Effect of sandblasting on the shear bond strength of recycled metal brackets: A systematic review and meta-analysis of in-vitro studies.

INTRODUCTION AND OBJECTIVE: Sandblasting is an efficient and economic method of rebonding brackets. Literature is divided regarding the Shear Bond Strength (SBS) associated with sandblasted brackets. Hence this systematic review was conducted to obtain conclusive evidence on the same. The aim was to compare the SBS between sandblasted brackets bonded to extracted human teeth and new brackets bonded on extracted teeth that have not been previously bonded. MATERIALS AND METHODS: The following databases were searched up to April 30, 2021: PubMed via Medline, Web of Science, LILACS, Cochrane, EMBASE and Scopus. Articles comparing SBS of a new bracket with that of a rebonded bracket following sandblasting were included. Two reviewers independently selected the studies, extracted the data and assessed the risk of bias which was based on a modification of the Risk Of Bias In Nonrandomized Studies of Interventions Tool (ROBINS-I). SBS data generated from the systematic review was summarized and a meta-analysis using random effects inverse-generic model was done. RESULTS: Sixteen studies generated 521 samples for the new bracket group and 391 samples for the sandblasted group. These sixteen studies showed a low risk of bias. Meta analysis reported the mean difference between the SBS of new and sandblasted brackets to be 0.85. (95 CI of -0.24 to 1.94). This difference can be clinically disregarded. The high degree of heterogeneity indicated by an I(2) of 87% led to a subgroup analysis. CONCLUSIONS: With the studies showing a high quality of evidence, it can be concluded that sandblasting is an efficient means of recycling debonded brackets without affecting SBS. The inherent deficiencies of in vitro bond strength studies should be borne in mind when making this conclusion. The study protocol was registered on the International Prospective Register of Systematic Reviews (Reg no: CRD42020193616).