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 This paper examines the evidence demonstrating the effectiveness of sealants in high-caries-risk children and discusses the Research Triangle Institute/University of North Carolina 's ( RTI/UNC ) systematic review . The strict RTI/UNC protocol limited the number of sealant studies that could be included . This analysis exp and ed their criteria to permit additional methods of determining caries risk ( for example , past caries experience , less than two pairs of sound first permanent molars available/child in half-mouth design s ) and outcome measures in addition to DMFS ( that is , percent sealant retention , survival rates , cost-effectiveness , changes in salivary S. mutans levels ) . Nine clinical studies with a r and omized , half-mouth , clinical trial design and seven studies with observational study design s were included . There is good evidence that  sealants can be used efficaciously and effectively in high-risk  children as long as the sealant is retained . Sealants are more effective in preventing further caries and providing cost savings in a shorter time span if placed in children who have high rather than low caries risk This study aim ed to assess the in vitro efficacy of the lasers Er : YAG , Nd : YAG , and CO(2 ) operating in the low energy mode for caries prevention in pits and fissures . Forty-five caries-free enamel occlusal sections were r and omly divided into three groups : G1 - Er : YAG ( 80 mJ/2 Hz ) ; G2 - Nd : YAG Laser ( 1 W and 10 Hz ) ; and G3 - CO(2 ) Laser ( 0.4 W and 20 Hz ) . After surface treatment , the sample s were su bmi tted to challenge with acid consisting of a 10-day immersion in demineralizing ( 6 h ) and remineralizing solution ( 18 h ) . Next , enamel demineralization was quantitatively evaluated by subsurface microhardness test and polarized-light microscopy ( PLM , mm(2 ) ) and qualitatively assessed by scanning electron microscopy . The Wilcoxon test was used for comparison of each group with its own control . ANOVA ( α = 5 % ) was employed for comparison among groups , and Fisher 's LSD multiple comparison test was applied , to check the difference in means . Concerning the microhardness analyses , statistical difference between control , and experimental areas was only detected for the CO(2 ) group . Experimental values were higher than the controls . As for PLM analyses , smaller demineralized areas were measured for G2 ( Nd : YAG ) and G3 ( CO(2 ) ) compared with the control areas . In conclusion , the present findings suggest that the CO(2 ) laser should be selected in order to increase the enamel resistance to acid in pits and fissures Objective : This study was performed to assess the resin tag length penetration in enamel surface after bonding of brackets to identify which system was most efficient . Methodology : Our study was based on a more robust confocal microscopy for visualizing the resin tags in enamel . Totally , 100 extracted human first and second premolars have been selected for this study and were r and omly divided into ten groups of 10 teeth each . In Group 1 , the buccal enamel surface was etched with 37 % phosphoric acid ( 3 M ESPE ) , Group 2 with 37 % phosphoric ( Ultradent ) . In Groups 5 , 6 , and 7 , erbium , chromium-doped : Yttrium sc and ium-gallium-garnet ( Er , Cr : YSGG ) laser ( Biolase ) was used for etching the using following specifications : Group 5 ( 1.5 W/20 Hz , 15 s ) , Group 6 ( 2 W/10 Hz , 15 s ) , and Group 7 ( 2 W/20 Hz , 15 s ) . In Groups 8 , 9 , and 10 , Er , Cr : YSGG laser ( Biolase ) using same specifications and additional to this step , conventional etching on the buccal enamel surface was etched with 37 % ( 3 M ESPE ) after laser etching . In Groups 1 , 5 , 6 , 7 , 8 , 9 , and 10 3 M Unitek Transbond XT primer was mixed with Rhodamine B dye ( Sigma-Aldrich , Germany ) to etched surface and then cured for 20 s. In Group 2 , Ultradents bonding agent was mixed with Rhodamine B. In Group 3 , 3 M Unitek Transbond PLUS , Monrovia , USA , which was mixed with Rhodamine B dye ( Sigma-Aldrich , Germany ) . Group 4 , with self-etching primer ( Ultradent-Peak SE , USA ) was mixed with Rhodamine B dye ( Sigma-Aldrich , Germany ) . Later ( 3 M Unitek , Transbond XT , Monrovia USA ) [ Figure 1 ] was used to bond the modified Begg brackets ( T. P. Orthodontics ) in Groups 1 , 3 , 5 , 6 , 7 , 8 , 9 , and 10 . In Groups 2 , 4 Ultradent-Peak LC Bond was used to bond the modified brackets . After curing brackets were debonded , and enamel depth penetration was assessed using confocal laser scanning microscope . Results : Group J had a mean maximum depth of penetration of 100.876 μm , and Group D was the least having a maximum value of 44.254 μm . Conclusions : Laser alone groups had comparable depths of penetration to that of self-etching groups but much lower than conventional acid etched groups Objectives The purpose of this in vitro study was to evaluate the microleakage and penetration of fissure sealant  in permanent molar teeth with fluorosis after pretreatment of the occlusal surface . Material s and Methods A total of 120 third molars with mild dental fluorosis were r and omly divided into 6 groups ( n = 20 ) . The tooth surfaces were sealed with an unfilled resin fissure sealant ( FS ) material . The experimental groups included : 1 ) phosphoric acid etching ( AE ) + FS ( control ) ; 2 ) AE + One-Step Plus ( OS , Bisco ) + FS ; 3 ) bur + AE + FS ; 4 ) bur + AE + OS + FS ; 5 ) Er : YAG laser + AE + FS ; and 6 ) Er : YAG laser + AE + OS + FS . After thermocycling , the teeth were immersed in 0.5 % fuchsin and sectioned . Proportions of mircoleakage ( PM ) and unfilled area ( PUA ) were measured by digital microscope . Results Overall , there were significant differences among all groups in the PM ( p = 0.00 ) . Group 3 showed the greatest PM , and was significantly different from groups 2 to 6 ( p < 0.05 ) . Group 6 showed the lowest PM . Pretreatment with Er : YAG with or without adhesive led to less PM than bur pretreatment . There were no significant differences among groups in PUA . Conclusions Conventional acid etching provided a similar degree of occlusal seal in teeth with fluorosis compared to those pretreated with a bur or Er : YAG laser . Pretreatment of pits and fissures with Er : YAG in teeth with fluorosis may be an alternative method before fissure sealant application A split mouth clinical trial was undertaken to compare the  retention of fissure sealants placed using laser or acid conditioning .  After a mean follow-up period of 14.5 months , the retention rate for laser conditioning was greater than that for acid etching ( 97.9 per cent versus 94.6 per cent , respectively ) , although this difference was not statistically significant . No adverse effects occurred during or subsequent to laser conditioning procedures . It is concluded that carbon dioxide laser conditioning is a viable alternative to acid etching for fissure sealing OBJECTIVE This clinical study compared the retention rates of a nanofilled occlusal fissure sealant placed with the use of an etch- and -rinse or a self-etch adhesive over 24 months . METHODS Two-hundred and forty-four sealants were placed on the permanent premolars and molars of 16 subjects who had no restorations or sealants present on the fissures and no detectable caries . The sealants were placed with either SoloBond M two-step etch- and -rinse adhesive or FuturaBond NR one-step self-etch adhesive by four previously calibrated dentists , using a table of r and om numbers . After completion of the adhesive application , a nanofilled sealant , Gr and io Seal , was applied and light-cured . Clinical evaluations were done at baseline and at 1- , 3- , 6- , 12- , 18- and 24-month recalls . Two other calibrated examiners , who were unaware of which adhesive had been used , independently evaluated the sealants . Evaluation of the sealants on every follow-up visit involved visual examination with the aid of a dental explorer and an intra-oral mirror . Each sealant was evaluated with the following criteria : 1 = completely retained ; 2 = partial loss ; 3 = total loss . The Pearson Chi-square test was used to evaluate differences in the retention rates among the sealants used with different adhesives for each evaluation period . RESULTS For the 12-month recalls , complete retention rates of 89.3 % for the SoloBond M group and 20.5 % for the FuturaBond NR group were observed . Sixteen of the 244 restorations were unavailable after 12 months . At 24 months , a total loss of 9 sealants in the SoloBond M group and 84 in the FuturaBond NR group were observed , result ing in retention rates of 81.6 % and 15.8 % , respectively . There were statistically significant differences in retention rates between the SoloBond M and FuturaBond NR groups in all periods of evaluation ( p < 0.05 ) . No statistically significant difference between the retention rates for premolars and molars was found at each evaluation period ( p > 0.05 ) . There was no new caries formation throughout the 24-month recall period . CONCLUSION Fissure sealants placed with etch- and -rinse adhesive showed better retention rates than those placed with self-etch adhesive BACKGROUND Fissure sealants prevent occlusal caries in permanent molars .  Enamel preparation methods are used before fissure sealing . AIMS To investigate effects of bioglass air-abrasion pre-treatment with and without an adhesive , on fissure enamel of permanent teeth , with respect to etchability , microleakage and microtensile bond strength . DESIGN Half of the occlusal surfaces of 50 extracted premolars underwent bioglass air-abrasion . Dye was applied to the entire occlusal surface . Photographs were taken to score etched surface by dye uptake . Adhesive was applied to 25 of the bioglass-treated areas and all teeth were fissure sealed , sectioned , and evaluated using confocal microscopy . Buccal and lingual surfaces of a further eight premolars were acid-etched and r and omly received : air-abrasion , adhesive , both , or none before sealant application for microtensile bond strength measurement in half of the sample s immediately and half following 6 months of water immersion . RESULTS Linear mixed models and multinomial logistic regression were used ( P = 0.05 ) . Bioglass air-abrasion significantly improved enamel etchability and reduced microleakage . The addition of an adhesive made no difference to either microleakage or microtensile bond strength . The combination of bioglass abrasion and adhesive led to more cohesive , rather than adhesive , failure . CONCLUSIONS Bioglass air-abrasion improved enamel etchability and reduced microleakage irrespective of the adhesive use but neither pre-treatment affected the microtensile bond strength Objective : Micro-leakage , one of the major reasons for recurrent decays , may lead to uncontrollable flow of liquids , pulp inflammation and peri-apical pathology . The purpose of this in vitro study was to evaluate micro-leakage of pit and fissure sealants after using three different pit and fissure preparation techniques : 1 ) acid etching , 2 ) fissure enameloplasty and acid etching , and 3 ) air abrasion and acid etching . Material s and Methods : Sixty-nine extracted sound molars and premolars were r and omly divided into three groups ( 23 sample s in each group ) . Teeth were prepared using one of three occlusal surface treatments . Then the sealant was applied on the occlusal fissures of all teeth . The teeth were thermocycled and stored in normal saline . All teeth were sealed apically and coated with nail varnish and then were immersed in a 2 % solution of methylen blue 
    Output:
    
agent
One study reported that laser preparation as an adjunct to acid-etching enhanced the retention rate .
No significant difference in the incidence of caries was reported .
And no significant differences were found in heart rates , oxygen saturation or degree of the patient dental anxiety between acid-etching and laser preparation .
Conclusion The present limited evidence suggests that lasers could be an effective pretreatment method .
The retention rate was similar to that of conventional acid etching .
***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 This paper examines the evidence demonstrating the effectiveness of sealants in high-caries-risk children and discusses the Research Triangle Institute/University of North Carolina 's ( RTI/UNC ) systematic review . The strict RTI/UNC protocol limited the number of sealant studies that could be included . This analysis exp and ed their criteria to permit additional methods of determining caries risk ( for example , past caries experience , less than two pairs of sound first permanent molars available/child in half-mouth design s ) and outcome measures in addition to DMFS ( that is , percent sealant retention , survival rates , cost-effectiveness , changes in salivary S. mutans levels ) . Nine clinical studies with a r and omized , half-mouth , clinical trial design and seven studies with observational study design s were included . There is good evidence that  sealants can be used efficaciously and effectively in high-risk  children as long as the sealant is retained . Sealants are more effective in preventing further caries and providing cost savings in a shorter time span if placed in children who have high rather than low caries risk This study aim ed to assess the in vitro efficacy of the lasers Er : YAG , Nd : YAG , and CO(2 ) operating in the low energy mode for caries prevention in pits and fissures . Forty-five caries-free enamel occlusal sections were r and omly divided into three groups : G1 - Er : YAG ( 80 mJ/2 Hz ) ; G2 - Nd : YAG Laser ( 1 W and 10 Hz ) ; and G3 - CO(2 ) Laser ( 0.4 W and 20 Hz ) . After surface treatment , the sample s were su bmi tted to challenge with acid consisting of a 10-day immersion in demineralizing ( 6 h ) and remineralizing solution ( 18 h ) . Next , enamel demineralization was quantitatively evaluated by subsurface microhardness test and polarized-light microscopy ( PLM , mm(2 ) ) and qualitatively assessed by scanning electron microscopy . The Wilcoxon test was used for comparison of each group with its own control . ANOVA ( α = 5 % ) was employed for comparison among groups , and Fisher 's LSD multiple comparison test was applied , to check the difference in means . Concerning the microhardness analyses , statistical difference between control , and experimental areas was only detected for the CO(2 ) group . Experimental values were higher than the controls . As for PLM analyses , smaller demineralized areas were measured for G2 ( Nd : YAG ) and G3 ( CO(2 ) ) compared with the control areas . In conclusion , the present findings suggest that the CO(2 ) laser should be selected in order to increase the enamel resistance to acid in pits and fissures Objective : This study was performed to assess the resin tag length penetration in enamel surface after bonding of brackets to identify which system was most efficient . Methodology : Our study was based on a more robust confocal microscopy for visualizing the resin tags in enamel . Totally , 100 extracted human first and second premolars have been selected for this study and were r and omly divided into ten groups of 10 teeth each . In Group 1 , the buccal enamel surface was etched with 37 % phosphoric acid ( 3 M ESPE ) , Group 2 with 37 % phosphoric ( Ultradent ) . In Groups 5 , 6 , and 7 , erbium , chromium-doped : Yttrium sc and ium-gallium-garnet ( Er , Cr : YSGG ) laser ( Biolase ) was used for etching the using following specifications : Group 5 ( 1.5 W/20 Hz , 15 s ) , Group 6 ( 2 W/10 Hz , 15 s ) , and Group 7 ( 2 W/20 Hz , 15 s ) . In Groups 8 , 9 , and 10 , Er , Cr : YSGG laser ( Biolase ) using same specifications and additional to this step , conventional etching on the buccal enamel surface was etched with 37 % ( 3 M ESPE ) after laser etching . In Groups 1 , 5 , 6 , 7 , 8 , 9 , and 10 3 M Unitek Transbond XT primer was mixed with Rhodamine B dye ( Sigma-Aldrich , Germany ) to etched surface and then cured for 20 s. In Group 2 , Ultradents bonding agent was mixed with Rhodamine B. In Group 3 , 3 M Unitek Transbond PLUS , Monrovia , USA , which was mixed with Rhodamine B dye ( Sigma-Aldrich , Germany ) . Group 4 , with self-etching primer ( Ultradent-Peak SE , USA ) was mixed with Rhodamine B dye ( Sigma-Aldrich , Germany ) . Later ( 3 M Unitek , Transbond XT , Monrovia USA ) [ Figure 1 ] was used to bond the modified Begg brackets ( T. P. Orthodontics ) in Groups 1 , 3 , 5 , 6 , 7 , 8 , 9 , and 10 . In Groups 2 , 4 Ultradent-Peak LC Bond was used to bond the modified brackets . After curing brackets were debonded , and enamel depth penetration was assessed using confocal laser scanning microscope . Results : Group J had a mean maximum depth of penetration of 100.876 μm , and Group D was the least having a maximum value of 44.254 μm . Conclusions : Laser alone groups had comparable depths of penetration to that of self-etching groups but much lower than conventional acid etched groups Objectives The purpose of this in vitro study was to evaluate the microleakage and penetration of fissure sealant  in permanent molar teeth with fluorosis after pretreatment of the occlusal surface . Material s and Methods A total of 120 third molars with mild dental fluorosis were r and omly divided into 6 groups ( n = 20 ) . The tooth surfaces were sealed with an unfilled resin fissure sealant ( FS ) material . The experimental groups included : 1 ) phosphoric acid etching ( AE ) + FS ( control ) ; 2 ) AE + One-Step Plus ( OS , Bisco ) + FS ; 3 ) bur + AE + FS ; 4 ) bur + AE + OS + FS ; 5 ) Er : YAG laser + AE + FS ; and 6 ) Er : YAG laser + AE + OS + FS . After thermocycling , the teeth were immersed in 0.5 % fuchsin and sectioned . Proportions of mircoleakage ( PM ) and unfilled area ( PUA ) were measured by digital microscope . Results Overall , there were significant differences among all groups in the PM ( p = 0.00 ) . Group 3 showed the greatest PM , and was significantly different from groups 2 to 6 ( p < 0.05 ) . Group 6 showed the lowest PM . Pretreatment with Er : YAG with or without adhesive led to less PM than bur pretreatment . There were no significant differences among groups in PUA . Conclusions Conventional acid etching provided a similar degree of occlusal seal in teeth with fluorosis compared to those pretreated with a bur or Er : YAG laser . Pretreatment of pits and fissures with Er : YAG in teeth with fluorosis may be an alternative method before fissure sealant application A split mouth clinical trial was undertaken to compare the  retention of fissure sealants placed using laser or acid conditioning .  After a mean follow-up period of 14.5 months , the retention rate for laser conditioning was greater than that for acid etching ( 97.9 per cent versus 94.6 per cent , respectively ) , although this difference was not statistically significant . No adverse effects occurred during or subsequent to laser conditioning procedures . It is concluded that carbon dioxide laser conditioning is a viable alternative to acid etching for fissure sealing OBJECTIVE This clinical study compared the retention rates of a nanofilled occlusal fissure sealant placed with the use of an etch- and -rinse or a self-etch adhesive over 24 months . METHODS Two-hundred and forty-four sealants were placed on the permanent premolars and molars of 16 subjects who had no restorations or sealants present on the fissures and no detectable caries . The sealants were placed with either SoloBond M two-step etch- and -rinse adhesive or FuturaBond NR one-step self-etch adhesive by four previously calibrated dentists , using a table of r and om numbers . After completion of the adhesive application , a nanofilled sealant , Gr and io Seal , was applied and light-cured . Clinical evaluations were done at baseline and at 1- , 3- , 6- , 12- , 18- and 24-month recalls . Two other calibrated examiners , who were unaware of which adhesive had been used , independently evaluated the sealants . Evaluation of the sealants on every follow-up visit involved visual examination with the aid of a dental explorer and an intra-oral mirror . Each sealant was evaluated with the following criteria : 1 = completely retained ; 2 = partial loss ; 3 = total loss . The Pearson Chi-square test was used to evaluate differences in the retention rates among the sealants used with different adhesives for each evaluation period . RESULTS For the 12-month recalls , complete retention rates of 89.3 % for the SoloBond M group and 20.5 % for the FuturaBond NR group were observed . Sixteen of the 244 restorations were unavailable after 12 months . At 24 months , a total loss of 9 sealants in the SoloBond M group and 84 in the FuturaBond NR group were observed , result ing in retention rates of 81.6 % and 15.8 % , respectively . There were statistically significant differences in retention rates between the SoloBond M and FuturaBond NR groups in all periods of evaluation ( p < 0.05 ) . No statistically significant difference between the retention rates for premolars and molars was found at each evaluation period ( p > 0.05 ) . There was no new caries formation throughout the 24-month recall period . CONCLUSION Fissure sealants placed with etch- and -rinse adhesive showed better retention rates than those placed with self-etch adhesive BACKGROUND Fissure sealants prevent occlusal caries in permanent molars .  Enamel preparation methods are used before fissure sealing . AIMS To investigate effects of bioglass air-abrasion pre-treatment with and without an adhesive , on fissure enamel of permanent teeth , with respect to etchability , microleakage and microtensile bond strength . DESIGN Half of the occlusal surfaces of 50 extracted premolars underwent bioglass air-abrasion . Dye was applied to the entire occlusal surface . Photographs were taken to score etched surface by dye uptake . Adhesive was applied to 25 of the bioglass-treated areas and all teeth were fissure sealed , sectioned , and evaluated using confocal microscopy . Buccal and lingual surfaces of a further eight premolars were acid-etched and r and omly received : air-abrasion , adhesive , both , or none before sealant application for microtensile bond strength measurement in half of the sample s immediately and half following 6 months of water immersion . RESULTS Linear mixed models and multinomial logistic regression were used ( P = 0.05 ) . Bioglass air-abrasion significantly improved enamel etchability and reduced microleakage . The addition of an adhesive made no difference to either microleakage or microtensile bond strength . The combination of bioglass abrasion and adhesive led to more cohesive , rather than adhesive , failure . CONCLUSIONS Bioglass air-abrasion improved enamel etchability and reduced microleakage irrespective of the adhesive use but neither pre-treatment affected the microtensile bond strength Objective : Micro-leakage , one of the major reasons for recurrent decays , may lead to uncontrollable flow of liquids , pulp inflammation and peri-apical pathology . The purpose of this in vitro study was to evaluate micro-leakage of pit and fissure sealants after using three different pit and fissure preparation techniques : 1 ) acid etching , 2 ) fissure enameloplasty and acid etching , and 3 ) air abrasion and acid etching . Material s and Methods : Sixty-nine extracted sound molars and premolars were r and omly divided into three groups ( 23 sample s in each group ) . Teeth were prepared using one of three occlusal surface treatments . Then the sealant was applied on the occlusal fissures of all teeth . The teeth were thermocycled and stored in normal saline . All teeth were sealed apically and coated with nail varnish and then were immersed in a 2 % solution of methylen blue 
    Output:
    