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 ) OBJECTIVES This longitudinal r and omized controlled clinical trial evaluated the longevity of composite resin inlays in single- or multi-surface cavities up to 4 years . METHODS 21 dental students placed 75 Artglass and 80 Charisma composite resin inlays in class I and II cavities in posterior teeth ( 89 adult patients ) luted with dual-curing resin cements .  Clinical evaluation was performed up to 4 years using modified USPHS criteria . RESULTS 87.2 % of Artglass and 76.6 % of Charisma inlays were assessed to be clinical ly excellent or acceptable . Up to the 4-year recall 5 Artglass and 11 Charisma inlays failed mainly because of postoperative symptoms , bulk fracture , and loss of marginal integrity . No significant differences between both composite resin material s could be detected at 4 years for all clinical criteria ( Mann-Whitney U-test , p>0.05 ) . The comparison of restoration performance with time yielded a significant increase in marginal discolouration and postoperative symptoms ( p<0.05 ) , deterioration of surface texture quality , marginal and restoration integrity ( p<0.05 ) for both inlay systems . However , the changes were mainly effects of scoring shifts from alfa to bravo . Small inlays compared to large inlays and premolar restorations compared to molar restorations showed significant better outcome for some of the tested clinical parameters for the Artglass inlays ( p<0.05 ) . For Charisma inlays no such influences were revealed . CONCLUSIONS Clinical assessment of Artglass and Charisma composite resin inlays exhibited an annual failure rate of 3.2 % and 5.9 % that is within the range of published data . Within the limitations of this study indirect composite inlays are a competitive restorative procedure in stress-bearing preparations The purpose of this study was to compare the use of direct ( USPHS ) and indirect ( M-L ) systems of evaluating the  occlusal wear of posterior composite restorations . Additionally , this study has utilized the USPHS method to compare the in vivo performance of  posterior resin composite restorations made from four different visible-light-cured material s. Of the 202 restorations placed for this r and omized clinical trial , only those restorations that were scored by both direct and indirect evaluation systems were included in these comparisons . Restorations were evaluated by two calibrated examiners from baseline to 36 months . While there were some differences noted among the four material s , the majority ( 99 % ) of the restorations evaluated in this study received " alpha " or " bravo " scores for all USPHS parameters , indicating acceptable in vivo performance . The results of this study also indicate that there was a consistent relationship between the direct ( USPHS ) and indirect ( M-L scale ) scoring systems . For those restorations that changed anatomic form scores , the mean wear at the alfa/bravo transition was 100 + /- 80 microns . By the 24-month recall examination , the use of the USPHS evaluation system category of anatomic form enabled examiners to differentiate restorations and material s that had experienced little occlusal wear from those that had experienced greater amounts of wear The objective of this r and omized control trial was to compare the five-year clinical performance of direct and indirect resin composite restorations replacing cusps . In 157 patients , 176 restorations were made to restore maxillary premolars with Class II cavities and one missing cusp . Ninety-two direct and 84 indirect resin composite restorations  were placed by two operators , following a strict protocol . Treatment technique and operator were assigned r and omly . Follow-up period was at least 4.5 yrs . Survival rates were determined with time to reparable failure and complete failure as endpoints . Kaplan-Meier five-year survival rates were 86.6 % ( SE 0.27 % ) for reparable failure and 87.2 % ( SE 0.27 % ) for complete failure . Differences between survival rates of direct and indirect restorations [ 89.9 % ( SE 0.34 % ) vs. 83.2 % ( SE 0.42 % ) for reparable failure and 91.2 % ( SE 0.32 % ) vs. 83.2 % ( SE 0.42 % ) for complete failure ] were not statistically significant ( p = .23 for reparable failure ; p = .15 for complete failure ) . Mode of failure was predominantly adhesive . The results suggest that direct and indirect techniques provide comparable results over the long term ( trial registration number : IS RCT N29200848 ) PURPOSE This study aim ed to assess the efficacy and short-term effectiveness of the morphology and function of direct and indirect cusp-replacing resin composite restorations . MATERIAL S AND METHODS In 94 patients , 106 cusp-replacing restorations for maxillary premolars were fabricated to restore Class II caries lesions with 1 cusp missing . Fifty-four direct ( Clearfil AP-X ) and 52 indirect ( Estenia ) resin composite restorations were placed following a strict protocol . The treatment technique and operator were assigned r and omly . Treatment time was recorded for all restorations . One-month postoperative evaluation included assessment of postoperative sensitivity and presence of occlusal and proximal contacts . RESULTS Treatment time for the indirect technique ( 68 + /- 17 min ) was longer than for the direct technique ( 45 + /- 13 min ) . Regression analysis revealed that the restorative method , operator , and location of the preparation outline had a statistically significant effect on the total treatment time . Occlusal contacts were observed in 94 % of the direct restorations and in 98 % of the indirect restorations ( chi-square , P>.05 ) . Mesial proximal contacts were present in 98 % of the direct and in 97 % of the indirect restorations ( chi-square , P > .05 ) . Distal contacts were present in 100 % of the restorations for both techniques . Postoperative sensitivity within 1 week posttreatment was reported for 11 % of the direct restorations and for 13 % of the indirect restorations , but decreased to 4 % and 6 % , respectively , after 1 month ( chi-square , P > .05 ) . CONCLUSION The results of this study suggest that in the short term , both direct and indirect adhesive techniques are adequate to restore the morphology and function of premolars presenting with Class II caries lesions and a missing cusp STATEMENT OF THE PROBLEM Objective long-term clinical data are necessary to assess the performance of modern posterior composites as direct and indirect restorations . PURPOSE This prospect i ve , long-term clinical trial evaluated direct and indirect composite restorations for clinical acceptability as posterior restoratives in single or multisurface cavities and provided a survey on the 3-year results . MATERIAL AND METHODS Under the supervision of an experienced dentist , 9 dental students placed 88 composite restorations ( Tetric , blend-a-lux , Pertac-Hybrid Unifil ) , 43 direct composite restorations , and 45 indirect inlays .  Clinical evaluation was performed at baseline and in yearly intervals after placement by 2 other experienced dentists , using modified USPHS criteria . A third follow-up of 60 restorations took place within 33 to 36 months after placement . RESULTS A total of 93 % of indirect and 87 % of direct restorations were assessed to be clinical ly excellent or acceptable . During the third year , 1 direct restoration in a molar failed because of margin opening . Indirect inlays exhibited a significantly better anatomic form of the surface than direct composite restorations . Premolars revealed a significantly better marginal integrity and anatomic form of the surface than molars . Restorations in molars exhibited a significantly higher failure rate compared with premolars . CONCLUSION Posterior composite restorations provided a satisfactory clinical performance over a 3-year period , even if placed by relatively inexperienced but supervised students This study compared microleakage between  indirect composite inlays and direct composite restorations . Forty-eight st and ard inlay MOD cavities , with cervical margins located either in enamel or dentin , were prepared in extracted human third molars . The specimens were r and omly divided into 3 groups ( n=16 ) . In the control group , the cavities were restored with the composite Filtek Z250 ( 3 M ESPE ) . For the experimental groups , indirect restorations were made with the Artglass ( Heraeus-Kulzer ) or Belleglass HP ( Kerr Laboratories ) systems and cemented with the dual curing cement RelyX ARC ( 3 M ESPE ) . The adhesive system Single Bond ( 3 M ESPE ) was applied on all groups . The specimens were su bmi tted to thermolcycling , coated with nail varnish , then immersed in 2 % basic fuchsine aqueous solution for 24 hours . The teeth were then sectioned and leakage scores were evaluated ( 40x ) , based on a st and ard ranking . Data were su bmi tted to statistical analysis ( Mann-Whitney and Kruskal-Wallis tests ) with a 95 % confidence level . No statistical difference was found between substrates ( p=0.595 ) , and the material s performed similarly in dentin ( p=0.482 ) . Direct restorations showed higher leakage than indirect restorations at the enamel margins ( p=0.004 ) . Within the limitations of this experimental design , overall leakage was similar between both substrates , while the indirect systems provided a better sealing than direct composites only in enamel This study compared the clinical performance of  indirectly manufactured ceramic Evopress inlays with those of directly placed , fine particle hybrid Filtek Z250 composite restorations in posterior teeth . From January 2000 to October 2003 , 109 patients received 264 Evopress ( Wegold ) ceramic inlays and 68 patients received 145 Filtek Z250 ( 3 M ESPE ) composite restorations in a dental office . Two-hundred and fifty ceramic inlays ( 95 % ) and 135 composite restorations ( 93 % ) were re-examined up to 57 months after placement . Modified USPHS criteria were used for the study . The worst finding of all the assessment s was the overall assessment of individual restorations . On the basis of these criteria , 220 ( 88 % ) Evopress ceramic inlays were assessed as Alpha at the time of clinical re-examination , 26 ( 10 % ) were judged Beta and four ceramic inlays ( 2 % ) were rated Delta in the re-examination interval and thus categorized as failures . At the time of re-examination , 91 of the 135 composite restorations ( 67 % ) were judged Alpha , 36 restorations ( 26 % ) were rated Beta and three restorations ( 2 % ) were judged Charlie . Five restorations ( 4 % ) were categorized as failures ( Delta ) . In two cases , there were marginal gap formations ; there were also two cases of secondary caries after 28 and 35 months , as well as a fracture after 13 months . According to Kaplan and Meier , the survival rate after 57 months was 94 % for ceramic inlays and 93 % for composite restorations . The log rank test showed no significant differences in the survival curves . The current study showed that indirectly manufactured Evopress ceramic inlays performed better than direct Filtek Z250 composite restorations in marginal adaptation , color match and anatomic form . However , with regard to survival probability , there was no significant difference OBJECTIVE The study evaluated the clinical performance and marginal adaptation of  direct and semi-direct class II composite restorations  in a split-mouth design over 3.5 years . DESIGN 44 upper posterior teeth in 11 adults with primary carious lesions were treated with 22  direct and 22  semi-direct restorations . Conventional cavities were prepared for both types of restorations . A fine fine hybrid composite ( APH ) and a multifunctional adhesive system ( Prisma universal bond 3 ) were used for all restorations . The incremental " 3-sited light curing " technique was applied to direct restorations . Semi-direct inlays were prefab 
    Output:
    
agent
The difference of the two techniques did not reach statistical significance in order to recommend one technique over the other .
CLINICAL SIGNIFICANCE Resin composite material s , placed directly or indirectly , exhibit a promising long-term clinical performance when rehabilitation of posterior teeth is needed .
***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 ) OBJECTIVES This longitudinal r and omized controlled clinical trial evaluated the longevity of composite resin inlays in single- or multi-surface cavities up to 4 years . METHODS 21 dental students placed 75 Artglass and 80 Charisma composite resin inlays in class I and II cavities in posterior teeth ( 89 adult patients ) luted with dual-curing resin cements .  Clinical evaluation was performed up to 4 years using modified USPHS criteria . RESULTS 87.2 % of Artglass and 76.6 % of Charisma inlays were assessed to be clinical ly excellent or acceptable . Up to the 4-year recall 5 Artglass and 11 Charisma inlays failed mainly because of postoperative symptoms , bulk fracture , and loss of marginal integrity . No significant differences between both composite resin material s could be detected at 4 years for all clinical criteria ( Mann-Whitney U-test , p>0.05 ) . The comparison of restoration performance with time yielded a significant increase in marginal discolouration and postoperative symptoms ( p<0.05 ) , deterioration of surface texture quality , marginal and restoration integrity ( p<0.05 ) for both inlay systems . However , the changes were mainly effects of scoring shifts from alfa to bravo . Small inlays compared to large inlays and premolar restorations compared to molar restorations showed significant better outcome for some of the tested clinical parameters for the Artglass inlays ( p<0.05 ) . For Charisma inlays no such influences were revealed . CONCLUSIONS Clinical assessment of Artglass and Charisma composite resin inlays exhibited an annual failure rate of 3.2 % and 5.9 % that is within the range of published data . Within the limitations of this study indirect composite inlays are a competitive restorative procedure in stress-bearing preparations The purpose of this study was to compare the use of direct ( USPHS ) and indirect ( M-L ) systems of evaluating the  occlusal wear of posterior composite restorations . Additionally , this study has utilized the USPHS method to compare the in vivo performance of  posterior resin composite restorations made from four different visible-light-cured material s. Of the 202 restorations placed for this r and omized clinical trial , only those restorations that were scored by both direct and indirect evaluation systems were included in these comparisons . Restorations were evaluated by two calibrated examiners from baseline to 36 months . While there were some differences noted among the four material s , the majority ( 99 % ) of the restorations evaluated in this study received " alpha " or " bravo " scores for all USPHS parameters , indicating acceptable in vivo performance . The results of this study also indicate that there was a consistent relationship between the direct ( USPHS ) and indirect ( M-L scale ) scoring systems . For those restorations that changed anatomic form scores , the mean wear at the alfa/bravo transition was 100 + /- 80 microns . By the 24-month recall examination , the use of the USPHS evaluation system category of anatomic form enabled examiners to differentiate restorations and material s that had experienced little occlusal wear from those that had experienced greater amounts of wear The objective of this r and omized control trial was to compare the five-year clinical performance of direct and indirect resin composite restorations replacing cusps . In 157 patients , 176 restorations were made to restore maxillary premolars with Class II cavities and one missing cusp . Ninety-two direct and 84 indirect resin composite restorations  were placed by two operators , following a strict protocol . Treatment technique and operator were assigned r and omly . Follow-up period was at least 4.5 yrs . Survival rates were determined with time to reparable failure and complete failure as endpoints . Kaplan-Meier five-year survival rates were 86.6 % ( SE 0.27 % ) for reparable failure and 87.2 % ( SE 0.27 % ) for complete failure . Differences between survival rates of direct and indirect restorations [ 89.9 % ( SE 0.34 % ) vs. 83.2 % ( SE 0.42 % ) for reparable failure and 91.2 % ( SE 0.32 % ) vs. 83.2 % ( SE 0.42 % ) for complete failure ] were not statistically significant ( p = .23 for reparable failure ; p = .15 for complete failure ) . Mode of failure was predominantly adhesive . The results suggest that direct and indirect techniques provide comparable results over the long term ( trial registration number : IS RCT N29200848 ) PURPOSE This study aim ed to assess the efficacy and short-term effectiveness of the morphology and function of direct and indirect cusp-replacing resin composite restorations . MATERIAL S AND METHODS In 94 patients , 106 cusp-replacing restorations for maxillary premolars were fabricated to restore Class II caries lesions with 1 cusp missing . Fifty-four direct ( Clearfil AP-X ) and 52 indirect ( Estenia ) resin composite restorations were placed following a strict protocol . The treatment technique and operator were assigned r and omly . Treatment time was recorded for all restorations . One-month postoperative evaluation included assessment of postoperative sensitivity and presence of occlusal and proximal contacts . RESULTS Treatment time for the indirect technique ( 68 + /- 17 min ) was longer than for the direct technique ( 45 + /- 13 min ) . Regression analysis revealed that the restorative method , operator , and location of the preparation outline had a statistically significant effect on the total treatment time . Occlusal contacts were observed in 94 % of the direct restorations and in 98 % of the indirect restorations ( chi-square , P>.05 ) . Mesial proximal contacts were present in 98 % of the direct and in 97 % of the indirect restorations ( chi-square , P > .05 ) . Distal contacts were present in 100 % of the restorations for both techniques . Postoperative sensitivity within 1 week posttreatment was reported for 11 % of the direct restorations and for 13 % of the indirect restorations , but decreased to 4 % and 6 % , respectively , after 1 month ( chi-square , P > .05 ) . CONCLUSION The results of this study suggest that in the short term , both direct and indirect adhesive techniques are adequate to restore the morphology and function of premolars presenting with Class II caries lesions and a missing cusp STATEMENT OF THE PROBLEM Objective long-term clinical data are necessary to assess the performance of modern posterior composites as direct and indirect restorations . PURPOSE This prospect i ve , long-term clinical trial evaluated direct and indirect composite restorations for clinical acceptability as posterior restoratives in single or multisurface cavities and provided a survey on the 3-year results . MATERIAL AND METHODS Under the supervision of an experienced dentist , 9 dental students placed 88 composite restorations ( Tetric , blend-a-lux , Pertac-Hybrid Unifil ) , 43 direct composite restorations , and 45 indirect inlays .  Clinical evaluation was performed at baseline and in yearly intervals after placement by 2 other experienced dentists , using modified USPHS criteria . A third follow-up of 60 restorations took place within 33 to 36 months after placement . RESULTS A total of 93 % of indirect and 87 % of direct restorations were assessed to be clinical ly excellent or acceptable . During the third year , 1 direct restoration in a molar failed because of margin opening . Indirect inlays exhibited a significantly better anatomic form of the surface than direct composite restorations . Premolars revealed a significantly better marginal integrity and anatomic form of the surface than molars . Restorations in molars exhibited a significantly higher failure rate compared with premolars . CONCLUSION Posterior composite restorations provided a satisfactory clinical performance over a 3-year period , even if placed by relatively inexperienced but supervised students This study compared microleakage between  indirect composite inlays and direct composite restorations . Forty-eight st and ard inlay MOD cavities , with cervical margins located either in enamel or dentin , were prepared in extracted human third molars . The specimens were r and omly divided into 3 groups ( n=16 ) . In the control group , the cavities were restored with the composite Filtek Z250 ( 3 M ESPE ) . For the experimental groups , indirect restorations were made with the Artglass ( Heraeus-Kulzer ) or Belleglass HP ( Kerr Laboratories ) systems and cemented with the dual curing cement RelyX ARC ( 3 M ESPE ) . The adhesive system Single Bond ( 3 M ESPE ) was applied on all groups . The specimens were su bmi tted to thermolcycling , coated with nail varnish , then immersed in 2 % basic fuchsine aqueous solution for 24 hours . The teeth were then sectioned and leakage scores were evaluated ( 40x ) , based on a st and ard ranking . Data were su bmi tted to statistical analysis ( Mann-Whitney and Kruskal-Wallis tests ) with a 95 % confidence level . No statistical difference was found between substrates ( p=0.595 ) , and the material s performed similarly in dentin ( p=0.482 ) . Direct restorations showed higher leakage than indirect restorations at the enamel margins ( p=0.004 ) . Within the limitations of this experimental design , overall leakage was similar between both substrates , while the indirect systems provided a better sealing than direct composites only in enamel This study compared the clinical performance of  indirectly manufactured ceramic Evopress inlays with those of directly placed , fine particle hybrid Filtek Z250 composite restorations in posterior teeth . From January 2000 to October 2003 , 109 patients received 264 Evopress ( Wegold ) ceramic inlays and 68 patients received 145 Filtek Z250 ( 3 M ESPE ) composite restorations in a dental office . Two-hundred and fifty ceramic inlays ( 95 % ) and 135 composite restorations ( 93 % ) were re-examined up to 57 months after placement . Modified USPHS criteria were used for the study . The worst finding of all the assessment s was the overall assessment of individual restorations . On the basis of these criteria , 220 ( 88 % ) Evopress ceramic inlays were assessed as Alpha at the time of clinical re-examination , 26 ( 10 % ) were judged Beta and four ceramic inlays ( 2 % ) were rated Delta in the re-examination interval and thus categorized as failures . At the time of re-examination , 91 of the 135 composite restorations ( 67 % ) were judged Alpha , 36 restorations ( 26 % ) were rated Beta and three restorations ( 2 % ) were judged Charlie . Five restorations ( 4 % ) were categorized as failures ( Delta ) . In two cases , there were marginal gap formations ; there were also two cases of secondary caries after 28 and 35 months , as well as a fracture after 13 months . According to Kaplan and Meier , the survival rate after 57 months was 94 % for ceramic inlays and 93 % for composite restorations . The log rank test showed no significant differences in the survival curves . The current study showed that indirectly manufactured Evopress ceramic inlays performed better than direct Filtek Z250 composite restorations in marginal adaptation , color match and anatomic form . However , with regard to survival probability , there was no significant difference OBJECTIVE The study evaluated the clinical performance and marginal adaptation of  direct and semi-direct class II composite restorations  in a split-mouth design over 3.5 years . DESIGN 44 upper posterior teeth in 11 adults with primary carious lesions were treated with 22  direct and 22  semi-direct restorations . Conventional cavities were prepared for both types of restorations . A fine fine hybrid composite ( APH ) and a multifunctional adhesive system ( Prisma universal bond 3 ) were used for all restorations . The incremental " 3-sited light curing " technique was applied to direct restorations . Semi-direct inlays were prefab 
    Output:
    