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: INTRODUCTION Up-to- date studies comparing endodontic treatment versus implant-supported prosthesis have shown similar clinical outcome and survival rates . However , no data are available comparing both treatment modalities based on the patient 's perception of quality of life . This study was design ed to qualitatively describe and compare the quality of life of patients with restored , single endodontically treated teeth versus patients with single implant-supported fixed prostheses . METHODS Forty-eight patients agreed to participate in the study ( n = 24 from each treatment modality ) . Of those , 37 actually participated in the study : 17 were endodontically treated and 20 had an implant-supported prosthesis . Patients in each of the two groups were r and omly selected from the Graduate Endodontics and Graduate Periodontics Departments , respectively . Six focus group discussion s ( n = 3 per treatment group ) were held and audio-recorded for subsequent thematic analysis . Data were analyzed to identify common themes within each category and compared to assess any differences in quality of life between the two treatments . Additionally , a quality of life survey , the shortened version of the Oral Health Impact Profile ( OHIP-14 ) , was given before the discussion group and the responses analyzed . RESULTS The results obtained from this study show similar overall OHIP scores and show a high rate of satisfaction with both treatment modalities . Content analysis of the discussion groups revealed several themes and subthemes . The major themes were importance of overall health , financial implication s of the treatments , perception of the treatments and its outcomes , time since treatment , and follow-up dental visits . CONCLUSIONS The results help identify patients ' perception and concerns with each treatment modality and assist the clinician and patient in the selection of an optimal treatment for their given situation . In addition to the prognosis and outcomes , clinicians should consider patients ' perceptions and preferences as well as the influence each therapy may have on their quality of life , both short- and long-term . Overall , all the participants in this study were pleased with the treatment received and expressed a clear message to save their natural dentition whenever possible INTRODUCTION : Pulpectomy of primary teeth is commonly carried out with h and files and broaches ; a tricky and time consuming procedure . The purpose of this in vitro study was to compare the cleaning efficacy and time taken for instrumentation of deciduous molars using h and K-files and Flex Master rotary system . MATERIAL S AND METHODS : In this study , 68 canals of 23 extracted primary molars with at least two third intact roots and 7 - 12 mm length were selected . After preparing an access cavity , K-file size # 15 was introduced into the root canal and India ink was injected with an insulin syringe . Sixty sample s were r and omly divided in to experimental groups in group I ( n=30 ) , root canals were prepared with h and K-files ; in group II ( n=30 ) , rotary Flex Master files were used for instrumentation , and in group III 8 remained sample s were considered as negative controls . After clearing and root sectioning , the removal of India ink from cervical , middle , and apical thirds was scored . Data was analyzed using student 's T-test and Mann-Whitney U test . RESULTS : There was no significant difference between experimental groups cleaning efficacy at the cervical , middle and apical root canal thirds . Only the coronal third scored higher in the h and instrumented group ( P<0.001 ) . Instrumentation with Flex Master rotary files was significantly less time consuming ( P<0.001 ) . CONCLUSION : Although there was no difference in cleanliness efficacy at the apical and middle thirds , the coronal third was more effectively cleaned with h and files . Predictably , time efficiency was a significant advantage with rotary technique AIM To compare in vitro intracanal bacterial reduction using nickel-titanium rotary instruments with and without apical enlargement . METHODOLOGY Thirty-eight palatal roots of maxillary molar teeth , with mature apices were subdivided according to lengths and then r and omly assigned to two experimental and one control groups . The roots were sterilized and then reinfected with Enterococcus faecalis , which served as a bacteriological marker . All roots in the experimental groups were prepared in a step-down sequence with engine-driven GT rotary files at 350 rpm . In experimental group A ( n = 16 ) additional apical enlargement to ISO size 35 was performed . In group B ( n = 16 ) a serial step-back technique was followed with no apical enlargement . This was combined in groups A and B with irrigation with NaOCl and EDTA . In the control group ( group C , n = 6 ) irrigation only was carried out , with no mechanical preparation . Sample s were then taken from the root canals to determine the numbers of remaining bacteria . RESULTS In groups A and B , 15 ( 94 % ) and 13 ( 81 % ) specimens were rendered bacteria-free , respectively . In the control group C none of the specimens were bacteria-free . There was a significant difference ( P < 0.001 ) in the antibacterial effects of experimental and control regimens . There was , however , no significant difference ( P = 0.276 ) between the preparation methods used in the experimental groups . CONCLUSIONS There was no significant difference in intracanal bacterial reduction when Ni-Ti GT rotary preparation with NaOCl and EDTA irrigation was used with or without apical enlargement preparation technique . It may therefore not be necessary to remove dentine in the apical part of the root canal when a suitable coronal taper is achieved to allow satisfactory irrigation of the root canal system with antimicrobial agents OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review INTRODUCTION The aim of any root canal treatment is to achieve a canal free of micro organisms , residual pulp remnants , debris and smear layer for the long term success of the procedure . Manual and automated instrumentation techniques along with proper irrigation regime is used to arrive at the aforementioned goal . Many authors focused on the preparation capabilities of various manual and rotary instruments but very few investigators stressed on the actual cleaning abilities of these instruments . AIMS AND OBJECTIVES This study was undertaken to evaluate the cleaning efficiency of manual K flex files and rotary Pro File systems in the root canals using a scanning electron microscope . MATERIAL AND METHODS Thirty single rooted m and ibular first premolars were divided into two groups and r and omized ( the manual group-M and the ProFile group-P ) with respect to the preparation technique . The Manual group was h and instrumented with stainless steel K- Flexofiles by means of a conventional filing technique . The Pro File group was instrumented according to the manufacturer 's instructions using a rotary h and piece . All canals were shaped and cleaned under frequent irrigation with EDTA . Final irrigation was carried out with 3 mL of normal saline solution to neutralize the action of the irrigant . The roots were split , one half of each tooth was selected for further SEM technique analysis and examined under the scanning electron microscope . The canal walls were quantitatively evaluated for the amount of debris and smear layer . The apical , middle and coronal regions of the canal surface , were grade d ( 1 - 5 ) for debris and smear layer . A statistical analysis was performed using a Mann-Whitney Rank Sum test . ProFile performed least effective cleaning . Manual K-Flexofiles led to a grooved pattern . RESULTS AND CONCLUSION A statistically significant difference was observed ( p<0.05 ) between the two instrumentation techniques concerning the amount of debris and smear layer at the apical level . The manually filed canals had less debris and smear layer than those using a rotary technique . It was concluded from this study that none of the instrumentation techniques employed , produced the canal walls which were free of surface debris and smear layer . The manual instrumentation technique was better in cleaning the canals compared to the ProFile rotary Ni-Ti instruments despite the step-back technique used for manual instrumentation . How to cite this article : Manjunatha M , Kini A , Sudhakar V , Sunil K V C , Hiremath V K , Shah A. Smear Layer Evaluation on Root Canal Preparation with Manual and Rotary Techniques using EDTA as an Irrigant : A Scanning Electron Microscopy Study . J Int Oral Health 2013 ; 5(1):66 - 78 BACKGROUND The purpose of this in-vitro study was to compare canal transportation and centering ability of Twisted and Hyflex Rotary Files with stainless steel h and k-flexofiles by using Spiral Computed Tomography . MATERIAL S & METHODS A total of 90 freshly extracted human m and ibular single rooted Premolar teeth were selected . The crowns were flattened with steel disks and a final dimension of 18-mm WL was achieved for each tooth . Canals were divided r and omly into 3 groups of 30 teeth each . Group I : Hyflex files , Group II : Twisted files , Group III : stainless steel h and k-flexofiles . Three sections from apical , mid-root , and coronal levels of the canal were recorded . All the teeth were scanned before and after instrumentation by using Spiral Computed Tomography . RESULTS K-files showed highest transportation and less centered when compared to the Twisted and Hyflex rotary files . No significant difference was found between TF and Hyflex CM instruments . CONCLUSION TF and Hyflex files shaped curved root canals without significant shaping errors when compared to the H and stainless steel k-flexofiles . How to cite this article : Kumar BS , Pattanshetty S , Prasad M , Soni S , Pattanshetty KS , Prasad S. An in-vitro Evaluation of canal transportation and centering ability of two rotary Nickel Titanium systems ( Twisted Files and Hyflex files ) with conventional stainless Steel h and K-flexofiles by using Spiral Computed Tomography . J Int Oral Health 2013;5(5):108 - 15 AIM To investigate the probability of and factors influencing periapical status of teeth following primary ( 1 ° RCT x ) or secondary ( 2 ° RCT x ) root canal treatment .  METHODOLOGY This prospect i ve study involved annual clinical and radiographic follow-up of  1 ° RCT x ( 1170 roots , 702 teeth and 534 patients ) or 2 ° RCT x ( 1314 roots , 750 teeth and 559 patients ) carried out by Endodontic postgraduate students for 2 - 4 ( 50 % ) years . Pre- , intra- and postoperative data were collected prospect ively on customized forms . The proportion of roots with complete periapical healing was estimated , and prognostic factors were investigated using multiple logistic regression models . Clustering effects within patients were adjusted in all models using robust st and ard error . RESULTS proportion of roots with complete periapical healing after 1 ° RCT x ( 83 % ; 95 % CI : 81 % , 85 % ) or 2 ° RCT x ( 80 % ; 95 % CI : 78 % , 82 % ) were similar . Eleven prognostic factors were identified . The conditions that were found to improve periapical healing significantly were : the preoperative absence of a periapical lesion ( P = 0.003 ) ; in presence of a periapical lesion , the smaller its size ( P ≤ 0.001 ) , the better the treatment prognosis ; the absence of a preoperative sinus tract ( P = 0.001 ) ; achievement of patency at the canal terminus ( P = 0.001 ) ; extension of canal cleaning as close as possible to its apical terminus ( P = 0.001 ) ; the use of ethylene-diamine-tetra-acetic acid ( EDTA ) solution as a penultimate wash followed by final rinse with NaOCl solution in 2 ° RCT x cases ( P = 0.002 ) ; abstaining from using 2 % chlorexidine as an adjunct irrigant to NaOCl solution ( P =  
    Output:
    
agent
Conclusions The results of this systematic review suggested that NiTi rotary instruments were associated with lower canal transportation and apical extrusion when compared to SST h and files , whereas both groups had similar outcomes in terms of success of therapy , amount of residual bacteria , and cleansing ability after treatment .
***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: INTRODUCTION Up-to- date studies comparing endodontic treatment versus implant-supported prosthesis have shown similar clinical outcome and survival rates . However , no data are available comparing both treatment modalities based on the patient 's perception of quality of life . This study was design ed to qualitatively describe and compare the quality of life of patients with restored , single endodontically treated teeth versus patients with single implant-supported fixed prostheses . METHODS Forty-eight patients agreed to participate in the study ( n = 24 from each treatment modality ) . Of those , 37 actually participated in the study : 17 were endodontically treated and 20 had an implant-supported prosthesis . Patients in each of the two groups were r and omly selected from the Graduate Endodontics and Graduate Periodontics Departments , respectively . Six focus group discussion s ( n = 3 per treatment group ) were held and audio-recorded for subsequent thematic analysis . Data were analyzed to identify common themes within each category and compared to assess any differences in quality of life between the two treatments . Additionally , a quality of life survey , the shortened version of the Oral Health Impact Profile ( OHIP-14 ) , was given before the discussion group and the responses analyzed . RESULTS The results obtained from this study show similar overall OHIP scores and show a high rate of satisfaction with both treatment modalities . Content analysis of the discussion groups revealed several themes and subthemes . The major themes were importance of overall health , financial implication s of the treatments , perception of the treatments and its outcomes , time since treatment , and follow-up dental visits . CONCLUSIONS The results help identify patients ' perception and concerns with each treatment modality and assist the clinician and patient in the selection of an optimal treatment for their given situation . In addition to the prognosis and outcomes , clinicians should consider patients ' perceptions and preferences as well as the influence each therapy may have on their quality of life , both short- and long-term . Overall , all the participants in this study were pleased with the treatment received and expressed a clear message to save their natural dentition whenever possible INTRODUCTION : Pulpectomy of primary teeth is commonly carried out with h and files and broaches ; a tricky and time consuming procedure . The purpose of this in vitro study was to compare the cleaning efficacy and time taken for instrumentation of deciduous molars using h and K-files and Flex Master rotary system . MATERIAL S AND METHODS : In this study , 68 canals of 23 extracted primary molars with at least two third intact roots and 7 - 12 mm length were selected . After preparing an access cavity , K-file size # 15 was introduced into the root canal and India ink was injected with an insulin syringe . Sixty sample s were r and omly divided in to experimental groups in group I ( n=30 ) , root canals were prepared with h and K-files ; in group II ( n=30 ) , rotary Flex Master files were used for instrumentation , and in group III 8 remained sample s were considered as negative controls . After clearing and root sectioning , the removal of India ink from cervical , middle , and apical thirds was scored . Data was analyzed using student 's T-test and Mann-Whitney U test . RESULTS : There was no significant difference between experimental groups cleaning efficacy at the cervical , middle and apical root canal thirds . Only the coronal third scored higher in the h and instrumented group ( P<0.001 ) . Instrumentation with Flex Master rotary files was significantly less time consuming ( P<0.001 ) . CONCLUSION : Although there was no difference in cleanliness efficacy at the apical and middle thirds , the coronal third was more effectively cleaned with h and files . Predictably , time efficiency was a significant advantage with rotary technique AIM To compare in vitro intracanal bacterial reduction using nickel-titanium rotary instruments with and without apical enlargement . METHODOLOGY Thirty-eight palatal roots of maxillary molar teeth , with mature apices were subdivided according to lengths and then r and omly assigned to two experimental and one control groups . The roots were sterilized and then reinfected with Enterococcus faecalis , which served as a bacteriological marker . All roots in the experimental groups were prepared in a step-down sequence with engine-driven GT rotary files at 350 rpm . In experimental group A ( n = 16 ) additional apical enlargement to ISO size 35 was performed . In group B ( n = 16 ) a serial step-back technique was followed with no apical enlargement . This was combined in groups A and B with irrigation with NaOCl and EDTA . In the control group ( group C , n = 6 ) irrigation only was carried out , with no mechanical preparation . Sample s were then taken from the root canals to determine the numbers of remaining bacteria . RESULTS In groups A and B , 15 ( 94 % ) and 13 ( 81 % ) specimens were rendered bacteria-free , respectively . In the control group C none of the specimens were bacteria-free . There was a significant difference ( P < 0.001 ) in the antibacterial effects of experimental and control regimens . There was , however , no significant difference ( P = 0.276 ) between the preparation methods used in the experimental groups . CONCLUSIONS There was no significant difference in intracanal bacterial reduction when Ni-Ti GT rotary preparation with NaOCl and EDTA irrigation was used with or without apical enlargement preparation technique . It may therefore not be necessary to remove dentine in the apical part of the root canal when a suitable coronal taper is achieved to allow satisfactory irrigation of the root canal system with antimicrobial agents OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review INTRODUCTION The aim of any root canal treatment is to achieve a canal free of micro organisms , residual pulp remnants , debris and smear layer for the long term success of the procedure . Manual and automated instrumentation techniques along with proper irrigation regime is used to arrive at the aforementioned goal . Many authors focused on the preparation capabilities of various manual and rotary instruments but very few investigators stressed on the actual cleaning abilities of these instruments . AIMS AND OBJECTIVES This study was undertaken to evaluate the cleaning efficiency of manual K flex files and rotary Pro File systems in the root canals using a scanning electron microscope . MATERIAL AND METHODS Thirty single rooted m and ibular first premolars were divided into two groups and r and omized ( the manual group-M and the ProFile group-P ) with respect to the preparation technique . The Manual group was h and instrumented with stainless steel K- Flexofiles by means of a conventional filing technique . The Pro File group was instrumented according to the manufacturer 's instructions using a rotary h and piece . All canals were shaped and cleaned under frequent irrigation with EDTA . Final irrigation was carried out with 3 mL of normal saline solution to neutralize the action of the irrigant . The roots were split , one half of each tooth was selected for further SEM technique analysis and examined under the scanning electron microscope . The canal walls were quantitatively evaluated for the amount of debris and smear layer . The apical , middle and coronal regions of the canal surface , were grade d ( 1 - 5 ) for debris and smear layer . A statistical analysis was performed using a Mann-Whitney Rank Sum test . ProFile performed least effective cleaning . Manual K-Flexofiles led to a grooved pattern . RESULTS AND CONCLUSION A statistically significant difference was observed ( p<0.05 ) between the two instrumentation techniques concerning the amount of debris and smear layer at the apical level . The manually filed canals had less debris and smear layer than those using a rotary technique . It was concluded from this study that none of the instrumentation techniques employed , produced the canal walls which were free of surface debris and smear layer . The manual instrumentation technique was better in cleaning the canals compared to the ProFile rotary Ni-Ti instruments despite the step-back technique used for manual instrumentation . How to cite this article : Manjunatha M , Kini A , Sudhakar V , Sunil K V C , Hiremath V K , Shah A. Smear Layer Evaluation on Root Canal Preparation with Manual and Rotary Techniques using EDTA as an Irrigant : A Scanning Electron Microscopy Study . J Int Oral Health 2013 ; 5(1):66 - 78 BACKGROUND The purpose of this in-vitro study was to compare canal transportation and centering ability of Twisted and Hyflex Rotary Files with stainless steel h and k-flexofiles by using Spiral Computed Tomography . MATERIAL S & METHODS A total of 90 freshly extracted human m and ibular single rooted Premolar teeth were selected . The crowns were flattened with steel disks and a final dimension of 18-mm WL was achieved for each tooth . Canals were divided r and omly into 3 groups of 30 teeth each . Group I : Hyflex files , Group II : Twisted files , Group III : stainless steel h and k-flexofiles . Three sections from apical , mid-root , and coronal levels of the canal were recorded . All the teeth were scanned before and after instrumentation by using Spiral Computed Tomography . RESULTS K-files showed highest transportation and less centered when compared to the Twisted and Hyflex rotary files . No significant difference was found between TF and Hyflex CM instruments . CONCLUSION TF and Hyflex files shaped curved root canals without significant shaping errors when compared to the H and stainless steel k-flexofiles . How to cite this article : Kumar BS , Pattanshetty S , Prasad M , Soni S , Pattanshetty KS , Prasad S. An in-vitro Evaluation of canal transportation and centering ability of two rotary Nickel Titanium systems ( Twisted Files and Hyflex files ) with conventional stainless Steel h and K-flexofiles by using Spiral Computed Tomography . J Int Oral Health 2013;5(5):108 - 15 AIM To investigate the probability of and factors influencing periapical status of teeth following primary ( 1 ° RCT x ) or secondary ( 2 ° RCT x ) root canal treatment .  METHODOLOGY This prospect i ve study involved annual clinical and radiographic follow-up of  1 ° RCT x ( 1170 roots , 702 teeth and 534 patients ) or 2 ° RCT x ( 1314 roots , 750 teeth and 559 patients ) carried out by Endodontic postgraduate students for 2 - 4 ( 50 % ) years . Pre- , intra- and postoperative data were collected prospect ively on customized forms . The proportion of roots with complete periapical healing was estimated , and prognostic factors were investigated using multiple logistic regression models . Clustering effects within patients were adjusted in all models using robust st and ard error . RESULTS proportion of roots with complete periapical healing after 1 ° RCT x ( 83 % ; 95 % CI : 81 % , 85 % ) or 2 ° RCT x ( 80 % ; 95 % CI : 78 % , 82 % ) were similar . Eleven prognostic factors were identified . The conditions that were found to improve periapical healing significantly were : the preoperative absence of a periapical lesion ( P = 0.003 ) ; in presence of a periapical lesion , the smaller its size ( P ≤ 0.001 ) , the better the treatment prognosis ; the absence of a preoperative sinus tract ( P = 0.001 ) ; achievement of patency at the canal terminus ( P = 0.001 ) ; extension of canal cleaning as close as possible to its apical terminus ( P = 0.001 ) ; the use of ethylene-diamine-tetra-acetic acid ( EDTA ) solution as a penultimate wash followed by final rinse with NaOCl solution in 2 ° RCT x cases ( P = 0.002 ) ; abstaining from using 2 % chlorexidine as an adjunct irrigant to NaOCl solution ( P =  
    Output:
    