Orthodontic treatment with fixed appliances is frequently associated with compromised oral hygiene due to plaque retention around brackets, archwires, and ligatures [1]. The accumulation of dental plaque can result in gingivitis, enamel decalcification, and long-term periodontal sequelae if not adequately controlled [2]. Conventional orthodontic brackets require elastomeric or stainless-steel ligatures, which act as additional plaque retentive sites [3]. In contrast, self-ligating bracket systems incorporate a built-in locking mechanism that eliminates the need for external ligatures, theoretically reducing plaque accumulation [4]. Previous studies evaluating oral hygiene outcomes between bracket systems have yielded conflicting results, with some reporting improved periodontal parameters in self-ligating systems, while others show negligible differences [5,6]. Furthermore, limited prospective data from Indian clinical settings are available. Given the increasing use of self-ligating brackets and the importance of maintaining periodontal health during orthodontic treatment, the present study aimed to prospectively compare oral hygiene status in patients treated with self-ligating versus conventional brackets.

Study Design and Ethical Approval A prospective, comparative clinical study was conducted at a tertiary dental care center after obtaining institutional ethical clearance. Written informed consent was obtained from all participants. Sample Size and Allocation A total of 120 patients requiring fixed orthodontic therapy were enrolled and divided into two groups (n = 60 each): • Group A: Self-ligating bracket system • Group B: Conventional pre-adjusted edgewise brackets Inclusion Criteria • Age between 15 and 30 years • Permanent dentition • Good general health Exclusion Criteria • Periodontal disease at baseline • Systemic diseases affecting oral health • Antibiotic therapy in the previous 3 months Oral Hygiene Assessment Oral hygiene status was assessed using: • Plaque Index (Silness and Löe) • Gingival Index (Löe and Silness) • Oral Hygiene Index-Simplified (Greene and Vermillion) Assessments were performed at: • Baseline (T0) • 3 months (T1) • 6 months (T2) Statistical Analysis Data were analyzed using SPSS software. Independent t-tests and repeated-measures ANOVA were used. Significance was set at p < 0.05.

Table 1 (Baseline Oral Hygiene Parameters) At baseline, there were no statistically significant differences between the self-ligating and conventional bracket groups with respect to plaque index, gingival index, or OHI-S scores (p > 0.05). This indicates that both groups were comparable in terms of initial oral hygiene status prior to orthodontic appliance placement, ensuring uniformity for subsequent comparisons. Table 2 (Oral Hygiene Parameters at 3 Months) At the 3-month follow-up, patients treated with self-ligating brackets demonstrated significantly lower plaque accumulation, gingival inflammation, and overall oral hygiene scores compared to those with conventional brackets (p < 0.01). The findings suggest an early divergence in oral hygiene status, with conventional brackets showing greater plaque retention during the initial phase of orthodontic treatment. Table 3 (Oral Hygiene Parameters at 6 Months) By 6 months, the differences between the two groups became more pronounced. The conventional bracket group exhibited significantly higher plaque index, gingival index, and OHI-S scores than the self-ligating group (p < 0.001). This progressive deterioration indicates sustained plaque accumulation and gingival inflammation associated with conventional ligation over time. Table 4 (Change in Oral Hygiene Scores from Baseline to 6 Months) Analysis of score changes from baseline to 6 months revealed that the magnitude of increase in plaque, gingival inflammation, and overall oral hygiene deterioration was significantly greater in the conventional bracket group compared to the self-ligating group (p < 0.001). These results indicate that self-ligating brackets are associated with better maintenance of oral hygiene throughout the course of treatment. Table 1. Baseline Oral Hygiene Parameters Parameter Self-Ligating (Mean ± SD) Conventional (Mean ± SD) p-value Plaque Index 0.84 ± 0.21 0.86 ± 0.23 0.62 Gingival Index 0.79 ± 0.19 0.81 ± 0.20 0.58 OHI-S 1.32 ± 0.28 1.35 ± 0.30 0.55 Table 2. Oral Hygiene Parameters at 3 Months Parameter Self-Ligating Conventional p-value Plaque Index 1.12 ± 0.24 1.38 ± 0.27 <0.01 Gingival Index 1.05 ± 0.22 1.29 ± 0.25 <0.01 OHI-S 1.78 ± 0.31 2.10 ± 0.34 <0.01 Table 3. Oral Hygiene Parameters at 6 Months Parameter Self-Ligating Conventional p-value Plaque Index 1.20 ± 0.26 1.56 ± 0.29 <0.001 Gingival Index 1.10 ± 0.24 1.45 ± 0.28 <0.001 OHI-S 1.85 ± 0.33 2.32 ± 0.36 <0.001 Table 4. Change in Oral Hygiene Scores from Baseline to 6 Months Index Self-Ligating (Δ Mean) Conventional (Δ Mean) p-value Plaque Index +0.36 +0.70 <0.001 Gingival Index +0.31 +0.64 <0.001 OHI-S +0.53 +0.97 <0.001

The present study demonstrated that patients treated with self-ligating brackets maintained significantly better oral hygiene compared with those treated using conventional ligated brackets. These findings align with earlier investigations reporting reduced plaque retention around self-ligating systems due to the absence of elastomeric ligatures [7,8]. Elastomeric ligatures used in conventional brackets are known to harbor microorganisms and undergo surface degradation, increasing bacterial adherence [9]. This may explain the significantly higher plaque and gingival index scores observed in the conventional bracket group. At 3 and 6 months, statistically significant differences were observed across all oral hygiene indices. Similar trends have been reported in prospective studies that evaluated periodontal parameters during orthodontic treatment [10,11]. The progressive increase in plaque accumulation over time underscores the importance of appliance design in influencing oral hygiene. However, it is noteworthy that even self-ligating brackets demonstrated some deterioration in hygiene parameters over time, emphasizing that appliance type alone cannot eliminate plaque accumulation. Patient compliance with oral hygiene instructions remains a critical determinant [12]. Studies assessing oral hygiene behavior during orthodontic treatment have highlighted the role of patient education and motivation in maintaining periodontal health [13]. Evidence from institutional surveys and clinical audits has demonstrated that reinforcement of oral hygiene instructions significantly improves outcomes, regardless of bracket type [14]. Salivary factors, oral microbial shifts, and behavioral compliance also influence plaque accumulation during orthodontic therapy [15]. Previous work from Indian populations has emphasized the role of saliva and oral hygiene awareness in dental disease prevention, supporting the multifactorial nature of plaque control [16–20]. Limitations of the present study include the single-center design and relatively short follow-up period. Future studies incorporating microbiological analysis and longer observation periods would provide more comprehensive insights.

Self-ligating brackets demonstrated superior oral hygiene outcomes compared to conventional brackets during orthodontic treatment. Although both systems showed increased plaque accumulation over time, the absence of ligatures in self-ligating brackets appears to reduce plaque retention and gingival inflammation. Proper oral hygiene reinforcement remains essential irrespective of appliance type.

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