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 split-mouth design is a popular design in oral health research . In the most common split-mouth study , each of two treatments are r and omly assigned to either the right or left halves of the dentition . The attractiveness of the design is that it removes a lot of inter-individual variability from the estimates of the treatment effect . However , already about 20 years ago the pitfalls of the design have been reported in the oral health literature . Yet , many clinicians are not aware of the potential problems with the split-mouth design . Further , it is our experience that most statisticians are not even aware of the existence of this design . Since most of the critical remarks appeared in the oral health literature , we argue that it is necessary to introduce the split-mouth design to a statistical audience , so that both clinicians and statisticians clearly underst and the advantages , limitations , statistical considerations , and implication s of its use in clinical trials and advise them on its use in practice The clinical performance of packable and conventional hybrid resin composites in Class I restorations for a period of three years was compared using a r and omized controlled double-blind clinical trial with self-matching design . A total of 50 pairs of Class I restorations were placed in 32 adult patients by one dentist in a self-matching prospect i ve clinical trial . The paired teeth were divided into the TPH Spectrum/XenoIII ( TS ) restoration group and the Synergy Compact/One Coat ( SC ) restoration group according to a r and om number table . Application of the material s followed the manufacturer 's instructions . The restorations were evaluated by two independent evaluators using US Public Health Service (USPHS)-Ryge modified criteria . Statistical analysis was performed using the McNemar 's test with Yates ' continuity correction . After three years , 40 pairs of restorations were available for evaluation . Four TS and two SC restorations failed due to fracture . Only one TS-restored tooth showed postoperative sensitivity at baseline and the symptom disappeared one week later . Alpha ratings of TS vs SC restorations were as follows : 95 % vs 98 % for color match , 85 % vs 88 % for marginal integrity , 88 % vs 90 % for anatomical form , 85 % vs 83 % for marginal discoloration , 88 % vs 93 % for occlusal contact . For both material s , Alpha ratings were 88 % for surface texture . The three-year clinical performances of the two restorative material s were satisfactory and not significantly different for each of the parameters evaluated Dentin bonding using the total-etch method has been cl aim ed to be technique-sensitive . The aim of this study is to examine the effect of acid-etch variations on the dentin demineralization and interfacial structure of the adhesive-dentin bond using a differential staining technique . Single Bond adhesive with 35 % phosphoric acid gel was used . The occlusal one-third of the crown was removed from 60 extracted , unerupted human third molars . Smear layers were created by abrading the dentin with 600 grit SiC under water for 30 s. The prepared teeth were r and omly assigned to four groups according to etching time ( Group 1 , 10 s ; Group 2 , 15 s ; Group 3 , 30 s ; Group 4 , 60 s ) . In each group , the etching gel was : ( i ) applied and spread to the dentin surface and left to st and undisturbed ; ( ii ) applied and gently agitated during etching ; ( iii ) applied without using dispensing tips for the syringe and left for the same period as above . After rinsing , the etched dentin was then treated with the adhesive per manufacturers ' instructions . 3 - 5 micro m thin sections of the adhesive/dentin ( a/d ) interface were cut with a microtome and stained with Goldner 's trichrome . Stained , thin sections from each prepared tooth were imaged with light microscopy . The depth and extent of dentin demineralization , and the a/d interdiffusion zone were clearly visible by this differential staining microtechnique . The thickness of the interdiffusion zone increased as a function of etching time . However , the etchant gel application methods have a significant influence on dentin demineralization . Although agitating acid gel facilitates the penetration and etching into dentin , it should not be recommended , especially for longer etching time . These results indicated that the etching technique has a large effect on the profile of both dentin demineralization and interfacial structure The five-year findings of a study to compare the performance of restorations of Occlusin ( ICI Dental , Macclesfield , UK ) in butt-joint and bevel-edged preparations are reported . Ninety-four ( 79 % ) of the restorations originally placed were review ed at five years , 20 restorations ( 17 % ) having failed during the study . Initial analysis of the overall results having failed to reveal any significant differences between the five-year performance of the two types of restorations , the results were combined and analyzed by Chi-square tests and step-wise logistic regression . Chi-square analysis indicated that of the independent variables investigated , size of restoration had the greatest effect on clinical performance . Step-wise logistic regression revealed that only four of the eight dependent variables investigated showed significant predictive relationships with the independent variables , the logistic equation for occlusal marginal adaptation being the most complex . The greatest amount of generalized occlusal surface wear tended to be seen in large-sized Class II restorations in molar teeth , with the main factor influencing wear being found to be the type of restoration ( Class I or Class II ) . It is concluded that the performance of  restorations of Occlusin  has not been found to differ significantly in butt-joint and bevel-edged preparations after five years in clinical service . Step-wise logistic regression has been found to be a useful tool in the analysis of data obtained during the clinical evaluation of a restorative material Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more A study was conducted to determine whether the wear resistance of a posterior composite could be improved by maximizing filler particle-to-particle contacts . This was expected to reduce stress concentrations on the resin matrix and thus reduce occlusal wear . A self-curing quartz-filled composite with this design , P-10 , was used to restore 90 Class I and II cavity preparations in adult teeth . Restorations were recalled after baseline at six months , one year , two years , and three years to measure wear by direct and indirect evaluation methods . There was no apparent advantage for this material compared with other previously evaluated posterior composites . The average cumulative wear for P-10 after three years was 145 microns . In addition , the restorations were evaluated for color-matching , interfacial staining , secondary caries , marginal adaptation , surface texture , and postoperative sensitivity . This material was not significantly different in those ways from other posterior composite products except in terms of more rapid color change , because it is self-cured Abstract . This study investigated the clinical performance of two packable composite resins  in Class-II restorations . One hundred and four Class-II restorations were placed in 52 patients by five dentists ( four in dental practice s and one in a university clinic ) in a controlled prospect i ve multicentre clinical trial . Each patient received one Definite/Etch & Prime 3.0 ( D-EP ) and one Solitaire/Solid Bond ( S-SB ) restoration , which were examined clinical ly according to modified USPHS- criteria after 1 week ( baseline ) and after 1 year . Statistical analysis was performed using the Wilcoxon rank sum test and the error rates method . The significance level was set to 0.05 . At baseline both material s performed equally according to the evaluated criteria . After 1 year D-EP showed significantly worse marginal adaptation compared to S-SB . Both material s displayed significant deterioration for the criteria marginal adaptation , marginal discolouration , approximal contact , and fracture of restoration after 1 year compared to baseline . With a failure rate of 9.6 % after 1 year , D-EP did not fulfill ADA acceptance criteria for restorative material s. It is proposed that at least 1-year data of clinical testing should be available before a new material is broadly marketed BACKGROUND Self-etching adhesives are believed to prevent postoperative sensitivity when used under posterior resin-based composite restorations . The authors tested a twofold hypothesis : a self-etch , or SE , adhesive would result in less postoperative sensitivity than a total-etch , or TE , adhesive ; an SE adhesive would result in poorer enamel marginal integrity than a TE adhesive . METHODS Patients were selected on the basis of requiring Class I and II restorations in molars and premolars . The authors placed 30 restorations with the SE material ( Clearfil SE Bond , Kuraray America , New York ) and 36 restorations with Prime & Bond NT ( Dentsply Caulk , Milford , Del. ) , which uses 34 percent phosphoric acid to etch enamel and dentin simultaneously . Preparations were of st and ard design , with all margins in enamel without beveling . Upon rubber dam isolation , the authors conditioned the enamel and dentin walls with the self-etching primer ( for Clearfil SE Bond ) or etched with the proprietary 34 percent phosphoric acid ( for Prime & Bond NT ) , followed by application of the corresponding dentin adhesive . Teeth were restored with the proprietary hybrid resin-based composite indicated for posterior restorations : Clearfil AP-X for Clearfil SE Bond or Esthet-X Micro Matrix Restorative for Prime & Bond NT . The restored teeth were evaluated preoperatively and at two weeks , eight weeks and six months postoperatively for sensitivity to cold ( ice ) , air and masticatory forces , as well as for marginal discoloration . RESULTS Analysis of variance revealed no statistically significant differences in postoperative sensitivity between the SE and TE material s at any recall time . Marginal discoloration was rated as " absent " for all restorations at six months . Only one tooth displayed sensitivity to occlusal forces at six months . CONCLUSION The SE adhesive did not differ from the TE adhesive in regard to sensitivity and marginal discoloration . CLINICAL IMPLICATION S Postoperative sensitivity may depend on the restorative technique rather than on the type of dentin adhesive used PURPOSE This longitudinal r and omized controlled clinical trial evaluated direct composite restorations for clinical acceptability as posterior restoratives in single- or multi-surface cavities and provides a survey of the 4-year results . MATERIAL S AND METHODS Three dentists placed 46 Quixfil ( Xeno III ) and 50 Tetric Ceram ( Syntac Classic ) composite restorations in stress-bearing Class I and II cavities in first or second molars ( 43 adult patients ) . Clinical evaluation was performed at baseline and after 4 years by 2 other dentists using modified USPHS criteria . At the last recall period , 37 Quixfil and 46 Tetric Ceram restorations  were assessed . RESULTS A total of 89.2 % of Quixfil and 97.8 % of Tetric Ceram posterior composites were assessed to be clinical ly excellent or acceptable with predominating alfa scores . Up to the 4-year recall , four Quixfil restorations failed because of bulk fracture , partial tooth fracture ( 2x ) and postoperative symptoms . One Tetric Ceram restoration was lost due to problems with tooth integrity . No significant differences between the two composites could be detected at 4 years for any of the evaluated clinical criteria ( p > 0.05 ) . The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration and decrease in marginal integrity for both material s. After 4 years , small restorations exhibited significantly less marginal discoloration than large restorations . CONCLUSION Clinical assessment of stress-bearing Quixfil and Tetric Ceram posterior composite restorations showed good clinical results with predominantly alfa scores for both material OBJECTIVES To analyze the relationship between the cavity depth and liners with postoperative sensitivity of  resin composite restorations .  METHODS A clinical follow-up was conducted on 319 resin composite restorations made in the final year of an undergraduate program over a 3-year period . Along with the analyses of cavity type , cavity depth , type of pulpal protection and the material s used , the postoperative sensitivity was also examined on each restoration . RESULTS Thirty-nine percent of the restorations had no protective layer ( Group 1 ) . As the depth of the prepared cavities increased , the restorations received one of the three pulpal protection methods ; a calcium hydroxide base ( Group 2 ) , glass ionomer cement ( Group 3 ) , or protection with a calcium hydroxide base in combination with glass ionomer cement ( Group 4 ) . The incidence of postoperative sensitivity showed no significant difference among Groups 1 , 2 and 3 , but was significantly lower in Group 1 than in Group 4 . The restorations made in shallow and medium depth cavities demonstrated significantly less-postoperative sensitivity than those made in deep cavities . The newer generation dentine-bonding agents showed a significantly lower incidence of postoperative sensitivity than the early generation group . CONCLUSIONS Postoperative sensitivity in resin  composite restorations was not related to the absence of protective layers but increased with the depth of cavities restored with the resin composite . The type of dentine-bonding agents could also be responsible for postoperative sensitivity Abstract .The purpose of this study was to evaluate the clinical performance of two " packable " posterior composites : Prodigy Condensable ( P ) ( Kerr ) and Definite ( D ) ( Degussa ) .  Thirty-six patients participated in the study . A total of 78 restorations were made , 40 with D and 38 with  P.  Each patient received at least two restorations  , one of each studied material . The material s were h and led according to the manufacturer 's instructions . The restorations were finished and polished after 1 week . They were evaluated at bas 
    Output:
    
agent
No overall effect was revealed in the meta-analyses , meaning that no influence of the  ER or SE strategy on POS .
SIGNIFICANCE The type of adhesive strategy ( ER or SE ) for posterior resin composite restorations does not influence the risk and intensity of POS .
***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 split-mouth design is a popular design in oral health research . In the most common split-mouth study , each of two treatments are r and omly assigned to either the right or left halves of the dentition . The attractiveness of the design is that it removes a lot of inter-individual variability from the estimates of the treatment effect . However , already about 20 years ago the pitfalls of the design have been reported in the oral health literature . Yet , many clinicians are not aware of the potential problems with the split-mouth design . Further , it is our experience that most statisticians are not even aware of the existence of this design . Since most of the critical remarks appeared in the oral health literature , we argue that it is necessary to introduce the split-mouth design to a statistical audience , so that both clinicians and statisticians clearly underst and the advantages , limitations , statistical considerations , and implication s of its use in clinical trials and advise them on its use in practice The clinical performance of packable and conventional hybrid resin composites in Class I restorations for a period of three years was compared using a r and omized controlled double-blind clinical trial with self-matching design . A total of 50 pairs of Class I restorations were placed in 32 adult patients by one dentist in a self-matching prospect i ve clinical trial . The paired teeth were divided into the TPH Spectrum/XenoIII ( TS ) restoration group and the Synergy Compact/One Coat ( SC ) restoration group according to a r and om number table . Application of the material s followed the manufacturer 's instructions . The restorations were evaluated by two independent evaluators using US Public Health Service (USPHS)-Ryge modified criteria . Statistical analysis was performed using the McNemar 's test with Yates ' continuity correction . After three years , 40 pairs of restorations were available for evaluation . Four TS and two SC restorations failed due to fracture . Only one TS-restored tooth showed postoperative sensitivity at baseline and the symptom disappeared one week later . Alpha ratings of TS vs SC restorations were as follows : 95 % vs 98 % for color match , 85 % vs 88 % for marginal integrity , 88 % vs 90 % for anatomical form , 85 % vs 83 % for marginal discoloration , 88 % vs 93 % for occlusal contact . For both material s , Alpha ratings were 88 % for surface texture . The three-year clinical performances of the two restorative material s were satisfactory and not significantly different for each of the parameters evaluated Dentin bonding using the total-etch method has been cl aim ed to be technique-sensitive . The aim of this study is to examine the effect of acid-etch variations on the dentin demineralization and interfacial structure of the adhesive-dentin bond using a differential staining technique . Single Bond adhesive with 35 % phosphoric acid gel was used . The occlusal one-third of the crown was removed from 60 extracted , unerupted human third molars . Smear layers were created by abrading the dentin with 600 grit SiC under water for 30 s. The prepared teeth were r and omly assigned to four groups according to etching time ( Group 1 , 10 s ; Group 2 , 15 s ; Group 3 , 30 s ; Group 4 , 60 s ) . In each group , the etching gel was : ( i ) applied and spread to the dentin surface and left to st and undisturbed ; ( ii ) applied and gently agitated during etching ; ( iii ) applied without using dispensing tips for the syringe and left for the same period as above . After rinsing , the etched dentin was then treated with the adhesive per manufacturers ' instructions . 3 - 5 micro m thin sections of the adhesive/dentin ( a/d ) interface were cut with a microtome and stained with Goldner 's trichrome . Stained , thin sections from each prepared tooth were imaged with light microscopy . The depth and extent of dentin demineralization , and the a/d interdiffusion zone were clearly visible by this differential staining microtechnique . The thickness of the interdiffusion zone increased as a function of etching time . However , the etchant gel application methods have a significant influence on dentin demineralization . Although agitating acid gel facilitates the penetration and etching into dentin , it should not be recommended , especially for longer etching time . These results indicated that the etching technique has a large effect on the profile of both dentin demineralization and interfacial structure The five-year findings of a study to compare the performance of restorations of Occlusin ( ICI Dental , Macclesfield , UK ) in butt-joint and bevel-edged preparations are reported . Ninety-four ( 79 % ) of the restorations originally placed were review ed at five years , 20 restorations ( 17 % ) having failed during the study . Initial analysis of the overall results having failed to reveal any significant differences between the five-year performance of the two types of restorations , the results were combined and analyzed by Chi-square tests and step-wise logistic regression . Chi-square analysis indicated that of the independent variables investigated , size of restoration had the greatest effect on clinical performance . Step-wise logistic regression revealed that only four of the eight dependent variables investigated showed significant predictive relationships with the independent variables , the logistic equation for occlusal marginal adaptation being the most complex . The greatest amount of generalized occlusal surface wear tended to be seen in large-sized Class II restorations in molar teeth , with the main factor influencing wear being found to be the type of restoration ( Class I or Class II ) . It is concluded that the performance of  restorations of Occlusin  has not been found to differ significantly in butt-joint and bevel-edged preparations after five years in clinical service . Step-wise logistic regression has been found to be a useful tool in the analysis of data obtained during the clinical evaluation of a restorative material Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more A study was conducted to determine whether the wear resistance of a posterior composite could be improved by maximizing filler particle-to-particle contacts . This was expected to reduce stress concentrations on the resin matrix and thus reduce occlusal wear . A self-curing quartz-filled composite with this design , P-10 , was used to restore 90 Class I and II cavity preparations in adult teeth . Restorations were recalled after baseline at six months , one year , two years , and three years to measure wear by direct and indirect evaluation methods . There was no apparent advantage for this material compared with other previously evaluated posterior composites . The average cumulative wear for P-10 after three years was 145 microns . In addition , the restorations were evaluated for color-matching , interfacial staining , secondary caries , marginal adaptation , surface texture , and postoperative sensitivity . This material was not significantly different in those ways from other posterior composite products except in terms of more rapid color change , because it is self-cured Abstract . This study investigated the clinical performance of two packable composite resins  in Class-II restorations . One hundred and four Class-II restorations were placed in 52 patients by five dentists ( four in dental practice s and one in a university clinic ) in a controlled prospect i ve multicentre clinical trial . Each patient received one Definite/Etch & Prime 3.0 ( D-EP ) and one Solitaire/Solid Bond ( S-SB ) restoration , which were examined clinical ly according to modified USPHS- criteria after 1 week ( baseline ) and after 1 year . Statistical analysis was performed using the Wilcoxon rank sum test and the error rates method . The significance level was set to 0.05 . At baseline both material s performed equally according to the evaluated criteria . After 1 year D-EP showed significantly worse marginal adaptation compared to S-SB . Both material s displayed significant deterioration for the criteria marginal adaptation , marginal discolouration , approximal contact , and fracture of restoration after 1 year compared to baseline . With a failure rate of 9.6 % after 1 year , D-EP did not fulfill ADA acceptance criteria for restorative material s. It is proposed that at least 1-year data of clinical testing should be available before a new material is broadly marketed BACKGROUND Self-etching adhesives are believed to prevent postoperative sensitivity when used under posterior resin-based composite restorations . The authors tested a twofold hypothesis : a self-etch , or SE , adhesive would result in less postoperative sensitivity than a total-etch , or TE , adhesive ; an SE adhesive would result in poorer enamel marginal integrity than a TE adhesive . METHODS Patients were selected on the basis of requiring Class I and II restorations in molars and premolars . The authors placed 30 restorations with the SE material ( Clearfil SE Bond , Kuraray America , New York ) and 36 restorations with Prime & Bond NT ( Dentsply Caulk , Milford , Del. ) , which uses 34 percent phosphoric acid to etch enamel and dentin simultaneously . Preparations were of st and ard design , with all margins in enamel without beveling . Upon rubber dam isolation , the authors conditioned the enamel and dentin walls with the self-etching primer ( for Clearfil SE Bond ) or etched with the proprietary 34 percent phosphoric acid ( for Prime & Bond NT ) , followed by application of the corresponding dentin adhesive . Teeth were restored with the proprietary hybrid resin-based composite indicated for posterior restorations : Clearfil AP-X for Clearfil SE Bond or Esthet-X Micro Matrix Restorative for Prime & Bond NT . The restored teeth were evaluated preoperatively and at two weeks , eight weeks and six months postoperatively for sensitivity to cold ( ice ) , air and masticatory forces , as well as for marginal discoloration . RESULTS Analysis of variance revealed no statistically significant differences in postoperative sensitivity between the SE and TE material s at any recall time . Marginal discoloration was rated as " absent " for all restorations at six months . Only one tooth displayed sensitivity to occlusal forces at six months . CONCLUSION The SE adhesive did not differ from the TE adhesive in regard to sensitivity and marginal discoloration . CLINICAL IMPLICATION S Postoperative sensitivity may depend on the restorative technique rather than on the type of dentin adhesive used PURPOSE This longitudinal r and omized controlled clinical trial evaluated direct composite restorations for clinical acceptability as posterior restoratives in single- or multi-surface cavities and provides a survey of the 4-year results . MATERIAL S AND METHODS Three dentists placed 46 Quixfil ( Xeno III ) and 50 Tetric Ceram ( Syntac Classic ) composite restorations in stress-bearing Class I and II cavities in first or second molars ( 43 adult patients ) . Clinical evaluation was performed at baseline and after 4 years by 2 other dentists using modified USPHS criteria . At the last recall period , 37 Quixfil and 46 Tetric Ceram restorations  were assessed . RESULTS A total of 89.2 % of Quixfil and 97.8 % of Tetric Ceram posterior composites were assessed to be clinical ly excellent or acceptable with predominating alfa scores . Up to the 4-year recall , four Quixfil restorations failed because of bulk fracture , partial tooth fracture ( 2x ) and postoperative symptoms . One Tetric Ceram restoration was lost due to problems with tooth integrity . No significant differences between the two composites could be detected at 4 years for any of the evaluated clinical criteria ( p > 0.05 ) . The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration and decrease in marginal integrity for both material s. After 4 years , small restorations exhibited significantly less marginal discoloration than large restorations . CONCLUSION Clinical assessment of stress-bearing Quixfil and Tetric Ceram posterior composite restorations showed good clinical results with predominantly alfa scores for both material OBJECTIVES To analyze the relationship between the cavity depth and liners with postoperative sensitivity of  resin composite restorations .  METHODS A clinical follow-up was conducted on 319 resin composite restorations made in the final year of an undergraduate program over a 3-year period . Along with the analyses of cavity type , cavity depth , type of pulpal protection and the material s used , the postoperative sensitivity was also examined on each restoration . RESULTS Thirty-nine percent of the restorations had no protective layer ( Group 1 ) . As the depth of the prepared cavities increased , the restorations received one of the three pulpal protection methods ; a calcium hydroxide base ( Group 2 ) , glass ionomer cement ( Group 3 ) , or protection with a calcium hydroxide base in combination with glass ionomer cement ( Group 4 ) . The incidence of postoperative sensitivity showed no significant difference among Groups 1 , 2 and 3 , but was significantly lower in Group 1 than in Group 4 . The restorations made in shallow and medium depth cavities demonstrated significantly less-postoperative sensitivity than those made in deep cavities . The newer generation dentine-bonding agents showed a significantly lower incidence of postoperative sensitivity than the early generation group . CONCLUSIONS Postoperative sensitivity in resin  composite restorations was not related to the absence of protective layers but increased with the depth of cavities restored with the resin composite . The type of dentine-bonding agents could also be responsible for postoperative sensitivity Abstract .The purpose of this study was to evaluate the clinical performance of two " packable " posterior composites : Prodigy Condensable ( P ) ( Kerr ) and Definite ( D ) ( Degussa ) .  Thirty-six patients participated in the study . A total of 78 restorations were made , 40 with D and 38 with  P.  Each patient received at least two restorations  , one of each studied material . The material s were h and led according to the manufacturer 's instructions . The restorations were finished and polished after 1 week . They were evaluated at bas 
    Output:
    