Bracket positioning have an impact on smile arc protection – a systematic review and meta-analysis
DOI:
https://doi.org/10.3329/bjms.v24i3.82964Keywords:
Orthodontic bracket; smile arc protection; Orthodontic aesthetics; Orthodontic therapyAbstract
Background and objectives The available literature concerning bracket positioning and its relationship with smile arc protection (SAP) lacks adequate methodology and significant sample sizes. The majority of the literature consists of case reports with small sample sizes, cross-sectional studies, in vitro studies, literature reviews, and systematic reviews. Thus, the principal objective of this study was to assess the existing literature on bracket positioning and its influence on SAP, and to amalgamate the data from various studies to generate a comprehensive analysis of the effectiveness of bracket positioning in achieving SAP. Selection criteria and search protocol: Databases of Cochrane Library, EMBASE, PubMed, MEDLINE, Scopus and Google Scholar were searched using predetermined selection criteria. Analysis protocol: The Newcastle-Ottawa Scale (NOS) was employed for the evaluation of bias in the studies included in the review. Results Three relevant studies were considered for inclusion in the review. Odds ratio (OR) of 0.53 with a 95% confidence interval (CI) of 0.33 to 0.85, and risk ratio (RR) of 0.64 with a 95% CI of 0.45 to 0.90 were obtained after meta-analysis, indicating a significant impact of bracket positioning on SAP. The test for overall effect also demonstrated a statistically significant effect of bracket positioning on SAP. Conclusion and further implications: The findings suggest that bracket positioning has a noticeable impact on SAP, with decreased odds or relative risk of protection associated with improper positioning. However, the level of heterogeneity between the studies suggests that further research is needed to confirm these findings. The limitations of the study include the small number of studies under review and the variability in study designs and methods. Registration and protocol: Registration was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards [CRD42023407270]. The research protocol was created to meet the goals and was properly filed with PROSPERO.
BJMS, Vol. 24 No. 03 July’25 Page : 984-994
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Copyright (c) 2025 Mohammad Khursheed Alam , Huda Abutayyem, Manal J Almaslamani , Ruba Odeh

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