Clinical, microbiological, and patient-reported outcomes of ceramic versus metallic orthodontic brackets: a prospective comparative study.

Introduction. Orthodontic fixed appliances significantly influence the oral environment by creating plaque-retentive surfaces that may alter microbial balance and periodontal health. Among available systems, ceramic and metallic brackets differ in their surface characteristics, mechanical properties, and aesthetic appeal. Aim of the study. This prospective observational study aimed to compare clinical periodontal indices, microbiological changes, and patient-reported outcomes between patients treated with ceramic and metallic orthodontic brackets. Methods. Sixty orthodontic patients aged 15–30 years were divided into two groups: metallic brackets (n = 30) and ceramic brackets (n = 30). Plaque Index and Gingival Index were recorded at baseline, 3 months, and 6 months. Subgingival plaque samples were analyzed qualitatively using phase-contrast microscopy. Patient satisfaction was assessed using a standardized Likert-scale questionnaire. Results. Results demonstrated significantly higher plaque accumulation and gingival inflammation in the ceramic bracket group at three months (PI: 1.48 vs. 1.21; GI: 1.15 vs. 0.92). Pathogenic microbial flora developed more frequently in ceramic bracket wearers (40%) compared with metallic bracket patients (20%). However, ceramic brackets showed superior aesthetic satisfaction scores. Following reinforcement of oral hygiene protocols, microbiological conditions improved in both groups at six months. Conclusions. Ceramic brackets offer clear aesthetic benefits, but may be associated with increased plaque retention and microbial imbalance. Strict oral hygiene protocols and patient compliance remain essential for maintaining periodontal health during orthodontic treatment.

DOI: https://doi.org/10.62838/ASMJ.2026.1.08