***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: The objective of this study was to investigate the effect of bracket type ( conventional and self-ligating ) on the levels of Streptococcus mutans and total bacterial counts in whole saliva of orthodontic patients . Thirty-two male and female patients were selected using the following inclusion criteria : adolescents ( mean age 13.6 years , range 11 - 17 years ) , fixed appliances in both arches , non-smoker , and no reported oral habits . Demographic and oral hygiene characteristics were determined for each subject . The patients were subdivided into two groups with r and om allocation of bracket type ( conventional or self-ligating ) . An initial saliva sample was obtained before the initiation of treatment ( T1 ) and a second sample 2 - 3 months following appliance bonding ( T2 ) . Salivary S. mutans and total bacteria were enumerated and analysed after growth in culture . The demographic and clinical characteristics of the sample s were analysed with a t- or chi-square test , where applicable , to assess the r and om allocation of bracket group to participants . The results of S. mutans and total facultative bacterial counts were log transformed and statistically analysed with analysis of covariance with bracket ( conventional versus self-ligating ) as the categorical variable and initial total bacterial counts or initial S. mutans levels serving as the covariate . No difference was found in the demographics and oral hygiene indices between the two groups , verifying the r and om assignment of brackets to the population sample . The levels of S. mutans in whole saliva of orthodontically treated patients do not seem to be significantly different between conventional and self-ligating brackets . The pre-treatment levels of S. mutans are significant predictors of the levels of S. mutans after placement of orthodontic appliances , while this was not the case for total bacterial counts INTRODUCTION Self-ligating orthodontic brackets rely on clips , rather than ligatures , to hold the archwire in place . It is unknown whether replacing ligatures with clips affects the adherence of Streptococcus mutans . The aim of this research was to evaluate whether self-ligating brackets have an advantage over conventional brackets as determined by the adherence of S mutans . METHODS The sample consisted of 50 esthetic brackets , divided into 3 experimental groups and 2 control groups of 10 brackets each . Two experimental groups were active self-ligating brackets ( QuicKlear ; Forestadent , Pforzheim , Germany ; and In-Ovation C ; Dentsply GAC , Bohemia , NY ) ; the other was a passive self-ligating bracket ( Damon 3 ; Ormco , Glendora , Calif ) . The 2 control groups were conventional brackets ( Mystique ; Dentsply GAC ; and Clarity ; 3 M Unitek , Monrovia , Calif ) . The brackets were r and omly bonded to the canines , first and second premolars , and first and second molars in the m and ibular left hemiarch of 10 male participants . Biofilm was collected from the tooth surfaces before bonding and from the brackets on day 21 and placed in Petri dishes containing Mitis salivarius agar . The brackets were removed on day 28 and examined by using scanning electron microscopy . Statistical analysis , analysis of variance , and the Tukey correction with a P value of 0.05 were used . RESULTS The greatest numbers of colonies were found in an active self-ligating bracket group ( In-Ovation C ) , and the fewest colonies were in a conventional bracket group ( Clarity ) . The largest colonies formed on active self-ligating brackets . In the slot , the greatest formation was in a control group ( Mystique ) . CONCLUSIONS Self-ligating esthetic brackets do not promote greater or lesser S mutans colonization when compared with conventional brackets . Differences were found to be related to the material composition of the bracket The objective of this study was to investigate the effect of fluori date d elastomeric ligatures on the microbiology of local dental plaque in vivo . This r and omized , prospect i ve , longitudinal , clinical trial had a split-mouth crossover design . The subjects were 30 patients at the beginning of their treatment with fixed orthodontic appliances in the orthodontic departments of the Liverpool and the Sheffield dental hospitals in the United Kingdom . The study consisted of 2 experimental periods of 6 weeks with a washout period between . Fluori date d elastomers were r and omly allocated at the first visit to be placed around brackets on tooth numbers 12 , 11 , 33 or 22 , 21 , 43 . Nonfluori date d elastomers were placed on the contralateral teeth . St and ard nonantibacterial fluori date d toothpaste and mouthwash were supplied . After 6 weeks ( visit 2 ) , the elastomers were removed , placed in transport media , and plated on agar within 2 hours . Nonfluori date d elastomers were placed on all brackets for 1 visit to allow for a washout period . At visit 3 , fluori date d elastomers were placed on the teeth contralateral to those that received them at visit 1 . At visit 4 , the procedures at visit 2 were repeated . Sample s were collected on visits 2 and 4 . A logistic regression was performed , with the presence or absence of streptococcal or anaerobic growth as the dependent variable . A mixed-effects analysis of variance was carried out with the percentage of streptococcal or anaerobic bacterial count as the dependent variable . The only significant independent variables were the subject variable ( P = < .001 ) for the percentage of streptococcal and anaerobic bacterial count and the visit variable for the percentage of streptococcal count ( P = < .001 ) . The use of fluori date d or nonfluori date d elastomers was not significant for percentage of either streptococcal ( P = .288 ) or anaerobic count ( P = .230 ) . Fluori date d elastomers are not effective at reducing local streptococcal or anaerobic bacterial growth after a clinical ly relevant time in the mouth INTRODUCTION Enamel decalcification is a common problem in orthodontics . The objectives of this r and omized clinical study were to enumerate and compare plaque bacteria surrounding 2 bracket types , self-ligating ( SL ) vs elastomeric ligating ( E ) , and to determine whether adenosine triphosphate (ATP)-driven bioluminescence could be used for rapid assessment of bacterial load in plaque . METHODS Patients ( ages , 11 - 17 years ) were bonded with SL and E brackets  in 14 maxillary and 12 m and ibular arches by using a split-mouth design . Recall visits were at 1 and 5 weeks after bonding . Plaque specimens were assayed for oral bacteria and subjected to ATP-driven bioluminescence determinations with a luciferin-based assay . RESULTS In most patients , teeth bonded with SL attachments had fewer bacteria in plaque than did teeth bonded with E brackets . At 1 and 5 weeks after bonding , the means for SL vs E brackets were statistically lower for total bacteria and oral streptococci ( P < 0.05 ) . ATP bioluminescence values were statistically correlated to the total oral bacteria and oral streptococci , with correlation coefficients of 0.895 and 0.843 , respectively . CONCLUSIONS SL appliances promote reduced retention of oral bacteria , and ATP bioluminescence might be a useful tool in the rapid quantification of bacterial load and the assessment of oral hygiene during orthodontic treatment Objective : This in vitro study aim ed to compare the microleakage of orthodontic brackets between enamel-adhesive and adhesive-bracket interfaces at the occlusal and gingival margins bonded with different adhesive systems . Material s and Methods : A total of 144 human maxillary premolar teeth extracted for orthodontic reasons was r and omly divided into four groups . Each group was then further divided into three sub-groups . Three total-etching bonding systems ( Transbond XT , Greengloo and Kurasper F ) , three one-step self-etching bonding systems ( Transbond Plus SEP , Bond Force and Clearfil S3 ) , three two-step self-etching bonding systems ( Clearfil SE Bond , Clearfil Protectbond and Clearfil Liner Bond ) , and three self-adhesive resin cements ( Maxcem Elite , Relyx U 100 and Clearfil SA Cement ) were used to bond the brackets to the teeth . After bonding , all teeth were sealed with nail varnish and stained with 0.5 % basic fuchsine for 24 h. All sample s were sectioned and examined under a stereomicroscope to score for microleakage at the adhesive-enamel and adhesive-bracket interfaces from both occlusal and gingival margins . Statistical Analysis Used : Statistical analyses were performed with Kruskal-Wallis and Wilcoxon signed-rank tests . Results : The results indicate no statistically significant differences between the microleakage scores of the adhesives ; microleakage was detected in all groups . Comparison of the average values of the microleakage scores in the enamel-adhesive and adhesive-bracket interfaces indicated statistically significant differences ( P < 0.05 ) . The amount of the microleakage was higher at the enamel-adhesive interface than at the bracket-adhesive interface . Conclusions : All of the brackets exhibited some amount of microleakage . This result means that microleakage does not depend on the type of adhesive used Multibracket orthodontic appliances increase dental plaque retention and make teethbrushing more difficult for patients . As a result , advice from the orthodontist on oral hygiene along with patient motivation regarding teethbrushing are particularly important . The aim of this study was to compare the efficacy of electric toothbrushes with that of manual brushing associated with mouth-rinses comprising chlorhexidine ( 0.12 % ) and 0 % alcohol . To this end , 84 patients receiving current orthodontic treatment were r and omly selected from patients treated at the Dento-Facial Orthopedics department in the Casablanca Dental Consultation and Treatment Center . Selected patients were divided into three groups : Group 1 : manual teethbrushing ; Group 2 : electric teethbrushing ; Group 3 : manual brushing combined with mouth rinse .  Oral hygiene was assessed using the Loe-Silness plaque and gingival indices . Measurements were made before and 4 weeks after the observation period . Results were subjected to statistical comparison in order to determine the group showing greatest improvement and to deduce the best means of controlling bacterial plaque . The electric toothbrush and the chlorhexidine mouth rinse appear to control dental plaque more effectively than manual teethbrushing alone . Following this study , patients receiving multibracket treatment were invited to combine manual brushing with short clinical mouth-rinsing sessions or to use an electric toothbrush Fixed or removable orthodontic appliances impede the maintenance of oral hygiene and result in plaque accumulation . Plaque retention surrounding orthodontic appliances leads to enamel demineralization caused by organic acids produced by bacteria in the dental plaque . Many studies have evaluated the effects of fixed orthodontic appliances on microbial flora and periodontal status , but only a few have evaluated the method of ligation as an additional factor . The aim of this study was to determine the changes in microbial flora and periodontal status after orthodontic bonding and to determine whether two different archwire ligation techniques affect these changes . A total of 21 orthodontic patients scheduled for fixed orthodontic treatment were selected for this split-mouth study . Two commonly used auxiliaries ( elastomeric rings and ligature wires ) for tying archwires were tested . Microbial and periodontal records were obtained before bonding ( T0 ) , one week later ( T1 ) , and five weeks after bonding ( T2 ) . Paired t-test and Wilcoxon signed rank test were used to compare the groups statistically . Although , teeth ligated with elastomeric rings exhibited slightly greater numbers of microorganisms than teeth ligated with steel ligature wires , the differences were not statistically significant and could be ignored . The two archwire ligation techniques showed no significant differences in the gingival index , bonded bracket plaque index , or pocket depths of the bonded teeth . However , teeth ligated with elastomeric rings were more prone to bleeding . Therefore , elastomeric ring use is not recommended in patients with poor oral hygiene OBJECTIVE To determine the effect of different bracket design s ( conventional brackets and self-ligating brackets ) on periodontal clinical parameters and periodontal pathogens in subgingival plaque . MATERIAL AND METHODS The following inclusion criteria were used : requirement of orthodontic treatment plan starting with alignment and leveling , good general health , healthy periodontium , no antibiotic therapy in the previous 6 months before the beginning of the study , and no smoking . The study sample totaled 38 patients ( 13 male , 25 female ; mean age , 14.6 ± 2.0 years ) . Patients were divided into two groups with r and om distribution of brackets . Recording of clinical parameters was done before the placement of the orthodontic appliance ( T0 ) and at 6 weeks ( T1 ) , 12 weeks ( T2 ) , and 18 weeks ( T3 ) after full bonding of orthodontic appliances . Periodontal pathogens of subgingival microflora were detected at T3 using a commercially available polymerase chain reaction test ( micro-Dent test ) that contains probes for Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis , Prevotella intermedia , Tannerella forsythia , and Treponema denticola . RESULTS There was a statistically significant higher prevalence of A actinomycetemcomitans in patients with conventional brackets than in patients with self-ligating brackets , but there was no statistically significant difference for other putative periodontal pathogens . The 
    Output:
    
Conclusion : Based on the limited evidence , self-ligating metallic brackets accumulate less S. mutans than conventional ones .