Evaluating Direct and Indirect Bonding Techniques - A Comparative Approach to Orthodontic Practice

Abstract

AIM: This study provides a comparative analysis of direct bonding (DB), indirect bonding (IB), and CAD/CAM techniques, focusing on chairside time, treatment efficacy, bond failure rates, bracket placement accuracy, periodontal parameters, and white spot lesions (WSLs). The objective is to offer evidence-based guidance for clinical practice through a review of recent in vivo and in vitro studies.

METHODS: A manual and electronic search was conducted in PubMed, Google Scholar, and the Cochrane Library between December 2024 and January 2025 using keywords such as “direct bonding,” “indirect bonding,” “CAD/CAM,” and “orthodontics.” After applying specific inclusion and exclusion criteria, 21 studies were selected: 16 in vivo, 4 in vitro, and 1 combined. These studies compared bonding techniques regarding time efficiency, accuracy, bond failure, treatment efficacy, periodontal outcomes, and white spot lesions.

RESULTS: The reviewed studies revealed no consistent superiority among bonding techniques concerning bond failure rates or shear bond strength. Indirect bonding generally demonstrated greater accuracy in bracket placement and modest advantages in treatment duration and oral hygiene outcomes, including fewer WSLs. While overall treatment efficiency appeared comparable, IB and CAD/CAM techniques showed potential clinical benefits.

CONCLUSION: All bonding techniques demonstrate comparable overall effectiveness, with no clear advantage in bond strength or failure rates. Indirect bonding and CAD/CAM methods may provide slight clinical benefits in accuracy and oral hygiene, especially in complex cases.