***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 aim of this r and omized clinical study was to compare the efficacy of a fluorescence-controlled erbium-loaded yttrium aluminum garnet ( Er : YAG ) laser with conventional bur treatment  for caries therapy in adults . Twenty-six patients with 102 carious lesions were treated using either the Er : YAG laser , at threshold levels of 7 , 8 , 9 , and 10 [ U ] , or rotary burs . Both techniques were applied to each lesion at separate locations . After treatment , dentine sample s were obtained using a carbide bur . The viable counts of Streptococcus mutans ( SM ) and lactobacilli ( LB ) [ expressed as colony-forming units ( log10 CFUs ) ] , treatment time , pain , vibration , and sound intensity were determined . The median numbers of CFUs for SM and LB were not statistically different between laser and bur treatment at threshold levels 7 and 8 [ U ] . At threshold levels 9 and 10 [ U ] , the median number of CFUs for LB [ 1.11 ( range : 0.00 - 2.04 ) ] were significantly higher following laser treatment than following bur treatment [ 0.30 ( range : 0.00 - 0.60 ) ] . The results indicate that treatment with a fluorescence-controlled Er : YAG laser at threshold levels of 7 and 8 removed caries to a level similar to that achieved using conventional bur treatment , with clinical ly irrelevant amounts of remaining bacteria . Although more time consuming , laser treatment provided higher patient comfort than bur treatment Following the development of the ruby laser by M aim an in 1960 , the Nd : YAG laser , the CO2 laser , the semiconductor laser , the He-Ne laser , excimer lasers , the argon laser , and finally the Er : YAG laser capable of cutting hard tissue easily were developed and have come to be applied clinical ly . In the present study , the Er : YAG laser emitting at a wavelength of 2.94 microns developed by Luxar was used for the clinical preparation of class V cavities . Parameters of 8 Hz and approx . 250 mJ/pulse maximum output were used for irradiation . Sixty teeth of 40 patients were used in this clinical study . The Er : YAG laser used in this study was found to be a system suitable for clinical application . No adverse reaction was observed in any of the cases . Class V cavity preparation was performed without inducing any pain in 48/60 cases ( 80 % ) . All of the 12 cases that complained of mild or severe intraoperative pain had previously complained of cervical dentin hypersensibility during the preoperative examination . Cavity preparation was completed with this laser system in 58/60 cases ( 91.7 % ) . No treatment-related clinical problems were observed during the follow-up period of approx . 30 days after cavity preparation and resin filling . Cavity preparation took between approx . 10 sec and 3 min and was related more or less to cavity size and depth . Overall clinical evaluation showed no safety problem with very good rating in 49 cases ( 81.7 % ) OBJECTIVE The aim of this study is to evaluate the quality of laser ablation  in comparison with the classical drilling preparation . METHODS For the experiment , the  Er : YAG laser drilling machine was used . The system had a laser head , water cooler , and power supply with automatic control . Spot size of 300 - 350 microns was used for the preparation . Repetition rate of 1 - 4 Hz , and pulse energies of 100 - 400 mJ with water spray were chosen . Cavity shape in comparison with classical drill , time of preparation , and influence of cavity shape on filling material s retention in accordance with the U.S. Public Health Service System were used . The evaluation criteria for noncontact Er : YAG ablation were done . RESULTS The cavity shape is irregular , but spot surface has larger area and microretentive appearance . Caries of enamel and dentin were treated with a noncontact preparation . It was possible to remove the old insufficient fillings , except for amalgam or metal alloys . The average number of pulses was 111.22 ( SE 67.57 ) . Vibrations of microexplosions during preparation were felt by patients on 14 cavities ; however , nobody felt unpleasant pain . The qualities of filling material s in laser cavities were very stable ; however , cavo surface margin discoloration of 82 - 86 % of Alfa rating could be a problem . Changes of the color and anatomic form of the tooth were observed in 4 - 8 % . CONCLUSIONS In comparison with the classical treatment , it could be said that the retention and quality of filling material s is the same or very similar OBJECTIVES The purpose of this study was to compare microleakage of Class V restorations following acid , laser or laser and acid treatment of cavity walls . METHODS St and ardized lingual and buccal Class V preparations were made in 18 human extracted third molars . The preparations were r and omly assigned to three equal groups ( n=12 ) . Group 1 : cavities were treated with 35 % phosphoric acid . Group 2 : cavities were irradiated with an Er-YAG laser at 2Hz and 250mJ on dentin and 300mJ on enamel , with water cooling . Group 3 : cavities were irradiated with the laser before acid etching . Scotchbond 1 Adhesive System and Z100 resin composite were used for restorations . The specimens were stored in water for 24h at 37 degrees C and thermally cycled ( 500x ) between 6 - 60 degrees C. After 24h immersion in 0.5 % basic fuchsin , dye penetration was recorded according to an ordinal scale . Data were analysed using non-parametric statistical tests ( Kruskal-Wallis and Mann-Whitney ) . RESULTS On the occlusal walls , microleakage in acid etched cavities was significantly lower than that achieved after laser treatment ( P<0.001 ) or after both treatments ( P<0.05 ) . On the gingival walls , no statistical differences were found . SIGNIFICANCE Laser irradiation of enamel is not a valid alternative to acid-etching pretreatment for resin composite material s adhesion . Acid etching alone gave the lowest microleakage at the occlusal margin . No differences were found for microleakage on gingival wall , although lased dentin surfaces presented several characteristics that appear to be advantageous for bonding Objective A r and omised controlled trial to determine the acceptability to dentists and patients of cavity preparation with an Erbium : YAG laser as compared with conventional h and pieces . Methods Fifteen dentists ( 9 GDPs , 1 community dentist and 5 hospital dentists ) treated 77 patients ( age range 3.5–68 years old ) who had two matched cavities , in a split mouth , r and omised trial . One cavity was prepared conventionally , the other with the laser , with dentist and patient preference determined by question naire . Results In the majority of cases , where dentists expressed a preference , it was for conventional cavity preparation , and this was significant ( p < 0.001 ) . In more than half of the laser appointments , dentists had to use conventional h and pieces to complete the cavity . Principle difficulties reported with the laser were access ( 25 cases ) and slow speed of cutting ( 11 cases ) . Patients aged ≥10 years who expressed a preference , preferred  laser treatment , and this was significant ( p < 0.001 ) . Patients aged < 10 years , assessed using a simplified pictorial question naire , did not show a significant preference for either technique . Conclusions Dentists preferred conventional h and pieces for cavity preparation while patients aged ≥10 years old preferred laser treatment .  Patients < 10 years old did not express a preference The purpose of this study was to evaluate the dentin bond strength to resin composite following erbium : yttrium-aluminum-garnet ( Er : YAG ) laser preparation using different adhesive systems . Seventy dentin specimens prepared from human molar teeth were r and omly assigned to seven groups of ten . The first five groups were prepared with an Er : YAG laser 2940 nm at the manufacturer ’s recommended setting s and ( 1 ) acid etched , and etch- and -rinse adhesive Excite was applied ; ( 2 ) Excite was applied ; ( 3 ) two-step self-etching adhesive AdheSE was applied ; ( 4 ) laser etched ( 120 mJ/10 Hz ) , and Excite was applied ; ( 5 ) laser etched , and AdheSE was applied . The last two groups were added as controls ( prepared with a diamond bur ) : ( 6 ) acid etched , and Excite was applied ; ( 7 ) AdheSE was applied . Nanohybrid composite cylinders 4 mm × 2 mm were bonded to the dentin surfaces . After the specimens had been stored in distilled water and had undergone thermocycling , the shear bond strength was tested and the data were analyzed statistically . The Duncan multiple comparison test showed that specimens prepared with a diamond bur and with acid and Excite applied showed the highest mean bond strength ( 13.01 ± 2.09 MPa ) , followed by those prepared with Er : YAG and with AdheSE applied ( 11.5 ± 3.59 MPa ) and those prepared with a diamond bur and with AdheSE applied ( 10.75 ± 1.95 MPa ) , but there were no significant differences among them ( P > 0.05 ) . Er : YAG-prepared specimens , with acid , Excite ( 3.28 ± 0.95 MPa ) and specimens that were laser etched and with AdheSE applied ( 3.37 ± 0.63 MPa ) showed the lowest mean values for bond strength ( P < 0.05 ) . The results suggested that dentin surfaces prepared with Er : YAG laser may provide comparable composite resin bond strengths depending on the adhesives used OBJECTIVE We determined that the Er : YAG pulsed 2.94 micron radiation was successful in the removal of caries , cavity preparation , and etching prior to acid etching . SUMMARY BACKGROUND DATA The laser group was compared to a control group in which the high-speed drill was employed . Parameters measured included histological evaluation of the pulp , scanning electron microscopy of the surface morphology of the tooth , dye penetration studies , bond strength measurements , and rating of the laser 's ability to remove caries and form the preparation . METHODS We collectively evaluated 60 patients with 106 teeth in both the laser and control groups over a 1-year period . Teeth were treated in vivo and then extracted immediately , at 2 days , 1 month , and up to 1-year to assess pulpal healing , surface morphology , and the quality of the preparation , restoration , and pain . RESULTS The dental laser was shown to be equal or better than the drill in the tested procedures of caries removal , cavity preparation , and etching prior to acid etching . The scanning electron microscopy revealed no microfracturing , open dentinal tubules , and effective etching with the laser having a mean of 2.7 with an optimum rating of 3 . The histological testing confirmed that the pulp was not compromised using the laser with scores of theta for hemorrhage , 0.47 for hyperemia , and 0.12 for inflammation on a scale of 0 to 3 where 0 is no effect . CONCLUSIONS The FDA has recently cleared the Er : YAG to remove all classes of caries , form the cavity preparation , and modify the enamel and dentin prior to acid etching . In this Phase I study conducted as part of the clinical trials , there were no complications and no tooth was compromised . Patients were consistently treated without anesthesia with the same or better results than the drill as confirmed by scanning electron microscopy and histological studies BACKGROUND Laser systems have been developed for the cutting of dental hard tissues . The erbium , chromium : yttrium-sc and ium-gallium-garnet , or Er , Cr : YSGG , laser system used in conjunction with an air-water spray has been shown to be efficacious in vitro for cavity preparation . METHODS The authors r and omly selected subjects for cavity preparation with conventional air turbine/bur dental surgery or an Er , Cr : YSGG laser-powered system using a split-mouth design . They prepared Class I , III and V cavities , placed resin restorations and evaluated subjects on the day of the procedure and 30 days and six months postoperatively for pulp vitality , recurrent caries , pain and discomfort , and restoration retention .  Sixty-seven subjects completed the study . RESULTS There were no statistical differences between the two treatment groups for the parameters measured with one exception ; there was a statistically significant decrease in discomfort levels for the laser system at the time of cavity preparation for subjects who declined to receive local anesthetic . CONCLUSIONS The Er , Cr : YSGG laser system is effective for preparation of Class I , III and V cavities and resin restorations are retained by lased tooth surfaces . CLINICAL IMPLICATION S Hard-tissue cutting lasers are being introduced for use in operative dentistry . In this study , an Er , Cr : YSGG laser has been shown to be effective for cavity preparation and restoration replacement OBJECTIVE We evaluated the applicability of a novel Er : YAG laser under clinical conditions . BACKGROUND DATA The Er : YAG laser has been demonstrated to be a safe and effective alternative to the conventional turbine bur , but the relatively low cutting speed prevented the wide application of Er : YAG laser in clinical cavity preparation . METHODS A Smart 2940 D laser developed by Deka Corporation was used for cavity preparation in 95 teeth 
    Output:
    
There is limited scientific evidence that laser treatment is as effective as a rotary bur for removing carious tissue .
Treatment time is prolonged .
There is limited scientific evidence that adults prefer laser treatment .
No conclusions can be drawn regarding biological or technical complications , children 's perception of laser treatment or the cost-effectiveness of the method