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 Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing . However , the information is mainly based on 1- to 2-year follow-up data . The present prospect i ve study was design ed to re-examine a large sample of teeth treated with apical surgery after 5 years . METHODS Patients were recalled 5 years after apical surgery , and treated teeth were classified as healed or not healed based on clinical and radiographic examination . ( The latter was performed independently by 3 observers ) . Two different methods of root-end preparation and filling ( primary study parameters ) were to be compared ( mineral trioxide aggregate [ MTA ] vs adhesive resin composite [ COMP ] ) without r and omization . RESULTS A total of 271 patients and teeth from a 1-year follow-up sample of 339 could be re-examined after 5 years ( dropout rate = 20.1 % ) . The overall rate of healed cases was 84.5 % with a significant difference ( P = .0003 ) when comparing MTA ( 92.5 % ) and COMP ( 76.6 % ) . The evaluation of secondary study parameters yielded no significant difference for healing outcome when comparing subcategories ( ie , sex , age , type of tooth treated , post/screw , type of surgery ) . CONCLUSIONS The results from this prospect i ve nonr and omized clinical study with a 5-year follow-up of 271 teeth indicate that MTA exhibited a higher healing rate than COMP in the longitudinal prognosis of root-end sealing OBJECTIVE R and omized clinical prospect i ve study to evaluate the application of MTA and IRM as retro grade sealers in surgical endodontics . STUDY DESIGN One hundred single-rooted teeth were surgically treated . After r and omization , MTA or IRM was used as a retrosealer . Radiographs were taken 1 week , 3 months , and 1 year postoperatively . Assessment was performed by 2 independent assessors 1 year after surgery . Both treatment groups were homogeneous in their composition , and clinical features and radiographic findings were classified according to Rud 's classification . RESULTS Complete healing was observed in 64 % of the MTA-treated teeth vs 50 % of the IRM-treated teeth . Incomplete healing was seen in 28 % ( MTA ) vs 36 % ( IRM ) , and unsatisfactory in 6 % ( MTA ) vs 14 % ( IRM ) . Only 1 failure was seen ( MTA ) . No statistically significant differences were found between the 2 retrofilling material s. CONCLUSION As root-end filling material s in this clinical prospect i ve r and omized design on single rooted teeth , MTA and IRM had the same clinical effectiveness INTRODUCTION This prospect i ve study examined the potential prognostic factors of endodontic microsurgery and compared the predictors of an isolated endodontic lesion with those of both an isolated endodontic lesion and an endodontic-periodontal lesion . METHODS Data were collected from the Microscope Center of the Department of Conservative Dentistry at the Dental College of Yonsei University , Seoul , Korea , between March 2001 and March 2011 . A total number of 584 teeth were included , and all clinical procedures were performed by a single operator ( E.K. ) . The evaluation was performed at least 1 year after surgery . For statistical analysis of the predisposing factors , the chi-square test and logistic regression were performed . RESULTS Of the 584 cases treated , 431 cases came for recall after a period of at least 12 months . Sex ( female ) , tooth position ( anterior ) , arch type ( maxilla ) , and lesion type ( isolated endodontic lesion ) were found to have a positive effect on surgical outcome . With regards to isolated endodontic lesions , the tooth position ( anterior ) , arch type ( maxilla ) , and type of restoration ( single/splinted crown , short bridge , and removable partial denture abutment ) were found to be pure positive predictors . CONCLUSIONS In endodontic microsurgery , it is likely that preoperative factors , particularly the tooth position and arch type , have a greater influence on the healing outcome than intra- and post-operative factors The two objectives of the present study were : to assess the healing after periradicular surgery  using the Periotest device , and to compare the recorded Periotest values with the healing category determined after a one-year follow-up using radiographic and clinical criteria . In 43 patients with periradicular surgery ,  Periotest values  could be recorded pre- and postoperatively , as well as after six and twelve months . Cases with a successful healing , as determined at the one-year follow-up , demonstrated a continuous decrease of the Periotest values over time , whereas one-year failures showed increasing Periotest values over the study period . In control teeth , the Periotest values remained unchanged for the whole study period . It appears that the Periotest measurements correlate with the postoperative healing mode following periradicular surgery , and therefore , allow an additional assessment of the healing outcome 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 This clinical study prospect ively evaluated the influence of various predictors on healing outcome 1 year after periapical surgery .  The study cohort included 194 teeth in an equal number of patients . Three teeth were lost for the follow-up ( 1.5 % drop-out rate ) .  Clinical and radiographic measures were used to determine the healing outcome . For statistical analysis , results were dichotomized ( healed versus nonhealed ) . The overall success rate was 83.8 % ( healed cases ) . The only individual predictors to prove significant for the outcome were pain at initial examination ( p=0.030 ) and other clinical signs or symptoms at initial examination ( p=0.042 ) , meaning that such teeth had lower healing rates 1 year after periapical surgery compared with teeth without such signs or symptoms . Logistic regression revealed that pain at initial examination ( odds ratio=2.59 , confidence interval=1.2 - 5.6 , p=0.04 ) was the only predictor reaching significance . Several predictors almost reached statistical significance : lesion size ( p=0.06 ) , retrofilling material ( p=0.06 ) , and postoperative healing course ( p=0.06 ) This prospect i ve clinical study aim ed to evaluate the benefits of the endoscope as an aid to root-end management , and to assess the treatment outcome during 2 years following surgery . Forty-three endodontic surgical procedures in 30 patients were performed with the aid of an endoscope and followed for a period of 2 years . Radiographic criteria and clinical evaluation were used to assess the outcome . All cases were evaluated in terms of healing and functionality . 91.1 % and 90.7 % of the teeth evaluated after 1 and 2 years , respectively , were classified as successful . We found no statistically significant differences for both healing and functionality between the 1- and 2-year evaluations . No difference related to tooth type or tooth location was found at the 2-year follow-up . Fisher 's exact test was used to statistically assess the difference between successful and unsuccessful cases for each of the variables considered . The endoscope can be an aid for endodontic surgical procedures in terms of both periapical healing and functionality up to 2 years follow-up INTRODUCTION The long-term outcome of apical surgery performed on root-filled teeth presenting with post-treatment apical periodontitis has been the subject of debate ; therefore , current evidence is required to support the prognosis of this important procedure . The objectives of this study were ( 1 ) to assess the long-term outcome of apical surgery and ( 2 ) to identify significant outcome predictors in Phases 3 - 5 of the Toronto Study , pooled with the previously reported Phases 1 and 2 . METHODS The 4- to 10-year outcome of apical surgery was prospect ively assessed by a blinded , independent , calibrated examiner and dichotomized as " healed " ( periapical index score < or=2 or scar ; no signs or symptoms ) or " diseased . " Teeth presenting without signs or symptoms were classified as " functional . " Multivariate analysis was performed to investigate outcome predictors , pooling Phases 3 - 5 ( n = 40 ) with Phases 1 and 2 ( n = 94 ) for improved power . RESULTS Of 261 treated teeth in the pooled sample , 96 were lost to follow-up , and 31 were extracted . Of the remaining 134 teeth ( 85 % recall , excluding 66 teeth that could not be recalled ) examined for outcome , 99 teeth ( 74 % ) were healed , and 126 teeth ( 94 % ) were functional . Three significant ( P < .05 ) outcome predictors were identified : age ( odds ratio [ OR ] , 2.5 ; confidence interval [ CI ] , 1.01 - 6.00 ; healed : > 45 years , 84 % , < or=45 years , 68 % ) , preoperative root-filling length ( OR , 3.4 ; CI , 1.34 - 8.76 ; healed : inadequate , 84 % ; adequate , 68 % ) , and size of the surgical crypt ( OR , 1.9 ; CI , 1.19 - 3.16 ; healed : < or=10 mm , 80 % ; > 10 mm , 53 % ) . CONCLUSIONS In this 4- to 10-year cohort study , the outcome was better in subjects > 45 years old , teeth with inadequate root-filling length , and crypt size of < or=10 mm We  did apicectomies  of 30 teeth with periradicular lesions in 23 patients , using a 3 mm endoscope . Two patients failed to attend for postoperative assessment and of the remaining 21 patients who had 28 teeth treated the operation was judged after 1 year to be a success in 26 ( 93 % ) INTRODUCTION The purpose of the present study was to evaluate the clinical outcomes of endodontic microsurgery when super ethoxy-benzoic acid ( Super EBA ; Harry J. Bosworth , Skokie , IL ) and mineral trioxide aggregate ( MTA ) were used as root-end filling material s in a prospect i ve r and omized controlled study . METHODS Of the 388 teeth eligible for endodontic microsurgery , 128 teeth were excluded from the study , and 260 teeth were r and omly assigned to either the Super EBA group or the MTA group with equal numbers using the " minimization method . " Endodontic microsurgical procedures were performed according to the Yonsei protocol reported in a previous study and were carried out by a single operator . The patients were followed up at 3 , 6 , and 12 months . The primary outcome measure was the change in the apical bone density at 12 months , and the secondary outcome measures were the presence of clinical symptoms or abnormal findings at 12 months . RESULTS A total of 192 teeth were examined at the 12-month follow-up ; 102 teeth were in the Super EBA group , and 90 were in the MTA group . The overall success rate was 94.3 % , with a success rate of 95.6 % ( 86/90 teeth ) for MTA and 93.1 % ( 95/102 teeth ) for Super EBA . The statistical analysis of the success rate results did not show any significant difference between the groups ( P = .472 ) . CONCLUSIONS In this prospect i ve r and omized controlled study , there was no significant difference in the clinical outcomes of endodontic microsurgery when Super EBA and MTA were used as root-end filling material Objective : To evaluate the clinical efficacy of polycarboxylate cement as retro grade filling material . Design : A prospect i ve clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes , in which polycar 
    Output:
    
agent
Conclusions : The probability for success for EMS proved to be significantly greater than the probability for success for RES , providing best available evidence on the influence of cavity preparation with ultrasonic tips and /or SuperEBA ( Keystone Industries , Gibbstown , NJ ) , IRM ( Dentsply Sirona , York , PA ) , MTA , or silicate cements as root‐end filling material instead of a shallow cavity preparation and placement of a resin‐based material .
HIGHLIGHTSEndodontic microsurgery ( EMS ) with the use of high‐magnification ultrasonic root‐end preparation and root‐end filling with SuperEBA , IRM , MTA , or other calcium silicate cements has a high probability of success .
Resin‐based endodontic surgery with the use of high‐magnification preparation of a shallow concave root‐end cavity with bonded resin‐based root‐end filling material performed less favorably than EMS
***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 Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing . However , the information is mainly based on 1- to 2-year follow-up data . The present prospect i ve study was design ed to re-examine a large sample of teeth treated with apical surgery after 5 years . METHODS Patients were recalled 5 years after apical surgery , and treated teeth were classified as healed or not healed based on clinical and radiographic examination . ( The latter was performed independently by 3 observers ) . Two different methods of root-end preparation and filling ( primary study parameters ) were to be compared ( mineral trioxide aggregate [ MTA ] vs adhesive resin composite [ COMP ] ) without r and omization . RESULTS A total of 271 patients and teeth from a 1-year follow-up sample of 339 could be re-examined after 5 years ( dropout rate = 20.1 % ) . The overall rate of healed cases was 84.5 % with a significant difference ( P = .0003 ) when comparing MTA ( 92.5 % ) and COMP ( 76.6 % ) . The evaluation of secondary study parameters yielded no significant difference for healing outcome when comparing subcategories ( ie , sex , age , type of tooth treated , post/screw , type of surgery ) . CONCLUSIONS The results from this prospect i ve nonr and omized clinical study with a 5-year follow-up of 271 teeth indicate that MTA exhibited a higher healing rate than COMP in the longitudinal prognosis of root-end sealing OBJECTIVE R and omized clinical prospect i ve study to evaluate the application of MTA and IRM as retro grade sealers in surgical endodontics . STUDY DESIGN One hundred single-rooted teeth were surgically treated . After r and omization , MTA or IRM was used as a retrosealer . Radiographs were taken 1 week , 3 months , and 1 year postoperatively . Assessment was performed by 2 independent assessors 1 year after surgery . Both treatment groups were homogeneous in their composition , and clinical features and radiographic findings were classified according to Rud 's classification . RESULTS Complete healing was observed in 64 % of the MTA-treated teeth vs 50 % of the IRM-treated teeth . Incomplete healing was seen in 28 % ( MTA ) vs 36 % ( IRM ) , and unsatisfactory in 6 % ( MTA ) vs 14 % ( IRM ) . Only 1 failure was seen ( MTA ) . No statistically significant differences were found between the 2 retrofilling material s. CONCLUSION As root-end filling material s in this clinical prospect i ve r and omized design on single rooted teeth , MTA and IRM had the same clinical effectiveness INTRODUCTION This prospect i ve study examined the potential prognostic factors of endodontic microsurgery and compared the predictors of an isolated endodontic lesion with those of both an isolated endodontic lesion and an endodontic-periodontal lesion . METHODS Data were collected from the Microscope Center of the Department of Conservative Dentistry at the Dental College of Yonsei University , Seoul , Korea , between March 2001 and March 2011 . A total number of 584 teeth were included , and all clinical procedures were performed by a single operator ( E.K. ) . The evaluation was performed at least 1 year after surgery . For statistical analysis of the predisposing factors , the chi-square test and logistic regression were performed . RESULTS Of the 584 cases treated , 431 cases came for recall after a period of at least 12 months . Sex ( female ) , tooth position ( anterior ) , arch type ( maxilla ) , and lesion type ( isolated endodontic lesion ) were found to have a positive effect on surgical outcome . With regards to isolated endodontic lesions , the tooth position ( anterior ) , arch type ( maxilla ) , and type of restoration ( single/splinted crown , short bridge , and removable partial denture abutment ) were found to be pure positive predictors . CONCLUSIONS In endodontic microsurgery , it is likely that preoperative factors , particularly the tooth position and arch type , have a greater influence on the healing outcome than intra- and post-operative factors The two objectives of the present study were : to assess the healing after periradicular surgery  using the Periotest device , and to compare the recorded Periotest values with the healing category determined after a one-year follow-up using radiographic and clinical criteria . In 43 patients with periradicular surgery ,  Periotest values  could be recorded pre- and postoperatively , as well as after six and twelve months . Cases with a successful healing , as determined at the one-year follow-up , demonstrated a continuous decrease of the Periotest values over time , whereas one-year failures showed increasing Periotest values over the study period . In control teeth , the Periotest values remained unchanged for the whole study period . It appears that the Periotest measurements correlate with the postoperative healing mode following periradicular surgery , and therefore , allow an additional assessment of the healing outcome 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 This clinical study prospect ively evaluated the influence of various predictors on healing outcome 1 year after periapical surgery .  The study cohort included 194 teeth in an equal number of patients . Three teeth were lost for the follow-up ( 1.5 % drop-out rate ) .  Clinical and radiographic measures were used to determine the healing outcome . For statistical analysis , results were dichotomized ( healed versus nonhealed ) . The overall success rate was 83.8 % ( healed cases ) . The only individual predictors to prove significant for the outcome were pain at initial examination ( p=0.030 ) and other clinical signs or symptoms at initial examination ( p=0.042 ) , meaning that such teeth had lower healing rates 1 year after periapical surgery compared with teeth without such signs or symptoms . Logistic regression revealed that pain at initial examination ( odds ratio=2.59 , confidence interval=1.2 - 5.6 , p=0.04 ) was the only predictor reaching significance . Several predictors almost reached statistical significance : lesion size ( p=0.06 ) , retrofilling material ( p=0.06 ) , and postoperative healing course ( p=0.06 ) This prospect i ve clinical study aim ed to evaluate the benefits of the endoscope as an aid to root-end management , and to assess the treatment outcome during 2 years following surgery . Forty-three endodontic surgical procedures in 30 patients were performed with the aid of an endoscope and followed for a period of 2 years . Radiographic criteria and clinical evaluation were used to assess the outcome . All cases were evaluated in terms of healing and functionality . 91.1 % and 90.7 % of the teeth evaluated after 1 and 2 years , respectively , were classified as successful . We found no statistically significant differences for both healing and functionality between the 1- and 2-year evaluations . No difference related to tooth type or tooth location was found at the 2-year follow-up . Fisher 's exact test was used to statistically assess the difference between successful and unsuccessful cases for each of the variables considered . The endoscope can be an aid for endodontic surgical procedures in terms of both periapical healing and functionality up to 2 years follow-up INTRODUCTION The long-term outcome of apical surgery performed on root-filled teeth presenting with post-treatment apical periodontitis has been the subject of debate ; therefore , current evidence is required to support the prognosis of this important procedure . The objectives of this study were ( 1 ) to assess the long-term outcome of apical surgery and ( 2 ) to identify significant outcome predictors in Phases 3 - 5 of the Toronto Study , pooled with the previously reported Phases 1 and 2 . METHODS The 4- to 10-year outcome of apical surgery was prospect ively assessed by a blinded , independent , calibrated examiner and dichotomized as " healed " ( periapical index score < or=2 or scar ; no signs or symptoms ) or " diseased . " Teeth presenting without signs or symptoms were classified as " functional . " Multivariate analysis was performed to investigate outcome predictors , pooling Phases 3 - 5 ( n = 40 ) with Phases 1 and 2 ( n = 94 ) for improved power . RESULTS Of 261 treated teeth in the pooled sample , 96 were lost to follow-up , and 31 were extracted . Of the remaining 134 teeth ( 85 % recall , excluding 66 teeth that could not be recalled ) examined for outcome , 99 teeth ( 74 % ) were healed , and 126 teeth ( 94 % ) were functional . Three significant ( P < .05 ) outcome predictors were identified : age ( odds ratio [ OR ] , 2.5 ; confidence interval [ CI ] , 1.01 - 6.00 ; healed : > 45 years , 84 % , < or=45 years , 68 % ) , preoperative root-filling length ( OR , 3.4 ; CI , 1.34 - 8.76 ; healed : inadequate , 84 % ; adequate , 68 % ) , and size of the surgical crypt ( OR , 1.9 ; CI , 1.19 - 3.16 ; healed : < or=10 mm , 80 % ; > 10 mm , 53 % ) . CONCLUSIONS In this 4- to 10-year cohort study , the outcome was better in subjects > 45 years old , teeth with inadequate root-filling length , and crypt size of < or=10 mm We  did apicectomies  of 30 teeth with periradicular lesions in 23 patients , using a 3 mm endoscope . Two patients failed to attend for postoperative assessment and of the remaining 21 patients who had 28 teeth treated the operation was judged after 1 year to be a success in 26 ( 93 % ) INTRODUCTION The purpose of the present study was to evaluate the clinical outcomes of endodontic microsurgery when super ethoxy-benzoic acid ( Super EBA ; Harry J. Bosworth , Skokie , IL ) and mineral trioxide aggregate ( MTA ) were used as root-end filling material s in a prospect i ve r and omized controlled study . METHODS Of the 388 teeth eligible for endodontic microsurgery , 128 teeth were excluded from the study , and 260 teeth were r and omly assigned to either the Super EBA group or the MTA group with equal numbers using the " minimization method . " Endodontic microsurgical procedures were performed according to the Yonsei protocol reported in a previous study and were carried out by a single operator . The patients were followed up at 3 , 6 , and 12 months . The primary outcome measure was the change in the apical bone density at 12 months , and the secondary outcome measures were the presence of clinical symptoms or abnormal findings at 12 months . RESULTS A total of 192 teeth were examined at the 12-month follow-up ; 102 teeth were in the Super EBA group , and 90 were in the MTA group . The overall success rate was 94.3 % , with a success rate of 95.6 % ( 86/90 teeth ) for MTA and 93.1 % ( 95/102 teeth ) for Super EBA . The statistical analysis of the success rate results did not show any significant difference between the groups ( P = .472 ) . CONCLUSIONS In this prospect i ve r and omized controlled study , there was no significant difference in the clinical outcomes of endodontic microsurgery when Super EBA and MTA were used as root-end filling material Objective : To evaluate the clinical efficacy of polycarboxylate cement as retro grade filling material . Design : A prospect i ve clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes , in which polycar 
    Output:
    