Loupes‑assisted versus conventional orthodontic bracket bonding: a split‑mouth randomized controlled trial evaluating patient discomfort and bonding time

The impact of magnification loupes on both patient-reported discomfort and bonding time during orthodontic bracket bonding remains unexplored. Therefore, this study aimed to address this gap by directly comparing patient-centered outcomes between loupes-assisted bonding and conventional unaided vision in a controlled clinical condition. Sixty patients with dental crowding (240 quadrants) aged 18–28 years with sound enamel and good oral hygiene were enrolled. A split-mouth design was employed to minimize inter-patient variability. For each patient, quadrants were randomly allocated using a computer-generated randomization sequence. Two contralateral quadrants received direct bonding with 3.5× magnification loupes while the other two were bonded with conventional unaided vision. A standardized bonding protocol was followed for all quadrants, including etching with 37% phosphoric acid, application of light‑cured bonding agent, and placement of pre‑adjusted edgewise brackets. Cheek retraction and saliva control were performed consistently across all quadrants. Immediate patient‑reported discomfort per quadrant was assessed using a 100‑mm Visual Analog Scale (VAS). Total bonding time per quadrant was recorded with a stopwatch. Patient‑reported discomfort did not differ significantly between groups (VAS: 11.78 ± 15.907 mm with loupes vs. 12.18 ± 17.775 mm conventionally; p = 0.761). In contrast, total bonding time was significantly longer with loupes, with a mean increase of 48 s per quadrant (11:38.59 ± 02:31.35 vs. 10:50.30 ± 02:30.80; p < 0.001). While the use of magnification loupes significantly increased operative time, it did not affect immediate post-bonding patient-reported discomfort. Therefore, within these parameters, loupes did not offer a patient-centered advantage during the bonding procedure. ClinicalTrials.gov registry (NCT07474389). Retrospectively registered on 16 March 2026.