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: PURPOSE To evaluate the 18-month clinical performance of a multimode adhesive ( Scotchbond Universal Adhesive , SU , 3 M ESPE , St Paul , MN , USA ) in noncarious cervical lesions ( NCCLs ) using two evaluation criteria . MATERIAL S AND METHODS Thirty-nine patients participated in this study . Two-hundred restorations were assigned to four groups : ERm , etch- and -rinse + moist dentin ; ERd , etch- and -rinse + dry dentin ; Set , selective enamel etching ; and SE , self-etch . The composite resin , Filtek Supreme Ultra ( 3 M ESPE ) , was placed incrementally . The restorations were evaluated at baseline , and at 18 months , using both the World Dental Federation ( FDI ) and the United States Public Health Service ( USPHS ) criteria . Statistical analyses were performed using Friedman repeated- measures analysis of variance by rank and McNemar test for significance in each pair ( α=0.05 ) . RESULTS Five restorations ( SE : 3 ; Set : 1 ; and ERm : 1 ) were lost after 18 months ( p>0.05 for either criteria ) . Marginal staining occurred in four and 10 % of the restorations evaluated ( p>0.05 ) , respectively , for USPHS and FDI criteria . Nine restorations were scored as bravo for marginal adaptation using the USPHS criteria and 38 % , 40 % , 36 % , and 44 % for groups ERm , ERd , Set , and SE , respectively , when the FDI criteria were applied ( p>0.05 ) . However , when semiquantitative scores ( or SQUACE ) for marginal adaptation were used , SE result ed in a significantly greater number of restorations , with more than 30 % of the total length of the interface showing marginal discrepancy ( 28 % ) in comparison with the other groups ( 8 % , 6 % , and 8 % , respectively , for ERm , ERd , and Set ) . CONCLUSIONS The clinical retention of the multimode adhesive at 18 months does not depend on the bonding strategy . The only differences between strategies were found for the parameter marginal adaptation , for which the FDI criteria were more sensitive than the USPHS criteria This study tested the hypothesis that beveling and /or etching enamel does not affect the 6-month clinical performance of the self-etch adhesive Clearfil SE Bond in class V noncarious lesions . With Institutional Review Board approval , 34 patients were enrolled in this study . A total of 120 noncarious cervical lesions were selected and assigned to 4 groups : ( 1 ) Clearfil SE Bond was applied without any cavity preparation ; ( 2 ) After the enamel was beveled , Clearfil SE Bond was applied ; ( 3 ) After the enamel was etched for 15 seconds with 35 % phosphoric acid , Clearfil SE Bond was applied ; ( 4 ) After the enamel was beveled and etched with 35 % phosphoric acid for 15 seconds , Clearfil SE Bond was applied . A microfilled composite resin was used for all restorations . Six months after initial placement , 120 restorations ( a 100 % recall rate ) were re-evaluated . Retention rates at 6 months were 100 % for all groups . Sensitivity to air improved from baseline to 6 months , but the overall difference was not statistically significant . The 6-month retention rate of the self etch dentin adhesive system Clearfil SE Bond was not improved by enamel beveling or by enamel etching . For the self-etch material Clearfil SE Bond , instrumentation or etching of enamel may not be critical for its clinical performance at 6 months Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES This r and omized controlled clinical trial evaluated the 3-year clinical performance of a hybrid ( Clearfil AP-X ; AP ) and a flowable ( Clearfil Flow FX ; FX ) resin composite in 98 non-carious cervical lesions . METHODS Twenty-two patients , 11 males and 11 females ( mean age : 61.9 years , range : 29 - 78 years ) regularly visiting the Nagasaki University Hospital , participated in the study . Each patient received both material s r and omly . All restorations ( 48 restorations for AP and 50 restorations for FX ) were placed in conjunction with an all-in-one system ( Clearfil S(3 ) Bond ) by one dentist . The restorations were blindly evaluated by two examiners at baseline , 6 months , 1 , 2 and 3 years using modified USPHS criteria . The data were statistically analyzed using the Cochran 's Q-test and Fisher 's exact test . RESULTS All the patients were examined at each recall . However , five restorations could not be evaluated at 3-year recall as two teeth had been extracted and three restorations had been lost . The only minor problem was the integrity of the enamel margin . The incidence and extent of marginal staining increased with time , but it was still superficial . Marginal staining occurred adjacent to 11 restorations for AP and 12 restorations for FX after 3 years . Neither lesion size nor depth had influence on marginal staining adjacent to each type of resin composite . There were no significant differences in the clinical performances between AP and FX for each variable . CONCLUSIONS Under the protocol used in this study , both types of resin composite in conjunction with S(3 ) Bond demonstrated an acceptable clinical performance up to 3 years OBJECTIVES The objective of this r and omized controlled clinical trial was to evaluate the 8-year clinical performance of a mild 2-step self-etch adhesive in non-carious Class-V lesions with and without prior selective phosphoric acid-etching of the enamel cavity margins . METHODS A total of 100 non-carious Class-V lesions in 29 patients were restored with Clearfil AP-X ( Kuraray ) .  The composite restorations were bonded following two different approaches : ( 1 ) application of Clearfil SE ( Kuraray ) following a self-etch approach ( control group ; C-SE non-etch ) , ( 2 ) selective phosphoric acid-etching of the enamel cavity margins before application of Clearfil SE ( experimental group ; C-SE etch ) . The restorations were evaluated after 6 months , 1 , 2 , 3 , 5 and 8 years of clinical service regarding their retention , marginal integrity and discoloration , caries occurrence , preservation of tooth vitality and post-operative sensitivity . RESULTS The recall rate at 8 years was 76 % . Only two restorations , one of the C-SE non-etch group and one of the C-SE etch group , were clinical ly unacceptable due to loss of retention leading to a retention rate and a clinical success rate of 97 % in both groups . Aging of the restorations was characterized by an increase in the percentage of restorations with a small but clinical ly acceptable marginal defect ( C-SE non-etch : 92 % ; C-SE etch : 84 % ) and /or a superficial marginal discoloration ( C-SE non-etch : 44 % ; C-SE etch : 28 % ) . At the enamel side , the presence of small marginal defects ( C-SE non-etch : 86 % ; C-SE etch : 65 % ) and superficial marginal discoloration ( C-SE non-etch : 11 % ; C-SE etch% ) was more frequently noticed in the control group than in the experimental group . The difference , however , was only statistically significant for the presence of superficial marginal discoloration ( McNemar , p=0.01 ) . SIGNIFICANCE After 8 years of clinical functioning , the clinical effectiveness of Clearfil SE remained excellent , with selective acid-etching of the enamel cavity margins only having some minor positive effect on marginal integrity and absence of marginal discoloration at enamel This study evaluated the effect of the elastic modulus and margin configuration on the clinical performance of  resin-based composite restorations in Class V non-carious defects . One hundred and five cervical non-carious defects on buccal surfaces of canines and premolars were included in this study . Defects were r and omly divided into three Groups and restored according to the following techniques : Group 1 - -no enamel bevel was placed and the defect was restored with a microfilled resin-based composite ( Durafill VS ) ; Group 2 - -the enamel margin was beveled and the defect restored as in Group 1 ; Group 3-the enamel margin was beveled and the defect was restored with a flowable resin-based composite ( Natural Flow ) . Each group comprised 35 lesions . A total-etch , one-bottle adhesive ( One-Step ) was used in all groups . Retention rate , pre- and post-operative sensitivity , marginal discoloration and secondary caries were determined over a three-year period and the data were analyzed statistically . At six months post-insertion , the restorations placed with beveled enamel margins result ed in 100 % retention regardless of the composite used compared to a 66 % retention of the non-beveled margins . At two and three years , no significant difference in retention rate was found among the three groups . Post-operative sensitivity , marginal discoloration and secondary caries were not affected by enamel beveling and restorative material . Beveled enamel margins result ed in significantly better clinical retention in the first six months only . Enamel beveling and composite viscosity appeared to not significantly affect the clinical performance of Class V non-retentive composite restorations after three years PURPOSE This study tested the null hypothesis that the preparation of the enamel surface would not affect the enamel microtensile bond strengths of self-etching adhesive material s. MATERIAL S AND METHODS Ten bovine incisors were trimmed with a diamond saw to obtain a squared enamel surface with an area of 8 x 8 mm . The specimens were r and omly assigned to five adhesives : ( 1 ) ABF ( Kuraray ) , an experimental two-bottle self-etching adhesive ; ( 2 ) Clearfil SE Bond ( Kuraray ) , a two-bottle self-etching adhesive ; ( 3 ) One-Up Bond F ( Tokuyama ) , an all-in-one adhesive ; ( 4 ) Prompt L-Pop ( 3 M ESPE ) , an all-in-one adhesive ; and ( 5 ) Single Bond ( 3 M ESPE ) , a two-bottle total-etch adhesive used as positive control . For each specimen , one half was roughened with a diamond bur for 5 seconds under water spray , whereas the other half was left unprepared . The adhesives were applied as per manufacturers ' directions . A universal hybrid composite resin ( Filtek Z250 , 3 M ESPE ) was inserted in three layers of 1.5 mm each and light-cured . Specimens were sectioned in X and Y directions to obtain bonded sticks with a cross-sectional area of 0.8 + /- 0.2 mm2 . Sticks were tested in tension in an Instron at a cross-speed of 1 mm per minute . Statistical analysis was carried out with two-way analysis of variance and Duncan 's test at p < .05 . Ten extra specimens were processed for observation under a field-emission scanning electron microscope . RESULTS Single Bond , the total-etch adhesive , result ed in statistically higher microtensile bond strength than any of the other adhesives regardless of the enamel preparation ( unprepared = 31.5 MPa ; prepared = 34.9 MPa , not statistically different at p < .05 ) . All the self-etching adhesives result ed in higher microtensile bond strength when enamel was roughened than when enamel was left unprepared . However , for ABF and for Clearfil SE Bond this difference was not statistically significant at p > .05 . When applied to ground enamel , mean bond strengths of Prompt L-Pop were not statistically different from those of Clearfil SE Bond and ABF . One-Up Bond F did not bond to unprepared enamel . Commercial self-etching adhesives performed better on prepared enamel than on unprepared enamel . The field-emission scanning electron microscope revealed a deep inter prisma tic etching pattern for the total-etch adhesive , whereas the self-etching systems result ed in an etching pattern ranging from absent to moderate Laboratory testing of dentin adhesive systems still requires corroboration by long-term clinical trials for their ultimate clinical effectiveness to be vali date d. The objective of this clinical investigation was to evaluate , retrospectively , the clinical effectiveness of earlier-investigated dentin adhesive systems ( Scotchbond , Gluma , Clearf il New Bond , Scotchbond 2 , Tenure , and Tripton ) , and to compare their clinical results with those obtained with four modern total-etch adhesive systems ( Bayer exp . 1 and 2 , Clearfil Liner Bond System , and Scotchbond Multi- Purpose ) . In total , 1177 Class V cervical lesions in the teeth of 346 patients were restored following two cavity design s : In Group A , enamel was neither beveled nor intentionally etched , as per ADA guidelines ; in Group B , adjacent enamel was beveled and conditioned . Clinical retention rates definitely indicated the improved clinical efficacy of the newest dentin adhesives over the earlier systems . With regard to adhesion strategy , adhesive systems that removed the smear layer and concurrently demineralized the dentin surface layer performed clinical ly better than systems that modified the disorderly layer of smear debris without complete removal 
    Output:
    
agent
There is not enough evidence to support the bevelled technique over non-bevelled for NCCLs over longer periods of time .
***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 To evaluate the 18-month clinical performance of a multimode adhesive ( Scotchbond Universal Adhesive , SU , 3 M ESPE , St Paul , MN , USA ) in noncarious cervical lesions ( NCCLs ) using two evaluation criteria . MATERIAL S AND METHODS Thirty-nine patients participated in this study . Two-hundred restorations were assigned to four groups : ERm , etch- and -rinse + moist dentin ; ERd , etch- and -rinse + dry dentin ; Set , selective enamel etching ; and SE , self-etch . The composite resin , Filtek Supreme Ultra ( 3 M ESPE ) , was placed incrementally . The restorations were evaluated at baseline , and at 18 months , using both the World Dental Federation ( FDI ) and the United States Public Health Service ( USPHS ) criteria . Statistical analyses were performed using Friedman repeated- measures analysis of variance by rank and McNemar test for significance in each pair ( α=0.05 ) . RESULTS Five restorations ( SE : 3 ; Set : 1 ; and ERm : 1 ) were lost after 18 months ( p>0.05 for either criteria ) . Marginal staining occurred in four and 10 % of the restorations evaluated ( p>0.05 ) , respectively , for USPHS and FDI criteria . Nine restorations were scored as bravo for marginal adaptation using the USPHS criteria and 38 % , 40 % , 36 % , and 44 % for groups ERm , ERd , Set , and SE , respectively , when the FDI criteria were applied ( p>0.05 ) . However , when semiquantitative scores ( or SQUACE ) for marginal adaptation were used , SE result ed in a significantly greater number of restorations , with more than 30 % of the total length of the interface showing marginal discrepancy ( 28 % ) in comparison with the other groups ( 8 % , 6 % , and 8 % , respectively , for ERm , ERd , and Set ) . CONCLUSIONS The clinical retention of the multimode adhesive at 18 months does not depend on the bonding strategy . The only differences between strategies were found for the parameter marginal adaptation , for which the FDI criteria were more sensitive than the USPHS criteria This study tested the hypothesis that beveling and /or etching enamel does not affect the 6-month clinical performance of the self-etch adhesive Clearfil SE Bond in class V noncarious lesions . With Institutional Review Board approval , 34 patients were enrolled in this study . A total of 120 noncarious cervical lesions were selected and assigned to 4 groups : ( 1 ) Clearfil SE Bond was applied without any cavity preparation ; ( 2 ) After the enamel was beveled , Clearfil SE Bond was applied ; ( 3 ) After the enamel was etched for 15 seconds with 35 % phosphoric acid , Clearfil SE Bond was applied ; ( 4 ) After the enamel was beveled and etched with 35 % phosphoric acid for 15 seconds , Clearfil SE Bond was applied . A microfilled composite resin was used for all restorations . Six months after initial placement , 120 restorations ( a 100 % recall rate ) were re-evaluated . Retention rates at 6 months were 100 % for all groups . Sensitivity to air improved from baseline to 6 months , but the overall difference was not statistically significant . The 6-month retention rate of the self etch dentin adhesive system Clearfil SE Bond was not improved by enamel beveling or by enamel etching . For the self-etch material Clearfil SE Bond , instrumentation or etching of enamel may not be critical for its clinical performance at 6 months Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES This r and omized controlled clinical trial evaluated the 3-year clinical performance of a hybrid ( Clearfil AP-X ; AP ) and a flowable ( Clearfil Flow FX ; FX ) resin composite in 98 non-carious cervical lesions . METHODS Twenty-two patients , 11 males and 11 females ( mean age : 61.9 years , range : 29 - 78 years ) regularly visiting the Nagasaki University Hospital , participated in the study . Each patient received both material s r and omly . All restorations ( 48 restorations for AP and 50 restorations for FX ) were placed in conjunction with an all-in-one system ( Clearfil S(3 ) Bond ) by one dentist . The restorations were blindly evaluated by two examiners at baseline , 6 months , 1 , 2 and 3 years using modified USPHS criteria . The data were statistically analyzed using the Cochran 's Q-test and Fisher 's exact test . RESULTS All the patients were examined at each recall . However , five restorations could not be evaluated at 3-year recall as two teeth had been extracted and three restorations had been lost . The only minor problem was the integrity of the enamel margin . The incidence and extent of marginal staining increased with time , but it was still superficial . Marginal staining occurred adjacent to 11 restorations for AP and 12 restorations for FX after 3 years . Neither lesion size nor depth had influence on marginal staining adjacent to each type of resin composite . There were no significant differences in the clinical performances between AP and FX for each variable . CONCLUSIONS Under the protocol used in this study , both types of resin composite in conjunction with S(3 ) Bond demonstrated an acceptable clinical performance up to 3 years OBJECTIVES The objective of this r and omized controlled clinical trial was to evaluate the 8-year clinical performance of a mild 2-step self-etch adhesive in non-carious Class-V lesions with and without prior selective phosphoric acid-etching of the enamel cavity margins . METHODS A total of 100 non-carious Class-V lesions in 29 patients were restored with Clearfil AP-X ( Kuraray ) .  The composite restorations were bonded following two different approaches : ( 1 ) application of Clearfil SE ( Kuraray ) following a self-etch approach ( control group ; C-SE non-etch ) , ( 2 ) selective phosphoric acid-etching of the enamel cavity margins before application of Clearfil SE ( experimental group ; C-SE etch ) . The restorations were evaluated after 6 months , 1 , 2 , 3 , 5 and 8 years of clinical service regarding their retention , marginal integrity and discoloration , caries occurrence , preservation of tooth vitality and post-operative sensitivity . RESULTS The recall rate at 8 years was 76 % . Only two restorations , one of the C-SE non-etch group and one of the C-SE etch group , were clinical ly unacceptable due to loss of retention leading to a retention rate and a clinical success rate of 97 % in both groups . Aging of the restorations was characterized by an increase in the percentage of restorations with a small but clinical ly acceptable marginal defect ( C-SE non-etch : 92 % ; C-SE etch : 84 % ) and /or a superficial marginal discoloration ( C-SE non-etch : 44 % ; C-SE etch : 28 % ) . At the enamel side , the presence of small marginal defects ( C-SE non-etch : 86 % ; C-SE etch : 65 % ) and superficial marginal discoloration ( C-SE non-etch : 11 % ; C-SE etch% ) was more frequently noticed in the control group than in the experimental group . The difference , however , was only statistically significant for the presence of superficial marginal discoloration ( McNemar , p=0.01 ) . SIGNIFICANCE After 8 years of clinical functioning , the clinical effectiveness of Clearfil SE remained excellent , with selective acid-etching of the enamel cavity margins only having some minor positive effect on marginal integrity and absence of marginal discoloration at enamel This study evaluated the effect of the elastic modulus and margin configuration on the clinical performance of  resin-based composite restorations in Class V non-carious defects . One hundred and five cervical non-carious defects on buccal surfaces of canines and premolars were included in this study . Defects were r and omly divided into three Groups and restored according to the following techniques : Group 1 - -no enamel bevel was placed and the defect was restored with a microfilled resin-based composite ( Durafill VS ) ; Group 2 - -the enamel margin was beveled and the defect restored as in Group 1 ; Group 3-the enamel margin was beveled and the defect was restored with a flowable resin-based composite ( Natural Flow ) . Each group comprised 35 lesions . A total-etch , one-bottle adhesive ( One-Step ) was used in all groups . Retention rate , pre- and post-operative sensitivity , marginal discoloration and secondary caries were determined over a three-year period and the data were analyzed statistically . At six months post-insertion , the restorations placed with beveled enamel margins result ed in 100 % retention regardless of the composite used compared to a 66 % retention of the non-beveled margins . At two and three years , no significant difference in retention rate was found among the three groups . Post-operative sensitivity , marginal discoloration and secondary caries were not affected by enamel beveling and restorative material . Beveled enamel margins result ed in significantly better clinical retention in the first six months only . Enamel beveling and composite viscosity appeared to not significantly affect the clinical performance of Class V non-retentive composite restorations after three years PURPOSE This study tested the null hypothesis that the preparation of the enamel surface would not affect the enamel microtensile bond strengths of self-etching adhesive material s. MATERIAL S AND METHODS Ten bovine incisors were trimmed with a diamond saw to obtain a squared enamel surface with an area of 8 x 8 mm . The specimens were r and omly assigned to five adhesives : ( 1 ) ABF ( Kuraray ) , an experimental two-bottle self-etching adhesive ; ( 2 ) Clearfil SE Bond ( Kuraray ) , a two-bottle self-etching adhesive ; ( 3 ) One-Up Bond F ( Tokuyama ) , an all-in-one adhesive ; ( 4 ) Prompt L-Pop ( 3 M ESPE ) , an all-in-one adhesive ; and ( 5 ) Single Bond ( 3 M ESPE ) , a two-bottle total-etch adhesive used as positive control . For each specimen , one half was roughened with a diamond bur for 5 seconds under water spray , whereas the other half was left unprepared . The adhesives were applied as per manufacturers ' directions . A universal hybrid composite resin ( Filtek Z250 , 3 M ESPE ) was inserted in three layers of 1.5 mm each and light-cured . Specimens were sectioned in X and Y directions to obtain bonded sticks with a cross-sectional area of 0.8 + /- 0.2 mm2 . Sticks were tested in tension in an Instron at a cross-speed of 1 mm per minute . Statistical analysis was carried out with two-way analysis of variance and Duncan 's test at p < .05 . Ten extra specimens were processed for observation under a field-emission scanning electron microscope . RESULTS Single Bond , the total-etch adhesive , result ed in statistically higher microtensile bond strength than any of the other adhesives regardless of the enamel preparation ( unprepared = 31.5 MPa ; prepared = 34.9 MPa , not statistically different at p < .05 ) . All the self-etching adhesives result ed in higher microtensile bond strength when enamel was roughened than when enamel was left unprepared . However , for ABF and for Clearfil SE Bond this difference was not statistically significant at p > .05 . When applied to ground enamel , mean bond strengths of Prompt L-Pop were not statistically different from those of Clearfil SE Bond and ABF . One-Up Bond F did not bond to unprepared enamel . Commercial self-etching adhesives performed better on prepared enamel than on unprepared enamel . The field-emission scanning electron microscope revealed a deep inter prisma tic etching pattern for the total-etch adhesive , whereas the self-etching systems result ed in an etching pattern ranging from absent to moderate Laboratory testing of dentin adhesive systems still requires corroboration by long-term clinical trials for their ultimate clinical effectiveness to be vali date d. The objective of this clinical investigation was to evaluate , retrospectively , the clinical effectiveness of earlier-investigated dentin adhesive systems ( Scotchbond , Gluma , Clearf il New Bond , Scotchbond 2 , Tenure , and Tripton ) , and to compare their clinical results with those obtained with four modern total-etch adhesive systems ( Bayer exp . 1 and 2 , Clearfil Liner Bond System , and Scotchbond Multi- Purpose ) . In total , 1177 Class V cervical lesions in the teeth of 346 patients were restored following two cavity design s : In Group A , enamel was neither beveled nor intentionally etched , as per ADA guidelines ; in Group B , adjacent enamel was beveled and conditioned . Clinical retention rates definitely indicated the improved clinical efficacy of the newest dentin adhesives over the earlier systems . With regard to adhesion strategy , adhesive systems that removed the smear layer and concurrently demineralized the dentin surface layer performed clinical ly better than systems that modified the disorderly layer of smear debris without complete removal 
    Output:
    