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Lin K, Wang S, Xu X, Yu L, Pan R, Zheng M, Yang J, Guo J. Assessment of the correlation between supracrestal gingival tissue dimensions and other periodontal phenotypes components via the digital registration method: a cross‑sectional study in a Chinese population. BMC Oral Health 2024; 24:408. [PMID: 38561756 PMCID: PMC10985880 DOI: 10.1186/s12903-024-04158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Supracrestal gingival tissue dimensions (SGTDs) has been considered to be an essential element of periodontal phenotype (PP) components. This study aimed to explore the relationship between SGTDs and other PP components by digital superposition method that integrated cone beam computed tomography (CBCT) with intraoral scanning. METHODS This cross-sectional study was conducted at the Stomatology Hospital of Fujian Medical University. Participants were recruited based on the inclusion and exclusion criteria. The data obtained from the digital scanner (TRIOS 3, 3Shape, Denmark) and CBCT images were imported into the TRIOS software (Implant Studio, 3Shape, Denmark) for computing relevant parameters. The significant level was set at 0.05. RESULTS A total of 83 participants with 498 maxillary anterior teeth were finally included. The mean values of supracrestal gingival height (SGH) and the distance from the cementoenamel junction (CEJ) to the crest of the alveolar ridge (CEJ-ABC) on the buccal site were significantly higher than palatal SGH (SGH-p) and palatal CEJ-ABC (CEJ-ABC-p). Men exhibited taller CEJ-ABC and SGH-p than women. Additionally, tooth type was significantly associated with the SGH, SGH-p and CEJ-ABC-p. Taller SGH was associated with wider crown, smaller papilla height (PH), flatter gingival margin, thicker bone thickness (BT) and gingival thickness (GT) at CEJ, the alveolar bone crest (ABC), and 2 mm apical to the ABC. Smaller SGH-p displayed thicker BT and GT at CEJ, the ABC, and 2 and 4 mm apical to the ABC. Higher CEJ-ABC showed lower interproximal bone height, smaller PH, flatter gingival margin, thinner GT and BT at CEJ, and 2 mm apical to the ABC. Smaller CEJ-ABC-p displayed thicker BT at CEJ and 2 and 4 mm apical to the ABC. On the buccal, thicker GT was correlated with thicker BT at 2 and 4 mm below the ABC. CONCLUSION SGTDs exhibited a correlation with other PP components, especially crown shape, gingival margin and interdental PH. The relationship between SGTDs and gingival and bone phenotypes depended on the apico-coronal level evaluated. TRIAL REGISTRATION This study was approved by the Biomedical Research Ethics Committee of Stomatology Hospital of Fujian Medical University (approval no. 2023-24).
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Affiliation(s)
- Kaijin Lin
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Siyi Wang
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Xiaofeng Xu
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
- The Affiliated Hospital (Group) of Putian University, Putian, 351100, China
| | - Lu Yu
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Rui Pan
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China
| | - Minqian Zheng
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
- Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
| | - Jin Yang
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
- Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
| | - Jianbin Guo
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
- Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350001, China.
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P MK, Nagate RR, Chaturvedi S, Al-Ahmari MMM, Al-Qarni MA, Gokhale ST, Ahmed AR, Bariqi AA, Cicciù M, Minervini G. Importance of periodontal phenotype in periodontics and restorative dentistry: a systematic review. BMC Oral Health 2024; 24:41. [PMID: 38191372 PMCID: PMC10773067 DOI: 10.1186/s12903-023-03777-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Periodontal phenotype is regarded to be one of the key factors influencing the efficacy of restorative therapies in dental practice. The objective of the systematic review was to explore the importance of thin and thick periodontal phenotypes and how they affect the outcome of periodontal and restorative therapies by looking at a number of academic publications from various online databases. METHODS Following the PRISMA guidelines (Preferred Reporting Items for Systematic Review standards), relevant data will be searched and retrieved from three significant scientific databases, including PubMed, EBSCO, and Scopus. The articles with full texts that matched the keywords and published in English between 2018 and 2023 were taken into consideration. RESULTS The majorities of these articles were based on the type of periodontal phenotype and their impact on periodontal and restorative treatment outcomes were selected. The initial search yielded a total of 530 articles. Only 273 were relevant to the review's objectives, and these were considered for determining eligibility. Only 20 publications were eligible for analysis. CONCLUSION Understanding these anatomical aspects of periodontal phenotype is crucial to both periodontology and restorative dentistry. The clinical outcome of restorative, prosthetic, orthodontic, surgical, and periodontal therapies is determined in large part by the periodontal phenotype, which also plays a significant role in clinical failure or success in dental treatments. TRIAL REGISTRATION This study protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) dated 16th June 2023 with the registration ID CRD42023432568.
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Affiliation(s)
- Mohan Kumar P
- Department of Periodontics and Implantology, Vishnu Dental College, West Godavari, Vishnupur, Bhimavaram, 534202, Andhra Pradesh, India.
| | - Raghavendra Reddy Nagate
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Saurabh Chaturvedi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia.
| | - Manae Musa Musleh Al-Ahmari
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Mohammed A Al-Qarni
- Consultant in Restorative Dentistry, College of Dentistry, King Khalid University, P.O.Box 3263, Abha, 61471, Saudi Arabia
| | - Shankar T Gokhale
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Abdul Razzaq Ahmed
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Ahmed Al Bariqi
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, 95123, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India.
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Caserta, 81100, Italy.
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Valli Veluri S, Gottumukkala SN, Penmetsa GS, Ramesh K, P MK, Bypalli V, Vundavalli S, Gera D. Clinical and patient-reported outcomes of periodontal phenotype modification therapy using injectable platelet rich fibrin with microneedling and free gingival grafts: A prospective clinical trial. J Stomatol Oral Maxillofac Surg 2023; 125:101744. [PMID: 38128879 DOI: 10.1016/j.jormas.2023.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND To evaluate the clinical non-inferiority of injectable platelet-rich fibrin and micro-needling (iPRF+MN) with free gingival grafting (FGG) in periodontal phenotype modification therapy. METHODOLOGY Twenty participants with a gingival thickness (GT)<0.8 mm in the mandibular anterior region were included. The participants were randomly allocated into i-PRF+MN and FGG groups. i-PRF injection was done, and MN was done with the help of a lancet in the i-PRF+MN group. The clinical parameters, i.e., GT and Keratinized tissue width (KTW), were evaluated at baseline, 3 and 6 months post-operatively. Patient-reported outcomes (PROs), i.e., discomfort and esthetic satisfaction, were assessed using the visual analogue score(VAS) at one week and 3 months of re-evaluation, respectively. RESULTS Both groups showed a significant increase in GT and KTW with no intergroup variation (P-0.32, 0.48respectively) at the end of 6 months. However, the i-PRF+ MN group showed better PROs, i.e., less discomfort(1.11±0.60) and better esthetic satisfaction(8.77±0.44). CONCLUSION The non-invasive treatment of i-PRF+MN may lead to non-inferior clinical outcomes after 6 months with better PROs compared to more invasive FGG protocols in phenotype modification therapy.
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Affiliation(s)
- Sathya Valli Veluri
- Department of Periodontics and Implantology, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh 534202, India
| | - Sruthima Nvs Gottumukkala
- Department of Periodontics and Implantology, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh 534202, India.
| | - Gautami S Penmetsa
- Department of Periodontics and Implantology, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh 534202, India
| | - Ksv Ramesh
- Department of Periodontics and Implantology, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh 534202, India
| | - Mohan Kumar P
- Department of Periodontics and Implantology, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh 534202, India
| | - Vivek Bypalli
- Department of Periodontics and Implantology, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh 534202, India
| | - Sravanthi Vundavalli
- Department of Periodontics and Implantology, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh 534202, India
| | - Dinesh Gera
- Department of Periodontics and Implantology, Vishnu Dental College, Vishnupur, Bhimavaram, West Godavari, Andhra Pradesh 534202, India
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Rodrigues DM, Petersen RL, Montez C, de Moraes JR, Januário AL, Barboza EP. Relationship between anterior maxillary tooth sagittal root position and periodontal phenotype: a clinical and tomographic study. Clin Oral Investig 2021. [PMID: 34529147 DOI: 10.1007/s00784-021-04105-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the relationship between the tomographic sagittal root position (SRP) of maxillary anterior teeth and periodontal phenotype (PP). MATERIAL AND METHODS Seventy volunteers (420 teeth) were evaluated. Clinical and photographic exams included the evaluation of gingival phenotype (GP) by transparency of the periodontal probe, keratinized tissue width (KTW), gingival architecture, tooth shape, and papilla height (PH). Soft tissue tomographic scan (ST-CBCT) measurements included the SRP classification, GP, gingival thickness in the tissue zone (GT-TZ) and in the bone zone (GT-BZ), buccal bone thickness (BBT), and the distances from the gingival margin and from cementoenamel junction to the buccal bone crest (GM-BBC and CEJ-BBC). Kruskal-Wallis test and a linear regression analysis model were used. RESULTS The frequency of SRP over the 420 teeth was 65.2% (class I), 9.3% (class II), 0.7% (class III), and 24.8% (class IV). Linear regression analysis showed that SRP is related to PP (p < 0.05). Significantly different measurements of PP parameters were found in SRP classes. The higher and lower GT and BBT were found in classes II and I, respectively. Class IV presented the highest KTW, PH, CEJ-BBC, and GM-BBC. Central incisors (CI) classes I and II were most frequently square-shaped, while 89% of CI Class IV were triangular-shaped. CONCLUSION The SRP of maxillary anterior teeth is related to periodontal phenotype. CLINICAL RELEVANCE Clinical and ST-CBCT individual analysis of PP and SRP may be helpful for an esthetic and functional treatment plan based on soft and hard tissue thickness and tooth positioning.
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Kalina E, Zadurska M, Górski B. Postorthodontic lower incisor and canine inclination and labial gingival recession in adult patients : A prospective study. J Orofac Orthop 2021; 82:246-56. [PMID: 33237372 DOI: 10.1007/s00056-020-00263-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 10/13/2020] [Indexed: 10/27/2022]
Abstract
PURPOSE The goal was to determine whether changes in the inclination of lower incisors and canines upon orthodontic treatment with fixed appliances poses a threat for labial gingival recession in adult patients. METHODS The sample of this prospective clinical trial consisted of 32 adult patients (mean age 25.08 ±6.50 years) treated with fixed appliances. Plaque and bleeding indices, probing pocket depth, clinical attachment level, gingival recession height (GR) and width (GRW), gingival thickness (GT), and keratinized tissue width were clinically recorded, while cone beam computed tomography (CBCT) was used to evaluate teeth inclination before (T1) and after treatment (T2). Oral hygiene, brushing habits, and smoking were controlled. RESULTS During orthodontic treatment on 15 (8.33%) teeth (10 incisors and 5 canines), spontaneous complete improvement of pre-existing GR was observed. On 2 incisors, GR decreased and on 3 teeth GR did not change. Moreover, 1 incisor presented an increased GR, while 2 teeth developed new defects. Mean GR, GRW, and GT decreased significantly only on the incisors. Proclination of incisors and canines during treatment (compared with retroclination of the teeth) implicated a lower reduction in GR at T2: 0.19 mm (p = 0.034) and 0.18 mm (p = 0.037), respectively. Multiple regression analysis confirmed that more tooth proclination was associated with a higher risk for an increase in GR (p < 0.00). CONCLUSION Properly planned changes in lower incisor and canine inclination can be carried out in adult patients without posing a high risk to labial gingival recessions if the individual periodontal biotype is respected. The reported outcomes underscore the orthodontic principle to keep tooth roots inside the alveolar bone.
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Shu R. [Orthodontic treatment and periodontal soft tissue augmentation]. Zhonghua Kou Qiang Yi Xue Za Zhi 2020; 55:444-7. [PMID: 32634881 DOI: 10.3760/cma.j.cn112144-20200424-00226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During the orthodontic treatment, if the root moves lingually, the risk of buccal gingival recession is low. On the contrary, if the root moves buccally, the thin buccal bone probably leads to the buccal gingival recession. In patient without gingival recession, bony dehiscence and fenestration make the situation complicated. Both of the directions show high risk of gingival recession. The present article, from the point of view of periodontal soft tissue, introduces the periodontal soft tissue augmentation technique related to orthodontic treatment and the timing of the surgery.
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Cha S, Lee SM, Zhang C, Tan Z, Zhao Q. Correlation between gingival phenotype in the aesthetic zone and craniofacial profile-a CBCT-based study. Clin Oral Investig 2020; 25:1363-1374. [PMID: 32648062 DOI: 10.1007/s00784-020-03444-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/03/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the correlation between gingival phenotype and craniofacial profile and to evaluate the morphology of periodontal supporting tissues in the maxillary and mandibular anterior zones. MATERIALS AND METHODS A total of 66 patients with 264 central incisors in good periodontal health were included in this cross-sectional study. CBCT images were used to assess gingiva and alveolar bone thickness of the maxillary and mandibular incisors at four vertical levels. Cephalometric analysis was used to assess the sagittal profile of the craniofacial structures. Gingival thickness was compared in patients with different craniofacial profiles based on ANB value. Linear regression coefficients adjusted by age and gender were used to evaluate the correlation between gingival thickness and the cephalometric parameters. RESULTS Individuals with a smaller ANB value (ANB< 2) presented with thinner supporting tissue and a keratinized gingiva width in the anterior zone. Labial gingival thickness on the mandibular incisors at the cementoenamel junction (G1) and at the alveolar bone crest (G2) was positively related to cephalometric measures, indicating a maxillae-mandibular sagittal relationship (ANB value, Wits appraisal, A-NPog value). CONCLUSIONS A moderate correlation was found between mandibular gingival thickness and the sagittal craniofacial profile. Patients with a concave craniofacial profile had a smaller keratinized gingiva width and gingival thickness in the aesthetic zone. CLINICAL RELEVANCE Knowledge of these features on supporting tissue and their correlations with craniofacial morphology will help clinicians to develop a reasonable treatment plan and make decisions to achieve the best aesthetic outcome.
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Affiliation(s)
- Sa Cha
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sueng Min Lee
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chengxiaoxue Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhen Tan
- Department of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qing Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Kalina E, Zadurska M, Sobieska E, Górski B. Relationship between periodontal status of mandibular incisors and selected cephalometric parameters : Preliminary results. J Orofac Orthop 2019; 80:107-115. [PMID: 31041493 PMCID: PMC6491396 DOI: 10.1007/s00056-019-00170-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/11/2019] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this cross-sectional study was to evaluate the correlation between the periodontal tissue of mandibular incisors and several dentoalveolar and skeletal cephalometric parameters. Materials and methods The sample consisted of 35 patients (mean age 26.42 ± 8.02 years). Eligibility criteria included good overall health status with no history of dental trauma, congenital defects, active periodontal diseases, restorative and prosthetic treatment in the area of the mandibular incisors. Gingival recession width and height (GRW, GRH), gingival thickness (GT), width of keratinized gingiva (WKT) and clinical attachment loss (CAL) were evaluated at 140 lower incisors. Incisors inclination (1-:ML), skeletal class (ANB, WITS), intermaxillary angle (NL:ML) and mandibular symphysis dimensions (symph. length and width) were assessed in cephalograms. Spearman’s correlation coefficient was used for statistical analysis at the P < 0.05 level. Results A statistically significant positive moderate correlation was found for GT and WITS and also symph. length. WKT correlated positively with ANB, WITS and symph. length, with moderate strength of the correlation. GRW, GRH and CAL did not correlate with any cephalometric parameters. Conclusion The results of this study indicated evidence for an association between WKT and GT and some cephalometric variables—ANB, WITS, and symphysis length.
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Affiliation(s)
- Edyta Kalina
- Department of Orthodontics, Medical University of Warsaw, Nowogrodzka St 59, 02-006, Warsaw, Poland.
| | - Małgorzata Zadurska
- Department of Orthodontics, Medical University of Warsaw, Nowogrodzka St 59, 02-006, Warsaw, Poland
| | - Ewa Sobieska
- Department of Orthodontics, Medical University of Warsaw, Nowogrodzka St 59, 02-006, Warsaw, Poland
| | - Bartłomiej Górski
- Department of Periodontology and Oral Diseases, Medical University of Warsaw, Miodowa St 18, 00-246, Warsaw, Poland
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