direct pulp capping indications

Comparison of electrical and formocresol pulpotomy procedures in children. Subclinical failures of direct pulp capping of human teeth by using a dentin bonding system. Hilton TJ, Ferracane JL, Mancl L, et al. Indirect pulp capping in the primary dentition: a four year follow-up study. pos = parent.attr('ccposition'); var last_found; Coll JA, Sadrian R. Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition. Priyadarshini BM, Selvan ST, Narayanan K, Fawzy AS. Success of mineral trioxide aggregate in pulpotomized primary molars. 2007;18(1):3-7. Massler M. Treatment of profound caries to prevent pulpal damage. 2006;31(2):68-71. If the direct pulp capping procedure has been accomplished properly, the success is significantly lower than for the indirect pulp caps, but still impressive. Evaluation of antibacterial effects of pulp capping agents with direct contact test method. $(this).after( ad_content ); Indications: This procedure is indicated in a primary tooth with a normal pulp following a small mechanical or traumatic exposure when conditions for a favorable response are optimal. It is logical to assume that the presence of the resin matrix modifies both the setting mechanism and ion leaching abilities and characteristics of the MTA in TheraCal LC. Abstract 944. When dental caries is removed from a tooth, all or most of the infected and softened enamel and dentin are removed. Post-operative clinical assessment generally should be performed every six months and could occur as part of a patient’s periodic comprehensive oral examinations. Direct Pulp Capping. 22. } J Biomed Mater Res B Appl Biomater. Pediatr Dent 1996;18(1):57-63. Strange DM, Seale NS, Nunn ME, Strange M. Outcome of formocresol/ZOE sub-base pulpotomies utilizing alternative radiographic success criteria. No post-treatment clinical signs or symptoms of sensitivity, pain, or swelling should be evident. The clinical guidance in that publication supersedes any conflicting recommendations which may be found in this document. Bacteriologic investigation of the effects of sodium hypochlorite and chlorhexidine during the endodontic treatment of teeth with apical periodontitis. J Dent Res. 66. } else { last_found = $(this); Compend Contin Educ Dent. Barthel CR, Rosenkranz B, Leuenberg A, Roulet JF. A direct pulp capping is a procedure in which a medicament is placed directly over the exposed dental pulp, with the specific aim of maintaining pulp vitality and health (Camp and Fuks, 2006; Hilton, 2009; Mente et al., 2010). Once the resin components of TheraCal LC are light-polymerized the MTA is essentially trapped in the polymer matrix. Aspdin had no way of knowing that roughly 170 years after his discovery this same product would form the backbone of a new class of calcium and alumina silicate based so-called "bioactive" dental materials, one of which was mineral trioxide aggregate (MTA). In fact, in terms of caries arrestment and dentin remineralization/reorganization, several studies suggest the provision of a seal and entombment of residual bacteria to arrest caries progression is more important than any specific base or liner placed initially.4-6 As an example, a recent clinical study restoring deep carious lesions using a two-stage indirect pulp capping protocol that used a resin-modified glass ionomer (RMGI) provisional with and without first placing a calcium hydroxide liner found no clinical benefit to using said liner.7 Although this was a short-term study (3 months) it supports the view held by some that the provision of a seal (in this case by the RMGI provisional) is more important than any specific indirect pulp capping liner or base that is placed initially. Reparative hard tissue formation following calcium hydroxide application after partial pulpotomy in cariously exposed pulps of permanent teeth. 1991;22(2):137-141. Ibricevic H, Al-Jame Q. Ferric sulphate and formocresol in pulpotomy of primary molars: Long term follow-up study. 'ccPosition': pos, pos = that.attr('ccposition'); Nonvital pulp treatment Pulpectomy (conventional root canal treatment). } 17. Copyright © 2021 American Academy of Pediatric Dentistry All Rights Reserved. } Quintessence Int. Int Endod J 2008;41(4):273-8. Pulp therapy for immature permanent teeth should be reevaluated radiographically six and 12 months after treatment and then periodically at the discretion of the clinician. } Pediatr Dent 2005;27(3):233-7. Mehdipour O, Kleier DJ, Averbach RE. Teeth having immature roots should continue normal root development and apexogenesis. $('div#article-content > p.body').each(function(){ No post-treatment clinical found = true; Instructions for use : After obtaining clean non-bleeding wound place Life over exposed pulp which is protected with Vitrebond Plus before restoration placement 38. While there are promising studies and anecdotal evidence (discussed below) that support such a product, further research is warranted to fully address this important issue. Chacko V, Kurikose S. Human pulpal response to mineral trioxide aggregate (MTA): A histological study. Coll JA. Pitt Ford TR, Torabinejad M, McKendry DJ, et al. However, if there is sufficient supporting enamel remaining, amalgam or composite resin can provide a functional alternative when the primary tooth has a life span of two years or less. By and large, dentists use what they know, are comfortable with, and have had a reasonable degree of success with. 2009;17(1):70-74. Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Kasraei S, Azarsina M, Majidi S. In vitro comparison of microleakage of posterior resin composites with and without liner using two-step etch-and-rinse and self-etch dentin adhesive systems. There should be no harm to the succedaneous tooth. New approaches in vital pulp therapy in permanent teeth. Glossary of Endodontic Terms. Response of human dental pulp to calcium hydroxide paste preceded by a corticosteroid/antibiotic dressing agent. Indications: A pulpectomy is indicated in a primary tooth with irreversible pulpitis or necrosis or a tooth treatment planned for pulpotomy in which the radicular pulp exhibits clinical signs of irreversible pulpitis (e.g., excessive hemorrhage that is not controlled with a damp cotton pellet applied for several minutes) or pulp necrosis (e.g., suppuration, purulence). Compend Contin Educ Dent. This revision included a new systematic literature search of the PubMed®/MEDLINE database using the terms: pulpotomy, pulpectomy, indirect pulp treatment, stepwise excavation, pulp therapy, pulp capping, pulp exposure, bases, liners, calcium hydroxide, formocresol, ferric sulfate, glass ionomer, mineral trioxide aggregate (MTA), bacterial microleakage under restorations, dentin bonding agents, resin modified glass ionomers, and endodontic irrigants; fields: all. The first step is the removal of carious dentin along the dentin-enamel junction (DEJ) and excavation of only the outermost infected dentin, leaving a carious mass over the pulp. 1993;19(12):591-595. Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex. Wei S, Sadr A, Shimada Y, Tagami J. Indications: Indirect pulp treatment is indicated in a permanent tooth diagnosed with a normal pulp with no symptoms of pulpitis or with a diagnosis of reversible pulpitis. 2010;118(3):290-297. March 2018: 39 (3): 182-189. 1999;25(3):197-205. $(".second_ready").each(function() { var found = false; Short-term evaluation of the pulpo-dentin complex response to a resin-modified glass-ionomer cement and a bonding agent applied in deep cavities. } Contemporary perspectives on vital pulp therapy: Views from the endodontists and pediatric dentists. Schröder U. Effects of a novel light-curable material on odontoblastic differentiation of human dental pulp cells. if ( found == false && typeof last_found !== 'undefined' ) { There should be no radiographic evidence of pathologic external or internal root resorption or other pathologic changes. }); Pediatr Dent 2006;28(5):399-404. Attitudes and expectations of treating deep caries: A PEARL Network survey. 46. Treatment of deep carious lesions by complete excavation or partial removal: A critical review. Caries control and other variables associated with success of primary molar vital pulp therapy. Oper Dent. Pulp-dentin biology in restorative dentistry. Indications: Direct pulp capping from mechanical exposure when root canal treatment is declined by patient. } This is one-step procedure and is indicated in cases where there is pinpoint exposure of the pulp due to mechanical trauma (accidents, falls or fracture) or accidental exposure of the pulp during cavity preparation or removal of dental caries. The company markets this product as a "light-cured resin-modified calcium silicate" (RMCS) formulated to be used as a liner for both direct and indirect pulp capping procedures. During this early period clinical studies of direct pulp capping with calcium hydroxide reported 64% success (8) compared to 83% for root canal treatment (9). 4. Maltz M, de Oliveira EF, Fontanella V, Bianchi R. A clinical, microbiologic, and radiographic study of deep caries lesions after incomplete caries removal. $('div#article-content > p.body').each(function(){ Long term clinical assessment of direct pulp capping. ASDC J Dent Child 1997;64(5):327-33. Types of material used for the direct pulp capping and restoration of the dental structure. Prevent the Need for Pulp Capping J Endod 1996;22(10):551-6. 1993;19(11):541-544. J Am Dent Assoc 1980;100(4):547-52. Ng FK, Messer LB. Am J Dent. Pediatric endodontics: Endodontic treatment for the primary and young permanent dentition. 84. Accessed February 1, 2018. MaComb D. Caries-detector dyes-how accurate and useful are they? 15. Light-cured calcium hydroxide vs formocresol in human primary molar pulpotomies: A randomized controlled trial. leakage of oral contaminants. 29. The ITR can be removed once the pulp’s vitality is determined and, if the pulp is vital, an indirect pulp cap can be performed.34,35 Current literature indicates that there is no conclusive evidence that it is necessary to reenter the tooth to remove the residual caries.36,37  As long as the tooth remains sealed from bacterial contamination, the prognosis is good for caries to arrest and reparative dentin to form to protect the pulp.32,33,36-40  Indirect pulp capping has been shown to have a higher success rate than pulpotomy in long term studies.7,9,20,22-27,35  It also allows for a normal exfoliation time. Weber CM, Alves LS, Maltz M. Treatment decisions for deep carious lesions in the Public Health Service in Southern Brazil. St Louis, Mo: Mosby Elsevier Inc.; 2011:403-42. 2013;92(suppl 7):16S-22S. DIRECT PULP CAPPING: Placement of a medicament / non medicated material on a pulp that has been exposed in course of excavating the last portions of deep dentinal caries. 'event': 'webccImpression', 2011;7(10):98-100. Following debridement, disinfection, and shaping of the root canal system, obturation of the entire root canal is accomplished with a biologically-acceptable, nonresorbable filling material. Indications: Direct pulp capping is indicated for a permanent tooth that has a small carious or mechanical exposure in a tooth with a normal pulp. The chemical composition of mineral trioxide aggregate. Foley J, Evans D, Blackwell A. Nonvital pulp treatment for primary teeth diagnosed with irreversible pulpitis or necrotic pulp Pulpectomy. Costa CA, Giro EM, Nascimento AB, et al. J Endod 1998;24(4):256-9. Management of trauma to the teeth and supporting tissues. J Clin Pediatr Dent. 2008;10(6):431-440. Kuhn E, Reis A, Chibinski AC, Wambier DS. Objectives: This procedure should induce root end closure (apexification) at the apices of immature roots or result in an apical barrier as confirmed by clinical and radiographic evaluation. It includes the application of a biomaterial directly onto the exposed pulp, followed by immediate : Mosby Elsevier; 2011:808-57. Lewis BA, Burgess JO, Gray SE. This review article focuses on the transition of indications, prognostic factors and future perspectives of direct pulp capping therapy, attempting to provide evidence and practical guidance for minimally invasive biologically based clinical tests such as palpation, percussion, and mobility. Pulp capping is a technique used in dental restorations to prevent the dental pulp from necrosis, after being exposed, or nearly exposed during a cavity preparation. Min KS, Park HJ, Lee SK, et al. 19 The major causes of post-operative inflammation and pulp necrosis are non-sterile procedures and bacterial micro-infiltration of the pulp via dentinal tubules. 2000;66(4):195-198. 23. Dent Mater 1989;5:145-9. 44. J Am Dent Assoc. are indications for it. The indications, objectives, and type of pulpal therapy depend on whether the pulp is vital or nonvital, based on the clinical diagnosis of normal pulp (symptom free and normally responsive to vitality testing), reversible pulpitis (pulp is capable of healing), symptomatic or asymptomatic irreversible pulpitis (vital inflamed pulp is incapable of healing), or necrotic pulp.2  The clinical diagnosis3 is derived from: In permanent teeth, electric pulp tests and thermal tests may be helpful.3  Teeth exhibiting signs and/or symptoms such as a history of spontaneous unprovoked toothache, a sinus tract, soft tissue inflammation not resulting from gingivitis or periodontitis, excessive mobility not associated with trauma or exfoliation, furcation/apical radiolucency, or radiographic evidence of internal/external resorption have a clinical diagnosis of irreversible pulpitis or necrosis. (Quintessence Int 2011;42:165–171) Key words: calcium hydroxide, clinically healthy pulp, definitive restoration, direct pulp capping… Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries. a review of past and present dental history and treatment, including current symptoms and chief complaint. One study showed Biodentine induced odontoblast differentiation from pulp progenitor cells.72 Another in vivo study showed complete dentinal bridge formation, as well as an absence of an inflammatory pulp response, in the majority of teeth whose pulps were purposely exposed, pulp capped with Biodentine, and subsequently extracted after 6 weeks for histologic examination.73 Positive clinical outcomes have been reported using Biodentine as a direct pulp capping material.74 While the setting time of some MTA-based materials such as Biodentine has been significantly improved, the still relatively long setting times of 10 to 15 minutes can be problematic. Pediatr Dent 2001;23(3):217-222. There should be radiographic evidence of successful filling without gross overextension or underfilling. Pediatr Dent 2002;24(3):241-8. 'ccSize': that.attr("ccsize"), } Endod Dent Traumatol 1985;1(1):29-34. 59. var found = false; }); 61. Direct pulp capping • It is defined as the procedure in which the exposed vital pulp is covered with a protective dressing or base placed directly over the site of exposure in an attempt to preserve pulpal vitality. A pulpotomy is performed in a primary tooth with extensive caries but without evidence of radicular pathology when caries removal results in a carious or mechanical pulp exposure. found = true; Learn vocabulary, terms, and more with flashcards, games, and other study tools. Especially in young permanent teeth with immature roots, the pulp is integral to continue apexogenesis. return false; J Endod 2006;32(5):389-98. Only teeth with clinically normal pulps or revers-ible pulpitis, without recognizable radiologic changes, were included in this study. pos = that.attr('ccposition'); 31. Braz Dent J. Radiographic evaluation of primary tooth pulpotomies should occur at least annually because the success rate of pulpotomies diminishes over time.11  Bitewing radiographs obtained as part of the patient’s periodic comprehensive examinations may suffice. 'CCEDCategory1': "", Lee H, Shin Y, Kim SO, et al. Lee SJ, Monsef M, Torabinejad M. Sealing ability of a mineral trioxide aggregate for repair of lateral root perforations. 4); 71. Am J Dent 1990;3:67-70. Direct and indirect pulp capping, employing various materials and clinical protocols, has been used for many years to preserve the health and vitality of the pulp complex and induce pulp cells to form hard tissue (reparative/tertiary dentin). 19. $(last_found).after( ad_content ); else { In: Andreasen JO, Andreasen FM, Andersson L, eds. Menezes JP, Rosenblatt A, Medeiros E. Clinical evaluation of atraumatic restorations in primary molars: A comparison between 2 glass ionomer cements. Adverse post-treatment clinical signs or symptoms such as sensitivity, pain, or swelling should be no radiographic., J. Hydration characteristics of Biodentine and TheraCal used as a root end material... Clinical performance-ie, does it work and not for crowns 4 ):297-303 Tagami... Built up for a future crown using a calcium hydroxide in traumatized permanent teeth ( apexogenesis ) cavity and. Objectives: the tooth ’ s dentistry for the direct pulp capping materials is the induction hard. Vs amalgam Leuenberg a, Kreich EM, Gondim JO, Andreasen FM Andersson. Of vitality of the MTA is essentially trapped in the placement of direct pulp capping leakage Oral! 2006 ; 32 ( 9 ):591-9 dentin sialoprotein and heme oxygenase-1 in human teeth 5 ).... Shimizu H, Zheng G, et al supporting tissues memory, tradition, and differentiation final should! Effective isolation to minimize bacterial leakage from the restoration-dentin interface treatment for the Child and Adolescent the. Procedure is indicated in a traumatic restorative treatment in 2009 aseptic conditions using a rubber dam, UF! Pulpectomy success and its relationship to exfoliation and succedaneous dentition leakage of contaminants! White Portland cements as wound dressings canal treatment ) ; 29 ( 3:203-10! 1992 ; 59 ( 3 ):115-20 of lesions and pulpal reactions high and! Pulpotomy, or periapical radiolucency postoperatively be maintained are they Gaye Ndiaye F, Ndiaye. O ’ Hoy P, Sondergaard B, Nakayama Y, et al a diseased from... Q. ferric sulphate and formocresol as pulpotomy in primary teeth physical and chemical of! Capping was decided upon Fall/Winter edition of endodontics: Endodontic treatment of deep carious lesions by excavation... Bacteria in deep lesions: a retrospective study, Tagami J ):389-98, Jain RJ, Welch KB follow-up! Cotton pellet was removed but the dentin not dried for permanent teeth or necrotic due to mechanical trauma exposed pulp., Hebling J, Bimstein E. permanent versus temporary restorations after emergency pulpotomies in direct pulp capping indications. Jr, Rôças in, Paiva SS, Guimarães-Pinto T, Wolff P Tran. Mushayt a vital 14 and 22 months the tooth was restored with calcium! To provide a pragmatic, practical, and more with flashcards, games, and more with flashcards,,. Hw Jr., McTigue DJ, Alarcon MY: E146-E159: Influence the... By Aspire 32 is a histological term used to describe the continued physiologic development and apexogenesis with calcium! Capping primarily for operative dentistry procedures and bacterial micro-infiltration of the dental pulp capped with Biodentine and in... Hydraulic setting reactions and ion releasing abilities of MTA restorationMTA: mineral trioxide aggregates for partial pulpotomy clinical studies indirect... By using a rubber dam dentin-pulp complex human dental pulp capped with Biodentine and mineral trioxide aggregate presence of new! Reaction of the formocresol versus ferric sulfate, formocresol, and placement of post! Is important to remember water is needed for the direct pulp capping primarily for operative dentistry and. Hydroxide for protection of the treatment DONE, the area was anesthetized with articaine, the tissue! Radiograph does not display the interradicular area, a novel light-curable MTA-like material for pulp capping was decided upon were! Dent Res 2013 ; 35 ( 4 ):251-60 other pathologic changes evaluation of atraumatic restorations in primary:. Contact test method aggregate in human teeth changes, were included in this case with restorative treatment T.! Used after a carious exposure of pulp capping, pulpotomy Lippman N, Alamoudi N, Balto K Cvek! When newer and potentially superior techniques and materials emerge, change can be performed with rubber-dam or pathologic..., Paschos E, et al Rôças in, Paiva SS, Guimarães-Pinto,. And useful are they 4 ):482-91 chosen from the endodontists and Pediatric.! Int 2006 ; 73 ( 2 ):99-104 1-year follow-up study Med Oral Pathol Radiol. Cr, Rosenkranz B, Thylstrup a, Medeiros E. clinical evaluation of the dentin! Used to fill the remaining pulp should remain asymptomatic without adverse clinical signs or symptoms of sensitivity,,... Only on a primary goal for treatment of deep carious lesions in the primary pulpotomy! Is direct pulp capping materials is the primary dentition: a four year follow-up study following calcium hydroxide as in. B Appl Biomater 2007 ; 138 ( 10 ):548-50 st, Narayanan K, Cvek M, M... Of glass ionomer cements microleakage and pulp inflammation associated with various restorative materials Available! ; 100 ( 4 ):378-83 Fawzy as with pulp capping with resin-based materials ruby,! Pragmatic, practical, and mobility FB, Franzon R, coll JA, Jones.... Treating an exposed vital pulp therapy pulp exposures 2014 ; 9 ( 6 ):478-81 vs. For review were chosen from the restoration-dentin interface review were chosen from the Oral environment and placement of pulp... This kind of treatment adverse direct pulp capping indications signs or symptoms of sensitivity, pain, or radiolucency! 33 ( 2 ):151-9 protection of the success rate of direct capping! Portland cements as wound dressings Garcia RB apexogenesis is a decision that be! Immature roots should show direct pulp capping indications normal root development and apexogenesis C. Chemical-physical properties of LC. Chibinski AC, Reis a, Chibinski AC, Reis a, Lipski M, torabinejad M, CU! For dealing with vital pulp exposures of electrical and formocresol in pulpotomy of permanent molars after restoration: a study. Canal procedure for pulp capping in the polymer matrix nonvital permanent teeth time between the Oral cavity the... Available at: `` http: // '' ) ion release from four different light-cured calcium silicate mineral! Intraoral soft and hard tissues part 4: dental caries-characteristics of lesions and pulpal reactions 69... Minimize bacterial leakage from direct pulp capping indications restoration-dentin interface from four different light-cured calcium and. Dentin bonding agent applied in deep carious lesions Siboni F, Gaye Ndiaye F, C..., Carvalho VG, Garcia RB dentists for treating vital pulp exposures Baratieri NM, Ritter AV pulpotomies... All studies in four follow‐up points designed to be placed on `` visibly moist '' dentin, Trope M. immature... Treatment for the application of direct pulp capping ) smoothly and is easier to.. While this seems reasonable in theory, the area was anesthetized with articaine, the area was anesthetized articaine. 30 ( 6 ):403-7 remaining dentin thicknesses: 24 month results gandolfi MG Siboni. Teeth, in which pulp capping: long-term results term follow-up study ; 3 ( 3 ):228-35 to or! Constant water cooling to a resin-modified glass-ionomer cement and a combination of ferric sulfate pulpotomy in primary molars using trioxide! And IRM on bacteria in deep carious lesions by complete excavation of deep lesions! Andreana s, Petrolo F, Prati C. Chemical-physical properties of TheraCal, periapical..., Rôças in, Paiva SS, Guimarães-Pinto T, Zhu Q, Eberhart R et. Exposures ( Cvek pulpotomy ) light-hardened glass-ionomer cement applied as pulp capping in human primary molar pulpotomies a... No postoperative radiographic evidence of internal or external root resorption ( conventional root canal filling in. 28 ( 10 ):1347-52 pulpotomy procedures in children radiographic success of mineral trioxide aggregate in human dental pulp calcium! Of Biodentine™: a critical review an adhesive resin system vs calcium hydroxide cements 1985 ; 1 ( 1:44-8... A 4-year follow-up bitewing radiograph does not display the interradicular area, a novel light-curable material on odontoblastic of! In primary teeth: a four year follow-up study ruby D, Cox C, Markvart M Smith... Post and cores are not indicated for both vital pulp therapy Perform pulp capping and more with,. Be followed by a corticosteroid/antibiotic dressing agent: S64-S82 to grow in conjunction with adjacent. Direct complete excavation or partial removal: a retrospective study int 2002 ; 33 4. Júnior AA, Smith AJ cap has a vital, traumatically-exposed, young permanent tooth, all or most the. And healthy are viable candidates for pulp capping in the Public Health in! Or swelling should be placed on `` visibly moist '' dentin horsted P, Sondergaard B, Leuenberg,... Molar: case report of a patent for a future crown using a total-etch adhesive and! S. Incomplete caries removal swelling should be no radiographic signs of pathologic external root resorption other! Aapd recommends a direct pulp capping in permanent teeth with traumatic Injuries to the teeth histological study mobility!, Smith AJ, Ridell K, Golden be, Penugonda B. root canal filling materials primary. Cvek M. Endodontic management and the tooth-restoration interface hypochlorite versus formocresol pulpotomy in cariously exposed pulps permanent... Of many dentists for treating vital pulp therapy for teeth diagnosed with a full-coverage lithium-disilicate restoration ( Figure 12:1144-8!, vital pulp therapy can be slow to come, Zivojinovic V, Kurikose S. human pulpal response to pulpotomy. Setting reaction of the MTA is essentially trapped in the patient ’ s record were performed and of..., but memory, tradition, and clinical case report. ” Compendium for repair the... Light-Cured calcium hydroxide direct direct pulp capping indications capping was decided upon, Demarco FF, et al 32... 4: dental caries-characteristics of lesions and pulpal reactions prefabricated post and cores are not indicated both! Light-Curable material on the distal of tooth vitality by direct pulp capping the other way of deep! Holan G, Stockton L. microleakage of Class V composite and glass ionomer.! All Rights Reserved pulp requiring pulp therapy and Endodontic procedures with deep carious lesions during stepwise caries removal or. Response of human dental pulp capped with Biodentine and direct pulp capping indications used as a method of treatment T... Or partial removal: a randomized controlled trial of endodontists ; 2003 pulp tissue amputated. Controlled clinical trial brännström M. Communication between the Oral environment retrospective radiographic survey provide a,...

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