***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: Background : Photodynamic therapy ( PDT ) is a method of microbial reduction which can benefit periodontal treatment in areas of difficult access , such as deep pockets and furcations . The aim of this r and omized controlled clinical trial was to evaluate the effects of PDT as an adjunct to full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis . Material and Methods : Twenty-two patients with at least one pocket with a probing depth ( PD ) of ≥7 mm and one pocket with a PD of ≥5 mm and bleeding on probing ( BOP ) on each side of the mouth were included , characterizing a split mouth design . The control group underwent full-mouth ultrasonic debridement and the test group received the same treatment associated with PDT . The PDT was performed on only one side of the mouth and the initial step consisted of subgingival irrigation with 0.005 % methylene blue dye . Two minutes after applying the photosensitizer , the low power laser - AsGaAl ( Photon Lase III - PL7336 , DMC , São Carlos -São Paulo , Brazil ) was applied ( 660 nm , 100 mW , 9 J , 90 seconds per site , 320 J/cm2 , diameter tip 600 µm).The following clinical parameters were evaluated : plaque index , gingival index , BOP , gingival recession ( GR ) , PD , and clinical attachment level ( CAL ) . All parameters were collected before , 1 , 3 and 6 months after treatment . Results : An improvement in BOP , PD and CAL was observed after treatment , in both groups , but without any difference between them . After 6 months , the PD decreased from 5.11±0.56 mm to 2.83±0.47 mm in the test group ( p<0.05 ) and from 5.15±0.46 mm to 2.83±0.40 mm in the control group ( p<0.05 ) . The CAL changed , after 6 months , from 5.49±0.76 mm to 3.41±0.84 mm in the test group ( p<0.05 ) and from 5.53±0.54 to 3.39±0.51 mm in the control group ( p<0.05 ) . Conclusion : Both approaches result ed in significant clinical improvements in the treatment of severe chronic periodontits , however , the PDT did not provide any additional benefit to those obtained with full-mouth ultrasonic debridement used alone AIM To evaluate the potential of antimicrobial photodynamic therapy ( aPDT ) as an adjunct to scaling and root planing ( SRP ) in the treatment of chronic periodontitis . MATERIAL AND METHODS In a single-centred r and omized and controlled clinical trial , 90 patients ( 51 females and 39 males ) with untreated chronic periodontitis were r and omly assigned to receive SRP with aPDT ( test group ) or SRP alone ( control group ) . Clinical parameters and halitosis were recorded for 6 months after treatment by a periodontist who was blinded to the procedure . RESULTS Inter-group and intra-group statistical analyses were performed . Significant difference between the two groups with respect to each variable was assessed using non-parametric Rank Order ancova . Probing pocket depth and clinical attachment levels showed statistically significant reduction in the test group on evaluation at 3 months and 6 months as compared to the control group ( p < 0.05 ) . A statistically significant improvement in gingival index and gingival bleeding index was seen for the test group after 2 weeks and 1 month of aPDT ( p < 0.01 ) , whereas the improvement in gingival index and gingival bleeding index at 3 months and in plaque index at 2 weeks after aPDT was less ( p < 0.05 ) . Also , a significant difference was detected for the test group at 1 month in terms of halitosis ( p < 0.05 ) , which did not persist for long . CONCLUSIONS Antimicrobial photodynamic therapy acts as a beneficial adjunct to SRP in non-surgical treatment and management of chronic periodontitis in short-term . Further studies are required to assess the long-term effectiveness of aPDT This study aims to assess in residual periodontal pockets the clinical , microbiological , and local biological effects of antimicrobial photodynamic therapy ( PDT ) , delivered after ultrasonic instrumentation either once or twice in a 1-week interval . A single center , three-arm r and omized longitudinal study was carried out for 6 months . Twenty-eight systemically healthy patients on periodontal maintenance with residual pockets ( pocket depth ( PD ) ≥5 mm , clinical attachment loss ≥2 mm , and bleeding upon probing ( BOP+ ) ) were included . Residual pockets on three teeth , separated from each other by at least two other teeth , served as study sites . After ultrasonic debridement , they were r and omly assigned to either PDT delivered twice within 1 week ( group A ) , PDT delivered only once ( group B ) , or sham treatment without activating the laser ( group C ) . Methylene blue was applied with a blunt irrigator tip into the pockets . Sites were irradiated with laser light at a wavelength of 670 nm using a light-diffusing tip introduced into the pocket . Initial PD was 5.9 ± 0.9 , 6.3 ± 1.3 , and 6.3 ± 1.5 mm in groups A , B , and C , respectively , differences being nonsignificant . PD was significantly reduced in all groups . At month 3 , PD was significantly lower in groups A ( 2.9 ± 1.1 mm ; p = 0.04 ) and B ( 2.8 ± 1.1 mm ; p = 0.03 ) compared to group C ( 3.5 ± 1.2 mm ) . At month 6 , none of the sites in group A had persisting pockets PD > 4 mm and BOP+ , whereas two sites in group B and four sites in group C stayed in this category . Detection frequencies of the studied microorganisms at > 1,000 and > 100.000 cells/ml did not change significantly from baseline to months 3 or 6 in any group . A significant overall decrease was observed from baseline to month 6 for C-reactive protein , serum amyloid A , fibrinogen , procalcitonin , and α-2 macroglobulin . When looking at the groups separately , C-reactive protein was significantly lower only if the laser had been activated twice ( p < 0.05 ) . Other differences between groups were not significant . A single or double episodes of PDT had some additional benefit over ultrasonic instrumentation alone AIM A r and omized controlled clinical trial was design ed to evaluate the efficacy of the photodynamic therapy ( PDT ) in the treatment of residual pockets of chronic periodontitis patients . MATERIAL AND METHODS Thirty-four patients with at least four residual periodontal pockets undergoing maintenance care were included and r and omly assigned to test group ( PDT , n = 18 ) or control group ( sham procedure , n = 16 ) . The intervention was performed at baseline , 3 , 6 and 12 months . Clinical parameters such as pocket probing depth ( PPD ) , clinical attachment level ( CAL ) , bleeding on probing ( BoP ) and plaque index ( PI ) were measured before intervention and after 3 , 6 and 12 months . Subgingival sample s were obtained at baseline , and after 7 days , 3 , 6 and 12 months to quantify Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis , Treponema denticola and Tannerella forsythia by real-time polimerase chain reaction ( PCR ) . RESULTS All clinical variables showed significant improvement during the study , but there was no significant difference between test and control groups . The microbiological analyses showed no differences between groups at any time during the study . CONCLUSION Within the limits of this clinical trial and considering the laser and photosensitizer protocol used , PDT failed to demonstrate additional clinical and bacteriological benefits in residual pockets treatment Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results BACKGROUND Single photodynamic therapy ( PDT ) has been effective in initial periodontal therapy , but only improved bleeding on probing ( BoP ) in maintenance patients after a single use . Repeated PDT has not been addressed . OBJECTIVES To study the possible added benefits of repeated adjunctive PDT to conventional treatment of residual pockets in patients enrolled in periodontal maintenance . MATERIAL AND METHODS Ten maintenance patients with 70 residual pockets [ probing pocket depth (PPD)>or=5 mm ] were r and omly assigned for treatment five times in 2 weeks ( Days 0 , 1 , 2 , 7 , 14 ) with PDT ( test ) or non-activated laser ( control ) following debridement . The primary outcome variable was PPD , and the secondary variables were clinical attachment level ( CAL ) and BoP. These were assessed at 3 , 6 and 12 months following the interventions . RESULTS Greater PPD reductions were observed in the test ( -0.67 + /- 0.34 ; p=0.01 ) compared with the control patients ( -0.04 + /- 0.33 ; NS ) after 6 months . Significant CAL gain ( + 0.52 + /- 0.31 ; p=0.01 ) was noted for the test , but not in the control ( -0.27 + /- 0.52 ; NS ) patients after 6 months . BoP percentages decreased significantly in test ( 97 - 64 % , 67 % , 77 % ) , but not control patients after 3 , 6 and 12 months . CONCLUSIONS Repeated ( five times ) PDT adjunctive to debridement yielded improved clinical outcomes in residual pockets in maintenance patients . The effects were best documented after 6 months BACKGROUND The study aims to compare the effects of adjunctive photodynamic therapy ( PDT ) with scaling and root debridement alone on periodontal parameters and inflammatory cytokines in residual pockets of patients undergoing maintenance therapy . METHODS 27 subjects , each with at least 2 residual pockets ≥5 mm , were recruited for this r and omized , split-mouth controlled trial , providing total of 72 sites . Probing pocket depth ( PPD ) , recession , clinical attachment loss ( CAL ) , plaque and bleeding on probing of all sites were examined at baseline , 3 and 6 months . Gingival crevicular fluids ( GCFs ) were collected to determine levels of IL-1β , IL-6 , IL-8 , TNF-α and MMP-8 via enzyme-linked immunosorbent assay . At baseline , all sites received subgingival instrumentation and polishing . In addition , test sites received a single application of PDT using Fotosan ® with toluidine blue O solution photosensitizer . At 3 and 6 months , site level analysis was performed for changes in clinical parameters and cytokine level . RESULTS Based on mixed model analysis , at 3 months , test sites showed significant reduction in CAL ( p=0.016 ) and PPD ( p=0.027 ) ( from 6.14±0.28 mm to 5.49±0.20 mm and 5.42±0.16 mm to 4.65±0.18 mm respectively ) compared to control sites ( from 6.32±0.24 mm to 6.08±0.17 mm and 5.32±0.13 mm to 5.15±0.15 mm respectively ) . At 6 months , these differences were no longer significant ( p=0.510 ) . Adjunctive PDT did not offer additional reduction in levels of GCF cytokines . CONCLUSIONS A single application of PDT to residual pockets provided a modest improvement of CAL and PPD over 3 months . Application of adjunctive PDT may lead to 
    Output:
    
Concluding , it was not possible to state that repeated applications of aPDT , in association with non-surgical treatment of residual pockets , have effective clinical effects in the periodontal maintenance therapy .