***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 
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    Input: Clinical and radiographic diagnosis of occlusal caries is difficult . Resistance measurements in pits and fissures have shown better sensitivity compared with the more conventional methods of diagnosis . Two machines have been manufactured for this purpose : the Vanguard and the Caries Meter L. The aims of this study were to calibrate the readouts of these machines against a variable st and ard resistance box and use the Vanguard to compare readings taken in vivo and in vitro after extraction of the teeth . The diagnostic accuracy of clinical , radiographic , Vanguard and Caries Meter L diagnoses were also assessed . One hundred occlusal sites in 40 teeth of 20 patients were investigated in vivo with the Vanguard , noting clinical and radiographic appearances . The teeth were then extracted and the Vanguard readings repeated in vitro , together with Caries Meter L readings . The in vivo/in vitro comparison between Vanguard readings showed excellent reproducibility ( Cohen 's Kappa = 0.80 ) . The sensitivity and specificity for the different examination techniques at the enamel level of diagnosis were 27 % and 89 % for visual , 6 % and 100 % for radiographic , 81 % and 78 % for the Vanguard and 74 % and 74 % for the Caries Meter L. In conclusion , this study supports the renewed interest in resistance measurements as a diagnostic technique and indicates that the in vitro model used gives results comparable to those in OBJECTIVE To assess the effect of an ozone delivery system , combined with the daily use of a remineralising patient kit , on the clinical severity of non-cavitated leathery primary root carious lesions ( PRCL 's ) , in an older population group . DESIGN A total of 89 subjects , ( age range 60 - 82 , mean + /- SD , 70.8 + /- 6 years ) , each with two leathery PRCL 's , were recruited . The two lesions in each subject were r and omly assigned for treatment with ozone or air , in a double-blind design , in a general dental practice . Subjects were recalled at three , six , 12 and 18 months . Lesions were clinical ly recorded at each visit as soft , leathery or hard , scored with a vali date d root caries severity index . RESULTS There were no observed adverse events . After three months , in the ozone-treated group , 61 PRCL 's ( 69 % ) had become hard and none had deteriorated , whilst in the control group , four PRCL 's ( 4 % ) had become worse ( p<0.01 ) . At the six-month recall , in the ozone group , seven PRCL 's ( 8 % ) remained leathery , the remaining 82 ( 92 % ) PRCL 's had become hard , whilst in the control group , 10 PRCL 's had become worse ( 11 % ) and one had become hard ( p<0.01 ) . At 12 and 18 months , 87 Subjects attended . In the ozone group at 12 months , two PRCL 's remained leathery , compared to 85 ( 98 % ) that had hardened , whilst in the control group 21 ( 24 % ) of the PRCL 's had progressed from leathery to soft , i.e. became worse , 65 PRCL 's ( 75 % ) were still leathery , and one remained hard ( p<0.01 ) . At 18 months , 87 ( 100 % ) of ozone-treated PRCL 's had arrested , whilst in the control group , 32 lesions ( 37 % ) of the PRCL 's had worsened from leathery to soft ( p<0.01 ) , 54 ( 62 % ) PRCL 's remained leathery and only one of the control PRCL 's had reversed ( p<0.01 ) . CONCLUSIONS Leathery non-cavitated primary root caries can be arrested non-operatively with  ozone and remineralising products .  This treatment regime is an effective alternative to conventional " drilling and filling " PURPOSE To investigate , with a r and omized controlled clinical study , the effect of ozone on non-cavitated initial occlusal fissure caries compared with untreated contra-lateral control lesions ( split mouth ) considering the patient 's current caries risk . METHODS Forty-one patients with 57 pairs of lesions were enrolled in the study ( mean age 7.7 + /- 2.2 years ; upper jaw n=29 , lower jaw n=28 ) .  Gaseous ozone ( HealOzone ) was applied once for 40 seconds to the r and omly assigned test molar of each pair without the use of remineralizing solutions .  Lesion progression or reversal was monitored by the laser fluorescence system DIAGNOdent  for up to 3 months and the deterioration or improvement compared between the ozone-treated lesions and the untreated control lesions ( in pairs ) . This was done for the whole study population and a subgroup of patients with high current caries risk ( lesion pairs n=26 ) . RESULTS After 3 months , explorative data analysis revealed that the ozone-treated lesions showed significantly more caries reversal or reduced caries progression than the untreated control lesions within the group of patients at high current caries risk ( Wilcoxon-Test , P= 0.035 ) . There was no statistical significance examining the whole study population . From the data it can be concluded that ozone application significantly improved non-cavitated initial fissure caries in patients at high caries risk over a 3-month period Abstract The st and ard treatment of chronic skull-base osteomyelitis is antibiotics and surgical removal of sequestrums . Hyperbaric oxygen therapy has been found to be a useful method for managing refractory cases of chronic osteomyelitis . Since a minimal blood supply is needed for hyperbaric oxygen therapy , chronic osteomyelitis can produce necrotic infected areas that are not nutrified and therefore not assessible for hyperbaric oxygen therapy . Ozone is known to be an oxidizing medium with a strong bactericidal effect . We investigated the influence of locally applied ozonated oxygen on the development of chronic osteomyelitis in an experimental animal model using the femur of the rabbit . The proximal sides of the femurs of 40 rabbits were prepared and a needle inserted into the intramedullary cavity . Osteomyelitis was induced with an infusion of Staphyloccus aureus and sodium morrhuate into the bone . The needle was left in a intramedullar location . After a 4-week delay animals were r and omly separated into treatment and control groups . The infected femur of treated animals was flushed three times a day with 20 ml of ozonated oxygen at an ozone concentration of 107 μg/ml O2 over periods of 2 or 4 weeks . Clinical , radiographic and microbiological findings were documented . Chronic osteomyelitis occurred in all animals . Ten rabbits were excluded from further study during the investigation because of excessive weight loss  ( > 15 % of the original weight ) . Bacterial cultures showed no significant reduction of S. aureus concentrations in the ozone-treated group , although comparison of radiographic results revealed less serious osteomyelitis-related bone damage in these animals ( P < 0.01 ) . These findings indicate that refractory osteomyelitis in the head and neck may benefit from locally applied “ flush ” therapy with ozonated oxygen in addtion to treatment with antibiotics , surgery and hyperbaric oxygen PURPOSE To determine whether the treatment of dental caries with ozone was possible in apprehensive children and to ascertain whether ozone reverses caries in open single-surface lesions . Further , the influence of ozone on laser fluorescence was investigated . METHODS 82 lesions in 28 children with at least two open single-surface lesions were assessed . The children were anxious and were judged by the referring dentist as non-treatable . For each test lesion , which was treated with ozone , a control lesion was left without ozone treatment .  Hardness and laser fluorescence values were assessed and the changes for hardness and laser fluorescence values in the test lesion were compared with the values in the control lesion after 2 , 4 , 6 , and 8 months . RESULTS 94 percent of the children were treatable and 93 % lost their dental anxiety . The hardness values improved significantly in the ozone-treated test lesions after 4 , 6 , and 8 months ( P < 0.05 ) compared with baseline while the control lesions had no significant change in hardness at any recall interval . Comparing the differences between test and control teeth over time , the laser fluorescence values improved , however the improvement was not statistically significant ( P > 0.05 ) . The use of ozone result ed in an average reduction of 13 % of the laser fluorescence values immediately after the ozone treatment The aims of this present study were ( 1 ) to assess the antimicrobial effect of ozone from a novel ozone – generating device ( Heolozone , USA ) [ 0.052 % ( v/v ) in air delivered at a rate of 13.33 ml·s–1 ] on  primary root carious lesions ( PRCLs )  and ( 2 ) to evaluate the efficacy of ozone specifically on Streptococcus mutans and Streptococcus sobrinus . In study 1 , 40 soft PRCLs from freshly extracted teeth were r and omly divided into two groups to test the antimicrobial effect on PRCLs from exposure to ozonated water for either 10 or 20 s. Half of a lesion was removed using a sterile excavator . Subsequently , the remaining lesion was exposed to the ozonised water for a period of either 10 or 20 s ( corresponding to 0.069 or 0.138 ml of ozone , respectively ) . Using paired Student t tests , a significant ( p<0.001 ) reduction ( mean ± SE ) was observed in the ozone – treated groups with either a 10–second ( log10 3.57±0.37 ) or 20–second ( log10 3.77±0.42 ) ozone application compared with the control groups ( log10 5.91±0.15 and log10 6.18±0.21 , respectively ) . In study 2 , 40 sterile saliva – coated glass beads were r and omly divided into two groups for each micro – organism . One glass bead was put into each bijou bottle with 3 ml of Todd – Hewitt broth . S. mutans and S. sobrinus were inoculated anaerobically overnight . Each glass bead was then washed with 2 ml of phosphate – buffered saline . Immediately , 10 s of ozone gas was applied to each glass bead in the test groups . There was a significant ( p<0.0001 ) reduction ( mean ± SE ) in ozone – treated sample s for S. mutans ( log10 1.01±0.27 ) and S. sobrinus ( log10 1.09±0.36 ) compared with the control sample s ( log10 3.93±0.07 and log10 4.61±0.13 , respectively ) . This treatment regime is an effective , quick , conservative and simple method to kill micro – organisms in PRCLs . Ozone gas application for a period of 10 s was also capable of reducing the numbers of S. mutans and S. sobrinus on saliva – coated glass beads in vitro The aim of the study was to determine the reproducibility and validity of  DIAGNOdent in detecting  active and arrested caries lesions on free smooth surfaces . Volunteers were selected from state schools of Piracicaba , São Paulo , Brazil . Overall , 220 lesions were clinical ly examined . Two specially trained ( ‘ calibrated ’ ) examiners performed both clinical and laser evaluations independently , and after a 1-week interval , the examinations were repeated . The intra-examiner agreement for the laser evaluation was substantial ( ĸex1 = 0.79 , ĸex2 = 0.71 ) . There was almost perfect agreement between the two examiners for the clinical examination ( ĸex1 = 0.95 , ĸex2 = 0.85 ) . The inter-examiner agreement showed substantial reproducibility ( ĸ = 0.77 ) for the laser examination and almost perfect agreement ( ĸ = 0.85 ) for the clinical evaluation . The validation criterion was the clinical examination of white spots , recorded as active or arrested . The sensitivity was 0.72 and the specificity was 0.73 , which indicates that the DIAGNOdent was a good auxiliary method for detecting incipient caries lesions on free smooth surfaces . The utilization of both methods can improve the efficacy of caries diagnosis A prototype electronic caries meter ( ECM II ; LODE , Groningen . The Netherl and s ) was design ed to deliver a conductance reading when the reading had remained stable for 3 consecutive seconds . The aim of this study was to determine whether this type of stable conductance reading was optimal for caries diagnosis . The ECM II was connected to a graphic recorder which enabled the continuous resistance to be recorded . The graphic recording was calibrated using a st and ard , variable resistance box .  Stable conductance readings  were taken for 76 sites on 32 extracted teeth with no visible sign of cavitation at an airflow of 7.5 l/min . Simultaneous graphic recording of resistance was continued for 10 s and cumulative resistance measurements were calculated by adding the resistance values at 1-second intervals . Histological validation of caries status was carried out on macroradiographs of sections cut to include sample sites . The histological picture was compared with the stable conductance reading and the cumulative resistance value for each site . Sensitivity and specificity values were calculated by r and omly choosing stable conductance and cumulative resistance values to differentiate sound and carious sites . The results were presented as a series of receiver 
    Output:
    
RESULTS In vitro : Good evidence of  ozone biocompatibility with human oral epithelial cells , gingival fibroblast , and periodontal cells ; Conflicting evidence of antimicrobial efficacy of ozone but some evidence that ozone is effective in removing the microorganisms from dental unit water lines , the oral cavity , and dentures ; Conflicting evidence for the application of ozone in endodontics ; Insufficient evidence for the application of ozone in oral surgery and implantology ; Good evidence of the prophylactic application of ozone  in restorative dentistry prior to etching and the placement of dental sealants and restorations .
In vivo : Despite the promising in vitro evidence , the clinical application of ozone in dentistry ( so far in management of dental and root caries ) has not achieved a strong level of efficacy and cost-effectiveness .