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Risk of bias summary: review authors' judgments about each risk of bias item for each included study.
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Figure 1

Risk of bias summary: review authors' judgments about each risk of bias item for each included study.

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Flow diagram of study inclusion.
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Figure 2

Flow diagram of study inclusion.

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Comparison 1 Self etching primers versus conventional etchants, Outcome 1 Bond failure rate (5 to 37 months).
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Analysis 1.1

Comparison 1 Self etching primers versus conventional etchants, Outcome 1 Bond failure rate (5 to 37 months).

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Summary of findings for the main comparison. Self etching primers compared with conventional etchants for bonding fixed orthodontic brackets

Participants or population: Children and adults with fixed orthodontic brackets

Settings: Clinical (typically university dental clinics)

Intervention: Self etching primers (one‐step etchant and primer system)

Comparison: Conventional etchants (two‐step etch and prime method using 37% phosphoric acid)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Conventional etchants

Self etching primers

Bond failure rate (5 to 37 months)

196 per 1000

223 per 1000
(147 to 339)

RR 1.14 (0.75 to 1.73)

221
(5)

⊕⊕⊝⊝1, 2
low

Five more studies, which we were unable to include in the meta‐analysis, reported mixed results (Additional Table 2)

Decay (decalcification) associated with or around the etching field

Only one study (Ghiz 2009) assessed this outcome but data were reported at the tooth level rather than at the participant level and therefore was not amenable to analysis using Cochrane methods

Participant satisfaction

No studies assessed this outcome

Cost of treatment

No studies assessed this outcome

Damage to the teeth

No studies assessed this outcome

*The assumed risk is the median control group risk across studies. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Two studies at low risk of bias, one at unclear risk, but two with serious risk of selection bias.
2Low total number of events and the 95% CI includes both no effect and appreciable benefit and harm.

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Summary of findings for the main comparison. Self etching primers compared with conventional etchants for bonding fixed orthodontic brackets
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Table 1. Raw data for comparison 1.1

SEP

no failure

SEP

≥ 1 failure

Conventional

no failure

Conventional

≥ 1 failure

Total

Aljubouri 2004

46

5

41

10

102

Elekdag‐Turk 2008a

27

12

34

5

78

Elekdag‐Turk 2008b

35

2

35

2

74

Banks 2007

17

13

19

11

60

Manning 2006

7

10

8

9

34

Total

132

42

137

37

348

The actual total number of participants is 221, rather than 348, as the top three split‐mouth studies included the participants in both intervention groups.

SEP = self etching primer.
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Table 1. Raw data for comparison 1.1
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Table 2. Study data not included in comparison 1.1 meta‐analysis

Comparison

Results for bond failure rate (analyzed at tooth level) at 6 to 12 months

Asgari 2002

Transbond Plus SEP versus conventional

"The 'p' value of .037 indicated that the bond failure rate using Transbond Plus Self Etching Primer was significantly less than the bond failure rate in those quadrants where a 37% phosphoric acid etchant was used"

Cal‐Neto 2009

Transbond Plus SEP versus conventional

"There was no significant difference in terms of bracket failure risk over the 12 months between groups... P = 0.311)"

House 2006

Ideal 1 SEP versus conventional

Odds ratio at 12 months = 15.1 (95% confidence interval 7.7 to 29.3) for failure of SEP relative to conventional. Recruitment was stopped early due to high failure rate of SEP group

Ireland 2003

Transbond Plus SEP versus conventional

"The difference between the failure proportions was ‐0.06 with an associated 95% confidence interval of ‐0.121 to 0.001. This study produced weak evidence to suggest that bond failures with a self‐etching primer will be higher than those with conventional etching and priming"

Murfitt 2006

Transbond Plus SEP versus conventional

"Transbond Plus SEP was found to have a significantly higher failure rate than the conventional 37 per cent phosphoric acid and primer (P = 0.001)"

SEP = self etching primer.
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Table 2. Study data not included in comparison 1.1 meta‐analysis
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Comparison 1. Self etching primers versus conventional etchants

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Bond failure rate (5 to 37 months) Show forest plot

5

348

Risk Ratio (Random, 95% CI)

1.14 [0.75, 1.73]

1.1 Split‐mouth studies

3

254

Risk Ratio (Random, 95% CI)

1.09 [0.36, 3.25]

1.2 Parallel studies

2

94

Risk Ratio (Random, 95% CI)

1.14 [0.74, 1.76]
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Comparison 1. Self etching primers versus conventional etchants
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