***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: INTRODUCTION This article illustrates a new treatment method and evaluates the effect of the frequent use of fluori date d chewing sticks ( miswaks ) on the remineralization of white spot lesions ( WSLs ) diagnosed at debonding . METHODS Thirty-seven orthodontic patients ( mean age , 17.2 years ) , with a minimum of 4 WSLs on the buccal surfaces of the maxillary incisors , canines , premolars , and first molars after orthodontic therapy , were enrolled in a double-blind , r and omized , longitudinal trial lasting 6 weeks . The subjects were divided into 2 groups using fluori date d miswaks impregnated in 0.5 % sodium fluoride ( test group , n = 19 ) and nonfluori date d miswaks ( control group , n = 18 ) . A custom-made mouth tray , covering half of the maxillary dentition , was used while brushing with the miswaks 5 times per day . The WSLs were scored by using a DIAGNOdent pen ( KaVo , Biberach , Germany ) and with the International Caries Detection and Assessment System ( ICDAS II ) index , at baseline and 2 , 4 , and 6 weeks after debonding . RESULTS Both the DIAGNOdent readings and the ICDAS II index of the WSLs decreased in the test group on the uncovered side of the dentition but not on the covered side during the 6-week trial ( P < 0.0001 ) . There was also a slight improvement in the control group ( not significant ) . There was a strong correlation between the DIAGNOdent values and the ICDAS II index when all the data were pooled ( P < 0.001 ) . CONCLUSIONS The frequent use of fluori date d miswaks had a remineralizing effect on WSLs . The DIAGNOdent pen might be a useful tool for diagnosing and monitoring changes of WSLs over a relatively short period of time Orthodontic treatment with fixed appliances is considered a risk factor for the development of  white spot caries lesions ( WSL ) . Traditionally , brackets are bonded to the buccal surfaces . Lingual brackets are developing rapidly and have become more readily available . Buccal surfaces are considered to be more caries prone than lingual surfaces . Furthermore , lingual brackets are shaped to fit the morphology of the teeth and seal almost the entire surface . In the present study we tested the hypothesis that lingual brackets result in a lower caries incidence than buccal brackets . We tested this hypothesis using a split-mouth design where subjects were allocated r and omly to a group receiving either buccal or lingual brackets on the maxillary teeth and the alternative bracket type in the m and ible . The results indicate that buccal surfaces are more prone to WSL development , especially when WSL existed before treatment . The number of WSL that developed or progressed on buccal surfaces was 4.8 times higher than the number of WSL that developed or progressed on lingual surfaces . When measured using quantitative light-induced fluorescence ( QLF ) , the increase in integrated fluorescence loss was 10.6 times higher buccally than lingually . We conclude that lingual brackets make a difference when caries lesion incidence is concerned Dental caries and result ing tooth decay can produce a multifactorial destructive process with a very high incidence . Cariogenic bacteria attack enamel with acids that produce subsurface lesions , thereby weakening the enamel and allowing bacterial progression into the dentin . The formation of dental decay , because of demineralization of the tooth structure , can be prevented or delayed by increasing the rate of the tooth 's remineralization and replacement relative to the tooth 's rate of demineralization . This rebuilding of enamel may be accelerated by the addition of amorphous calcium phosphate ( ACP ) with the aid of casein phosphopeptide ( CPP ) ( Recaldent molecule ) . In this study , the role of CPP in stabilizing and releasing ACP on the tooth surface has been investigated to better underst and its efficacy in the prevention of tooth demineralization in orthodontic patients . Twenty-five patients who wore fixed orthodontic appliances were enrolled in this clinical trial . It was explained to the patients that CPP-ACP would be used for 3 weeks and then suspended for an additional 3 weeks . Salivary pH evaluation , plaque pH evaluation and oral hygiene index ( OHI ) were performed at T0 , T1 and T2 . Results showed an increase in OHI level and an increase of the salivary pH ( 76 % of the patients ) . Instead of plaque pH level that showed trivial results , only 48 % of the patients showed a bacterial plaque pH increase . In conclusion , this study has not provided unequivocal evidence for the protective properties of Recaldent molecule . Long-term studies are necessary to better underst and the role of this molecule INTRODUCTION Enamel demineralization is a problem in orthodontics . Fluoride is partially effective in addressing this problem , but additional treatment options are needed . The objective of this prospect i ve r and omized controlled trial was to determine the effectiveness of a new product , MI Paste Plus ( GC America , Alsip , Ill ) , in the prevention or reduction of white spot lesions in orthodontic patients . METHODS Sixty patients who were undergoing routine orthodontic treatment were recruited for this prospect i ve r and omized clinical trial . A double-blind method of r and omization was used to determine whether each patient received the MI Paste Plus or a placebo paste ( Tom 's of Maine , Salisbury , United Kingdom ) . Each patient was asked to administer the paste by using a fluoride tray for a minimum of 3 to 5 minutes each day at night after brushing . Photographic records obtained in a light-controlled environment were used to record the presence or absence of white spot lesions in both groups . The enamel decalcification index was used to determine the number of white spot lesions per surface at each time interval . Patients were followed at 4-week intervals for 3 months . A scoring system from 0 to 6 was used to determine the level of caries or cavitations . This system was also used for each tooth at each time interval . RESULTS Fifty patients ( 26 using MI Paste Plus , 24 using the placebo paste ) completed the study . The enamel decalcification index scores for all surfaces were 271 and 135 at the start of treatment and 126 and 258 at the end of treatment for the MI Paste Plus and placebo paste groups , respectively . The enamel decalcification index scores in the MI Paste Plus group reduced by 53.5 % , whereas the placebo group increased by 91.1 % during the study period . A 3-way analysis of variance ( ANOVA ) was done for the average enamel decalcification index scores . The surface type , the product/time interactions , and the product/surface interactions of the mean enamel decalcification index scores were significant ( P < 0.05 ) . CONCLUSIONS MI Paste Plus helped prevent the development of new white spot lesions during orthodontic treatment and decreased the number of white spot lesions already present . The placebo paste had no preventive action on white spot development during orthodontic treatment ; the number of lesions actually increased . MI Paste Plus reduced white spots on the gingival surfaces ; the placebo paste had the opposite effect . The incisal surface effect on the mean enamel decalcification index scores over time and between products was highly significant . The incisal enamel decalcification index scores were consistently higher than those for the other surfaces ( mesial , distal , and gingival ) The aims of this in vitro study were 2‐fold : 1 ) to evaluate two fluorescence methods ( DIAGNOdent and QLF ( quantitative light‐induced fluorescence ) ) for quantification of white spot lesions adjacent to fixed orthodontic appliances ; and 2 ) to determine the inter‐observer agreement of the DIAGNOdent and QLF methods for quantification of incipient enamel lesions adjacent to fixed orthodontic appliances . Forty‐one premolar teeth with visually sound smooth surfaces or visually white spot enamel lesions were included in the study .  Orthodontic brackets were fixed adjacent to the lesions , thus simulating the position of fixed appliances during orthodontic treatment . All teeth were measured using both the DIAGNOdent and QLF methods . Of the 41 teeth , 20 smooth surfaces were r and omly selected and analyzed by 4 operators using both DIAGNOdent and QLF . The teeth were sectioned into 300‐μm‐thick slices using a water‐cooled diamond saw and the slices manually ground to 80–100 μm thickness . Histopathology and transverse microradiography were performed to provide the gold st and ards for verification of lesion depth and mineral loss , respectively . The Spearman rank correlation coefficients between lesion depth determined by histopathology and the DIAGNOdent and QLF were 0.76 and 0.82 , respectively , whereas the Pearson correlation coefficients between mineral loss and the two methods were 0.64 and 0.84 , respectively . Inter‐observer agreement was found to be 0.80 and 0.93 for DIAGNOdent and QLF , respectively . In conclusion , QLF may be a suitable method for quantifying incipient carious lesions adjacent to fixed orthodontic appliances This study investigated , using digital bitewing radiography , the progression and regression of  approximal caries in adolescent subjects chewing a sugar-free gum containing 54 mg CPP-ACP  relative to the identical gum without CPP-ACP .  2,720 subjects from 29 schools were r and omly assigned to one of the two gums and were instructed to chew their assigned gum for 3 × 10 min/day , with one session supervised on school days , over the 24-month study period . St and ardized digital bitewing radiographs were taken at the baseline and 24-month clinical examinations for each subject . The radiographs , scored by a single examiner , were assessed for approximal surface dental caries at both the enamel and dentine level . Surface level transitions were scored using a transition matrix . Caries progression or regression was analysed using proportional-odds ordered logistic regression modelling of the transition scores at the tooth surface level . There was a statistically significant difference in the frequency distributions of the transition scores between the two gum groups ( OR = 0.82 , p = 0.03 ) . For subjects chewing the CPP-ACP gum the odds of a surface experiencing caries progression were 18 % less than those of a surface experiencing caries progression for subjects chewing the control gum . In conclusion , the 54 mg CPP-ACP sugar-free gum significantly slowed progression and enhanced regression of approximal caries relative to a control sugar-free gum in a 24-month clinical trial BACKGROUND Remineralization process is accelerated by the presence of fluoride ions in the oral environment , but this mechanism of caries reversal will be further enhanced if the concentration of calcium , phosphate and fluoride ions is supersaturated with respect to that of oral fluids . AIM This in vivo study was carried out to evaluate and compare the remineralizing efficacy of a urea-based mineral-enriched mouthrinse and a fluori date d dentifrice using an in vivo intraoral appliance model and polarized light microscopic evaluation technique . MATERIAL S AND METHODS The specimens were prepared from sound teeth and artificial caries was produced using an artificial caries medium in vitro and enamel specimens were inserted in removable orthodontic appliances that were to be worn by 14 children of 10 - 15 years of age . They were divided into three groups - nonfluori date d dentifrice , fluori date d dentifrice and mineral-enriched mouthrinse groups . After the 6-month experimental period , during which the enamel specimens inserted in the intraoral appliance were subjected to one of the agents ( either fluoride , nonfluoride dentifrice or mouthrinse ) in vivo , the specimens were retrieved from the patients and were evaluated using the polarized light microscopic technique . OBSERVATIONS AND RESULTS On analysis , mineral gain occurred in all groups , viz . nonfluoride dentifrice group , fluoride dentifrice and mineral-enriched mouthrinse group . However , it was found to be complete in the mouthrinse group , i.e. both at the surface and at the subsurface ( 67 % ) , while in the fluori date d dentifrice group , 43 % of the sample s showed mineral gain in both zones . In the nonfluori date d dentifrice group also , remineralization occurred but was limited either to the surface or the subsurface zone . CONCLUSIONS Urea-based mineral-enriched mouthrinse was shown to be more efficacious in the process of remineralization of artificial carious lesions BACKGROUND The anticariogenic potential of casein phosphopeptide-amorphous calcium phosphate nanocomplexes ( CPP-ACP ) has been demonstrated using laboratory , animal and human in situ caries models . The aim of this study was to determine the effect of CPP-ACP incorporation into a sugar-free lozenge ( pressed mint tablet ) on enamel remineralization in a human in situ model . METHODS The study utilized a double-blind , r and omized , cross-over design with four treatments : ( i ) a lozenge containing 56.4 mg ( 3 per cent w/w ) CPP-ACP ; ( ii ) a lozenge containing 18.8 mg ( 1 per cent w/w ) CPP-ACP ; ( iii ) a lozenge not containing CPP-ACP ; and ( iv ) a no lozenge nil-treatment control .  Ten subjects wore removable palatal appliances with four , human-enamel , half-slab insets containing subsurface lesions . Lozenges were consumed , without chewing , four times per day for 14 days duration . After each treatment period the enamel slabs were removed , paired with their 
    Output:
    
Based on the literature , there is a lack of reliable evidence to support the effectiveness of  remineralizing agents  for the treatment of postorthodontic white spot lesions