Recent advances in orthodontics / cosmetic dentistry courses

RECENT ADVANCES
IN ORTHODONTICS
www.indiandentalacademy.com

Contents
 Introduction
 Advances in Bonding materials
 Advances in Brackets
 Advances in Wires
 Advances in Appliance
 Advances in Anchorage
 Advances in Software's
 Future scope
 Bibliography

Introduction
 New technology is allowing orthodontists to
produce better results, with fewer visits and shorter
overall treatment time, as compared to time of 1 to
3 years to complete treatment during which the
patient visited every 4 to 6 weeks.

 New solutions to the old problems have resulted
in advancements in orthodontic materials and
their cascading effect on the appliance design
and treatment strategies.

The recent advances in
orthodontic materials shall be
covered under the following
headings.
 Bonding materials
 Brackets
 Wires
 Appliances
 Softwares

Bonding
Materials

Bonding materials
 Bonding in orthodontics is semi-permanent in nature, bond
strength should be high enough to resist accidental debonding
during the whole course of treatment but also low enough so that
excessive force need not be applied during debonding at the end
of the treatment.
 With the increased demand for adult orthodontics, the clinician
is often faced with the problem of luting brackets and retainer
wires to metal-ceramic fixed partial dentures, crowns, veneers or
even full ceramic restorations.
 To overcome this problem 6th & 7th generation cements are
being introduced by which it is possible to bond orthodontic
materials to Gold, Amalgam & Porcelain.

6th generation cement
 The history of dentin bonding is
quite remarkable and productive.
 The self-etching adhesives
involve a mechanism in which as
soon as the decalcification
process is initiated, the infusion
of the evacuated spaces by dentin
bonding agent is begun.
 As a result, the potential for
residual vacancies amongst the
collagenous fibers is dramatically
reduced or eliminated altogether.

Light Cure Bonding Cement
Capsules
 It is a 6th generation cement.
 Band cement in disposable capsules
is a no-mix, light-activated, glass
ionomer cement that contains
fluoride to control decalcification
under the bands during extensive
treatment.
 It eliminates excessive waste and
cross-contamination between
patients.
 The narrow-tipped design helps
accurately dispense adhesive
directly into the molar bands.

New light-cured glass ionomer
cement (Silverman in 1995, AJO)
 A new light-cured glass ionomer cement exhibited all
the necessary qualities needed to bond brackets,
without any etching and in the presence of saliva.
 The debonding procedures were also completely
undamaging to the underlying enamel surfaces.
 On removal of the appliances, no decalcification was
observed on any teeth, because the cement releases
fluoride.

Advantages
 The new light-cured, resin-reinforced glass ionomer
cement possesses the following advantages over
composite resins for bonding orthodontic brackets:
1. Saves a significant amount of chair time.
2. Eliminates the need for working in a dry field.
3. Eliminates the need for etching and priming enamel
surfaces.
4. Fluoride release protects teeth against decalcification.
5. Repairs are quick and easy.
6. Increased patient and operator comfort.

L-POP Bonding agents
 Prompt L-Pop is a water-based,
two-liquid, light-activated
dentin bonding agent marketed
by the ESPE America
Company.
 It is recommended for bonding
directly-placed, light-activated
resin composites and
compomers to enamel and
dentin.

L-POP adhesive

L-POP Adhesive
 Prompt L-Pop is the only product that contains all
three traditional bonding agent components (etchant,
primer, adhesive) in one solution that is applied to
tooth structure.
 The product has several important advantages
compared to currently available fifth-generation
bonding agents.
 It is applied to the enamel and dentin for 15 seconds.

L-POP Adhesive
 After evaporating the agent with a gentle
application of compressed air, the restorative
material is applied and light activated.
 Optionally cure the bonding agent with a 10-
second light exposure prior to placing the
restorative material.
 Prompt L-Pop's chief disadvantage is its low
bond strength.

7th Generation
 It is a fluoride releasing 7th
generation composite which
was formed to over come the
problems faced in 6th generation
like application of bonding
agents and low bond strength.
 These cements have come with
a basic property of no-mix.
 The seventh generation
essentially accomplish the same
objective as the 6th generation.
 However, all the ingredients are
in one bottle.
 It provides
 superior bond strength
 drift proof bracket placement

Brackets

Composition of brackets
 Due to allergy in brackets non-nickel and low
nickel stainless steel brackets are introduced.
 Newer alloys such as 2205 alloy demonstrate less
crevice corrosion than 316 and 318 alloy when
coupled with nickle titanium, beta titanium.
 Titanium brackets consists of hardness
comparable to nickel titanium wires but has
hardness of almost half of stainless steel wires.
 The new titanium brackets have reduced friction.

CAD-CAM System
 It is an orthodontic care system
incorporating a hand-held scanner
system and treatment planning
software in accordance with a
representative embodiment of the
invention.
 The hand-held scanner is used by
the orthodontist to acquire three-
dimensional information of the
dentition and associated anatomical
structures of a patient and provide
a base of information for
interactive, computer software-
based diagnosis, appliance design,
and treatment planning for the
patient.

CAD-CAM System
 The scanner is suitable for
in-vivo scanning, scanning a
plaster model, scanning an
impression, or any
combination thereof.
 Figure shows a graphical
representation of a three-
dimensional model of a
patient's upper front teeth.
 The user is applying
landmarks to the teeth as a
preliminary step in
determining bracket
placement on the labial
surface of the teeth.

Manufacturing
 The metal injection molding technique involves
mixing metal powders with particle sizes of a few
microns with organic binders, lubricants and
dispersants to obtain homogeneous mixture.
 The MIM manufactured products are having the
density of more than 97%.
 Porosity is a known defect of MIM parts with adverse
effects on mechanical and corrosion resistance.
 Latest technique is laser welding which has reduced
risks for corrosion or effect on the bulk material.

Esthetic Brackets
 Zirconia, Polycrystalline or single crystal alumina and plastics are
the material from which esthetic brackets are derived.
 Despite the poor hardness and associated more distortion on force
application there is even release of formaldehyde.
 New generations have improved debonding characteristics and
hence less of enamel fracture chances.
 The ceramic brackets have superior mechanical properties,
increased transparency, decreased reactivity with oral
environment and inert biological character.

Time brackets
 One of the major
disadvantage of
SPEED brackets were,
they require heavy
forces to slide the clip
open during
subsequent visits.
 To overcome this there
is a new development
known as Time
brackets.

 Advantages
 Easy to open throughout treatment
 Controlled delivery of forces
 More hygienic in patient

Damon III
 Recently a new type of
Damon bracket, Damon
III, which is part ceramic
(clear or tooth-colored) and
part metal. These brackets
appear smaller on the teeth
and are supposed to be
more comfortable for the
patient.

Smart clip brackets
 Another type of self-
ligating systems, Smart
Clips brackets do not
have a "sliding door" or
separate clip.
 The arch wire is held in
place with a specially
designed clip built into
the bracket.

Synergy Brackets
Better than Damon III by:
1. Synergy brackets have less
friction.
2. Synergy brackets provide
more control throughout the
treatment process.
3. Synergy brackets are
problem-free.
No sides or clips to deform,
break or clog unlike self-
ligating brackets, outstanding
bond strength, and no “food-
traps” to cause hygiene
problems.
Synergy brackets are easy to
place unlike self-ligating
brackets. www.indiandentalacademy.com

4. Synergy is the only bracket that takes advantage of
today’s super elastic wires.
5. The Synergy system gives greater patient comfort. Synergy
brackets are much smaller and have a significantly lower
profile. Bulky self-ligating brackets are prone to bond failures.
6. Synergy permits the look the patient wants without
compromising functionality. Synergy brackets can be ligated
in colors, and its compact size gives a more appealing look.
7. Synergy has greater practice profit potential. A 6-8 week
interval between patient visits, fast overall treatment time and a
much lower cost. www.indiandentalacademy.com

APC
Now a days brackets are available with
bonding agent already placed for
Pick
Position
Cure

APC - Adhesive Coated
Appliance System
 The APC System is still the only orthodontic bonding system
that precoats each bracket with adhesive.
 No messy mixing problem is there.
 No bracket handling problems with each individual bracket
clearly identified and pre-oriented on a special foam liner that
virtually eliminates bracket rotation in transit.
 Fewer steps, less time with the APC™ System

Indirect Bonding
 Given by H.STUART in
2003
 In this technique flowable
composites are used which
is applied to the brackets
placed in the tray.
 Then this tray is placed in
patients mouth and cured.
 This technique allows
precision placement and is
less time consuming.

New Coating Around Brackets
 Early tests on a new coating for orthodontic
brackets and wires developed by
researchers suggest that it could inhibit
plaque growth and decalcification common
in patients wearing fixed appliances without
decreasing the bond strength between
brackets and teeth.
 The coating is made from a calcium
phosphate base that releases zinc - a
common ingredient in mouthwash and
toothpaste - onto braces and surrounding
teeth. Zinc inhibits the growth of acid-
producing bacteria that dematerialized teeth,
and minimizes dental calculus formation.

InvisAlign
 A new technology that allows
tooth alignment without
brackets has been recently
introduced is called
InvisAlign™. The Invisalign
System™ offers the first true
alternative, by utilizing
advances in 3-D imaging
technology to create a series of
customized plastic aligners.

InvisAlign
 InvisAlign uses computer
technology to create a
sequence of finely-
calibrated clear plastic
aligners-as few as 12 or as
many as 48, depending on
your particular case.

InvisAlign
 Patient will wear each
aligner for about two weeks,
removing them only to eat,
brush, and floss. As you
replace each aligner with the
next, your teeth will move-
little by little, week by
week-until they reach the
final alignment your
orthodontist has prescribed.

Incognito-appliance
 Adult patients often refuse to wear
orthodontic appliances bonded to the
outer aspects of their teeth because they
are visible when speaking.
 In order to offer orthodontic treatment
for these patients, orthodontists use
brackets bonded to the inner aspects of
the teeth that are completely invisible
during normal activity.
 Since 2004, Incognito appliance is used
which is extremely flat and thus
comfortable for the patient.
 Most problems like
 tongue irritations
 speech problems
 rate of lost brackets
has declined dramatically.www.indiandentalacademy.com

Wires

ARCHWIRES
 After the introduction of thermoelastic and nobium
nickel titanium archwires a breakthrough in archwires
no major development has emerged in the past
decade.

 Technology such as nickel-titanium-alloy wires, have
replaced the traditional stainless steel wires of the
past, providing patients with a temperature-sensitive
wire that allow for continuous movement of the teeth
over longer periods of time. For patients this means
enhanced comfort, decreased treatment time and less
visits to the orthodontist.

Thermal-Activated Archwires
 It was introduced by
Evans & Danning in 1996
 In these wires desired
shape of arch was
incorporated using heat.
 These wires are ligated in
the patient’s mouth and
get activated to return to
its original shape due to
heat present in the oral
cavity.

 Advantages
 Desired arch form
could be achieved
 A gentle continuous
force for tooth
movement.
 Excellent for initial
leveling and
aligning.
 Provides maximum
spring and memory
with minimum
friction.

NICKEL-FREE TITANIUM
BETA III ARCHWIRES
 It was given by Dr Burstone &
Goldberg
 Beta III is a comparable nickel-free
titanium archwire that provides the
strength and versatility of stainless
steel along with the resiliency of
nickel titanium.
 Beta III offers a smooth surface for
excellent sliding mechanics and
superior bend performance. It
provides twice the bend and
deflection of stainless steel without
permanent deformation.

CNA
 Due to problems
associated with nickel-
titanium of
 not withstanding cold
bending
 not fabricating loops,
 not be weldable or
solderable
 CNA came to origin
 3-nitroaniline-2-chloro-
4-nitroaniline
alloy(CNA)www.indiandentalacademy.com

Superelastic composites wires
 Since mid-1990, 2 research teams working in United states and
Japan presented extensive evidence on feasibility of esthetic
polymeric wires.
 Super elastic composites have the potential to be used in
orthodontics.
 Super elastic SMA-polymer composites have the potential to
substantially reduce those forces.
 The design of these composites is based on a soft polymeric core
and a super elastic shape memory metal.

Optiflex wires
 Optiflex is a new
orthodontic archwire
that is designed to
combine unique
mechanical properties
with a highly esthetic
appearance.

 Made of clear optical fiber,
it comprises three layers
1. A silicon dioxide core that
provides the force for
moving teeth.
2. A silicon resin middle layer
that protects the core from
moisture and adds strength.
3. A stain-resistant nylon
outer layer that prevents
damage to the wire and
further increases its
strength.

 The wire can be either round or rectangular and is
manufactured in various sizes.
 Its mechanical properties include a wide range of action
and the ability to apply light, continuous force.
 Sharp bends must be avoided, since they could fracture
the core.
 It is a highly resilient archwire that is especially effective
in the alignment of crowded teeth.

Shape memory plastic wires
 Polynorbornen, a shape memory plastic developed in
Japan in 1991
 Has a glass transitional point of 35°C.
 Once the environmental temperature exceeds the
critical point, this plastic will begin to display an elastic
property, then return to its original shape, if deformed.
 This shape memory plastic wire of 1 mm in diameter
can be stretched to two to three times of its original
length at a temperature of 50°C and exert a relatively
stable continuous light force of 119–156 g to move the
teeth.

 This new material, compared with conventional
elastic modules used in orthodontic therapy, exhibited
a lesser degree of force degradation at a body
temperature of 37°C for a long period, and can be
manufactured to near the tooth color required.
 These advantages make feasible clinical application
of the shape memory plastic in orthodontics.

Appliances

Bite-Jumping Screw
 Introduced by MARC
GESERICK in 2006.
 A new method has been
developed to simplify
progressive bite
advancement in Twin
Block.
 Screw is incorporated
longitudinally in upper bites
blocks with a screw heads at
70 degree angle to lower
bite block.

 6mm of
antero-
posterior
correction
in either
class II or
class III
cases can
be done.

Transforce Arch Developing
Appliance
 Given by Dr. W. Clark
in 2004.
 This contains nickel-
titanium springs which
generate force
 It has a malleable arms
parallel to the incisal
edge for easy
adjustments

 It has many
advantages over the
previously developed
appliances used for
arch expansion
 Invisible for adult
arch development
 Less bulky
 Can be given in
lower arch
 It also helps in
expansion of arch
in sagittal direction

FLIP LOCK HERBST
APPLIANCE
 Miller R., 1996 - The Flip-Lock Herbst appliance
offers several advantages over conventional Herbst
designs:
• Improved patient comfort and acceptance
• Fewer clinical problems compared to screw or pin
attachments
• Less chair time for reactivation
• Less frequent emergency appointments
They are divided into -
 First generation
 Second generation
 Third generationwww.indiandentalacademy.com

FIRST GENERATION
 The first generation was made from a dense
polysulfone plastic but breakage occurred because of
the forces generated within the ball-joint attachment .

SECOND GENERATION FLIP
LOCK
 In the second generation, the plastic was replaced
with metal. However, fracture problems persisted.

THIRD GENERATION FLIP
LOCK
 The third generation is
made of a horse-shoe
ball joint. This system
has proved to be more
efficient than the
previous models, both
in terms of application
as well as its resistance
to fracture

MALU HERBST APPLAINCE
 The MALU – Mandibular Advancement Locking Unit
is a recently developed attachment device for the Herbst
It consists of two tubes, two plungers, two upper
"Mobee" hinges with ball pins and two lower key hinges
with brass pins.
 The major advantages are the lower cost, no laboratory
needed, flexibility and the possibility of using combined
with edgewise therapy

 Each upper Mobee hinge is inserted into the hole at
the end of the MALU tube and secured to the first
molar headgear tube with ball pin. Each lower key
hinge is inserted into the hole at the end of the
plunger and locked to the base arch, distal to the
cuspid, with the brass pin.

MALU HERBST

THE MAGNETIC TELESCOPIC
DEVICE
 This consists of two tubes and two plungers with a semi-circular
section and with (Nd,Fe,B) magnets placed in such a manner
that a repelling force is exerted . It is fixed using the MALU
system
 This appliance has the advantage of linking a magnetic field to
the functional appliance. Its main disadvantages are its
thickness, the laboratory work necessary to prepare it and the
covering of the magnets.

FORSUS
 FATIGUE RESISTANT
DEVICE given by WILLIAM
VOGT in 2004
 This is an innovative three
telescopic appliance with a
coil spring in its exterior part.
This feature makes it resemble
some flexible functional
appliances (AFF).
 In comparison with AFF its
great advantage lies in coil
spring which is resistance to
breaking. The coil spring is
applied by sliding it on a rigid
surface avoiding angulations at
the fixed points. www.indiandentalacademy.com

LINGUAL
ORTHODONTICS

 Lingual orthodontics, as we understand it today (a full,
multibracket appliance), began in the 1970s.
 The lingual appliance was not the consequence of an
esthetic demand, but it was started in Japan by Kinja
Fujita to satisfy the orthodontic needs of patients who
practiced martial arts, to protect the soft tissues (lips
and cheeks) from the possible impact against brackets.
 He submitted his concepts on lingual orthodontics in
1967, began his research in 1971, and published the
Fujita method in 1978, treating Class I and Class II
cases with extraction of four bicuspids.

 The Fujita bracket had
three slots—
 Occlusal
 Horizontal
 Vertical

GENERATIONS OF LINGUAL ORTHODONTICS
 In the second generation (1980), hooks were added to canine
brackets
 In the third generation (1981),hooks were added to all brackets and
to molar tubes.
 The fourth generation (1982-1984) included a lower profile
facilitating insertion of the archwire.
 With the fifth generation (1985-1986), the bite plane became more
pronounced, the torque was increased, and the molar brackets
included an accessory tube for a transpalatal bar.
 For the sixth generation (1987-1990), the hooks were elongated,
the transpalatal bar attachment was optional, and the hinge-cap
tube for the second molar was developed (self-ligated bracket).
 With the seventh generation (1990),the square bite plane became
rhomboid shaped, increasing the interbracket distance, and the
premolar brackets were widened mesiodistally for better rotational
control.

Favorable Cases
● Cases with mild incisor crowding and with anterior deep bite
● Long and uniform lingual tooth surfaces without fillings, crowns,
or bridges
● Good gingival and periodontal health
● Keen, compliant patient
● Skeletal Class I pattern
● Mesocephalic or mild/moderate brachycephalic
skeletal pattern
● Patients who are able to adequately open their
mouths and extend their neck

Unfavorable Cases
● Dolichocephalic skeletal pattern
● Maximum anchorage cases, unless treated with micro implants
● Short, abraded, and irregular lingual tooth surfaces
● Presence of multiple crowns, bridges, and large restorations
● Patients with a low level of compliance
● Patients with limited ability to open the mouth (trismus)
● Patients with cervical ankylosis or other neck injuries that prevent neck
extension

FUTURE ADVANCES IN
LINGUAL
 Self-ligating brackets have a great appeal; but to be
successful as a lingual bracket, they must have a robust,
durable opening/closing mechanism.
 In a malocclusion with crowded lower incisors, the
bracket width encroaches on the interbracket space to the
extent that the physical diameter of the archwire, even
with “spider-web” nickel-titanium wires, may prevent
closure of the bracket’s mechanism thus reducing initial
efficiency.
 This appliance is designed to accept auxiliary springs for
extra torque and tip control when necessary.

Incognito Appliance
 Incognito which is a custom-
made, cast gold, appliance
 Incognito appliances are
manufactured with the latest
state of the art CAD/CAM
technology.
 Each gold alloy bracket (anti-
allergenic) is manufactured
using the latest rapid
prototyping machines,
 The archwires are precisely
made by wire-bending
robots.

SKELETAL ANCHORAGE

 The first attempt to implant a stable device to be used for
orthodontic anchorage was made by Gainsforth and Higley
(1945) by inserting vitallium screws into a dog’s ramus to
distalize a maxillary canine.
 Linkow (1970) presented several cases associating endosseous
implants in orthodontics. In one of the cases, the author used a
blade vent implant as a posterior mandibular anchorage for
intermaxillary elastics.
 Sherman (1978) studied bone reaction to orthodontic forces on
vitreous carbon dental implants in dogs.
 It is known from the early studies of Branemark et al. (1977) that
the Osseo integrated titanium implants offer more predictable
results.

ORTHODONTIC
INDICATIONS
1 Distal movement of the anterior segment in premolar
extraction cases.
2. Distal movement of the posterior and anterior segment in
non-extraction cases.
3. Mesial movement of posterior teeth.
4. Intrusion of a single tooth or a group of teeth.
5. Uprighting of mesialised lower second and third molars.
6. Preprosthaetic orthodontics.
7. Loss of dental anchorage because of periodontal diseases.
8. Orthopaedic intermaxillary tractions.

 The osseointegrated implants could be also used
for
 distraction osteogenesis
 midface sutural expansion
 maxillofacial protraction.

CONTRA-INDICATIONS
 Unhealthy soft and hard tissues in implant
region, poor dental hygiene.

INTRA-OPERATIVE APPROACH
 All bone anchors are inserted under local anesthesia
with local sub-mucosal infiltration.
 Four anatomical sites are used according to different
orthodontic indications:
1. zygomatic buttress
2. nasal process of the maxilla
3. canine region of the mandible
4. molar region of the mandible

Orthodontic Mini Implants
 They are designed to be
temporarily implanted so
that dental movements
with the bio-mechanical
advantage of achieving
maximal anchorage can be
achieved.
 They are made of stainless
steel

 They do not induce Osseo
integration
 Once orthodontic movement
have been achieved they can
be easily removed
 The upper part features
groove similar to a button to
facilitate application of
elastic chains, elastics or
springs.

Software's

Insignia
 It is a fully interactive
software designed to
incorporate treatment plan
into a virtual 3D model.
 It gives a
 Patient specific brackets
 Computer assisted
bracket placement
 Custom wire
 All phases of treatment
adjustments

Digital Imaging
Software
 Now we can
 Create a treatment plan with just
a few mouse movements
 Quickly teach our ideas to
patients, surgeons, and students.
 Concentrate on facial structures
and beauty rather than on holding
protractors to measure angles and
distances.
 Let the computer generate
numerous analyses,
superimpositions, measurement
tables, growth and treatment
predictions, and much more with
a simple touch of a button.
 Print, store, or e-mail our results.
 Make it easy for your colleagues
to reliably reproduce your
decisions.www.indiandentalacademy.com

Paperless
operations
Whether we realize or not
within next few years our
records would all be
digitalized.
Features
 Computerization of patient
records
 Internet access to every part
of the world
Requirements
 Softwares
 Computer
 Patient Information
Delivery system

Photographic ‘Kesling set-up’
Kesling described the concept of planning individual orthodontic
tooth movement in 1945.
 The ‘Kesling set-up’ is a visual aid to communication between
the clinician and the patient at the treatment planning stage.
 It helps the clinician to plan the stages
 Type of orthodontic treatment required
 Gives the patient an idea of what is achievable and what is
involved.
 It can also highlight the limitation of tooth movement alone,
indicating the need for surgical intervention.

Future
Advances
 A novel concept under development are brackets using
so-called smart brackets. The smart bracket concept
consists of a bracket containing microchip capable of
measuring the forces applied to the bracket/tooth
interface.
 The goal of this successfully demonstrated concept is
to significantly reduce the duration of orthodontic therapy
and to set the applied forces in non-harmful, optimal
ranges.

BIBLIOGRAPHY
1. J. S. Russell,Current Products and Practice Aesthetic
Orthodontic Brackets; Journal of Orthodontics, Vol. 32, 2005,
146–163
2. Kocaderell, I.; Canay, S.; Akça, K.: Tensile bond strength of
ceramic orthodontic brackets bonded to porcelain surfaces, Am.
J. Orthod. Dentofac. Orthop. 2001;119:617-620,
3. Silverman, Cohen, Demke, and Silverman New light-cured
glass ionomer cement. Am. J. Orthod. Dentofac. Orthop. 1995
Sep (231 - 236)
4. M.F. TALASS, Optiflex Archwire Treatment of a Skeletal
Class III Open Bite; Journal of Clin Ortho, 1992, Apr.

BIBLIOGRAPHY
6. Transforce Lingual Appliances Development, Journal of Clin
Ortho, 2005;39;3:137-142
7. Bite Jumping Functional Mand. Advances, Journal of Clin
Ortho, 2005;39;19:696-700
8. Birt Melsen,Mini-Templates: Where Are We? , Journal of Clin
Ortho, 2004;39;9:539-547
9. H. Stuartmccrostie, Indirect Bonding Simplified, Journal of Clin
Ortho, 2003;37;5:248-257
10. S.S. Marie, Vibrator Stimulation As A Method Of Reducing
Pain After Orthodontic Appliance Adjustment, Journal of Clin
Ortho 2003;37; 4:205-208

BIBLIOGRAPHY
11. White, L.W.: An expedited indirect bonding technique. J. Clin.
Orthod. 35: 36-41, January 2001.
12. Williom Vogt, Forsus Fatigue Resistant, Journal of Clin
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