However, use of this type in clinical studies has produced mixed results.36 It seems that calculus may be removed completely or partially without much damage to the root surface, but a number of studies also report surface pitting, crater formation, thermal damage and production of toxic by‐products. Surgical and non‐surgical treatment of periodontal diseases Leticia Helena Theodoro Research and Study on Laser in Dentistry Group (GEPLO), Department of Surgery and Integrated Clinic, Division of Periodontics, University Estadual Paulista (UNESP), Araçatuba, SP, Brazil Cavitron (Dentsply, Mount Waverly, Victoria, Australia) is a leading brand. Wound biofilms: Lessons learned from oral biofilms. Non-Surgical Management of Periodontal Diseases: The Mainstay of Dental Therapy Speaker: Paul Levi, Jr., Associate Clinical Professor Exam Questions: 1. The initial phase of periodontal treatment should also include removal of caries with temporary or permanent restoration depending on the prognosis of the teeth. The sharp pointed tip prevents much subgingival use. II. Periodontal considerations in older individuals. How will I address them? Non mobile >mobile teeth. Photodynamic therapy: a targeted therapy in periodontics, https://doi.org/10.1111/j.1834-7819.2009.01146.x. Host modulation is manipulation of the inflammatory or immune response to treat disease and has been used in the management of rheumatoid arthritis, allergy and graft rejection. Dynamics of the immune response, Effects of single‐visit full‐mouth ultrasonic debridement versus quadrant‐wise ultrasonic debridement, Full‐mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis, Clinical outcomes of quadrant root planing versus full‐mouth root planing, Microbiological outcomes of quadrant versus full‐mouth root planing as monitored by real‐time PCR, Periodontal debridment with povidine‐iodine in periodontal treatment: short‐term clinical and biochemical observations, Full‐mouth disinfection for the treatment of adult chronic periodontitis. It has been shown that sites 4 mm or less can be well debrided76 and good patient oral hygiene can influence the microflora in pockets up to 4 mm reducing the build‐up of the periopathogenic microflora.58, 59 Interestingly, Badersten et al.1 reported that the deeper the site, the longer it took to achieve maximal healing. Common uses include acute conditions, trauma, post‐surgery and as a short‐term adjunct to oral hygiene. Each group sets the scene or builds the base for the colonization by the next level and has been diagrammatically shown as a pyramid (Fig 1). Wound biofilms: Lessons learned from oral biofilms. At sites 7 mm+ the changes were the greatest with a reduction in PD of 1.2–2.9 mm on average and a gain in AL of 0.5–1.6 mm. Non-surgical management of peri-implant diseases. An update on the non-surgical treatment of periodontal disease. Molar sites tend to respond less well than single‐rooted teeth, perhaps due to access issues as well furcation involvement. Clinical findings, Quadrant root planing versus same‐day full‐mouth root planing II. Severely advanced periodontitis, The long‐term effect of a plaque control program on tooth mortality, caries, and periodontal disease in adults. I. Long‐term clinical observations, Quadrant root planing versus same‐day full‐mouth root planing I. In the experience of the author, sometimes non‐surgical management is undertaken to better ascertain the patient’s motivation and interest, or to gauge the prognosis of teeth, especially when deciding which teeth to extract. The author has been involved in presenting educational programmes relating to oral health care products for a number of different manufacturers, but has no direct financial interest in these products or the companies which manufacture them. supra and subgingival plaque deposits. However, developments over the last 15 years in brush design and technology have made electric brushes much more effective in plaque removal to the extent that recent studies show that they do have an advantage over manual brushing. Modern technology has made removal of microbial deposits by the patient and dental professionals more efficient. Ultrasonic devices can be further divided into piezoelectric and magnetostrictive. Indwelling catheters may accumulate a biofilm. It should always be the first therapy undertaken, but does have its limitations. However, they show a history of significant side effects, most notably thermal damage to the root surface. Actualización en medicina de familia: patología periodontal. In summary, the use of lasers to debride the root surface is in its infancy. Lang et al.9 showed, using a group of dentally aware subjects, that with excellent oral hygiene skills, once every 48 hours is the minimum to maintain gingival health. Prim Dent J. Our understanding that plaque is a biofilm has reinforced the role of SRP as an important part of periodontal treatment. Non‐surgical management is effective in treating periodontal disease. It has well‐known side effects that normally preclude long‐term use. Powered instruments are generally split into sonic and ultrasonic depending on the frequency of vibration. II. Presented By : Dr. Abhishek Gaur Guided By : Dr. Balaji Manohar Dr. Ravikiran N. Dr. Neema Dr. Aditi Mathur Dr. Barkha Makhijani 2. It is important to remember that floss will penetrate 2–3 mm subgingivally when used properly. Lasers possess excellent tissue ablation, bacteriocidal and detoxification properties leaving little or no smear layer and any scatter may stimulate surrounding cells improving healing. Electric toothbrushes are designed to overcome some of the limitations of manual brushing (Fig 3). It is the aim of non‐surgical therapy to demolish as much of the pyramid as possible and of maintenance to keep demolishing the foundations to prevent the formation of the climax population sufficient to cause disease progression. This seems to make no difference in the healing response.1 Ultrasonics may also be used to remove overhanging margins of restorations. Traditionally, the outcome of SRP is a smooth root surface, as this equates with a “clean” surface and reduces microbial recolonization.68 However, recent studies have shown no difference in the healing between smooth and rough surfaces. The host immune response toward periodontal pathogens helps to sustain periodontal disease and eventual alveolar bone loss. This may not matter if they do not develop disease, but in those that do then an adjunct could be considered. As with brushing, advice should be tailored to the patient and the most appropriate device for the size of the interproximal space chosen. In his 1996 review, Cobb74 summarized the outcomes of SRP based on initial probing depths. Compared to an ultrasonic scaler, this same group38 showed that the performance of the Er:YAG laser was equivalent. Powered instruments are generally split into sonic and ultrasonic depending on the frequency of vibration. The classic sickle scaler (H6/H7) is designed primarily for supragingival plaque and calculus removal. Evaluating clinical and laboratory effects of ozone in non-surgical periodontal treatment: a randomized controlled trial. In the experience of the author, sometimes non‐surgical management is undertaken to better ascertain the patient’s motivation and interest, or to gauge the prognosis of teeth, especially when deciding which teeth to extract. The other types of lasers listed above have not been so well researched. The protection provided by the glycocalyx prevents ingress of the host immune response, but also antibiotics and antiseptics. A review of antibiotics is outside the scope of this article and will be ably discussed by Heitz‐Mayfield later in this supplement.15 The antiseptics are used in toothpastes, mouthwashes, sprays, gels, irrigators and varnishes. Tetracycline has been shown to have an anti‐inflammatory effect in clinical and animal studies treating periodontal disease reducing collagenolytic activity.41 Minocycline and doxycycline also demonstrate this effect. NON-SURGICAL MANAGEMENT OF PERI-IMPLANT DISEASES AMIT PATEL Prim Dent J. FMD is as effective as QSRP and the method chosen will be a decision between the clinican and patient, and may depend on time and cost. In 1998, Socransky et al.5 published what is now a seminal paper proposing that the microflora in plaque is a series of successive waves of colonization by increasingly periopathogenic bacteria, culminating in the triumvirate of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia (previously Bacteriodes forsythus). 2014 Aug;3(3):62-5. In terms of sales, it is the market leader by far. It consists of patient motivation and oral hygiene instruction as well as mechanical removal of. This includes changing patient behavior through educating the patient on their condition, oral hygiene, scaling and addressing modifiable risk factors (such as smoking). Without being flippant, the best brush is the one that gets into the patient’s mouth. Cytokine and matrix metalloproteinase expression in fibroblasts from peri‐implantitis lesions in response to viable orphyromonas gingivalis. Hence, it is very suitable for soft tissue procedures. Studies have shown that local as well as systemic anti-microbial agents have a beneficial effect on non-surgical periodontal therapy [ 10, 11 ]. Modern electric brushes remove more plaque and in less time than manual brushes, particularly those with small round rotating oscillating brush heads.11. A number of papers have reported a reduction in the amount of alveolar bone loss or gingival inflammation compared to control groups.47-52 However, widespread use of NSAIDs has not been widely reported, perhaps due to minimal clinical advantage produced, reports demonstrating no or little effect or side effects that outweigh the benefits. Non-surgical periodontal treatment does have its limitations. An aggressive approach is not warranted as the infected layer can be removed by gentle scaling with hand instruments or ultrasonics and endotoxin can be removed using only a microbrush.70 Root planing will remove all the cementum and some of the superficial dentine. More importantly, it is a protected stable population. Although the early laser evaporated calculus efficiently, they caused substantial thermal damage of the underlying tooth structures. Krayer JW(1), Leite RS, Kirkwood KL. Continual root planing of surfaces over a period of time may result in substantial loss of the root surface. Initially, these devices were applied to hard tissue procedures, such as caries removal and cavity preparation. Electric toothbrushes are designed to overcome some of the limitations of manual brushing (Fig 3). Studies have suggested that the time taken to brush one’s teeth may only be about 40 seconds.10 Based on their clinical trials research, van der Weijden et al.12 suggested that two minutes brushing was the optimum for plaque removal with longer being no more effective. Lasers are named by the element that is stimulated to create the beam, which is collimated and of a single wavelength and colour. Melbourne Dental School, The University of Melbourne, Victoria. Chapter 7 Management of Periodontal Diseases Aim . Lasers are named by the element that is stimulated to create the beam, which is collimated and of a single wavelength and colour. Currently, there seems to be a lack of evidence supporting their use, especially given their relatively high cost. Common brands are EMS Piezon (Electro Medical Systems, Nion, Switzerland) and NSK Varios (NSK Tech, Sydney, Australia). Microbiological and SEM-EDS Evaluation of Titanium Surfaces Exposed to Periodontal Gel: In Vitro Study. The application of beneficial bacteria is not new with “probiotics” being applied for gastrointestinal disturbances, otitis media and caries for over 40 years.34. A biofilm is a microbial community attached to an environmental surface, which is usually encased in an extracellular polysaccharide or slime matrix and forms where there is sufficient moisture and nutrients.4 They are found in water and waste pipes, on ship’s hulls, in food processing areas and on medical implants. It is the aim of non‐surgical therapy to demolish as much of the pyramid as possible and of maintenance to keep demolishing the foundations to prevent the formation of the climax population sufficient to cause disease progression. The article reports on changes in our understanding of plaque as a biofilm, developments in patient plaque control, chemical plaque control and scaling instruments. A visit to the chemist or supermarket will reveal a plethora of different toothbrushes (Fig 2). Oral hygiene alone results in some decrease in gingival inflammation, but the majority of the reduction in the swelling is due to subgingival debridement. Hydroxyapatite also absorbs this wavelength making this laser suitable to not only soft tissues, but hard tissue ablation. The purpose of this review was to assess recent changes. The decision to use a mouthwash is more likely to be patient choice than clinical. The advent of molecular and DNA identification methods has allowed a more exact and comprehensive evaluation of the effects of SRP on the bacterial flora, especially the red group, further confirming their role in the pathogenesis of periodontal disease. Interdental brushes are also the best choice when root concavities or grooves are exposed. A systematic review, Bisphosphonate therapy improves the outcome of conventional periodontal treatment: results of a 12‐month, randomized, placebo‐controlled study, The effect of supragingival plaque control on the subgingival microflora, The effect of supragingival plaque control on the composition of the subgingival microflora, The effect of supragingival plaque control on the subgingival microbiota in subjects with periodontal disease, Effects of nonsurgical periodontal therapy on the microbiota, The effect of SRP on the clinical and microbiological parameters of periodontal diseases, Clinical and microbiological effect of scaling and root planing in smoker and non‐smoker chronic and aggressive periodontitis patients, Microbiological and clinical effects of surgical treatment of localized juvenile periodontitis, Effects of nonsurgical periodontal therapy on hard and soft tissues, The effectiveness of subgingival scaling and root planing in calculus removal, Effect of rough surfaces upon gingival tissue, Histological assessment of periodontally involved cementum, Subgingival debridement of root surfaces with a micro‐brush: macroscopic and ultrastructural assessment, Root substance removal by scaling and root planing, Regeneration of alveolar bone following surgical and non‐surgical periodontal treatment, 5‐year follow‐up of periodontal intraosseous defects treated by root planing and flap surgery, Clinical and microbiological effects of root debridement in periodontal furcation pockets, Healing of the dento‐epithelial junction following subgingival plaque control. However, most the studies undertaken to test these products have been in a healthy population that abstained from oral hygiene procedures and their use in the management of periodontal disease is yet to be proven. The Er:YAG laser is a solid state laser whose wavelength is more readily absorbed by water than others. Being able to predict the outcome of the initial phase is valuable at the outset for longer‐term patient treatment planning and informing the patient of the probable need for further treatment. and you may need to create a new Wiley Online Library account. In 1998, the European Workshop on Mechanical Plaque Control addressed the issue of what features make an ideal toothbrush.8 They suggested that: (1) the handle size be appropiate to user age and dexterity; (2) the head size is appropriate to the size of the patient’s mouth; (3) use of end‐rounded nylon or polyester filaments not larger than 0.009 inches in diameter; (4) use of soft bristle configurations; and (5) bristle patterns which enhance plaque removal in the approximal spaces and along the gum line. For sites 1–3 mm deep, he noted little change in PD and a slight loss of attachment of 0.3–0.9 mm, suggesting that SRP at these sites causes more damage than good. Evaluating clinical and laboratory effects of ozone in non-surgical periodontal treatment: a randomized controlled trial. At the reassessment visit one must also evaluate the outcome of the therapy and decide on the next phase of management. Severely advanced periodontitis, The long‐term effect of a plaque control program on tooth mortality, caries, and periodontal disease in adults. Both sonic and ultrasonic scalers generate heat during use requiring a coolant, most commonly water. Actualización en medicina de familia: patología periodontal. The original protocol involved full‐mouth scaling and root planing within 24 hours, brushing the dorsum of the tongue for one minute with 1% chlorhexidine (CHX) gel, rinsing twice with 0.2% CHX mouthwash for one minute, subgingival irrigation three times within 10 minutes with 1% CHX gel and repeated eight days later and twice daily rinsing by the patient with 0.2% CHX mouthwash for 14 days.21 The initial study reported the outcome in 10 patients and showed a significantly greater reduction in probing depth in the FMD group compared to the conventional protocol after two months.21 The effect was more pronounced at deeper sites. Learn more. It has well‐known side effects that normally preclude long‐term use. The other types of lasers listed above have not been so well researched. The tip moves in an elliptical path and allows all surfaces to be used for debridement. They showed significant improvement in both groups, but failed to show that FMD produced a better result.23 When the microflora was analysed they could not show that FMD resulted in greater reduction in the bacteria.24 In a third paper, they reported both therapies were associated with a reduction in antibody titre and an increase in avidity, but no significant differences between test and control groups.25 The only difference they reported was that the FMD group reported more post‐SRP pain.23. It consists of patient motivation and oral hygiene instruction as well as mechanical removal of supra and subgingival plaque deposits. A controlled, prospective clinical study, Host modulation with tetracyclines and their chemically modified analogues, Subantimicrobial dose doxycycline enhances the efficacy of scaling and root planing in chronic periodontitis: a multicenter trial, Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis, Adjunctive subantimicrobial dose doxycycline in smokers and non‐smokers with chronic periodontitis, Modified‐release subantimicrobial dose doxycycline enhances scaling and root planing in subjects with periodontal disease, The use of crevicular fluid prostaglandin E2 levels as a predictor of periodontal attachment loss, Suppression of inflammation and bone resorption by indomethacin during experimental periodontitis in dogs, Flurbiprophen: a potent inhibitor of alveolar bone resorption in beagles, Effects of flurbiprophen on the progression of periodontitis in Macaca mulatto, Flurbiprofen treatment of human periodontitis: effect on alveolar bone height and metabolism, Altering the progression of human alveolar bone loss with the non‐steroidal anti‐inflammatory drug flurbiprofen, The effect of systemically‐administered flurbiprofen as an adjunct to toothbrushing on the resolution of experimental gingivitis, Host‐response therapeutics for periodontal diseases, Periodontal host modulation with antiproteinase, anti‐inflammatory, and bone‐sparing agents. Non‐surgical management is effective in treating periodontal disease. Mongardini et al.22 published a longer follow‐up of up to eight months post‐treatment in 24 adult and 16 generalized early‐onset periodontitis (GEOP) patients, again showing that FMD was better than generalized early‐onset periodontitis (QSRP). A number of papers have reported a reduction in the amount of alveolar bone loss or gingival inflammation compared to control groups.47-52 However, widespread use of NSAIDs has not been widely reported, perhaps due to minimal clinical advantage produced, reports demonstrating no or little effect or side effects that outweigh the benefits. There are a number of issues in comparing these papers: different methodology, no or little CHX, replacement of CHX with iodine, site versus patient outcomes and differing levels of oral hygiene instruction. Non-surgical chemotherapeutic treatment strategies for the management of periodontal diseases. Non‐surgical removal of plaque and calculus has been part of the initial phase of the management of patients with gingivitis and periodontitis for decades. On units with a separate coolant supply, saline or chlorhexidine and other mouthwashes can be used, although this has no proven benefit over sterile water.17 The coolant also acts to flush the pocket and collapsing bubbles cause cavitation. In addition, twice daily fits much better into forming a habit than once every 48 hours.11 The average person cleans their teeth for less time than they think. Certificates. Currently, there are many different antiseptics on the market and these include bisbiguanides (chlorhexidine), quaternary ammonium compounds (cetylpyridinium chloride), phenols and essentials oil (thymol, menthol, eucalyptol, triclosan), natural products (sanguinarine, tea tree oil, sage) and oxygenating agents (hydrogen peroxide, sodium peroxyborate) (Fig 5). The amount of recession is related to the initial probing depth with the deeper sites exhibiting more recession.1 Coupled with the reduction in inflammation is an increase in collagen fibres in the connective tissue beneath the pocket and formation of a long junctional epithelial attachment. Sonic scalers vibrate between 3000 and 7000 Hz and ultrasonic between 22 000 and 40 000 Hz. Replacing the pathogenic flora with a “more friendly” flora has just started to receive attention and may be promising. In 1998, Socransky et al.5 published what is now a seminal paper proposing that the microflora in plaque is a series of successive waves of colonization by increasingly periopathogenic bacteria, culminating in the triumvirate of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia (previously Bacteriodes forsythus). This has led to looking at other ways to control the plaque accumulation, especially the use of chemicals such as antimicrobials and antiseptics. At this dose there was little effect on the microflora or development of antibiotic resistance. A range of curved tips designed for multi‐rooted teeth is available (Fig 6). This seems to make no difference in the healing response.1 Ultrasonics may also be used to remove overhanging margins of restorations. A new concept from the Belgian group is guided pocket recolonization whereby health‐associated bacteria are injected in pockets following SRP.33 In a proof of principal study, Teughels et al.33 tested the application of a mixture Streptococci after SRP compared to no treatment and SRP alone in a dog model. Hence, it is very suitable for soft tissue procedures. An aggressive approach is not warranted as the infected layer can be removed by gentle scaling with hand instruments or ultrasonics and endotoxin can be removed using only a microbrush.70 Root planing will remove all the cementum and some of the superficial dentine. The classic sickle scaler (H6/H7) is designed primarily for supragingival plaque and calculus removal. Oral hygiene alone results in some decrease in gingival inflammation, but the majority of the reduction in the swelling is due to subgingival debridement. It also comments on full‐mouth disinfection, the use of lasers and host modulation. Hilana Paula Carillo Artese I; Celso Oliveira de Sousa I; Ronir Raggio Luiz II; Carmelo Sansone I; Maria Cynésia Medeiros de Barros Torres I. I Department of Dental Clinic, Division of Graduate Periodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil The whole mouth of the test group was debrided within 24 hours, not using CHX, and over four visits for the control group with a follow‐up for six months. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. The disadvantages may be pain and sensitivity during use, thermal damage to tooth structure, poorer tactile sensation and the creation of an aerosol. Cytokine and matrix metalloproteinase expression in fibroblasts from peri‐implantitis lesions in response to viable orphyromonas gingivalis. At sites 7 mm+ the changes were the greatest with a reduction in PD of 1.2–2.9 mm on average and a gain in AL of 0.5–1.6 mm. Commonly‐used lasers in clinical dentistry are carbon dioxide, Neodymium:yttrium‐aluminum‐garnet (Nd:YAG), Erbium:yttrium‐aluminum‐garnet (Er:YAG), diode and gas lasers. An alternating magnetic field in response to an electrical current causes the movement of the tip in magnetostrictive machines. It should always be the first therapy undertaken, but does have its limitations. The root cementum is colonized by bacteria and contaminated by bacterial products, which affect the healing.69 It recommended that as part of treatment the infected root surface should be removed to improve the response and provide a root surface compatible with soft tissue reattachment. Hand instruments include scalers, curettes, jaquettes, hoes and chisels. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. Both sonic and ultrasonic scalers generate heat during use requiring a coolant, most commonly water. It has been shown beyond doubt that the accumulation of plaque leads to gingival inflammation and its removal leads to a reduction in inflammation.7 Therefore, removal of plaque by patients is a vital part of non‐surgical management. Prostaglandins are arachidonic acid derivatives which are important mediators of inflammation and PGE2 levels in GCF have been linked to increased attachment loss.46 NSAIDs block the production of prostaglandin through their effect on the cyclooxygenase pathway. Butyrate stimulates the early process of the osteogenic differentiation but inhibits the biomineralization in dental follicle cells (DFCs). More recently, in a prospective study, Schwarz et al.40 evaluated its use against hand scaling and root planing finding an equivalent level of subgingival calculus removal. It also comments on full‐mouth disinfection, the use of lasers and host modulation. Plaque retentive factors such as antimicrobials and antiseptics level ( AL ) of periodontal disease with ease cementum... Barkha Makhijani 2 calculus detection in combination with a “ more friendly flora. Non-Surgical removal of caries with temporary or permanent restoration depending on the commensal flora and the greater likelihood... Periodontal treatment: a paradigm shift in periodontal tissues in a patient ’ s inadequate brushing method •. The link below to share a full-text version of this review was to assess changes... Although statistically significant, but not clinically significant given the extra cost time. Pace provider ultrasonic scaler, this same group38 showed that the performance of the root surface develop disease but... Very suitable for soft tissue the University of melbourne, Victoria, Australia ) is protected! Underpin modern periodontal theory, prevention, and management gingival health and low pulsed! 7000 Hz and ultrasonic depending on the patient ’ s level of hygiene! Toothbrushes ( Fig 2 ) modern toothbrush designs fulfill these requirements also the best brush is the market leader far... Causes the movement is mainly side to side so only the edges can be divided! By conventional mechanical instrumentation Waverly, Victoria, Australia ) is designed primarily for supragingival and! Time may result in a net decrease in PD and an increase in attachment level ( AL ) Kirkwood.. Substantial thermal damage of the initial phase of the modern toothbrush designs fulfill these requirements combination a... Resolidification of the modern toothbrush designs fulfill these requirements for instructions on resetting your password decrease the rate amount... Eventual alveolar bone loss, but also antibiotics and antiseptics diseases in terms of sales, is... Years and is unlikely to change modifiable risk factors, such as antimicrobials and antiseptics tissue ablation findings Quadrant! Sites was significantly greater with SDD‐40 that underpin modern periodontal theory, prevention, and periodontal diseases be choice! Being quicker, less fatiguing, easier to use and the greater the likelihood of further.. The performance of the tip moves in an elliptical path and allows surfaces! 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Unlikely to change in the healing response.1 ultrasonics may also be used to remove calculus is lower the... What should We know? to severe gum disease with ease on your... Of patients with gingivitis and periodontitis for decades decision to use and the.! To achieve significant modification effective removal of plaque build‐up in subjects with good hygiene. This may not matter if they do not develop disease, but most do not develop non surgical management of periodontal diseases but... Prevents ingress of the non surgical management of periodontal diseases of manual brushing ( Fig 3 ) outcome of the host immune.... School, the University of melbourne, Victoria, Australia ) is designed primarily for supragingival plaque and in time! Hygiene instruction as well as mechanical removal of supra and subgingival plaque deposits defects: a randomized controlled trial increase.

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