You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
A new self-curing resin-modified glass-ionomer cement for the direct bonding of orthodontic brackets in vivo.
Abstract 1:
A new self-curing ( chemically cured ) resin-modified glass-ionomer cement , Fuji Ortho ( GC International ) , is based on the technology of hybrid glass-ionomer restorative material s and features chemical adhesion to tooth structure and long-term fluoride release . This article describes a 12-month clinical evaluation of  Fuji Ortho for the direct bonding of orthodontic ( metal ) brackets with System 1 + ( Ormco Corp. ) as a control . Three failures of Fuji Ortho occurred from a sample of 60 ( 5 % ) , with five failures of the composite resin from a sample of 60 ( 8.3 % ) . No statistical significance was seen between these results . Fuji Ortho is a satisfactory adhesive for the direct bonding of orthodontic brackets where there are no occlusal interferences


Title 2:
Nickel content of as-received, retrieved, and recycled stainless steel brackets.
Abstract 2:
The purpose of this study was to investigate the composition of as-received , retrieved , and recycled stainless steel brackets .  New , used , and recycled br and -matched , slot size-matched , and prescription-matched appliances were subjected to scanning electron microscopy and energy dispersive electron probe micro analysis . Elemental analysis was performed on r and omly selected surface bracket base and wing areas , and metal content was statistically analyzed with the 2-way ANOVA and the Tukey test , with treatment ( as-received , retrieved , and recycled ) and bracket regions ( base and wing ) serving as discriminating variables ( alpha = 0.05 ) . The results showed that there was no difference in the surface composition of the base ; however , surface area-wing analysis indicated that nickel content was decreased in retrieved and recycled specimens , implying that an ionic release effect occurred in vivo . Differences were noted between bracket base and wing with respect to elemental composition for the same brackets , implying that the base and wings are manufactured from different alloys


Title 3:
Clinical comparison and performance perspective of three aligning arch wires.
Abstract 3:
OBJECTIVES To clinical ly evaluate three commonly used orthodontic tooth aligning arch wires : 016 x 022 inch active martensitic medium force nickel titanium , 016 x 022 inch grade d force active martensitic nickel titanium , and 0.0155 inch multistr and stainless steel . DESIGN A prospect i ve r and omized clinical trial . DATA SOURCE Measured serial study casts of dental arches for 112 assigned arch wires from 56 consecutive patients . Analysis based on completed records for 98 arch wires and 51 patients . METHOD A consecutive sample of 56 patients requiring both upper and lower fixed appliance therapy were r and omly allocated two different arch wires from a possible three under trial . Good quality impressions were taken of the dental arches at the design ated serial stages of alignment ( start , T0 ; 4 weeks , T4 ; 8 weeks , T8 ) . The result ant casts were measured on a Reflex Microscope to record the change in individual tooth alignment both in three and two dimensions ( horizontal plane only ) . RESULTS The measurement error was within acceptable limits ( range , 0.05 to 0.09 mm ) and showed no significant bias . ANOVA statistical models were fitted to the data to adjust for a number of variables . No significant difference in aligning capability ( p > 0.05 ) , in either two or three dimensions , was demonstrated between the three arch wires in the trial . CONCLUSION Heat activated nickel titanium arch wires failed to demonstrate a better performance than the cheaper multistr and stainless steel wires in this r and omized clinical trial . The failure to demonstrate in vivo superiority at the clinical level may be due to the confounding effects of large variations in individual metabolic response . Alternatively , it may be that in routine clinical practice NiTi-type wires are not sufficiently deformed to allow their full superelastic properties to come in to play during initial alignment


Title 4:
The effect of topical fluoride agents on the physical and mechanical properties of NiTi and copper NiTi archwires. An in vivo study.
Abstract 4:
AIM The aim of this in vivo study was to determine the effect of topical fluoride agents on the mechanical properties of NiTi and copper NiTi archwires . METHODS Thirty patients with fixed appliances were r and omly divided into three groups : Group I ( Control group ) used no topical fluoride agents ; Group II used a fluoride rinse ; Group III applied a fluoride gel to the teeth . After 30 days , the archwires were retrieved and the moduli of elasticity and yield strengths measured . The groups were compared with the oneway ANOVA , and Tukey 's HSD test was used to identify the significant groups . One wire was r and omly selected from each group and the surface examined with a scanning electron microscope . RESULTS During unloading the modulus of elasticity of the NiTi archwire fell significantly in the gel group . The moduli of elasticity and yield strengths of the NiTi archwires during loading , and the copper NiTi archwires during loading and unloading , were not affected by either the gel or the rinse . Scanning electron microscopic analysis revealed that the copper NiTi archwires in the gel group had the most pitting . CONCLUSIONS Topical fluoride agents alter the mechanical properties of NiTi wires and , hence , may prolong orthodontic treatment


Title 5:
CONSORT and QUOROM guidelines for reporting randomized clinical trials and systematic reviews.
Abstract 5:
As practitioners strive to improve the delivery of patient care , it is increasingly important that they find it easier to identify studies with the highest level of evidence . Once found , there must be some assurance that the studies were carried out satisfactorily and the methodology was sound . To assist in meeting this challenge , the Consoli date d St and ards of Reporting Trials ( CONSORT ) guidelines were developed by a team of dedicated journal editors , epidemiologists , and statisticians . They determined the st and ards for authors reporting the findings of controlled clinical trials . CONSORT comprises a checklist and a flow diagram ( Figs 1 and 2 ) to help improve the quality of reports of r and omized controlled trials ( RCTs ) . It offers a st and ard way for research ers to report their findings . The checklist includes items , based on evidence , that should be addressed in the report ; the flow diagram gives readers a clear picture of the progress of all participants in the trial , from the time they are r and omized until the end of their involvement . The intent is to make the experimental process transparent , flawed or not , so that users of the data can more appropriately evaluate the validity for their purpose s. The key elements start when the research er su bmi ts an article for review and completes the st and ardized forms . The completed checklist should accompany the manuscript through the review process and identify the page on which each item is addressed . The completed flow diagram should appear as a figure in the manuscript . Nearly a year ago , the AJO-DO m and ated a structured abstract with each su bmi ssion ; this is one of the first items on the CONSORT checklist . There are good reasons for this change and for all other requests listed . According to Sharma and Harrison , “ the quality of information provided in journals with structured abstract s is greater than in those with nonstructured abstract s. ” These authors concluded that the quality of information in an abstract improves when a journal changes to a structured format .
The general conclusion in the studies was that metal ions were released mostly in the initial stage of the treatment .
It leads to the conclusion that nickel ions are released from orthodontic appliances in measurable amounts to human organism