***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: OBJECTIVES The aim of this study was to evaluate the proportions of end-rounded bristles via observations of the end patterns of various children 's toothbrushes  with scanning electron microscopy ( SEM ) and stereomicroscopy . METHODS Ten different br and s of children 's toothbrushes were chosen , and tufts from each toothbrush were used . The prepared bristle specimens were observed on SEM and stereomicroscopic images and classified as acceptable ( A1-A3 ) and non-acceptable ( N1-N5 ) according to the modified classification . Then , the proportions of end-rounded bristles were calculated . RESULTS Analyses of the 10 toothbrushes revealed that the proportions of acceptable end-rounded bristles ranged from 1.4 % to 20.2 % on SEM and from 0.0 % to 18.0 % on stereomicroscopic examinations . Additionally , some toothbrushes had labels that indicated bristle end-rounding , but the proportions of end-rounded bristles were low . CONCLUSIONS The types and percentages of bristle ends of children 's toothbrushes marketed in Korea were various , but the amount of acceptable end-rounded bristles was low . The result , that even toothbrushes labelled as end-rounded had potential to harm oral tissue , demonstrates that quality control for rounding bristle ends as well as the labelling for end-rounded bristles is needed OBJECTIVES To compare a tapered filament toothbrush ( TFTB ) to a control toothbrush ( ADA ) in their potential to cause gingival abrasion and improve the gingival condition following a period of experimental gingivitis . METHODS Thirty-two subjects refrained from brushing m and ibular teeth for 21 days . During a subsequent 4-week treatment phase , the left or right side of the mouth was brushed with either the TFTB or ADA as r and omly allocated . Gingival abrasion , plaque and gingival bleeding were assessed . RESULTS During the treatment phase gingival abrasion showed a trend to be lower with the TFTB than the ADA , which was significant at the 2-week assessment . The mean plaque scores changed from 2.98 ( day 21 ) to 1.59 for the TFTB and from 3.00 ( day 21 ) to 1.31 for the ADA . The mean bleeding scores changed from 1.86 ( day 21 ) to 1.35 for the TFTB and from 1.85 ( day 21 ) to 1.20 for the ADA . Plaque and bleeding scores were significantly lower with the ADA . CONCLUSIONS Both toothbrushes improved gingival health and effectively removed plaque . Although there was a tendency towards fewer sites with gingival abrasion with the TFTB brush , it was less effective than the ADA in the removal of plaque biofilm and reduction of bleeding . Subjects considered the TFTB to be more pleasant to use OBJECTIVE The purpose of this study was to test the efficacy and safety of a newly design ed multi-level manual toothbrush ( Profit-Haije-Brush ) compared with a control flat-trimmed manual reference toothbrush from the American Dental Association ( ADA ) . MATERIAL AND METHODS For this study , 36 healthy subjects without previous experience in the use of the Profit-Haije-Brush ( PHB ) were selected . Subjects were given a period of 2 weeks to become familiar with both types of brushes and were instructed to use them on alternate days for 2 min twice daily . Prior to their visit , subjects refrained from all oral hygiene procedures for 48 h.  Prebrushing plaque and gingival abrasion scores were assessed . Subsequently , two r and omly chosen contra-lateral quadrants were brushed with one of both brushes and the other two quadrants with the alternate brush . Subjects were supervised during their 2-min brushing exercise . After brushing , plaque and gingival abrasion were re-assessed . A question naire was filled out to investigate the subjects ' attitudes towards both brushes . RESULTS The overall mean prebrushing PI was 2.47 for the PHB and 2.44 for the ADA . The reduction in PI was 1.32 and 1.23 respectively ( P < 0.05 ) . With regard to gingival abrasion the overall mean prebrushing scores were 4.57 ( PHB ) and 5.34 ( ADA ) . Post-brushing scores were 13.49 and 13.77 for the PHB and ADA respectively . CONCLUSION Statistically , the multi-level PHB was significantly more efficacious than the flat-trimmed ADA . However , the difference is clinical ly considered small and the amount of remaining plaque was not significantly different between brushes . No greater potential to cause gingival abrasion to the oral tissues was observed PURPOSE To compare the cleaning efficacy of ( A ) : a newly developed manual toothbrush with tapered filaments ( meridol , GABA International , CH-Münchenstein ) with ( B ) : a st and ard flat trim manual toothbrush ( ADA reference toothbrush ) in vivo . MATERIAL S AND METHODS 87 healthy participants took part in this study . Subjects were asked to abstain from all oral hygiene procedures for 48 hours . After plaque was scored ( Turesky modification of the Quigley Hein Index ) , the subjects brushed their teeth under supervision with the two manual toothbrushes according to a split-mouth design . In total , a cleaning time of two minutes was given for the whole procedure with an alert after every 30 seconds . Immediately after brushing , plaque was scored again by the same investigator , who was blind with respect to the toothbrush used . RESULTS Using the non-parametric Wilcoxon test for paired sample s ( p<0.05 ) the overall plaque scores were reduced for ( A ) from 1.95+/-0.48 to 1.02+/-0.41 ( p<0.001 ) , and ( B ) from 1.93+/-0.52 to 1.09+/-0.44 ( p<0.001 ) . At proximal surfaces the plaque scores were reduced ( A ) from 2.02+/-0.49 to 1.11+/-0.43 ( p<0.001 ) and ( B ) from 2.01+/-0.52 to 1.20+/-0.45 ( p<0.001 ) . The relative plaque reductions overall were ( A ) 47.4+/-18.0 % and ( B ) 44.1+/-15.6 % ( p=0.039 ) , at proximal surfaces ( A ) 44.2+/-18.8 % and ( B ) 40.5+/-15.9 % ( p=0.015 ) , and at lingual surfaces ( A ) 30.6+/-28.1 % and ( B ) 24.0+/-27.1 % ( p=0.016 ) . CONCLUSION Both brushes removed a significant amount of plaque . Overall and in areas difficult to reach , the meridol toothbrush was superior to the ADA reference brush OBJECTIVE The present study was design ed to evaluate the health promotion effectiveness , especially at the gingival margin , and the subjective satisfaction of a new toothbrush with soft conical filaments . METHODOLOGY Sixty-eight healthy adult subjects participated in the clinical trial and were r and omly divided into a test group ( meridol toothbrush ) or control group ( st and ard ADA reference toothbrush ) . Subjects were given oral hygiene instructions and a pre- study cleaning by a dental hygienist . Clinical examinations included the Gingival Index ( GI ) , Bleeding Index ( BLI ) , and Patient Hygiene Performance Index ( PHP ) for plaque levels ( before and after brushing ) , and were conducted at baseline , 30 , and 60 days . A self-administered satisfaction question naire was applied at 30 and 60 days . The statistical test employed for change within each test group was repeated measures ANOVA , and ANCOVA was employed for between-group analysis . For measures of satisfaction , Fisher 's Exact test was applied when comparing the percentages of answers . RESULTS For the GI , the test group demonstrated a highly significant statistical decrease ( from GI = 0.22 to GI = 0.13 , p = 0.0004 ) . The control group showed less of a decrease with statistical significance ( GI = 0.21 to GI = 0.16 , p = 0.05 ) . For the BLI , the test group also demonstrated a highly significant statistical decrease ( from BLI = 0.29 to BLI = 0.11 , p = 0.0013 ) , while the control group showed a very small decrease with no statistical significance ( BLI = 0.24 to BLI = 0.17 ) . The analyses of the PHP plaque levels after brushing showed significant and similar decreases for both groups over the study period ( test group : p = 0.04 , controls : p = 0.01 ) . In an analysis of PHP before brushing , both brushes showed increases from baseline to day 30 . This increase continued from day 30 to day 60 for the control group . For the test group , there was a significant decrease from day 30 to day 60 ( PHP = 0.84 to PHP = 0.75 , p = 0.037 ) . For satisfaction , a significantly higher percentage of test subjects expressed that the brush was " pleasant to use " as compared to controls , both at 30 and 60 days ( 77 % vs. 48 % , p = 0.02 , 80 % vs. 54 % , p = 0.04 , respectively ) . CONCLUSION The initial increase in plaque levels ( before brushing ) in the test group , is explained as a possible " learning curve " effect of using this new and unconventional brush . It is suggested that the conical filaments clean the subgingival pockets and that this is of important gingival health potential . This subgingival cleansing might not be adequately detected by the PHP index . These results might indicate a gingival health promotion potential for this toothbrush with conical filaments The aim of this RCT was to evaluate plaque control and gingival health promotion effectiveness of a new toothbrush with extra-soft filaments in postsurgical sets . Ten consecutive patients with at least two scheduled symmetrical periodontal surgeries were selected . Following the first periodontal surgery , a test ( TB1 ) or control ( TB2 ) toothbrush was r and omly assigned . After the second surgery , the remaining toothbrush was given . Patients were asked to gently wipe the surgical area from days 3 to 7 postoperatively and to gently brush using a roll technique from day 7 till the end of the study . Baseline evaluation took place on the day of surgery and follow-ups were performed at days 7 , 14 , and 30 postoperatively . A more evident PI reduction was recorded for test toothbrush where a regular decrease was observed till day 14 ; then , this parameter tended to stabilize , remaining however lower than that recorded for the control toothbrush . There were no statistical differences in the GI between test and control toothbrushes . All patients introduced the test toothbrush at surgical site at third day ; the control toothbrush was introduced within a mean of 9 days . The introduction of the test toothbrush 3 days after periodontal surgery may be recommended OBJECTIVE The elmex SENSITIVE extra soft toothbrush , with soft conical filaments design ed for plaque removal specifically in the cervical area and interdental spaces , and gentleness for hypersensitive teeth with exposed dentine , was evaluated for plaque removal effectiveness , safety , and subjective satisfaction . METHODS One-hundred and seven healthy adults participated in the clinical trial design ed according to American Dental Association ( ADA ) guidelines , and were r and omly divided into a test group ( N = 54 ) using the elmex brush , and a control group ( N = 53 ) using the ADA reference brush .  Subjects were chosen with gingival recession result ing in exposed dental necks and reported sensitivity , and were given a pre- study cleaning by a hygienist . Clinical examinations included the Rustogi plaque index ( before and after brushing ) , and an examination for any soft lesion adverse effects , at baseline , 30 , and 60 days . A subjective question naire , measuring satisfaction , sensitivity , and painless brushing , was administered at 30 and 60 days . An ANCOVA model , with baseline level as the covariate , was employed for testing clinical differences between groups at one and two months . The Mann-Whitney test measured differences in the satisfaction question naires . RESULTS The total plaque index , after brushing and at one and two months , demonstrated a significantly higher mean level for the control compared to the test group ( 3.05 vs. 2.16 ; p = 0.001 and 3.47 vs. 2.56 ; p = 0.0003 , respectively ) . Similar significant differences were detected for plaque levels at the gingival margin and the proximal dental surfaces , after brushing at one and two months . No significant differences were found pre-brushing at any of the measurement points . Most subjective assessment s of the two brushes at one and two months revealed significant differences in favor of the test brush . CONCLUSION These results indicate an effective toothbrush for promoting oral health , and patient acceptance of a toothbrush with soft conical filaments intended specifically for sensitive teeth OBJECTIVE The objective of this study was to evaluate the effect of different levels of filament end rounding on gingival abrasions ( GAs ) . METHODS The study was a crossover , split-mouth , contra-lateral , double-blinded , r and omized design using professional brushing . Three manual tooth 
    Output:
    
With respect to plaque removal , evidence that supports the recommendation for usage of a TFTB over an ERTB is lacking .
Regarding GI , there is minimal evidence favouring a TFTB over an ERTB and the clinical relevance of this difference is probably negligible .
Therefore , based on the collective evidence emerging from this systematic review , the strength and direction of the recommendation , there appears to be no firm evidence for a dental healthcare professional to advise the use of a TFTB over the use of an ERTB