***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: Dental caries remains a major public health problem , especially for certain high-risk population groups . The goal of this study was to assess the evidence regarding strategies meant to be used as alternatives or booster/supplements to  fluoride  for  caries prevention and management .  Articles were selected for inclusion if they had a prospect i ve longitudinal design , with a fluoride control arm , and were conducted in human subjects . Of the included studies , 7/18 studies on calcium-based strategies favored the test product ( the majority of studies included exposure of fluoride in all groups ) . All the arginine studies ( 8/8 ) included a combination of arginine and a calcium base , and concluded that this has the potential to significantly boost the performance of fluoride . The remaining included studies focused on the addition of microbial-related strategies to a fluoride-containing vehicle ( 2 xylitol studies and 1 study using a probiotic milk ) , and all favored the combination as a booster to fluoride .  Thus , the current study did not identify evidence for any strategy to effectively be used as a substitute or alternative to fluoride , but identified some consistent evidence derived from the use of prebiotic strategies ( primarily from use of arginine combined with calcium ) to support their potential use to boost the mechanism of action of fluoride . Thus , fluoride-based strategies remain the st and ard for caries prevention and management , with some evidence that boosting the effects of fluoride by the use of prebiotic strategies is a promising possibility 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 Concern about the survival of microorganisms in deep carious lesions may often lead to unnecessary exposure of the pulp during final excavation . There are reasons , therefore , to initiate systematic studies on the alternative procedure known as stepwise excavation . Clinical evaluation of stepwise excavation was performed on 31 deep carious lesions considered to result in pulp perforation by traditional excavation . This study examines the clinical and microbiological alterations during the final excavation performed during long intervals ( 6 - 12 months ) after the initial treatment that included peripheral dentine excavation and removal of the central cariogenic biomass and the superficial necrotic dentine . The dentine colour and consistency were assessed by means of st and ardized scales before application of a Ca(OH)2 compound and a temporary sealing for 6 - 12 months . Re assessment s were performed before the after final excavation . Microbiological dentine sample s were obtained in 19 r and omly selected lesions by a sterile bur  , transferred to and diluted in reduced transport fluid , and plated on tryptic soy agar . After anaerobic incubation at 37 degrees C for 7 days , total colony-forming units per millilitre were counted from ( 1 ) peripheral excavated and hard dentine ( control ) , ( 2 ) central demineralized dentine before and final excavation , and ( 3 ) central dentine after the final excavation . Six sample s of central demineralized dentine were without any cultivable flora increasing to 9 sample s after the final excavation . The clinical dentine changes occurring during stepwise excavation were characterized by enhanced hardness of the dentine which was associated with a marked reduction in bacterial growth after the final excavation . Despite the presence of bacteria in the excavated dentine none of the carious lesions result ed in pulp perforation , suggesting that the initial removal of the cariogenic biomass appears to be essential for control of caries progression . Stepwise excavation is not only an appropriate treatment of deep carious lesions but is also considered a suitable model for microbiological studies to determine the bacteria persisting in clinical ly excavated lesions OBJECTIVE The objective of this study was to assess radiographic outcomes after  partial carious dentin removal performed in deep caries lesions over a 10-year period . STUDY DESIGN Baseline image was compared to 3 follow-up radiographs ( at 6 - 7 months , 3 years , and 10 years ) . Tertiary dentin deposition and lesion depth were qualitatively assessed . Radiographic density changes in the radiolucent zone ( RZ ) beneath the restoration were quantitatively compared to the control areas ( CA ) using digital subtraction radiography ( Friedman repeated- measures analysis of variance ) . RESULTS A total of 13 teeth were evaluated . In most cases , lesion depth remained unchanged or decreased ( 12/13 ) and tertiary dentin formation was observed ( 10/13 ) after the 10-year follow-up . Differences between RZ and CA at the 6- to 7-month and 3-year follow-up periods were similar but significantly lower than those at the 10-year assessment . CONCLUSIONS Sealing of carious dentin arrested the caries process , promoted deposition of tertiary dentin , and induced mineral gain in the radiolucent zone PURPOSE To follow-up teeth with deep caries lesions su bmi tted to incomplete caries removal over a 10-year period . METHODS 27 subjects ( 32 permanent posterior teeth ) with deep caries lesions composed the sample . In this single-arm long-term prospect i ve study , the inclusion criteria were risk of pulp exposure during caries excavation , positive response to the cold test , absence of spontaneous pain or sensitivity during percussion , and radiographic absence of a periapical lesion . Subjects were su bmi tted to the following procedures : complete caries removal from the surrounding cavity walls , incomplete caries removal from the pulpal wall , capping with a calcium hydroxide cement , and sealing with a modified zinc oxide-eugenol cement . After 6 - 7 months , the temporary sealing was removed for method ological purpose s ( no further excavation was performed ) , and teeth were capped with a calcium hydroxide cement and filled with resin composite .  Clinical and radiographic assessment s were conducted after 6 - 7 months , 1.5 , 3 , 5 and 10 years . Success was defined as clinical and radiographic signs and symptoms of pulp sensitivity while failure was defined as endodontic treatment need . RESULTS Over 10 years , one tooth was excluded from the sample ( pulp exposure during treatment ) , five were lost to recall , 10 had therapy failure ( five fractures and four necroses leading to endodontic treatment need , and one extraction ) and 16 had therapy success ( pulp sensitivity ) . Overall survival rates were 97 % , 90 % , 82 % and 63 % at 1.5- , 3- , 5- and 10-year follow-ups , respectively . Teeth with two or more restored surfaces failed significantly more than teeth with one restored surface ( P= 0.01 ) Less invasive excavation methods have been suggested for deep caries lesions . We tested the effects of stepwise vs. direct complete excavation , 1 yr after the procedure had been carried out , in 314 adults ( from six centres ) who had received treatment of a tooth with deep caries . The teeth had caries lesions involving 75 % or more of the dentin and were central ly r and omized to stepwise or direct complete excavation . Stepwise excavation result ed in fewer pulp exposures compared with direct complete excavation [ difference : 11.4 % , 95 % confidence interval ( CI ) ( 1.2 ; 21.3 ) ] . At 1 yr of follow-up , there was a statistically significantly higher success rate with stepwise excavation , with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [ difference : 11.7 % , 95 % CI ( 0.5 ; 22.5 ) ] . In a subsequent nested trial , 58 patients with exposed pulps were r and omized to direct capping or partial pulpotomy . We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [ 31.8 % and 34.5 % ; difference : 2.7 % , 95 % CI ( -22.7 ; 26.6 ) ] . In conclusion , stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation . In view of the poor prognosis of vital pulp treatment , a stepwise excavation approach for managing deep caries lesions is recommended BACKGROUND More conservative techniques for managing dental caries including ' partial ' and ' no caries removal ' have been increasingly of interest . AIM To compare children 's  behaviour and pain perception , also technique acceptability ( parents and dentists ) , when approximal dentinal lesions ( ICDAS 3 - 5 ) in primary molars ( 3 - 8-year-olds ) were managed with three treatment strategies ; conventional restorations ( CR ) , hall technique ( HT ) , and non-restorative caries treatment ( N RCT ) . DESIGN Secondary care-based , three-arm parallel-group , r and omised controlled trial , with 169 participants treated by 12 dentists . OUTCOME MEASURES child 's pain perception ( Visual Analogue Scale of Faces ) ; behaviour ( Frankl scale ) ; and parents ' and dentists ' treatment opinions ( 5-point Likert scales ) . RESULTS Children showed more negative behaviour in the CR group ( 37 % ) compared to N RCT ( 21 % ) and HT ( 13 % ) ( P = 0.047 , CI = 0.41 to 0.52 ) . Pain intensity was rated ' very low ' or ' low ' in 88 % N RCT , 81 % HT , and 72 % CR ( P = 0.11 , CI = 0.10 to 0.12 ) . N RCT and HT were ' very easy ' or ' easy ' to perform for > 77 % of dentists , compared to 50 % in CR group ( P < 0.000 ) . There were no statistically significant differences in parents ' rating of their child 's level of comfort ( P = 0.46 , CI = 0.45 to 0.48 ) . CONCLUSIONS Dentists reported more negative behaviour in CR group . For all techniques , children 's pain perception and dentist/parent acceptability were similar OBJECTIVE To evaluate the clinical performance of atraumatic restorative treatment ( ART ) fillings using Fuji IX as a filling material in field conditions . DESIGN Longitudinal study of the ART fillings in permanent teeth of primary school children aged eight to fifteen years . SETTING Primary schools in Morogoro municipality , Tanzania . SUBJECTS AND METHODS St and ard 3 and 4 children in five primary schools r and omly selected from a list of 36 primary schools of Morogoro municipality were examined for dental caries and periodontal conditions . All 296 carious lesions that were indicated for restoration were treated using ART approach according to the instructions given in the manual for ART approach for the control of dental caries . Essential measurements for treated teeth and cavity were taken . The cavities were filled with Fuji IX glass ionomer cement as per manufacturer 's instructions . After one year , 238 restorations were evaluated using the criteria for evaluating ART restorations . MAIN OUTCOME MEASURE Clinical appearance of the surface of the restorations . RESULTS Ninety four per cent of the restorations evaluated were rated as good and intact , while 1.7 % were rated as having slight defects that needed no repair , giving a one year survival rate of 96.1 % . Mean working time was 14.5 minutes . CONCLUSIONS AND RECOMMENDATIONS The one-year survival rate of 96.1 % is high enough to recommend wide use of ART in Tanzania . Town and municipal councils should be encouraged to adopt ART in their school oral health programmes Resin infiltration is an innovative approach to arrest progression of caries lesions . The aim of this r and omized split-mouth placebo-controlled clinical trial was to assess whether resin infiltration of proximal lesions is more effective than non-operative measures alone with respect to the inhibition of caries progression . In 22 young adults , 29 pairs of interproximal lesions with radiological extension into the inner half of enamel or the outer third of dentin were r and omly allocated to two treatment groups . In the test group , lesions were infiltrated ( Icon , pre-product ; DMG ) . A placebo treatment was performed in the control group . All participants received instructions for diet , flossing , and fluoridation . The primary outcome after 18 months was radiographic lesion progression ( assessed by digital subtraction radiography ) . No unwanted effects could be observed . In the effect group , 2/27 lesions ( 7 % ) and in the control group 10/27 lesions ( 37 % ) showed progression ( p = 0.021 ; McNemar ) . Infiltration of interproximal car 
    Output:
    
For non-cavitated lesions , the use of  sealants  is supported by strong evidence , while the evidence for infiltration of proximal lesions is moderate .
The use of the ART technique to restore cavitated lesions is also supported by strong evidence as a suitable strategy that has been used extensively in the literature concerning non-dental setting s. Preservation of tooth structure through the use of MI treatment for both non-cavitated and cavitated lesions is supported by moderatestrong evidence , which supports the paradigm shift towards routine use of more conservative strategies in the treatment of carious lesions