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 this r and omized , clinical study was to evaluate the clinical performance of composite resin material s used for fillings and indirect inlays . Twenty-eight sets of five class II restorations ( two fillings , three inlays ) were placed in 88 premolars and 52 molars in 28 adults .  Brilliant Dentin and Estilux Posterior were used for both fillings and inlays , and SR-Isosit for inlays only . After 11 years , 27 sets of restorations ( 96 % ) were evaluated clinical ly using modified United States Public Health Service criteria . Replaced or repaired restorations were observed in 16 % of the fillings and 17 % of the inlays , and a further 5 % of the restorations were replaced for reasons not related to the restoration . The remaining 107 restorations exhibited optimal ratings in 30 % of the fillings and 12 % of the inlays ( P<0.05 ) and acceptable ratings in 70 % and 88 % , respectively . The reasons for failure were fracture of restoration ( four fillings , five inlays ) , secondary caries ( two fillings , four inlays ) , fracture of tooth ( two inlays ) , loss of proximal contact ( two fillings ) , and loss of restoration ( one inlay ) . Failures were seen more frequently in molar than premolar restorations ( P<0.05 ) , with no significant difference between fillings and inlays or between the five types of restoration ( P>0.05 ) OBJECTIVE The aim of this investigation was to evaluate the clinical performance of a new compomer restorative system , Dyract AP , placed in combination with Non-Rinse Conditioner and Prime & Bond NT in permanent posterior teeth . METHOD AND MATERIAL S Fifty Class II and 41 Class I restorations were placed in 39 patients by 1 dentist . The restorations were evaluated directly , with modified US Public Health Service criteria , and indirectly , with color slides and polyvinyl siloxane impressions , at baseline and 6 months and 1 year after placement . Preoperative and 1-year postoperative bitewing radiographs were also taken . RESULTS All 82 restorations available for 1-year evaluation were in situ . No postoperative sensitivity or pulpal problems were reported . Four Class II restorations ( 4.9 % ) failed because of partial fracture or recurrent caries . The percentages of Alfa score for each criterion were color match , 95.1 % ; marginal discoloration , 57.3 % ; marginal integrity , 35.4 % ; anatomic form , 98.8 % ; and surface texture , 91.5 % . The average wear rate of Dyract AP was low ( 18.5 + /- 11.7 microns at 6 months and 35.7 + /- 13.6 microns at 12 months ) . CONCLUSION The excellent h and ling characteristics , the good clinical performance , and the improved wear resistance suggest that this compomer will provide reliable direct tooth-colored restorations in stress-bearing areas PURPOSE To report the 4-year clinical performance of  posterior resin-based composite restorations placed using the total-etch technique . MATERIAL S AND METHODS Over a period of 1 year , 726 restorations ( 248 molars , 478 premolars ; 260 Class I , 466 Class II ; 540 replacements , 186 primary decay ) were placed on conservative preparations , using the incremental placement technique in a clinical environment . Baseline data were collected , and the restorations were evaluated after 4 years . Z100 and Scotchbond Multi- Purpose ( SBMP ) ( 3 M Dental Products , St. Paul , Minnesota ) were used as the restorative system . The criteria evaluated were color match , marginal adaptation , anatomic form , cavosurface marginal discoloration , axial contour , interproximal contact , secondary caries , postoperative sensitivity , and tooth vitality . RESULTS At baseline , 24 % of the teeth restored presented postoperative sensitivity ; 86 % of the sensitive teeth were from the replacement group . At 4 years , all teeth were vital to cold test . Eighteen restorations ( 2.5 % ) presented clinical ly detectable marginal fracture . The shade was acceptable in all restorations . Cavosurface marginal discoloration was observed in 47 restorations ( 6.5 % bravo scores ) . Axial contour , interproximal contact , and marginal adaptation received 100 % alfa scores . No secondary caries was diagnosed in any of the teeth examined . None of the examined restorations required replacement . CLINICAL SIGNIFICANCE Under controlled clinical conditions , posterior resin-based composite restorations placed with the total-etch technique and restorative Z100/SBMP have the potential to present a high success rate at 4 years . None of the examined restorations required replacement , and there was no clinical ly detectable wear in any of the restorations . Simultaneous etching of enamel and dentin followed by the application of a resin adhesive can be considered an adequate modality of pulp protection in nonexposed tooth preparations PURPOSE This study evaluated the clinical efficacy of the " open s and wich " restoration for pediatric dental practice . METHODS Three pediatric dentists used a st and ardized preparation and restorative technique to place the restorations . The prepared tooth was etched with a phosphoric acid semigel and rinsed . A resin modified glass ionomer ( Fuji II LCor Photac-Fil ) was placed short of the margins and then light cured . The resin modified glass ionomer was covered with an occlusal layer of a microhybrid flowable composite ( Aeliteflo or Flow-it ) . The same preparation for the experimental restorations was used for the control conventional amalgam ( Tytin ) restorations . The restorations were evaluated at 6-month intervals and ranked with a modified United States Public Heath Survey ( USPHS ) scale as follows : Alfa : No discernible marginal opening or stain ; Beta : Slight opening of margin discernible with dental explorer , but without stain ; Charlie : Open margin and stain ; Delta : Recurrent caries or restoration failure . Restoration failures were categorized according to etiology , pulpal necrosis , bruxism , marginal leakage , isthmus fracture , or adhesive failure . RESULTS All recalled experimental restorations , except 8 , were rated as either Alpha or Beta . Six failed due to isthmus fracture and 2 due to pulpal necrosis . Fifteen restorations had delaminating of the flowable composite from the resin modified glass ionomer . The use of the " open s and wich " technique compared favorably with a similar study using adhesive amalgam restorations . CONCLUSIONS The " open s and wich " technique can be successfully used in a pediatric dental practice OBJECTIVES The aim of the study was to identify risk indicators for  apical periodontitis ( AP )  in the individual . A parameter was defined as a ' risk indicator ' when its presence increased the individual 's risk of exhibiting AP . Risk indicators may , but need not be directly associated with the disease . METHODS The study included full-mouth surveys of 613 r and omly selected individuals , who were 20 - 60 years old and living in Aarhus County .  Logistic regression analyses were performed . The outcome variable was > or=1 AP/no AP . The independent variables were obtained from information on socioeconomic and dental status . RESULTS It was found that smoking , no usage of services from the dentist , > or=2 secondary caries lesions , > or=3 inadequate coronal fillings and the presence of root filling(s ) were statistically associated with AP . A separate analysis for individuals with no previous root fillings showed that individuals with regular dental visits as well as individuals who had all their teeth ( third three molars excluded ) were less likely to have AP , whereas individuals who had > or=3 inadequate coronal fillings were more likely to have AP . CONCLUSIONS The results from the present study of a Danish population showed that the most important risk indicator of having AP in the individual was the radiographic evidence of root fillings . The presence of several caries lesions , the quality of the dental treatment , the regularity of dental visits and smoking were also statistically associated with AP . Further , the socioeconomic status of the individual did not provide much additional information on the periapical status 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 Biocompatibility of  dentin bonding agents ( DBA ) and composite resin  may affect the treatment outcome ( e.g. , healthy pulp , pulpal inflammation , pulp necrosis )  after operative restoration .  Bisphenol-glycidyl methacrylate ( BisGMA ) is one of the major monomers present in DBA and resin . Prior studies focused on salivary esterase for metabolism and degradation of resin monomers clinical ly . This study found that human dental pulp cells expressed mainly carboxylesterase-2 ( CES2 ) and smaller amounts of CES1A1 and CES3 isoforms . Exposure to BisGMA stimulated CES isoforms expression of pulp cells , and this event was inhibited by catalase . Exogenous addition of porcine esterase prevented BisGMA- and DBA-induced cytotoxicity . Interestingly , inhibition of CES by bis(p-nitrophenyl ) phosphate ( BNPP ) and CES2 by loperamide enhanced the cytotoxicity of BisGMA and DBA . Addition of porcine esterase or N-acetyl-l-cysteine prevented BisGMA-induced prostagl and in E(2 ) ( PGE(2 ) ) and PGF(2α ) production . In contrast , addition of BNPP and loperamide , but not mevastatin , enhanced BisGMA-induced PGE(2 ) and PGF(2α ) production in dental pulp cells . These results suggest that BisGMA may induce the cytotoxicity and prostanoid production of pulp cells , leading to pulpal inflammation or necrosis via reactive oxygen species production . Expression of CES , especially CES2 , in dental pulp cells can be an adaptive response to protect dental pulp against BisGMA-induced cytotoxicity and prostanoid release . Resin monomers are the main toxic components in DBA , and the ester group is crucial for monomer toxicity Apical periodontitis ( AP ) are frequent findings in contemporary dental practice in association with dental pathology or dental care . They have also been studied from an anthropological background . The purpose of this study was to compare the prevalence of apical and dental lesions in an archeological Middle Ages sample and a modern population , and to evaluate the influence of environmental factors . Both the archaeological sample group and dental practice subjects were from southern France . The study included full mouth surveys of 252 individuals ( 2,780 teeth ) from a historic necropolis and 223 subjects ( 5,678 teeth ) r and omly selected from the Gard area .  Tooth wear , caries , and AP were accounted for clinical ly and radiographically according to specific indexes . Significant differences were found between period and age in the archeological sample as regards the main risk factors for AP . Antemortem teeth loss and dental wear had been reduced , whereas caries rates and AP had increased between archaeological and modern population . The AP ratio was associated with the level of dental care in the modern population . Although significant variations could be observed between archaeological periods , the rupture in E3 ( sixteenth and seventeenth centuries ) leads to consider the associated population as a premodern . However , it was found that although cultural and alimentary factors seemed to be the main risk factors in an archeological population , dental care seemed to have a strong influence on AP ratio in modern ones AIM To identify 
    Output:
    
agent
The included studies reported few , if any , endodontic complications .
Little or no differences emerged between teeth restored with  composite resins  and those restored with amalgam .
***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 this r and omized , clinical study was to evaluate the clinical performance of composite resin material s used for fillings and indirect inlays . Twenty-eight sets of five class II restorations ( two fillings , three inlays ) were placed in 88 premolars and 52 molars in 28 adults .  Brilliant Dentin and Estilux Posterior were used for both fillings and inlays , and SR-Isosit for inlays only . After 11 years , 27 sets of restorations ( 96 % ) were evaluated clinical ly using modified United States Public Health Service criteria . Replaced or repaired restorations were observed in 16 % of the fillings and 17 % of the inlays , and a further 5 % of the restorations were replaced for reasons not related to the restoration . The remaining 107 restorations exhibited optimal ratings in 30 % of the fillings and 12 % of the inlays ( P<0.05 ) and acceptable ratings in 70 % and 88 % , respectively . The reasons for failure were fracture of restoration ( four fillings , five inlays ) , secondary caries ( two fillings , four inlays ) , fracture of tooth ( two inlays ) , loss of proximal contact ( two fillings ) , and loss of restoration ( one inlay ) . Failures were seen more frequently in molar than premolar restorations ( P<0.05 ) , with no significant difference between fillings and inlays or between the five types of restoration ( P>0.05 ) OBJECTIVE The aim of this investigation was to evaluate the clinical performance of a new compomer restorative system , Dyract AP , placed in combination with Non-Rinse Conditioner and Prime & Bond NT in permanent posterior teeth . METHOD AND MATERIAL S Fifty Class II and 41 Class I restorations were placed in 39 patients by 1 dentist . The restorations were evaluated directly , with modified US Public Health Service criteria , and indirectly , with color slides and polyvinyl siloxane impressions , at baseline and 6 months and 1 year after placement . Preoperative and 1-year postoperative bitewing radiographs were also taken . RESULTS All 82 restorations available for 1-year evaluation were in situ . No postoperative sensitivity or pulpal problems were reported . Four Class II restorations ( 4.9 % ) failed because of partial fracture or recurrent caries . The percentages of Alfa score for each criterion were color match , 95.1 % ; marginal discoloration , 57.3 % ; marginal integrity , 35.4 % ; anatomic form , 98.8 % ; and surface texture , 91.5 % . The average wear rate of Dyract AP was low ( 18.5 + /- 11.7 microns at 6 months and 35.7 + /- 13.6 microns at 12 months ) . CONCLUSION The excellent h and ling characteristics , the good clinical performance , and the improved wear resistance suggest that this compomer will provide reliable direct tooth-colored restorations in stress-bearing areas PURPOSE To report the 4-year clinical performance of  posterior resin-based composite restorations placed using the total-etch technique . MATERIAL S AND METHODS Over a period of 1 year , 726 restorations ( 248 molars , 478 premolars ; 260 Class I , 466 Class II ; 540 replacements , 186 primary decay ) were placed on conservative preparations , using the incremental placement technique in a clinical environment . Baseline data were collected , and the restorations were evaluated after 4 years . Z100 and Scotchbond Multi- Purpose ( SBMP ) ( 3 M Dental Products , St. Paul , Minnesota ) were used as the restorative system . The criteria evaluated were color match , marginal adaptation , anatomic form , cavosurface marginal discoloration , axial contour , interproximal contact , secondary caries , postoperative sensitivity , and tooth vitality . RESULTS At baseline , 24 % of the teeth restored presented postoperative sensitivity ; 86 % of the sensitive teeth were from the replacement group . At 4 years , all teeth were vital to cold test . Eighteen restorations ( 2.5 % ) presented clinical ly detectable marginal fracture . The shade was acceptable in all restorations . Cavosurface marginal discoloration was observed in 47 restorations ( 6.5 % bravo scores ) . Axial contour , interproximal contact , and marginal adaptation received 100 % alfa scores . No secondary caries was diagnosed in any of the teeth examined . None of the examined restorations required replacement . CLINICAL SIGNIFICANCE Under controlled clinical conditions , posterior resin-based composite restorations placed with the total-etch technique and restorative Z100/SBMP have the potential to present a high success rate at 4 years . None of the examined restorations required replacement , and there was no clinical ly detectable wear in any of the restorations . Simultaneous etching of enamel and dentin followed by the application of a resin adhesive can be considered an adequate modality of pulp protection in nonexposed tooth preparations PURPOSE This study evaluated the clinical efficacy of the " open s and wich " restoration for pediatric dental practice . METHODS Three pediatric dentists used a st and ardized preparation and restorative technique to place the restorations . The prepared tooth was etched with a phosphoric acid semigel and rinsed . A resin modified glass ionomer ( Fuji II LCor Photac-Fil ) was placed short of the margins and then light cured . The resin modified glass ionomer was covered with an occlusal layer of a microhybrid flowable composite ( Aeliteflo or Flow-it ) . The same preparation for the experimental restorations was used for the control conventional amalgam ( Tytin ) restorations . The restorations were evaluated at 6-month intervals and ranked with a modified United States Public Heath Survey ( USPHS ) scale as follows : Alfa : No discernible marginal opening or stain ; Beta : Slight opening of margin discernible with dental explorer , but without stain ; Charlie : Open margin and stain ; Delta : Recurrent caries or restoration failure . Restoration failures were categorized according to etiology , pulpal necrosis , bruxism , marginal leakage , isthmus fracture , or adhesive failure . RESULTS All recalled experimental restorations , except 8 , were rated as either Alpha or Beta . Six failed due to isthmus fracture and 2 due to pulpal necrosis . Fifteen restorations had delaminating of the flowable composite from the resin modified glass ionomer . The use of the " open s and wich " technique compared favorably with a similar study using adhesive amalgam restorations . CONCLUSIONS The " open s and wich " technique can be successfully used in a pediatric dental practice OBJECTIVES The aim of the study was to identify risk indicators for  apical periodontitis ( AP )  in the individual . A parameter was defined as a ' risk indicator ' when its presence increased the individual 's risk of exhibiting AP . Risk indicators may , but need not be directly associated with the disease . METHODS The study included full-mouth surveys of 613 r and omly selected individuals , who were 20 - 60 years old and living in Aarhus County .  Logistic regression analyses were performed . The outcome variable was > or=1 AP/no AP . The independent variables were obtained from information on socioeconomic and dental status . RESULTS It was found that smoking , no usage of services from the dentist , > or=2 secondary caries lesions , > or=3 inadequate coronal fillings and the presence of root filling(s ) were statistically associated with AP . A separate analysis for individuals with no previous root fillings showed that individuals with regular dental visits as well as individuals who had all their teeth ( third three molars excluded ) were less likely to have AP , whereas individuals who had > or=3 inadequate coronal fillings were more likely to have AP . CONCLUSIONS The results from the present study of a Danish population showed that the most important risk indicator of having AP in the individual was the radiographic evidence of root fillings . The presence of several caries lesions , the quality of the dental treatment , the regularity of dental visits and smoking were also statistically associated with AP . Further , the socioeconomic status of the individual did not provide much additional information on the periapical status 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 Biocompatibility of  dentin bonding agents ( DBA ) and composite resin  may affect the treatment outcome ( e.g. , healthy pulp , pulpal inflammation , pulp necrosis )  after operative restoration .  Bisphenol-glycidyl methacrylate ( BisGMA ) is one of the major monomers present in DBA and resin . Prior studies focused on salivary esterase for metabolism and degradation of resin monomers clinical ly . This study found that human dental pulp cells expressed mainly carboxylesterase-2 ( CES2 ) and smaller amounts of CES1A1 and CES3 isoforms . Exposure to BisGMA stimulated CES isoforms expression of pulp cells , and this event was inhibited by catalase . Exogenous addition of porcine esterase prevented BisGMA- and DBA-induced cytotoxicity . Interestingly , inhibition of CES by bis(p-nitrophenyl ) phosphate ( BNPP ) and CES2 by loperamide enhanced the cytotoxicity of BisGMA and DBA . Addition of porcine esterase or N-acetyl-l-cysteine prevented BisGMA-induced prostagl and in E(2 ) ( PGE(2 ) ) and PGF(2α ) production . In contrast , addition of BNPP and loperamide , but not mevastatin , enhanced BisGMA-induced PGE(2 ) and PGF(2α ) production in dental pulp cells . These results suggest that BisGMA may induce the cytotoxicity and prostanoid production of pulp cells , leading to pulpal inflammation or necrosis via reactive oxygen species production . Expression of CES , especially CES2 , in dental pulp cells can be an adaptive response to protect dental pulp against BisGMA-induced cytotoxicity and prostanoid release . Resin monomers are the main toxic components in DBA , and the ester group is crucial for monomer toxicity Apical periodontitis ( AP ) are frequent findings in contemporary dental practice in association with dental pathology or dental care . They have also been studied from an anthropological background . The purpose of this study was to compare the prevalence of apical and dental lesions in an archeological Middle Ages sample and a modern population , and to evaluate the influence of environmental factors . Both the archaeological sample group and dental practice subjects were from southern France . The study included full mouth surveys of 252 individuals ( 2,780 teeth ) from a historic necropolis and 223 subjects ( 5,678 teeth ) r and omly selected from the Gard area .  Tooth wear , caries , and AP were accounted for clinical ly and radiographically according to specific indexes . Significant differences were found between period and age in the archeological sample as regards the main risk factors for AP . Antemortem teeth loss and dental wear had been reduced , whereas caries rates and AP had increased between archaeological and modern population . The AP ratio was associated with the level of dental care in the modern population . Although significant variations could be observed between archaeological periods , the rupture in E3 ( sixteenth and seventeenth centuries ) leads to consider the associated population as a premodern . However , it was found that although cultural and alimentary factors seemed to be the main risk factors in an archeological population , dental care seemed to have a strong influence on AP ratio in modern ones AIM To identify 
    Output:
    