Is LightForce the new Damon?

We are all familiar with the story of self-ligating brackets, specifically the Damon appliance. Many of us may also remember the claims made by Damon Key Opinion Leaders (KOLs) that suggested faster treatment, greater comfort, and even the ability to grow bone. However, these claims did not hold up to scientific scrutiny, and the orthodontic profession was misled. 

Now, a new development in brackets and wires called LightForce is being heavily marketed with claims of faster treatment times, reduced visits, and greater efficiency per patient. But the question remains: Is Lightforce the new Damon?

What is LightForce?

LightForce is a complete 3D-printed bracket system developed by an orthodontist named Alfred Griffin. It features customised brackets for each patient, digital planning tools and indirect bonding trays. The manufacturer suggests the system is more efficient than conventional appliances because LightForce appliances are custom-made. LightForce has secured significant investments and is a growing company with extensive advertising. However, I found only one study in the literature, which is unsurprising, as they introduced their product to the profession in 2020.

A USA-based team did this study, and the Journal of Clinical Orthodontics published the paper.

What did they ask?

They did the study to.

“Compare the clinical efficiency and efficacy of treatment with LightForce brackets to treatment with conventional bracket systems”.

What did they do?

They did a retrospective study of patients they treated in one orthodontic practice using LightForce appliances.

The team obtained pre and post-treatment records from two groups of consecutively debond patients. These were

• One hundred three consecutively treated LightForce patients whom they debonded between October 2020 and July 2023. 
• Seventy-four consecutively completed conventional appliance patients debonded between January 2021 and December 2021. They treated these patients with a mixture of conventional appliances.

The main inclusion criteria were the availability of digital models and treatment with upper and lower fixed appliances.

They collected the following data

• Peer Assessment Rating scores
• Extractions prescribed
• Number of appointments, unscheduled appointments, loose brackets, and final upper and lower archwires. 

They analysed the data with the relevant univariate statistics.

What did they find?

At the start of treatment, there were no differences between the groups concerning age, clinical severity (PAR score), extractions or other relevant variables. The pre-treatment PAR scores for the LightForce were 19.8 and for the conventional, 19.0. These are mild to moderate malocclusions.

I extracted the most critical data from the detailed data presentation.

Nickel-titanium wires were used as final wires for 78% of LightForce and 34% of conventional brackets in the upper arch. Similarly, nickel-titanium wires were used as final wires for 65% of LightForce compared to 31% of conventional brackets for the lower arch. This suggests that the finishing process may have been more straightforward with LightForce brackets.

They did not put forward any conclusions in this paper. However, in a summary of the paper on the LightForce website, they suggested.

“LightForce integration enabled them to achieve great results while nearly cutting the number of appointments and treatment time in half”. 

What did I think?

It was good to see that this study was done. It marked the initial phase of evaluating the introduction of a new technology. Although the research was not published in an academic journal, it provided useful insights. When I analyzed the effect size they discovered, it appeared to be remarkable. This suggests that this innovation could be beneficial in a clinical setting in the future.

Nevertheless, we should be cautious as medical/dental research is full of initial study papers that overestimate the effect of a new development. The authors drew attention to several issues with their study. The most marked is that it was a retrospective analysis of completed cases. This means that there must be some selection bias. I have thought about possible sources for the bias, and these are.

• The sample only includes completed cases. As a result, we have no idea how many patients did not complete their treatment or had a compromised treatment result.

• I was also concerned to see that the sizes of the treatment groups were different. The authors explained that this was because of the non availability of digital casts for the conventional group. However, they could have analysed the plaster casts. Furthermore, they did not give any reasons for losing ten patients in the LightForce group.

• More importantly, the team selected consecutively completed cases that finished treatment over different time points. This means they may have only included the patients that completed first in a series of cases. As a result, the treatment times would be shorter. They could have avoided this problem by enrolling consecutively started patients. 

Final thoughts

LightForce seems to be a promising technological development. While it may have some advantages, we must also consider whether it can replicate or replace the clinical skills that an experienced orthodontist possesses. In this regard, it may affect the outcome of treatment of a newly qualified orthodontist or a general practitioner, but I am not sure about the experienced orthodontist who constantly adapts their mechanics. Therefore, we need to conduct research to determine if it is a viable option.

I want to emphasize that this study is a good initial step as it provides some useful information. However, we all know that to minimize bias, we need to conduct a randomized trial. I have conducted a quick sample size calculation using the data from this paper.  My findings suggest that a trial with 30 patients in each group would be needed to achieve 80% power and detect a treatment time difference of 3 months. This is not a large-scale trial, I think the developers of LightForce should be able to conduct it.

Finally, I need to mention the advertising campaign of  LightForce. It is disheartening that they are making claims of faster treatment time. This is impossible to validate from a single retrospective study that may have selection bias. Sadly, we have observed similar marketing tactics from other companies such as Damon, Propel, AcceleDent, Piezocision, and many more. It is regrettable that this company has chosen to adopt such an approach. It would be great to see the company carry out a trial into their interesting development.