Pevnost adheze ortodontickyâ ch vazebnyâ ch materiaâluê a ortodontickyâchzaâ mkuê Bond strength of orthodontic adhesives and brackets

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1 ORTODONCIE rocïnõâk20 Pevnost adheze ortodontickyâ ch vazebnyâ ch materiaâluê a ortodontickyâchzaâ mkuê Bond strength of orthodontic adhesives and s *MUDr. Beata KonkolskaÂ, *Doc. MUDr. MilosÏ SÏ pidlen, Ph.D., *Prof. MUDr. Milan KamõÂnek, DrSc., *Mgr. KaterÏina LangovaÂ, Ph.D. *Ortodonticke oddeï lenõâ Kliniky zubnõâho leâ karïstvõâ LF UP Olomouc, CÏ eskaâ republika *Department of Orthodontics, Clinic of Dental Medicine, Medical Faculty of Palacky University, Olomouc **U stav leâ karïskeâ biofyziky, LF UP Olomouc **Institute of Medical Biophysics, Medical Faculty of Palacky University, Olomouc Souhrn CõÂl: CõÂlem teâ to studie bylo srovnaâ nõâ pevnosti vazby cï tyrï adhezivnõâch materiaâ luê urcï enyâ ch k lepenõâ kovovyâ ch a keramickyâ ch ortodontickyâ ch zaâ mkuê na povrch skloviny. Ve vsï ech prïõâpadech se jednalo o sveï tlem tuhnoucõâ kompozitnõâ pryskyrïice. Byly to Transbond TM Plus Color Change Adhesive (3M Unitek Monrovia, California), Light Bond TM (Reliance Orthodontic Products Inc., Itasca), ConTec LC (Dentaurum, Germany), Kurasper TM F (Kuraray Medical Inc., Okayama, Japan). Da le byl hodnocen Adhesive Remnant Index (ARI) pro urcï enõâ mõâsta narusï enõâ adheze prïi odstraneï nõâ ortodontickyâch zaâ mkuê. Metodika: Bylo pouzïito 240 premolaâruê, ktereâ byly zality do vaâ lecïkuê s Premacrylem a naâ hodneï rozdeï leny do 8 skupin po 30 vzorcõâch. Ortodonticke zaâ mky kovoveâ (Elite Ò Medium-Twin TM ) a keramickeâ (Signature III TM ) byly lepeny na povrch extrahovanyâ ch premolaâ ruê. Byla meï rïena pevnost vazby tahem ve smyku a stanoven Adhesive Remnant Index pro jednotliveâ adhezivnõâ materiaâ ly. ZaÂveÏr:Vy slednaâ meïrïenõâ pevnostõâ vazby se pohybovala od 4,5 MPa do 8,8 MPa. NejvysÏsÏ õâ nameïrïenaâ pevnost vazby byla u lepidla Light Bond TM, nejnizïsï õâ pevnost vazby meï lo adhezivum ConTec LC. RovneÏzÏ byl zjisïteï n signifikantnõâ rozdõâl prïi stanovenõâ Adhesive Remnant Indexu pro jednotliveâ adhezivnõâ materiaâ ly a ortodontickeâ zaâ mky (Ortodoncie 2011, 20, cï. 1, s ). Abstract Aim: The study aimed at comparison of bond strengths of four adhesive materials for attachment of metal and ceramic orthodontic s on the enamel surface. All the four were light cured composite resins: Transbond TM Plus Color Change Adhesive (3M Unitek Monrovia, California), Light Bond TM (Reliance Orthodontic Products Inc., Itasca), ConTec LC (Dentaurum, Germany), Kurasper TM F (Kuraray Medical Inc., Okayama, Japan). Further, Adhesive Remnant Index (ARI) was evaluated to determine the broken place ofadhesion. Methods: 240 premolars were imbedded in rollers with Premacryl and randomly divided into 8 groups with 30 specimens each. Metal orthodontic s (Elite Ò Medium-Twin TM ) and ceramic orthodontic s (Signature III TM ) were attached onto the surface of extracted premolars. Shear bond strength was measured and Adhesive Remnant Index determined for individual adhesive materials. Conclusion: The measurements ofshear bond strength oscillated between 4.5 MPa and 8.8 MPa. The best strength was found for Light Bond TM, the lowest value was measured for ConTec LC. Significant differences were found in Adhesive Remnant Index for individual adhesives and orthodontic s (Ortodoncie 2011, 20, No. 1, p ). KlõÂcÏ ovaâ slova: pevnost vazby, adhezivnõâ materiaâ l, Adhesive Remnant Index Key words: bond strength, adhesive (material), Adhesive Remnant Index 29

2 rocïnõâk20 ORTODONCIE U vod Sna stupem techniky leptaâ nõâ, kterou v roce 1955 zavedlbounocore [1], dosïlokvyâznamnyâm zmeïnaâ m v estetickeâ stomatologii, naâ sledneï takeâ v ortodoncii. Lepenõ zaâ mkuê na povrch skloviny se stalo nedõâlnou soucï aâ stõâ ortodontickeâ l eâ cï by. AcÏ koli mõâra selhaâ vaânõâ zaâ mkuê a jejich funkce v pruê beï hu ortodontickeâ l eâ cï by byâvaâ ruê znaâ, jednõâm z faktoruê ovlivnï ujõâcõâch pevnost vazby je zvolenyâ fixacïnõâ materiaâ l. Lepit zaâ mky muêzï eme jak materiaâ ly chemicky tuhnoucõâmi tak sveï tlem tuhnoucõâmi. Jedna se veï tsï inou o kompozitnõâ pryskyrïice, skloionomernõâ, eventuaâlneï kompomernõâ cementy. PrÏednostõ sveï tlem tuhnoucõâho materiaâ lu je dostatecï neï dlouhyâ manipulacï nõâ cï as pro prïesneâ dosazenõâ a umõâsteï nõâ zaâ mku, minimalizuje se riziko kontaminace lepidla v pruê beï hu vyzraâvaâ nõâ. DalsÏ õâ vyâhodou je dostatecï naâ pevnost vazby ihned po polymeraci a mozï nost okamzï iteâ ho zatõâzï enõâ soucï aâ stõâ fixnõâho aparaâ tu ortodontickyâmi silami [2, 3]. Optima lnõâ adhezivnõâ materiaâ lby meï lzajistit dostatecïnou odolnost vuê cï i ortodontickyâ m silaâ m,zï vyâ kacõâm tlakuê m. Za rovenï po sejmutõâ zaâ mku by meï lo ulpõâvat pouze minimaâ lnõâ mnozï stvõâ zbyleâ ho adheziva na sklovineï k naâ sledneâ mu nutneâmu ocïisïteïnõâ. SnõÂmaÂnõ zaâ mkuê by nemeïlo veâst k posï kozenõâ povrchu skloviny [4]. PosÏ kozenõâ skloviny se muê zï e projevit jako prasklina, prohlubenï po vylomenõâ prizmat, extreâ mnõâm prïõâpadem je fraktura korunky zubu (kazem, cïivyâplnõâ podmõâneïneâ defekty tvrdyâch zubnõâch tkaânõâ). K posï kozenõâ povrchu skloviny nejcï asteï ji vedlo pouzï itõâ keramickyâchzaâ mkuê, ktereâ majõâ posõâlenou vazebnou pevnost retencï nõâ plochy silanovou vrstvou. Takto silnaâ vazba ke sklovineï mohla zpuê sobit jejõâ posï kozenõâ [5]. ZpocÏ aâ tku prïi technice lepenõâ ortodontickyâch zaâ mkuê na sklovinu zubu bylo hlavnõâm cõâlem zajisï teï nõâ dostatecï neï pevneâ ho spojenõâ mezi naleptanou sklovinou a povrchem retencïnõâ baâze zaâ mku. RÏ ada vyâzkumuê seveï novala teâ to otaâ zce, vyârobci adhezivnõâch materiaâ luê a ortodontickyâch zaâ mkuê se snazïili sõâlu vazby maximaâ lneï zesõâlit. Tento zaâ kladnõâ probleâ m pevnosti vazby je staâ le aktuaâ lnõâm teâ matem a je rïadou studiõâ zkoumaâ n. Dnes nenõâ zkoumanaâ problematika zameï rïena pouze na pevnost, ale rovneïzï narïadu detailnõâch jevuê, jako naprïõâklad rychlost vytvrzovaâ nõâ materiaâ lu, antibakteriaâ lnõâ charakter a antikarieâ znõâ efekt lepidla, technika snõâmaânõâ ortodontickyâch zaâ mkuê, mnozï stvõâ zbytkoveâ ho lepidla na povrchu skloviny cï izaâ mku po sejmutõâ, rychlost a jednoduchost ocï isï teï nõâ reziduaâ lnõâho adheziva ze skloviny. Artun a Bergland vytvorïili Adhesive Remnant Index pro hodnocenõâ zbytkoveâ ho adheziva na sklovineï po sejmutõâ zaâ mkuê [6]. Tento index je doplnï ujõâcõâm parametrem prïi hodnocenõâ pevnosti vazby adhezivnõâch materiaâluê, urcï uje mõâsto selhaâ nõâ vazby lepidla po sejmutõâ zaâ mkuê. CõÂlem teâ to studie bylo srovnaâ vaâ nõâ pevnosti vazby ortodontickyâ ch sveï tlem tuhnoucõâch kompozitnõâch materiaâ luê ke sklovineï zubu. Byltake hodnocen Adhesive Remnant Index (ARI) pro urcï enõâ mõâsta narusï enõâ adheze prïi odstraneï nõâ ortodontickyâch zaâ mkuê. Introduction The technique of bonding introduced by Buonocore in 1955 [1] led to significant changes in esthetic dentistry and orthodontics. Attachment of s to the enamelsurface became the integralpart of orthodontic treatment. Though the rate of s failure and function during orthodontic treatment varies, one of the factors affecting bond strength is adhesive material. Brackets may be attached with chemically cured and light cured materials, usually composite resins, glass ionomers, or compomer cements. The advantage of light cured material is sufficiently long period of time allowing for precise adjustment and placement of the. The risk of adhesive contamination during polymerization is at the minimum. Another advantage is seen in sufficient bond strength acquired immediately after polymerization and the possible immediate loading of fixed appliance components with orthodontic forces [2, 3]. Optimum adhesive should secure sufficient resistance against orthodontic forces and mastication. After the removal there should remain only minimum residue of adhesive on the enamelthat needs to be cleaned. Brackets removal should not result in damaged enamelsurface [4]. The damaged enamelinclude fissures, hollow (after the prisms are broken), crown fracture is the extreme case (defects of hard dental tissues due to caries or filling). Enamel surface was most frequently damaged when ceramic s were applied - the s bond strength is enhanced with a silan layer on retention surface. The bond so strong may result in the enamel defect [5]. At the beginning of the application of the techniques of orthodontic s attachment onto enamelsurface, the main aim was to secure sufficient connection between the etched enameland surface of the retention base. A number of studies dealt with the problem, manufacturers of adhesives and orthodontic s strove to enhance the bond strength as much as possible. The bond strength is still the fundamental problem and the topic of a number of investigations. The studies focus not only on bond strength but they deal also with other details such as how fast the material solidify, antibacterialfeatures and anti-caries effects of an adhesive, method of s removal, amount of adhesive residue on the enamelsurface or on after the removal, quick and simple cleaning of adhesive residue from enamel. Artun and Bergland established Adhesive Remnant Index to evaluate adhesive residue on the enamelafter s removal[6]. ARI is the additionalparameter in the evaluation of adhesive materials bond strength. The Index identifies the place of bond failure after the s removal

3 ORTODONCIE rocïnõâk20 Metodika Na prïedem prïipravenou sklovinu jsou lepeny zaâ mky kovoveâ a keramickeâ (Elite Ò Medium-Twin TM a Signature III TM ). Pra ce byla provaâdeï na na premolaâ rech extrahovanyâch prïevaâzïneï z ortodontickyâch duê voduê. Pro vyâzkum byly vybraâ ny pouze zuby s makroskopicky intaktnõâm povrchem skloviny na bukaâ lnõâ plosï ce anatomickeâ korunky zubu. Do studie bylo zarïazeno celkem 240 premolaâruê. Extrahovane premolaâ ry byly uchovaâ vaâ ny ve fyziologickeâ m roztoku prïi teploteï pohybujõâcõâ se v rozmezõâ od 15 do 25 C a postupneï byly zaleâvaâ ny do premacrylovyâch vaâlecïkuê.vaâlecï ky byly prïi vyârobeï rozlisï eny 4 barevnyâmi odstõâny (zïlutyâ,ruêzï ovyâ, zelenyâ, pruê hlednyâ), kazïdaâ barva prïirïazena jednomu zkoumaneâ mu materiaâ lu. KazÏdy vzorek bylcï õâselneï oznacï en (Obr. 1), poteâ vyfotografovaânprïõâstrojem stereomikroskop Olympus SZ61 s USB kamerou ueye, software QuickPhoto Industrial2.3. Byla pouzï ita lupa s podsvõâcenõâm kruhovou zaâ rïivkou a optickou mohutnostõâ 8 dioptriõâ. 240 vaâlecïkuê bylo naâ hodneï rozdeï leno tedy do 4 barevneï rozlisï enyâ ch skupin, kazï daâ skupina obsahovala 30 naâ hodneï vybranyâ ch premolaâ ruê pro lepenõâ kovovyâ ch zaâ mkuê a 30 pro lepenõâ keramickyâch zaâ mkuê. Ve vsï ech skupinaâ ch byly rovnomeï rneï zastoupeny zuby s jizï delsïõâ dobou nalepenyâmi zaâ mky, stejneï jako zuby, u nichzï byl y zaâ mky nalepeny teprve prïed zkousï kami pevnosti. Vzorky zubuê, ktereâ se v pruêbeï hu trhacõâ zkousï ky uvolnily zvaâ lecï kuê, byly naâ sledneï ze studie vyrïazeny.pro polymeraci byla pouzï ita LED polymeracï nõâ lampa SDI Radii Plus (sveï telnaâ intenzita 1,500mW/cm 2 ). Po nalepenõâ zaâmkuê na sklovinu byly vzorky azï do provedenõâ testuê uchovaâny v destilovaneâ vodeïprïi teploteï od15do25 C. ZkousÏ ky pevnosti vazby mohou byâ t provedeny ruêznyâmi zpuê soby, jako zkousï ky pevnosti ve smyku, nebo zkousï ky pevnosti v tahu. Tato studie pouzïila typ zkousïky pevnosti ve smyku meï rïeneâ tahem. ZkousÏ ky pevnosti byly provaâdeï ny na FSI VUT Brno a bylpouzïitprïõâstroj TIRA Test 2300 (Obr. 2), pohyblivaâ cï aâ st stroje je opatrïena hlavicõâ porïizujõâcõâ zaâ znam, meï rïõâcõâ jednotka zaznamenaâ cï asovyâ pruêbeï h zkousï ky ve formeï grafu. PouzÏita silomeï rnaâ hlava 1 kn s prïesnostõâ odecï tu na 0.03 N, rychlost posunu testovacõâ hlavy byla nastavena na 2,3 mm/min. Po provedenõâ tahoveâ zkousï ky a zaznamenaâ nõâ hodnot byly labiaâ lnõâ This study focused on comparison of bond strength of orthodontic light cured composite materials attached to the enamelsurface. Adhesive Remnant Index (ARI) was evaluated to determine the place of adhesion fracture at the removalof orthodontic s Material and method Metaland ceramic s (Elite Ò Medium-Twin TM and Signature III TM ) are attached to the pretreated enamel. The s were attached to premolars extracted mostly due to orthodontic reasons. Only teeth with macroscopically intact enamel on the buccal surface of the anatomic crown were used. The study included 240 premolars. Extracted premolars were preserved in physiological solution at the temperature between 15 and 20 C, the teeth were gradually imbedded in premacryl rollers. The rollers were differentiated with the help of 4 colors (yellow, pink, green, transparent); each colour for one adhesive tested. Each specimen was numbered (Fig. 1), than photographed with a stereomicroscope Olympus SZ61 with USB camera ueye, software QuickPhoto Industrial2.3. A magnifying glass was used, and backlight with a round fluorescent tube, vergency of 8 dioptre. 240 rollers were randomly divided into 4 groups, each of a different colour, and each group consisted of 30 premolars chosen randomly for metal s attachment, and 30 premolars for ceramic s. In all groups there was the same number of teeth with s attached for a longer period of time, and teeth with s attached only before shear strength tests. The teeth that loosened from the rollers during the test were excluded from the study. For polymerization a LED polymerization lamp SDI Radii Plus was used (luminous efficiency 1.500mW/cm 2 ). After the s were attached to the enamel, the samples were preserved in distilled water at the temperature C untilthe testing started. Obr. 1: Barevne rozlisï enõâ vzorkuê zalityâch v pryskyrïicïnyâch blocïcõâch Fig. 1: Color identification according to the used adhesive Obr. 2: Uchycenõ zaâ mku v testovacõâm prïõâstroji ocelovyâm lankem Fig. 2: Bracket fixed to tested machine with steelcable 31

4 rocïnõâk20 ORTODONCIE Obr. 3: MrÏõÂzÏ ka prolozï ena na sklovineï po sejmutõâ zaâ mkuê Fig. 3: Grid on the enamelsurface after debonding Obr. 4: MrÏõÂzÏka prolozï ena na baâzi zaâ mku po sejmutõâ Fig. 4: Grid on the base after debonding Results Bond strength The highest values of bond strength were recorded for metals and for materials Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM. Bond strength was better in case of metals attachment (Table 1, Fig. 5); ceramic s showed a bit worse bond strength. The least strength measured was found for ConTec LC with attached ceramic s. Comparisons of levels of significance proplosï ky zubuê opeï t vyfotografovaâ ny. SnõÂmky dokumentujõâ stav skloviny a zbytku lepidla na povrchu zubu. Pro mozïnost stanovenõâ mõâsta selhaâ nõâ vazby byla takeâ fotograficky dokumentovaâ na retencï nõâ plocha baâ ze odtrzï eneâ ho zaâmku. Fotografie zubu a baâ ze zaâ mku byla analyzovaâ na pro stanovenõâ Adhesive Remnant Indexu (ARI). Celkem bylo hodnoceno 416 fotografiõâ. KazÏda fotografie byla prïekryta mrïõâzï kou deï lõâcõâ baâzizaâ mku a mõâsto zbyleâ ho lepidla po odtrzïenõâ zaâ mku na 16 polõâcï ek (Obr. 3, 4) - 4 rïady a 4 sloupce. Do tabulek pak byly zaznamenaâvaâ ny hodnoty podle prïõâtomnosti lepidla - 1, neprïõâtomnost lepidla - 0 v daneâ m polõâcï ku. PrÏi srovnaâ nõâ tabulek (zaâ mek a plocha po odtrzï enõâ zaâ mku) zjistõâme, kde dochaâ zõâ k porusï enõâ adheziva. Pokud je jednicï ka v tabulce pro povrch zubu, dosï lo k uvolneï nõâ lepidla od baâze zaâ mku, pokud je jednicïka v tabulce pro baâzizaâ mku, selhala pevnost vazby na testovaneâ m povrchu. V mõâstech kde se vyskytuje jednicï ka v tabulce pro povrch zubu i pro povrch zaâ mku, dosï lo k selhaânõâ vazby ve vrstveï samotneâ ho lepidla, vyskytuje se zbytek lepidla i na zaâ mku i na zubu. Pokud by se na povrchu zubu azaâ mku vyskytla na obou mõâstech nula, znamenaâ to, zïe lepidlo nebylo prïõâtomno (vyskytla se chyba v postupu) a vzorek je nutno ze studie vyrïadit. Vy sledky pevnosti vazby a ARI indexu byly podrobeny statistickeâ mu hodnocenõâ, byly pouzï ity testy analyâza rozptylu ANOVA, a testy mnohocï etneâ ho porovnaâ nõâ LSD (Least Significant Difference). Vy sledky Pevnost vazby NejvysÏsÏ õâ hodnoty pevnosti vazby byly nameï rïeny u kovovyâchzaâ mkuê a materiaâluê Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM. Pevnost vazby byla vysïsïõâ v prïõâpadeï lepenõâ kovovyâch zaâ mkuê, (Tab. 1, Obr. 5), keramickeâ zaâ mky prokaâ zaly lehce nizïsï õâ pevnost vazby. Adhezivnõ materiaâ lcontec LC dosaâ hlnejmensï õâ nameï rïeneâ sõâly v kombinaci s lepenyâ mi keramickyâ mi zaâ mky. Srovna nõâm hladin vyâ znamnosti bylo zjisï teï no, zï e nenõâ statisticky signifikantnõâ rozdõâlv pevnosti vazby mezi materiaâ ly Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM ve spojenõâ s kovovyâm zaâ mkem (Tab. 2). Da le se statisticky nelisï õâ materiaâ ly Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM ve vazbeï nazaâ mek keramickyâ a kovoveâ zaâ mky lepeneâ adhezivem ConTec LC. Materia lcontec LC spolu s keramickyâmi zaâ mky vykaâ zalnejnizïsï õâ nameï rïeneâ hodnoty pevnosti vazby a statisticky signifikantneï se lisïõâodvsï ech ostatnõâch druhuê lepidel (Tab. 2). Bond strength may be tested with various methods, e.g. shear bond strength test, or tensile test. In our work we used shear strength test measured with tensile force. Strength testing took place at FSI VUT Brno (Faculty of CivilEngineering) and the device TIRA Test 2300 was used (Fig. 2); the mobile part of the machine has a head with scanner, the measuring unit records the test time flow as a diagram (load gauge 1 kn, the accuracy of reading 0.03 N, advancing speed of the testing head 2.3 mm/min). After tensile testing and recording of values, the labial surfaces of teeth were photographed again. The photographs give evidence about the enamelcondition and adhesive residue on a tooth surface. To establish the place of bond failure, the retention surface of the base of the removed was documented. The photographs (a tooth, base) were analyzed to assess Adhesive Remnant Index (ARI). 416 photographs were evaluated. Each photograph was overlaid with a grid separating a base and the place with adhesive remnants after removalof the into 16 boxes (Fig. 3, 4) - 4 lines, 4 columns. In charts the values are filled in according to the presence -1/absence - 0 of the adhesive remnants in the respective box. Comparison of charts ( and surface after removal) shows where the adhesive was damaged. When the chart shows 1 for tooth surface, the adhesive broke off the base; when the charts shows 1 for base, then bond strength failed at the surface tested. When there is 1 for both the tooth and surface, the bond failed in the layer of an adhesive itself, adhesive remnants are both on and tooth. When there is 0 for both tooth and surface, no adhesive was present (i.e. there was an error) - such samples were excluded from the study. The results of bond strength tests and ARI were statistically evaluated. Analysis of variance (ANOVA) and multiple comparison LSD (Least Significant Difference) tests were used

5 ORTODONCIE rocïnõâk20 Tab. 1: VyÂsledne hodnoty pevnosti vazby Tab. 1: Shear bond strength results shear bond strength (MPa) Mean Max. Min. 0 Transbond stainless s. Transbond ceramic Light Bond stainless s. Light Bond ceramic KurasperF stainless s. KurasperF ceramic ConTec stainless s. ConTec ceramic Obr. 5: VyÂsledky pevnosti adheze. OznacÏ eny minimaâ lnõâ, maximaâ lnõâ a pruêmeï rneâ hodnoty v MPa Fig. 5: Shear bond strength results. Minimal, maximal and mean values in MPa VyÂsledky ARI U kovovyâch zaâ mkuê u vsï ech druhuê lepidel zuê staly zbytky adheziva ve veï tsï ineï meï rïenyâ ch polõâcï ek na povrchu zubuê, zvlaâsïteïvyârazneïjsï õâ je hodnota vyâskytu zuê statku na sklovineï u lepidel Kurasper TM F, Light Bond TM. MateriaÂly, kteryâmi byly fixovaâ ny keramickeâ zaâ mky na premolaâ ry, vykazujõâ rovneï zï veï tsï õâ vyâ skyt zbyleâ ho adheziva po sejmutõâ na povrchu skloviny, nejvysï sï õâ procento bylo nameï rïeno u adheziva Transbond TM Plus Color Change Adhesive. Transbond TM Plus Color Change Adhesive a ConTec LC ve ved there was no statistically significant difference between bond strength for materials Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM when they were used with metals (Table 2). There was no statistically significant difference between adhesives Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM with ceramic s and ConTec LC adhesive with metals. ConTec LC with ceramic s showed the lowest values of bond strength measured, and thus the adhesive is significantly different from the rest adhesives tested (Table 2). ARI In metals with allkinds of adhesives tested the remnants were found in most boxes on tooth sur- Tab. 2: Statisticke srovnaâ nõâ pevnosti vazby Tab. 2: Statistic comparison of shear bond strength Statisticky potvrzeneâ rozdõâly, statistically significant differences: * p < 0.05, ** p < 0.01, *** p < 0.001, **** p <

6 rocïnõâk20 ORTODONCIE vazbeï na kovovyâ zaâ mek majõâ vysï sï õâ procento vyâ skytu adheziva na povrchu skloviny i baâzizaâ mku, stejneï tak se projevuje i adhezivum Light Bond TM a Kurasper TM ve vazbeï na keramickyâ zaâ mek. V tabulce je uvedeno procentuaâ lnõâ zastoupenõâ mõâst, na kteryâch zuê staâvaâ zuê statek lepidla. Tyto procentuaâ lnõâ hodnoty jsou pocï õâtaâ ny pro maximaâ lnõâ prïesnost ne ze zaokrouhlenyâ ch hodnot pro jednotliveâ povrchy (pokud by naprïõâklad byl urcï en zbytek lepidla tam, kde bude ve veïtsï ineï z 16 polõâcï ek jednicï ka), ale prïõâmo z hodnot soucï tuê zuê statku lepidla v jednotlivyâ ch polõâch testovacõâ mrïõâzï ky. Tabulka zobrazuje, v kolika procentech prïõâpaduê zuê staâvaâ lepidlo na baâzizaâ mku, v kolika na povrchu zubu, nebo kolika procenty je zastoupeno reziduum na povrchu zaâ mku i zubu. V prïõâpadeï,zï e je tato procentuaâ lnõâ hodnota vysï sï õâ nezï 60%, je cï õâslo oznacï eno cï erveneï (Tab. 3). Statisticky m vyhodnocenõâm jsme nalezli rozdõâly ve vyâskytu zbytkuê jednotlivyâch adheziv na sklovineï a bazõâch zaâ mkuê (Tab. 4, 5). Diskuse Pro porovnaâ nõâ vyâ sledkuê jsme pouzï ili praâ ci Tvardka. Tvardek ve sveâ praâ ci hodnotilpevnost vazby ruê znyâch adhezivnõâch materiaâluê. Jednalo se o kompozitnõâ pryskyrïice sveï tlem a chemicky tuhnoucõâ, skloionomernõâ cementy sveï tlem a chemicky tuhnoucõâ, daâ le byl v jeho studii zarïazen takeâ materiaâ l Spofacryl. Lepeny byly vzïdy stejneâ kovoveâ zaâ mky Omniarch (GAC) se sõât'ovanyâ m povrchem retencï nõâ plochy baâ ze zaâ mku. V jeho studii byly hodnoceny pevnosti vazby materiaâluê nejen ve vazbeï na povrch extrahovanyâ ch premolaâ ruê, ale hodnotil rovneïzï vazebnou sõâlu adhezivnõâch materiaâluê na plastovyâch, kompozitnõâch, keramickyâch povrsï õâch [8]. V teâ to praâ ci byla sveï tlem tuhnoucõâ kompozitnõâ adheziva hodnocena pouze ve vztahu ke sklovineï zubuê (extrahovaneâ premolaâ ry). Studie Tvardka zjisï t'uje, zï e v pevnosti vazby dosaâ hly srovnatelneï podobnyâ ch vyâ sledkuê kompozitnõâ chemicky tuhnoucõâ materiaâ lbrackfix NT a akrylaâ tovaâ face; the values are particularly high in case of Kurasper TM F, Light Bond TM. Ceramic s also show greater amount of adhesive remnants on the enamel surface (the highest values were found out for Transbond TM Plus Color Change Adhesive). Transbond TM Plus Color Change Adhesive and ConTec LC with metal s show greater amount of residue both on the enamelsurface and base; the same applies to Light Bond TM and Kurasper TM used with ceramic s. The table gives the places with adhesive remnants in per cents. The values were calculated not from rounded values for individual surfaces (e.g. in case an adhesive remnant would be determined in case where there would be 1 in most boxes), but directly from the values of adhesive remnants sums in individualboxes of the testing grid. The table shows per cents of adhesive remnants on base, on tooth surface, and on both tooth and surface. In case the value in per cents exceeds 60%, the figure is given in red (Table 3). The statistical evaluation revealed the differences in remnants of individualadhesives on the enameland bases (Table 4, 5). Discussion To compare the results we choose a work by Tvardek. In his work, Tvardek evaluated bond strength of different adhesives: composite resins (light cured as well as chemically cured), glass-ionomer cements (both light and chemically cured), and Spofacryl. The same metals Omniarch (GAC) with mesh base were used. Tvardek evaluated bond strength of adhesives attached not only to surface of extracted premolars, but also at plastic, composite, and ceramic surfaces [8]. In our work light cured composite adhesives were evaluated only in terms of their attachment to the enamelsurface (extracted premolars). Tvardek reports Tab. 3: Procentua lnõâ zbytky lepidel (ARI) na povrsïõâch Tab. 3: Per centage of remmants (ARI) on surgaces VeÏtsÏ ina zbytkuê lepidla oznacï ena modrïe. Zbytky lepidla prïesahujõâcõâ 60 % jsou znacï eny cï erveneï. Majority of remmants is blue. Adhesive remmants with the value over 60 % are in red color

7 ORTODONCIE rocïnõâk20 Tab. 4: Statisticke srovnaâ nõâ ARI na povrchu zubu Tab. 4: Statistic comparison of ARI on tooth surface Statisticky potvrzeneâ rozdõâly, statistically significant differences: * p < 0.05, ** p < 0.01, *** p < 0.001, **** p < Tab. 5: Statisticke srovnaâ nõâ ARI na baâzizaâ mku Tab. 5.: Statistic comparison of adhesives on the base Statisticky potvrzeneâ rozdõâly, statistically significant differences: * p < 0.05, ** p < 0.01, *** p < 0.001, **** p < pryskyrïice Spofacryl. SveÏ tlem tuhnoucõâ materiaâ ly dosaâhly o neï co nizïsï õâch hodnot pevnosti vazby, nejnizïsï õâ hodnoty pevnosti vazby Tvardek nameï rïilu skloionomernõâch cementuê. PodobneÏ veï tsï ina studiõâ v dostupneâ literaturïe hodnotõâ kompozitnõâ pryskyrïice jako pevneï jsï õâ ve srovnaânõâ se skloionomernõâmi cementy, pevnost skloionomernõâch that composite chemically cured adhesives BrackFix NT and acrylate resin Spofacryl showed similar results of bond strength. Light cured adhesives had a bit lower values of the bond strength; the lowest values were found for glass ionomer cements. Most works published report more favourable values of bond strength for 35

8 rocïnõâk20 ORTODONCIE materiaâluêbyâvaâazï o 30 % nizïsï õâ. Haydar doporucï uje lepenõâ keramickyâch zaâmkuê pomocõâ skloionomernõâch cementuê, pro zajisïteï nõâ bezpecïneâ ho snõâmaâ nõâ aparaâ tu [9]. Owens a Miller nezjistili statisticky signifikantnõâ rozdõâl v pevnosti vazby dvou adhezivnõâch kompozitnõâch pryskyrïic, ale dosïli kzaâveï ru, zïe se lisï õâ signifikantneï od sveï tlem tuhnoucõâho skloionomernõâho cementu. Skloionomer se projevil svou pevnostõâ slabsï õâ o 30 % nezï li kompozitnõâ pryskyrïice Transbond a Enlight [10]. Adhezivum Transbond XT dosaâhlo hodnot pevnosti 7.9 ± 2.1 MPa, cozï je obdobnaâ hodnota jako ve studii Tvardka. V nasï õâ studii jsme nameï rïili podobneâ hodnoty vazebneâ pevnosti u veï tsï iny adhezivnõâch materiaâluê. JmenoviteÏ nebylnalezen statistickyâ rozdõâlv pevnosti vazby sveïtlem tuhnoucõâch materiaâluê Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM ve spojenõâ s kovovyâmzaâ mkem. Tyto materiaâ ly vykazujõâ nejvysï sï õâ zmeï rïenou pevnost vazby. Transbond TM Plus Color Change Adhesives meï lpruê meï rnou hodnotu pevnosti 8,4 MPa, Kurasper TM F 8,2 MPa, nejveïtsï õâ pruêmeï rnou hodnotu jsme nameïrïili u adheziva Light Bond TM a lepenyâch kovovyâch zaâmkuê, pruêmeï rnaâ hodnota 8,8 MPa, cozï jsou podobneâ vyâsledky jako hodnoty nameïrïeneâ u adheziv sveïtlem tuhnoucõâch v praâ ci Tvardka. Pra ce Moravcove srovnaâ vala vazebnou pevnost 6 druhuê keramickyâ ch zaâ mkuê [11]. PouzÏ ityâ m adhezivem bylchemicky tuhnoucõâ materiaâ lbrackfix NT, kteryâm byly lepeneâ zaâ mky: Allure (polykrystalickeâ keramickeâ), Elation (plastoveâ ) a Envision (plastoveâ polyuretanoveâ s draâ zï kou vyztuzï enou kovem) - vykazovaly optimaâ lnõâ pevnost vazby (8,687 MPa; 9,987 MPa; 8,214 MPa), monokrystalickeâ zaâ mky Crystal Clear s vazebnou silou 3,595 MPa a keramickeâ polykrystalickeâ zaâ mky s draâ zïkou vyztuzï enou slitinami zlata Aspire Gold s vazebnou silou 5,736 MPa. Pouze u zaâ mkuê Inspire Ice bylo dosazï eno srovnatelneâ pevnosti vazby (11,054 MPa) jakou uvaâ dõâ pro kovoveâ zaâ mky Tvardek (11,324 MPa) [8]. ZaÂmek Inspire Ice je polykrystalickyâ keramickyâ zaâ mek, retencï nõâ plocha baâzezaâ mku maâ mechanickyâ zpuê sob retence zajisïteïnyâ pokrytõâm povrchu retencï nõâmi perlami. V nasï õâ praâ ci jsme zmeïrïili u vsï ech srovnaâ vanyâch adheziv nizïsï õâ vazebnou sõâlu vzï dy ve vztahu ke keramickeâ mu zaâ mku, cozï mohlzaprïõâcï init rozdõâlnyâ tvar retencïnõâch ploch zaâ mkuê. Ve studii byly pouzï ity zaâ mky polykrystalickeâ s mechanickou uâ pravou retencï nõâ plochy ve formeï zaârïezuê - preparace tvaru rybiny. PodobneÏ tento zpuê sob uâ pravy retencï nõâ plochy polykrystalickeâ ho zaâ mku ve studii Moravcove vykaâ zalnizïsï õâ vazebnou pevnost ve srovnaâ nõâ s ostatnõâmi keramickyâ mizaâ m- ky (zaâ mek Aspire Gold s vazebnou silou 5,736 MPa). RÏ ada studiõâ udaâ vaâ ruê zneâ hodnoty pevnosti vazby jako optimaâ lnõâ a adekvaâ tnõâ pro klinickeâ pouzï itõâ. Tyto hodnoty by meï l y spl nï ovat dobrou funkci prïi zatõâzï enõâ ortodontickyâmi silami, ale zaâ rovenï by nemeïly veâ st k posï kozenõâ composite resins than for glass-ionomer cements (strength in glass-ionomer adhesives is lower by as much as 30%). Haydar recommends using glass-ionomer cements for ceramic s - the removalof s seems to be safer [9]. Owens and Miller did not find statistically significant difference of bond strength for the two adhesive composite resins. However, they conclude that composite resins are significantly different in comparison with light cured glassionomer cement. Glass-ionomer was by 30% less strong than composite resins Transbond and Enlight [10]. Bond strength values for Transbond XT were 7.9 ± 2.1 MPa, which agrees with the results given by Tvardek. In our study the values of bond strength measured for most adhesives were similar. There was no statistically significant difference in bond strength of light cured materials Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM combined with metal s. The adhesives mentioned showed the highest values of bond strength. The mean value of bond strength for Transbond TM Plus Color Change Adhesive was 8.4 MPa, for Kurasper TM F it was 8.2 MPa. The highest mean value was measured for Light Bond TM and metal s = 8.8 MPa. Our results are similar to those given by Tvardek for light cured adhesives. Moravcova made the comparison of bond strength in 6 different ceramic s [11]. The adhesive used was chemically cured BrackFix NT, ceramic s Allure (polycrystalline ceramic), Elation (plastic), Envision (plastic polyurethane with a groove reinforced with metal) - they revealed optimum bond strength (8.687 MPa; MPa; MPa); monocrystalline s CrystalClear with the bond strength of MPa; ceramic polycrystalline s with a groove reinforced with gold alloys Aspire Gold - the bond strength of MPa. Only with Inspire Ice s the bond strength was comparable ( MPa) to that reported by Tvardek for metals ( MPa) [8]. Inspire Ice is a polycrystalline ceramic ; retention surface of the base uses mechanical retention secured by the layer of retention pearls. In our work, in all adhesives was found lower value of bond strength with ceramic s, which might be due to the different shape of retention surfaces of the s. Polycrystalline s with mechanically modified retention surface were used - grooves in the shape of dovetail. Similarly, the polycrystalline with the same modification of retention surface used by Moravcova also showed lower values of bond strength compared to other ceramic s (Aspire Gold, the bond strength of MPa). A number of studies give different values of bond strength as optimum and adequate for clinical use

9 ORTODONCIE rocïnõâk20 struktur skloviny prïi snõâmaâ nõâzaâ mkuê [12, 13, 14]. Dle Reynoldse je optimaâ lnõâ a bezpecï naâ pevnost vazby v rozmezõâ 5-8 MPa. V literaturïe nachaâ zõâme mnoho ruê znyâ ch vyâ slednyâ ch hodnot pevnostõâ vazby pro nejruê zneï jsï õâ materiaâ l y, stejneï tak je mnoho ruê znyâch zpuê sobuê testovaâ nõâ pevnosti vazby. PodobneÏ jsou v literaturïe uvaâdeï ny hodnoty vazebneâ pevnosti, ktereâ jsou pro snõâmaâ nõâ zaâ mkuê oznacï o- vaâ ny za bezpecïneâ, ktereâ by nezpuê sobovaly posï kozenõâ skloviny prïi snõâmaânõâzaâmkuê. Studie Weinbergera a kol. se zameïrïila na srovnaânõâ pevnosti vazby polykrystalickyâ ch a monokrystalickyâ ch keramickyâ ch zaâ mkuê lepenyâ ch adhezivnõâ pryskyrïicõâ chemicky tuhnoucõâ, sveï tlem tuhnoucõâ, a tuhnoucõâch pomocõâ argon laseroveâ polymerace. NejvysÏ sï õâ pruê meï rnou vazebnou pevnost vykazovaly monokrystalickeâ zaâ mky prïi pouzï itõâ laser argonoveâ polymerace, hodnota pruê meï rneâ vazebneâ pevnosti byla 29,58 MPa, praâ ce se zabyâvala takeâ vznikem prasklin ve sklovineï po sejmutõâ zaâmkuê, u obou typuê zaâ mkuê nebylprokaâ zaâ n vznik novyâ ch prasklin jen u materiaâ lu chemicky tuhnoucõâho. Ostatnõ adheziva prokaâ zala vznik prasklin u 10 % prïõâpaduê nalepenyâch zaâ mkuê [15]. Naproti tomu studie Retiefa prokaâ zala vyâ skyt sklovinnyâ ch fraktur a prasklin uzï prïi hodnotaâ ch pevnosti vazby pod 10 MPa a to prïi hodnoteï 9,7 MPa [16]. RuÊ zneâ hodnoty meï rïenyâ ch pevnostõâ vazby ortodontickyâ ch fixacïnõâch materiaâluê vyskytujõâcõâ se v literaturïe se lisï õâ, je to daâno ruê znyâ mi podmõânkami pruê beï hu studiõâ, rozdõâlnyâ mi zpuê soby testovaâ nõâ vazebnyâch sil. V nasï õâ studii materiaâ ly Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM odpovõâdajõâ kriteriõâm stanovenyâch Reynoldsem pro optimaâ lnõâ bezpecï nou pevnost vazby, lepidlo ConTec LC se nachaâ zõâ mõârneï pod hranicõâ tohoto limitu. ZaÂveÏr Ve studii byla hodnocena pevnost vazby cï tyrï sveï tlem tuhnoucõâch kompozitnõâch materiaâluê Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM, ConTec LC. Byltestova n vzaâ jemnyâ rozdõâlv pevnosti mezi jednotlivyâ mi adhezivy. Da le byla porovnaâ vaâ na pevnost vazby adhezivnõâch materiaâ l uê prïi pouzï itõâ kovovyâ ch ortodontickyâchzaâmkuê Elite Ò Medium-Twin TM a keramickyâch ortodontickyâch zaâmkuê Signature III TM. Vy slednaâ meï rïenõâ pevnostõâ vazby se pohybovala od 4,5 MPa do 8,8 MPa. NejvysÏsÏ õâ nameï rïenaâ pevnost vazby byla u adheziva Light Bond TM, nejnizïsï õâ pevnost vazby meïlo adhezivum ConTec LC. V teâ to studii testovanaâ adheziva ve vazbeï na kovoveâ ortodontickeâ zaâ mky projevila vysï sï õâ vazebnou pevnost nezï ve vazbeï na keramickeâ ortodontickeâ zaâ mky. StanovenõÂm Adhesive Remnant Indexu bylo urcï eno mõâsto selhaâ nõâ vazby pro jednotlivaâ adheziva. Byly nalezeny statisticky signifikantnõâ rozdõâly v mõâsteï selhaânõâ vazby jednotlivyâch materiaâluê. AutorÏi nemajõâ komercï nõâ, vlastnickeâ nebo financï nõâ zaâ jmy na produktech nebo spolecï nostech popsanyâ ch v tomto cïlaâ nku. The bonds should provide a good function when loaded with orthodontic forces, at the same time they should not result in damage of the enamel structures during the s removal[12, 13, 14]. Reynolds stated the optimum and safe bond strength between 5-8 MPa. In literature we can find a number of bond strength values for a variety of adhesives, as well as different kinds of testing for the bond strength. We can also find different values of bond strength that are considered safe during the s removal, and do not cause any damage to the enamel. The study by Weinberger et al. compared bond strengths of polycrystalline and monocrystalline ceramic s attached with adhesive resin chemically cured, light cured, and cured by means of argon-laser polymerization. The highest average bond strength was reached with monocrystalline s cured by argon-laser polymerization (the mean value of MPa). Weinberger dealt also with the occurrence of cracks in the enamelafter the s removal- no cracks appeared only when chemically cured adhesive was used (with both types of s). Other adhesives proved cracks in 10% of the attached s [15]. On the other hand, Retief proved the occurrence of fractures and cracks of the enameleven at values of bond strength below 10 MPa (at 9.7 MPa) [16]. The values given by individualstudies vary. This is due to different conditions, different ways to test bond strength. In our study the adhesives Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM meet the criteria given by Reynolds for the optimum safe bond strength. ConTec LC adhesive is moderately below this limit. Conclusion The study evaluated bond strength for four light cured composite adhesives: Transbond TM Plus Color Change Adhesive, Kurasper TM F, Light Bond TM, Con- Tec LC. The difference in strength between the individualadhesives was tested. Further the bond strength of the adhesive materials with metal orthodontic s Elite Ò Medium-Twin TM, and ceramic orthodontic s Signature III TM was compared. The values measured were between 4.5 MPa and 8.8 MPa. The highest value of bond strength was found for Light Bond TM adhesive, the lowest for ConTec LC. The adhesives tested proved better bond strength when used with metalorthodontic s than with ceramic ones. Adhesive Remnant Index was established to determine the place of bond failure for individual adhesives. Statistically significant differences were found for the place of bond failure for individual adhesives. Authors have no commercial, proprietary or financial interest in products or companies mentioned in the article

10 rocïnõâk20 ORTODONCIE Liretarura/References 1. Buonocore, M. G.: A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. J. Dent Res. 1955, 34, cï. 6, s Bishara, S. E., VonWald, L., Olsen, M. E., Laffoon, J. F.: Effect of time on the shear bond strength of glass ionomer and composite orthodontic adhesives. Amer. J. Orthodont. dentofacialorthop. 1999, 116, cï. 6, s Movahhed, M.Z., Ogaard, B., Syverud, M.: An in vitro comparison of the shear bond strength of a resin-reinforced glass ionomer cement and a composite adhesive for bonding orthodontic s. Eur. J. Orthodont. 2005, 27, cï. 5, s Trimpeneers, L. M, Verbeeck, R. M., Dermaut, L. R., Moors, M. G.: Comparative shear bond strength of some orthodontic bonding resins to enamel. Eur. J. Orthodont. 1996, 18, cï. 1, s Stratmann, U., Schaarschmidt, K., Wegener, H., Ehmer, U.: The extent of enamelsurface fractures. A quantitative comparison of thermally debonded ceramic and mechanically debonded metal s by energy dispersive micro - and image-analysis. Eur. J. Orthodont. 1996, 18, cï. 6, s Artun J, Bergland S.: Clinical trials with crystal growth conditioning as an alternative to acid-etch enamel pretreatment. Amer. J. Orthodont. 1984, 85, cï. 4, s Newman, GV.: Epoxy adhesives for orthodontics attachments: progress report. Amer. J. Orthodont.1965, 51, s Tvardek, J.: Pevnost vazby ortodontickyâ ch adhezivnõâch materiaâluê a jejich vliv na sklovinu. Doktorska disertacïnõâ praâ ce, LF MU, Brno, Haydar, B., Sarikaya, S., Ceherli, Z.C.: Comparison of shear bond strength of three bonding agents with metal and ceramic s. Angle Orthodont., 1999, 69, cï.5, s Owens, S. E., Miller, B. H.: A comparison of shear bond strengths of three visible light cured orthodontic adhesives. Angle Orthodont., 2000, 70, cï. 5, s MoravcovaÂ, S. Pevnost vazby ortodontickyâ ch estetickyâch zaâ mkuê k zubnõâmu povrchu. AtestacÏ nõâ praâ ce, LFMU, Brno, Asgari, S., Sala, A., English, J., Powers, J.: Clinical evaluation of bond failure with a self-etching primer: a randomized controlled trial. J. Orthodont. 2007, 34, cï. 4, s Buonocore, M. G.: The use of adhesives in dentistry. Illinois: Charles C Thomas, Reynolds, I. R.: A review of direct orthodontic bonding, Brit. J. Orthodont. 1975, 2, cï. 2, s Mitiko, F., Kitahara-CeõÂa, F., Mucha, J.N.: Assessment of enameldamage after removalof ceramic s. Amer. J. Orthodont. dentofacialorthop. 2008, 134, cï. 4, s Retief, D. H.: Failure at the dental adhesive etched enamelinterface: J. OralRehab. 1974, 1, s MUDr.Beata Konkolska Klinika zubnõâho leâ karïstvõâ LF UP Palacke ho 12, Olomouc ROD OSTRAVA PrÏehled chystanyâch zahranicï nõâch akcõâ: 18± Congress of the European Orthodontic Society Istanbul, Turecko PrÏehled chystanyâch domaâ cõâch akcõâ: (zmeï na termõânu!) Maria n Svorad Olomouc ¹SpolupraÂcele karïe a technika Aneb co je dobreâ veïdeït o praâ ci toho druheâ hoª Odborny kurz pro leâ karïe i zubnõâ techniky v ortodoncii Doc. MUDr. Olga JedlicÏ kovaâ, CSc. Brno ¹LeÂcÏ ba ve smõâsï eneâ m chrupuª Za sady leâcï by dle indikacõâ snõâmacõâmi i fixnõâmi aparaâ ty v I., II a III. Angl. trïõâdeï MUDr. Marie SÏ tefkovaâ, CSc. Olomouc ¹PodõÂl sester a zubnõâch technikuê v ortodontickeâ leâcïbeïª Odborny seminaârï pro personaâ li zubnõâ techniky v ortodoncii * * * Informace: ROD Ostrava ± BeÏ lovaâ Olga, MojmõÂrovcuÊ 799/45, Ostrava-Mar. Hory Tel.: , ,

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