***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: 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 Objective The aim of this r and omized controlled clinical trial was to compare oral health-related quality of life ( OHRQoL ) of patients treated with conventional , active self-ligating ( ASL ) , and passive self-ligating ( PSL ) brackets  in different therapeutic phases . Methods Sixty patients ( mean age 18.3 years ; 29 males and 31 females ) requiring orthodontic treatment were r and omly and equally assigned to receive conventional ( Victory Series ) , ASL ( In-Ovation R ) , or PSL ( Damon 3MX ) brackets .  OHRQoL was measured with a self-administered modified 16-item Malaysian version of the Oral Health Impact Profile for immediate ( soon after the visit ) and late ( just before the subsequent visit ) assessment s of the bonding and activation phases . Data were analyzed with the Kruskal-Wallis and chi-square tests . Results The PSL and ASL groups showed more immediate and late impacts in the bonding phase , respectively ; the conventional group was affected in both the assessment s. The first activation phase had similar impacts in the groups . After the second activation , the conventional group showed more immediate impacts , whereas the PSL and ASL groups had more late impacts . The commonly affected domains were " physical disability , " " functional limitation , " " physical pain , " and " psychological discomfort . " No significant differences in the prevalence and severity of immediate and late impacts on OHRQoL of the patients were noted in any therapeutic phase . Conclusions No bracket system seems to ensure superior OHRQoL. This information could be useful for explaining the therapeutic phases , especially the initial one , and selecting the optimal bracket system based on the patient 's preference OBJECTIVE To compare the effectiveness of a self-ligating ( SL ) porcelain bracket with a conventional porcelain ( CP ) bracket tied with ligatures for initial alignment in the upper arch , to compare the discomfort of both bracket - archwire combinations and to compare the times taken ( both assisted and unassisted ) to untie and ligate both bracket - archwire combinations . METHODS Sixty non extraction patients were r and omly assigned to either a group with CP brackets on the upper six anterior teeth and conventional metal brackets on the premolars and first molars , or a group with SL porcelain brackets on the anterior teeth and SL metal brackets on the posterior teeth . The CP brackets were tied with coated ligatures . The irregularity index was measured at the start of treatment and at the first recall 10.7 weeks later . Discomfort was recorded over the first week with a Likert scale and the times to untie and ligate the six anterior porcelain brackets ( assisted and unassisted ) were recorded . RESULTS There were no differences in irregularities at the start of treatment ( p = 0.91 ) or 10.7 weeks later ( p = 0.12 ) . No significant difference in discomfort was found between the bracket types ( p = 0.90 ) . The porcelain SL brackets were significantly faster ( p < 0.001 ) to untie and ligate than the CP brackets with ligatures . CONCLUSION Porcelain SL brackets were faster to untie and ligate by 22 seconds per bracket , but there were no significant differences in the alignment achieved or discomfort experienced INTRODUCTION The objective of this study was to evaluate the effect of fixed appliances on oral malodor . METHODS Forty-one patients participated in this study . They were r and omized into 2 groups : treated with fixed orthodontic appliances and untreated controls .  Oral malodor measurements and the gingival and plaque indexes were recorded in each group by same periodontist . Measurements were taken from the study group before bonding , 1 week after bonding , and 4 weeks after bonding . The control group 's measurements were made at the same time . RESULTS Oral malodor and the gingival and plaque indexes were significantly increased 1 week after bonding ( P < 0.05 ) . Oral malodor was increased at 4 weeks after bonding ( P > 0.05 ) . The comparison of the groups showed differences 1 week and 4 weeks after bonding . CONCLUSIONS The oral malodor reached the critical level during fixed orthodontic treatment . Oral malodor could indicate a need to evaluate oral health and remind patients of the importance of maintaining ideal oral hygiene The aim of this study was to compare the degree of discomfort experienced during the period of initial orthodontic tooth movement using Damon3 self-ligating and Synthesis conventional ligating pre-adjusted bracket systems .  Sixty-two subjects were recruited from two centres ( 32 males and 30 females ; mean age 16 years , 3 months ) with lower incisor irregularity between 5 and 12 mm and a prescribed extraction pattern , including lower first premolar teeth . These subjects were r and omly allocated for treatment with either bracket system . Fully ligated Damon3 0.014-inch Cu NiTi archwires were used for initial alignment in both groups . Following archwire insertion , the subjects were given a prepared discomfort diary to complete over the first week , recording discomfort by means of a 100 mm visual analogue scale at 4 hours , 24 hours , 3 days , and 1 week . The subjects also noted any self-prescribed analgesics that were taken during the period of observation . Data were analysed using repeated measures analysis of variance . There were no statistically significant differences in perceived discomfort levels between the two appliances ; discomfort did not differ at the first time point and did not develop differently across subsequent measurement times . Overall , this investigation found no evidence to suggest that Damon3 self-ligating brackets are associated with less discomfort than conventional pre-adjusted brackets during initial tooth alignment , regardless of age or gender OBJECTIVE To determine the effect of bracket type on  halitosis , periodontal status , and microbial colonization . MATERIAL S AND METHODS Forty-six patients scheduled for fixed orthodontic treatment ( age 11 - 16 years ) were selected from the orthodontic department of Suleyman Demirel University . Patients were divided into two groups with r and om distribution of brackets ; 23 patients were treated with self-ligating brackets ( group SLBs ) , the others with conventional brackets ( group CBs ) . Halitosis measurements and periodontal and microbial records were obtained before the placement of brackets ( T0 ) , 1 week later ( T1 ) , and 5 weeks after bonding ( T2 ) . Periodontal parameters , including plaque index ( PI ) , gingival index ( GI ) , and bleeding on probing index ( BOP ) , were obtained from all the bonded teeth . Halitosis measurements were performed at the same time . Microbial sample s were obtained from the buccal surfaces of all the bonded teeth . Data were analyzed by using a repeated-measurement analysis of variance test for the comparison of parameters between groups and times . RESULTS Periodontal parameters and halitosis results were higher in the CBs group than in the SLBs group ( P<.05 ) . In the SLBs group , halitosis and BOP values revealed no pronounced changes between T1 and T2 ( P>.05 ) . Intra- and intergroup comparisons showed that there were no statistically significant differences for microbial colonization between all the time intervals ( P>.05 ) . CONCLUSION Bracket type has an effect on halitosis and periodontal status . Therefore , self-ligating brackets may be advised in order to prevent patients from developing halitosis and to increase the likelihood of good oral hygiene during orthodontic treatment A retrospective survey of 358 local Chinese adult orthodontic patients was undertaken to determine the motivating factors behind orthodontic treatment and the discomfort caused by fixed orthodontic appliances . From the completed question naires of 203 patients , the principal conclusions were that the improvement in dento-facial aesthetics following orthodontic treatment enhanced their self-confidence and self-esteem in a majority of patients ; discomfort in oral soft tissues and teeth were transient and did not exceed 7 days ; transient pain from teeth was experienced by 91 % of patients and in 39 % of these patients the discomfort to teeth was experienced with each new archwire or elastic force application . These results may be useful in relating discomfort levels to prospect i ve orthodontic patients . It was also evident in the study that several cross-cultural differences existed in the attitudes of our patients compared to those reported in Caucasians 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 two different types of brackets did not show statistically significant differences in periodontal clinical parameters . CONCLUSION Bracket design does not seem to have a strong influence on periodontal clinical parameters and periodontal pathogens in subgingival plaque . The correlation between some periodontal pathogens and clinical periodontal parameters was weak OBJECTIVES To test the hypotheses that ( 1 ) there is no difference in the pain experience during the week following initial placement of two orthodontic appliances ( Sm 
    Output:
    
SLBs and CBs are not significantly different in discomfort reduction at any of four time points ( 4 h , 24 h , 3 days and 7 days ) .
Conclusions : Clinical evidence s from existing RCTs suggest that SLBs do not outperform CBs in reliving discomfort or promoting oral health in clinic