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Our professional organizations have prepared this paper as part of an integrated, multidisciplinary plan to ensure the availability of well-trained practitioner teams to sustain safe, effective and high-quality rural surgical and operative delivery services. Without these robust local (or nearby) surgical services, sustaining rural maternity care is much more difficult. This paper describes the "network model" as a health human resources solution to meet the surgical needs, including operative delivery, of rural residents; outlines necessary policy directions for achieving this solution; and poses a series of enabling recommendations. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the effectiveness of Dental Monitoring (DM) (Dental Monitoring SAS, Paris, France) compared with conventional monitoring (CM) during active orthodontic treatment., Methods: The Peer Assessment Rating (PAR) index was used to evaluate the pretreatment and posttreatment records of 51 patients, with 26 in the CM group and 25 in the DM group. The change in weighted PAR was analyzed to assess the effectiveness of treatment., Results: The chi-square test revealed that the CM group had a higher percentage of patients in the great improvement category compared with the DM group. However, this difference was not statistically significant (P = 0.192). A repeated measures general linear model demonstrated significant improvement over time (P <0.001), with no statistically significant group differences noted between CM and DM (P = 0.181) and no statistically significant time-by-group interaction (P = 0.299)., Conclusions: Both CM and DM showed significant improvements in weighted PAR scores, but no statistically significant difference is present between the 2 groups., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: A total of 18%-30% of Canadians live in a rural area and are served by 8% of the country's general surgeons. The demographic characteristics of Canada's population and its geography greatly affect the health outcomes and needs of the population living in rural areas, and rural general surgeons hold a unique role in meeting the surgical needs of these communities. Rural general surgery is a distinct area of practice that is not well understood. We aimed to define the Canadian rural general surgeon to inform rural health human resource planning., Methods: A scoping review of the literature was undertaken of Ovid, MEDLINE, and Embase using the terms "rural," "general surgery," and "workforce." We limited our review to articles from North America and Australia., Results: The search yielded 425 titles, and 110 articles underwent full-text review. A definition of rural general surgery was not identified in the Canadian literature. Rurality was defined by population cut-offs or combining community size and proximity to larger centres. The literature highlighted the unique challenges and broad scope of rural general surgical practice., Conclusion: Rural general surgeons in Canada can be defined as specialists who work in a small community with limited metropolitan influence. They apply core general surgery skills and skills from other specialties to serve the unique needs of their community. Surgical training programs and health systems planning must recognize and support the unique skill set required of rural general surgeons and the critical role they play in the health and sustainability of rural communities., Competing Interests: Competing interests:: Lyndsay Glass is a member of the Canadian Association of General Surgeons Rural Surgery Committee. Peter Miles is a member and past chair of the Canadian Association of General Surgeons Rural Committee. Lauren Smithson is chair of the Advisory Council for Rural Surgery, American College of Surgeons. Evan Wong reports a Canadian Association of General Surgeons operating grant. Caitlin Champion reports a Skin Investigation Network of Canada Team Development Grant, and is a member of the Canadian Association of General Surgeons Rural Surgery Committee and co-chair of the Continuing Professional Development Committee. No other competing interests were declared., (© 2024 CMA Impact Inc. or its licensors.)

Background: In Canada, endoscopy is primarily performed by gastroenterologists and surgeons, and some studies report that colonoscopies performed by nongastroenterologists have more complications and higher rates of future colorectal cancer. Our objective was to determine whether rural-based nongastroenterologist endoscopists are achieving quality benchmarks in colonoscopy., Methods: This quality improvement initiative prospectively evaluated 6 key performance indicators (KPIs) (cecal intubations, polyp detection [males and females; for first-time colonoscopies on patients aged ≥ 50 yr], bowel preparations, patient comfort and withdrawal times) on consecutive colonoscopies performed by participating Alberta North Zone endoscopists. The study period was June 2018 to March 2020. Overall and individual endoscopist's KPIs were compared with standard benchmarks. Additional performance indicators included mean number of polyps per colonoscopy and an exploration of study-defined sedation-related level of consciousness., Results: Data were collected on 6212 colonoscopies performed by 16 endoscopists (9 surgeons, 5 family physicians and 2 internists) in 6 hospitals. All 6 KPI benchmarks were achieved when results were pooled over all endoscopists in the study. Overall, cecal intubation occurred in 6006 of 6209 (96.7%, 95% confidence interval 94.5%-99.0%) cases. Polyp detection was 65.9% (592/898) and 49.8% (348/699) for male and female patients, respectively, aged 50 years or older. Variability in individual endoscopist results existed, especially for the mean number of polyps per 100 colonoscopies and sedation-related level of consciousness., Interpretation: Overall, Alberta North Zone endoscopists are performing high-quality colonoscopies, collectively achieving all 6 KPIs. To understand endoscopic performance and encourage individual and group reflection on endoscopic practices, Canadian endoscopists are encouraged to participate in similar colonoscopy quality initiative studies., Competing Interests: Competing interests: Michael Kolber founded EMPRSS, a University of Alberta spin-off company that supported the data collection, synthesis and reporting of results to the participants and their teams. No other competing interests were declared., (© 2023 CMA Impact Inc. or its licensors.)

Introduction: This 2-arm randomized controlled clinical trial (RCT) aimed to assess the effect of Dental Monitoring (DM) on the efficiency of clear aligner therapy (CAT) and patient experience compared with conventional monitoring (CM) used for regularly scheduled clinical appointments., Methods: Fifty-six patients with full permanent dentition treated with CAT participated in this RCT. Patients were recruited from a single private practice and treated by 1 experienced orthodontist. Randomization was performed with permutated blocks of 8 patients assigned to either a CM or DM group with allocations concealed in opaque, sealed envelopes. It was not feasible to blind subjects or investigators. The primary treatment efficiency outcome assessed was the number of appointments. Secondary outcomes included the time to reach the first refinement, the number of refinements, the total number of aligners, and treatment duration. The patient experience was assessed using a visual analog scale questionnaire administered at the end of CAT., Results: No patients were lost to follow-up. There was no significant difference in the number of refinements (mean = 0.1; 95% confidence interval [CI], -0.2 to 0.5; P = 0.43) and the number of total aligners (median = 5; 95% CI, -1 to 13; P = 0.09). There was a significant difference in the number of appointments, with the DM group requiring 1.5 fewer visits (95% CI, -3.3, -0.7; p = 0.02) as well as overall treatment duration, with the DM group taking 1.9 months longer (95% CI, 0.0-3.6; P = 0.04). There was a difference between study groups regarding the importance of face-to-face appointments, with the DM group not perceiving face-to-face appointments as important (P = 0.03)., Conclusions: DM with CAT resulted in 1.5 fewer clinical appointments and a longer treatment duration of 1.9 months. There were no significant intergroup differences in the number of refinements or total aligners. CM and DM groups had similarly high levels of satisfaction with CAT., Registration: The trial was registered at Australian New Zealand Clinical Trials Registry (ACTRN12620000475943)., Protocol: The protocol was published before trial commencement., Funding: This research did not receive any grant from funding agencies., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the essential components of well-resourced and high-functioning multidisciplinary networks that support high-quality anesthesia, surgery, and maternity care for rural Canadians, delivered as close to home as possible., Composition of the Committee: A volunteer Writers' Group was drawn from the Society of Obstetricians and Gynaecologists of Canada, the Society of Rural Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, the Canadian Association of General Surgeons, the College of Family Physicians of Canada, and the Association of Canadian University Departments of Anesthesia., Methods: A collaborative effort over the past several years among the professional stakeholders has culminated in this consensus statement on networked care designed to integrate and support a specialist and non-specialist, urban and rural, anesthesia, surgery, and maternity work force into high-functioning networks based on the best available evidence., Report: Surgical and maternity triage needs to be embedded within networks to address the tensions between sustainable regional programs and local access to care. Safety and quality must be demonstrated to be equivalent across similar patients and procedures, regardless of network site. Triage of patients across multiple sites is a quality outcome metric requiring continuous iterative scrutiny. Clinical coaching between rural and regional centres can be helpful in building and sustaining high-functioning networks. Maintenance of quality and the provision of continuing professional development in low-volume settings represent a mutual value proposition., Conclusion: The trusting relationships that are foundational to successful networks are built through clinical coaching, continuing professional development, and quality improvement. Currently, a collaborative effort in British Columbia is delivering a provincial program-Rural Surgical Obstetrical Networks-built on the principles and supporting evidence described in this consensus statement., (Copyright © 2022 the College of Family Physicians of Canada.)

Background: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties., Methods: Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16., Results: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives., Conclusion: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.

In 2017, the Birmingham Institute of Forest Research (BIFoR) began to conduct Free Air Carbon Dioxide Enrichment (FACE) within a mature broadleaf deciduous forest situated in the United Kingdom. BIFoR FACE employs large-scale infrastructure, in the form of lattice towers, forming 'arrays' which encircle a forest plot of ~30 m diameter. BIFoR FACE consists of three treatment arrays to elevate local CO 2 concentrations (e[CO 2 ]) by +150 µmol/mol. In practice, acceptable operational enrichment (ambient [CO 2 ] + e[CO 2 ]) is ±20% of the set point 1-min average target. There are a further three arrays that replicate the infrastructure and deliver ambient air as paired controls for the treatment arrays. For the first growing season with e[CO 2 ] (April to November 2017), [CO 2 ] measurements in treatment and control arrays show that the target concentration was successfully delivered, that is: +147 ± 21 µmol/mol (mean ± SD) or 98 ± 14% of set point enrichment target. e[CO 2 ] treatment was accomplished for 97.7% of the scheduled operation time, with the remaining time lost due to engineering faults (0.6% of the time), CO 2 supply issues (0.6%) or adverse weather conditions (1.1%). CO 2 demand in the facility was driven predominantly by wind speed and the formation of the deciduous canopy. Deviations greater than 10% from the ambient baseline CO 2 occurred <1% of the time in control arrays. Incidences of cross-contamination >80 µmol/mol (i.e. >53% of the treatment increment) into control arrays accounted for <0.1% of the enrichment period. The median [CO 2 ] values in reconstructed three-dimensional [CO 2 ] fields show enrichment somewhat lower than the target but still well above ambient. The data presented here provide confidence in the facility setup and can be used to guide future next-generation forest FACE facilities built into tall and complex forest stands., (© 2019 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

Introduction: The purpose of this 2-arm parallel trial was to assess the effect of the AcceleDent Aura appliance (OrthoAccel Technologies, Houston, Tex) on the rate of maxillary premolar extraction space closure in adolescent patients., Methods: Forty Class II adolescents treated with full fixed appliances and maxillary premolar extractions participated in this randomized clinical trial. They were recruited in a private practice and treated by 1 clinician. Randomization was accomplished in blocks of 10 patients assigned to either a no-appliance group or the AcceleDent Aura appliance group with the allocations concealed in opaque, sealed envelopes. Both the operator and the outcome assessor were blinded; however, it was not feasible to blind the patients. Models were taken of the maxillary arch at the start of space closure and just before complete space closure. The space was measured parallel to the occlusal plane from the cusp tips of the teeth mesial and distal to the extraction spaces., Results: There was no clinically (0.05 mm per month; 95% confidence interval [CI], -0.24, 0.34) or statistically significant difference in the rate of space closure (P = 0.74). In both the univariable and multivariable analyses, the mean rate of tooth movement was slower by 0.13 mm per month (95% CI, -.26, .005) on the left side compared with the right side, but this was not statistically significant (P = 0.06)., Conclusions: The AcceleDent Aura appliance had no effect on the rate of maxillary premolar extraction space closure. Only a few participants were considered to be good compliers with the appliance. However, the rate of space closure in the good compliers was similar to the overall group and did not appear to influence the result., Registration: This trial was not registered., Protocol: The protocol was not published before trial commencement., (Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this 2-arm parallel trial was to assess the effects of the AcceleDent Aura (OrthoAccel Technologies, Houston, Tex) appliance on the increase in mandibular anterior arch perimeter, the reduction in mandibular arch irregularity, and the amount of discomfort during initial alignment of the mandibular arch with fixed appliances., Methods: Forty Class II adolescent patients with full fixed appliances and treated with maxillary premolar extractions and no extractions in the mandibular arch participated in this randomized clinical trial. They were recruited in a private practice and treated by 1 clinician. Randomization to either a no-appliance group or the AcceleDent Aura appliance group was accomplished with permuted blocks of 10 patients with the allocations concealed in opaque, sealed envelopes. Both the operator and the outcome assessor were blinded, but it was not feasible to blind the patients. Discomfort was recorded during the first week of treatment. Mandibular anterior arch perimeter and anterior irregularity were measured from plaster models taken at the start of treatment and after 5, 8, and 10 weeks., Results: No patients were lost to follow-up, and no data were missing. There was no difference in anterior arch perimeter at the start of treatment (P = 0.85; median, 0.6 mm; 95% confidence interval [CI], -1.6, +1.8 mm) or at any other time point (5 weeks: P = 0.84; median, -0.2 mm; 95% CI, -1.6, +1.2 mm; 8 weeks: P = 0.56; median, -0.3 mm; 95% CI, -1.6, +0.7 mm; 10 weeks: P = 0.67; median, -0.1 mm; 95% CI, -1.5, +1.1 mm). There was also no difference between groups for incisor irregularity (P = 0.46; median, -0.5 mm; 95% CI, -2.2, +2.8 mm; P = 0.80; median, 0.0 mm; 95% CI, -1.0, +1.1 mm; P = 0.70; median, 0.1 mm; 95% CI, -0.7, +0.8 mm; P = 0.65; median, 0.2 mm; 95% CI, -0.6, +0.6 mm). No difference was detected at any time during the first week for discomfort (baseline: P = 0.84; median, -1.5 mm; 95% CI, -15.9, +9.8 mm; 6 hours: P = 0.96; median, 0.3 mm; 95% CI, -23.5, +21.8 mm; 1 day: P, 0.75; median, -3.5 mm; 95% CI, -27.1, +26.9 mm; 3 days: P = 0.98; median, -0.6 mm; 95% CI, -20.6, +20.0; 7 days: P = 0.57; median, 0.5 mm; 95% CI, -5.0, +5.3 mm). However, significantly fewer participants in the AcceleDent Aura group used analgesics at day 1 (P = <0.01)., Conclusions: The AcceleDent Aura appliance had no effect compared with no appliance on increasing anterior arch perimeter, or reducing irregularity or perceived discomfort during initial alignment with fixed appliances, although more subjects used painkillers at 24 hours in the no-appliance group., Registration: This trial was not registered., Protocol: The protocol was not published before trial commencement., Funding: A special research grant was obtained from the Australian Society of Orthodontists Foundation for Research and Education to purchase the AcceleDent Aura appliances and fund the statistical analysis., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Summary: Time is long overdue for action to improve rural surgical services in Canada. In this issue of CJS, a proposed curriculum for the provision of enhanced surgical skills (ESS) to rural family physicians offers an opportunity to fortify a seamless network of high-quality surgical care for rural Canada. It is supported and enhanced by the best available evidence and measured advice from specialists and generalists alike. Publication of this curriculum proposal provides for essential dialogue with general surgeons. We discuss why we must play an active role in the development, teaching and evaluation of ESS, or we will have minimal influence and limited grounds on which to criticize its outcome or celebrate the opportunity of success it promises.

This review discusses the rationale behind recommending immunopharmacological guidance of long-term therapies with anti-TNF-α specific biotherapies. "Arguments why therapeutic decision-making should not rely on clinical outcomes alone are presented. Central to this is that the use of theranostics (i.e., monitoring circulating levels of functional anti-TNF-α drugs and antidrug antibodies) would markedly improve treatment because therapies can be tailored to individual patients and provide more effective and economical long-term clinical benefits while minimising risk of side effects. Large-scale immunopharmacological knowledge of the pharmacokinetics of TNF-α biopharmaceuticals in individual patients would also help industry to develop more effective and safer TNF-α inhibitors" [1].

Aim: This survey of Australian orthodontists was conducted to assess treatment preferences., Methods: Email invitations to participate in an online survey were sent to a total of 433 Australian Society of Orthodontists (ASO) members and 158 replies were received (36% response)., Results: For Class II treatment, most practitioners preferred to wait and treat later but when early treatment was performed, the Twin Block was the most popular appliance. For fixed appliance treatment, the 0.022 inch slot was the most commonly used (73%) and the median treatment time was 20 months. The median extraction rate was 23% which was similar to that reported in a 2008 USA survey. Sequential plastic aligners were used by 73% of respondents and Temporary Skeletal Anchorage Devices were used by 77%. The most common research question clinicians would like answered related to retention., Conclusion: The responses were similar Australia-wide but some areas of difference were revealed and discussed.

Introduction: The aim of this study was to assess the rate of tooth movement and discomfort experienced by orthodontic patients using a vibrational appliance (Tooth Masseuse)., Methods: In this randomised controlled trial (RCT), 66 consecutive patients were assigned to a control or experimental group. The experimental group was instructed to use a vibrational appliance for a minimum of 20 minutes per day. All of the patients had the same fixed appliance and a 0.014 inch thermal NiTi wire during the 10 week study period. Impressions of the mandibular six anterior teeth were taken at 4 time points: at the start of treatment, 5 weeks, 8 weeks, and at 10 weeks after commencement. Little's Irregularity Index was used to record alignment and assess the rate of tooth movement. A discomfort score chart was used to evaluate patient pain levels at 5 time points., Results: The experimental group showed a 65% reduction in irregularity at 10 weeks, while the control group showed a 69% reduction in irregularity over the same period. No significant differences in irregularity or pain levels were observed at any of the time points between the groups., Conclusions: The results demonstrate that, for 20 minute use per day, there appears to be no clinical advantage in using the vibrational appliance for the early resolution of crowding or the alleviation of pain during initial alignment.

Aim: To compare the efficiency of orthodontic archwire sequences produced by three manufacturers., Design: Prospective, randomized clinical trial with three parallel groups., Setting: Private orthodontic practice in Caloundra, QLD, Australia., Subjects and Methods: One hundred and thirty-two consecutive patients were randomized to one of three archwire sequence groups: (i) 3M Unitek, 0·014 inch Nitinol, 0·017 inch × 0·017 inch heat activated Ni-Ti; (ii) GAC international, 0·014 inch Sentalloy, 0·016 × 0·022 inch Bioforce; and (iii) Ormco corporation, 0·014 inch Damon Copper Ni-Ti, 0·014 × 0·025 inch Damon Copper Ni-Ti. All patients received 0·018 × 0·025 inch slot Victory Series™ brackets., Outcome Measures: Mandibular impressions were taken before the insertion of each archwire. Patients completed discomfort surveys according to a seven-point Likert Scale at 4 h, 24 h, 3 days and 7 days after the insertion of each archwire. Efficiency was measured by time required to reach the working archwire, mandibular anterior alignment and level of discomfort., Results: No significant differences were found in the reduction of irregularity between the archwire sequences at any time-point (T1: P = 0·12; T2: P = 0·06; T3: P = 0·21) or in the time to reach the working archwire (P = 0·28). No significant differences were found in the overall discomfort scores between the archwire sequences (4 h: P = 0·30; 24 h: P = 0·18; 3 days: P = 0·53; 7 days: P = 0·47). When the time-points were analysed individually, the 3M Unitek archwire sequence induced significantly less discomfort than GAC and Ormco archwires 24 h after the insertion of the third archwire (P = 0·02). This could possibly be attributed to the progression in archwire material and archform., Conclusions: The archwire sequences were similar in alignment efficiency and overall discomfort. Progression in archwire dimension and archform may contribute to discomfort levels. This study provides clinical justification for three common archwire sequences in 0·018 × 0·025 inch slot brackets.

Aim: To compare the clinical failure rates over six months of indirectly bonded brackets with and without methyl methacrylate monomer (MMM) conditioned custom bases., Methods: Thirty-six consecutive patients satisfying the selection criteria were randomly assigned to two groups in a split-mouth study design. In Group 1, the maxillary right and mandibular left quadrants were indirectly bonded after the custom bases had been conditioned with MMM. The brackets bonded to the teeth in the contralateral quadrants were not conditioned. In Group 2, the custom bases on the brackets indirectly bonded to the teeth in the maxillary left and mandibular right quadrants were conditioned and the brackets in the contralateral quadrants were not conditioned. Over the 6-month observation period all loose brackets were recorded, and the data were compared with a Wilcoxon signed ranks test., Results: Of the 828 brackets placed, six with the MMM conditioning came loose (1.4 per cent failed) compared with five in the Control group (1.2 per cent failed). The difference was not statistically significant (p = 0.74)., Conclusion: These results indicate that conditioning custom bases with methyl methacrylate monomer is an unnecessary step when indirectly bonding brackets.

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 nonextraction patients were randomly 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.

The purpose of this study was to determine the effects of beta-blockers (BBs) on heart rate recovery (HRR) following exercise stress testing. HRR is a predictor of mortality following exercise stress testing and is thought to be due to reinstitution of vagal tone. Exercise testing in the presence of BBs should have no effect on reinstitution of vagal tone and therefore no effect on HRR. One published study contradicts this understanding. The authors performed a retrospective analysis of the University of California, Davis, treadmill database and found 334 patients who underwent exercise stress echocardiography (ESE) with complete data. Patients undergoing ESE without a BB were compared with patients who were receiving a BB. HRR was not affected by BB use in patients without stress-induced echocardiographic abnormalities (negative ESE result). In patients with stress-induced echocardiographic abnormalities (positive ESE result), HRR was delayed compared with patients with negative ESE. BB use improved HRR in patients with positive ESE. BBs do not affect HRR in patients with a negative ESE result, and HRR can be used for mortality prediction. In patients with a positive ESE result, HRR is improved in the presence of a BB.

Aim: To determine if microetching the mandibular premolars and first molars prior to acid-etching reduced bracket failures during the first six months of orthodontic treatment., Methods: Sixty four patients with 384 mandibular first molar and premolar brackets were used in a split-mouth study design. In each patient the teeth on one side were acid-etched and the contralateral teeth were microetched prior to acid-etching. The microetched side was alternated in successive patients. The brackets were indirect bonded to the teeth on both sides. First time bracket failures were recorded over a 6-month period., Results: Two brackets (1 per cent) came loose on the microetched enamel side and four brackets (2.1 per cent) failed on the conventionally acid-etched side. This difference was not clinically or statistically significant (p = 0.41)., Conclusion: The addition of microetching prior to acid-etching does not result in fewer bracket failures during the first six months of treatment.

Recently, there has been a resurgence in the use of self-ligating (SL) brackets, which were introduced in the early 20th century. From a synthesis of both in-vitro and in-vivo evidence-based literature, we present general concepts, principles, and axioms. The references to "active" and "passive" SL brackets are explained and juxtaposed in relation to their perceived advantages and disadvantages. We also present new concepts in regard to the future of SL brackets: combination bracket system, hybrid system, and selective use of SL brackets.

Introduction: The aim of this study was to compare the rate of en-masse space closure with sliding mechanics between passive self-ligating SmartClip brackets (3M Unitek, Monrovia, Calif) and conventional twin brackets ligated with stainless steel ligatures., Methods: Nineteen patients including 20 arches participated in this prospective trial with 0.018-in slot brackets. All patients had first premolar extractions in at least 1 arch, with the second premolar and the first molar distal to the extraction site bonded with SmartClip brackets on 1 side and conventional twin brackets on the other. The sides were alternated with each consecutive patient. Space closure was achieved on 0.016 x 0.022-in stainless steel wires with nickel-titanium coil springs activated 6 to 9 mm. The patients were recalled every 5 weeks until 1 side had closed. The distances from the mesial aspect of the canine bracket to the distal aspect of the first molar bracket were recorded before and after space closure, and an average rate of space closure per month was calculated., Results: Thirteen patients completed the trial (14 arches); the median rates of tooth movement for the SmartClip bracket side (1.1 mm per month) and the conventional twin bracket side (1.2 mm per month) were not significantly different (P = .86)., Conclusions: There was no significant difference in the rate of en-masse space closure between passive SmartClip brackets and conventional twin brackets tied with stainless steel ligatures.

Objective: To compare the effectiveness of SmartClip brackets and conventional twin brackets for initial alignment of the lower arch., Methods: Fifty-eight patients participated in this prospective trial. The patients were assigned alternately to either a group treated with SmartClip MBT prescription brackets or a group treated with conventional MBT twin brackets. Lower anterior irregularity was measured at the start of treatment, 10 weeks later at the first archwire change and 20 weeks after the start of treatment at the second archwire change., Results: There was no difference in irregularity at the start of treatment. At 10 weeks subjects treated with conventional brackets had a lower irregularity index than subjects treated with SmartClip brackets (Mean difference: 0.7 mm; p = 0.005). After 20 weeks there were no statistically significant differences in irregularity between the two groups (Mean difference: 0 mm; p = 0.82)., Conclusion: The SmartClip bracket was no more effective at reducing irregularity during the initial stage of treatment than a conventional twin bracket ligated with elastomeric modules or stainless steel ligatures.