human
***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 This controlled clinical trial evaluated the 5-year clinical performance of a self-etching primer system including selective enamel-etching with phosphoric acid and a one-bottle adhesive system . METHODS Seventy-two non-carious cervical lesions in 8 patients ( 4 male and 4 female ) with a mean age of 61.3 years ( range 45 - 78 ) participated in the study . An enamel bevel was placed and dentin lightly ground , and cavities restored with clearfil liner bond II ( LB ) or single bond ( SB ) in conjunction with a hybrid resin composite ( Clearfil AP-X ) . In the case of 27 cavities for LB , the enamel was pretreated with 37 % phosphoric acid for 10 s. Each patient received both types of restoration , which were distributed on a r and om basis . All restorations ( 37 restorations for LB and 35 restorations for SB ) were placed by one dentist . The restorations were evaluated blind after 5 years using modified USPHS criteria . The data were statistically analyzed using the Fisher 's exact test . RESULTS All but one restoration ( which was replaced by a crown after the 2-year recall ) were evaluated after 5 years . 100 % retention rates were recorded for both restorative groups . No caries was detected in association with any restorations . The only minor problem was marginal discoloration ; superficial and localized marginal discoloration occurred around 18 % of the restorations , and mainly at the dentin margin . There were no significant differences in the marginal integrity between the LB and SB groups . CONCLUSIONS Restorative material s used in this study demonstrated a good clinical effectiveness in the restoration of non-carious cervical lesions for 5 years This study evaluated the clinical performance of unprepared Class V resin composites , placed using a self-etching primer and a single-bottle adhesive , over a period of 18 months . Thirty-eight pairs of restorations of Renew hybrid resin composite ( BISCO , Inc ) were placed using adhesives from the same manufacturer in caries-free cervical erosion/abfraction lesions . Based on insensitivity to air , the dentin in 76 % of these lesions was considered to be sclerotic . The restorations were placed without abrasion of tooth surfaces , except for cleaning with plain pumice . One of each pair was placed using Tyrian , a self-etching primer and the other was placed using One-Step , a single-bottle adhesive placed after acid etching . Both the etchant and self-etching primer were applied for 20 seconds . The restorations were clinical ly evaluated at baseline , 6 , 12 and 18 months , using modified Ryge/USPHS criteria . For both adhesives , very low retention of 50 % to 56 % of the restorations was observed over 18 months , leading to the conclusion that tooth surfaces must receive some additional treatment prior to restoration with these adhesives . No statistically significant difference ( p=0.75 ) between the two adhesives was observed in overall performance , and dentinal sclerosis and axial depth did not appear to be important factors in the study BACKGROUND A new restorative called a " giomer composite " has been introduced . The authors conducted a study to determine retention , anatomical form , caries , staining , marginal discoloration , marginal adaptation , surface roughness and sensitivity of giomer  compared with those of a microfilled composite . METHODS The authors placed 40 sets of restorations r and omly in canines and premolars in vivo . They used a giomer composite and a microfilled composite in erosion/abrasion/abfraction Class V lesions that were not altered with rotary instruments . They placed the restorations according to manufacturer 's recommendations , and two calibrated examiners evaluated the restorations independently using modified U.S. Public Health Service criteria at baseline and at six , 18 and 36 months . The lesions receiving the restorations did not differ from each other in the amount of circumferential enamel present , the percentage of the surface area of dentin or lesion type . RESULTS There were no differences in the restorations at baseline , an evaluation made two weeks after placement . At 36 months , the giomer and microfilled composite restorations were not significantly different from one another in any of the eight criteria evaluated . The percentage agreement between examiners was at least 83 percent for each criterion in each evaluation period . CONCLUSIONS Both the giomer and the microfilled composite used in this study meet the clinical portion of the Acceptance Program Guidelines for Dentin and Enamel Adhesives Material s established by the American Dental Association . CLINICAL IMPLICATION S Both the giomer and the microfilled composite used in this study can be used with confidence in Class V lesions This r and omized clinical trial compared the performance of an all-in-one adhesive ( iBond ) applied in sclerotic and non-sclerotic non-carious cervical lesions with that of a three-step etch-prime-bond adhesive ( Gluma Solid Bond , SB ) .  One-hundred and five lesions were r and omly assigned to four groups according to adhesive , sclerosis scale and technique : 1 ) SB applied to lesions with sclerosis scale 1 and 2 ( n=26 ) ; 2 ) iBond applied to lesions with sclerosis scale 1 and 2 ( n=28 ) ; 3 ) iBond applied to lesions with sclerosis scale 3 and 4 ( n=25 ) and 4 ) iBond applied with prior acid-etching to lesions with sclerosis scale 3 and 4 ( n=26 ) . A microfilled composite ( Durafill VS ) was used as the restorative material . The restorations were evaluated for retention , color match , marginal adaptation , anatomic form , cavosurface margin discoloration , secondary caries , pre- and post-operative sensitivity , surface texture and fracture at insertion ( baseline ) , 6 , 18 months and at 3 years using modified USPHS evaluation criteria ( Alfa = excellent ; Bravo= clinical ly acceptable ; Charlie= clinical ly unacceptable ) . There was a high percentage of Bravo scores for marginal adaptation ( 4%-32 % ) and marginal discoloration ( 18%-60 % ) in Groups 2 , 3 and 4 , but all groups had < 5 % Charlie scores at 6 months and < 10 % Charlie scores at 18 months for retention and marginal discoloration , respectively . However , it should be noted that 13 % of the restorations in Group 4 were not retained at three years This controlled clinical trial evaluated the 2-year clinical performance of a one-bottle etch- and -rinse adhesive and resin composite system ( Excite/Tetric Ceram ) compared to a resin-modified glass ionomer cement ( RMGIC ) ( Vitremer/3 M ) in non-carious cervical lesions . Seventy cervical restorations ( 35 resin composite - RC- restorations and 35 RMGIC restorations ) were placed by a single operator in 30 patients under rubber dam isolation without mechanical preparation . All restorations were evaluated blindly by 2 independent examiners using the modified USPHS criteria at baseline , and after 6 , 12 and 24 months . Data were analyzed statistically by Fisher 's exact and McNemar tests . After 2 years , 59 out of 70 restorations were evaluated . As much as 78.8 % retention rate was recorded for RC restorations , while 100 % retention was obtained for RMGIC restorations . Fisher 's exact test showed significant differences ( p=0.011 ) for retention . However , there were no significant differences for marginal integrity , marginal discoloration , anatomic form and secondary caries between the RC and RMGIC restorations . The McNemar test detected significant differences for Excite/TC between baseline and the 2-year recall for retention ( p=0.02 ) , marginal integrity ( p=0.002 ) and anatomic form ( p=0.04 ) . Therefore , the one-bottle etch- and -rinse bonding system/resin composite showed an inferior clinical performance compared to the RMGIC OBJECTIVES This r and omized controlled clinical trial evaluated the 2-year clinical performance of S3 Bond ( S3 ) and G-Bond ( GB ) in 108 non-carious cervical lesions . METHODS Twenty-three patients , 12 male and 11 female ( mean age : 61.8 years , range : 30 - 79 years ) regularly visiting the Nagasaki University Hospital of Medicine and Dentistry , participated in the study . Each patient received both material s r and omly . All restorations ( 53 restorations for S3 and 55 restorations for GB ) were placed by one dentist . The restorations were blindly evaluated by two examiners at baseline , 6 months , 1 and 2 years using modified USPHS criteria . The data were statistically analyzed using the Cochran Q test and Fisher 's exact test . RESULTS One restoration of each material was lost during 2 years . The only minor clinical problem was the integrity of the enamel margin . Slight marginal staining occurred adjacent to 11 restorations of both S3 and GB . There was no significant difference in the clinical performance between S3 and GB for each variable . CONCLUSIONS Under the protocol used in this study , S3 and GB have demonstrated an acceptable clinical performance up to 2 years OBJECTIVE To determine if the results of  resin-dentin microtensile bond strength ( μTBS ) is correlated with the outcome parameters of clinical studies on non-retentive Class V restorations . METHODS  Resin-dentin μTBS data were obtained from one test center ; the in vitro tests were all performed by the same operator . The μTBS testing was performed 8 h after bonding and after 6 months of storing the specimens in water . Pre-test failures ( PTFs ) of specimens were included in the analysis , attributing them a value of 1MPa . Prospect i ve clinical studies on cervical restorations ( Class V ) with an observation period of at least 18 months were search ed in the literature . The clinical outcome variables were retention loss , marginal discoloration and marginal integrity . Furthermore , an index was formulated to be better able to compare the laboratory and clinical results . Estimates of adhesive effects in a linear mixed model were used to summarize the clinical performance of each adhesive between 12 and 36 months . Spearman correlations between these clinical performances and the μTBS values were calculated subsequently . RESULTS Thirty-six clinical studies with 15 adhesive/restorative systems for which μTBS data were also available were included in the statistical analysis . In general 3-step and 2-step etch- and -rinse systems showed higher bond strength values than the 2-step/3-step self-etching systems , which , however , produced higher values than the 1-step self-etching and the resin modified glass ionomer systems . Prolonged water storage of specimens result ed in a significant decrease of the mean bond strength values in 5 adhesive systems ( Wilcoxon , p<0.05 ) . There was a significant correlation between μTBS values both after 8 h and 6 months of storage and marginal discoloration ( r=0.54 and r=0.67 , respectively ) . However , the same correlation was not found between μTBS values and the retention rate , clinical index or marginal integrity . SIGNIFICANCE As μTBS data of adhesive systems , especially after water storage for 6 months , showed a good correlation with marginal discoloration in short-term clinical Class V restorations , longitudinal clinical trials should explore whether early marginal staining is predictive for future retention loss in non-carious cervical restorations OBJECTIVE To evaluate the performance of All Bond SE used in a one- or two-step protocol in a 24-month r and omized clinical study . METHODS Thirty-three patients with two similarly sized non-carious cervical lesions participated in this study . A total of 66 restorations were placed , half using the one-step All Bond SE protocol ( SE-1 ) and the other half using the two-step All Bond SE protocol ( SE-2 ) . The restorations were evaluated at baseline and after 6 , 12 and 24 months following the modified USPHS criteria and analyzed by the McNemar 's test and Fisher 's exact test ( alpha = 0.05 ) . RESULTS After 24 months , six SE-1 and four SE-2 restorations were rated as Bravo in marginal discoloration The retention rates for SE-1 and SE-2 were 84.8 % and 90.9 % , respectively , after 24 months . Compared to baseline , the retention rate for SE-1 was statistically lower . CONCLUSIONS All Bond SE used in the one- or two-step protocol result ed in high retention rates after 24 months OBJECTIVES Flexure at the tooth cervix has been suggested to dislodge cervical restorations more rapidly . The objective of this r and omized controlled clinical trial was to test the hypothesis that a higher composite flexibility better withst and s tooth flexure stress . METHODS One hundred and forty-two non-carious cervical lesions were restored with composites with contrasting stiffness . Seventy-one patients r and omly received two cervical restorations  placed following two out of the three experimental groups : ( 1 ) the three-step etch- and -rinse adhesive Permaquick applied with the stiff micro-hybrid composite Amelogen Hybrid ( PMQ/A-Hy , Ultradent ) , ( 2 ) Permaquick applied with the more flexible micro-filled composite Amelogen Microfill ( PMQ/A-Mi , Ultradent ) , or ( 3 ) the ' golden st and ard ' three-step etch- and -rinse adhesive Optibond FL applied with 
    Output:
    
agent
There is not enough evidence to support one adhesive or bonding strategy over another for treatment of NCCLs .
CLINICAL SIGNIFICANCE Studies with low overall risk of bias demonstrated good clinical performance for adhesives with all four bonding strategies .
However , included studies showed wide variation between adhesives of the same category
***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 This controlled clinical trial evaluated the 5-year clinical performance of a self-etching primer system including selective enamel-etching with phosphoric acid and a one-bottle adhesive system . METHODS Seventy-two non-carious cervical lesions in 8 patients ( 4 male and 4 female ) with a mean age of 61.3 years ( range 45 - 78 ) participated in the study . An enamel bevel was placed and dentin lightly ground , and cavities restored with clearfil liner bond II ( LB ) or single bond ( SB ) in conjunction with a hybrid resin composite ( Clearfil AP-X ) . In the case of 27 cavities for LB , the enamel was pretreated with 37 % phosphoric acid for 10 s. Each patient received both types of restoration , which were distributed on a r and om basis . All restorations ( 37 restorations for LB and 35 restorations for SB ) were placed by one dentist . The restorations were evaluated blind after 5 years using modified USPHS criteria . The data were statistically analyzed using the Fisher 's exact test . RESULTS All but one restoration ( which was replaced by a crown after the 2-year recall ) were evaluated after 5 years . 100 % retention rates were recorded for both restorative groups . No caries was detected in association with any restorations . The only minor problem was marginal discoloration ; superficial and localized marginal discoloration occurred around 18 % of the restorations , and mainly at the dentin margin . There were no significant differences in the marginal integrity between the LB and SB groups . CONCLUSIONS Restorative material s used in this study demonstrated a good clinical effectiveness in the restoration of non-carious cervical lesions for 5 years This study evaluated the clinical performance of unprepared Class V resin composites , placed using a self-etching primer and a single-bottle adhesive , over a period of 18 months . Thirty-eight pairs of restorations of Renew hybrid resin composite ( BISCO , Inc ) were placed using adhesives from the same manufacturer in caries-free cervical erosion/abfraction lesions . Based on insensitivity to air , the dentin in 76 % of these lesions was considered to be sclerotic . The restorations were placed without abrasion of tooth surfaces , except for cleaning with plain pumice . One of each pair was placed using Tyrian , a self-etching primer and the other was placed using One-Step , a single-bottle adhesive placed after acid etching . Both the etchant and self-etching primer were applied for 20 seconds . The restorations were clinical ly evaluated at baseline , 6 , 12 and 18 months , using modified Ryge/USPHS criteria . For both adhesives , very low retention of 50 % to 56 % of the restorations was observed over 18 months , leading to the conclusion that tooth surfaces must receive some additional treatment prior to restoration with these adhesives . No statistically significant difference ( p=0.75 ) between the two adhesives was observed in overall performance , and dentinal sclerosis and axial depth did not appear to be important factors in the study BACKGROUND A new restorative called a " giomer composite " has been introduced . The authors conducted a study to determine retention , anatomical form , caries , staining , marginal discoloration , marginal adaptation , surface roughness and sensitivity of giomer  compared with those of a microfilled composite . METHODS The authors placed 40 sets of restorations r and omly in canines and premolars in vivo . They used a giomer composite and a microfilled composite in erosion/abrasion/abfraction Class V lesions that were not altered with rotary instruments . They placed the restorations according to manufacturer 's recommendations , and two calibrated examiners evaluated the restorations independently using modified U.S. Public Health Service criteria at baseline and at six , 18 and 36 months . The lesions receiving the restorations did not differ from each other in the amount of circumferential enamel present , the percentage of the surface area of dentin or lesion type . RESULTS There were no differences in the restorations at baseline , an evaluation made two weeks after placement . At 36 months , the giomer and microfilled composite restorations were not significantly different from one another in any of the eight criteria evaluated . The percentage agreement between examiners was at least 83 percent for each criterion in each evaluation period . CONCLUSIONS Both the giomer and the microfilled composite used in this study meet the clinical portion of the Acceptance Program Guidelines for Dentin and Enamel Adhesives Material s established by the American Dental Association . CLINICAL IMPLICATION S Both the giomer and the microfilled composite used in this study can be used with confidence in Class V lesions This r and omized clinical trial compared the performance of an all-in-one adhesive ( iBond ) applied in sclerotic and non-sclerotic non-carious cervical lesions with that of a three-step etch-prime-bond adhesive ( Gluma Solid Bond , SB ) .  One-hundred and five lesions were r and omly assigned to four groups according to adhesive , sclerosis scale and technique : 1 ) SB applied to lesions with sclerosis scale 1 and 2 ( n=26 ) ; 2 ) iBond applied to lesions with sclerosis scale 1 and 2 ( n=28 ) ; 3 ) iBond applied to lesions with sclerosis scale 3 and 4 ( n=25 ) and 4 ) iBond applied with prior acid-etching to lesions with sclerosis scale 3 and 4 ( n=26 ) . A microfilled composite ( Durafill VS ) was used as the restorative material . The restorations were evaluated for retention , color match , marginal adaptation , anatomic form , cavosurface margin discoloration , secondary caries , pre- and post-operative sensitivity , surface texture and fracture at insertion ( baseline ) , 6 , 18 months and at 3 years using modified USPHS evaluation criteria ( Alfa = excellent ; Bravo= clinical ly acceptable ; Charlie= clinical ly unacceptable ) . There was a high percentage of Bravo scores for marginal adaptation ( 4%-32 % ) and marginal discoloration ( 18%-60 % ) in Groups 2 , 3 and 4 , but all groups had < 5 % Charlie scores at 6 months and < 10 % Charlie scores at 18 months for retention and marginal discoloration , respectively . However , it should be noted that 13 % of the restorations in Group 4 were not retained at three years This controlled clinical trial evaluated the 2-year clinical performance of a one-bottle etch- and -rinse adhesive and resin composite system ( Excite/Tetric Ceram ) compared to a resin-modified glass ionomer cement ( RMGIC ) ( Vitremer/3 M ) in non-carious cervical lesions . Seventy cervical restorations ( 35 resin composite - RC- restorations and 35 RMGIC restorations ) were placed by a single operator in 30 patients under rubber dam isolation without mechanical preparation . All restorations were evaluated blindly by 2 independent examiners using the modified USPHS criteria at baseline , and after 6 , 12 and 24 months . Data were analyzed statistically by Fisher 's exact and McNemar tests . After 2 years , 59 out of 70 restorations were evaluated . As much as 78.8 % retention rate was recorded for RC restorations , while 100 % retention was obtained for RMGIC restorations . Fisher 's exact test showed significant differences ( p=0.011 ) for retention . However , there were no significant differences for marginal integrity , marginal discoloration , anatomic form and secondary caries between the RC and RMGIC restorations . The McNemar test detected significant differences for Excite/TC between baseline and the 2-year recall for retention ( p=0.02 ) , marginal integrity ( p=0.002 ) and anatomic form ( p=0.04 ) . Therefore , the one-bottle etch- and -rinse bonding system/resin composite showed an inferior clinical performance compared to the RMGIC OBJECTIVES This r and omized controlled clinical trial evaluated the 2-year clinical performance of S3 Bond ( S3 ) and G-Bond ( GB ) in 108 non-carious cervical lesions . METHODS Twenty-three patients , 12 male and 11 female ( mean age : 61.8 years , range : 30 - 79 years ) regularly visiting the Nagasaki University Hospital of Medicine and Dentistry , participated in the study . Each patient received both material s r and omly . All restorations ( 53 restorations for S3 and 55 restorations for GB ) were placed by one dentist . The restorations were blindly evaluated by two examiners at baseline , 6 months , 1 and 2 years using modified USPHS criteria . The data were statistically analyzed using the Cochran Q test and Fisher 's exact test . RESULTS One restoration of each material was lost during 2 years . The only minor clinical problem was the integrity of the enamel margin . Slight marginal staining occurred adjacent to 11 restorations of both S3 and GB . There was no significant difference in the clinical performance between S3 and GB for each variable . CONCLUSIONS Under the protocol used in this study , S3 and GB have demonstrated an acceptable clinical performance up to 2 years OBJECTIVE To determine if the results of  resin-dentin microtensile bond strength ( μTBS ) is correlated with the outcome parameters of clinical studies on non-retentive Class V restorations . METHODS  Resin-dentin μTBS data were obtained from one test center ; the in vitro tests were all performed by the same operator . The μTBS testing was performed 8 h after bonding and after 6 months of storing the specimens in water . Pre-test failures ( PTFs ) of specimens were included in the analysis , attributing them a value of 1MPa . Prospect i ve clinical studies on cervical restorations ( Class V ) with an observation period of at least 18 months were search ed in the literature . The clinical outcome variables were retention loss , marginal discoloration and marginal integrity . Furthermore , an index was formulated to be better able to compare the laboratory and clinical results . Estimates of adhesive effects in a linear mixed model were used to summarize the clinical performance of each adhesive between 12 and 36 months . Spearman correlations between these clinical performances and the μTBS values were calculated subsequently . RESULTS Thirty-six clinical studies with 15 adhesive/restorative systems for which μTBS data were also available were included in the statistical analysis . In general 3-step and 2-step etch- and -rinse systems showed higher bond strength values than the 2-step/3-step self-etching systems , which , however , produced higher values than the 1-step self-etching and the resin modified glass ionomer systems . Prolonged water storage of specimens result ed in a significant decrease of the mean bond strength values in 5 adhesive systems ( Wilcoxon , p<0.05 ) . There was a significant correlation between μTBS values both after 8 h and 6 months of storage and marginal discoloration ( r=0.54 and r=0.67 , respectively ) . However , the same correlation was not found between μTBS values and the retention rate , clinical index or marginal integrity . SIGNIFICANCE As μTBS data of adhesive systems , especially after water storage for 6 months , showed a good correlation with marginal discoloration in short-term clinical Class V restorations , longitudinal clinical trials should explore whether early marginal staining is predictive for future retention loss in non-carious cervical restorations OBJECTIVE To evaluate the performance of All Bond SE used in a one- or two-step protocol in a 24-month r and omized clinical study . METHODS Thirty-three patients with two similarly sized non-carious cervical lesions participated in this study . A total of 66 restorations were placed , half using the one-step All Bond SE protocol ( SE-1 ) and the other half using the two-step All Bond SE protocol ( SE-2 ) . The restorations were evaluated at baseline and after 6 , 12 and 24 months following the modified USPHS criteria and analyzed by the McNemar 's test and Fisher 's exact test ( alpha = 0.05 ) . RESULTS After 24 months , six SE-1 and four SE-2 restorations were rated as Bravo in marginal discoloration The retention rates for SE-1 and SE-2 were 84.8 % and 90.9 % , respectively , after 24 months . Compared to baseline , the retention rate for SE-1 was statistically lower . CONCLUSIONS All Bond SE used in the one- or two-step protocol result ed in high retention rates after 24 months OBJECTIVES Flexure at the tooth cervix has been suggested to dislodge cervical restorations more rapidly . The objective of this r and omized controlled clinical trial was to test the hypothesis that a higher composite flexibility better withst and s tooth flexure stress . METHODS One hundred and forty-two non-carious cervical lesions were restored with composites with contrasting stiffness . Seventy-one patients r and omly received two cervical restorations  placed following two out of the three experimental groups : ( 1 ) the three-step etch- and -rinse adhesive Permaquick applied with the stiff micro-hybrid composite Amelogen Hybrid ( PMQ/A-Hy , Ultradent ) , ( 2 ) Permaquick applied with the more flexible micro-filled composite Amelogen Microfill ( PMQ/A-Mi , Ultradent ) , or ( 3 ) the ' golden st and ard ' three-step etch- and -rinse adhesive Optibond FL applied with 
    Output:
    