***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: PURPOSE This study 's purpose was to test silver diammine fluoride ( SDF ) in arresting incipient occlusal caries in erupting permanent first molars and to compare it with other approaches . METHODS Sixty-six first erupting permanent molars were r and omly divided into 3 groups : cross tooth-brushing technique ( CTT ) , application of SDF , and glass ionomer fissure sealant ( GIC ) . The clinical procedures were conducted by the same dentist . Teeth were assessed clinical ly by 1 blinded examiner using visual inspection at baseline and after 3 , 6 , 12 , 18 , and 30 months and radiographically at 6- , 12- , and 30-month follow-up evaluations . The Kruskall-Wallis test was used to compare noninvasive treatments , and the Friedman test was performed to evaluate differences for each group during different follow-up periods . RESULTS A reduced number of active caries lesions was noted in all groups . After 3 and 6 months , SDF showed a significantly greater capacity for arresting caries lesions than CTT and GIC . At 18- and 30-month evaluations , no differences were observed among the 3 groups . All groups showed differences between baseline and all follow-up re-examinations . CONCLUSIONS All the tested techniques are equally efficient in controlling initial occlusal caries in erupting permanent first molars after 30-months of follow-up Objective : Considering the minimally invasive approach to dentistry , the scientific community has focused on non-invasive treatments for caries lesions . The aim of this study was to evaluate the efficacy of a nonsurgical approach to arrest occlusal non-cavitated dentin lesions through glass ionomer sealing . Methods : In this controlled clinical trial , 51 teeth with clinical ly non-cavitated occlusal caries radiographically located beneath the enamel-dentine junction ( radiolucent area ) were selected among patients presenting a moderate to high risk of caries . The teeth were r and omly divided into two groups : an experimental group receiving an application of Vidrion-R ( SS White ) glass ionomer and a control group not su bmi tted to any clinical intervention .  Caries progression was monitored by clinical and radiographic examination at 4-monthly intervals over a period of one year . In addition , marginal integrity of the sealant was evaluated in the experimental group . Results : Clinical examination showed no statistical difference between the groups ( P=.13 ) . On the other h and , sealed teeth presented lower caries progression when analyzed by radiographic examination ( P=.004 ) . Conclusion : A glass ionomer sealant over non-cavitated occlusal caries lesions in dentin may not be sufficiently effective in arresting their progression The aim of this double-blind r and omized clinical trial was to evaluate the efficacy of 1.23 % APF gel application on the arrest of active incipient carious lesions in children . Sixty 7- to 12-year-old children , with active incipient lesions were included in the study . Children were divided r and omly into 2 groups : 1.23 % APF gel and placebo gel applications . Each group received 8 weekly applications of treatment . The lesions were re-evaluated at the 4th and 8th appointments . Poisson regression analysis was used to estimate relative risks of the presence of active white spot lesions . Groups showed similar results ( PR = 1.67 ; CI 95 % 0.69 - 3.98 ) . The persistence of at least 1 active lesion was associated with a higher number of lesions in the baseline ( PR = 2.67 ; CI 95 % 1.19 - 6.03 ) , but not with sugar intake ( PR = 1.06 ; CI 95 % 0.56 - 2.86 ) and previous exposure to fluoride dentifrice ( PR = 1.26 ; CI 95 % 0.49 - 2.29 ) . The trial demonstrates the equivalence of the treatments . The use of the APF gel showed no additional benefits in this sample of children exposed to fluori date d water and dentifrice . The professional dental plaque removal in both groups may also account for the result ing equivalence of the treatments This 12-week clinical study evaluated the impact of 10 % CPP-ACP and 5 % sodium fluoride varnish regimes on the regression of nonorthodontic white spot lesions ( WSLs ) .  The study included 21 children with 101 WSLs who were r and omised into four treatment regimes : weekly clinical applications of fluoride varnish for the first month ( FV ) ; twice daily self-applications of CPP-ACP paste ( CPP-ACP ) ; weekly applications of fluoride varnish for the first month and twice daily self-applications of CPP-ACP paste ( CPP-ACP-FV ) ; and no intervention ( control ) . All groups undertook a st and ard oral hygiene protocol and weekly consultation . Visual appraisal s and laser fluorescence ( LF ) measurements were made in weeks one and twelve . The majority of WSLs in the control and FV groups exhibited no shift in appearance , whereas , in the CPP-ACP and CPP-ACP-FV groups , the lesions predominantly regressed . The visual and LF assessment s indicated that the extent of remineralisation afforded by the treatments was of the following order : control ~ FV < CPP-ACP ~ CPP-ACP-FV . Self-applications of CPP-ACP paste as an adjunct to st and ard oral hygiene significantly improved the appearance and remineralisation of WSLs . No advantage was observed for the use of fluoride varnish as a supplement to either the st and ard or CPP-ACP-enhanced oral hygiene regimes OBJECTIVE To compare the effectiveness of annual topical application of silver diamine fluoride ( SDF ) solution , semi-annual topical application of SDF solution , and annual application of a flowable high fluoride-releasing glass ionomer in arresting active dentine caries in primary teeth . METHODS A total of 212 children , aged 3 - 4 years , were r and omly allocated to one of three groups for treatment of carious dentine cavities in their primary teeth :  Gp1-annual application of SDF , Gp2-semi-annual application of SDF , and Gp3-annual application of glass ionomer . Follow-up examinations were carried out every six months to assess whether the treated caries lesions had become arrested . RESULTS After 24 months , 181 ( 85 % ) children remained in the study . The caries arrest rates were 79 % , 91 % and 82 % for Gp1 , Gp2 and Gp3 , respectively ( p=0.007 ) . In the logistic regression model using GEE to adjust for clustering effect , higher caries arrest rates were found in lesions treated in Gp2 ( OR=2.98 , p=0.007 ) , those in anterior teeth ( OR=5.55 , p<0.001 ) , and those in buccal/lingual smooth surfaces ( OR=15.6 , p=0.004 ) . CONCLUSION Annual application of either SDF solution or high fluoride-releasing glass ionomer can arrest active dentine caries . Increasing the frequency of application to every 6 months can increase the caries arrest rate of SDF application . CLINICAL SIGNIFICANCE Arrest of active dentine caries in primary teeth by topical application of SDF solution can be enhanced by increasing the frequency of application from annually to every 6 months , whereas annual paint-on of a flowable glass ionomer can also arrest active dentine caries and may provide a more aesthetic outcome The possibility of achieving a caries-reducing effect by a combination of fortnightly mouthrinsings with 0.2 % NaF-solutions and topical painting with solutions containing Al- , Fe- , and Mn-ions was examined in a 4-year clinical study . In addition to the fluoride rinses  one of two r and omized groups was given three paintings per year with a 0.2 % NaF-solution . The other group was painted three times per year with a potassium fluoride solution containing Al- , Fe- , and Mn-ions . This group developed significantly less caries during the study than the NaF-group . The results indicate that certain metal ions can enhance the caries-prophylactic action of the fluoride ions Objectives The hypothesis was that the daily use of a high dose of a xylitol chewing gum for 6 months would reduce the increment of decayed permanent first molar surfaces ( ΔD6S ) in high-risk schoolchildren after 2 years . Methods In this r and omised , clinical trial , 204 schoolchildren with a high caries risk were assigned to two experimental groups , xylitol and non-xylitol . Caries status , salivary mutans streptococci , and lactobacilli were re-evaluated 2 years later in 74 xylitol-treated and 83 non-xylitol-treated schoolchildren . Differences in mean ∆D6S between groups registered at baseline and at follow-up were evaluated using the nonparametric Mann – Whitney U test . Results Outcome was the development of detectable carious lesions initial ( D1–D2 ) and manifest ( D3 ) in the permanent first molars . In the xylitol group , the difference in proportion of children with decayed first permanent molars at baseline and follow-up was 1.43 % for manifest lesion and 2.86 % for initial lesions ; while in the non-xylitol group was 10.26 % ( p < 0.01 ) and 16.66 % ( p < 0.01 ) , respectively . A statistically significant difference regarding means was also observed in the non-xylitol group : the ∆D6S for manifest lesion was 0.18 ( p = 0.03 ) and 0.67 ( p = 0.02 ) for initial lesion . Conclusion The use of a chewing gum containing a high dose of xylitol for a period of 6 months has been shown to produce a long-term effect on caries development in high caries-risk children . Clinical relevance A school-based preventive programme based on 6 months ’ administration of a high dose of xylitol via chewing gum proved to be efficacious in controlling caries increment in high-risk children OBJECTIVES Little is known about the effect of Cervitec , a chlorhexidine-thymol varnish , on root caries . Our objective was to determine whether a 3-monthly application of Cervitec over 1 year would limit the progress of existing root caries lesions and reduce the incidence of dental root caries in a group of dentate institutionalized elderly , as a complement to their usual oral hygiene practice s. METHODS A double-blind r and omized clinical trial was conducted in 68 subjects ( 34 per group ) in two residences in Almería ( Spain ) . Twenty-one subjects with 60 root caries lesions and 25 with 65 lesions , in the Cervitec and placebo groups , respectively , completed the study . Varnishes were applied twice in the first week , 1 month later , and every 3 months until the end of the study . Clinical parameters associated with established lesions were determined at baseline and after 6 and 12 months , as was the incidence of root caries lesions . RESULTS The clinical evolution of lesions was significantly better in the Cervitec group as opposed to the placebo group in terms of width , height , color , and texture . The increase in root caries was significantly lower ( p=0.039 ) in the Cervitec group . CONCLUSION According to these results , Cervitec may help to control established root lesions and reduce the incidence of root caries lesion among institutionalized elderly Sound evidence on the effectiveness of fluoride varnishes ( FV ) to reduce caries incidence  in preschool children is lacking . Objective : To assess whether the application of FV  in preschool children at 6-month intervals decreases the incidence of caries and produces any adverse effects . Methods : A r and omized , examiner- and patient-blind , placebo-controlled , parallel-group design , clinical trial , comprising 1- to 4-year-old children , 100 in each group ( FV or placebo varnish , PV ) , was conducted in Rio de Janeiro , Brazil . Two trained pediatric dentists performed the clinical examinations ( kappa = 0.85 ) . Dental caries was recorded at the d2 ( cavitated enamel ) and d3 ( dentine ) levels using the International Caries Diagnosis and Assessment System . Results : At baseline , the mean age of the participants was 2.4 years ( SD 0.9 ) and the mean d3mfs was 0.8 ( SD 1.9 ) . Most of the children brushed their teeth with fluoride toothpaste and consumed fluori date d tap water . After 24 months , 89 and 92 children of the test and the control groups were analyzed , respectively . A total of 32 ( 35.9 % ) children in the FV group and 43 ( 46.7 % ) in the PV group presented new dentine caries lesions ( χ2 test ; p = 0.14 ) , showing relative and absolute risk reductions of 23 % ( 95 % CI : -9.5 to 45.9 ) and 11 % ( 95 % CI : -3.5 to 25.0 ) . The mean caries increment differences between the test and control groups were -0.8 ( 95 % CI : -2.0 to 0.4 ) at the d2 level and -0.7 ( 95 % CI : -1.9 to 0.4 ) at the d3 level . Only 2 minor complaints regarding the intervention were reported . Conclusion : Although safe and well accepted , twice-yearly professional FV application , during 2 years , did not result in a significant decrease in caries incidence 
    Output:
    
Study -level data indicated that 5 % NaF varnish was the most effective for arresting or reversing noncavitated facial/lingual carious lesions ( low certainty ) and that 38 % silver diamine fluoride solution applied biannually was the most effective for arresting advanced cavitated carious lesions on any coronal surface ( moderate to high certainty ) .