___.Twenty-five years ago, there was no World Wide Web, and computers filled a huge, refrigerated room. “Telecommuting” and AIDS weren’t part of the lexicon. In 1976, the US became cleaner and more secure as Congress passed the EPA’s Clean Water Act, and planes were sent head-on into dozens of hurricanes. Mao Zedong and Paul Robeson were still alive, and Saul Bellow took the Nobel Prize for literature. The country lived the post-Vietnam syndrome while Gerald Ford was the US President: his Secretary of Defense, Donald Rumsfeld, however, is still in place!
___.Twenty-five years ago, two companies started a strange activity: processing used direct bonding brackets (which were considered garbage) well enough to have them placed again in somebody’s else mouth. Esmadent, which has since quit the activity, used to char the adhesive, subjecting the stainless steel parts to sensitization and intergranular corrosion. Their demise is no wonder: according to the Longitudinal Business Database, the business survival rate for the US companies that started that year is less than ten percent.
___.The other, Ortho-Cycle Company, which removed the adhesive by dissolving it, is doing well and thriving in spite of repeated attacks by major manufacturers either separately or concertedly (OMA, the Orthodontic Manufacturers Association). Some of these manufacturers obviously forgot that they have once delved, unsuccessfully, into the same business, Fig.1.
___.Some attacks were indirect, such as sending orthodontists thousands of pamphlets scorning recycling destined to be displayed in waiting rooms, Fig.2, or using NBC-TV. Counting probably on the poor memory of the audience, who may have forgotten the first NBC-TV broadcast in 1990, the second was presented as the best kept secret (“What’s hidden behind your children’s smile”, Lynn Dale, March1998). The crew of six, invited by Ortho-Cycle, looked for any detail they could use, Fig. 3. The comments aired contained biases, half-truths, innuendos, omissions and plain deceptions, which we all rebutted in the article “Move over, Machiavelli!”². The clinician who accepted to defend recycling, Dr. Douglas D. Durbin described the broadcast as “the lowest form of attack”³. Even Dr. Todd A. Fisher, whose Master’s thesis was used to downgrade recycling, considered the information “watered down, omitted, in some cases misrepresented”⁴.
___.NBC-TV’s attitude, unworthy of free press (the company is owned by General Electric, one of the largest and most diversified companies in the US) may have been sparked by several articles we wrote exposing the many factory-made defects found in brackets, Fig. 4 and 5. Seizing the improperty, the American Association of Orthodontists took our defense, Fig.6.
___.To quote the Chicago Sun¹, “Competition forces device manufacturers to hold down prices. Learning from the activists, the device manufacturers have launched an intensive public relations campaign creating unfounded alarm about reprocessed devices. They want reprocessors out of business. Reminiscent of other now debunked health scares —including Alar on apples, and cancer from power lines — the device manufacturers raise the specter of “possible” health threats to patients”.
___.Almost all medical devices are currently reused, among these being even the difficult to decontaminate plastic ones such as catheters and angioplasty balloons.“Third-party reprocessing of medical devices labeled for single use is a safe, FDA regulated practice that helps hospitals reduce costs without compromising patient care. Simply because a device is labeled as single use does not mean it cannot be safely reprocessed. To the contrary, the single use label is chosen by the manufacturer, sometimes for economic gain, as there are no formal FDA regulations or standards to distinguish between reusable and single use devices. The current FDA regulatory framework for third-party reprocessors emphasizes compliance with FDA quality assurance requirements”⁵.
___.According to an article in the British Medical Journal⁶, “Dr Larry Kessler, director of the office of surveillance and biometrics at the Food and Drug Administration, said: ‘there are no products where we have significant evidence that there is immediate harm to the public health. His view is shared by Dr William Jarvis, head of the ‘infections and prevention branch of the hospitals’ infection programme, at the Centers for Disease Control and Prevention. The Food and Drug Administration has proposed a strategy designed to protect the public health by ensuring that the practice of reprocessing and reusing single use products is based on good science”.
___.Inspite of these attacks, Ortho-Cycle has continued, undeterred, in its activities listed in its web site www.Orthocycle.com. Responding to all the requirements imposed on manufacturers (among which it is registered, Fig. 7), Ortho-Cycle. Co has obtained the sought after ISO 9002 certification, Fig. 9, and in processto get the CE Mark.
___.After FDA found “substantial equivalence of (Ortho-Cycle’s) refurbished orthodontic appliance to the legally marketed predicated devices”⁷, Ortho-Cycle Co. has not only participated, but also contributed to the meetings this regulatory agency has held over the years. Concurrently, Ortho-Cycle pursued active research in orthodontic biomaterials, resulting in a number of articles and chapters published in many journals and in its “Insider” (see pag.7-8), as well as in courses held all over the world8, as one may see at the web site www.Matasa.net shown in Fig. 9. In 1996, attempts to intimidate Ortho-Cycle Co. (Fig.10) claiming “patent infringement” were aborted by Ormco as it became obvious that no jury could condemn recycling.
___.In twenty-five years, our company has been repeatedly flattered by attempts to copy its success: armed with know–ledge that exceeds these of its competitors, we hope to continue to grow as demands become more diverse and sophisticated....
References
1. Milloy SJ, Big business stoops to activists’ level in attack on small competitors, Chicago Sun, Febr. 22, 2000
2. Matasa CG, Move over, Machiavelli! The Orthodontic Materials Insider, 1998; 11 (1): 1-2.
3. The Orthodontic Materials Insider, 1998; 11(2): 1-8
4. The Orthodontic Materials Insider, 1998,11(4): 1-8
5. Furman PJ. Third party reprocessing of endoscopic accessories, Gastrointestinal Endoscopy Clinics of North America, 10(2): 385-92, 2000]
6. Charatan, F, Controversy erupts over reuse of “single use” medical devices, British Medical Journal, 319(7221); 1320 November 1999] 
7. FDA, Case K913913, Refurbished orthodontic appliances, 1991

A new and simple way to evaluate slot size

___.The most important features of a bracket are its adhesion to the tooth and the accuracy of the slot. In our March 2001 issue¹, we have shown that it is possible, using the Adhesion Remnant Index concept², to evaluate and compare various brackets. In another issue³, we have shown the results obtained by a forensic expert when he compared identical brackets new, i.e. before reconditioning, and after these were processed using Ortho-Cycle’s unique dissolution process. The expert, Professor Dr. Mitchell W. Haller Jr., (MWH), previously called to testify in the case Dr. Donald M Fox vs. TP Orthodontics⁴, has used a highly sophisticated non-contact optical apparatus capable of a nominal accuracy of + .00015 (.004 mm) (Smart Scope^R by Optical Gaging Products, Rochester, NY). With the help of such an apparatus, which costs today US$ 38.995.00 (the “Flash”, seen in Fig. 1), he arrived at the conclusion that the slot’s “dimensional changes from recycling were extremely small compared with the variability observed in new brackets”³.
___.In our lab, technicians currently examine each bracket by moving laterally a gauge (0.022” or 0.018”) into its slot, rejecting those where the “play” shows an angle, we have extended the idea to find the apparent width of any edgewise bracket slot by using simple tools and geometry.
Materials and method
___.The materials used were a common small vise, an adjustable clamp (described in our previous issue), various brackets having a slot width of .022”, new and recycled, and a 14 inch long stainless steel wire “straight length”(.021x.025”, REF STSS2125, G& H, Greenwood, IN). The instruments used comprised an electronic caliper (721B-6/150 by L.S. Starrett Co.(Athol, MA) and a graduated steel ruler divided in 1/64”.
___.The tested brackets were first secured in the adjustable clamp, which was in turn tightened in the vise. Their position was chosen in such a way that one end of the wire, which was placed into its slot at a 90^o angle against the graduated liner, almost touched the latter. Each time special care was taken to insert the wires in such a way that the geometry of the arrangement was respected. To keep always a right angle between the wire and the ruler, both were placed upon a graph paper. The arrangement is shown in Fig. 2, and details given in Fig.3.
___.The experiments were performed by moving late–rally the inserted wire from its shorter end, while holding it at the bottom of the slot of various brackets. Only slight forces were applied in order to avoid any plastic deformation of the wire. The maximum displacement of the other end on the ruler, marked with D2, was recorded.
___.From Fig. 3 it can be seen that the two triangles formed due to the wire movement, DCC’ and DEF are acceptably isosceles, the angle a being well under 5^o (maximum reached: 2.2^o). Having the same shape while being different in size, the following relationship ensues between edges:
DC/ CC’= DE/ D2
___.In other words, the line CC’, D₁ , or the “play”, i.e. the difference in width between the wire a and the slot, can be obtained by dividing the product between the length of the line DF (the 12.5” portion of the wire) and the slot length DC (measured with the caliper) by the maximum course of the wire‘s longer end, D2.
To the “play” thus determined, the width of the wire (selected and tested to be .0210” throughout the length) was added to give the apparent slot width: w = L1+D1.
___.I. To compare results, we followed the technique employed by MWH. Only brand new brackets having gingival-distal marks were used. To evidence the influence of recycling, new brackets had their mesh base marked with a tungsten carbide vibrating tip and then tested before and after refurbishing. In what follows, only the middle two columns from Table 1 were used, i.e. these showing the width found at the bottom of the slot of .022” Ormco Diamond upper laterals, measured before and after recycling. As one can see, MWH found values both above and under .022”. The mean values of the two sets of values are .02237” and .02242” for the new and recycled brackets, respectively, and the standard deviations are .000800662 and .00351247. Let us consider the differences between the values of the new and recycled values of the individual brackets: their mean is 0.00055 and their standard deviation is .0002259. It is obvious that the standard deviation of the values for the new brackets (.00080662 is 3.57 times higher than the standard deviation of the recycled ones (.0002259).
Results
___.II. New brackets. Several upper laterals from four brands, .022” slot width, were compared to check the variations of the latter using the geometric method. The results are presented in Table 2. Using these values, we have performed an analysis of variance (ANOVA) to test the null hypothesis that the four groups of brackets were drawn from populations having the same mean values of the width. The high F-value (37.15) obtained is highly significant (the critical value of F, at .01 rejection level, is 4.5). In other words, the four types of brackets have significantly different mean slot widths.
___.II. New vs. recycled brackets. The same statistical analysis used to for MWH’s results was done for the values of the same type of brackets found in the first columns of Table 3. The mean and standard deviation for the 10 sample values of the new brackets are .02192 and .00049, respectively. Calculating the differences between the values of the new and recycled brackets, we have found that the means and the standard deviations are .000435 and .0005241, respectively. As one can see, the standard deviation of the values for the new brackets (.00049) is about the same as the standard deviation of the difference found for recycled brackets (.0005241).

Discussion
___.The results show that the actual width found in upper laterals released as having a .022” varies from brand to brand, as both the individual and the mean values show (Table II).
___.The difference between identical new brackets, tested using sophisticated and expensive instruments (MWH), is almost four times larger than that found between the new and the recycled ones. The same difference, tested this time with the geometric method is minimal, probably because the accuracy of the latter is superior. From a highly exclusive test, the measurement of brackets’ slot width as now becomes a do-it-yourself method, like the many others that we have developed during the years.
___.From the clinical point of view, all these differences found between both new, and new and recycled brackets seems to be insignificant. Indeed, here are the conclusions drawn in Dr. Todd Fisher’s Master’s Thesis, which was used in the NBC-TV broadcast against recycling (see page 2), “A note must be made that the company Z (Ortho-Cycle Co.) recycled group had been been labeled by the recycler as having a .022’ slot size rather than the .018” slot for the rest of the groupings, and thus the change in slot size for this group was also clinically insignificant”⁵ .
___.The same has been confirmed by Dr. Kesling, at that time President of the Orthodontic Manufacturers Association and owner of TP Orthodontics, who declared under oath, when his company was sued for allegedly releasing faulty brackets, in regard to slot tolerance: “I wouldn’t know the difference if I had a .0025” or a .005” difference. Not significantly different”⁴.
___.Slot widths vary from brand to brand, and within samples of the same type. This variation, as that between new and Ortho-Cycle recycled brackets is, however, insignificant from the clinical point of view as both the above results and experts confirm.
___.To accurately measure slot widths, a simple, do-it-yourself method allows an arrangement which can substitute highly expensive instruments.
References
1. Matasa CG, The ARI Concept can help you save money! The Orthodontic Materials Insider 2001; 14(1): 1-8
2. Artun J, Bergland S., Clinical trials with crystal growth conditioning, Am. J. Orthod. Dentofac. Orthop. 1984;85: 333-340
3. Matasa CG, Are reconditioned attachments worse than the new ones? The Orthodontic Materials Insider 1998: 11(1): 2-3
4. Fox vs. TP Orthodontics, Case 3:97CV181, Richmond,VA 5. Fisher TA, an in vitro comparative study of new and recycled orthodontic brackets, Master Thesis at the University of Iowa, 1995, quoted in The Orthodontic Materials Insider 1996: 9(4): 2

ARTICLES WRITTEN IN THE COMPANY’S NEWSLETTER
(“PHOENIX WITHOUT ASHES” (1987-1994) & “THE ORTHODONTIC MATERIALS INSIDER”)

DECEMBER 1987: -Why Phoenix? Why without ashes? (Advantages of direct-bonding, adhesive dissolution compared with thermal recycling)
-Are reconditioned brackets identifiable? (Criteria for their identification in the absence of any painted dots)
MARCH 1988: -Sapphire brackets: progress or problem? (Ceramic brackets characteristics, as a difference from the metallic or plastic ones)
-How to preserve the most delicate part of a bracket, the slot (Adequate debonding methods)
JUNE 1988: -Adhesion and its ten commandments (Do and don’ts in direct bonding)
SEPTEMBER 1988: -Electro thermal debracketing (Basic information and comparison between systems)
DECEMBER 1988: -Is he a dentist, or a chemist? (Eulogy of Rafael L. Bowen)
MARCH 1989: -A breakthrough in direct bonding: the film adhesive
-Sapphire brackets, revisited (New developments)
-Factory misfits (Faulty, brand new direct bonding brackets detected)
JUNE 1988: -Finally, somebody called a spade, a spade (Discussion of Dr. Al Buchwald’s article in Am. J. Orthod. April ’89)
-Etching and direct bonding bases (Description of a method to increase surface area)
SEPTEMBER 1989: -Still throwing away money? (Discussion of C.G. Matasa’s article in Am. J. Orthod. July ’89)
-A “Blue book” of today’s metal direct bonding brackets (Dimensional characteristics and mechanical evaluation of standard size and miniaturized direct bonding brackets) DECEMBER 1989: -A pioneer in orthodontics (Eulogy of Dr. George V. Newman)
MARCH 1990: -Beware of lemons (Discussion of C.G. Matasa’s article on faulty brackets in J. Clinical Orthodontics, March 1990)
-Sapphire brackets in review
JUNE 1990: -Trends in direct bonding appliances I.
SEPTEMBER 1990: -Trends in direct bonding appliances II
-What limits bracket miniaturization? (Discussion of available alloys and mechanical constraints)
DECEMBER 1990: -You are forcing us to disclose, Mr. Horowitz! (Answer to NBC-TV: a detailed description of Ortho-Cycle’s “Adhesive dissolution” recycling method)
APRIL 1991: -Reality, or April fooling? (Quiz: Incredible bracket manufacturing errors vs. computer altered images)
-Trends in ceramic brackets
-The sales tool of tomorrow: computer imaging (Smile images, without and with simulated braces)
JUNE 1991: -Bracket brazing (Discussion of the mesh-based brackets assembly)
SEPTEMBER 1991:
-Bracket metal is not the same! (Discussion of the alloys used)
DECEMBER 1991: -Pioneers and movers in orthodontic materials (Eulogy of Dr. Hugo Retief)
-Orthodontics in Eastern Europe
-A do-it-yourself test for bacterial contamination
APRIL 1992: -Facts about bracket corrosion. I. Phenomena and consequences
-Aren’t you fed up with molar bands? (Discussion of banding vs. bonding)
-Orthodontics in the former USSR
JUNE 1992: -A tribute to the “Earth Summit” at Rio de Janeiro (How can some still argue against recycling?
-Facts about bracket corrosion. II. Prevention
SEPTEMBER 1992: -Your bonds may decay, without your knowledge (Discussion of the adhesive’s microbial attack)
DECEMBER 1992: -Pioneers and movers in orthodontic materials (Eulogy of Dr. Brainerd F. Swain)
-Microbes feed on your stainless steel attachments
-Not everything that glitters is good gold (Problems encountered in bracket gold plating)
APRIL 1993: -Preadjusted appliances: One shoe fits all? (Questioning the “universality” of the prescriptions)
-The “Poor man’s tensile strength tester” (Use of the P.N. Gardner’s Elcometer to determine bracket bond strength)
JUNE 1993: -Evolution of several orthodontic biomaterials (Script of C. G. Matasa’s conference at the 66th European Scientific Reunion of the French Society of Dentofacial Orthopedics)
SEPTEMBER 1993: -Reconditioned brackets offer less friction (Wear lends their slot smoother) -Magnets and orthodontics
DECEMBER 1993: -Pioneers and movers in orthodontic materials (Eulogy of Thomas D. Creekmore)
-Could the gap be ever bridged? (An interview with Dr. Hans P. Bimler on removable and fixed orthodontic appliances)
-Ignored milestones in orthodontics (Means to apply force: screws and nuts vs. springs)
MARCH 1994: -Bracket recycling: case closed? (The confrontation between bracket manufacturers and recyclers)
-One-piece brackets are here to stay! I. Manufacture, advantages, disadvantages
JUNE 1994: -Attachment surface treatments (Electro-polishing, etching, gold plating, silanation)
-One-piece brackets are here to stay! II. (Sporadic or accidental faults, systematic faults, slot analysis)
SEPTEMBER 1994: -Preadjusted appliances: One shoe fits all? II (Prescription comparison)
-Microhardness, a tool to evaluate brackets
DECEMBER 1994: -Why have information on orthodontic materials?
-Breakthroughs are already here, or expected soon… (Advances in other fields which may have an impact on orthodontic biomaterials)
MARCH 1995: -The edgewise bracket versus friction (Discussion of various brackets in respect to the sliding mechanism)
-The Herbst appliance
JUNE 1995:-Ionites, complexes, chelates (Their relationship with modern adhesives)
SEPTEMBER 1995: -A do-it-yourself friction testing (Description of a new and simple system using the principle of the deadened coil spring balance)
-Titanium, a metal with future in orthodontics
DECEMBER 1995: -Trends: good bye Ni, welcome Co, Mn
-Traditional Chinese medicine and the edgewise technique (Presentation of a study performed at Moscow’s Dentistry Institute)
MARCH 1996: -Milling, casting, or injection molding? (Discussion of the bracket manufacturing methods)
-Diamond and fluorine-based coatings lower friction
JUNE 1996: -Materials orthodontists use: elastomers
-Cytotoxicity of polyurethane elastomers
SEPTEMBER 1996: -Ortho-Cycle’s“ Ortho-Recycling” (Twenty years since its humble beginnings), an overview on its scientific accomplishments)
DECEMBER 1996: -A New Year’s gift to the profession? (Comments on NBC-TV’s invited visit to Ortho-Cycle’s premises)
-How do reconditioned brackets compare to new ones?
-Self-engaging brackets: passive vs. active
MARCH 1997: -NiTi alloys: two metals in one
JUNE 1997: -Ceramic brackets: properties never studied before: I. Impact resistance through optical lenses standards
II. Bracket slot friction through Atomic Force Microscopy
SEPTEMBER 1997: -Thinking of a Website? (Indications related to its designing and use)
-Composite attachments in orthodontics
DECEMBER 1997: -Reader’s comments at the “Insider”s tenth anniversary
MARCH 1998: -What NBC-TV knew and didn’t tell you (A list of the deceptions, half-truths, omissions, biases and innuendos contained in NBC’s broadcast on bracket recycling of March 9, 1998)
-Are reconditioned attachments worse than the new ones? (A forensic analysis of both kinds showing that the differences between the reconditioned and the new brackets is lesser than the one between that between new brackets of the same type)
-The first antimicrobial resin is on the market (Immunization of acrylic resins as recommended by Ortho-Cycle Co. six years sooner
JUNE 1998: -Measure up to“Smart materials”! (Discussion of the martensitic transformations occurring in steels, NiTi, ceramics and plastics)
SEPTEMBER 1998: -Metallography and You. I. “Dissection”. (Factors influencing bracket behavior vs. microstructure)
DECEMBER 1998: -Metallography and You. II. Surface analysis (Surface defects, consequences, testing)
MARCH 1999: -Orthodontic biomaterials in China.
-An insidious syndrome may threaten your practice: “Patentite” (Patents and orthodontics, materials and procedures)
JUNE 1999: -Orthodontic recycling enters the new millennium (An overview on recycling in medicine and orthodontics)
SEPTEMBER 1999: -The wear and corrosion resistance of metal deposits (Comparison between gold- and Ti, Zr nitride-coated brackets)
DECEMBER 1999: -Single use, or useless appliances? (Defects commonly encountered in direct bonding brackets)
-Doc, I’m allergic to metals! (A new, do-it-yourself test for leached metals)
MARCH 2000: -We got an ISO 9002 certification; you may have to get it too…
-Do you really know the resins you use? Bis GMA (Cytotoxicity, mutagenicity, carcinogenicity, estrogenicity, hydrophilicity)
JUNE 2000: -The Congress laughs, sings and dances…(An analysis of the impact of the Invisalign system)
-Current prescriptions (Centrals to IInd bicuspids) (Torques and angulations for forty two prescriptions)
SEPTEMBER 2000: -It’s just up to you to fight nickel allergies…(A do-it-yourself test allowing to detect heavy metals leaching)
DECEMBER 2000: -Medice, cura te ipsum! (Appliances destined to suppress appetite)
-An ISO modified reagent detects leachable nickel
MARCH 2001: -The ARI concept allows clinicians to compare bond strengths (The Adhesive Remnant Index reveals bonding strengths and thus to compare brackets
JUNE 2001: -Elastic ligation and the resulting friction (Sharp angles made by the ligature over the sliding arch wire and cross or multiple-ligatures cause high friction.)

Should we continue to publish “The Insider”?

___.Fifteen years ago, when it started, to quote Prof. T.M. Graber, “The Insider” filled a gap. Today there are, aside many valuable articles in specialty’s journals, a book entirely consecrated to the domain (Orthodontic Materials, Brantley WA, Eliades T, Eds. Thieme, Stuttgart, NY, 2001) and a chapter in the “Orthodontist’s Bible” (Matasa C G, Orthodontic Biomaterials, in: Graber TN, Vanarsdall R, Orthodontics, Current Principles and Techniques III^rd ed., Mosby, St. Louis, 2000).
At our Silver Anniversary, we have had to rethink the sending to thousands of clinicians all over the world a free two-color newsletter dedicated to their tools. This constitutes a financial burden which even large companies can ill afford.
___.While during the years we tried our best to use our expertise and laboratories to provide do-it-yourself testing, analyses and information, we are not sure if we should continue to sacrifice a good part of our revenue to continue to produce this newsletter and mail it. An alternative could be to have the research posted on the Internet: right now, you can find the newsletter as an addition to www.Orthocycle.com. If you believe that the “Insider” is of real use to you, please send us a letter within two months, using your letterhead, stating:
a. You want it, and why you do so.
b. If you would look for it on the Internet