***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 study was to monitor the effect of an antibacterial varnish using the readings of a caries‐detecting device ( DIAGNOdent ) in fissures of young permanent molars . The material consisted of 32 healthy patients with a mean age of 14.1 years undergoing orthodontic treatment with fixed appliances . The inclusion criteria were presence of one homologous pair of 2nd upper or lower molars with clinical ly intact occlusal surfaces . A split‐mouth study design was used in which the fissures were treated with either an antibacterial chlorhexidine/thymol‐containing varnish or a placebo varnish every 6th week . The follow‐up period was 42 weeks and laser fluorescence ( LF ) readings were carried out every 12th week . The mean LF values increased significantly ( P < 0.05 ) after 24 , 36 , and 48 weeks compared to baseline following the placebo treatments but not after treatment with the active antibacterial varnish . During the study period , micro‐cavities were diagnosed in two test‐treated and five placebo‐treated teeth . In conclusion , the results reinforce previous findings that frequent applications of a chlorhexidine/thymol‐containing dental varnish might have a protective role in fissures of young permanent molars and that this could be monitored with a chair‐side caries detecting LF device Objective : To evaluate the effect of chlorhexidine-thymol varnish alone , its combination with chlorhexidine-fluoride containing dentifrice and fluoride varnish on oral hygiene and caries prevention in orthodontic patients . Study design : Sixty patients , aged 12 - 18 , with orthodontic fixed appliances were r and omly assigned into three groups as follows : Group 1 ( n=20 ) : 1 % chlorhexidine and 1 % thymol varnish ( Cervitec ® Plus ) ; Group 2 ( n=20 ) : Cervitec ® Plus+ 0.2 % chlorhexidine and 0.2 % sodium fluoride ( 900 ppm fluoride ) ( Cervitec ® Gel ) ) ; and Group 3 ( n=20 ) : 0.1 % fluoride varnish ( Fluor Protector ® )  . Mutans streptococci ( MS ) , lactobacilli ( LB ) levels , buffering capacity ( BC ) , visible plaque index ( VPI ) , and gingival bleeding index ( GBI ) scores were evaluated at four stages : T0 , before orthodontic bonding ; T1 , one week after orthodontic bonding ; T2 , one week ; and T3 , four weeks after the first application , respectively . Inter and intra group comparisons were made by the Kruskal-Wallis , Mann-Whitney U , Friedman and Wilcoxon Signed-Rank tests with Bonferroni step-down correction ( P<0.017 ) . Results : Significantly lower MS and LB levels were found in Group 2 than Group 1 ( T2 ) and 3 ( T2 , T3 ) ( P<0.017 ) . Groups 1 - 2 ( T2 ) showed significantly higher BC ( P<0.017 ) and lower VPI and GBI ( P<0.017 ) scores compared with Group 3 . Decreased MS levels at T2 ( P<0.017 ) and T3 ( P>0.017 ) were found in Group1 - 2 compared with T0 . Significantly lower LB levels were recorded in Group 2 at T2 compared with T0 ( P<0.017 ) while no significant differences were seen in Group 1 and 3 ( P>0.017 ) . Conclusions : Addition of Cervitec ® Plus+Cervitec ® Gel combination to the st and ard oral hygiene regimen may be beneficial for orthodontic patients for maintaining oral health by reducing bacterial colonisation and gingivitis . Key words : Chlorhexidine , flouride , mutans streptococci , lactobacilli , antibacterial effect , plaque , gingivitis , orthodontic treatment The plaque-retentive effects of fixed orthodontic appliances may induce a rapid increase in the amount of plaque . The aim of the present study was to conduct a longitudinal clinical investigation on the antibacterial effect of chlorhexidine-containing Cervitec varnish during orthodontic treatment . Twenty-four subjects ( 9 male , 15 female ) , aged 16.5 + /- 2.5 years , participated in the study . At baseline , the subjects ' DMF-S scores , stimulated salivary flow rates ( ml/min ) and levels of salivary Streptococcus mutans ( SM ) and lactobacilli ( LB ) were determined using Dentocult SM strip and Dentocult LB methods . After placing the orthodontic appliances , the subjects were treated with Cervitec or a placebo varnish around the b and s and brackets . The chlorhexidine varnish was applied r and omly in the first or second quadrant , and placebo varnish in the opposite quadrant , according to the split-mouth technique . The varnish application was repeated every 3 months to the same sites . Follow-up sample s of saliva and plaque from around brackets and b and s were collected at 1 , 3 , 6 , 9 and 12 months . Plaque SM and salivary SM , as well as LB counts were determined as at baseline . The results showed that a significantly higher proportion of plaque sample s belonged to the low-risk category ( SM count10(5 ) CFU/ml ) on the test side than on the placebo side . Distribution of salivary sample s between the low-risk and high-risk categories ( based on SM and LB counts ) did not change significantly until the end of the follow-up period . The number of new carious lesions after debonding the fixed orthodontic appliance was significantly lower ( p < 0.05 ) in the Cervitec-treated quadrant compared to the placebo varnish-treated quadrant . The results show that the chlorhexidine-containing varnish effectively reduced the number of SM in dental plaque around fixed orthodontic appliances A r and omized prospect i ve clinical study , with 220 patients scheduled for fixed orthodontic therapy , was conducted to test the hypothesis that application of an antimicrobial varnish in combination with a fluoride varnish ( group 1 ) is significantly more efficient in reducing white spot lesions on the labial surfaces than application of the fluoride varnish alone ( group 2 ) . The effects of the antimicrobial varnish on the occurrence of gingivitis and plaque formation were also studied . A third aim was to investigate whether white spot lesion development could be predicted early during treatment . The antimicrobial varnish significantly reduced the number of mutans streptococci in plaque during the first 48 weeks of treatment . This effect did not result in significantly less development of white spot lesions on the labial surfaces compared with the group receiving only the fluoride varnish application . There was however a clear trend that the combination of the antimicrobial and fluoride varnishes more effectively reduced the increments of new lesions on the maxillary incisors . It was speculated that this could be due partly to an inhibiting effect of the antimicrobial varnish in an area with low oral clearance ( with low pH and loss of fluoride ) and partly to an inhibiting effect of the varnish on mutans streptococci . No significant differences between the groups with respect to gingivitis and plaque were found . Lesion development was difficult to predict early after bonding , despite a number of caries-relevant parameters of orthodontic importance . The best predictors for white spot lesions at debonding were visible plaque and mutans streptococci ( eg , the level of oral hygiene and thus the cariogenic challenge ) around the appliance shortly after bonding The aim of the present investigation was to study the effect of combined application of a fluoride varnish ( Fluor Protector ) and an antimicrobial varnish ( Cervitec ) on the oral microflora , caries and gingival condition in patients receiving treatment with fixed orthodontic appliances . A total of 198 individuals ( 12 to 15 years old ) , scheduled for fixed orthodontic treatment , were r and omized into 2 groups . Prior to bonding , the Cervitec and the control group received one application with Cervitec or a placebo every week for 3 weeks , respectively . In the Cervitec group . Fluor Protector was applied at bonding and Cervitec at the next visit , 6 weeks later . Each varnish was then applied every 12 weeks for 24 weeks . In the control group , the fluoride varnish was applied only at bonding and every 12 weeks . The Visible Plaque Index ( VPI ) , the Gingival Bleeding Index ( GBI ) , the White Spot Lesion Index ( WSL ) and the level of mutans streptococci in plaque and saliva were recorded 3 weeks prior to bonding and after 24 weeks . At bonding and after 12 weeks , only VPI , GPI , plaque and salivary mutans streptococcus counts were recorded . During the 3-week prebonding period , the mean VPI , GBI and mutans streptococci in plaque decreased in both groups . At bonding , the mean level of mutans streptococci in plaque was significantly lower in the Cervitec group than in the control group . The mean level of mutans streptococci was significantly lower after 12 weeks ' bonding in the Cervitec group than in the control group . No effects on the other parameters were found during the 24 weeks OBJECTIVE The aim of this prospect i ve study was to evaluate the re-colonisation pattern of Streptococcus mutans ( MS ) in highlevel MS-colonised patients with fixed orthodontic appliances following 40 % chlorhexidine varnish application prior to bracket placement . MATERIAL S AND METHODS The subjects of this single-blinded clinical trial were 13 - 14year-old adolescents ( N = 14 ) with significant orthodontic treatment need , a high salivary MS count but without any carious lesions . Baseline MS levels were determined by the cultivation of saliva collected from each subject using strips developed for this purpose ( Strip-mutans , Orion Diagnostica , Espoo , Finl and ) . Prior to the bonding of orthodontic brackets , 40 % chlorhexidine varnish ( EC 40 , Explore , Nijmegen , Netherl and s ) was applied to all teeth for 10 minutes . The re-colonisation of MS was assessed at one , two , four and six week time periods . The data obtained were subjected to a repeated measures design . RESULTS Chlorhexidine varnish reduced salivary MS significantly at the first , second and fourth weeks compared to baseline values . Significant MS suppression lasted less than six weeks and MS colonisation gradually returned to baseline level . CONCLUSION Repeated application of chlorhexidine varnish in orthodontic patients with high MS levels may be beneficial throughout fixed appliance orthodontic treatment The occurrence of new carious lesions is among the most detrimental side effects in subjects undergoing orthodontic therapy with fixed appliances . The present study evaluated the efficacy of repeated applications of a 40 % chlorhexidine varnish in this patient group with regard to long-term suppression of elevated mutans streptococci levels and the frequency and location of new carious lesions .  Thirty-three prospect i ve orthodontic patients age 11 to 18 harboring more than 105 mutans streptococci per ml saliva at the initial examination participated in the study . At baseline the previous carious involvement in each subject was recorded using the DMFS index , and extensive information on caries prevention was given . Using a r and om assignment 18 subjects were included in the test group while the remaining 15 subjects were assigned to the placebo group . From the time of b and ing until removal of the fixed appliances ( median : 21 months ) salivary mutans streptococci counts were recorded once every 8 weeks in both groups . At the same appointment all teeth and intraoral appliances in the test group were coated with a 40 % chlorhexidine varnish . Subjects in the placebo group were treated in the same way , using a placebo varnish with the same varnish base . After deb and ing , the DMFS score of each participant was recorded again . Analysis of the data revealed that mutans streptococci counts in the test group were only temporarily suppressed and were restored almost to baseline levels by the end of the study . In both groups a clinical ly relevant increase in the average DMFS score was recorded . Inter-group differences were not significant . ZusammenfassungDas Auftreten neuer kariöser Läsionen zählt zu den gravierendsten unerwünschten Nebenwirkungen kieferorthopädischer Therapie mit festsitzenden Geräten . In dieser Studie wurde untersucht , ob bei Patienten mit Multib and apparaturen die regelmäßige Applikation eines 40%igen Chlorhexidin-Lacks auf Zähne und inkorporierte Geräte hohe Mutans-Streptokokken-Zahlen langfristig zu supprimieren und die Entstehlung neuer kariöser Läsionen zu verhindern vermag.33 prospektive Multib and patienten i m Alter von elf bis 18 Jahren , die zum Zeitpunkt der Erstuntersuchung mehr als 105 Mutans-Streptokokken pro ml Speichel aufwiesen , nahmen an der Studie teil . Zu Studienbeginn wurden der bisherige Kariesbefall jedes Prob and en mit Hilfe des DMFS-Index ermittelt und die Prinzipien kariesprophylaktischer Mundhygiene sowie Ernährungslenkung intensiv mit dem Patienten besprochen . Dem Zufallsprinzip folgend wurden darauf 18 Prob and en der Chlorhexidin-Gruppe und 15 Prob and en der Plazebog 
    Output:
    
On the basis of the pooled meta- analysis of continuous data , we were able to conclude that professional application of chlorhexidine varnish is effective in caries incidence reduction during fixed orthodontic treatment