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Davó R, Fan S, Wang F, Wu Y. Long-term survival and complications of Quad Zygoma Protocol with Anatomy-Guided Approach in severely atrophic maxilla: A retrospective follow-up analysis of up to 17 years. Clin Implant Dent Relat Res 2024; 26:343-355. [PMID: 38084831 DOI: 10.1111/cid.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION The objective of the study was to provide long-term clinical outcomes and complications in the severely atrophic edentulous maxillae treated by means of the quad zygoma protocol (QZP) using the Anatomy-Guided Approach (AGA). METHODS This was a retrospective cohort study of all consecutive patients with severely atrophic edentulous maxilla and insufficient bone height and width in the anterior and posterior regions bilaterally, who underwent rehabilitation with the QZP between May 2006 and December 2021. All patients were followed for at least 1 year. All zygomatic implants (ZIs) were placed by the same surgeon. The primary endpoint of the study was the implant survival rate. Secondary endpoints were implant success rate, prosthesis success rate, complications, and Oral Health-Related Quality of Life using the OHIP-14 questionnaire. RESULTS A total of 56 patients (men 16, women 40) with 224 ZIs (Nobel Biocare, n = 204; Straumann, n = 16; Southern Implant, n = 4) placement were included with a mean follow-up period 8.8 ± 3.9 years (range, 1.2-17.0). The survival (success) rate was 97.7%. Five ZIs in four patients failed. The mean time between implant placement and failure was 8.6 years (range, 0.5-13.3). All patients received immediate loading with acrylic prosthesis. The successful rates for the definitive prosthesis were 98.2%. Forty-two patients received posterior cantilever for rehabilitation of fixed definitive prosthesis. Local orofacial inflammation (35.7%) and Sinusitis (12.5%) were the most common complications, occurring at a mean follow-up of 10.0 (range, 4.2-14.9) and 10.3 (range, 4.3-16.2) years, respectively. In 48 patients, the mean score of the OHIP-14 questionnaire was 1.7 ± 2.6 with the follow-up period of 9.0 ± 4.1 years. CONCLUSIONS The rehabilitation of severely atrophic edentulous maxilla using the QZP has shown a predictable and high survival rate in the long term. The implementation of an immediate loading protocol offers potential benefits in stabilizing ZIs with cross-arch stabilization. Moreover, the use of a posterior cantilever in reconstruction can effectively establish functional occlusion through well-distributed ZIs, eliminating the need for additional implant placement.
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Affiliation(s)
- Rubén Davó
- Department of Implantology and Maxillofacial Surgery, Vithas Davó Instituto Dental, Hospital Medimar Internacional, Alicante, Spain
| | - Shengchi Fan
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, Mainz, Germany
- Second Dental Clinic, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Feng Wang
- Second Dental Clinic, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yiqun Wu
- Second Dental Clinic, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
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Cipollina A, Ceddia M, Di Pietro N, Inchingolo F, Tumedei M, Romasco T, Piattelli A, Specchiulli A, Trentadue B. Finite Element Analysis (FEA) of a Premaxillary Device: A New Type of Subperiosteal Implant to Treat Severe Atrophy of the Maxilla. Biomimetics (Basel) 2023; 8:336. [PMID: 37622941 PMCID: PMC10452205 DOI: 10.3390/biomimetics8040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Extreme atrophy of the maxilla still poses challenges for clinicians. Some of the techniques used to address this issue can be complex, risky, expensive, and time consuming, often requiring skilled surgeons. While many commonly used techniques have achieved very high success rates, complications may arise in certain cases. In this context, the premaxillary device (PD) technique offers a simpler approach to reconstruct severely atrophic maxillae, aiming to avoid more complicated and risky surgical procedures. Finite element analysis (FEA) enables the evaluation of different aspects of dental implant biomechanics. Our results demonstrated that using a PD allows for an optimal distribution of stresses on the basal bone, avoiding tension peaks that can lead to bone resorption or implant failure. ANSYS® was used to perform localized finite element analysis (FEA), enabling a more precise examination of the peri-crestal area and the PD through an accurate mesh element reconstruction, which facilitated the mathematical solution of FEA. The most favorable biomechanical behavior was observed for materials such as titanium alloys, which helped to reduce stress levels on bone, implants, screws, and abutments. Additionally, stress values remained within the limits of basal bone and titanium alloy strengths. In conclusion, from a biomechanical point of view, PDs appear to be viable alternatives for rehabilitating severe atrophic maxillae.
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Affiliation(s)
| | - Mario Ceddia
- Department of Mechanics, Mathematics and Management, Politecnico di Bari University, 70125 Bari, Italy; (M.C.); (B.T.)
| | - Natalia Di Pietro
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
- Center for Advanced Studies and Technologies (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Margherita Tumedei
- Department of Medical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy;
| | - Tea Romasco
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
- Center for Advanced Studies and Technologies (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Adriano Piattelli
- School of Dentistry, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy;
- Facultad de Medicina, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | - Alessandro Specchiulli
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
| | - Bartolomeo Trentadue
- Department of Mechanics, Mathematics and Management, Politecnico di Bari University, 70125 Bari, Italy; (M.C.); (B.T.)
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Kämmerer PW, Fan S, Aparicio C, Bedrossian E, Davó R, Morton D, Raghoebar GM, Zarrine S, Al-Nawas B. Evaluation of surgical techniques in survival rate and complications of zygomatic implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review. Int J Implant Dent 2023; 9:11. [PMID: 37198345 DOI: 10.1186/s40729-023-00478-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To assess the outcome [zygomatic implant (ZI) survival] and complications of the original surgical technique (OST) and an Anatomy-Guided approach (AGA) in the placement of ZI in patients with severely atrophic maxillae. METHODS Two independent reviewers conducted an electronic literature search from January 2000 to August 2022. The inclusion criteria were articles reporting at least five patients with severely atrophic edentulous maxilla undergoing placement OST and/or AGA, with a minimum of 6 months of follow-up. Number of patients, defect characteristics, number of ZI, implant details, surgical technique, survival rate, loading protocol, prosthetic rehabilitation, complications, and follow-up period were compared. RESULTS Twenty-four studies comprised 2194 ZI in 918 patients with 41 failures. The ZI survival rate was 90.3-100% in OST and 90.4-100% in AGA. Probability of complications with ZI with OST was as follows: sinusitis, 9.53%; soft tissue infection, 7.50%; paresthesia, 10.78%; oroantral fistulas, 4.58%; and direct surgical complication, 6.91%. With AGA, the presenting complications were as follows: sinusitis, 4.39%; soft tissue infection, 4.35%; paresthesia, 0.55%; oroantral fistulas, 1.71%; and direct surgical complication, 1.60%. The prevalence of immediate loading protocol was 22.3% in OST and 89.6% in the AGA. Due to the heterogeneity of studies, statistical comparison was only possible after the descriptive analysis. CONCLUSIONS Based on the current systematic review, placing ZI in severely atrophic edentulous maxillae rehabilitation with the OST and AGA is associated with a high implant survival rate and surgical complications within a minimum of 6 months follow-up. Complications, including sinusitis and soft tissue infection around the implant, are the most common. The utilization of immediate loading protocol is more observed in AGA than in OST.
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Affiliation(s)
- Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery-Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - Shengchi Fan
- Department of Oral and Maxillofacial Surgery-Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, School of Medicine Second Dental Clinic, Ninth People's Hospital, National Clinical Research Center for Oral Disease, College of Stomatology, Shanghai Jiao Tong University, 200011, Shanghai, China
| | - Carlos Aparicio
- Indiana University School of Dentistry, Indianapolis, USA
- Zygomatic Unit at Hepler Bone Clinic, ZAGA Center Barcelona, Barcelona, Spain
| | - Edmond Bedrossian
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, USA
| | - Rubén Davó
- Department of Implantology and Maxillofacial Surgery, Vithas Davó Instituto Dental, Alicante, Spain
| | - Dean Morton
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, USA
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | | | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery-Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
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González Rueda JR, Galparsoro Catalán A, de Paz Hermoso VM, Riad Deglow E, Zubizarreta-Macho Á, Pato Mourelo J, Montero Martín J, Hernández Montero S. Accuracy of computer-aided static and dynamic navigation systems in the placement of zygomatic dental implants. BMC Oral Health 2023; 23:150. [PMID: 36918837 PMCID: PMC10015906 DOI: 10.1186/s12903-023-02856-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/04/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Zygomatic implants are widely used in the rehabilitation of severely atrophic maxillae, but implant placement is not without risks, and it can potentially cause damage to related anatomical structures. The aim of this study was to perform a comparative analysis of the accuracy of static navigation systems in placing zygomatic dental implants in comparison to dynamic navigation systems. METHODS Sixty zygomatic dental implants were randomly allocated to one of three study groups, categorized by which implant placement strategy was used: A: computer-aided static navigation system (n = 20) (GI); B: computer-aided dynamic navigation system (n = 20) (NI); or C: free-hand technique (n = 20) (FHI). For the computer-aided study groups, a preoperative cone-beam computed tomography (CBCT) scan of the existing situation was performed in order to plan the approach to be used during surgery. Four zygomatic dental implants were inserted in each of fifteen polyurethane stereolithographic models (n = 15), with a postoperative CBCT scan taken after the intervention. The pre- and postoperative CBCT scans were then uploaded to a software program used in dental implantology to analyze the angular deviations, apical end point, and coronal entry point. Student's t-test was used to analyze the results. RESULTS The results found statistically significant differences in apical end-point deviations between the FHI and NI (p = 0.0053) and FHI and GI (p = 0.0004) groups. There were also statistically significant differences between the angular deviations of the FHI and GI groups (p = 0.0043). CONCLUSIONS The manual free-hand technique may enable more accurate placement of zygomatic dental implants than computer-assisted surgical techniques due to the different learning curves required for each zygomatic dental implant placement techniques.
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Affiliation(s)
- Juan Ramón González Rueda
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Agustín Galparsoro Catalán
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | | | - Elena Riad Deglow
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Álvaro Zubizarreta-Macho
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
- grid.11762.330000 0001 2180 1817Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Jesús Pato Mourelo
- grid.5924.a0000000419370271Department of Surgery, Faculty of Dentistry, University of Navarra, 31009 Pamplona, Navarra Spain
| | - Javier Montero Martín
- grid.11762.330000 0001 2180 1817Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Sofía Hernández Montero
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
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Yildirim G, Kocaelli HA. Assessment of the content and quality of YouTube videos related zygomatic implants: A content-quality analysis. Clin Implant Dent Relat Res 2023. [PMID: 36808698 DOI: 10.1111/cid.13194] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/19/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION This study aimed to evaluate the content and quality of YouTube videos of zygomatic implants. METHODS According to Google Trends (2021), "zygomatic implant" was the most preferred keyword related to the topic. Therefore, in this study "zygomatic implant" was used as a keyword for the video search. Demographic characteristics such as the number of views, likes/dislikes, comments, video duration, number of days after upload, uploaders, and target audiences of the videos were evaluated. To evaluate the accuracy and content quality of videos (available from YouTube), the video information and quality index (VIQI) and global quality scale (GQS) were used. Statistical analyses were performed using the Kruskal-Wallis test, Mann-Whitney U test, chi-square test, Fisher's exact chi-square test, Yates continuity correction, and Spearman correlation analysis (p < 0.05). RESULTS A total of 151 videos were searched; 90 met all inclusion criteria. According to the video content score, 78.9% of the videos were identified as low content, 20% as moderate, and 1.1% as high content. There was no statistical difference between the groups in video demographic characteristics (p > 0.001). Conversely, information flow, accuracy of information, video quality and precision, and total VIQI scores were statistically different between the groups. The moderate-content group had a higher GQS score than the low-content group (p < 0.001). The videos were mainly uploaded (40%) from hospitals and universities. Most videos were targeted toward professionals (46.75%). Low-content videos had higher ratings than the moderate- and high-content videos. CONCLUSIONS Most YouTube videos on zygomatic implants showed low-content quality. This implies that YouTube is not a reliable source of information on zygomatic implants. Dentists, prosthodontists, and oral and maxillofacial surgeons should be aware of the content of video-sharing platforms and take responsibility for enriching video content.
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Affiliation(s)
- Gulhan Yildirim
- Department of Prosthodontics, Beykent University, Istanbul, Turkey
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Success Rates of Zygomatic Implants for the Rehabilitation of Severely Atrophic Maxilla: A Systematic Review. Dent J (Basel) 2022; 10:dj10080151. [PMID: 36005249 PMCID: PMC9406716 DOI: 10.3390/dj10080151] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/02/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Zygomatic implants are a treatment solution for patients with severe maxillary atrophy. This treatment option allows delivering immediate fixed teeth within 24 h. Numerous peer-reviewed publications have reported different success rates, resulting in a disagreement on the topic. Therefore, the overall efficacy and predictability of this rehabilitation is still a matter of discussion. With this study, we aimed to identify the published literature on the use of zygomatic implants for the reconstruction of the severely atrophic maxilla and report the cumulative success rate (CSR) as a function of follow-up time. A systematic review of the literature on zygomatic implant for the treatment of severe maxillary atrophy was performed and 196 publications were included in the study. The cumulative success rate of zygomatic implants for the treatment of severe maxillary atrophy was 98.5% at less than 1 year, 97.5% between 1 and 3 years, 96.8% between 3 and 5 years and 96.1% after more than 5 years. The most commonly reported complications were soft tissue dehiscence, rhinosinusitis and prosthetic failures. The treatment of severe lack of bone in the upper maxilla with zygomatic implants is a safe procedure, reaching a cumulative success rate of 96.1% after more than 5 years.
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González Rueda JR, García Ávila I, de Paz Hermoso VM, Riad Deglow E, Zubizarreta-Macho Á, Pato Mourelo J, Montero Martín J, Hernández Montero S. Accuracy of a Computer-Aided Dynamic Navigation System in the Placement of Zygomatic Dental Implants: An In Vitro Study. J Clin Med 2022; 11:jcm11051436. [PMID: 35268527 PMCID: PMC8910948 DOI: 10.3390/jcm11051436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this in vitro study was to evaluate and compare the accuracy of zygomatic dental implant (ZI) placement carried out using a dynamic navigation system. Materials and Methods: Forty (40) ZIs were randomly distributed into one of two study groups: (A) ZI placement via a computer-aided dynamic navigation system (n = 20) (navigation implant (NI)); and (B) ZI placement using a conventional free-hand technique (n = 20) (free-hand implant (FHI)). A cone-beam computed tomography (CBCT) scan of the existing situation was performed preoperatively to plan the surgical approach for the computer-aided study group. Four zygomatic dental implants were placed in anatomically based polyurethane models (n = 10) manufactured by stereolithography, and a postoperative CBCT scan was performed. Subsequently, the preoperative planning and postoperative CBCT scans were added to dental implant software to analyze the coronal entry point, apical end point, and angular deviations. Results were analyzed using the Student’s t-test. Results: The results showed statistically significant differences in the apical end-point deviations between FHI and NI (p = 0.0018); however, no statistically significant differences were shown in the coronal entry point (p = 0.2617) or in the angular deviations (p = 0.3132). Furthermore, ZIs placed in the posterior region showed more deviations than the anterior region at the coronal entry point, apical end point, and angular level. Conclusions: The conventional free-hand technique enabled more accurate placement of ZIs than the computer-assisted surgical technique. In addition, placement of ZIs in the anterior region was more accurate than that in the posterior region.
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Affiliation(s)
- Juan Ramón González Rueda
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
| | - Irene García Ávila
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
| | | | - Elena Riad Deglow
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
| | - Álvaro Zubizarreta-Macho
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
- Correspondence:
| | - Jesús Pato Mourelo
- Department of Surgery, Faculty of Dentistry, University of Navarra, 31009 Pamplona, Spain;
| | - Javier Montero Martín
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
| | - Sofía Hernández Montero
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
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