Bracket positioning have an impact on smile arc protection – a systematic review and meta-analysis

Authors

  • Mohammad Khursheed Alam Orthodontic Division, Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka 72345, Saudi Arabia, Department of Dental Research Cell, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Chennai 600077, India, Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh.
  • Huda Abutayyem Assistant Professor and Consultant Orthodontist. Department of Clinical Sciences, Center of Medical and Bio-Allied Health Sciences Research, College of Dentistry, Ajman University, Ajman, United Arab Emirates.
  • Manal J Almaslamani Department of Clinical Sciences, Center of Medical and Bio-Allied Health Sciences Research, College of Dentistry, Ajman University, Ajman P.O. Box 346, United Arab Emirates. Department of Clinical Sciences, Center of Medical and Bio-Allied Health Sciences Research, College of Dentistry, Ajman University, Ajman, United Arab Emirates.
  • Ruba Odeh Department of Clinical Sciences, Center of Medical and Bio-Allied Health Sciences Research, College of Dentistry, Ajman University, Ajman P.O. Box 346, United Arab Emirates. Department of Clinical Sciences, Center of Medical and Bio-Allied Health Sciences Research, College of Dentistry, Ajman University, Ajman, United Arab Emirates.

DOI:

https://doi.org/10.3329/bjms.v24i3.82964

Keywords:

Orthodontic bracket; smile arc protection; Orthodontic aesthetics; Orthodontic therapy

Abstract

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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Published

2025-07-25

How to Cite

Alam , M. K., Abutayyem, H., Almaslamani , M. J., & Odeh , R. (2025). Bracket positioning have an impact on smile arc protection – a systematic review and meta-analysis. Bangladesh Journal of Medical Science, 24(3), 984–994. https://doi.org/10.3329/bjms.v24i3.82964

Issue

Vol. 24 No. 3 (2025)

Section

Original Articles

License

Copyright (c) 2025 Mohammad Khursheed Alam , Huda Abutayyem, Manal J Almaslamani , Ruba Odeh

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