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: Background : CPP-ACP ( Phosphopeptide-Amorphous Calcium Phosphate ) has an important role in caries prevention in pediatric patients . This study was done , because of the great use of CPP-ACP and the need for restoration for teeth treated with CPP-ACP as well as the importance of shear bond strength of adhesives in the success of restorations . Objectives : This study aim ed to evaluate the effect of casein phosphopeptide-amorphous calcium phosphate ( CPP-ACP ) on shear bond strength of dental adhesives to enamel of primary teeth molars . Material s and Methods : This in vitro study was conducted on 180 extracted primary molars . They were r and omly divided into 6 groups and each group was divided into 2 subgroups ( treated with CPP-ACP and untreated ) . In subgroups with CPP-ACP , enamel was treated with CPP-ACP paste 1 h/d for 5 days . Types of adhesives that were evaluated in this study were Tetric N-Bond , AdheSE , AdheSE One F , single Bond 2 , SE Bond , and Adper Prompt L-Pop . Shear bond strength was tested with a universal testing machine and mode of failure was evaluated under stereomicroscope . Data were analyzed by T test , 2-way analysis of variance ( ANOVA ) , Tukey and Fisher exact test using SPSS18 . P < 0.05 was considered as significance level . Results : Shear bond strengths of different adhesive systems to enamel of primary teeth treated and untreated with CPP-ACP showed no significant difference ( P > 0.05 ) . Mode of failure in all groups regardless of CPP-ACP administration was mainly adhesive type . Our results indicated that CPP-ACP did not affect shear bond strength of studied adhesives to primary teeth enamel . Conclusions : To have a successful and durable composite restoration , having a high strength bonding is essential . Considering the wide use of CPP-ACP in preventing tooth decay and the role of adhesive shear bond strength ( SBS ) in success of composite restoration , we conducted the present study to evaluate the effect of CPP-ACP on the SBS of adhesives to primary teeth enamel PURPOSE The aims of this in vitro study were to : ( 1 ) compare bond strength of different adhesive systems to primary and permanent dentin using microtensile test ; and ( 2 ) evaluate the interaction of these material s to primary and permanent dentin by means of scanning electron microscopy ( SEM ) . METHODS Middle-coronal dentin surfaces of 18 exfoliated primary and 18 extracted permanent molars were exposed and teeth were r and omly divided , according to their adhesive system , into 3 groups ( N=6 per group ) : ( 1 ) Clearfil SE Bond ( SE ) ; ( 2 ) One Up Bond F ( OU ) ; and ( 3 ) Single Bond ( SB ) . Then , 5-mm high composite blocks were constructed . After bonding procedures , the teeth were stored in distilled water at 37 degrees C for 24 hours prior to the specimens ' preparation . For the microtensile test , teeth ( N=5 per group ) were longitudinally sectioned into 2 axes rendering beam-specimens that were glued to special devices , which were mounted in a Universal Testing Machine to be loaded under a crosshead speed of 1 mm/min until fracture . One tooth of each group was prepared for SEM . RESULTS Microtensile bond strength mean values ( MPa ) to primary /permanent dentin were : ( 1 ) SE=60.0/61.4 ; ( 2 ) OU=54.5/53.3 ; and ( 3 ) SB=70.1/64.9 . Two-way analysis of variance ( ANOVA ) showed no significant differences ( P>.05 ) for the bond strength values among primary and permanent dentin groups , neither among groups SExSB and SExOU . SEM images of SE and SB showed a well-defined , uniform , and continuous hybrid layer . A continuous hybrid layer , however , was not found for OU . CONCLUSIONS Bond strength and micromorphologic characteristics of the adhesive systems evaluated were not influenced by the substrate . OU achieved worse results PURPOSE The purpose of this study was to evaluate the effect of the material s used for indirect pulp treatment ( IPT ) on the long-term outcome of primary molar teeth . METHODS Forty-eight teeth with deep carious lesions , but without signs and symptoms of irreversible pulpitis , were r and omly divided into 2 groups , according to the material placed on the demineralized dentin remain : ( 1 ) experimental group , adhesive system ( Scotchbond Multi purpose ) ; and ( 2 ) control group , calcium hydroxide liner ( Dycal ) . Both groups were followed by a resin restoration application . RESULTS After 4 to 5 years , the clinical and radiographic success rates between groups were similar ( group 1=14 of 15 ; group 2=8 of 10 ; P=0.350 ) . Subsequent to exfoliation , scanning electron microscopy revealed the presence of a hybrid layer at the resin-dentin interface and a microtensile bond strength of 9.63 MPa ( group 1 ) . Histological analysis showed that the pulp health status was similar in both groups . CONCLUSIONS Indirect pulp treatment has a high clinical and radiographic long-term success rate in primary teeth and is not material -dependent PURPOSE To investigate the bonding of a new universal adhesive applied using different etching strategies on sound and caries-affected dentin of primary teeth . MATERIAL S AND METHODS Flat dentin surfaces from 50 primary molars were r and omly assigned to 10 groups according to substrate ( sound dentin [ SD ] vs caries-affected dentin [ CAD ] pH cycled for 14 days ) and bonding approach ( Scotchbond Universal Adhesive : self-etching , vs dry or wet-bonding etch- and -rinse strategies ; Adper Single Bond Plus [ two-step etch- and -rinse adhesive ] and Clearfil SE Bond [ two-step self-etching system ] as controls ) . After 24 h of water storage , bonded sticks with cross-sectional areas of 0.8 mm2 were tested for microtensile bond strength ( μTBS ) . Two sticks from each tooth were immersed in silver nitrate solution in order to evaluate nanoleakage ( NL ) with SEM . The μTBS means were analyzed using two-way ANOVA and Tukey 's tests . For NL , the Kruskal-Wallis and Mann-Whitney tests were used ( α = 0.05 ) . RESULTS The influence of the etching strategy on the bonding performance of the universal adhesive was substrate dependent . The self-etching approach result ed in lower μTBS values and higher silver nitrate uptake into hybrid layers for Scotchbond Universal Adhesive on SD , while no difference among experimental groups was observed in CAD . CONCLUSION It is preferable to use the universal adhesive following either a dry- or wet-bonding etch- and -rinse approach on both sound and caries-affected primary dentin The aims of this study were to evaluate the shear bond strength ( SBS ) off our adhesive systenms applied to primary dentin and enamel and verify , after SBS testing , the failure mode of the adhesive interface . Sixty extracted sound primary molars were selected and crowns were sectioned in a mesial-distal direction . Specimens were r and omly assigned into two groups ( adhesion to enamel and adhesion to dentin ) and then subdivided into four subgroups according to the adhesive system ( n=15 ) . Scotchbond Multi- Purpose (SMP)--Single Bond (SB)--Clearfil SE Bond ( and Adper Prompt L-Pop (APL)--SBS tests were performed and the obtained values were statistically analyzed using ANOVA and Tukey tests ( p < 0.05 ) . The failure mode analysis was performed with a Scanning Electron Microscope ( XL-30 , Philips ) . SBS mean values on enamel were [ MPa ( SD ) ] : SMP--2789 ( 749 ) ; SB--23.92 ( 8.8 ) ; CSB--24.36 ( 6.69 ) , APL--25.96 ( 4.08 ) ; and on dentin : SMP--17.29 ( 4.25 ) SB--18.2 ( 8.74 ) ; CSB--16.13 ( 714 ) ; APL--6 . 04 ( 3.35 ) . The predominant failure mode was cohesive ( primarily of the bonding agent ) . On enamel SBS was statistically similar for all four adhesives . On dentin SBS ofAPL was lower than the other tested adhesives PURPOSE The objective of this study was to assess in vitro the tensile bond strength of a self-etching and 2 total-etch , single-bottle adhesive systems to primary dentin . METHODS Thirty-six sound primary canine buccal surfaces were r and omly assigned to 3 groups ( N = 12 ) , corresponding to the tested adhesive systems : ( 1 ) group I = Excite ( EX ) ; ( 2 ) group II = Single Bond ( SB ) ; and ( 3 ) group III = Prompt L-Pop ( PLP ) . After 24-hour storage in distilled water , tensile bond strength was tested for failure at a crosshead speed of 0.5 mm/min . RESULTS Means ( MPa ) and st and ard deviation ( + /- ) were : ( 1 ) EX = 12.72 ( + /- .89 ) ; ( 2 ) SB = 10.86 ( + /- 2.09 ) ; ( 3 ) PLP = 8.66 ( + /- 2.23 ) . Single Bond and Excite showed statistically similar results ( P > .05 ) and provided the highest means . Prompt L-Pop was statistically different from the other groups ( P < .05 ) and reached the lower bond strength to primary dentin . CONCLUSIONS Total-etch agents provided the best overall bonding performance , whereas the all-in-one , self-etching , self-priming adhesive system yielded remarkably lower bond strength to primary teeth dentin BACKGROUND The objec tives of this study were to determine microtensile bond strengths of two dentin adhesives and to compare the micromorphological structure of the resin/dentin interface in caries-affected dentin with that of intact dentin . METHODS The authors r and omly divided 40 proximal dentinal carious primary teeth and 40 noncarious anterior primary teeth into two groups ( self-etching and total-etching ) . They used a caries-detecting dye as an indicator of the need to remove the outer carious dentin . The authors restored the teeth with a hybrid resin-based composite . After 24 hours ' storage in 37 C water , specimens were sectioned and shaped to form a curved section with a cross-sectional area of 1 square millimeter , then tension was applied until they fractured . The authors prepared the resin/dentin interfaces for the two bonding systems and examined them in 10 occlusal carious and 10 noncarious teeth . STATISTICAL ANALYSIS The bond strengths for intact and caries-affected dentin within the same group were analyzed via a t test . The authors compared the remaining dentin thickness ( RDT ) and dentin hardness using analysis of variance and the least significant difference test at the .05 level of significance . RESULTS The self-etching adhesive demonstrated no statistical difference in bond strength between intact and caries-affected dentin . However , the total-etching adhesive demonstrated different bond strengths for intact and caries-affected dentin . Moreover , the RDT of specimens with intact and caries-affected dentin was not significantly different , whereas the dentin hardness of caries-affected dentin was significantly lower than that of intact dentin . The authors found a thicker hybrid layer in intact and caries-affected dentin of specimens in the total-etching group . CONCLUSION The adhesives exhibited significantly different bond strengths in intact dentin of primary teeth . However , they exhibited similar bond strengths in caries-affected dentin PURPOSE To evaluate the bonding of simplified adhesive systems to sound and caries-affected dentin of primary teeth with microtensile ( µTBS ) and nanoleakage ( NL ) tests . MATERIAL S AND METHODS Occlusal cavities were prepared in 36 sound second primary molars . Half of the specimens were su bmi tted to pH cycling to simulate caries-affected dentin . Teeth were r and omly restored with one of three material s : the etch- and -rinse adhesive system Adper Single Bond 2 ( SB ) , the two-step self-etching adhesive system Adper SE Plus ( SE ) , and the one-step self-etching adhesive system Adper Easy One ( EASY ) . After storage for 24 h , specimens with cross-sectional areas of 0.8 mm2 were prepared for microtensile testing ( 1 mm/min ) . One stick from each tooth was immersed in silver nitrate solution ( 24 h ) and allowed to develop for 8 h in order to score the nano leakage with SEM . The fracture pattern was evaluated using a stereomicroscope ( 400X ) . The µTBS means were analyzed by two-way ANOVA and Tukey 's post-hoc test . For NL , the Kruskal- Wallis and Mann-Whitney tests were used ( α < 0.05 ) . RESULTS SB ( 35.5 ± 3.5 ) showed the highest µTBS value to sound dentin , followed by EASY ( 26.3 ± 1.9 ) and SE ( 18.2 ± 6.5 ) ( p < 0.05 ) . No difference among material s was observed for caries-affected dentin ( SB : 17.8 ±  
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agent
RESULTS No statistical significant difference in bond strength between both categories was observed in caries-affected dentin at immediate evaluation and in sound dentin after ageing .
Etch- and -rinse adhesives , however , performed better in sound enamel and dentin substrates considering immediate bond strength .
None study assessed the long-term adhesive effectiveness to sound or demineralized enamel .
Although the articles included in this meta- analysis showed high heterogeneity and high risk of bias , the in vitro literature suggests superior performance of etch- and -rinse adhesives in primary teeth in comparison with self-etch systems
***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: Background : CPP-ACP ( Phosphopeptide-Amorphous Calcium Phosphate ) has an important role in caries prevention in pediatric patients . This study was done , because of the great use of CPP-ACP and the need for restoration for teeth treated with CPP-ACP as well as the importance of shear bond strength of adhesives in the success of restorations . Objectives : This study aim ed to evaluate the effect of casein phosphopeptide-amorphous calcium phosphate ( CPP-ACP ) on shear bond strength of dental adhesives to enamel of primary teeth molars . Material s and Methods : This in vitro study was conducted on 180 extracted primary molars . They were r and omly divided into 6 groups and each group was divided into 2 subgroups ( treated with CPP-ACP and untreated ) . In subgroups with CPP-ACP , enamel was treated with CPP-ACP paste 1 h/d for 5 days . Types of adhesives that were evaluated in this study were Tetric N-Bond , AdheSE , AdheSE One F , single Bond 2 , SE Bond , and Adper Prompt L-Pop . Shear bond strength was tested with a universal testing machine and mode of failure was evaluated under stereomicroscope . Data were analyzed by T test , 2-way analysis of variance ( ANOVA ) , Tukey and Fisher exact test using SPSS18 . P < 0.05 was considered as significance level . Results : Shear bond strengths of different adhesive systems to enamel of primary teeth treated and untreated with CPP-ACP showed no significant difference ( P > 0.05 ) . Mode of failure in all groups regardless of CPP-ACP administration was mainly adhesive type . Our results indicated that CPP-ACP did not affect shear bond strength of studied adhesives to primary teeth enamel . Conclusions : To have a successful and durable composite restoration , having a high strength bonding is essential . Considering the wide use of CPP-ACP in preventing tooth decay and the role of adhesive shear bond strength ( SBS ) in success of composite restoration , we conducted the present study to evaluate the effect of CPP-ACP on the SBS of adhesives to primary teeth enamel PURPOSE The aims of this in vitro study were to : ( 1 ) compare bond strength of different adhesive systems to primary and permanent dentin using microtensile test ; and ( 2 ) evaluate the interaction of these material s to primary and permanent dentin by means of scanning electron microscopy ( SEM ) . METHODS Middle-coronal dentin surfaces of 18 exfoliated primary and 18 extracted permanent molars were exposed and teeth were r and omly divided , according to their adhesive system , into 3 groups ( N=6 per group ) : ( 1 ) Clearfil SE Bond ( SE ) ; ( 2 ) One Up Bond F ( OU ) ; and ( 3 ) Single Bond ( SB ) . Then , 5-mm high composite blocks were constructed . After bonding procedures , the teeth were stored in distilled water at 37 degrees C for 24 hours prior to the specimens ' preparation . For the microtensile test , teeth ( N=5 per group ) were longitudinally sectioned into 2 axes rendering beam-specimens that were glued to special devices , which were mounted in a Universal Testing Machine to be loaded under a crosshead speed of 1 mm/min until fracture . One tooth of each group was prepared for SEM . RESULTS Microtensile bond strength mean values ( MPa ) to primary /permanent dentin were : ( 1 ) SE=60.0/61.4 ; ( 2 ) OU=54.5/53.3 ; and ( 3 ) SB=70.1/64.9 . Two-way analysis of variance ( ANOVA ) showed no significant differences ( P>.05 ) for the bond strength values among primary and permanent dentin groups , neither among groups SExSB and SExOU . SEM images of SE and SB showed a well-defined , uniform , and continuous hybrid layer . A continuous hybrid layer , however , was not found for OU . CONCLUSIONS Bond strength and micromorphologic characteristics of the adhesive systems evaluated were not influenced by the substrate . OU achieved worse results PURPOSE The purpose of this study was to evaluate the effect of the material s used for indirect pulp treatment ( IPT ) on the long-term outcome of primary molar teeth . METHODS Forty-eight teeth with deep carious lesions , but without signs and symptoms of irreversible pulpitis , were r and omly divided into 2 groups , according to the material placed on the demineralized dentin remain : ( 1 ) experimental group , adhesive system ( Scotchbond Multi purpose ) ; and ( 2 ) control group , calcium hydroxide liner ( Dycal ) . Both groups were followed by a resin restoration application . RESULTS After 4 to 5 years , the clinical and radiographic success rates between groups were similar ( group 1=14 of 15 ; group 2=8 of 10 ; P=0.350 ) . Subsequent to exfoliation , scanning electron microscopy revealed the presence of a hybrid layer at the resin-dentin interface and a microtensile bond strength of 9.63 MPa ( group 1 ) . Histological analysis showed that the pulp health status was similar in both groups . CONCLUSIONS Indirect pulp treatment has a high clinical and radiographic long-term success rate in primary teeth and is not material -dependent PURPOSE To investigate the bonding of a new universal adhesive applied using different etching strategies on sound and caries-affected dentin of primary teeth . MATERIAL S AND METHODS Flat dentin surfaces from 50 primary molars were r and omly assigned to 10 groups according to substrate ( sound dentin [ SD ] vs caries-affected dentin [ CAD ] pH cycled for 14 days ) and bonding approach ( Scotchbond Universal Adhesive : self-etching , vs dry or wet-bonding etch- and -rinse strategies ; Adper Single Bond Plus [ two-step etch- and -rinse adhesive ] and Clearfil SE Bond [ two-step self-etching system ] as controls ) . After 24 h of water storage , bonded sticks with cross-sectional areas of 0.8 mm2 were tested for microtensile bond strength ( μTBS ) . Two sticks from each tooth were immersed in silver nitrate solution in order to evaluate nanoleakage ( NL ) with SEM . The μTBS means were analyzed using two-way ANOVA and Tukey 's tests . For NL , the Kruskal-Wallis and Mann-Whitney tests were used ( α = 0.05 ) . RESULTS The influence of the etching strategy on the bonding performance of the universal adhesive was substrate dependent . The self-etching approach result ed in lower μTBS values and higher silver nitrate uptake into hybrid layers for Scotchbond Universal Adhesive on SD , while no difference among experimental groups was observed in CAD . CONCLUSION It is preferable to use the universal adhesive following either a dry- or wet-bonding etch- and -rinse approach on both sound and caries-affected primary dentin The aims of this study were to evaluate the shear bond strength ( SBS ) off our adhesive systenms applied to primary dentin and enamel and verify , after SBS testing , the failure mode of the adhesive interface . Sixty extracted sound primary molars were selected and crowns were sectioned in a mesial-distal direction . Specimens were r and omly assigned into two groups ( adhesion to enamel and adhesion to dentin ) and then subdivided into four subgroups according to the adhesive system ( n=15 ) . Scotchbond Multi- Purpose (SMP)--Single Bond (SB)--Clearfil SE Bond ( and Adper Prompt L-Pop (APL)--SBS tests were performed and the obtained values were statistically analyzed using ANOVA and Tukey tests ( p < 0.05 ) . The failure mode analysis was performed with a Scanning Electron Microscope ( XL-30 , Philips ) . SBS mean values on enamel were [ MPa ( SD ) ] : SMP--2789 ( 749 ) ; SB--23.92 ( 8.8 ) ; CSB--24.36 ( 6.69 ) , APL--25.96 ( 4.08 ) ; and on dentin : SMP--17.29 ( 4.25 ) SB--18.2 ( 8.74 ) ; CSB--16.13 ( 714 ) ; APL--6 . 04 ( 3.35 ) . The predominant failure mode was cohesive ( primarily of the bonding agent ) . On enamel SBS was statistically similar for all four adhesives . On dentin SBS ofAPL was lower than the other tested adhesives PURPOSE The objective of this study was to assess in vitro the tensile bond strength of a self-etching and 2 total-etch , single-bottle adhesive systems to primary dentin . METHODS Thirty-six sound primary canine buccal surfaces were r and omly assigned to 3 groups ( N = 12 ) , corresponding to the tested adhesive systems : ( 1 ) group I = Excite ( EX ) ; ( 2 ) group II = Single Bond ( SB ) ; and ( 3 ) group III = Prompt L-Pop ( PLP ) . After 24-hour storage in distilled water , tensile bond strength was tested for failure at a crosshead speed of 0.5 mm/min . RESULTS Means ( MPa ) and st and ard deviation ( + /- ) were : ( 1 ) EX = 12.72 ( + /- .89 ) ; ( 2 ) SB = 10.86 ( + /- 2.09 ) ; ( 3 ) PLP = 8.66 ( + /- 2.23 ) . Single Bond and Excite showed statistically similar results ( P > .05 ) and provided the highest means . Prompt L-Pop was statistically different from the other groups ( P < .05 ) and reached the lower bond strength to primary dentin . CONCLUSIONS Total-etch agents provided the best overall bonding performance , whereas the all-in-one , self-etching , self-priming adhesive system yielded remarkably lower bond strength to primary teeth dentin BACKGROUND The objec tives of this study were to determine microtensile bond strengths of two dentin adhesives and to compare the micromorphological structure of the resin/dentin interface in caries-affected dentin with that of intact dentin . METHODS The authors r and omly divided 40 proximal dentinal carious primary teeth and 40 noncarious anterior primary teeth into two groups ( self-etching and total-etching ) . They used a caries-detecting dye as an indicator of the need to remove the outer carious dentin . The authors restored the teeth with a hybrid resin-based composite . After 24 hours ' storage in 37 C water , specimens were sectioned and shaped to form a curved section with a cross-sectional area of 1 square millimeter , then tension was applied until they fractured . The authors prepared the resin/dentin interfaces for the two bonding systems and examined them in 10 occlusal carious and 10 noncarious teeth . STATISTICAL ANALYSIS The bond strengths for intact and caries-affected dentin within the same group were analyzed via a t test . The authors compared the remaining dentin thickness ( RDT ) and dentin hardness using analysis of variance and the least significant difference test at the .05 level of significance . RESULTS The self-etching adhesive demonstrated no statistical difference in bond strength between intact and caries-affected dentin . However , the total-etching adhesive demonstrated different bond strengths for intact and caries-affected dentin . Moreover , the RDT of specimens with intact and caries-affected dentin was not significantly different , whereas the dentin hardness of caries-affected dentin was significantly lower than that of intact dentin . The authors found a thicker hybrid layer in intact and caries-affected dentin of specimens in the total-etching group . CONCLUSION The adhesives exhibited significantly different bond strengths in intact dentin of primary teeth . However , they exhibited similar bond strengths in caries-affected dentin PURPOSE To evaluate the bonding of simplified adhesive systems to sound and caries-affected dentin of primary teeth with microtensile ( µTBS ) and nanoleakage ( NL ) tests . MATERIAL S AND METHODS Occlusal cavities were prepared in 36 sound second primary molars . Half of the specimens were su bmi tted to pH cycling to simulate caries-affected dentin . Teeth were r and omly restored with one of three material s : the etch- and -rinse adhesive system Adper Single Bond 2 ( SB ) , the two-step self-etching adhesive system Adper SE Plus ( SE ) , and the one-step self-etching adhesive system Adper Easy One ( EASY ) . After storage for 24 h , specimens with cross-sectional areas of 0.8 mm2 were prepared for microtensile testing ( 1 mm/min ) . One stick from each tooth was immersed in silver nitrate solution ( 24 h ) and allowed to develop for 8 h in order to score the nano leakage with SEM . The fracture pattern was evaluated using a stereomicroscope ( 400X ) . The µTBS means were analyzed by two-way ANOVA and Tukey 's post-hoc test . For NL , the Kruskal- Wallis and Mann-Whitney tests were used ( α < 0.05 ) . RESULTS SB ( 35.5 ± 3.5 ) showed the highest µTBS value to sound dentin , followed by EASY ( 26.3 ± 1.9 ) and SE ( 18.2 ± 6.5 ) ( p < 0.05 ) . No difference among material s was observed for caries-affected dentin ( SB : 17.8 ±  
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