***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: PURPOSE The present follow-up study was carried out to evaluate the performance of Class II Cerec inlays after 10 years of clinical service . MATERIAL S AND METHODS Sixty-six Class II CAD/CAM ceramic inlays were placed in 27 patients . Each patient received at least one inlay luted with a dual-cured resin composite and one inlay luted with a chemically cured resin composite . At the 10-year recall , 25 ( 93 % ) patients with 61 ( 92 % ) inlays were available for evaluation using a slight modification of the USPHS criteria . RESULTS Fifty-four ( 89 % ) of the 61 inlays reevaluated still functioned well at the 10-year recall . During the follow-up period , seven ( 11 % ) of the inlays required replacement because of : four inlay fractures , one cusp fracture , endodontic problems in one case , and postoperative symptoms in one case . All the replaced inlays had been luted with the dual-cured resin composite . The fractured inlays were all placed in molars . The estimated survival rate after 10 years was 89 % , 77 % for the dual-cured resin composite-luted inlays and 100 % for the chemically cured resin composite-luted ones . The difference was statistically significant . CONCLUSION Patient satisfaction with and acceptance of the Cerec inlays were high , and the performance after 10 years of clinical service was acceptable , especially regarding the inlays luted with the chemically cured resin composite . The properties of the luting agents seem to affect the longevity of the type of ceramic inlays evaluated OBJECTIVES To evaluate  fixed dental prostheses ( FDPs ) and single crowns made of zirconia substructures veneered with new fluorapatite veneering porcelain . METHOD AND MATERIAL S Thirty-eight patients received 18 FDPs and 50 single crowns . Zirconia substructures were fabricated by a CAD/CAM system and veneered using the powder buildup technique . All restorations were cemented with glass ionomer . Baseline evaluation was performed 2 weeks after cementation with recall examinations at 12 , 24 , and 36 months by calibrated investigators . SEM was performed on replicas of all restorations . Survival probabilities according to Kaplan-Meier were calculated . RESULTS The mean service time was 35 ( + /- 14 ) months . After 3 years of clinical service , three biologic and five technical failures were recorded . All failures occurred in the FDP group . One FDP was removed after biologic failure of one abutment tooth . The Kaplan-Meier survival probability was 88.2 % after 35 months for all types of failures and 98.5 % concerning restorations in service . The type of restoration showed significant influence on the survival probability ( P < .001 , log-rank test ) . No influence on gingival parameters from the restorations was observed compared to control teeth . CONCLUSIONS Zirconia substructures veneered with fluorapatite veneering porcelain seem to be a reliable treatment option . More research has to be conducted to investigate differences between single crowns and FDPs PURPOSE The objective of this follow-up study was to examine the performance of Cerec inlays and onlays in terms of clinical quality over a functional period of 10 years . MATERIAL S AND METHODS Of 200 Cerec inlays and onlays placed in a private practice between 1989 and early 1991 , 187 restorations were observed over a period of 10 years . The restorations were fabricated chairside using the Cerec-1 computer-aided design /manufacturing ( CAD/CAM ) method and Vita MK I feldspathic ceramic . An adhesive technique and luting composite resin were used for seating the restorations . After 10 years , the clinical performance of the restorations was evaluated using modified USPHS criteria . The results were used to classify success and failure . RESULTS According to Kaplan-Meier analysis , the success rate of Cerec inlays and onlays dropped to 90.4 % after 10 years . A total of 15 ( 8 % ) failures were found in 11 patients . Of these failures , 73 % were caused by either ceramic fractures ( 53 % ) or tooth fractures ( 20 % ) . The reasons for the remaining failures were caries ( 20 % ) and endodontic problems ( 7 % ) . The three-surface Cerec reconstructions were found to have the most failures . CONCLUSION The failure rate of 8 % and the drop of the survival probability rate to 90.4 % after 10 years of clinical service of Cerec-1 CAD/CAM restorations made of Vita MK I feldspathic ceramic appear to be acceptable in private practice . This is particularly true in light of the very high patient satisfaction Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results This study prospect ively evaluated the clinical performance of computer-assisted design and computer-assisted manufacturing (CAD/CAM)-generated In-Ceram Alumina core crowns in Japanese patients for up to 5 years . A total of 101 In-Ceram crowns with aluminium copings fabricated using the GN-I system were placed in Japanese patients . The crowns were evaluated using a California Dental Association ( CDA ) quality assessment system at baseline and at all follow-up examinations . Gingival condition was assessed using plaque and bleeding scores . The survival of anterior and posterior crowns was analysed according to the Kaplan-Meier method . The scores of gingival condition were compared between restored crowns and contralateral teeth using a t-test . During the observation period , six crowns were lost to follow-up . Five crowns were fractured from the copings and removed , and four crowns were removed for other reasons . Chipping within the porcelain was detected in three crowns , which were then polished . The cumulative survival rates after 60 months were 96·9 % for anterior crowns and 87·7 % for posterior ones , and there were no significant differences between anterior and posterior crowns . According to the CDA criteria , most of the crowns were rated as satisfactory during the observation period . There were significant differences in soft tissue conditions between In-Ceram crowns and control teeth at 2- and 5-year examinations . Despite the five fractures from copings , In-Ceram Alumina crowns with copings fabricated using the CAD/CAM ( GN-I system ) for replacing both anterior and posterior teeth showed predictable results during a 5-year observation period OBJECTIVE The aim of this study was to evaluate the clinical performance of ceramic inlays made from machinable ceramic blocks . METHOD AND MATERIAL S The 2 inlay systems involved computer-aided design and computer-aided machining ( Cerec Cos 2.1 ) or copy-milling technique ( Celay ) . The study comprised 15 Celay inlays and 15 Cerec inlays placed in 17 patients . The inlays were evaluated clinical ly at baseline ( 1 week ) as well as 1 and 3 years later ( modified California Dental Association quality evaluation system ) . RESULTS One Celay inlay fractured after 1 year of service , and 2 Cerec inlays were replaced , 1 after 6 months and 1 after 1 year , because of pulpal pain and persisting hypersensitivity . One Celay inlay lost retention after 2 years . At the 3-year evaluation , chipping and hairline cracks were seen in 2 Celay inlays . Progressive disintegration of the marginal luting cement was seen for both Celay and Cerec inlays . The remaining 25 inlays performed satisfactorily throughout the 3-year period . CONCLUSION Because of their relatively high failure rate , these inlays should be reserved for esthetic indications The authors conducted a long-term clinical study of 50 CEREC ( Siemens AG ) CAD-CAM inlay restorations in 28 patients . After four years , they found the inlays to rate very highly in color matching , interfacial staining , secondary caries , anatomic contour , marginal adaptation , surface texture and postoperative sensitivity . They monitored cement loss along the occlusal margins and found it to be relatively low , with an unusual decrease in measured cement wear from the third to the fourth year . The favorable results of this long-term clinical study of these CAD-CAM restorations portend significant success for this restorative approach Procera AllCeram crowns were prospect ively evaluated clinical ly in both anterior and posterior regions in Japanese . One-hundred and one crowns were fabricated for 57 patients at the Tsurumi University Dental Hospital from August 2001 to October 2002 and evaluated according to the California Dental Association ( CDA ) quality evaluation system at baseline and annually at all follow-up examinations for 5 years . The plaque index ( PI ) and gingival index ( GI ) were recorded , and chipping and fracture were checked at the same time as well . A total of 75 Procera AllCeram crowns were evaluated , and the cumulative survival rate was 90.2 % over the 5-year clinical trial . Six crowns experienced fractures within the veneering porcelain and from aluminium oxide coping , all of which occurred on the premolar and molar regions , and they had to be removed . Small chipping was observed on three crowns . According to the CDA criteria , 98 % of Procera AllCeram crowns were rated as satisfactory , and PI and GI were comparable to those of control teeth during the observation period The purpose of this study was to evaluate Cerec CAD/CAM inlays processed of two industrially made machinable ceramics during an 8-yr follow-up period . Each of 16 patients received two similar ceramic inlays . Half the number of the inlays were made of a feldspathic ( Vita Mark II ) and the other of a glass ceramic ( Dicor MGC ) block . The inlays were luted with a dual resin composite and evaluated clinical ly using modified USPHS criteria at baseline , 8 months , 2 , 3 , 5 , 6 and 8 yr , and indirectly using models . At baseline , 84 % of the inlays were estimated as optimal and 16 % as acceptable . Postoperative sensitivity was reported by one patient for 8 months . Of the 32 inlays evaluated during the 8 yr , 3 failed due to fracture of the material . No secondary caries was found adjacent to the inlays . No significant differences in the clinical performance were found between inlays made of the two ceramics . It can be concluded that the CAD/CAM inlays processed of the two ceramics functioned well during the 8-yr follow-up period The aim of this prospect i ve r and omised controlled clinical trial was to evaluate the clinical outcome of shrinkage-free ZrSiO4 -ceramic full-coverage crowns on premolars and molars in comparison with conventional gold crowns over a 5-year period . Two hundred and twenty-three patients were included and r and omly divided into two treatment groups . One hundred and twenty-three patients were restored with 123 ZrSiO4 -ceramic crowns , and 100 patients received 100 gold crowns , which served as the control . All crowns were conventionally cemented with glass-ionomer cement . After an observation period of 6 , 12 , 24 , 36 , 48 and 60 months , the survival probability ( Kaplan-Meier ) for the shrinkage-free ZrSiO4 -ceramic crowns was 98·3 % , 92·0 % , 84·7 % , 79 % and 73·2 % and for the gold crowns , 99 % , 97·9 % , 95·7 % , 94·6 % and 92·3 % , respectively . The difference between the test and 
    Output:
    
The overall survival rate of single-tooth ceramic restorations fabricated with CAD/CAM technology was similar to those conventionally manufactured