Comparison of Bracket Adhesion Failure Rates with Resin-Modified Glass Ionomer Cement Versus Conventional Resin Adhesives: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives: The aim of the present systematic review and meta-analysis is to compare bracket adhesion failure rates between resin-modified glass ionomer cement (RMGIC) and conventional resin adhesives (CRA) during fixed orthodontic treatment (OT), based on evidence from randomized controlled trials (RCTs). Methods: The research question is “Is there a difference in bracket adhesion failure rates between RMGIC and CRA?” The study was performed in accordance with the PRISMA guidelines. A comprehensive literature search was performed across multiple databases without time or language restrictions through February 2026. Keywords were used in different combinations using Boolean operators. Hand searching was performed and disagreements were resolved via discussion. The risk of bias (RoB) and certainty of evidence (CoE) were assessed using the Cochrane risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation approach, respectively. Quantitative data synthesis was conducted using a random-effects model to calculate pooled odds ratios and 95% confidence intervals. Results: Seven RCTs met the inclusion criteria. Bracket failure rates ranged from 5.95% to 15.0% for RMGIC and 3.4% to 25.0% for CRA. The pooled meta-analysis revealed no statistically significant difference in bracket failure between the two adhesive types (OR = 1.00; 95% CI: 0.60 to 1.67), although substantial statistical heterogeneity was observed (I2 = 69.0%, p = 0.0065). One included trial demonstrated significantly improved retention for RMGIC when combined with a specific enamel deproteinization conditioning step prior to bonding. Three studies had a low RoB and the remaining were judged as having “some concerns”. The overall CoE was low. Conclusions: Based on the currently available randomized evidence, no statistically significant difference in bracket adhesion failure rates was observed between RMGIC and CRA during fixed OT. However, given the low CoE, substantial heterogeneity among studies, and relatively short follow-up periods, these findings should be interpreted with caution. Further well-designed randomized controlled trials with longer follow-up are needed to provide more definitive conclusions.