clinician to 18 patients with a total number of 298 permanent teeth. Then loupes were used to improve bracket positioning. Intraoral scanning of the dental arches was performed before bonding, after direct bonding and after the use of loupes. Subsequently, an orthodontic software was used to virtually indirectly bond the brackets on the first intraoral scanning taken before bonding. A three-dimensional mesh processing software was used to superimpose the three scans and to perform measurements in the mesio-distal and occlusal-gingival dimensions as well as in the mesio-distal angulation.

Results: Virtual indirect bonding was more accurate in bracket positioning compared to direct bonding by eye vision or using loupes in all teeth and most of the teeth groups measured. Specific teeth and locations in the dental arch areas exhibited more bonding inaccuracies in the two direct bonding groups as compared to virtual indirect bonding. The use of loupes did not significantly increase the bonding accuracy compared to direct vision.

Conclusion: Indirect virtual bonding facilitated accurate bracket positioning compared to direct vision or with loupes direct bonding in the dimensions and angulation measured.