***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: Results are reported of a double-blind trial to assess the accuracy with which three examiners identified an  opaque and a clear fissure sealant .  The combined identification error rate for opaque resin was only 1.4 % , whilst for clear resin it was 22.8 % . The difference was highly significant ( P less than 0.0001 ) . Significant differences were also found in the accuracy with which the three dentists identified each type of resin . The most common error was to identify the presence of clear resin on an untreated PURPOSE To evaluate the clinical performance of Helioseal-F , a fluoride-containing fissure sealant , in school children at caries risk . MATERIAL S AND METHODS A caries risk assessment based on past caries experience , saliva microbial tests , buffer capacity and frequency of sugar intake was carried out in 204 healthy children , 6 - 7 years of age . Children exhibiting one or more risk factors were considered at caries risk ( n = 121 ) and their permanent molars were sealed with a fluoride-containing fissure sealant , thus forming a fissure sealant group ( FSG ) . The remaining 83 children with low caries risk received no fissure sealants and constituted a reference group ( RG ) . Both groups were followed for 2 years . From 15 children of both groups , unstimulated whole saliva was collected 1 month after sealant placement in order to determine fluoride levels . In another 20 children , a split-mouth study design was utilized to compare the colonization of mutans streptococci adjacent to and on F-containing sealants and conventional controls . The sealants were placed by dental hygienists according to the manufacturers ' instructions . RESULTS A total of 431 fissure sealants were placed at baseline . Complete retention was found in 76.6 % during the study period while 22.0 % were partially lost . Six sealants ( 1.4 % ) were completely lost . The enamel caries incidence was 45 % lower ( P < 0.05 ) in the permanent molars of the caries risk FSG compared with the low risk RG . There was no significant increase in saliva fluoride concentration following placement of the sealants and the proportion of mutans streptococci in relation to total viable counts was unaffected by type of material . The levels of salivary mutans streptococci were mainly unchanged in both groups during the study period , while the levels of salivary lactobacilli decreased in the FSG PURPOSE The effect of sealants on S. mutans presence in situ was investigated . METHODS Four intact , fully erupted first permanent molars in each of 74 children , aged 6 - 8 years were required for inclusion in the study . Baseline examination included deft and plaque index . S. mutans presence on occlusal surfaces of the molars was evaluated , using a microbial replica method . Immediately after sealing the first permanent molars on one side , S. mutans presence in situ was re-evaluated , as well as three and six months thereafter . Three months after the initiation of the study , S. mutans presence was evaluated on the molars of the unsealed side , which were consequently sealed and re-evaluated immediately , and three months later . RESULTS Positive correlation was found between deft scores , plaque indices and microbial replica values , at baseline . Sealing caused a significant reduction in S. mutans levels on the treated occlusal surfaces , in vivo ( P < 0.001 ) , which lasted , in most cases , up to six months . CONCLUSIONS The data suggest that sealants enable a prolonged reduction of S. mutans presence in situ , indicating an additional prevention effect , by reducing one source of dissemination This study evaluated the outcome of a targeted dental sealant program by comparing the survival probabilities of sealed high-risk first molar tooth sites to unsealed low-risk tooth sites in 1,122 children enrolled in a school-based sealant program .  A comparison of the survival probabilities between low-risk first molar teeth that did not receive sealants and the sealed high-risk first molar teeth did not show significant differences . The results suggest that the protocol used by the program provides a satisfactory method for identification of children who could best benefit from  sealants  in a school-based situation Recent in vitro work and a short clinical study suggest that adding a bonding agent layer between sealant and saliva-contaminated enamel allows for adequate bond strength and retention of resin sealants and may improve success of all sealant applications . This five-year clinical study scored 617 occlusal and 441 buccal/lingual molar sealants , with use of a split-mouth design , with half receiving sealant alone and half bonding agent plus sealant . Treatment effects and potential risk factors for sealant failure were tested by means of a Cox regression model . Three bonding agent groups were analyzed for treatment effect : Tenure primer , Scotchbond Multi- Purpose , and 3 single-bottle dentin bonding agents as a third group . The single-bottle group was successful in reducing risk of sealant failure , with a hazard ratio ( HR ) of 0.53 ( p = 0.014 ) for occlusal and 0.35 ( p = 0.006 ) for buccal/lingual sealants . Scotchbond was detrimental to occlusal sealant success , with a HR of 2.96 ( p = 0.0003 ) . Tenure primer was neutral , showing HRs close to 1.0 . Variables that affected success differed between occlusal and buccal/lingual sealants , suggesting that failures on these two surfaces may be dependent upon differing factors . Early eruption stage was a significant risk factor for both surfaces ( HR = 2.91 , p = 0.00001 , occlusal ; and HR = 1.52 , p = 0.015 , buccal/lingual ) . Behavior ( HR = 1.96 , p = 0.0007 ) , salivary problems ( HR = 1.73 , p = 0.002 ) , and visually apparent variations in enamel ( HR = 1.51 , p = 0.018 ) were significant risk factors for occlusal sealants only . In addition to completing detailed analyses of risk factors for sealant survival , this study shows that single-bottle bonding agents protect sealant survival , yielding half the usual risk of failure for occlusal sealants and one-third the risk of failure for buccal/lingual sealants Following a single application of a chemically polymerized fissure sealant ( Concise Enamel Bond System ) 60 % of the sealants were present after 2 years of examination . The effectiveness of the treatment was highly significant and the caries reduction , irrespective of the sealant status , was found to be about 50 % . The caries reduction was 98 % in sealed pairs where the material was fully retained The half-mouth technique was used to determine the treatment effect of an application of an ultraviolet-light-polymerized sealant . The side of the mouth to be treated with the sealant was r and omly selected . At the one-year examination , a statistically significant reduction in occlusal caries was found for teeth coated with the sealant . Practically no color change or marginal discoloration was evident and retention of the sealant was excellent 
    Output:
    
There is good evidence that  sealants can be used efficaciously and effectively in high-risk  children as long as the sealant is retained .
Sealants are more effective in preventing further caries and providing cost savings in a shorter time span if placed in children who have high rather than low caries risk