***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: OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity The aim of this study was to assess to what extent adult Herbst treatment is an alternative to orthognathic surgery by comparing the dentoskeletal treatment effects in 46 adult Class II Division 1 subjects treated with a combined orthodontic-orthognathic surgery approach ( m and ibular sagittal split osteotomy without genioplasty ) and 23 adult Class II Division 1 subjects treated with the Herbst appliance .  Lateral headfilms in habitual occlusion from before and after treatment ( multibracket appliance treatment after surgery or Herbst treatment ) were analyzed . All surgery and Herbst subjects were treated successfully to Class I occlusal relationships with normal overjet and overbite . In the surgery group , the improvement in sagittal occlusion was achieved by skeletal more than dental changes ; in the Herbst group , the opposite was the case . Skeletal and soft tissue facial profile convexity was reduced significantly in both groups , but the amount of profile convexity reduction was larger in the surgery group . The success and predictability of Herbst treatment for occlusal correction was as high as for surgery . Thus , Herbst treatment can be considered an alternative to orthognathic surgery in borderline adult skeletal Class II malocclusions , especially when a great facial improvement is not the main treatment goal Aim : It was the aim of this clinical study to compare the skeletal and dentoalveolar effects as well as those on the profile of three different treatment approaches in Class II patients ( camouflage orthodontics , dentofacial orthopedics , and combined orthodontic and surgical treatment ) . Patients and Method : Our study cohort consisted of 60 young adults presenting a skeletal Class II , Division 1 malocclusion : 20 patients whose overjet was reduced by camouflage following premolar extraction , 20 patients whose occlusions were corrected by placement of a fixed functional orthopedic appliance , and 20 who underwent orthognathic surgery ( bilateral sagittal split osteotomy of the m and ible without genioplasty ) .  We documented the therapeutic progress using cephalometry . Results : Each patient group achieved a reduction in overjet via their respective treatment . While no treatment-related changes in the maxillary area were assessable , the effects on the m and ible differed . We observed advancement of the bony chin and an increase in m and ibular length in the sagittal-diagonal dimension in the surgical and functional orthopedic groups . However , the extent of the treatment-related changes was significant only in the group of patients that had undergone orthognathic surgery .  Only the surgical group presented changes in vertical relationships . Incisor repositioning as an outcome of the respective treatments differed fundamentally , with those in the surgical group revealing significant protrusion of the upper incisors . The maxillary incisors were retruded and m and ibular incisors proclined in the functional orthopedic group , whereas the upper and lower incisors both retruded significantly in the extraction group . Softtissue remodeling bore no linear relationship to treatment-induced skeletal and dental effects . Still , orthognathic surgery led to the most marked profile changes . Treatment using fixed functional orthopedic appliances reduced the convexity of the soft-tissue profile at least moderately . Camouflage orthodontics , on the other h and , result ed in an increase in the nasolabial angle . Conclusions : In young adults fixed functional appliances are a treatment alternative to extraction therapy but to a lesser extent to orthognathic surgery . Because of their limited skeletal effects and minor changes in the profile they are indicated only in patients with a moderately severe Class II malocclusion . Pre-treatment proclined m and ibular incisors limit the scope of indications for fixed functional appliances , as they can cause an increase in lower incisor proclination . Significant reductions in profile convexity are achievable only by combined orthodontic and surgical treatment of the malocclusion . When performing camouflage orthodontics in conjunction with maxillary premolar extraction s in adults , an increase in the nasolabial angle , which is often esthetically undesirable , has to be discussed as a potential side effect and has to be taken into account when considering the different therapeutic approaches . ZusammenfassungZiel : Ziel einer klinischen Studie war es , skelettale und dentoalveoläre Effekte sowie Auswirkungen auf das Profil bei drei unterschiedlichen Beh and lungen von Distalbisslagen ( Camouflage-Orthodontie , dentofaziale Orthopädie , Kombinationsbeh and lung Orthodontie und Dysgnathiechirurgie ) zu vergleichen . Patienten und Method e : Das Prob and engut umfasste 60 junge Adulte mit einer skelettalen Klasse-II/1-Anomalie : 20 Patienten , bei denen nach Prämolarenextraktionen durch Camouflage-Orthodontie  die sagittale Frontzahnstufe verringert wurde , 20 Patienten , bei denen ein festsitzendes funktionskieferorthopädisches Gerät zur Korrektur der Bisslagen eingegliedert wurde , sowie 20 Dysgnathiechirurgiefälle ( bilaterale sagittale Spaltosteotomie der M and ibula ohne Genioplastik )  . Die Beh and lungsverläufe wurden kephalometrisch dokumentiert . Ergebnisse : Bei allen Patientengruppen konnte infolge der jeweiligen Beh and lung eine Reduktion der sagittalen Frontzahnstufe erreicht werden . Während keine therapiebedingten Veränderungen i m maxillären Bereich evaluiert werden konnten , differierten die Effekte auf die M and ibula : Vorverlagerungen des knöchernen Kinns und Längenzunahmen der M and ibula in sagittal-diagonaler Richtung waren bei den Patienten der Chirurgie- und der Funktionskieferorthopädie-(FKO-)Gruppe nachweisbar , jedoch war das Ausmaß der therapeutischen Veränderung nur in der Gruppe der dysgnathiechirurgisch beh and elten Patienten signifikant . Veränderungen der vertikalen Relation f and en lediglich in der Chirurgiegruppe statt . Die infolge der jeweiligen Beh and lung result ierenden Positionsveränderungen der Schneidezähne unterschieden sich grundlegend : Eine signifikante Protrusion der oberen Schneidezähne konnte bei den Patienten der Chirurgiegruppe festgestellt werden . In der FKO-Gruppe wurden die oberen Inzisivi retrahiert und die unteren Schneidezähne nach labial gekippt . In der Extraktionsgruppe hingegen wurden beide Schneidezahnpartien signifikant retrahiert . Die Weichgewebeadaptationen st and en in keinem linearen Zusammenhang zu den therapeutisch erzielten skelettalen und dentalen Effekten . Dennoch result ierten infolge der Dysgnathiechirurgie die ausgeprägtesten Veränderungen des Profils . Durch eine Beh and lung mit festsitzenden funktionskieferorthopädischen Geräten erfuhr auch das Weichteilprofil eine zumindest moderate Konvexitätsreduzierung . Eine Camouflage-Orthodontie hingegen führte insbesondere zu einer Vergrößerung des Nasolabialwinkels . Schlussfolgerungen : Aufgrund der nur eingeschränkten skelettalen Wirkungen und der geringen Auswirkungen auf das Profil sind festsitzende funktionskieferorthopädische Geräte bei jungen Adulten eine therapeutische Alternative zur Extraktionstherapie , weniger zur Dysgnathiechirurgie und nur bei Patienten mit einer moderat ausgeprägten Klasse-II-Anomalie indiziert . Eine bereits prätherapeutisch vorh and ene Protrusion der Unterkieferfront stellt aufgrund einer therapiebedingten Progredienz eine Indikationseinschränkung für festsitzende funktionskieferorthopädische Geräte dar . Eine signifikante Reduktion der Profilkonvexität kann nur infolge einer kombiniert orthodontisch-dysgnathiechirurgischen Beh and lung erzielt werden . Bei Durchführung einer Camouflage-Orthodontie mit Extraktion von Prämolaren des Oberkiefers muss bei Erwachsenen eine ästhetisch oft unerwünschte Vergrößerung des Nasolabialwinkels als mögliche Nebenwirkung diskutiert und bei differentialtherapeutischen Überlegungen beachtet werden INTRODUCTION Previous research has demonstrated that current methods of informed consent are relatively ineffective as shown by poor recall and comprehension by adolescent patients and their parents . The purpose of this study was to determine whether adding a short videotape presentation reiterating the issues related to informed consent to a modified informed consent document that emphasizes a limited number of core and patient-specific custom " chunks " at the beginning of an informed consent presentation improved the recall and comprehension of the risks , benefits , and alternatives of orthodontic treatment . A second objective was to evaluate the current related data for recommendable practice s. METHODS Seventy patient-parent pairs were r and omly divided into 2 groups . The intervention group ( group A ) patients and parents together review ed a customized slide show and a short videotape presentation describing the key risks of orthodontic treatment . Group B followed the same protocol without viewing the videotape . All patients and parents were interviewed independently by research assistants using an established measurement tool with open-ended questions . Interviews were transcribed and scored for the appropriateness of responses using a previously established codebook . Lastly , the patients and parents were given 2 reading literacy tests , 1 related to health and 1 with general content followed by the self-administered demographic and psychological state question naires . RESULTS There were no significant differences between the groups for sociodemographic variables . There were no significant differences between the groups for overall recall and comprehension ; recall and comprehension for the domains of treatment , risk , and responsibility ; and recall and comprehension for core , general , and custom items . The positional effects were limited in impact . When compared with previous studies , these data further demonstrate the benefit of improved readability and audiovisual supplementation with the addition of " chunking . " CONCLUSIONS There is no benefit to adding a short video to the previously established improved readability and audiovisual supplementation . There is a significant benefit of improved readability and audiovisual slide supplementation with the addition of " chunking " over traditional informed consent methods in terms of patient improvement in overall comprehension , treatment recall , and treatment comprehension . The treatment domain is the most affected OBJECTIVE To compare two groups of subjects at the peak of the pubertal growth period treated with the Functional M and ibular Advancer ( FMA ; Forestadent , Pforzheim , Germany ) appliance using either single-step or stepwise m and ibular advancement . MATERIAL S AND METHODS This study was conducted on 34 Class II division 1 malocclusion subjects at or just before the peak phase of pubertal growth as assessed by h and -wrist radiographs . Subjects were assigned to two groups of m and ibular advancement , using matched r and omization . Both groups were treated with the FMA . While the m and ible was advanced to a super Class I molar relation in the single-step advancement group ( SSG ) , patients in the stepwise m and ibular advancement group ( SWG ) had a 4-mm initial bite advancement and subsequent 2-mm advancements at bimonthly intervals . The material consisted of lateral cephalograms taken before treatment and after 10 months of FMA treatment . Data were analyzed by means paired t-tests and an independent t-test . RESULTS There were statistically significant changes in SNB , Pg horizontal , ANB , Co-Gn , and Co-Go measurements in both groups ( P < .001 ) ; these changes were greater in the SWG with the exception of Co-Go ( P < .05 ) . While significant differences were found in U1-SN , IMPA , L6 horizontal , overjet , and overbite appraisal s in each group ( P < .001 ) , these changes were comparable ( P > .05 
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The difference between treatments was not statistically significant regarding SNA angle , linear measurement of the lower lip to Ricketts ' aesthetic line , convexity of the skeletal profile , or the soft tissue profile excluding the nose .
In contrast ,  surgical-orthodontic treatment was more effective with regard to ANB , SNB , and ML/NSL angles and the soft tissue profile including the nose .
Different treatment effects on overjet and overbite were found according to the severity of the initial values .