LightForce vs Conventional Brackets: Treatment Time and Failures

One of the most recent innovations in orthodontic treatment has been the introduction of customised bracket systems. These CAD/CAM systems Are all designed to improve bracket placement accuracy and thereby increase the effectiveness of orthodontic treatment. One of these systems is LightForce, which is heavily marketed in the USA. 

I have discussed two studies that have been produced by the Lightforce company and pointed out that these were significantly flawed. It is therefore good to see an independent study,Which is a retrospective evaluation of cases. The results provide us with further information on this new technology. 

A team from Connecticut, USA, carried out this research. The Anglo orthodontist published the paper. 

What did they ask?

They did this study too. 

“Examine the treatment outcomes and complications between customised ceramic brackets and conventional fixed appliances to determine whether the proposed advantages of customised systems result in measurable improvements in clinical performance and efficiency.” 

What did they do? 

They conducted a retrospective cohort study of orthodontic records from a multi-doctor, single-practice office in Connecticut, United States. 

This practice has used LightForce brackets since 2019. 

The team screened all the records of patients who completed comprehensive treatment between 2019 and 2025 on a non-extraction basis. Of these, 75 met the inclusion criteria. Thirty-six were treated with light force, and 39 with fixed appliances. 

The main inclusion criteria were that patients were 12 to 30 years old at the start of treatment, had fully erupted permanent dentition, and had complete pre- and post-treatment records. 

Four ABO-certified orthodontists with more than 14 years of experience treated all the patients. They gave the patients standardised verbal and written instructions, and there was no difference between the two systems in these instructions. Importantly, the archway sequences were based on treatment progress. 

They saw the patients every 4 to 5 weeks. 

The primary outcome measure was the ABO-OGS score at the End of treatment. Secondary outcomes were:

• the bracket failure
• emergency visits
• total scheduled visits
• overall treatment duration

What did they find? 

Thirty-six patients were treated with LightForce, and 39 were treated with conventional brackets. The groups did not differ in sex distribution, skeletal malocclusion, or ABO-DI scores. 

I have included the outcome-measure data in this table. 

	Conventional N=39	Lighforce N=36	Difference	P
ABO-OGS score	25.95 ([22.90 – 28.99]	29.31 (26.76 – 31.858	3.4 [-0.69 -7.4]]	0.061
Treatment Duration (months)	20.59  (18.96 – 22.21]	16.61 [15.35 – 17.84]	3.98 [-6.0 to -1.89]	<0.001
Scheduled appointments, n	14.87 (13.71 – 16.02]	12.86 [11.87 – 13.72]	-2.0 [-3.49 to -0.52]	0.012
Broken brackets, n	1.44 (0.69 – 2.19)	3.46 [2.44 – 4.47]	2.0 [0.75-3.2]	<0.001
Emergency appointments n	0.36 (0.13 – 0.58)	1.28 [0.999 – 1.56]	0.9 [0.55-1.24]	<0.001

I have calculated the differences in means and 95% confidence intervals using their data.  One important feature to note is that the 95% CIs are wide and this signifies that there is uncertainty in the data. This is likely to be due to the relatively small sample sizes.

The authors wrote a nice discussion on this data. They noted that the end of treatment ABO-OGS scores were similar between the groups, and that the 3-point difference was marginally significant. They also noted that the LightForce group had a shorter treatment duration of about 4 months, with fewer scheduled visits. However, they also pointed out that bracket-related complications were more frequent in the LightForce group, with more broken brackets and more emergency visits for bracket failure. 

Their final conclusions were: 

“LightForce achieved overall treatment quality comparable to conventional fixed appliances, but with an improved treatment efficiency. However, they were associated with a higher rate of bracket-related complications.” 

What did I think? 

The study offers a useful advance in research on customised brackets. I have noted that other preliminary publications have been significantly flawed. As a result, it is good to see that this paper provides us with more robust information. 

The results are clinically interesting. Importantly, the authors showed no real difference in the quality of finish. The most relevant finding was that LightForce required a shorter treatment time and fewer scheduled visits. However, LightForce had more bracket failures, so the differences in the number of visits were reduced. As a result, this study reflects the effectiveness of LightForce, which is influenced by “swings and roundabouts”. 

The authors highlighted several deficiencies in the study design. These included the study’s retrospective nature and, importantly, a lack of information on the patient-selection method and how many patient records were searched. It also struck me that the sample size was rather low, given the almost 6-year data collection period. This suggests there may be considerable selection bias in this study. 

Nevertheless, as I said before, this is a step in the right direction, and it would be great to see some randomised trials in this area. At the moment, these new developments do not seem to offer many clinically significant advantages.