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: AIM To compare the clinical outcomes of laterally moved , coronally advanced flap ( LMCAF ) versus Bilaminar technique ( BT ) in the treatment of single gingival recession on molar teeth . MATERIAL AND METHODS Fifty patients showing Miller I and II gingival recessions at first molar teeth were treated : 25 were r and omly assigned to the BT group and 25 belonged to the LMCAF group .  Patient 's post-operative morbidity was assessed 1 week after the surgery , while aesthetic evaluation and the clinical evaluation were made 1 year later . RESULTS No statistically significant difference was demonstrated in terms of recession and PPD reduction . Statistically greater probability of complete root coverage ( CRC , Odds Ratio 22.1 ) and greater increase in gingival thickness were observed in the BT group . Greater increase in keratinized tissue was obtained in the LMCAF .  Patient satisfaction with aesthetics was very high in both treatment groups . Better post-operative course was observed in the LMCAF , while better post-operative sensitivity and root coverage evaluation were demonstrated in patients treated with BT . CONCLUSIONS Gingival recession at first molar teeth can be successfully treated with LMCAF and BT . Better CRC was achieved with BT , while more comfortable post-operative course was associated with the LMCAF BACKGROUND The effective treatment of gingival recession ( GR ) defects is crucial for predictable outcomes . The most common treatment is the subepithelial connective tissue graft ( CTG ) , but good outcomes have also been obtained using enamel matrix derivative ( EMD ) . A split-mouth , r and omized controlled trial was previously performed during a 12-month period to evaluate primary and secondary outcomes in Miller Class I and II GR defects treated with CTG or EMD , both in combination with coronally advanced flap ( CAF ) . The purpose of the current study is to examine the major qualitative and quantitative parameters of this study after a 10-year follow-up . METHODS Nine of 17 original patients were available for follow-up evaluation 10 years after the original surgery . The parameters measured were : ( 1 ) GR depth ; ( 2 ) probing depth ( PD ) ; ( 3 ) clinical attachment level ; ( 4 ) width of keratinized tissue ( wKT ) ; ( 5 ) percentage of root coverage ; ( 6 ) root dentin hypersensitivity ; ( 7 ) color , texture , and contour of treatment sites ; and ( 8) patient satisfaction at 10 years . Results at 1 and 10 years of these nine patients ( nine test and nine control teeth ) were compared to original baseline values . In addition , results within treatment groups between 1 and 10 years and between treatment groups ( i.e. , EMD versus CTG ) at the same time points were examined . RESULTS At 10 years , all quantitative parameters except PD for both treatment protocol s showed statistically significant improvements from baseline values , including wKT in the EMD group , which at 1 year was not significantly improved compared with baseline wKT . In addition , at 10 years , there were no statistically significant differences between EMD + CAF and CTG + CAF for any measured parameter . The only statistically significant finding in this study was the difference in wKT found at 1 year ( EMD , 3.00 mm ; CTG , 3.89 mm ; P = 0.031 ) . Qualitative parameters at 10 years demonstrated similar stability . The only major qualitative difference was the marginal tissue contour , which was similar to adjacent tissues at EMD-treated sites but greater than adjacent tissues at all CTG sites except one . Esthetically , both EMD- and CTG-mediated treatments were similar at 10 years . However , given the choice , six of nine patients would choose EMD over CTG treatment to avoid a secondary harvesting procedure . CONCLUSIONS This paper highlights the importance of long-term data as it relates to procedural effectiveness in selecting optimally effective protocol s to treat gingival recession . Based on the results of this 10-year follow-up investigation , treatment with either EMD + CAF or CTG + CAF for Miller Class I and II GR defects appears stable , clinical ly effective , and similar to each other on all measured parameters BACKGROUND In the presence of a thin and narrow zone of gingival tissue root recessions caused by trauma or inflammatory reactions seem to be a common feature of the buccal tissue morphology . The surgical coverage is mainly indicated for aesthetic reasons and may be accomplished with pedicled flaps in conjunction with or without the use of connective tissue grafts . AIM The purpose of the present study was to evaluate the degree of vascularization of connective tissue grafts by applying a microsurgical approach . In addition , the clinical outcome was followed for 1 year . MATERIAL AND METHODS The study population consisted of 10 patients with bilateral Class I and II recessions at maxillary canines . In split-mouth design , the defects were r and omly selected for recession coverage either by a microsurgical ( test ) or macrosurgical ( control ) approach . Immediately after the surgical procedures , and after 3 and 7 days of healing , fluorescent angiograms were performed to evaluate graft vascularization . In addition , the clinical parameters were assessed before the surgical intervention , and 1 , 3 , 6 and 12 months postoperatively . RESULTS The results of the angiographic evaluation at test sites revealed a vascularization of 8.9+/-1.9 % immediately after the procedure . After 3 days and after 7 days , the vascularization rose to 53.3+/-10.5 % and 84.8+/-13.5 % , respectively . The corresponding vascularization at control sites were 7.95+/-1.8%/44.5+/-5.7 % and 64.0+/-12.3 % , respectively . All the differences between test and control sites were statistically significant . The clinical measurements revealed a mean recession coverage of 99.4+/-1.7 % for the test and 90.8+/-12.1 % for the control sites after the first month of healing . Again , this difference was statistically significant . The percentage of root coverage both test and control sites remained stable during the first year at 98 % and 90 % , respectively . CONCLUSIONS The present controlled clinical study has demonstrated that in root surface coverage , a microsurgical approach substantially improved the vascularization of the grafts and the percentages of root coverage compared with applying a conventional macroscopic approach AIM The aim of this r and omized controlled clinical study was to evaluate the outcomes of acellular dermal matrix ( ADM ) graft in combination with tunnel technique ( TUN ) on root coverage , aesthetics , and patient satisfaction and to compare with coronally advanced flap (CAF)+ADM in the treatment of multiple gingival recessions . MATERIAL AND METHODS A total of 20 patients with 58 Miller Class I multiple recessions ≥3 mm were included and divided into TUN+ADM and CAF+ADM groups . At baseline and 12 months , probing depth ( PD ) , clinical attachment level ( CAL ) , recession height ( RH ) and width ( RW ) , keratinized tissue height ( KT ) , gingival thickness , and complete and mean root coverage ( CRC , MRC ) were evaluated . Patient satisfaction and root coverage aesthetic scores ( RES ) were also assessed . RESULTS Mean root coverage was 75.72 % in TUN+ADM and 93.81 % in CAF+ADM . Intragroup comparisons revealed significant differences at 12 months for all parameters in both groups ( p < 0.05 ) . Intergroup differences were found to be statistically significant for RH and RW reduction , KT increase , CAL gain , MRC , CRC , and RES in favour of CAF+ADM group ( p < 0.05 ) . CONCLUSION Both techniques were effective in root coverage of multiple recessions ; however , better clinical results were achieved with CAF and ADM combination Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed BACKGROUND The root coverage esthetic score ( RES ) system was proposed for evaluating esthetic outcomes of root coverage procedures . The aim of this multicenter study is to assess the interrater agreement of the RES among expert periodontists . METHODS Eleven periodontists were selected in different clinical centers . Each operator had ≥15 years of experience in mucogingival surgery . Each periodontist was trained to use RES before the beginning of the study . Subsequently , baseline and post-treatment ( 6 months ) photographs of 41 Class I and II gingival recessions in 41 patients were separately given to each operator who evaluated the outcomes according to the RES method . A two-way r and om interclass correlation coefficient and 95 % confidence interval ( CI ) were used to assess the global interrater agreement for RESs . RESULTS The total interrater agreement for RESs was 0.92 ( 95 % CI : 0.88 to 0.95 ) , which indicated that an almost perfect agreement was achieved . CONCLUSION Tested individually by a group of periodontists , the RES seems to be a reliable method for assessing the esthetic outcomes of root coverage procedures BACKGROUND Periodontal root coverage procedures to treat recession areas are indicated for unesthetic , exposed , and /or painful root surfaces . Many methods , most using autogenous soft tissue grafts , have been utilized , but with associated morbidity at the donor sites . An alternative donor material would reduce the morbidity and provide for sufficient available donor tissue . METHODS An acellular allogeneic dermal connective tissue matrix ( AD ) and autogenous palatal connective tissue ( CT ) were compared as subepithelial grafts for the treatment of gingival recession . Twenty-two patients with similar isolated gingival recession of > or = 2 mm on 2 separate teeth were treated with the  subepithelial graft technique . Exposed roots were h and root planed only and , by r and om allocation , either a fitted AD or fitted CT graft was secured in place and covered by coronally positioned flaps . RESULTS Mann Whitney U test analysis found the following changes at 6 months for AD and CT , respectively , compared to presurgical conditions : root coverage of 1.7 + /- 1.2 ( 65.9 % ) and 2.2 + /- 1.1 mm ( 74.1 % ) ( both P<0.01 ) , increase in keratinized tissue ( KT ) of 1.2 + /- 1.3 and 1.6 + /- 1.9 ( both P<0.01 ) , and an increase in gingival thickness with both ; 83.2 % of expected root coverage was obtained with AD and 88.6 % with CT ( P= 0.43 ) . There were no significant differences between treatments for any parameter . Global assessment s by clinicians and patients suggested a more esthetic clinical result with AD . CONCLUSIONS These results suggest that acellular allogeneic dermal matrix may be a useful substitute for autogenous connective tissue grafts in root coverage procedures BACKGROUND The aim of this r and omized clinical trial ( RCT ) was to evaluate the adjunctive benefit of Connective Tissue Graft ( CTG ) to Coronally Advanced Flap ( CAF ) for the treatment of gingival recession associated with inter-dental clinical attachment loss equal or smaller to the buccal attachment loss ( RT2 ) . MATERIAL AND METHODS A total of 29 patients with one recession were enrolled ; 15 patients were r and omly assigned to CAF+CTG while 14 to CAF alone . Measurements were performed by a blind and calibrated examiner . Outcome measures included complete root coverage ( CRC ) , recession reduction ( RecRed ) , Root coverage Esthetic Score ( RES ) , intra-operative and post-operative morbidity , and root sensitivity . RESULTS After 6 months , CAF+CTG result ed in better outcomes in terms of CRC ( adjusted OR = 15.51 , p = 0.0325 ) than CAF alone . CRC was observed in > 80 % of the cases treated with CAF+CTG when the baseline amount of inter-dental CAL was ≤ 3 mm . No difference was detected in term of RecRed  . CAF+CTG was associated with longer surgical-time ( p < 0.0001 ) , higher number of days with post-operative morbidity ( p = 0.0222 ) and the need for a greater number of analgesics ( p = 0.0178 ) than CAF alone . No difference for final RES score was detected ( p = 0.1612 ) . CONCLUSION Both treatments can provide CRC in single gingival recession with inter-dental CAL loss . The application of CTG under CAF result ed in predictable CRC when inter-dental CAL was ≤ 3 mm BACKGROUND Recession defects around teeth have been treated with a variety of surgical techniques . Most of the literature suggests that the subepithelial 
    Output:
    
agent
Periodontal Plastic Surgery ( PPS ) techniques applying grafts underneath CAF with or without the adding of EMD are associated with improved aesthetics assessed by final patient perception and RES as professional evaluation system
***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: AIM To compare the clinical outcomes of laterally moved , coronally advanced flap ( LMCAF ) versus Bilaminar technique ( BT ) in the treatment of single gingival recession on molar teeth . MATERIAL AND METHODS Fifty patients showing Miller I and II gingival recessions at first molar teeth were treated : 25 were r and omly assigned to the BT group and 25 belonged to the LMCAF group .  Patient 's post-operative morbidity was assessed 1 week after the surgery , while aesthetic evaluation and the clinical evaluation were made 1 year later . RESULTS No statistically significant difference was demonstrated in terms of recession and PPD reduction . Statistically greater probability of complete root coverage ( CRC , Odds Ratio 22.1 ) and greater increase in gingival thickness were observed in the BT group . Greater increase in keratinized tissue was obtained in the LMCAF .  Patient satisfaction with aesthetics was very high in both treatment groups . Better post-operative course was observed in the LMCAF , while better post-operative sensitivity and root coverage evaluation were demonstrated in patients treated with BT . CONCLUSIONS Gingival recession at first molar teeth can be successfully treated with LMCAF and BT . Better CRC was achieved with BT , while more comfortable post-operative course was associated with the LMCAF BACKGROUND The effective treatment of gingival recession ( GR ) defects is crucial for predictable outcomes . The most common treatment is the subepithelial connective tissue graft ( CTG ) , but good outcomes have also been obtained using enamel matrix derivative ( EMD ) . A split-mouth , r and omized controlled trial was previously performed during a 12-month period to evaluate primary and secondary outcomes in Miller Class I and II GR defects treated with CTG or EMD , both in combination with coronally advanced flap ( CAF ) . The purpose of the current study is to examine the major qualitative and quantitative parameters of this study after a 10-year follow-up . METHODS Nine of 17 original patients were available for follow-up evaluation 10 years after the original surgery . The parameters measured were : ( 1 ) GR depth ; ( 2 ) probing depth ( PD ) ; ( 3 ) clinical attachment level ; ( 4 ) width of keratinized tissue ( wKT ) ; ( 5 ) percentage of root coverage ; ( 6 ) root dentin hypersensitivity ; ( 7 ) color , texture , and contour of treatment sites ; and ( 8) patient satisfaction at 10 years . Results at 1 and 10 years of these nine patients ( nine test and nine control teeth ) were compared to original baseline values . In addition , results within treatment groups between 1 and 10 years and between treatment groups ( i.e. , EMD versus CTG ) at the same time points were examined . RESULTS At 10 years , all quantitative parameters except PD for both treatment protocol s showed statistically significant improvements from baseline values , including wKT in the EMD group , which at 1 year was not significantly improved compared with baseline wKT . In addition , at 10 years , there were no statistically significant differences between EMD + CAF and CTG + CAF for any measured parameter . The only statistically significant finding in this study was the difference in wKT found at 1 year ( EMD , 3.00 mm ; CTG , 3.89 mm ; P = 0.031 ) . Qualitative parameters at 10 years demonstrated similar stability . The only major qualitative difference was the marginal tissue contour , which was similar to adjacent tissues at EMD-treated sites but greater than adjacent tissues at all CTG sites except one . Esthetically , both EMD- and CTG-mediated treatments were similar at 10 years . However , given the choice , six of nine patients would choose EMD over CTG treatment to avoid a secondary harvesting procedure . CONCLUSIONS This paper highlights the importance of long-term data as it relates to procedural effectiveness in selecting optimally effective protocol s to treat gingival recession . Based on the results of this 10-year follow-up investigation , treatment with either EMD + CAF or CTG + CAF for Miller Class I and II GR defects appears stable , clinical ly effective , and similar to each other on all measured parameters BACKGROUND In the presence of a thin and narrow zone of gingival tissue root recessions caused by trauma or inflammatory reactions seem to be a common feature of the buccal tissue morphology . The surgical coverage is mainly indicated for aesthetic reasons and may be accomplished with pedicled flaps in conjunction with or without the use of connective tissue grafts . AIM The purpose of the present study was to evaluate the degree of vascularization of connective tissue grafts by applying a microsurgical approach . In addition , the clinical outcome was followed for 1 year . MATERIAL AND METHODS The study population consisted of 10 patients with bilateral Class I and II recessions at maxillary canines . In split-mouth design , the defects were r and omly selected for recession coverage either by a microsurgical ( test ) or macrosurgical ( control ) approach . Immediately after the surgical procedures , and after 3 and 7 days of healing , fluorescent angiograms were performed to evaluate graft vascularization . In addition , the clinical parameters were assessed before the surgical intervention , and 1 , 3 , 6 and 12 months postoperatively . RESULTS The results of the angiographic evaluation at test sites revealed a vascularization of 8.9+/-1.9 % immediately after the procedure . After 3 days and after 7 days , the vascularization rose to 53.3+/-10.5 % and 84.8+/-13.5 % , respectively . The corresponding vascularization at control sites were 7.95+/-1.8%/44.5+/-5.7 % and 64.0+/-12.3 % , respectively . All the differences between test and control sites were statistically significant . The clinical measurements revealed a mean recession coverage of 99.4+/-1.7 % for the test and 90.8+/-12.1 % for the control sites after the first month of healing . Again , this difference was statistically significant . The percentage of root coverage both test and control sites remained stable during the first year at 98 % and 90 % , respectively . CONCLUSIONS The present controlled clinical study has demonstrated that in root surface coverage , a microsurgical approach substantially improved the vascularization of the grafts and the percentages of root coverage compared with applying a conventional macroscopic approach AIM The aim of this r and omized controlled clinical study was to evaluate the outcomes of acellular dermal matrix ( ADM ) graft in combination with tunnel technique ( TUN ) on root coverage , aesthetics , and patient satisfaction and to compare with coronally advanced flap (CAF)+ADM in the treatment of multiple gingival recessions . MATERIAL AND METHODS A total of 20 patients with 58 Miller Class I multiple recessions ≥3 mm were included and divided into TUN+ADM and CAF+ADM groups . At baseline and 12 months , probing depth ( PD ) , clinical attachment level ( CAL ) , recession height ( RH ) and width ( RW ) , keratinized tissue height ( KT ) , gingival thickness , and complete and mean root coverage ( CRC , MRC ) were evaluated . Patient satisfaction and root coverage aesthetic scores ( RES ) were also assessed . RESULTS Mean root coverage was 75.72 % in TUN+ADM and 93.81 % in CAF+ADM . Intragroup comparisons revealed significant differences at 12 months for all parameters in both groups ( p < 0.05 ) . Intergroup differences were found to be statistically significant for RH and RW reduction , KT increase , CAL gain , MRC , CRC , and RES in favour of CAF+ADM group ( p < 0.05 ) . CONCLUSION Both techniques were effective in root coverage of multiple recessions ; however , better clinical results were achieved with CAF and ADM combination Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed BACKGROUND The root coverage esthetic score ( RES ) system was proposed for evaluating esthetic outcomes of root coverage procedures . The aim of this multicenter study is to assess the interrater agreement of the RES among expert periodontists . METHODS Eleven periodontists were selected in different clinical centers . Each operator had ≥15 years of experience in mucogingival surgery . Each periodontist was trained to use RES before the beginning of the study . Subsequently , baseline and post-treatment ( 6 months ) photographs of 41 Class I and II gingival recessions in 41 patients were separately given to each operator who evaluated the outcomes according to the RES method . A two-way r and om interclass correlation coefficient and 95 % confidence interval ( CI ) were used to assess the global interrater agreement for RESs . RESULTS The total interrater agreement for RESs was 0.92 ( 95 % CI : 0.88 to 0.95 ) , which indicated that an almost perfect agreement was achieved . CONCLUSION Tested individually by a group of periodontists , the RES seems to be a reliable method for assessing the esthetic outcomes of root coverage procedures BACKGROUND Periodontal root coverage procedures to treat recession areas are indicated for unesthetic , exposed , and /or painful root surfaces . Many methods , most using autogenous soft tissue grafts , have been utilized , but with associated morbidity at the donor sites . An alternative donor material would reduce the morbidity and provide for sufficient available donor tissue . METHODS An acellular allogeneic dermal connective tissue matrix ( AD ) and autogenous palatal connective tissue ( CT ) were compared as subepithelial grafts for the treatment of gingival recession . Twenty-two patients with similar isolated gingival recession of > or = 2 mm on 2 separate teeth were treated with the  subepithelial graft technique . Exposed roots were h and root planed only and , by r and om allocation , either a fitted AD or fitted CT graft was secured in place and covered by coronally positioned flaps . RESULTS Mann Whitney U test analysis found the following changes at 6 months for AD and CT , respectively , compared to presurgical conditions : root coverage of 1.7 + /- 1.2 ( 65.9 % ) and 2.2 + /- 1.1 mm ( 74.1 % ) ( both P<0.01 ) , increase in keratinized tissue ( KT ) of 1.2 + /- 1.3 and 1.6 + /- 1.9 ( both P<0.01 ) , and an increase in gingival thickness with both ; 83.2 % of expected root coverage was obtained with AD and 88.6 % with CT ( P= 0.43 ) . There were no significant differences between treatments for any parameter . Global assessment s by clinicians and patients suggested a more esthetic clinical result with AD . CONCLUSIONS These results suggest that acellular allogeneic dermal matrix may be a useful substitute for autogenous connective tissue grafts in root coverage procedures BACKGROUND The aim of this r and omized clinical trial ( RCT ) was to evaluate the adjunctive benefit of Connective Tissue Graft ( CTG ) to Coronally Advanced Flap ( CAF ) for the treatment of gingival recession associated with inter-dental clinical attachment loss equal or smaller to the buccal attachment loss ( RT2 ) . MATERIAL AND METHODS A total of 29 patients with one recession were enrolled ; 15 patients were r and omly assigned to CAF+CTG while 14 to CAF alone . Measurements were performed by a blind and calibrated examiner . Outcome measures included complete root coverage ( CRC ) , recession reduction ( RecRed ) , Root coverage Esthetic Score ( RES ) , intra-operative and post-operative morbidity , and root sensitivity . RESULTS After 6 months , CAF+CTG result ed in better outcomes in terms of CRC ( adjusted OR = 15.51 , p = 0.0325 ) than CAF alone . CRC was observed in > 80 % of the cases treated with CAF+CTG when the baseline amount of inter-dental CAL was ≤ 3 mm . No difference was detected in term of RecRed  . CAF+CTG was associated with longer surgical-time ( p < 0.0001 ) , higher number of days with post-operative morbidity ( p = 0.0222 ) and the need for a greater number of analgesics ( p = 0.0178 ) than CAF alone . No difference for final RES score was detected ( p = 0.1612 ) . CONCLUSION Both treatments can provide CRC in single gingival recession with inter-dental CAL loss . The application of CTG under CAF result ed in predictable CRC when inter-dental CAL was ≤ 3 mm BACKGROUND Recession defects around teeth have been treated with a variety of surgical techniques . Most of the literature suggests that the subepithelial 
    Output:
    