February 19, 2024

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.


Clinical Efficiency of LightForce 3D-Printed Custom Brackets

Alexander Waldman et al

Journal of Clinical Orthodontics. May 2023

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.

Outcome/Treatment groupLightforceConventionalP
Treatment time (months14.2 (6.5)26.0 (8.1)<0.001
Appointments8.3 (3.1)14.0 (5.3)<0.001
Loose brackets3.5 (4.8)5.6 (4.9)0.0001
Final PAR4.8 (4.8)6.9 (4.6)0.0021
PAR improvement (%)74.0 (0.3)57.0 (0.3)

They pointed out that the LightForce mean treatment time was 45% less than that of the conventional appliance.

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.

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Have your say!

  1. Since they were all finished with preformed, nickel, titanium wires, the ability to maintain original arch form and entertain nine dimensions is not possible. Therefore, long-term stability is doomed.

    • I totally agree sir. Stability is definitely compromised. With expanded arch wires in Damon system promising lateral bone development is bizarre. What about respect of inter canine width and more then 20 plus research articles on the stability….. suggesting us not the alter the width or arch forms.

  2. I am not a believer in self-ligation. But I am a believer that friction is critically important. Do these plastic brackets have less friction that metal brackets with metal wires?
    Also the shape of nitie wires is a seriously underestimated factor. Ovoid, square, tapered shapes in small, medium, and large ovoid is critical to reducing friction, faster leveling, smoother mechanics, and better retention. Ooops, I don’t have a study to prove this….

  3. We are piloting LightForce in our office right now. We are starting with 10 cases to see how they go. I will say the Damon comparison is not a totally fair comparison. LightForce does not claim their product can move teeth more quickly than another appliance. It is also does not promote a certain system of treatment or any special mechanics. I actually like that the basis of their shorter treatment time claim is based on the concept of precision. Whether it is true or not is yet to be seen, but in concept I like that type of claim. There is no additional risk to the patient versus any other bracket, so I put this in the “can’t hurt/might help” category. It is an expensive bracket that doesn’t really claim to be anything more than that. I am interested to see if it truly delivers a more precise result, leading to better finishes and reduced treatment time. I agree with your conclusion that we need more information and only time and additional research will tell.

  4. Good evening Sir,

    Thank you for this article. Customised appliances have yet to displace conventional fixed appliances completely but they are increasingly in vogue.

    Are there any RCTs available that show how long does it take to move the roots into correct position? Faster treatment with any technique would be welcomed by the profession and patients alike if the results are stable and are comparable to already accepted and more widely practiced slower techniques.

    Also, do we keep ordering new brackets with Lightforce in case of severely rotated or partially erupted teeth ? Especially, where there is no room to place a bracket in the middle of the middle third from the start?

    Thank you for your guidance always.

    Yours sincerely,

    Karun Sagar, BDS
    Orthodontic Assistant

  5. What is the Orthodontic problem we are treating?
    Spacing,crowding ,deep bite ,open bite ?
    Is treatment planned force based or appliance based .

  6. Regrettably when I read comments about this people leave out some really important facts. Most importantly with Lightforce is that it is a custom printed ceramic not plastic slot. Clinicians need to appreciate that custom set up custom slot appliances just align quicker because there is not a lot of round tripping. I have several hundred Lightforce cases. It is just a better system than a pre stock generic bracket. It minimizes the number of bends that need to be placed into the wires to finish. Many things are left out in this discussion such as how and why you need to take the time to critically look at setups prior to approving them. I don’t think lightforce is magic but I do think it is clever. It is not perfect and has some obstacles to overcome like debris in the molar slot. All that said I think it is fair to say it is a good product. Bashing it because you don’t understand it is not helpful. But I will say the indirect bonding system is nothing short of brilliant as it is predictable and easy to utilize.

  7. Would be interesting to compare with Ormco’s Insignia as this is also a system with fully customised brackets (and archwires…). Nothing new?

  8. I believe that two enduring myths in orthodontics are that friction is a problem when moving teeth and that the speed of tooth movement can be increased by changing the design of the bracket.

    Regarding friction Burrow argues that binding, not friction is the main component of resistance to sliding during tooth movement (2009, https://doi.org/10.1016/j.ajodo.2008.09.023). Even so, if none of the force applied to the tooth was dissipated by overcoming friction/binding then all the force would be acting on the cells in the periodontal ligament, with possibly (even more) damaging consequences to the root and surrounding structures.

    Regarding the speed or rate of tooth movement, this occurs because of an individual patient’s biological response to a force placed on a tooth. There is no evidence that cells can discriminate between forces produced by different brackets. Orthodontic treatment with fixed appliances consists of four basic stages: alignment, levelling (including overbite reduction when necessary), space closure (including overjet reduction when necessary) and finishing. Differences in the time taken for each stage is usually due to the type of tooth movement occurring (tipping v bodily movement). Any time ‘saved’ in one stage (usually through tipping of teeth) has to be made up in another stage or a compromised result accepted.

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