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 clinical ly evaluate an all-ceramic restorative system ( Finesse All-Ceramic ) when used in conjunction with an ultra-low fusing porcelain ( Finesse ) using bonded esthetic resin cements ( Enforce & Calibra ) . METHODS This report describes the 3-year results of a prospect i ve , consecutive case clinical evaluation for Finesse All-Ceramic .  Forty posterior and anterior crowns , 20 all ceramic inlays and onlays , and 26 veneers were placed in 43 patients at the initiation of this study .  St and ard ceramic preparations were performed followed by conventional polyvinylsiloxane ( Aquasil ) impression techniques using cord retraction . The bonded resin cement was used to place the restorations following manufacturer 's instructions . RESULTS A majority of restorations ( 95 - 100 % ) were evaluated to be optimal at baseline ( B ) , 1 month , 12 , 24 and 36 months using a modified Ryge criteria for the following categories : color match , marginal adaptation , porcelain staining , secondary caries , postoperative sensitivity , and retention . Assessment of color match at 36 months result ed in 97 % of all crowns and 100 % of all veneers and onlays being rated alfa for shade match to Vita Lumin shade guide . The overall 3-year success rate at the 3-year recall ( inlay/onlays , crowns , and veneers ) was 98.57 % , with the success rate for crowns and veneers at this time period being 100 % OBJECTIVES The purpose of this study was to investigate the durability of extensive dentin-enamel-bonded posterior ceramic coverages  in a 15 years follow-up . METHODS All extensive dentin-enamel-bonded posterior partial and complete all-ceramic coverages placed during the period November 1992-December 1998 were included . In 121 patients , 252 coverages ( IPS Empress ) were placed . The adhesive bonding to dentin and enamel was performed with three 3-step and one 2-step etch and rinse bonding . In 106 restorations the classic Syntac was used in combination with the dual-cured resin composite Variolink . The other restorations were luted with the chemically cured resin composite Bisfil 2B and bonded with 3-step etch and rinse systems , classic Gluma ( 37 ) , Allbond 2 ( 57 ) , Syntac ( 32 ) or the 2-step etch and rinse system , One step ( 20 ) . The ceramics were evaluated yearly by modified USPHS criteria during 15 years . RESULTS Postoperative sensitivity was registered in 4 patients during bite forces lasting for 2 - 4 weeks . Fifty-five of 228 coverages ( 24.1 % ) failed . The mean observation period of the acceptable coverages was 12.6 years ( range 11 - 15 years ) . The main reasons for failure were lost restorations ( 18 ) , ceramic fracture ( 16 ) , and secondary caries ( 11 ) . Significant differences in failure rate were observed between the dentin bonding agents but not between the two luting agents . Ceramic  coverages placed on non-vital teeth failed in 39 % and on vital teeth in 20.9 % ( p=0.014 ) . Logistic regression indicated three significant predictors for failure of the coverages : gender and parafunctional habits of the patient and non-vitality of the tooth . SIGNIFICANCE The technique investigated showed advantages like less destruction of healthy tissue , and avoiding of endodontic treatment and /or deep cervical placement of restoration margins to obtain retention The aim of this r and omized controlled clinical trial was to compare the early clinical outcome of slip-cast glass-infiltrated Alumina/Zirconia and CAD/CAM Zirconia all-ceramic crowns .  A total of 30 InCeram ® Zirconia and Cercon ® Zirconia crowns were fabricated and cemented with a glass ionomer cement in 20 patients . At baseline , 6-month , 1-year , and 2-year recall appointments , Californian Dental Association ( CDA ) quality evaluation system was used to evaluate the prosthetic replacements , and plaque and gingival index scores were used to explore the periodontal outcome of the treatments . No clinical sign of marginal discoloration , persistent pain and secondary caries was detected in any of the restorations . All InCeram ® Zirconia crowns  survived during the 2-year period , although one nonvital tooth experienced root fracture coupled with the fracture of the veneering porcelain of the restoration . One Cercon ® Zirconia restoration fractured and was replaced . According to the CDA criteria , marginal integrity was rated excellent for InCeram ® Zirconia ( 73 % ) and Cercon ® Zirconia ( 80 % ) restorations , respectively . Slight color mismatch rate was higher for InCeram ® Zirconia restorations ( 66 % ) than Cercon ® Zirconia ( 26 % ) restorations . Plaque and gingival index scores were mostly zero and almost constant over time . Time-dependent changes in plaque and gingival index scores within and between groups were statistically similar ( p>0.05 ) . This clinical study demonstrates that single-tooth InCeram ® Zirconia and Cercon ® Zirconia crowns have comparable early clinical outcome , both seem as acceptable treatment modalities , and most importantly , all-ceramic alumina crowns strengthened by 25 % zirconia can sufficiently withst and functional load in the posterior zone OBJECTIVES The literature demonstrates that conventional luting of metal-based restorations using zinc phosphate cements is clinical ly successful over 20 years . This study compared the clinical outcomes of metal-based fixed partial dentures luted conventionally with zinc phosphate and self-adhesive resin cement . METHODS Forty-nine patients ( mean age 54+/-13 years ) received 49 metal-based fixed partial dentures r and omly luted using zinc phosphate ( Richter & Hoffmann , Berlin , Germany ) or self-adhesive resin cement ( RelyX Unicem Aplicap , 3 M ESPE , Germany ) at the University Medical Center Regensburg . The core build-up material was highly viscous glass ionomer ; the finishing line was in dentin . The study included 42 posterior , 5 anterior crowns and two onlays . Forty-seven restorations were made of precious alloys , 2 of non-precious alloys . The restorations were clinical ly examined every year . The clinical performance was checked for plaque ( 0 - 5 ; PI , Quigley-Hein ) , bleeding ( 0 - 4 ; PBI ; Mühlemann ) and attachment scores . The examination included pulp vitality and percussion tests . STATISTICS Means of scores , st and ard deviation , cumulative survival and complication rates were calculated using life tables . RESULTS The mean observation time was 3.16+/-0.6 years ( min : 2.0 ; max : 4.5 years ) . During that time no restoration was lost , no recementation became necessary . One endodontic treatment was performed in the self-adhesive composite group after 2.9 years . At study end bleeding ( 1.44 RelyX Unicem vs. 1.25 zinc phosphate ) and plaque ( 1.64 RelyX Unicem vs. 1.0 zinc phosphate ) scores showed no statistically significant difference . SIGNIFICANCE The self-adhesive resin cement performed clinical ly as well and can be used as easily as zinc phosphate cement to retain metal-based restorations over a 38-month observation period STATEMENT OF PROBLEM Few long-term clinical studies have reported data of modern posterior composites as direct and indirect restorations . PURPOSE This prospect i ve , long-term clinical trial ( 1 ) evaluated direct and indirect composite restorations for clinical acceptability as posterior restoratives in single or multisurface carious teeth and ( 2 ) provided a survey on the 2-year results . MATERIAL AND METHODS Nine dental students placed 88 composite restorations ( Tetric , blend-a-lux , Pertac-Hybrid Unifil ) , 43 direct composite restorations and 45 indirect inlays , under the supervision of an experienced dentist . The first clinical evaluation was performed 11 to 13 months after placement by 2 other experienced dentists , using modified USPHS criteria . A second follow-up of 60 restorations took place within 20 to 26 months after placement . RESULTS A total of 93 % of indirect and 90 % of direct composite restorations were assessed to be clinical ly excellent or acceptable . Two restorations ( 1 indirect composite inlay and 1 margin of a direct composite restoration )  failed during the second year because of fracture . Indirect inlays demonstrated a significantly better " anatomic form of the surface " than direct composite restorations . Premolars revealed a significantly better margin integrity and postoperative symptoms than molars . CONCLUSION Posterior composite restorations provided a satisfactory clinical performance over a 2-year period when placed by relatively inexperienced but supervised students BACKGROUND Adhesively luted all-ceramic restorations preserve and stabilize weakened tooth structure , but there is little published information about the clinical performance of large , all-ceramic restorations . METHODS In this pilot study , the authors placed 58 large , single-tooth , all-ceramic restorations in 26 patients using a computer-aided design /computer-aided manufacturing , or CAD/CAM , system ( CEREC 2 , Sirona Dental Systems GmbH , Bensheim , Germany ) . They documented the maximum height of the restoration and remaining cementoenamel junction , or CEJ . In 21 cases , rubber dam isolation was not possible during adhesive luting . They re-evaluated the restorations after three years according to the U.S. Public Health Service criteria . RESULTS After three years , the authors rated 56 ( 97 percent ) of the 58 restorations as Bravo or better in regard to marginal integrity , secondary caries ( four could not be rated ) , discoloration and anatomical form . One restoration was rated as Charlie because of poor marginal integrity , and one restoration had to be replaced owing to a bulk fracture . The authors rated the adequacy of proximal contact and occlusal relationships as acceptable-to-good for all restorations . Neither the extent of the remaining enamel at the cavity margin nor application of a rubber dam had any statistically significant influence ( chi2 test , P > .05 ) on the clinical performance of the restorations after three years . CONCLUSIONS At the three-year recall appointment , the authors found that the adhesively luted all-ceramic restorations had successfully repaired large coronal defects , irrespective of the cavity margin location ( that is , coronal or apical to the CEJ ) . CLINICAL IMPLICATION S Tooth-colored , all-ceramic CAD/CAM-generated restorations are an alternative to conventional restorations if large coronal defects need to be treated The gathering of clinical data on fractures of dental restorations through prospect i ve clinical trials is a labor- and time-consuming enterprise . Here , we propose an unconventional approach for collecting large data sets , from which clinical information on indirect restorations can be retrospectively analyzed . The authors accessed the data base of an industry-scale machining center in Germany and obtained information on 34,911 computer-aided design (CAD)/computer-aided manufacturing ( CAM ) all-ceramic posterior restorations . The fractures of bridges , crowns , onlays , and inlays fabricated from different all-ceramic systems over a period of 3.5 y were reported by dentists and entered in the data base . Survival analyses and estimations of future life revealed differences in performance among  ZrO2-based restorations  and lithium disilicate and leucite-reinforced glass-ceramics Compomers , resin-modified glass ionomers , were developed to improve the physical properties and clinical h and ling of glass ionomers . Compomers can be design ed to be light-activated and used as restoratives or liners . This article reports data collected up to 12 months after placement of both compomer restorations and liners and is part of an ongoing study evaluating the performance of this material . Based on this data , the authors conclude that this new generation of light-activated glass-ionomer restoratives provides clinical results comparable to those recorded for composite resins at 12 months AIM It is the aim of this paper to consider the factors associated with the need for re-intervention on a crown , and the times to re-intervention . METHODS A data set was established consisting of patients , 18 years or older , whose birthdays were included within a set of a r and omly selected date s , one of which was chosen in each possible year of birth and whose restoration records contained the placement of one or more indirect restorations on courses of treatment with last date on the cl aim form after 31st December 1990 , and with date of acceptance after September 1990 and before January 2002 . For each tooth treated with a crown , the subsequent history of intervention on that tooth was consulted , and the next date of intervention , if any could be found in the extended data set , was obtained . Thus , a data set was created of crowns which have been placed , with their date s of placement and their date s , if any , of re-intervention . RESULTS Data for over 80,000 different adult patients were analysed , of whom 46 % were male and 54 % female . A 
    Output:
    
agent
An association between the kind of complications and different types of restorations could not be established .
Nevertheless , a relatively high failure rate due to caries and ceramic fractures was noted
***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 clinical ly evaluate an all-ceramic restorative system ( Finesse All-Ceramic ) when used in conjunction with an ultra-low fusing porcelain ( Finesse ) using bonded esthetic resin cements ( Enforce & Calibra ) . METHODS This report describes the 3-year results of a prospect i ve , consecutive case clinical evaluation for Finesse All-Ceramic .  Forty posterior and anterior crowns , 20 all ceramic inlays and onlays , and 26 veneers were placed in 43 patients at the initiation of this study .  St and ard ceramic preparations were performed followed by conventional polyvinylsiloxane ( Aquasil ) impression techniques using cord retraction . The bonded resin cement was used to place the restorations following manufacturer 's instructions . RESULTS A majority of restorations ( 95 - 100 % ) were evaluated to be optimal at baseline ( B ) , 1 month , 12 , 24 and 36 months using a modified Ryge criteria for the following categories : color match , marginal adaptation , porcelain staining , secondary caries , postoperative sensitivity , and retention . Assessment of color match at 36 months result ed in 97 % of all crowns and 100 % of all veneers and onlays being rated alfa for shade match to Vita Lumin shade guide . The overall 3-year success rate at the 3-year recall ( inlay/onlays , crowns , and veneers ) was 98.57 % , with the success rate for crowns and veneers at this time period being 100 % OBJECTIVES The purpose of this study was to investigate the durability of extensive dentin-enamel-bonded posterior ceramic coverages  in a 15 years follow-up . METHODS All extensive dentin-enamel-bonded posterior partial and complete all-ceramic coverages placed during the period November 1992-December 1998 were included . In 121 patients , 252 coverages ( IPS Empress ) were placed . The adhesive bonding to dentin and enamel was performed with three 3-step and one 2-step etch and rinse bonding . In 106 restorations the classic Syntac was used in combination with the dual-cured resin composite Variolink . The other restorations were luted with the chemically cured resin composite Bisfil 2B and bonded with 3-step etch and rinse systems , classic Gluma ( 37 ) , Allbond 2 ( 57 ) , Syntac ( 32 ) or the 2-step etch and rinse system , One step ( 20 ) . The ceramics were evaluated yearly by modified USPHS criteria during 15 years . RESULTS Postoperative sensitivity was registered in 4 patients during bite forces lasting for 2 - 4 weeks . Fifty-five of 228 coverages ( 24.1 % ) failed . The mean observation period of the acceptable coverages was 12.6 years ( range 11 - 15 years ) . The main reasons for failure were lost restorations ( 18 ) , ceramic fracture ( 16 ) , and secondary caries ( 11 ) . Significant differences in failure rate were observed between the dentin bonding agents but not between the two luting agents . Ceramic  coverages placed on non-vital teeth failed in 39 % and on vital teeth in 20.9 % ( p=0.014 ) . Logistic regression indicated three significant predictors for failure of the coverages : gender and parafunctional habits of the patient and non-vitality of the tooth . SIGNIFICANCE The technique investigated showed advantages like less destruction of healthy tissue , and avoiding of endodontic treatment and /or deep cervical placement of restoration margins to obtain retention The aim of this r and omized controlled clinical trial was to compare the early clinical outcome of slip-cast glass-infiltrated Alumina/Zirconia and CAD/CAM Zirconia all-ceramic crowns .  A total of 30 InCeram ® Zirconia and Cercon ® Zirconia crowns were fabricated and cemented with a glass ionomer cement in 20 patients . At baseline , 6-month , 1-year , and 2-year recall appointments , Californian Dental Association ( CDA ) quality evaluation system was used to evaluate the prosthetic replacements , and plaque and gingival index scores were used to explore the periodontal outcome of the treatments . No clinical sign of marginal discoloration , persistent pain and secondary caries was detected in any of the restorations . All InCeram ® Zirconia crowns  survived during the 2-year period , although one nonvital tooth experienced root fracture coupled with the fracture of the veneering porcelain of the restoration . One Cercon ® Zirconia restoration fractured and was replaced . According to the CDA criteria , marginal integrity was rated excellent for InCeram ® Zirconia ( 73 % ) and Cercon ® Zirconia ( 80 % ) restorations , respectively . Slight color mismatch rate was higher for InCeram ® Zirconia restorations ( 66 % ) than Cercon ® Zirconia ( 26 % ) restorations . Plaque and gingival index scores were mostly zero and almost constant over time . Time-dependent changes in plaque and gingival index scores within and between groups were statistically similar ( p>0.05 ) . This clinical study demonstrates that single-tooth InCeram ® Zirconia and Cercon ® Zirconia crowns have comparable early clinical outcome , both seem as acceptable treatment modalities , and most importantly , all-ceramic alumina crowns strengthened by 25 % zirconia can sufficiently withst and functional load in the posterior zone OBJECTIVES The literature demonstrates that conventional luting of metal-based restorations using zinc phosphate cements is clinical ly successful over 20 years . This study compared the clinical outcomes of metal-based fixed partial dentures luted conventionally with zinc phosphate and self-adhesive resin cement . METHODS Forty-nine patients ( mean age 54+/-13 years ) received 49 metal-based fixed partial dentures r and omly luted using zinc phosphate ( Richter & Hoffmann , Berlin , Germany ) or self-adhesive resin cement ( RelyX Unicem Aplicap , 3 M ESPE , Germany ) at the University Medical Center Regensburg . The core build-up material was highly viscous glass ionomer ; the finishing line was in dentin . The study included 42 posterior , 5 anterior crowns and two onlays . Forty-seven restorations were made of precious alloys , 2 of non-precious alloys . The restorations were clinical ly examined every year . The clinical performance was checked for plaque ( 0 - 5 ; PI , Quigley-Hein ) , bleeding ( 0 - 4 ; PBI ; Mühlemann ) and attachment scores . The examination included pulp vitality and percussion tests . STATISTICS Means of scores , st and ard deviation , cumulative survival and complication rates were calculated using life tables . RESULTS The mean observation time was 3.16+/-0.6 years ( min : 2.0 ; max : 4.5 years ) . During that time no restoration was lost , no recementation became necessary . One endodontic treatment was performed in the self-adhesive composite group after 2.9 years . At study end bleeding ( 1.44 RelyX Unicem vs. 1.25 zinc phosphate ) and plaque ( 1.64 RelyX Unicem vs. 1.0 zinc phosphate ) scores showed no statistically significant difference . SIGNIFICANCE The self-adhesive resin cement performed clinical ly as well and can be used as easily as zinc phosphate cement to retain metal-based restorations over a 38-month observation period STATEMENT OF PROBLEM Few long-term clinical studies have reported data of modern posterior composites as direct and indirect restorations . PURPOSE This prospect i ve , long-term clinical trial ( 1 ) evaluated direct and indirect composite restorations for clinical acceptability as posterior restoratives in single or multisurface carious teeth and ( 2 ) provided a survey on the 2-year results . MATERIAL AND METHODS Nine dental students placed 88 composite restorations ( Tetric , blend-a-lux , Pertac-Hybrid Unifil ) , 43 direct composite restorations and 45 indirect inlays , under the supervision of an experienced dentist . The first clinical evaluation was performed 11 to 13 months after placement by 2 other experienced dentists , using modified USPHS criteria . A second follow-up of 60 restorations took place within 20 to 26 months after placement . RESULTS A total of 93 % of indirect and 90 % of direct composite restorations were assessed to be clinical ly excellent or acceptable . Two restorations ( 1 indirect composite inlay and 1 margin of a direct composite restoration )  failed during the second year because of fracture . Indirect inlays demonstrated a significantly better " anatomic form of the surface " than direct composite restorations . Premolars revealed a significantly better margin integrity and postoperative symptoms than molars . CONCLUSION Posterior composite restorations provided a satisfactory clinical performance over a 2-year period when placed by relatively inexperienced but supervised students BACKGROUND Adhesively luted all-ceramic restorations preserve and stabilize weakened tooth structure , but there is little published information about the clinical performance of large , all-ceramic restorations . METHODS In this pilot study , the authors placed 58 large , single-tooth , all-ceramic restorations in 26 patients using a computer-aided design /computer-aided manufacturing , or CAD/CAM , system ( CEREC 2 , Sirona Dental Systems GmbH , Bensheim , Germany ) . They documented the maximum height of the restoration and remaining cementoenamel junction , or CEJ . In 21 cases , rubber dam isolation was not possible during adhesive luting . They re-evaluated the restorations after three years according to the U.S. Public Health Service criteria . RESULTS After three years , the authors rated 56 ( 97 percent ) of the 58 restorations as Bravo or better in regard to marginal integrity , secondary caries ( four could not be rated ) , discoloration and anatomical form . One restoration was rated as Charlie because of poor marginal integrity , and one restoration had to be replaced owing to a bulk fracture . The authors rated the adequacy of proximal contact and occlusal relationships as acceptable-to-good for all restorations . Neither the extent of the remaining enamel at the cavity margin nor application of a rubber dam had any statistically significant influence ( chi2 test , P > .05 ) on the clinical performance of the restorations after three years . CONCLUSIONS At the three-year recall appointment , the authors found that the adhesively luted all-ceramic restorations had successfully repaired large coronal defects , irrespective of the cavity margin location ( that is , coronal or apical to the CEJ ) . CLINICAL IMPLICATION S Tooth-colored , all-ceramic CAD/CAM-generated restorations are an alternative to conventional restorations if large coronal defects need to be treated The gathering of clinical data on fractures of dental restorations through prospect i ve clinical trials is a labor- and time-consuming enterprise . Here , we propose an unconventional approach for collecting large data sets , from which clinical information on indirect restorations can be retrospectively analyzed . The authors accessed the data base of an industry-scale machining center in Germany and obtained information on 34,911 computer-aided design (CAD)/computer-aided manufacturing ( CAM ) all-ceramic posterior restorations . The fractures of bridges , crowns , onlays , and inlays fabricated from different all-ceramic systems over a period of 3.5 y were reported by dentists and entered in the data base . Survival analyses and estimations of future life revealed differences in performance among  ZrO2-based restorations  and lithium disilicate and leucite-reinforced glass-ceramics Compomers , resin-modified glass ionomers , were developed to improve the physical properties and clinical h and ling of glass ionomers . Compomers can be design ed to be light-activated and used as restoratives or liners . This article reports data collected up to 12 months after placement of both compomer restorations and liners and is part of an ongoing study evaluating the performance of this material . Based on this data , the authors conclude that this new generation of light-activated glass-ionomer restoratives provides clinical results comparable to those recorded for composite resins at 12 months AIM It is the aim of this paper to consider the factors associated with the need for re-intervention on a crown , and the times to re-intervention . METHODS A data set was established consisting of patients , 18 years or older , whose birthdays were included within a set of a r and omly selected date s , one of which was chosen in each possible year of birth and whose restoration records contained the placement of one or more indirect restorations on courses of treatment with last date on the cl aim form after 31st December 1990 , and with date of acceptance after September 1990 and before January 2002 . For each tooth treated with a crown , the subsequent history of intervention on that tooth was consulted , and the next date of intervention , if any could be found in the extended data set , was obtained . Thus , a data set was created of crowns which have been placed , with their date s of placement and their date s , if any , of re-intervention . RESULTS Data for over 80,000 different adult patients were analysed , of whom 46 % were male and 54 % female . A 
    Output:
    