***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 purpose of this study was to compare the effectiveness of toothbrushing followed by fluoride rinsing , fluoride gel brushing , or fluoride gel dentifrice brushing alone in controlling the demineralization that often follows orthodontic treatment . Seventy-eight consecutive adolescent patients undergoing orthodontic care were divided into 3 groups : group 1 ( control ) used a low-potency , high-frequency fluoride rinse ; group 2 used a high-potency , high-frequency fluoride brush-on gel ; and group 3 used a high-potency , high-frequency fluoride gel dentifrice . When pretreatment levels of demineralization were subtracted from posttreatment values , both gel groups displayed a significant difference ( P < .05 ) in smooth surface demineralization sites when compared to controls . Reversal of white-spot lesions occurred in 15 % of sites that exhibited pathology as a result of the fluoride and preventive regimen . These results indicate that a daily use of a 5000-ppm fluoride gel along with toothbrushing with a fluoride paste or brushing twice daily with a 5000-ppm fluoride dentifrice alone provides greater protection beyond that of tooth-brushing with a fluoride paste ( 1000 ppm ) and rinsing with a 0.05 % sodium fluoride rinse The effect of an anti-adhesive enamel coating on plaque accumulation , gingival health , and enamel demineralization was evaluated in 39 adolescents undergoing treatment with fixed orthodontic appliances using a prospect i ve split-mouth design . Immediately after bracket insertion , the polymer was r and omly applied after enamel etching to the buccal surfaces of the teeth in the left or right upper quadrant , leaving the opposite quadrant as an untreated control ( 218 test and 216 control teeth ) . Reapplications were carried out every 3rd month during the course of the study . The following data were collected at baseline and at design ated follow-ups : visible plaque index , total viable counts and proportion of mutans streptococci in plaque sample s , gingival bleeding index , and amount of gingival crevicular fluid . The incidence of enamel demineralization adjacent to the appliances was scored clinical ly at the termination of the orthodontic treatment . The observation time ranged from 6 - 24 months , during which the participants used fluoride rinses and toothpaste daily . A slightly impaired gingival health and increased levels of mutans streptococci compared with baseline was disclosed during the treatment . Five subjects showed enamel demineralization on a total of 30 teeth at the time of de-bonding . The results indicated no statistically significant differences between the enamel-coated and untreated teeth with regard to the studied variables at any follow-up . In conclusion , the present findings did not support a clinical ly beneficial effect of the polymeric tooth coating in a low-caries group of adolescents treated with fixed orthodontic appliances Decalcification and caries during orthodontic treatment still remains a problem . A method to protect the susceptible area beneath and adjacent to bonded attachments , independent of patient compliance , would be extremely beneficial . A clinical trial was performed using a dual-cured lightly filled BIS-GMA fluoride-releasing sealant . The barrier effect of this material on white spot formation , gingival irritation , and plaque accumulation during fixed orthodontic therapy was examined . Twenty patients with a total of 225 metal brackets placed on anterior teeth participated in this study . Brackets were placed in both arches in a conventional manner with a chemically cured , unfilled bonding resin ; 112 teeth ( every other tooth ) received the barrier material after bracket placement , while the remaining 113 teeth served as controls . Intraoral photographic slides were taken before and after treatment and were evaluated blindly by 7 observers for white spot formation . Gingival and plaque indexes were recorded initially and consecutively every 6 months . Observation time ranged from 5 to 18 months . The results of this prospect i ve clinical study indicated that there was no significant difference ( P > .05 ) between the decalcification rates of the treatment or control groups . Likewise there was no added benefit with respect to plaque accumulation or gingival irritation The presence of clinical ly detectable areas of decalcification ( observable as whitened areas ) following the removal of orthodontic appliances is well recognized . The aim of the present study was to determine quantitatively the amount of demineralization and the ability of commercially available products to inhibit or reverse orthodontically related demineralization .  Twenty orthodontic patients scheduled to have premolars extracted were r and omly divided into four groups -- one control and three test groups . The extracted premolars ( numbering 58 ) were bracketed using an acid-etch composite system ; each patient was given precise oral hygiene instructions and supplied with a sodium fluoride ( 1,100 ppm fluoride ) dentifrice and an orthodontic toothbrush . The control group brushed only with the supplied dentifrice . In addition to brushing with the dentifrice , those in test group I rinsed once each night with a sodium fluoride ( 0.05 % ) mouthrinse ; group II received a weekly topical APF treatment ( 1.2 % fluoride ) ; and Group III received a weekly topical APF treatment and rinsed once each night with the sodium fluoride mouthrinse . All premolars were extracted after 1 calendar month . Mineral profiles were determined on cross-sectioned teeth 50 to 75 micron occlusal and cervical to the brackets , directly underneath the brackets , and 500 micron away from the brackets . The control teeth ( dentifrice only ) demonstrated up to 15 % demineralization to a depth of 50 micron . All of the test teeth produced rehardening and /or inhibition of demineralization ( P less than 0.01 ) . Those in test group III showed a particularly hard outer layer . The study demonstrated that measurable demineralization occurred around orthodontic appliances after only 1 month and this demineralization can be completely inhibited and /or reversed by the use of commercially available fluoride products OBJECTIVES The aim of the present study was to evaluate the efficacy of an electric toothbrush with a specially design ed orthodontic brush head compared with a manual toothbrush in controlling plaque and gingivitis in patients with fixed orthodontic appliances over an 8-week period in a dental practice setting . METHODS This was a r and omised controlled , single blind , stratified , parallel group trial conducted in two specialist orthodontic dental practice s by a specialist orthodontist . Group 1 comprised 41 subjects who used the electric toothbrush and Group 2 consisted of 43 subjects who brushed with a manual toothbrush around the orthodontic appliance for a timed 2 minutes twice daily for 8 weeks .  Plaque around the fixed appliance attachments was measured using an orthodontic modification to the Silness and Loe plaque index , while gingival condition was scored using the gingival index and Eastman interdental bleeding index . RESULTS There was baseline balance for all clinical variables ( p > 0.05 ) . Both groups had significantly less plaque after 8 weeks than at baseline ( p < 0.001 ) but the group using the electric brush also had significantly less interdental gingival bleeding , as determined by the Eastman interdental bleeding index both at week 4 ( p < 0.001 ) and week 8 ( p = 0.004 ) . The majority of subjects ( n = 54 , 64.3 % ) preferred the electric toothbrush . CONCLUSIONS In conclusion , the results from this study would suggest that use of an electric toothbrush with an orthodontic brush head may be of benefit in promoting  gingival health in fixed orthodontic appliance patients ; however , the long-term effects ( over at least 6 months ) need to be evaluated A clinical trial comparing a conventional adhesive , Concise ® , with a new fluoride-containing composite cement  is described . The bond failure rate , plaque score , gingival health , and enamel decalcification were assessed for each material after a minimum period of 1 year . The preliminary results show no significant difference between the two material s for each of the variables examined , although there was a reduction in the number of white spot lesions using the fluoride-containing composite . The level of fluoride ion concentration required to inhibit the growth of oral micro-organisms is discussed Patients undergoing orthodontic treatment with fixed appliances are at risk of developing carious white spot lesions and gingival inflammation because of the challenge of oral hygiene . The purpose of this study was to evaluate under home conditions the effectiveness of three different types of electric toothbrushes during active appliance therapy : Interplak ( Bausch & Lomb , Berlin , Germany ) , Rota-dent ( Rota-dent , Kusnacht , Switzerl and ) , and Braun Oral-B Plaque Remover ( Braun/Oral-B , Kronberg , Germany ) . A manual technique , which included normal toothbrush , interdental brush , and dental floss , served as reference . The study was structured as a single-blind " Latin square design " study . Thirty-eight orthodontic patients were r and omly allocated to groups who , within the test period , alternately used the toothbrushes . Before getting a new toothbrush that was to be used for a period of 4 weeks , each patient received video and written instructions . For another 4 weeks , the patient returned to the usual oral hygiene procedures before receiving the next new toothbrush . Oral hygiene was evaluated at the start of a new test period and after 2 and 4 weeks . Clinical scores included a modified O'Leary Plaque Index and Ainamo Gingival Bleeding Index . Wilcoxon rank testing for aggregated surfaces revealed statistically significantly lower plaque scores for Rota-dent than for the manual technique ( p < 0.01 ) . For all other toothbrushes , no differences were found in comparison to the manual technique . For Plaque Indices of specific sites , statistical analysis revealed all electric toothbrushes to be equal to the manual technique . No differences in Gingival Bleeding Indices were found after 4 weeks with either toothbrush . Patients with poor oral hygiene who used Rota-dent and Braun Oral-B Plaque Remover OD5 had statistically significantly lower plaque scores compared with the manual technique ( p < 0.01 ; p < 0.05 ) ; for patients with good oral hygiene , these differences were neutralized . It may be concluded that electric toothbrushes of the new generation are a real alternative to the often laborious manual tooth cleaning procedures used during active appliance therapy . Patients with poor oral hygiene may benefit from them especially because plaque removal can be achieved easier and faster The inhibition of enamel demineralisation and the enhancement of remineralisation are positively but not linearly related to the concentration of fluoride , especially when high fluoride concentrations are used . The aim of this in situ experiment was to determine the maximum amount of enamel remineralisation that can be achieved with daily applications of very high concentrations of fluoride . For this purpose we compared the efficacy of a daily application of fluori date d topical gel ( 12,500 ppm F , partly as NaF , Olafluor and Dectafluor , pH 4.5 ) in combination with a fluori date d toothpaste ( 1,450 ppm F as NaF ) , with fluori date d toothpaste alone .  Participants ( n = 26 , with partial dentures ) were fitted with a  demineralised enamel specimen  ( mean mineral loss of 1,674 vol%·µm ) and were instructed to use one of the two fluoride treatments . After 4 weeks of treatment , the specimens were retrieved , a section was cut and analysed with microradiography . The remainder of each of the specimens was used for analysis of the ‘ loosely bound ’ and ‘ bound ’ fluoride . Fluoride was measured with gas-liquid chromatography . After 4 weeks in the mouth , the original lesion was reduced in size by 54 % in the toothpaste + gel group ( n = 14 ) and by 44 % in the toothpaste-only group ( n = 12 ) , but the difference between the groups was not statistically significant . The mineral content profiles showed remineralisation of the lesions throughout the depth of the lesion . The enhancement of remineralisation by the high amounts of fluoride was most pronounced in the surface layer . For both the ‘ loosely bound ’ and ‘ bound ’ fluoride , a statistically significant increase in fluoride concentration could be found in the toothpaste + gel group . In the 4-week in situ period the use of high amounts of fluoride result ed in a maximum remineralisation rate . This is illustrated by an increase in remineralisation and higher fluoride concentrations in the toothpaste + gel group compared to the toothpaste-only group White spot or areas of decalcification are carious lesions of varying extent . The incidence and severity of white spots after a full term of orthodontic treatment were studied among patients in the separate private practice s of two of the authors . To establish a base line of comparison , the presence of white spots in a r and om sample of untreated persons was observed . The incidence of white spots among patients treated by a multibonded technique  was recorded at the time of debonding . In addition , white spots were sought in the before- and after-treatment Kodachrome slides of persons whose maxillary incisors had been h and ed . It was found that individual teeth , b and ed or bonded , exhibited significantly more white spot formation than was found in the control group . For the teeth studied , there was no difference in white spot formation in those that were b and ed or bonded . The labiogingival area of the maxillary lateral incisors had the highest incidence of white spots . When studied by segments , the highest incidence occurred among the maxillary incisors ; the lowest was in the maxillary posterior segment . No white spots were found on the lingual surfaces of m and ibular canines and in 
    Output:
    
Comparing the measures applied in the orthodontic practice s with the evidence from a systematic review , a number of differences became apparent .
The additional use of chlorhexidine or toothpaste with a high fluoride concentration ( which has been demonstrated to have an inhibitive effect ) is rarely prescribed .
Fluoride rinse is prescribed most often , although there is not any high- quality , long-term study that demonstrates a caries preventive effect in orthodontic patients .
CONCLUSIONS Orthodontists do not implement the available evidence in order to prevent enamel demineralizations during fixed-appliance treatment .