***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: Abstract The present investigation is a preliminary double-blind , controlled placebo , r and omized clinical trial with a six month follow-up period . The study aim ed to assess the efficacy of type A botulinum toxin ( Botox , Allergan , Inc. Irvine , CA ) to treat myofascial pain symptoms and to reduce muscle hyperactivity in bruxers . Twenty patients ( ten males , ten females ; age range 25 - 45 ) with a clinical diagnosis of bruxism and myofascial pain of the masticatory muscles were enrolled in a double-blind , controlled placebo , r and omized clinical trial , with a treatment group ( ten subjects treated with botulinum toxin injections- BTX-A ) and a control group ( ten subjects treated with saline placebo injections ) . A number of objective and subjective clinical parameters ( pain at rest and during chewing ; mastication efficiency ; maximum nonassisted and assisted mouth opening , protrusive and laterotrusive movements ; functional limitation during usual jaw movements ; subjective efficacy of the treatment ; tolerance of the treatment ) were assessed at baseline time and at one week , one month , and six months follow-up appointments . Descriptive analysis showed that improvements in both objective ( range of m and ibular movements ) and subjective ( pain at rest ; pain during chewing ) clinical outcome variables were higher in the Botox treated group than in the placebo treated subjects . Patients treated with BTX-A had a higher subjective improvement in their perception of treatment efficacy than the placebo subjects . Differences were not significant in some cases due to the small sample size . Results from the present study supported the efficacy of BTX-A to reduce myofascial pain symptoms in bruxers , and provided pilot data which need to be confirmed by further research using larger sample Background Bruxism is a disorder of jaw-muscle activity characterised by repetitive clenching or grinding of the teeth which results in discomfort and damage to dentition . The two clinical manifestations of the condition ( sleep and awake bruxism ) are thought to have unrelated aetiologies but are palliated using similar techniques . The lack of a definitive treatment has prompted renewed interest in biofeedback , a behaviour change method that uses electronic detection to provide a stimulus whenever bruxism occurs . This systematic review aims to provide a comprehensive overview of the state of research into biofeedback for bruxism ; to assess the efficacy and acceptability of  biofeedback therapy in management of awake bruxism and , separately , sleep bruxism in adults ; and to compare findings between the two variants . Methods A systematic review of published literature examining biofeedback as an intervention directed at controlling primary bruxism in adults . We will search electronic data bases and the grey literature using a predefined search strategy to identify r and omised and non-r and omised studies , technical reports and patents . Search es will not be restricted by language or date and will be exp and ed through contact with authors and experts , and by following up reference lists and citations . Two authors , working independently , will conduct screening of search results , study selection , data extraction and quality assessment and a third will resolve any disagreements . The primary outcomes of acceptability and effectiveness will be assessed using only r and omised studies , segregated by bruxism subtype . A meta- analysis of these data will be conducted only if pre-defined conditions for quality and heterogeneity are met , otherwise the data will be summarized in narrative form . Data from non-r and omised studies will be used to augment a narrative synthesis of the state of technical developments and any safety-related issues . PROSPERO registration number : CRD42013006880 . Discussion Biofeedback is not new , but its place in the clinical management of bruxism remains unclear . New research , and the availability of miniaturized consumer- grade devices , makes a systematic review timely to guide treatment decisions and inform future research The aim of this study was to assess the effects of sleep hygiene measures combined with relaxation techniques in the management of sleep bruxism ( SB )  in a double-blind , parallel , controlled , r and omised clinical trial design . Sixteen participants ( mean ± s.d . age = 39·9 ± 10·8 years ) were r and omly assigned to a control group ( n = 8) or to the experimental treatment group ( n = 8) . Participants belonging to the latter group were instructed to perform sleep hygiene measures and progressive muscle relaxation techniques for a 4-week period . Two polysomnographic recordings , including bilateral masseter electromyographic activity , were made : one prior to the treatment and the other after the treatment period . The number of bruxism episodes per hour , the number of burst per hour and the bruxism time index ( i.e. the percentage of total sleep time spent bruxing ) were established as outcome variables . No significant differences could be observed between the outcome measures obtained before and after the 4-week period , neither for the sleep bruxism variables nor for the sleep variables . Within the limitations of this study , it was concluded that there is no effect of sleep hygiene measures together with progressive relaxation techniques  on sleep bruxism or sleep over a 4-week observation period OBJECTIVES Sleep bruxism ( SB ) frequently is associated with other sleep disorders and pain concerns . Our study assesses the efficacy of a m and ibular advancement appliance ( MAA ) for SB management in adolescents reporting snoring and headache ( HA ) . METHODS Sixteen adolescents ( mean age , 14.9±0.5 ) reporting SB , HA ( > 1d/wk ) , or snoring underwent four ambulatory polysomnographies for baseline ( BSL ) and while wearing MAA during sleep . MAA was worn in three positions ( free splints [ FS ] , neutral position [ NP ] , and advanced to 50 % of maximum protrusion [ A50 ] ) for 1 week each in r and om order ( FS-NP-A50 or NP-A50-FS ; titration order , NP-A50 ) . Reports of HA were assessed with pain question naires . RESULTS Overall , sleep variables did not differ across the four nights . SB index decreased up to 60 % with MAA in A50 ( P=.004 ; analysis of variance ) . Snoring was measured as the percentage of sleep time spent snoring . The subgroup of snorers ( n=8 ) showed significant improvement with MAA ( -93 % ; P=.002 ) . Initial HA intensity was reported at 42.7±5/100 mm , showing a decreasing trend with MAA ( -21 % to -51 % ; P=.07 ) . CONCLUSION Short-term use of an MAA appears to reduce SB , snoring , and reports of HA . However , interactions between SB , breathing during sleep , and HA as well as the long-term effectiveness and safety of MAA in adolescents need further investigation 
    Output:
    
Discussion This systematic review aims at identifying and evaluating therapies to treat bruxism .