***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction : The bonding of orthodontic brackets and their failure rates by both direct and in-direct procedures are well-documented in orthodontic literature . Over the years different adhesive material s and various indirect bonding transfer procedures have been compared and evaluated for bond failure rates . The aim of our study is to highlight the use of a simple , inexpensive and ease of manipulation of a single thermo-plastic transfer tray and the use the of a single light cure adhesive to evaluate the bond failure rates in clinical situations . Material s and Methods : A total of 30 patients were r and omly divided into two groups ( Group A and Group B ) . A split-mouth study design was used , for , both the groups so that they were distributed equally with-out bias . After initial prophylaxis , both the procedures were done as per manufactures instructions . All patients were initially motivated and review ed for bond failures rates for 6 months . Results : Bond failure rates were assessed for over-all direct and indirect procedures , anterior and posterior arches , and for individual tooth . Z-test was used for statistically analyzing , the normal distribution of the sample in a spilt mouth study . The results of the two groups were compared and P value was calculated using Z-proportion test to assess the significance of the bond failure . Conclusion : Over-all bond failure was more for direct bonding . Anterior bracket failure was more in-direct bonding than indirect procedure , which showed more posterior bracket failures . In individual tooth bond failure , m and ibular incisor , and premolar brackets showed more failure , followed by maxillary premolars and canines OBJECTIVE To evaluate the effect of different bracket types on the levels of Streptococcus mutans ( SM ) and Lactobacillus ( LB ) in saliva , in plaque , and on the periodontal condition . MATERIAL S AND METHODS Forty patients aged 14 to 16 years , who had Angle Class I malocclusion with minimal crowding , were nonsmokers , were without systematic disease , and did not use antibiotics or oral mouth rinses during the 3-month period before the study were r and omly selected . The patients were subdivided into two groups with r and om allocation of bracket type : conventional brackets ( CB ; Avex Mx , OPAL orth . ) with steel wire ligature or self-ligating brackets ( SLB ; F1000 , Leone S.p . A. ) . Microbial and periodontal records were obtained before bonding ( T1 ) and 1 month after bonding ( T2 ) . Microbial sample s were collected from the stimulated saliva and the plaque from the labial surfaces of the upper and lower lateral incisors . To estimate the number of colony-forming units of SM and LB , Dentocult SM and LB kits were used . The plaque index ( PI ) , gingival index ( GI ) , and pocket depth ( PD ) values were recorded to evaluate the periodontal condition . Paired t-test and Mann-Whitney U-test were used to compare the groups statistically . RESULTS No significant differences occurred in SM or LB colonization between the groups . In the SLB group , PI , GI , and PD values increased significantly ( P < .05 ) . A greater increase was found in PD value in the SLB group ( 0.98 mm ) compared with the CB group ( 0.04 mm ; P < .05 ) . CONCLUSIONS The F1000 SLB do not have an advantage over Avex Mx CB with respect to periodontal status and colonization of SM and LB OBJECTIVE To evaluate the effects of fixed orthodontic treatment with steel-ligated conventional brackets and self-ligating brackets  on halitosis and periodontal health .  MATERIAL S AND METHODS Sixty patients , at the permanent dentition stage aged 12 to 18 years , who had Angle Class I malocclusion with mild-to-moderate crowding were r and omly selected . Inclusion criteria were nonsmokers , without systematic disease , and no use of antibiotics and oral mouth rinses during the 2-month period before the study . The patients were subdivided into three groups r and omly : the group treated with conventional brackets ( group 1 , n = 20 ) ligated with steel ligature wires , the group treated with self-ligating brackets ( group 2 , n = 20 ) , and the control group ( group 3 , n = 20 ) . The periodontal records were obtained 1 week before bonding ( T1 ) , immediately before bonding ( T2 ) , 1 week after bonding ( T3 ) , 4 weeks after bonding ( T4 ) , and 8 weeks after bonding ( T5 ) . Measurements of the control group were repeated within the same periods . The volatile sulfur components determining halitosis were measured with the Halimeter at T2 , T3 , T4 , and T5 . A two-way repeated measures of analysis of variance ( ANOVA ) was used to compare the groups statistically . RESULTS No statistically significant group × time interactions were found for plaque index , gingival index , pocket depth , bleeding on probing , and halitosis , which means three independent groups change like each other by time . The risk of tongue coating index ( TCI ) being 2 was 10.2 times higher at T1 than at T5 ( P < .001 ) . Therefore , the probability of higher TCI was decreased by time in all groups . CONCLUSIONS The self-ligating brackets do not have an advantage over conventional brackets with respect to periodontal status and halitosis A trial was carried out to evaluate the clinical performance of a visible light-cured adhesive when used with a foil mesh base in an indirect bonding technique . Thirty-seven patients entered the trial , and a total of 407 brackets were placed . The incidence and site of bond failure were recorded . The overall failure rate was 6.5 % . There were no significant differences detected between the failure rates for either the upper or the lower arches or for the anterior and the posterior segments of the arches ( p less than 0.01 ) AIM The aim of this study was to evaluate microleakage under orthodontic ceramic brackets bonded with direct and different indirect bonding techniques and adhesives using micro-computed tomography . MATERIAL S AND METHODS A total of 30 human maxillary premolars were r and omly separated into five groups with six teeth in each group . In group I , teeth were bonded directly with Transbond XT ( 3 M Unitek ) . In group II , group III , group IV , and group V , teeth were bonded through an indirect technique with Custom I.Q. ( Reliance Orthodontic Products ) , Sondhi Rapid-Set ( 3 M Unitek ) , RMbond ( RMO ) , and Transbond IDB ( 3 M Unitek ) , respectively , following the manufacturer 's instructions . Micro-CT system model 1172 of Skyscan ( Kontich , Belgium ) was used to scan all sample s. NRecon ( Skyscan ) version 1.6 , CT-Analyser V.1.11 ( Skyscan ) , and TView ( SkyScan , Bvba ) software programs were used for microleakage evaluation . Microleakage values between the test groups were assessed using the Kruskal-Wallis test , while the Wilcoxon signed rank test was used for within-group comparisons . The level of significance was set at P < 0.05 . RESULTS According to the Kruskal-Wallis analysis of variance test , there were no significant differences among the tested groups , with regard to volume and percentage ( microleakage/region of interest × 100 ) of microleakage values ( P < 0.05 ) . The Wilcoxon signed rank test showed that coronal microleakage volume and percentage values significantly differed for RMbond and Transbond IDB groups . LIMITATIONS In the study , only ceramic brackets were used and microleakage into mini gaps did not show up on the micro-CT image because 50 % silver nitrate solution could not penetrate into mini gaps which are smaller than silver nitrate particles . CONCLUSION Use of direct and indirect bonding techniques with different adhesives did not significantly affect the amount of microleakage The aim of this in vitro study was to compare microleakage of orthodontic brackets between enamel-composite and composite-bracket interfaces at the occlusal and gingival margins , bonded using indirect bonding systems with that of a conventional direct bonding method . Forty freshly extracted human maxillary premolar teeth were r and omly divided into two groups . In group 1 , the brackets were bonded to teeth directly according to the manufacturer 's recommendations . Group 2 consisted of 20 teeth bonded indirectly with Transbond XT ( 3M-Unitek ) , as the adhesive , and Sondhi Rapid Set A/B Primer ( 3M-Unitek ) , a filled resin primer . After bonding , the specimens were further sealed with nail varnish , stained with 0.5 per cent basic fuchsine for 24 hours , sectioned and examined under a stereomicroscope , and scored for microleakage at the enamel-composite and composite-bracket interfaces from both the occlusal and gingival margins . Statistical analyses were performed using Kruskal-Wallis and Mann-Whitney U-tests with Bonferroni correction . The gingival sides of group 1 displayed a higher median microleakage score than the occlusal side at the enamel-composite interface but this was not statistically significant ( P > 0.05 ) . All occlusal margins in both groups showed no microleakage under orthodontic brackets at the enamel-composite or composite-bracket interfaces . Comparisons of the microleakage scores between the direct and the indirect bonding groups at the enamel-composite and composite-bracket interfaces indicated no statistically significant microleakage differences at the gingival and occlusal margins ( P > 0.05 ) . The type of bonding method ( direct versus indirect ) did not significantly affect the amount of microleakage at the enamel-composite-bracket complex Objective To compare bond failure rates between direct and indirect techniques for bonding orthodontic brackets . Design A two-centre single blinded prospect i ve r and omized controlled clinical trial . Material s and methods This study was undertaken at the Birmingham Dental Hospital and Good Hope Hospital , Sutton Coldfield . Thirty-three subjects meeting the inclusion criteria were selected from orthodontic waiting lists and assigned to either of two study groups according to a split-mouth study design . The number and site of bracket failures between tooth types was recorded over 1 year . Statistical analysis was carried out using chi-square tests . Results Brackets were lost from 14 of the 553 teeth bonded , giving an overall bond failure rate of 2.5 % . There were no significant differences in bond failures between direct and indirect bonding or in the tooth types of the failures . Conclusions There was no significant difference in the bond failure rates between direct and indirect bonding OBJECTIVE To evaluate if the use of an indirect braces bonding protocol for localized enamel etching and adhesive application could help reduce plaque accumulation and demineralization around the brackets compared with a conventional direct-bonding technique . MATERIAL S AND METHODS Thirty patients were bonded with a split-mouth approach : two r and omly selected opposite quadrants were used as the test sides and the other two as control sides . During the first 6 months , the plaque presence around the braces was recorded monthly according to a plaque accumulation index ( PAI ) , as was the presence of demineralization . PAI values were measured at each of the four bracket sides for every bonded tooth . Analysis of variance was used to identify significant differences between different bracket margins and between test and control sides . RESULTS Test and control sides differed significantly for PAI measurements from t(1 ) ( 1 month after bonding ) to t(4 ) ( 4 months after bonding ) , with the highest value of significance ( P < .001 ) at t(1 ) but with no significant differences from t(5 ) to t(7 ) ( treatment end ) . Considering whole-mouth results , different bracket margin PAI scores did not differ significantly . PAI scores were higher at t(1 ) and progressively decreased during the treatment . At debonding , the onset of 21 new white spots was recorded overall for the control sides and eight new white spots for the test sides . CONCLUSION Especially during the first 4 months after brackets placement , this indirect bonding protocol allowed for significant reduction in plaque accumulation around the braces and reduced onset of white spots during the orthodontic treatment Objective To determine the accuracy of  direct or indirect bracket placement . Design A prospect i ve , r and omized comparison of 2 different methods of bracket placement . Setting Queens Hospital , Burton upon Trent , UK between February and May 2001 . Material s and method Twenty-six consecutive patients requiring upper and lower MBT ™ pre-adjusted Edgewise appliances had their labial segments bonded directly or indirectly according to a split mouth system of allocation . Before and after bond-up all brackets were photographed and measured from tracings to determine positional differences from the ideal . Results Using ANOVA ( General Linear Model ) , vertical errors were found to be greater than those in the horizontal plane , which in turn were greater than angular errors ( p<0.05 ) . Errors were greater in the maxillary arch than in the m and ibular arch . There was no significant difference between the mean errors produced by the two methods of bracket placement . Conclusions Mean bracket placement errors were similar with both techniques This r and omized controlled trial aim ed to evaluate the duration and outcome quality of orthodontic treatment with a customized fixed appliance system versus a noncustomized system .  Patients ( n = 180 ) were r and omized and received orthodontic treatment with the Insignia customized orthodontic system or the Damon Q noncustomized orthodontic system .  The allocation sequence was concealed using identical , sequentially numbered , opaque , sealed envelopes . Patients with non extraction treatment plans were treated by 2 equally experienced orthodontists . Pretreatment and posttreatment plaster casts were made for each patient , and the models were rated using the Peer Assessment Rating ( PAR ) score . Planning time , treatment duration , and numbers of loose brackets , visits , and complaints were recorded . The examined null hypothesis was that the customized appliance system was not associated with significantly ( P < 0.05 ) shorter treatment duration compared to a noncustomized appliance . We 
    Output:
    
The indirect bonding was found to involve less chairside time but more total working time compared with the direct bonding .
Conclusion Weak evidence suggested that the direct and indirect bonding techniques had no significant difference in bracket placement accuracy , oral hygiene status and bond failure rate , for bonding orthodontic brackets .
The indirect bonding might require less chairside time but more total working time in comparison with the direct bonding technique .