***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: The conservative technique of professionally dispensed and supervised , home-administered vital bleaching is now a routine treatment in the dental profession . This double-blind study evaluated the Rembr and t Lightening Gel and Whitening Toothpaste for shade change , colorimeter shade change . As well , it evaluated soft tissue health by periodontal probing , plaque index , and bleeding index . A patient question naire evaluated perception of whitening , perception of oral hygiene , average hours per day , and average days per week . Bleaching trays were worn over a 4-week period . The bleaching system showed definitive whitening effects as evaluated with the Vita shade guide and the colorimeter . The bleaching system had no deleterious effects on the soft tissue . The Rembr and t toothpaste alone demonstrated two-shade lightening . This vital bleaching system shows definitive whitening of the teeth in short periods of time with no adverse effects To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results PURPOSE To compare the clinical response of two self-directed vital bleaching systems under market use conditions . MATERIAL S AND METHODS A r and omized , parallel-group clinical trial was conducted . A total of 20 healthy adults were r and omized to either a 6.0 % hydrogen peroxide strip-based bleaching system or a combination system involving a 10 % carbamide peroxide gel in a stock tray along with an anticavity whitening dentifrice and after-bleaching whitening mouthrinse . Only the maxillary arch was bleached over a 14-day period . Subjects were evaluated at 3 , 8 and 15 days . Efficacy was measured objective ly using digital image analysis to derive individual color parameters ( L*a*b * ) and overall color change ( deltaE * ) . RESULTS After 14 days , the adjusted mean reduction in yellow ( Ab * ) was -2.23 + /- 0.157 for the whitening strips compared to -0.97 + /- 0.188 for the combination system . This represented a highly statistically significant ( P < 0.0001 ) , two-fold superior reduction in yellowness for the whitening strip group compared to the marketed control . Similar results were seen for other color parameters , with the whitening strip group exhibiting two-fold color improvement relative to the tray/dentifrice/rinse combination . With respect to tolerability , tooth sensitivity and oral irritation were the most common findings . Considering event duration and severity , median bleaching tolerability severity-days scores were 0.07 and 0.58 for the strip and combination systems respectively , with these treatments differing statistically ( P= 0.04 1 ) favoring the whitening strips A r and omized , parallel , examiner-blind clinical trial was conducted to compare two professionally dispensed vital bleaching systems . A total of 20 subjects were r and omized to either the Crest Professional Whitestrips system or the Nite White Excel 2 tray system , balancing for baseline tooth color . During the 2-week treatment period , subjects were instructed to use the strip system for one-half hour twice daily ( 14 contact hours ) and the tray system for 2 hours daily ( 28 contact hours ) . Only the maxillary teeth were treated , and all bleaching was unsupervised . Whitening was measured objective ly by comparing digital images of the maxillary anterior dentition at pretreatment and posttreatment . Compared with baseline , both the strip and tray systems exhibited statistically significant decreases ( P < 0.05 ) in yellowness ( delta b * ) and increases in brightness ( delta L * ) . Compared with the tray-system group , the strip-system group experienced significant additional whitening ( P < 0.03 ) , as evidence d by a 62 % to 209 % improvement in tooth color ( delta b * , delta L * , and delta E * ) after 14 days . Both systems were generally well tolerated , and none of the subjects discontinued treatment early because of an adverse event . Under the conditions tested , this clinical trial demonstrates that the 14-contact-hour treatment with the strip system result ed in superior whitening efficacy compared with the 28-contact-hour treatment with the tray system This clinical study compared the efficacy of three different bleaching techniques with respect to the bleaching times required in order to achieve six grade s of whitening  in human teeth . Any side effects that were noted and the patients ' acceptance of the method were recorded by a visual analog scale ranging from 0 to 10 . Moreover , epoxy casts from the study teeth were analyzed by scanning electron microscopy in order to detect any potential changes in the enamel surface due to treatments . Thirty-nine volunteers participated in the study and were allocated r and omly to one of three different bleaching treatments : Group A ( n=13 ) used Whitestrips ( over-the-counter technique ; one cycle=30 minutes ) , Group B ( n=13 ) used Opalescence PF 10 % ( at-home bleaching technique ; one cycle=8 hours ) and Group C ( n=13 ) used Opalescence Xtra Boost ( in-office bleaching technique ; one cycle=15 minutes ) until a defined whitening of six tabs compared to the baseline were reached ( assessed by the VITA shade guide ) . All three methods achieved six grade s of whitening . The mean treatment time required to reach the defined level of whitening was 31.85 + /- 6.63 cycles in Group A , 7.15 + /- 1.86 cycles in Group B and 3.15 + /- 0.55 cycles in Group C. All products differed significantly from each other in terms of treatment cycles and required treatment time ( p<0.001 by ANOVA and Mann-Whitney-U-test ) . Using the VA scale , side effects noted within the three groups were minimal . Tooth hypersensitivity ranged from 2.62 ( Whitestrips ) to 3.38 ( Opalescence PF ) , and gingival irritation ranged between 0.23 ( Opalescence Xtra Boost ) and 0.85 ( Whitestrips ) . The most accepted method was the at-home bleaching technique . None of the teeth studied showed detectable enamel surface changes in the subsequent SEM analysis using 200x and 2000x magnification This study tested the hypothesis that beveling and /or etching enamel does not affect the 6-month clinical performance of the self-etch adhesive Clearfil SE Bond in class V noncarious lesions . With Institutional Review Board approval , 34 patients were enrolled in this study . A total of 120 noncarious cervical lesions were selected and assigned to 4 groups : ( 1 ) Clearfil SE Bond was applied without any cavity preparation ; ( 2 ) After the enamel was beveled , Clearfil SE Bond was applied ; ( 3 ) After the enamel was etched for 15 seconds with 35 % phosphoric acid , Clearfil SE Bond was applied ; ( 4 ) After the enamel was beveled and etched with 35 % phosphoric acid for 15 seconds , Clearfil SE Bond was applied . A microfilled composite resin was used for all restorations . Six months after initial placement , 120 restorations ( a 100 % recall rate ) were re-evaluated . Retention rates at 6 months were 100 % for all groups . Sensitivity to air improved from baseline to 6 months , but the overall difference was not statistically significant . The 6-month retention rate of the self etch dentin adhesive system Clearfil SE Bond was not improved by enamel beveling or by enamel etching . For the self-etch material Clearfil SE Bond , instrumentation or etching of enamel may not be critical for its clinical performance at 6 months A r and omized and controlled , parallel-group clinical trial compared the whitening benefits of a novel 5.3 % hydrogen peroxide bleaching strip to 10 % , 15 % , and 20 % carbamide peroxide tray-based bleaching systems . A total of 36 healthy adults were r and omized to a 14-day regimen in which both arches were whitened for 1 hour per day in the whitening-strip group or 2 hours per day in the tray groups . Efficacy was measured objective ly using digital images of the anterior teeth at baseline and after 14 days of treatment . Overall tooth color ( L*a*b * ) was derived from individual pixel values , and then mean levels of delta b * , delta L * , and composite color ( delta E * ) were compared using analysis of covariance . After 14 days of treatment , all groups experienced a greater than 1-unit mean improvement in delta b * , delta L * , and delta E * relative to baseline . For the primary study variable , reduction of yellow ( delta b * ) outcomes after 14 hours of using the experimental strip were comparable to those observed with the 10 % tray group after 28 hours of use . These two treatment groups did not differ statistically with respect to any of the color measurements used in this study . For the tray groups , there was a reasonable dose relationship for the primary end point , delta b * , with the 15 % and 20 % tray groups averaging 17 % and 68 % improvements in yellow , respectively , over the 10 % group . Except for the 20 % carbamide peroxide system , where sensitivity was relatively common , all test products were well tolerated . In this first comparative evaluation vs marketed controls , use of the whitening strips twice daily for 14 days yielded a highly significant improvement in tooth color vs baseline This clinical trial tested the efficacy and safety of a professional strip-based whitening system ( Crest Whitestrips Supreme ) using the manufacturer 's recommended 3-week treatment regimen . These strips have a higher concentration , but a similar amount of hydrogen peroxide relative to Crest Professional Whitestrips , because the thickness of the gel on strips is reduced . Tooth whitening was measured using the value-oriented VITA Classic Shade Guide before and after treatment . Twenty-nine subjects were treated with either Crest Whitestrips Supreme or placebo strips that did not contain hydrogen peroxide . Participants in the experimental group achieved a mean lightening of nearly eight VITA shades relative to placebo , with minimal side effects A 2-week study was conducted to compare the tooth-whitening efficacy of two 10 % carbamide peroxide products : Colgate Platinum Professional Toothwhitening System and Rembr and t Lighten Bleaching Gel .  Fifty subjects were divided into two groups and assigned a product to use for 2 weeks . Change in tooth color was measured by reflectance spectroscopy at the initiation of study , at 1 week , and at 2 weeks into the study . Color change was calculated using the color-difference equation established by the Commission International de L'Eclairage . Results showed that Colgate Platinum was 62 % more effective at tooth whitening after 1 week and 83 % more effective after 2 weeks of treatment vs Rembr and t. At the termination of the study , the mean color difference ( deltaE ) for Colgate Platinum was 4.29 and 2.34 for Rembr and t. Statistical analysis demonstrated that the Colgate product is significantly superior at increasing tooth whiteness , increasing tooth lightness , reducing redness , and reducing yellowness . In this study , no adverse reactions were noted on clinical examination and none were reported by panelists with normal healthy dentition PURPOSE To evaluate objective and subjective whitening responses of two marketed vital bleaching systems under intended use conditions . MATERIAL SA ND METHODS : The r and omized clinical trial evaluated 50 adults who received either a combination system with a 3 % hydrogen peroxide bleaching gel , pre-formed dual arch tray , dentifrice and oral rinse ( Rapid White ) , or 6 % hydrogen peroxide whitening strips ( Crest Whitestrips ) .  Efficacy was assessed objective ly from L*a*b * tooth color at Days 7 & 14 , while subjective , first-person whitening perception was measured by question naire . A cumulative multinomial probability model was generated to predict subjective responses from objective ly measured tooth color . RESULTS At end-of-treatment , adjusted mean deltab * was -2.05 + /- 0.158 for the whitening strip group compared to -0.69 + /- 0.141 for the combination group , with these groups differing significantly ( P < 0.0001 ) . This response held across every color parameter and time point in this study . Relative to the combination system , subjects in the whitening strip group rated that product significantly ( P < 0.01 ) more favorably with respect to the amount of whiteness improvement , as well as whitening satisfaction and overall impression . These subjective responses were correlated with objective changes in to 
    Output:
    
Mild ' to ' moderate ' tooth sensitivity and gingival irritation were the most common side effects .
The whitening strips and products with high concentrations of HP caused more users to complain from tooth sensitivity .
There is evidence that whitening products work when compared with placebo/no treatment .
There are differences in efficacy between the products , mainly due to the levels of active ingredients , hydrogen peroxide and carbamide peroxide .