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: The purpose of the present study is to evaluate smear layer generation and residual debris after using self-adjusting file ( SAF ) or rotary instrumentation and to compare the debris and smear layer removal efficacy of the SAF cleaning/shaping irrigation system against final agitation techniques . One hundred and eight maxillary lateral incisor teeth were r and omly divided into nine experimental groups ( n = 12 ) , and root canals were prepared using ProTaper Universal rotary files , with the exception of the SAF instrumentation group . During instrumentation , root canals were irrigated with a total of 16 mL of 5 % NaOCl . For final irrigation , rotary-instrumented groups were irrigated with 10 mL of 17 % EDTA and 10 mL of 5 % NaOCl using different irrigation agitation regimens ( syringe irrigation with needles , NaviTip FX , manual dynamic irrigation , CanalBrush , EndoActivator , EndoVac , passive ultrasonic irrigation ( PUI ) , and SAF irrigation ) . In the SAF instrumentation group , root canals were instrumented for 4 min at a rate of 4 mL/min with 5 % NaOCl and received a final flush with same as syringe irrigation with needles . The surface of the root dentin was observed using a scanning electron microscope . The SAF instrumentation group generated less smear layer and yielded cleaner canals compared to rotary instrumentation . The EndoActivator , EndoVac , PUI , and SAF irrigation groups increased the efficacy of irrigating solutions on the smear layer and debris removal . The SAF instrumentation yielded cleaner canal walls when compared to rotary instrumentation . None of the techniques completely removed the smear layer from the root canal walls AIM To compare the smear layer and debris removal effectiveness of four root canal irrigation protocol s as well as their effectiveness in removing remaining soft tissues in curved root canals . METHODOLOGY The mesiobuccal and mesial root canals of 107 extracted human maxillary and m and ibular molars were instrumented using Mtwo rotary NiTi instruments then r and omly divided into four groups according to a final rinse protocol : Group 1 ( n = 28 ) - manual agitation of 1 % NaOCl and 15 % EDTA ; Group 2 ( n = 26 ) - CanalBrush agitation of 1 % NaOCl and 15 % EDTA ; Group 3 ( n = 26 ) - 3 % H(2 ) O(2 ) alternated with 1 % NaOCl ; Group 4 ( n = 27 ) - passive ultrasonic agitation of 1 % NaOCl and 15 % EDTA . All irrigation protocol s were performed in a closed system . Eleven roots per group were prepared and histologically stained ( H&E ) to assess percentage of remaining pulpal tissues in the apical thirds . The remaining specimens were split longitudinally and examined under scanning electron microscope at ×2000 magnification to assess smear layer and debris removal . Image Pro Plus 6.0 software was used to analyse smear layer and remaining pulp tissue . Debris presence was scored by two blinded investigators using a five-point scale . Data were analysed using Univariate analysis of variance ( GenStat 13 , α = 0.05 ) . RESULTS CanalBrush and passive ultrasonic irrigation were equally effective with significantly less smear layer and debris than manual agitation and H(2 ) O(2 ) alternated with NaOCl ( P < 0.05 ) . The H(2 ) O(2 ) alternated with NaOCl protocol was significantly more effective in removing pulp tissue remnants in the apical level than manual agitation ( P = 0.009 ) and passive ultrasonic irrigation ( P = 0.01 ) . CONCLUSIONS CanalBrush was as effective as passive ultrasonic irrigation in smear layer and debris removal . Alternating H(2 ) O(2 ) with NaOCl was effective in removing soft tissues from root canal complexities . Further studies are required to evaluate effectiveness of this regimen taking into account irrigant volume differences and effect of root canal system configuration AIM To compare the effect of passive ultrasonic irrigation with manual dynamic irrigation on smear layer removal from root canals using a closed apex in vitro model . METHODS The root canals of 45 freshly-extracted human single-rooted m and ibular premolar teeth were prepared by the Pro-Taper rotary system to an apical preparation of F4 size . Prepared teeth were r and omly divided into three groups ; two experimental groups and one control group ( n = 15 ) on the basis of the type of activation of final irrigation as follows : ( a ) Group A , 3 % sodium hypochlorite ( NaOCl ) and 17 % ethylenediaminetetraacetic acid ( EDTA ) , no activation received ; ( b ) Group B , 3 % NaOCl and 17 % EDTA , ultrasonic activation with a small file ; and ( c ) Group C , 3 % NaOCl and 17 % EDTA , manual activation with a master gutta-percha point . The prepared teeth were decoronated and split into two halves longitudinally , and observed under a scanning electron microscope to assess the removal of the smear layer . RESULTS In the apical-third region , the mean smear scores for groups B and C were significantly less than those of Group A ( control group ) ( P < 0.05 ) . CONCLUSION Both activation techniques are important adjuncts in removing the smear layer , with manual dynamic activation being a simpler , safer , and more cost-effective technique INTRODUCTION The aim of this study was to compare the outcome of a root canal treatment with and without additional ultrasonic activation of the irrigant . METHODS Single-rooted teeth with radiographic evidence of periapical bone loss were r and omly assigned to 2 treatment groups . In both groups syringe irrigation was performed , and in one group the irrigant was also activated by ultrasound . Ten to 19 months after treatment , the teeth were examined by using periapical radiography ( PA ) and cone-beam computed tomography ( CBCT ) . Area and volume of the periapical lesions were measured , and the outcome was presented in 4 categories : absence , reduction or enlargement of the radiolucency , or uncertain . Lesions were classified as reduced or enlarged when the change in size of the radiolucency was 20 % or more . RESULTS The recall rate was 82 % , and 84 teeth were analyzed . CBCT detected significantly more post-treatment lesions than PA ( P = .038 ) , but the percentages of absence and reduction of the radiolucency together revealed by CBCT and PA were similar ( P = .383 ) . The CBCT results showed that absence of the radiolucency was observed in 16 of 84 teeth ( 19 % ) and reduction of the radiolucency in 61 of 84 teeth ( 72.6 % ) , but there was no significant difference between the results of the 2 groups ( P = .470 ) . Absence and reduction of the radiolucency together were observed in the ultrasonic group in 39 of 41 teeth ( 95.1 % ) and in the syringe group in 38 of 43 teeth ( 88.4 % ) . CONCLUSIONS Root canal treatments with and without additional ultrasonic activation of the irrigant contributed equally to periapical healing Background Root canal irrigation carries a risk of extrusion of irrigant into the periapical tissues which can be associated with pain , swelling , and tissue damage . Studies have shown less extrusion with sonic or apical negative pressure devices compared with syringe and side-port needle or passive ultrasonic irrigation with continuous irrigant flow . This study aim ed to evaluate the effectiveness of the EndoVac irrigation system , regarding 1 ) debris removal and 2 ) the control of apically extruded irrigating solution . Methods Fifty extracted human single-rooted teeth were used in this study . The teeth were then r and omly divided into three experimental groups according to the type of irrigation used and one control group . In group 1 , irrigation was performed using the EndoVac irrigation system . In group 2 , irrigation was performed using a 30-gauge , tip-vented irrigation needle . In group 3 , irrigation was performed using a 30-gauge , side-vented irrigation needle . The control group received instrumentation with no irrigation to serve as a control for cleaning efficiency . Root canal instrumentation was performed using the Profile NiTi rotary system with a crown-down technique . All of the experimental teeth were irrigated with the same amount of 5.25 % sodium hypochlorite . The amount of extruded irrigating solution was then measured by subtracting the post-instrumentation weight from the pre-instrumentation weight using an electronic balance . The cleanliness of debris removal was evaluated using scanning electron microscopy . Results EndoVac irrigation had the least amount of extrusion followed by the side-vented and tip-vented method . The difference between the groups was statistically significant ( P < 0.01 ) . As for the cleaning results , the debris collection in the EndoVac and tip-vented groups was the least in the apical third . In the control and the side-vented groups , the debris was the greatest in the apical third , but this difference was not significant among the three experimental groups . Conclusions The EndoVac irrigation system extruded significantly less irrigant solution than either needle irrigation system . Debris collection was the least in the apical third for the EndoVac irrigation system . No significant difference was found in the cleaning efficiency among the three irrigation systems Background Efforts to improve the efficacy of smear layer removal by applying irrigant activation at the final irrigation or by elevating the temperature of the irrigant have been reported . However , the combination of such activation protocol s with 60 ° C 3 % sodium hypochlorite ( NaOCl ) has seldom been mentioned . The aim of this study was to compare the efficacy in smear layer removal of four different irrigation techniques combined with 60 ° C 3 % NaOCl and 17 % EDTA . Methods Fifty single-rooted teeth were r and omly divided into five groups ( n = 10 ) according to the irrigant agitation protocol s used during chemomechanical preparation(Dentsply Maillefer , Ballaigues , Switzerl and ): a side-vented needle group , a ultrasonic irrigation ( UI ) group , a NaviTip FX group , an EndoActivator group , and a control group ( no agitation ) . After each instrumentation , the root canals were irrigated with 1 mL of 3 % NaOCl at 60 ° C for 1 minute , and after the whole instrumentation , the root canals were rinsed with 1 mL of 17 % EDTA for 1 minute . Both NaOCl and EDTA were activated with one of the five irrigation protocol s. The efficacy of smear layer removal was scored at the apical , middle and coronal thirds . The Data were statistically analyzed using SAS version 9.2 for Windows ( rank sum test for a r and omised block design and ANOVA ) . Results No significant differences among the NaviTip FX group , EndoActivator group and control groups , and each of these groups showed a lower score than that of UI group ( P < 0.05 ) . Within each group , all three thirds were ranked in the following order : coronal > middle > apical ( P < 0.05 ) . In the coronal third , the NaviTip FX group was better than UI group . In the middle and apical third , the differences were not significant among any of the groups . Conclusions Even without any activation , the combination of 60 ° C 3 % NaOCl and 17 % EDTA  could remove the smear layer effectively , similar to NaviTip FX or EndoActivator , and these three protocol s were more effective than UI . However , regardless of different types of irrigation technique applied , complete removal of the smear layer was not achieved , particularly in the apical third AIM To compare the cleaning effectiveness of chamomile hydroalcoholic extract and tea tree oil to 2.5 % sodium hypochlorite ( NaOCl ) solution as an intracanal irrigant for the removal of the smear layer . METHODOLOGY Forty extracted , single-rooted , mature , permanent , human teeth were allocated at r and om into one of three experimental groups of ten teeth and two control groups of five teeth . For each tooth , the pulp chamber was accessed and the canal prepared using K-type files and Gates-Glidden burs , using a step-back technique ; the apical stop was prepared to a size 30 . Each canal was subsequently irrigated with one of the following solutions : distilled water ( as a negative control ) , 2.5 % NaOCl + 17 % ethylenediamine tetraacetic acid ( EDTA ) ( as a positive control ) , chamomile or tea tree oil or 2.5 % NaOCl . Each tooth was split longitudinally and prepared for examination by scanning electron microscopy ( SEM ) . The quantity of smear layer remaining on the three levels of each canal ( coronal , middle and apical ) was examined using magnifications of 2000 and 5000x . The data were analysed using nonparametric Kruskal-Wallis and Mann-Whitney U-tests . RESULTS The most effective removal of smear layer occurred with the use of NaOCl with a final rinse of 17 % EDTA ( negative control ) followed by the use of a chamomile extract . Chamomile extract was found to be significantly more effective than distilled water and tea tree oil ( P < 0.008 ) . The use of a 2.5 % NaOCl solution alone , without EDTA and that of tea tree oil , was found to have only minor effects . There was no statistical difference between distilled water , 2.5 % NaOCl and tea tree oil . CONCLUSIONS The efficacy of chamomile to remove smear layer was superior to NaOCl alone but less than NaOCl combined 
    Output:
    
agent
IATs improve intracanal cleanliness across a substantial portion of the canal , and therefore , their use is recommended throughout root canal preparation .
***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: The purpose of the present study is to evaluate smear layer generation and residual debris after using self-adjusting file ( SAF ) or rotary instrumentation and to compare the debris and smear layer removal efficacy of the SAF cleaning/shaping irrigation system against final agitation techniques . One hundred and eight maxillary lateral incisor teeth were r and omly divided into nine experimental groups ( n = 12 ) , and root canals were prepared using ProTaper Universal rotary files , with the exception of the SAF instrumentation group . During instrumentation , root canals were irrigated with a total of 16 mL of 5 % NaOCl . For final irrigation , rotary-instrumented groups were irrigated with 10 mL of 17 % EDTA and 10 mL of 5 % NaOCl using different irrigation agitation regimens ( syringe irrigation with needles , NaviTip FX , manual dynamic irrigation , CanalBrush , EndoActivator , EndoVac , passive ultrasonic irrigation ( PUI ) , and SAF irrigation ) . In the SAF instrumentation group , root canals were instrumented for 4 min at a rate of 4 mL/min with 5 % NaOCl and received a final flush with same as syringe irrigation with needles . The surface of the root dentin was observed using a scanning electron microscope . The SAF instrumentation group generated less smear layer and yielded cleaner canals compared to rotary instrumentation . The EndoActivator , EndoVac , PUI , and SAF irrigation groups increased the efficacy of irrigating solutions on the smear layer and debris removal . The SAF instrumentation yielded cleaner canal walls when compared to rotary instrumentation . None of the techniques completely removed the smear layer from the root canal walls AIM To compare the smear layer and debris removal effectiveness of four root canal irrigation protocol s as well as their effectiveness in removing remaining soft tissues in curved root canals . METHODOLOGY The mesiobuccal and mesial root canals of 107 extracted human maxillary and m and ibular molars were instrumented using Mtwo rotary NiTi instruments then r and omly divided into four groups according to a final rinse protocol : Group 1 ( n = 28 ) - manual agitation of 1 % NaOCl and 15 % EDTA ; Group 2 ( n = 26 ) - CanalBrush agitation of 1 % NaOCl and 15 % EDTA ; Group 3 ( n = 26 ) - 3 % H(2 ) O(2 ) alternated with 1 % NaOCl ; Group 4 ( n = 27 ) - passive ultrasonic agitation of 1 % NaOCl and 15 % EDTA . All irrigation protocol s were performed in a closed system . Eleven roots per group were prepared and histologically stained ( H&E ) to assess percentage of remaining pulpal tissues in the apical thirds . The remaining specimens were split longitudinally and examined under scanning electron microscope at ×2000 magnification to assess smear layer and debris removal . Image Pro Plus 6.0 software was used to analyse smear layer and remaining pulp tissue . Debris presence was scored by two blinded investigators using a five-point scale . Data were analysed using Univariate analysis of variance ( GenStat 13 , α = 0.05 ) . RESULTS CanalBrush and passive ultrasonic irrigation were equally effective with significantly less smear layer and debris than manual agitation and H(2 ) O(2 ) alternated with NaOCl ( P < 0.05 ) . The H(2 ) O(2 ) alternated with NaOCl protocol was significantly more effective in removing pulp tissue remnants in the apical level than manual agitation ( P = 0.009 ) and passive ultrasonic irrigation ( P = 0.01 ) . CONCLUSIONS CanalBrush was as effective as passive ultrasonic irrigation in smear layer and debris removal . Alternating H(2 ) O(2 ) with NaOCl was effective in removing soft tissues from root canal complexities . Further studies are required to evaluate effectiveness of this regimen taking into account irrigant volume differences and effect of root canal system configuration AIM To compare the effect of passive ultrasonic irrigation with manual dynamic irrigation on smear layer removal from root canals using a closed apex in vitro model . METHODS The root canals of 45 freshly-extracted human single-rooted m and ibular premolar teeth were prepared by the Pro-Taper rotary system to an apical preparation of F4 size . Prepared teeth were r and omly divided into three groups ; two experimental groups and one control group ( n = 15 ) on the basis of the type of activation of final irrigation as follows : ( a ) Group A , 3 % sodium hypochlorite ( NaOCl ) and 17 % ethylenediaminetetraacetic acid ( EDTA ) , no activation received ; ( b ) Group B , 3 % NaOCl and 17 % EDTA , ultrasonic activation with a small file ; and ( c ) Group C , 3 % NaOCl and 17 % EDTA , manual activation with a master gutta-percha point . The prepared teeth were decoronated and split into two halves longitudinally , and observed under a scanning electron microscope to assess the removal of the smear layer . RESULTS In the apical-third region , the mean smear scores for groups B and C were significantly less than those of Group A ( control group ) ( P < 0.05 ) . CONCLUSION Both activation techniques are important adjuncts in removing the smear layer , with manual dynamic activation being a simpler , safer , and more cost-effective technique INTRODUCTION The aim of this study was to compare the outcome of a root canal treatment with and without additional ultrasonic activation of the irrigant . METHODS Single-rooted teeth with radiographic evidence of periapical bone loss were r and omly assigned to 2 treatment groups . In both groups syringe irrigation was performed , and in one group the irrigant was also activated by ultrasound . Ten to 19 months after treatment , the teeth were examined by using periapical radiography ( PA ) and cone-beam computed tomography ( CBCT ) . Area and volume of the periapical lesions were measured , and the outcome was presented in 4 categories : absence , reduction or enlargement of the radiolucency , or uncertain . Lesions were classified as reduced or enlarged when the change in size of the radiolucency was 20 % or more . RESULTS The recall rate was 82 % , and 84 teeth were analyzed . CBCT detected significantly more post-treatment lesions than PA ( P = .038 ) , but the percentages of absence and reduction of the radiolucency together revealed by CBCT and PA were similar ( P = .383 ) . The CBCT results showed that absence of the radiolucency was observed in 16 of 84 teeth ( 19 % ) and reduction of the radiolucency in 61 of 84 teeth ( 72.6 % ) , but there was no significant difference between the results of the 2 groups ( P = .470 ) . Absence and reduction of the radiolucency together were observed in the ultrasonic group in 39 of 41 teeth ( 95.1 % ) and in the syringe group in 38 of 43 teeth ( 88.4 % ) . CONCLUSIONS Root canal treatments with and without additional ultrasonic activation of the irrigant contributed equally to periapical healing Background Root canal irrigation carries a risk of extrusion of irrigant into the periapical tissues which can be associated with pain , swelling , and tissue damage . Studies have shown less extrusion with sonic or apical negative pressure devices compared with syringe and side-port needle or passive ultrasonic irrigation with continuous irrigant flow . This study aim ed to evaluate the effectiveness of the EndoVac irrigation system , regarding 1 ) debris removal and 2 ) the control of apically extruded irrigating solution . Methods Fifty extracted human single-rooted teeth were used in this study . The teeth were then r and omly divided into three experimental groups according to the type of irrigation used and one control group . In group 1 , irrigation was performed using the EndoVac irrigation system . In group 2 , irrigation was performed using a 30-gauge , tip-vented irrigation needle . In group 3 , irrigation was performed using a 30-gauge , side-vented irrigation needle . The control group received instrumentation with no irrigation to serve as a control for cleaning efficiency . Root canal instrumentation was performed using the Profile NiTi rotary system with a crown-down technique . All of the experimental teeth were irrigated with the same amount of 5.25 % sodium hypochlorite . The amount of extruded irrigating solution was then measured by subtracting the post-instrumentation weight from the pre-instrumentation weight using an electronic balance . The cleanliness of debris removal was evaluated using scanning electron microscopy . Results EndoVac irrigation had the least amount of extrusion followed by the side-vented and tip-vented method . The difference between the groups was statistically significant ( P < 0.01 ) . As for the cleaning results , the debris collection in the EndoVac and tip-vented groups was the least in the apical third . In the control and the side-vented groups , the debris was the greatest in the apical third , but this difference was not significant among the three experimental groups . Conclusions The EndoVac irrigation system extruded significantly less irrigant solution than either needle irrigation system . Debris collection was the least in the apical third for the EndoVac irrigation system . No significant difference was found in the cleaning efficiency among the three irrigation systems Background Efforts to improve the efficacy of smear layer removal by applying irrigant activation at the final irrigation or by elevating the temperature of the irrigant have been reported . However , the combination of such activation protocol s with 60 ° C 3 % sodium hypochlorite ( NaOCl ) has seldom been mentioned . The aim of this study was to compare the efficacy in smear layer removal of four different irrigation techniques combined with 60 ° C 3 % NaOCl and 17 % EDTA . Methods Fifty single-rooted teeth were r and omly divided into five groups ( n = 10 ) according to the irrigant agitation protocol s used during chemomechanical preparation(Dentsply Maillefer , Ballaigues , Switzerl and ): a side-vented needle group , a ultrasonic irrigation ( UI ) group , a NaviTip FX group , an EndoActivator group , and a control group ( no agitation ) . After each instrumentation , the root canals were irrigated with 1 mL of 3 % NaOCl at 60 ° C for 1 minute , and after the whole instrumentation , the root canals were rinsed with 1 mL of 17 % EDTA for 1 minute . Both NaOCl and EDTA were activated with one of the five irrigation protocol s. The efficacy of smear layer removal was scored at the apical , middle and coronal thirds . The Data were statistically analyzed using SAS version 9.2 for Windows ( rank sum test for a r and omised block design and ANOVA ) . Results No significant differences among the NaviTip FX group , EndoActivator group and control groups , and each of these groups showed a lower score than that of UI group ( P < 0.05 ) . Within each group , all three thirds were ranked in the following order : coronal > middle > apical ( P < 0.05 ) . In the coronal third , the NaviTip FX group was better than UI group . In the middle and apical third , the differences were not significant among any of the groups . Conclusions Even without any activation , the combination of 60 ° C 3 % NaOCl and 17 % EDTA  could remove the smear layer effectively , similar to NaviTip FX or EndoActivator , and these three protocol s were more effective than UI . However , regardless of different types of irrigation technique applied , complete removal of the smear layer was not achieved , particularly in the apical third AIM To compare the cleaning effectiveness of chamomile hydroalcoholic extract and tea tree oil to 2.5 % sodium hypochlorite ( NaOCl ) solution as an intracanal irrigant for the removal of the smear layer . METHODOLOGY Forty extracted , single-rooted , mature , permanent , human teeth were allocated at r and om into one of three experimental groups of ten teeth and two control groups of five teeth . For each tooth , the pulp chamber was accessed and the canal prepared using K-type files and Gates-Glidden burs , using a step-back technique ; the apical stop was prepared to a size 30 . Each canal was subsequently irrigated with one of the following solutions : distilled water ( as a negative control ) , 2.5 % NaOCl + 17 % ethylenediamine tetraacetic acid ( EDTA ) ( as a positive control ) , chamomile or tea tree oil or 2.5 % NaOCl . Each tooth was split longitudinally and prepared for examination by scanning electron microscopy ( SEM ) . The quantity of smear layer remaining on the three levels of each canal ( coronal , middle and apical ) was examined using magnifications of 2000 and 5000x . The data were analysed using nonparametric Kruskal-Wallis and Mann-Whitney U-tests . RESULTS The most effective removal of smear layer occurred with the use of NaOCl with a final rinse of 17 % EDTA ( negative control ) followed by the use of a chamomile extract . Chamomile extract was found to be significantly more effective than distilled water and tea tree oil ( P < 0.008 ) . The use of a 2.5 % NaOCl solution alone , without EDTA and that of tea tree oil , was found to have only minor effects . There was no statistical difference between distilled water , 2.5 % NaOCl and tea tree oil . CONCLUSIONS The efficacy of chamomile to remove smear layer was superior to NaOCl alone but less than NaOCl combined 
    Output:
    