## 3 Results
### Efficiency Outcomes  
#### 3.1.1 Patient Comfort and Pain Perception  
Eight studies (Table 2) were found that specifically examined patients' pain experience with PSLBs and compared them with CBs or other types of SLBs. In an SMD study, rigid rectangular archive introduced and removed using SmartClip (PSLB) appliances resulted in higher pain than with conventional ones ([PERSON] et al., 2013) [29]. However, another randomized controlled clinical trial concluded that no bracket system offered superior oral health-related quality of life (OHRQoL) ([PERSON] et al., 2014) [19]. Moreover, a study found that the CB and Damon systems were similar concerning clinical periodontal parameters and pain intensity ([PERSON] and [PERSON], 2014) [20]. However, a multicenter randomized controlled clinical trial revealed no statistically significant difference in the level of pain experienced by patients treated using an SLB system compared to those treated using a conventional ligation system. ([PERSON] et al., 2016) [30]. In another two-arm parallel trial, there was no evidence that the pain intensity differed between conventional and passive self-ligating brackets at different time intervals ([PERSON] et al., 2020) [31]. Finally, a randomized clinical trial found that CBs caused more pain and had a negative impact on quality of life than PSLBs ([PERSON] et al., 2021) [32].  
In terms of apical root resorption, patient pain perception and extraction space closure, [PERSON] et al. (2022) [33] compared CBs and PSLBs. They discovered that PSLBs had  
\begin{table}
\begin{tabular}{p{113.8 pt} p{113.8 pt} p{113.8 pt} p{113.8 pt}} \hline \hline
**Efficiency Outcomes** & \begin{tabular}{} \end{tabular} & \
\begin{tabular}{} \end{tabular} &
\begin{tabular}{} \end{tabular} \\ \hline Patient comfort and pain perception & 8 & Incisor position modification with torque control & 5 \\ Alignment and space closure & 8 & Transversal arch dimensional changes & 10 \\ Periodontal health & 9 & & 20,23, 36, 37, 38, 43, 44, 45, 46, 47] & Apical root resorption & 3 \\ Bracket bond failure & 1 & Stability of the results & 2 \\ Chair time, treatment duration & [56] & & [24, 57] \\ \hline \hline \end{tabular}
\end{table}
Table 1: The number of studies identified in the review according to the outcomes.  
\begin{table}
\begin{tabular}{p{113.8 pt} p{113.8 pt} p{113.8 pt}} \hline \hline
\begin{tabular}{} \end{tabular} \\ \hline \hline \end{tabular}
\end{table}
Table 2: Summary of the studies analyzing patient comfort and pain perception.  
shorter chairside times, less pain, and improved patient comfort. Although the study discovered that passive self-ligating brackets lengthened treatment times, the difference was not statistically significant, and the results must be interpreted.  
[PERSON] et al. (2019) [16] compared the alignment efficiency and pain experience of [PERSON]'s self-ligating and MBT prescription preadjusted brackets during the initial alignment stage of orthodontic treatment. They found that PSLBs resulted in significantly more improvement in upper dental irregularity than CBs, but there was no significant difference in pain experience between the two types of brackets.