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: PURPOSE To compare microtensile bond strength ( μTBS ) and interfacial morphology of a new one-step multimode adhesive with a two-step self-etching adhesive and two etch- and -rinse adhesives systems on enamel . MATERIAL S AND METHODS Thirty human third molars were sectioned to obtain two enamel fragments . For μTBS , 48 enamel surfaces were ground using 600-grit SiC paper and r and omly assigned into 6 groups ( n = 8) : nonetched Scotchbond Universal [ SBU ] ; etched SBU [ SBU-et ] ; non-etched Clearfil SE Bond [ CSE ] ; etched CSE [ CSE-et ] ; Scotchbond Multi- PURPOSE [ SBMP ] ; Excite [ EX ] . The etched specimens were conditioned with 37 % phosphoric acid for 30 s , each adhesive system was applied according to manufacturers ' instructions , and composite resin blocks ( Filtek Supreme Plus , 3 M ESPE ) were incrementally built up . Specimens were sectioned into beams with a cross-sectional area of 0.8-mm2 and tested under tension ( 1 mm/min ) . The data were analyzed with oneway ANOVA and Fisher 's PLSD ( α = 0.05 ) . For interface analysis , two sample s from each group were embedded in epoxy resin , polished , and then observed using scanning electron microscopy ( SEM ) . RESULTS The μTBS values ( in MPa ) and the st and ard deviations were : SBU = 27.4 ( 8.5 ) ; SBU-et = 33.6 ( 9.3 ) ; CSE = 28.5 ( 8.3 ) ; CSE-et = 34.2 ( 9.0 ) ; SBMP = 30.4 ( 11.0 ) ; EX = 23.3 ( 8.2 ) . CSE-et and SBU-et presented the highest bond strength values , followed by SBMP , CSE , and SBU which did not differ significantly from each other . EX showed the statistically significantly lowest bond strength values . SEM images of interfaces from etched sample s showed long adhesive-resin tags penetrating into demineralized enamel . CONCLUSIONS Preliminary etching of enamel significantly increased bond strength for the new one-step multimode adhesive SBU and two-step self-etching adhesive CSE OBJECTIVE To evaluate the microtensile bond strengths ( μTBS ) and nanoleakage ( NL ) of three universal or multi-mode adhesives , applied with increasing solvent evaporation times . METHODS One-hundred and forty caries-free extracted third molars were divided into 20 groups for bond strength testing , according to three factors : ( 1 ) Adhesive - All-Bond Universal ( ABU , Bisco , Inc. ) , Prime&Bond Elect ( PBE , Dentsply ) , and Scotchbond Universal Adhesive ( SBU , 3 M ESPE ) ; ( 2 ) Bonding strategy - self-etch ( SE ) or etch- and -rinse ( ER ) ; and ( 3 ) Adhesive solvent evaporation time - 5s , 15s , and 25s . Two extra groups were prepared with ABU because the respective manufacturer recommends a solvent evaporation time of 10s . After restorations were constructed , specimens were stored in water ( 37 ° C/24h ) . Resin-dentin beams ( 0.8mm(2 ) ) were tested at 0.5mm/min ( μTBS ) . For NL , forty extracted molars were r and omly assigned to each of the 20 groups . Dentin disks were restored , immersed in ammoniacal silver nitrate , sectioned and processed for evaluation under a FESEM in backscattered mode . Data from μTBS were analyzed using two-way ANOVA ( adhesive vs. drying time ) for each strategy , and Tukey 's test ( α=0.05 ) . NL data were computed with non-parametric tests ( Kruskal-Wallis and Mann-Whitney tests , α=0.05 ) . RESULTS Increasing solvent evaporation time from 5s to 25s result ed in statistically higher mean μTBS for all adhesives when used in ER mode . Regarding NL , ER result ed in greater NL than SE for each of the evaporation times regardless of the adhesive used . A solvent evaporation time of 25s result ed in the lowest NL for SBU-ER . SIGNIFICANCE Residual water and /or solvent may compromise the performance of universal adhesives , which may be improved with extended evaporation times UNLABELLED The self-etch approach provides dentists with a generation of user-friendly and less technique-sensitive adhesives . Nevertheless , some concern has been raised regarding their bonding effectiveness to enamel , in particular when so-called ' mild ' self-etch adhesives are employed . OBJECTIVES The purpose of this study was to test the hypothesis that the two-step self-etch adhesive Clearfil SE Bond ( C-SE ; Kuraray , Osaka , Japan ) bonds equally effective to enamel/dentin either with or without prior etching with phosphoric acid . METHODS Bur-cut enamel/dentin surfaces prepared from human molars were partially split in two halves by cutting a shallow groove . One half was first etched with 40 % phosphoric acid ( K-etchant ) , while protecting the other half by holding a razor blade in the groove . Next , C-SE was applied strictly following the manufacturer 's instructions , after which the surface was built up using Z100 ( 3 M Espe ) . After 24-h water storage , micro-specimens were prepared with the interface circularly constricted using a Micro-Specimen Former , prior to micro-tensile bond strength ( MPa ) measurement . In addition , interfaces of C-SE with enamel/dentin prepared with and without beforeh and acid etching were examined by Feg-SEM and TEM . RESULTS Beforeh and etching significantly increased the bonding effectiveness of C-SE to enamel . A clearly more micro-retentive surface was revealed by TEM and Feg-SEM when enamel was etched . Phosphoric-acid etching prior to C-SE application on dentin significantly decreased the muTBS to dentin . TEM provided indications of a low- quality hybrid layer after beforeh and phosphoric-acid etching . CONCLUSION Using C-SE , additional etching with phosphoric acid to improve bonding effectiveness should be limited to enamel This study examined the effect of phosphoric acid ( PA ) etching on the bond strength and acid-base resistant zone ( ABRZ ) formation of a two-step self-etching adhesive ( SEA ) system to enamel . An etch- and -rinse adhesive ( EAR ) system Single Bond ( SB ) and a two-step SEA system Clearfil SE Bond ( SE ) were used . Human teeth were r and omly divided into four groups according to different adhesive treatments : 1 ) SB ; 2 ) SE ; 3 ) 35 % PA etching→SE primer→SE adhesive ( PA/SEp+a ) ; ( 4 ) 35 % PA etching→SE adhesive ( PA/SEa )  . Microshear bond strength to enamel was measured and then statistically analyzed using one-way analysis of variance and the Tukey honestly significant difference test . The failure mode was recorded and analyzed by χ ( 2 ) test . The etching pattern of the enamel surface was observed with scanning electron microscope ( SEM ) . The bonded interface was exposed to a demineralizing solution ( pH=4.5 ) for 4.5 hours and then 5 % sodium hypochlorite with ultrasonication for 30 minutes . After argon-ion etching , the interfacial ultrastructure was observed using SEM . The microshear bond strength to enamel of the SE group was significantly lower ( p<0.05 ) than that of the three PA-etched groups , although the latter three were not significantly different from one another . The ABRZ was detected in all the groups . In morphological observation , the ABRZ in the three PA-etched groups were obviously thicker compared with the SE group with an irregular wave-shaped edge OBJECTIVE Bond strengths of composite resin to enamel using self-etch adhesive ( SEA ) Clearfil SE bond system on intact enamel and enamel pre-etched with phosphoric acid were compared . The objective was to determine if the pre-etching would increase the bond strengths of the SEA systems to intact enamel and to evaluate the effect of pre-etching on bond formation of self-etch adhesives on intact enamel . MATERIAL S AND METHOD Labial surfaces of 40 caries free permanent upper central and lateral incisors were cleaned , sectioned of their roots . All specimens were mounted on acrylic block and divided r and omly into four groups . In two groups the application of self-etch adhesive , Clearfil SE bond was carried as per manufacturer 's instructions , composite cylinders were built , whereas in the other two groups , 37 % phosphoric acid etching was done before the application of self-etching adhesives . Then the resin tags were analyzed using scanning electron microscope and shear bond strength was measured using Instron universal testing machine . RESULTS When phosphoric acid was used , there was significant increase in the depth of penetration of resin tags and in the Shear Bond Strength of composite to enamel . CONCLUSION The results indicate that out of both treatment groups , pre-etching the intact enamel with 37 % phosphoric acid result ed in formation of longer resin tags and higher depth of penetration of resin tags of the Clearfil SE bond , and attaining higher bond strength of the Clearfil SE bond to intact enamel PURPOSE To evaluate the 18-month clinical performance of a multimode adhesive ( Scotchbond Universal Adhesive , SU , 3 M ESPE , St Paul , MN , USA ) in noncarious cervical lesions ( NCCLs ) using two evaluation criteria . MATERIAL S AND METHODS Thirty-nine patients participated in this study . Two-hundred restorations were assigned to four groups : ERm , etch- and -rinse + moist dentin ; ERd , etch- and -rinse + dry dentin ; Set , selective enamel etching ; and SE , self-etch . The composite resin , Filtek Supreme Ultra ( 3 M ESPE ) , was placed incrementally . The restorations were evaluated at baseline , and at 18 months , using both the World Dental Federation ( FDI ) and the United States Public Health Service ( USPHS ) criteria . Statistical analyses were performed using Friedman repeated- measures analysis of variance by rank and McNemar test for significance in each pair ( α=0.05 ) . RESULTS Five restorations ( SE : 3 ; Set : 1 ; and ERm : 1 ) were lost after 18 months ( p>0.05 for either criteria ) . Marginal staining occurred in four and 10 % of the restorations evaluated ( p>0.05 ) , respectively , for USPHS and FDI criteria . Nine restorations were scored as bravo for marginal adaptation using the USPHS criteria and 38 % , 40 % , 36 % , and 44 % for groups ERm , ERd , Set , and SE , respectively , when the FDI criteria were applied ( p>0.05 ) . However , when semiquantitative scores ( or SQUACE ) for marginal adaptation were used , SE result ed in a significantly greater number of restorations , with more than 30 % of the total length of the interface showing marginal discrepancy ( 28 % ) in comparison with the other groups ( 8 % , 6 % , and 8 % , respectively , for ERm , ERd , and Set ) . CONCLUSIONS The clinical retention of the multimode adhesive at 18 months does not depend on the bonding strategy . The only differences between strategies were found for the parameter marginal adaptation , for which the FDI criteria were more sensitive than the USPHS criteria PURPOSE The aim of this study was to investigate the intra- and intertooth microtensile bond strength variability of two adhesive systems applied to dentin . MATERIAL S AND METHODS Twenty human third molars were ground to expose a flat dentin surface . Two adhesive systems ( Single Bond and One Step ) were applied according to the manufacturers ' instructions and composite resin crowns were constructed incrementally . After 24 h in distilled water at 37 degrees C , each tooth was longitudinally sectioned in both " x " and " y " directions under 300 rpm to obtain sticks with a cross-sectional area of 0.8 mm2 . The sticks from each tooth were tested at a crosshead speed of 0.5 mm/min . The fracture pattern of each stick was microscopically analyzed after debonding ( 400X ) . A mixed model with adhesive as a fixed variable , tooth as a r and om variable , and bonded area included as a covariate , was employed for the data treatment . In this model , all observations have the same variance , which is the sum of two components : the variance of the r and om effect ( intertooth ) and the variance of the errors ( intratooth ) . RESULTS The intratooth variability was greater than the intertooth variability . CONCLUSION The intratooth variability is higher than the intertooth variability . Sticks from the same tooth can not be considered as an experimental unit , since it does not fulfill all ANOVA requirements BACKGROUND The author compared the clinical performance of a two-step self-etching adhesive system and a one-step self-etching adhesive system over one year . METHODS Thirty-five patients with noncarious cervical lesions were enrolled in the study . The author restored 163 lesions using a two-step ( Clearfil Protect Bond , Kuraray , Osaka , Japan ) or a one-step ( 
    Output:
    
agent
However , for the ultra-mild All-Bond Universal adhesive , the etch- and -rinse strategy was significantly different than the self-etch mode in terms of dentin micro-tensile bond strength , as well as in the global analysis of enamel micro-tensile and micro-shear bond strength ( p≤0.05 ) .
The enamel bond strength of universal adhesives is improved with prior phosphoric acid etching .
However , this effect was not evident for dentin with the use of mild universal adhesives with the etch- and -rinse strategy .
CLINICAL SIGNIFICANCE Selective enamel etching prior to the application of a mild universal adhesive is an advisable strategy for optimizing bonding
***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: PURPOSE To compare microtensile bond strength ( μTBS ) and interfacial morphology of a new one-step multimode adhesive with a two-step self-etching adhesive and two etch- and -rinse adhesives systems on enamel . MATERIAL S AND METHODS Thirty human third molars were sectioned to obtain two enamel fragments . For μTBS , 48 enamel surfaces were ground using 600-grit SiC paper and r and omly assigned into 6 groups ( n = 8) : nonetched Scotchbond Universal [ SBU ] ; etched SBU [ SBU-et ] ; non-etched Clearfil SE Bond [ CSE ] ; etched CSE [ CSE-et ] ; Scotchbond Multi- PURPOSE [ SBMP ] ; Excite [ EX ] . The etched specimens were conditioned with 37 % phosphoric acid for 30 s , each adhesive system was applied according to manufacturers ' instructions , and composite resin blocks ( Filtek Supreme Plus , 3 M ESPE ) were incrementally built up . Specimens were sectioned into beams with a cross-sectional area of 0.8-mm2 and tested under tension ( 1 mm/min ) . The data were analyzed with oneway ANOVA and Fisher 's PLSD ( α = 0.05 ) . For interface analysis , two sample s from each group were embedded in epoxy resin , polished , and then observed using scanning electron microscopy ( SEM ) . RESULTS The μTBS values ( in MPa ) and the st and ard deviations were : SBU = 27.4 ( 8.5 ) ; SBU-et = 33.6 ( 9.3 ) ; CSE = 28.5 ( 8.3 ) ; CSE-et = 34.2 ( 9.0 ) ; SBMP = 30.4 ( 11.0 ) ; EX = 23.3 ( 8.2 ) . CSE-et and SBU-et presented the highest bond strength values , followed by SBMP , CSE , and SBU which did not differ significantly from each other . EX showed the statistically significantly lowest bond strength values . SEM images of interfaces from etched sample s showed long adhesive-resin tags penetrating into demineralized enamel . CONCLUSIONS Preliminary etching of enamel significantly increased bond strength for the new one-step multimode adhesive SBU and two-step self-etching adhesive CSE OBJECTIVE To evaluate the microtensile bond strengths ( μTBS ) and nanoleakage ( NL ) of three universal or multi-mode adhesives , applied with increasing solvent evaporation times . METHODS One-hundred and forty caries-free extracted third molars were divided into 20 groups for bond strength testing , according to three factors : ( 1 ) Adhesive - All-Bond Universal ( ABU , Bisco , Inc. ) , Prime&Bond Elect ( PBE , Dentsply ) , and Scotchbond Universal Adhesive ( SBU , 3 M ESPE ) ; ( 2 ) Bonding strategy - self-etch ( SE ) or etch- and -rinse ( ER ) ; and ( 3 ) Adhesive solvent evaporation time - 5s , 15s , and 25s . Two extra groups were prepared with ABU because the respective manufacturer recommends a solvent evaporation time of 10s . After restorations were constructed , specimens were stored in water ( 37 ° C/24h ) . Resin-dentin beams ( 0.8mm(2 ) ) were tested at 0.5mm/min ( μTBS ) . For NL , forty extracted molars were r and omly assigned to each of the 20 groups . Dentin disks were restored , immersed in ammoniacal silver nitrate , sectioned and processed for evaluation under a FESEM in backscattered mode . Data from μTBS were analyzed using two-way ANOVA ( adhesive vs. drying time ) for each strategy , and Tukey 's test ( α=0.05 ) . NL data were computed with non-parametric tests ( Kruskal-Wallis and Mann-Whitney tests , α=0.05 ) . RESULTS Increasing solvent evaporation time from 5s to 25s result ed in statistically higher mean μTBS for all adhesives when used in ER mode . Regarding NL , ER result ed in greater NL than SE for each of the evaporation times regardless of the adhesive used . A solvent evaporation time of 25s result ed in the lowest NL for SBU-ER . SIGNIFICANCE Residual water and /or solvent may compromise the performance of universal adhesives , which may be improved with extended evaporation times UNLABELLED The self-etch approach provides dentists with a generation of user-friendly and less technique-sensitive adhesives . Nevertheless , some concern has been raised regarding their bonding effectiveness to enamel , in particular when so-called ' mild ' self-etch adhesives are employed . OBJECTIVES The purpose of this study was to test the hypothesis that the two-step self-etch adhesive Clearfil SE Bond ( C-SE ; Kuraray , Osaka , Japan ) bonds equally effective to enamel/dentin either with or without prior etching with phosphoric acid . METHODS Bur-cut enamel/dentin surfaces prepared from human molars were partially split in two halves by cutting a shallow groove . One half was first etched with 40 % phosphoric acid ( K-etchant ) , while protecting the other half by holding a razor blade in the groove . Next , C-SE was applied strictly following the manufacturer 's instructions , after which the surface was built up using Z100 ( 3 M Espe ) . After 24-h water storage , micro-specimens were prepared with the interface circularly constricted using a Micro-Specimen Former , prior to micro-tensile bond strength ( MPa ) measurement . In addition , interfaces of C-SE with enamel/dentin prepared with and without beforeh and acid etching were examined by Feg-SEM and TEM . RESULTS Beforeh and etching significantly increased the bonding effectiveness of C-SE to enamel . A clearly more micro-retentive surface was revealed by TEM and Feg-SEM when enamel was etched . Phosphoric-acid etching prior to C-SE application on dentin significantly decreased the muTBS to dentin . TEM provided indications of a low- quality hybrid layer after beforeh and phosphoric-acid etching . CONCLUSION Using C-SE , additional etching with phosphoric acid to improve bonding effectiveness should be limited to enamel This study examined the effect of phosphoric acid ( PA ) etching on the bond strength and acid-base resistant zone ( ABRZ ) formation of a two-step self-etching adhesive ( SEA ) system to enamel . An etch- and -rinse adhesive ( EAR ) system Single Bond ( SB ) and a two-step SEA system Clearfil SE Bond ( SE ) were used . Human teeth were r and omly divided into four groups according to different adhesive treatments : 1 ) SB ; 2 ) SE ; 3 ) 35 % PA etching→SE primer→SE adhesive ( PA/SEp+a ) ; ( 4 ) 35 % PA etching→SE adhesive ( PA/SEa )  . Microshear bond strength to enamel was measured and then statistically analyzed using one-way analysis of variance and the Tukey honestly significant difference test . The failure mode was recorded and analyzed by χ ( 2 ) test . The etching pattern of the enamel surface was observed with scanning electron microscope ( SEM ) . The bonded interface was exposed to a demineralizing solution ( pH=4.5 ) for 4.5 hours and then 5 % sodium hypochlorite with ultrasonication for 30 minutes . After argon-ion etching , the interfacial ultrastructure was observed using SEM . The microshear bond strength to enamel of the SE group was significantly lower ( p<0.05 ) than that of the three PA-etched groups , although the latter three were not significantly different from one another . The ABRZ was detected in all the groups . In morphological observation , the ABRZ in the three PA-etched groups were obviously thicker compared with the SE group with an irregular wave-shaped edge OBJECTIVE Bond strengths of composite resin to enamel using self-etch adhesive ( SEA ) Clearfil SE bond system on intact enamel and enamel pre-etched with phosphoric acid were compared . The objective was to determine if the pre-etching would increase the bond strengths of the SEA systems to intact enamel and to evaluate the effect of pre-etching on bond formation of self-etch adhesives on intact enamel . MATERIAL S AND METHOD Labial surfaces of 40 caries free permanent upper central and lateral incisors were cleaned , sectioned of their roots . All specimens were mounted on acrylic block and divided r and omly into four groups . In two groups the application of self-etch adhesive , Clearfil SE bond was carried as per manufacturer 's instructions , composite cylinders were built , whereas in the other two groups , 37 % phosphoric acid etching was done before the application of self-etching adhesives . Then the resin tags were analyzed using scanning electron microscope and shear bond strength was measured using Instron universal testing machine . RESULTS When phosphoric acid was used , there was significant increase in the depth of penetration of resin tags and in the Shear Bond Strength of composite to enamel . CONCLUSION The results indicate that out of both treatment groups , pre-etching the intact enamel with 37 % phosphoric acid result ed in formation of longer resin tags and higher depth of penetration of resin tags of the Clearfil SE bond , and attaining higher bond strength of the Clearfil SE bond to intact enamel PURPOSE To evaluate the 18-month clinical performance of a multimode adhesive ( Scotchbond Universal Adhesive , SU , 3 M ESPE , St Paul , MN , USA ) in noncarious cervical lesions ( NCCLs ) using two evaluation criteria . MATERIAL S AND METHODS Thirty-nine patients participated in this study . Two-hundred restorations were assigned to four groups : ERm , etch- and -rinse + moist dentin ; ERd , etch- and -rinse + dry dentin ; Set , selective enamel etching ; and SE , self-etch . The composite resin , Filtek Supreme Ultra ( 3 M ESPE ) , was placed incrementally . The restorations were evaluated at baseline , and at 18 months , using both the World Dental Federation ( FDI ) and the United States Public Health Service ( USPHS ) criteria . Statistical analyses were performed using Friedman repeated- measures analysis of variance by rank and McNemar test for significance in each pair ( α=0.05 ) . RESULTS Five restorations ( SE : 3 ; Set : 1 ; and ERm : 1 ) were lost after 18 months ( p>0.05 for either criteria ) . Marginal staining occurred in four and 10 % of the restorations evaluated ( p>0.05 ) , respectively , for USPHS and FDI criteria . Nine restorations were scored as bravo for marginal adaptation using the USPHS criteria and 38 % , 40 % , 36 % , and 44 % for groups ERm , ERd , Set , and SE , respectively , when the FDI criteria were applied ( p>0.05 ) . However , when semiquantitative scores ( or SQUACE ) for marginal adaptation were used , SE result ed in a significantly greater number of restorations , with more than 30 % of the total length of the interface showing marginal discrepancy ( 28 % ) in comparison with the other groups ( 8 % , 6 % , and 8 % , respectively , for ERm , ERd , and Set ) . CONCLUSIONS The clinical retention of the multimode adhesive at 18 months does not depend on the bonding strategy . The only differences between strategies were found for the parameter marginal adaptation , for which the FDI criteria were more sensitive than the USPHS criteria PURPOSE The aim of this study was to investigate the intra- and intertooth microtensile bond strength variability of two adhesive systems applied to dentin . MATERIAL S AND METHODS Twenty human third molars were ground to expose a flat dentin surface . Two adhesive systems ( Single Bond and One Step ) were applied according to the manufacturers ' instructions and composite resin crowns were constructed incrementally . After 24 h in distilled water at 37 degrees C , each tooth was longitudinally sectioned in both " x " and " y " directions under 300 rpm to obtain sticks with a cross-sectional area of 0.8 mm2 . The sticks from each tooth were tested at a crosshead speed of 0.5 mm/min . The fracture pattern of each stick was microscopically analyzed after debonding ( 400X ) . A mixed model with adhesive as a fixed variable , tooth as a r and om variable , and bonded area included as a covariate , was employed for the data treatment . In this model , all observations have the same variance , which is the sum of two components : the variance of the r and om effect ( intertooth ) and the variance of the errors ( intratooth ) . RESULTS The intratooth variability was greater than the intertooth variability . CONCLUSION The intratooth variability is higher than the intertooth variability . Sticks from the same tooth can not be considered as an experimental unit , since it does not fulfill all ANOVA requirements BACKGROUND The author compared the clinical performance of a two-step self-etching adhesive system and a one-step self-etching adhesive system over one year . METHODS Thirty-five patients with noncarious cervical lesions were enrolled in the study . The author restored 163 lesions using a two-step ( Clearfil Protect Bond , Kuraray , Osaka , Japan ) or a one-step ( 
    Output:
    