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: INTRODUCTION Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing . However , the information is mainly based on 1- to 2-year follow-up data . The present prospect i ve study was design ed to re-examine a large sample of teeth treated with apical surgery after 5 years . METHODS Patients were recalled 5 years after apical surgery , and treated teeth were classified as healed or not healed based on clinical and radiographic examination . ( The latter was performed independently by 3 observers ) . Two different methods of root-end preparation and filling ( primary study parameters ) were to be compared ( mineral trioxide aggregate [ MTA ] vs adhesive resin composite [ COMP ] ) without r and omization . RESULTS A total of 271 patients and teeth from a 1-year follow-up sample of 339 could be re-examined after 5 years ( dropout rate = 20.1 % ) . The overall rate of healed cases was 84.5 % with a significant difference ( P = .0003 ) when comparing MTA ( 92.5 % ) and COMP ( 76.6 % ) . The evaluation of secondary study parameters yielded no significant difference for healing outcome when comparing subcategories ( ie , sex , age , type of tooth treated , post/screw , type of surgery ) . CONCLUSIONS The results from this prospect i ve nonr and omized clinical study with a 5-year follow-up of 271 teeth indicate that MTA exhibited a higher healing rate than COMP in the longitudinal prognosis of root-end sealing Introduction Root-end preparation and restoration with an endodontic material are required when nonsurgical endodontic retreatment has failed or is impossible . The present clinical study reports the treatment outcomes of periradicular surgery using calcium-enriched mixture ( CEM ) cement . Material s and Methods A prospect i ve outcome study of periradicular surgery using CEM was conducted on 14 permanent teeth with persistent apical periodontitis . Using a st and ardized surgical protocol , 2 - 3 mm of the root apex was resected ; approximately 3 mm deep root-end cavities were ultrasonically prepared and filled with CEM cement .  All patients were available for recall . Results Clinical and radiographic examination revealed complete healing of periradicular lesions , i.e. regeneration of periodontal ligament and lamina dura in 13 teeth ( 93 % success ) during a mean time of 18 months ; moreover , the teeth were functional and asymptomatic . Conclusion Favorable treatment outcomes in this prospect i ve clinical study suggested that CEM cement may be a suitable root-end filling bio material Introduction : This prospect i ve r and omized controlled study evaluated the clinical and radiographic outcome of endodontic microsurgery when using iRoot BP Plus Root Repair Material ( BP‐RRM ; Innovative BioCeramix Inc , Vancouver , BC , Canada ) or mineral trioxide aggregate ( MTA ) as the retro grade filling material and analyzed the relationship between some potential prognostic factors and the outcome of the surgery . Methods : By using strict inclusion and exclusion criteria , 240 teeth were successfully enrolled and r and omly and equally allocated to either the MTA or BP‐RRM treatment group . A st and ardized surgical procedure was performed by a single operator . The patients were followed up at 1 week , 3 months , 6 months , and 12 months ; follow‐up included clinical and radiographic examination . Clinical and radiographic evaluations acquired at the 12‐month follow‐up were taken as the primary outcome . For the identification of prognostic factors , the dichotomous outcome ( success vs failure ) was taken as the dependent variable . Results : A total of 158 teeth were analyzed at the 12‐month follow‐up , including 87 teeth in the MTA group and 71 teeth in the BP‐RRM group . The success rate in the MTA and BP‐RRM groups was 93.1 % ( 81/87 teeth ) and 94.4 % ( 67/71 teeth ) , respectively ( P > .05 ) . Three significant outcome predictors were identified : quality of root filling ( P < .05 ) , tooth type ( P < .05 ) , and size of the lesion ( P < .05 ) Conclusions : These results suggest that BP‐RRM is comparable with MTA in clinical outcome when used as root‐end filling material s in endodontic microsurgery This clinical study prospect ively evaluated the influence of various predictors on healing outcome 1 year after periapical surgery .  The study cohort included 194 teeth in an equal number of patients . Three teeth were lost for the follow-up ( 1.5 % drop-out rate ) .  Clinical and radiographic measures were used to determine the healing outcome . For statistical analysis , results were dichotomized ( healed versus nonhealed ) . The overall success rate was 83.8 % ( healed cases ) . The only individual predictors to prove significant for the outcome were pain at initial examination ( p=0.030 ) and other clinical signs or symptoms at initial examination ( p=0.042 ) , meaning that such teeth had lower healing rates 1 year after periapical surgery compared with teeth without such signs or symptoms . Logistic regression revealed that pain at initial examination ( odds ratio=2.59 , confidence interval=1.2 - 5.6 , p=0.04 ) was the only predictor reaching significance . Several predictors almost reached statistical significance : lesion size ( p=0.06 ) , retrofilling material ( p=0.06 ) , and postoperative healing course ( p=0.06 ) This in vitro study used rhodamine B fluorescent dye and a confocal microscope to evaluate the sealing ability of amalgam , super EBA , and a mineral trioxide aggregate when used as root end filling material s. Thirty single-canal teeth were cleaned , shaped , and obturated with gutta-percha and root canal sealer . After application of nail polish to the external surface , the apical 3 mm of each root was resected and 3-mm deep root end preparations were made . The roots were r and omly divided into three groups and the root end preparations filled with the experimental material s. All roots were then exposed to an aqueous solution of rhodamine B fluorescent dye for 24 h , longitudinally sectioned , and the extent of dye penetration measured using a confocal microscope . Statistical analysis showed that the mineral trioxide aggregate leaked significantly less than amalgam and super EBA INTRODUCTION The purpose of the present study was to evaluate the clinical outcomes of endodontic microsurgery when super ethoxy-benzoic acid ( Super EBA ; Harry J. Bosworth , Skokie , IL ) and mineral trioxide aggregate ( MTA ) were used as root-end filling material s in a prospect i ve r and omized controlled study . METHODS Of the 388 teeth eligible for endodontic microsurgery , 128 teeth were excluded from the study , and 260 teeth were r and omly assigned to either the Super EBA group or the MTA group with equal numbers using the " minimization method . " Endodontic microsurgical procedures were performed according to the Yonsei protocol reported in a previous study and were carried out by a single operator . The patients were followed up at 3 , 6 , and 12 months . The primary outcome measure was the change in the apical bone density at 12 months , and the secondary outcome measures were the presence of clinical symptoms or abnormal findings at 12 months . RESULTS A total of 192 teeth were examined at the 12-month follow-up ; 102 teeth were in the Super EBA group , and 90 were in the MTA group . The overall success rate was 94.3 % , with a success rate of 95.6 % ( 86/90 teeth ) for MTA and 93.1 % ( 95/102 teeth ) for Super EBA . The statistical analysis of the success rate results did not show any significant difference between the groups ( P = .472 ) . CONCLUSIONS In this prospect i ve r and omized controlled study , there was no significant difference in the clinical outcomes of endodontic microsurgery when Super EBA and MTA were used as root-end filling material OBJECTIVE The purpose of this study was to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment . STUDY DESIGN A r and omized prospect i ve design was used in a st and ardized treatment protocol . Patients were allocated to treatment with an ultrasonic device ( P-Max Newtron ) or treatment with a bur in an otherwise similar protocol . One year after treatment the results were evaluated by 2 oral and maxillofacial surgeons who were blinded for the therapy . RESULTS Out of a total group of 399 patients who were included in the study , adequate follow-up could be obtained in 290 patients . The overall success rate in the ultrasonic group was 80.5 % and in the group treated with a bur 70.9 % ( P = .056 ) . In molars , the difference in success rate was significant ( P = .02 ) . CONCLUSION The use of an ultrasonic device in apical surgery improved the outcome of treatment . In molars this effect was significant Objectives : The aim of this study was to evaluate marginal adaptation of mineral trioxide aggregate ( MTA ) , calcium enriched mixture ( CEM ) cement , Biodentine and BioAggregate in presence of normal saline and human blood . Material s and Methods : In this in-vitro experimental study , 80 extracted single-rooted human teeth were instrumented and filled with gutta-percha . After resecting the root-end , apical cavity preparation was done and the teeth were r and omly divided into 4 groups (N=20)(a total of 8 subgroups ) . Root-end filling material s were placed in 3 mm root-end cavities prepared ultrasonically . Half the specimens in each group were exposed to normal saline and the other half to fresh whole human blood . After 4 days , epoxy resin replicas of the apical portion of sample s were fabricated and scanning electron microscopy ( SEM ) analysis was performed to find gaps in the adaptation of the root-end filling material s at their interface with dentin . The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis of data with P<0.05 as the limit of significance . Results : There were no significant differences in marginal adaptation of the 8 tested groups ( P>0.05 ) . Conclusion : Based on the results , blood contamination does not affect the marginal adaptation of MTA , CEM cement , Biodentine or BioAggregate AIM To compare healing after root-end resection with a root-end filling of mineral trioxide aggregate ( MTA ) or smoothing of the ortho grade gutta-percha ( GP ) root filling . METHODOLOGY Forty-four patients ( consisting of 52 teeth with periapical infection ) , average age of 54.6 years ( range 30 - 77 ) participated in a r and omized clinical trial ( RCT ) comparing the MTA and GP treatment methods . Radiographs produced 1-week and 12 months post-operatively were compared after blinding for treatment method , and healing was assessed as complete , incomplete , uncertain , or unsatisfactory . RESULTS Six teeth were not available for the 12-month follow-up : three teeth ( GP ) had been re-operated because of pain and two teeth ( one GP , one MTA ) had been extracted because of root fracture ( these five teeth were classified as failures ) . One patient ( GP ) was not available for recall . In the GP group , seven teeth ( 28 % ) showed complete healing , six teeth ( 24 % ) incomplete healing , six teeth ( 24 % ) uncertain healing and two teeth ( 8 % ) unsatisfactory healing after 1 year . In the MTA group , 22 teeth ( 85 % ) showed complete healing , three teeth ( 12 % ) incomplete healing , and none were scored as uncertain or unsatisfactory healing after 1 year . The difference in healing between the GP and the MTA groups was significant ( P < 0.001 ) . CONCLUSIONS The results from this RCT emphasize the importance of placing a root-end filling after root-end resection . Teeth treated with MTA had significantly better healing ( 96 % ) than teeth treated by smoothing of the ortho grade GP root filling only ( 52 % ) A prospect i ve outcome study of  periradicular surgery  using microsurgical techniques and root-end filling with mineral trioxide aggregate ( MTA ) was performed . Nonhealing endodontically treated teeth ( n = 321 ) were included in the study . Surgery was completed under local anesthesia using a st and ardized clinical protocol . Patients were recalled periodically and examined for signs and symptoms of failure . Thirty-nine teeth were lost from recall . Of the 276 teeth examined , 163 showed complete healing radiographically with no other signs and symptoms ; 82 teeth had no symptoms but incomplete or uncertain healing , and 31 teeth showed nonhealing ( three had persistent pain despite evidence of complete radiologic healing and eight teeth did not heal for reasons unrelated to the surgical treatment ) . The overall success rate was 88.8 % , including all teeth with no clinical symptoms . In this study , the use of MTA as a root-end filling , following microsurgical techniques , showed a high success rate A prospect i ve study was set up to evaluate a one-visit  apicectomy technique . Calcium hydroxide cement was used as the root canal filling material . The calcium hydroxide cement set rapidly and clearly revealed the position , size and outline form of the root canals at the level of resection . This facilitated preparation of the apical cavities to a depth of 3 mm . Each cavity was varnished before placement of the amalgam .  Sixty-eight patients ( 93 teeth ) were included in the study . Five patients ( 8 teeth ) were lost to follow-up . The success 
    Output:
    
agent
Bioceramics has significantly higher success rates than amalgam , but they were statistically similar to intermediate restorative material ( IRM ) and Super ethoxybenzoic acid ( Super EBA ) when used as retro grade filling material s in apical surgery .
However , it seems that the high success rates were not solely attributable to the type of the root-end filling material s. The surgical/microsurgical techniques and tooth prognostic factors may significantly affect treatment outcome
***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: INTRODUCTION Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing . However , the information is mainly based on 1- to 2-year follow-up data . The present prospect i ve study was design ed to re-examine a large sample of teeth treated with apical surgery after 5 years . METHODS Patients were recalled 5 years after apical surgery , and treated teeth were classified as healed or not healed based on clinical and radiographic examination . ( The latter was performed independently by 3 observers ) . Two different methods of root-end preparation and filling ( primary study parameters ) were to be compared ( mineral trioxide aggregate [ MTA ] vs adhesive resin composite [ COMP ] ) without r and omization . RESULTS A total of 271 patients and teeth from a 1-year follow-up sample of 339 could be re-examined after 5 years ( dropout rate = 20.1 % ) . The overall rate of healed cases was 84.5 % with a significant difference ( P = .0003 ) when comparing MTA ( 92.5 % ) and COMP ( 76.6 % ) . The evaluation of secondary study parameters yielded no significant difference for healing outcome when comparing subcategories ( ie , sex , age , type of tooth treated , post/screw , type of surgery ) . CONCLUSIONS The results from this prospect i ve nonr and omized clinical study with a 5-year follow-up of 271 teeth indicate that MTA exhibited a higher healing rate than COMP in the longitudinal prognosis of root-end sealing Introduction Root-end preparation and restoration with an endodontic material are required when nonsurgical endodontic retreatment has failed or is impossible . The present clinical study reports the treatment outcomes of periradicular surgery using calcium-enriched mixture ( CEM ) cement . Material s and Methods A prospect i ve outcome study of periradicular surgery using CEM was conducted on 14 permanent teeth with persistent apical periodontitis . Using a st and ardized surgical protocol , 2 - 3 mm of the root apex was resected ; approximately 3 mm deep root-end cavities were ultrasonically prepared and filled with CEM cement .  All patients were available for recall . Results Clinical and radiographic examination revealed complete healing of periradicular lesions , i.e. regeneration of periodontal ligament and lamina dura in 13 teeth ( 93 % success ) during a mean time of 18 months ; moreover , the teeth were functional and asymptomatic . Conclusion Favorable treatment outcomes in this prospect i ve clinical study suggested that CEM cement may be a suitable root-end filling bio material Introduction : This prospect i ve r and omized controlled study evaluated the clinical and radiographic outcome of endodontic microsurgery when using iRoot BP Plus Root Repair Material ( BP‐RRM ; Innovative BioCeramix Inc , Vancouver , BC , Canada ) or mineral trioxide aggregate ( MTA ) as the retro grade filling material and analyzed the relationship between some potential prognostic factors and the outcome of the surgery . Methods : By using strict inclusion and exclusion criteria , 240 teeth were successfully enrolled and r and omly and equally allocated to either the MTA or BP‐RRM treatment group . A st and ardized surgical procedure was performed by a single operator . The patients were followed up at 1 week , 3 months , 6 months , and 12 months ; follow‐up included clinical and radiographic examination . Clinical and radiographic evaluations acquired at the 12‐month follow‐up were taken as the primary outcome . For the identification of prognostic factors , the dichotomous outcome ( success vs failure ) was taken as the dependent variable . Results : A total of 158 teeth were analyzed at the 12‐month follow‐up , including 87 teeth in the MTA group and 71 teeth in the BP‐RRM group . The success rate in the MTA and BP‐RRM groups was 93.1 % ( 81/87 teeth ) and 94.4 % ( 67/71 teeth ) , respectively ( P > .05 ) . Three significant outcome predictors were identified : quality of root filling ( P < .05 ) , tooth type ( P < .05 ) , and size of the lesion ( P < .05 ) Conclusions : These results suggest that BP‐RRM is comparable with MTA in clinical outcome when used as root‐end filling material s in endodontic microsurgery This clinical study prospect ively evaluated the influence of various predictors on healing outcome 1 year after periapical surgery .  The study cohort included 194 teeth in an equal number of patients . Three teeth were lost for the follow-up ( 1.5 % drop-out rate ) .  Clinical and radiographic measures were used to determine the healing outcome . For statistical analysis , results were dichotomized ( healed versus nonhealed ) . The overall success rate was 83.8 % ( healed cases ) . The only individual predictors to prove significant for the outcome were pain at initial examination ( p=0.030 ) and other clinical signs or symptoms at initial examination ( p=0.042 ) , meaning that such teeth had lower healing rates 1 year after periapical surgery compared with teeth without such signs or symptoms . Logistic regression revealed that pain at initial examination ( odds ratio=2.59 , confidence interval=1.2 - 5.6 , p=0.04 ) was the only predictor reaching significance . Several predictors almost reached statistical significance : lesion size ( p=0.06 ) , retrofilling material ( p=0.06 ) , and postoperative healing course ( p=0.06 ) This in vitro study used rhodamine B fluorescent dye and a confocal microscope to evaluate the sealing ability of amalgam , super EBA , and a mineral trioxide aggregate when used as root end filling material s. Thirty single-canal teeth were cleaned , shaped , and obturated with gutta-percha and root canal sealer . After application of nail polish to the external surface , the apical 3 mm of each root was resected and 3-mm deep root end preparations were made . The roots were r and omly divided into three groups and the root end preparations filled with the experimental material s. All roots were then exposed to an aqueous solution of rhodamine B fluorescent dye for 24 h , longitudinally sectioned , and the extent of dye penetration measured using a confocal microscope . Statistical analysis showed that the mineral trioxide aggregate leaked significantly less than amalgam and super EBA INTRODUCTION The purpose of the present study was to evaluate the clinical outcomes of endodontic microsurgery when super ethoxy-benzoic acid ( Super EBA ; Harry J. Bosworth , Skokie , IL ) and mineral trioxide aggregate ( MTA ) were used as root-end filling material s in a prospect i ve r and omized controlled study . METHODS Of the 388 teeth eligible for endodontic microsurgery , 128 teeth were excluded from the study , and 260 teeth were r and omly assigned to either the Super EBA group or the MTA group with equal numbers using the " minimization method . " Endodontic microsurgical procedures were performed according to the Yonsei protocol reported in a previous study and were carried out by a single operator . The patients were followed up at 3 , 6 , and 12 months . The primary outcome measure was the change in the apical bone density at 12 months , and the secondary outcome measures were the presence of clinical symptoms or abnormal findings at 12 months . RESULTS A total of 192 teeth were examined at the 12-month follow-up ; 102 teeth were in the Super EBA group , and 90 were in the MTA group . The overall success rate was 94.3 % , with a success rate of 95.6 % ( 86/90 teeth ) for MTA and 93.1 % ( 95/102 teeth ) for Super EBA . The statistical analysis of the success rate results did not show any significant difference between the groups ( P = .472 ) . CONCLUSIONS In this prospect i ve r and omized controlled study , there was no significant difference in the clinical outcomes of endodontic microsurgery when Super EBA and MTA were used as root-end filling material OBJECTIVE The purpose of this study was to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment . STUDY DESIGN A r and omized prospect i ve design was used in a st and ardized treatment protocol . Patients were allocated to treatment with an ultrasonic device ( P-Max Newtron ) or treatment with a bur in an otherwise similar protocol . One year after treatment the results were evaluated by 2 oral and maxillofacial surgeons who were blinded for the therapy . RESULTS Out of a total group of 399 patients who were included in the study , adequate follow-up could be obtained in 290 patients . The overall success rate in the ultrasonic group was 80.5 % and in the group treated with a bur 70.9 % ( P = .056 ) . In molars , the difference in success rate was significant ( P = .02 ) . CONCLUSION The use of an ultrasonic device in apical surgery improved the outcome of treatment . In molars this effect was significant Objectives : The aim of this study was to evaluate marginal adaptation of mineral trioxide aggregate ( MTA ) , calcium enriched mixture ( CEM ) cement , Biodentine and BioAggregate in presence of normal saline and human blood . Material s and Methods : In this in-vitro experimental study , 80 extracted single-rooted human teeth were instrumented and filled with gutta-percha . After resecting the root-end , apical cavity preparation was done and the teeth were r and omly divided into 4 groups (N=20)(a total of 8 subgroups ) . Root-end filling material s were placed in 3 mm root-end cavities prepared ultrasonically . Half the specimens in each group were exposed to normal saline and the other half to fresh whole human blood . After 4 days , epoxy resin replicas of the apical portion of sample s were fabricated and scanning electron microscopy ( SEM ) analysis was performed to find gaps in the adaptation of the root-end filling material s at their interface with dentin . The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis of data with P<0.05 as the limit of significance . Results : There were no significant differences in marginal adaptation of the 8 tested groups ( P>0.05 ) . Conclusion : Based on the results , blood contamination does not affect the marginal adaptation of MTA , CEM cement , Biodentine or BioAggregate AIM To compare healing after root-end resection with a root-end filling of mineral trioxide aggregate ( MTA ) or smoothing of the ortho grade gutta-percha ( GP ) root filling . METHODOLOGY Forty-four patients ( consisting of 52 teeth with periapical infection ) , average age of 54.6 years ( range 30 - 77 ) participated in a r and omized clinical trial ( RCT ) comparing the MTA and GP treatment methods . Radiographs produced 1-week and 12 months post-operatively were compared after blinding for treatment method , and healing was assessed as complete , incomplete , uncertain , or unsatisfactory . RESULTS Six teeth were not available for the 12-month follow-up : three teeth ( GP ) had been re-operated because of pain and two teeth ( one GP , one MTA ) had been extracted because of root fracture ( these five teeth were classified as failures ) . One patient ( GP ) was not available for recall . In the GP group , seven teeth ( 28 % ) showed complete healing , six teeth ( 24 % ) incomplete healing , six teeth ( 24 % ) uncertain healing and two teeth ( 8 % ) unsatisfactory healing after 1 year . In the MTA group , 22 teeth ( 85 % ) showed complete healing , three teeth ( 12 % ) incomplete healing , and none were scored as uncertain or unsatisfactory healing after 1 year . The difference in healing between the GP and the MTA groups was significant ( P < 0.001 ) . CONCLUSIONS The results from this RCT emphasize the importance of placing a root-end filling after root-end resection . Teeth treated with MTA had significantly better healing ( 96 % ) than teeth treated by smoothing of the ortho grade GP root filling only ( 52 % ) A prospect i ve outcome study of  periradicular surgery  using microsurgical techniques and root-end filling with mineral trioxide aggregate ( MTA ) was performed . Nonhealing endodontically treated teeth ( n = 321 ) were included in the study . Surgery was completed under local anesthesia using a st and ardized clinical protocol . Patients were recalled periodically and examined for signs and symptoms of failure . Thirty-nine teeth were lost from recall . Of the 276 teeth examined , 163 showed complete healing radiographically with no other signs and symptoms ; 82 teeth had no symptoms but incomplete or uncertain healing , and 31 teeth showed nonhealing ( three had persistent pain despite evidence of complete radiologic healing and eight teeth did not heal for reasons unrelated to the surgical treatment ) . The overall success rate was 88.8 % , including all teeth with no clinical symptoms . In this study , the use of MTA as a root-end filling , following microsurgical techniques , showed a high success rate A prospect i ve study was set up to evaluate a one-visit  apicectomy technique . Calcium hydroxide cement was used as the root canal filling material . The calcium hydroxide cement set rapidly and clearly revealed the position , size and outline form of the root canals at the level of resection . This facilitated preparation of the apical cavities to a depth of 3 mm . Each cavity was varnished before placement of the amalgam .  Sixty-eight patients ( 93 teeth ) were included in the study . Five patients ( 8 teeth ) were lost to follow-up . The success 
    Output:
    