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Oblique lateral cephalometric radiographs of the mandible in implantology: usefulness and accuracy of the technique in height measurements of mandibular bone in vivo

Identifieur interne : 008E55 ( Main/Curation ); précédent : 008E54; suivant : 008E56

Oblique lateral cephalometric radiographs of the mandible in implantology: usefulness and accuracy of the technique in height measurements of mandibular bone in vivo

Auteurs : Jan Willem Verhoeven [Pays-Bas] ; Marco Stephan Cune [Pays-Bas]

Source :

RBID : ISTEX:FE756772C7A979E77D3857A4EF910DF2B39AA6DC

Descripteurs français

English descriptors

Abstract

Various radiographic techniques are used for longitudinal studies of changes in the height of the mandible with implants. Advantages and disadvantages of panoramic radiographs, lateral cephalometric radiographs, periapical films and modern CT‐ and MRI‐techniques are briefly discussed. In this study, the usefulness of a conventional radiographic technique for measuring the height of the mandible, i.e. oblique lateral cephalometric radiography (OLCR) is evaluated in vivo. In 16 patients with permucosal implants in the anterior mandible OLCRs were repeated the same day. The mean total error for the radiographic procedure and analysis was 0.38 mm. The intra‐observer error for the determination of the mandibular height by means of the image analysis procedure was 0.16 mm (analysis error). In 12 other patients pairs of radiographs of the same area of the mandible were made using both a “standard” horizontal X‐ray beam direction and an individually determined “optimal” horizontal X‐ray beam direction; the maximum difference between these two angulations was plus or minus 7.5 degrees. The effect of this different angulation on the height measurements is comparable to the above‐mentioned total error of the measurement procedure (positioning error). An accurate positioning of the patient seems important for reliable measurements. The described radiographic (OLCR) and analysis (IBAS) technique can be used relatively simply for clinical studies. The described methods appear to be useful for measuring the mandibular height in longitudinal studies in patients with or without implants.

Url:
DOI: 10.1034/j.1600-0501.2000.011001039.x

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ISTEX:FE756772C7A979E77D3857A4EF910DF2B39AA6DC

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<term>Algorithm</term>
<term>Aluminium</term>
<term>Aluminium reference wedge</term>
<term>Aluminium transformation</term>
<term>Aluminium wedge</term>
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<term>Alveolar Bone Loss (diagnostic imaging)</term>
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<term>Analysis of Variance</term>
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<term>Cephalometric radiographs</term>
<term>Cephalometry (methods)</term>
<term>Clinical periodontology</term>
<term>Clinical studies</term>
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<term>Cune</term>
<term>Deliberate change</term>
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<term>Densitometric measurements</term>
<term>Densitometry (methods)</term>
<term>Dental Implantation, Endosseous</term>
<term>Dental Implants</term>
<term>Dentomaxillofacial radiology</term>
<term>Digital subtraction radiography</term>
<term>Edentulous mandible</term>
<term>Eld</term>
<term>Endosseous implants</term>
<term>Extraoral</term>
<term>Group patients</term>
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<term>Horizontal angle</term>
<term>Horizontal beam direction</term>
<term>Humans</term>
<term>Ibas</term>
<term>Image acquisition</term>
<term>Image analysis</term>
<term>Image processing</term>
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<term>Implant region</term>
<term>Implantology</term>
<term>Implants research</term>
<term>Intraoral</term>
<term>Intraoral periapical</term>
<term>Jaw, Edentulous (diagnostic imaging)</term>
<term>Jeffcoat</term>
<term>Jeffcoat reddy</term>
<term>Lateral</term>
<term>Lateral cephalometric radiographs</term>
<term>Light source</term>
<term>Longitudinal Studies</term>
<term>Longitudinal studies</term>
<term>Longitudinal study</term>
<term>Mandible</term>
<term>Mandible (anatomy & histology)</term>
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<term>Mandibular segment</term>
<term>Measurement error</term>
<term>Measurement errors</term>
<term>Measurement results</term>
<term>Measurement series</term>
<term>Measurements series</term>
<term>Median</term>
<term>Oblique</term>
<term>Observer Variation</term>
<term>Olcr</term>
<term>Olcrs</term>
<term>Optimal projection</term>
<term>Oral maxillofacial surgery</term>
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<term>Panoramic radiographs</term>
<term>Para</term>
<term>Periapical</term>
<term>Periapical radiographs</term>
<term>Periodontal research</term>
<term>Permucosal implants</term>
<term>Phantoms, Imaging</term>
<term>Posture</term>
<term>Present study</term>
<term>Quantitative densitometric measurements</term>
<term>Radiograph</term>
<term>Radiographic</term>
<term>Radiographic Image Enhancement</term>
<term>Radiographic Image Interpretation, Computer-Assisted</term>
<term>Radiographic technique</term>
<term>Radiographic techniques</term>
<term>Radiography</term>
<term>Reference Values</term>
<term>Relative difference</term>
<term>Relative effect</term>
<term>Reliable measurements</term>
<term>Repositioning</term>
<term>Reproducibility of Results</term>
<term>Soft tissue correction</term>
<term>Soft tissue correction algorithm</term>
<term>Soft tissue projection</term>
<term>Soft tissues</term>
<term>Square measurement</term>
<term>Total error</term>
<term>Utrecht</term>
<term>Utrecht university</term>
<term>Verhoeven</term>
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<term>Webber</term>
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<term>Amélioration d'image radiographique</term>
<term>Analyse de variance</term>
<term>Biais de l'observateur</term>
<term>Céphalométrie ()</term>
<term>Densitométrie ()</term>
<term>Densité osseuse</term>
<term>Fantômes en imagerie</term>
<term>Humains</term>
<term>Implants dentaires</term>
<term>Interprétation de radiographie assistée par ordinateur</term>
<term>Mandibule (anatomie et histologie)</term>
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<term>Mâchoire édentée (imagerie diagnostique)</term>
<term>Pose d'implant dentaire endo-osseux</term>
<term>Posture</term>
<term>Reproductibilité des résultats</term>
<term>Résorption alvéolaire (imagerie diagnostique)</term>
<term>Valeurs de référence</term>
<term>Études longitudinales</term>
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<term>Dental Implants</term>
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<term>Atrophic mandible</term>
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<term>Bone density</term>
<term>Cephalometric</term>
<term>Cephalometric radiographs</term>
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<term>Clinical studies</term>
<term>Conventional radiographic technique</term>
<term>Correction</term>
<term>Cune</term>
<term>Deliberate change</term>
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<term>Densitometric measurements</term>
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<term>Dentomaxillofacial radiology</term>
<term>Digital subtraction radiography</term>
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<term>Endosseous implants</term>
<term>Extraoral</term>
<term>Group patients</term>
<term>Hauteur mandibulaire</term>
<term>Height measurements</term>
<term>Horizontal angle</term>
<term>Horizontal beam direction</term>
<term>Humans</term>
<term>Ibas</term>
<term>Image acquisition</term>
<term>Image analysis</term>
<term>Image processing</term>
<term>Implant</term>
<term>Implant region</term>
<term>Implantology</term>
<term>Implants research</term>
<term>Intraoral</term>
<term>Intraoral periapical</term>
<term>Jeffcoat</term>
<term>Jeffcoat reddy</term>
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<term>Light source</term>
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<term>Longitudinal studies</term>
<term>Longitudinal study</term>
<term>Mandible</term>
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<term>Measurement error</term>
<term>Measurement errors</term>
<term>Measurement results</term>
<term>Measurement series</term>
<term>Measurements series</term>
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<term>Oblique</term>
<term>Observer Variation</term>
<term>Olcr</term>
<term>Olcrs</term>
<term>Optimal projection</term>
<term>Oral maxillofacial surgery</term>
<term>Panoramic</term>
<term>Panoramic radiographs</term>
<term>Para</term>
<term>Periapical</term>
<term>Periapical radiographs</term>
<term>Periodontal research</term>
<term>Permucosal implants</term>
<term>Phantoms, Imaging</term>
<term>Posture</term>
<term>Present study</term>
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<term>Radiograph</term>
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<term>Radiographic technique</term>
<term>Radiographic techniques</term>
<term>Radiography</term>
<term>Reference Values</term>
<term>Relative difference</term>
<term>Relative effect</term>
<term>Reliable measurements</term>
<term>Repositioning</term>
<term>Reproducibility of Results</term>
<term>Soft tissue correction</term>
<term>Soft tissue correction algorithm</term>
<term>Soft tissue projection</term>
<term>Soft tissues</term>
<term>Square measurement</term>
<term>Total error</term>
<term>Utrecht</term>
<term>Utrecht university</term>
<term>Verhoeven</term>
<term>Verhoeven cune</term>
<term>Webber</term>
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<term>Céphalométrie</term>
<term>Densitométrie</term>
<term>Densité osseuse</term>
<term>Fantômes en imagerie</term>
<term>Humains</term>
<term>Implants dentaires</term>
<term>Interprétation de radiographie assistée par ordinateur</term>
<term>Pose d'implant dentaire endo-osseux</term>
<term>Posture</term>
<term>Reproductibilité des résultats</term>
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<div type="abstract" xml:lang="en">Various radiographic techniques are used for longitudinal studies of changes in the height of the mandible with implants. Advantages and disadvantages of panoramic radiographs, lateral cephalometric radiographs, periapical films and modern CT‐ and MRI‐techniques are briefly discussed. In this study, the usefulness of a conventional radiographic technique for measuring the height of the mandible, i.e. oblique lateral cephalometric radiography (OLCR) is evaluated in vivo. In 16 patients with permucosal implants in the anterior mandible OLCRs were repeated the same day. The mean total error for the radiographic procedure and analysis was 0.38 mm. The intra‐observer error for the determination of the mandibular height by means of the image analysis procedure was 0.16 mm (analysis error). In 12 other patients pairs of radiographs of the same area of the mandible were made using both a “standard” horizontal X‐ray beam direction and an individually determined “optimal” horizontal X‐ray beam direction; the maximum difference between these two angulations was plus or minus 7.5 degrees. The effect of this different angulation on the height measurements is comparable to the above‐mentioned total error of the measurement procedure (positioning error). An accurate positioning of the patient seems important for reliable measurements. The described radiographic (OLCR) and analysis (IBAS) technique can be used relatively simply for clinical studies. The described methods appear to be useful for measuring the mandibular height in longitudinal studies in patients with or without implants.</div>
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<term>Conventional radiographic technique</term>
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<div type="abstract" xml:lang="en">Various radiographic techniques are used for longitudinal studies of changes in the height of the mandible with implants. Advantages and disadvantages of panoramic radiographs, lateral cephalometric radiographs, periapical films and modern CT‐ and MRI‐techniques are briefly discussed. In this study, the usefulness of a conventional radiographic technique for measuring the height of the mandible, i.e. oblique lateral cephalometric radiography (OLCR) is evaluated in vivo. In 16 patients with permucosal implants in the anterior mandible OLCRs were repeated the same day. The mean total error for the radiographic procedure and analysis was 0.38 mm. The intra‐observer error for the determination of the mandibular height by means of the image analysis procedure was 0.16 mm (analysis error). In 12 other patients pairs of radiographs of the same area of the mandible were made using both a “standard” horizontal X‐ray beam direction and an individually determined “optimal” horizontal X‐ray beam direction; the maximum difference between these two angulations was plus or minus 7.5 degrees. The effect of this different angulation on the height measurements is comparable to the above‐mentioned total error of the measurement procedure (positioning error). An accurate positioning of the patient seems important for reliable measurements. The described radiographic (OLCR) and analysis (IBAS) technique can be used relatively simply for clinical studies. The described methods appear to be useful for measuring the mandibular height in longitudinal studies in patients with or without implants.</div>
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<div type="abstract" xml:lang="en">In the literature intraoral periapical radiographs are commonly used for densitometric measurements of the mandible with implants. These films give detailed information of the implant and the surrounding bone. However, in extreme mandibular atrophy it can be difficult to obtain intraoral radiographs of adequate diagnostic quality. Extraoral Oblique Lateral Cephalometric Radiographs (OLCRs) can then be the alternative: reproducible images of large parts of the mandible can be obtained. In vitro, the results of densitometry using periapical films and OLCRs were shown to be similar. The present study aims to determine the measurement error of densitometry with OLCRs in vivo. In 16 patients (group I) with atrophic mandible and implants, duplicate OLCRs of one side of the jaw were obtained. The error of measurement for the densitometric measurements of the mandibular bone was 5.5%. The use of a specially developed correction program to compensate for undesired variations in the projection of the soft tissues of the face (tongue, lips, cheek and neck) on the radiographs resulted in a 40% reduction of that measurement error to 3.5%. This remaining error is mainly brought about by an imperfect repositioning of the patient when the duplicate OLCRs are obtained. The error caused by the image acquisition, processing and measurement is less than 1%. Deliberate variation up to 7.5 degrees of the horizontal angle wherein the OLCRs are made, results in a large error of measurement of 13.5% (group II: 17 patients). To reduce this variation the additional soft tissue correction program is unsuitable. It is concluded from this study that the described radiographic and image analysis technique is a promising tool for prospective densitometric studies of the mandible with or without implants. Especially in mandibles with bone grafts and implants, substantial changes in the graft can occur. The described technique may be particularly valuable in analyzing these changes.</div>
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<div type="abstract" xml:lang="en">Various radiographic techniques are used for longitudinal studies of changes in the height of the mandible with implants. Advantages and disadvantages of panoramic radiographs, lateral cephalometric radiographs, periapical films and modern CT- and MRI-techniques are briefly discussed. In this study, the usefulness of a conventional radiographic technique for measuring the height of the mandible, i.e. oblique lateral cephalometric radiography (OLCR) is evaluated in vivo. In 16 patients with permucosal implants in the anterior mandible OLCRs were repeated the same day. The mean total error for the radiographic procedure and analysis was 0.38 mm. The intra-observer error for the determination of the mandibular height by means of the image analysis procedure was 0.16 mm (analysis error). In 12 other patients pairs of radiographs of the same area of the mandible were made using both a "standard" horizontal X-ray beam direction and an individually determined "optimal" horizontal X-ray beam direction; the maximum difference between these two angulations was plus or minus 7.5 degrees. The effect of this different angulation on the height measurements is comparable to the above-mentioned total error of the measurement procedure (positioning error). An accurate positioning of the patient seems important for reliable measurements. The described radiographic (OLCR) and analysis (IBAS) technique can be used relatively simply for clinical studies. The described methods appear to be useful for measuring the mandibular height in longitudinal studies in patients with or without implants.</div>
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<nlm:affiliation>Utrecht University, Department of Oral & Maxillofacial Surgery, Prosthodontics and Special Dental Care, PO Box 80.037, 3508 TA Utrecht, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Utrecht University, Department of Oral & Maxillofacial Surgery, Prosthodontics and Special Dental Care, PO Box 80.037, 3508 TA Utrecht</wicri:regionArea>
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<name sortKey="Verhoeven, J W" sort="Verhoeven, J W" uniqKey="Verhoeven J" first="J W" last="Verhoeven">J W Verhoeven</name>
<affiliation wicri:level="4">
<nlm:affiliation>Utrecht University, Department of Oral & Maxillofacial Surgery, Prosthodontics and Special Dental Care, PO Box 80.037, 3508 TA Utrecht, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Utrecht University, Department of Oral & Maxillofacial Surgery, Prosthodontics and Special Dental Care, PO Box 80.037, 3508 TA Utrecht</wicri:regionArea>
<orgName type="university">Université d'Utrecht</orgName>
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<settlement type="city">Utrecht</settlement>
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<name sortKey="Ruijter, J" sort="Ruijter, J" uniqKey="Ruijter J" first="J" last="Ruijter">J. Ruijter</name>
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<name sortKey="Cune, M S" sort="Cune, M S" uniqKey="Cune M" first="M S" last="Cune">M S Cune</name>
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<name sortKey="Terlou, M" sort="Terlou, M" uniqKey="Terlou M" first="M" last="Terlou">M. Terlou</name>
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<title level="j">Clinical oral implants research</title>
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<term>Aluminum</term>
<term>Alveolar Bone Loss (diagnostic imaging)</term>
<term>Analysis of Variance</term>
<term>Bone Density</term>
<term>Cephalometry (methods)</term>
<term>Densitometry (methods)</term>
<term>Dental Implantation, Endosseous</term>
<term>Dental Implants</term>
<term>Humans</term>
<term>Jaw, Edentulous (diagnostic imaging)</term>
<term>Mandible (diagnostic imaging)</term>
<term>Phantoms, Imaging</term>
<term>Radiographic Image Enhancement</term>
<term>Radiographic Image Interpretation, Computer-Assisted</term>
<term>Reference Values</term>
<term>Reproducibility of Results</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr">
<term>Aluminium</term>
<term>Amélioration d'image radiographique</term>
<term>Analyse de variance</term>
<term>Céphalométrie ()</term>
<term>Densitométrie ()</term>
<term>Densité osseuse</term>
<term>Fantômes en imagerie</term>
<term>Humains</term>
<term>Implants dentaires</term>
<term>Interprétation de radiographie assistée par ordinateur</term>
<term>Mandibule (imagerie diagnostique)</term>
<term>Mâchoire édentée (imagerie diagnostique)</term>
<term>Pose d'implant dentaire endo-osseux</term>
<term>Reproductibilité des résultats</term>
<term>Résorption alvéolaire (imagerie diagnostique)</term>
<term>Valeurs de référence</term>
</keywords>
<keywords scheme="MESH" type="chemical" xml:lang="en">
<term>Aluminum</term>
<term>Dental Implants</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en">
<term>Alveolar Bone Loss</term>
<term>Jaw, Edentulous</term>
<term>Mandible</term>
</keywords>
<keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr">
<term>Mandibule</term>
<term>Mâchoire édentée</term>
<term>Résorption alvéolaire</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en">
<term>Cephalometry</term>
<term>Densitometry</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Analysis of Variance</term>
<term>Bone Density</term>
<term>Dental Implantation, Endosseous</term>
<term>Humans</term>
<term>Phantoms, Imaging</term>
<term>Radiographic Image Enhancement</term>
<term>Radiographic Image Interpretation, Computer-Assisted</term>
<term>Reference Values</term>
<term>Reproducibility of Results</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Aluminium</term>
<term>Amélioration d'image radiographique</term>
<term>Analyse de variance</term>
<term>Céphalométrie</term>
<term>Densitométrie</term>
<term>Densité osseuse</term>
<term>Fantômes en imagerie</term>
<term>Humains</term>
<term>Implants dentaires</term>
<term>Interprétation de radiographie assistée par ordinateur</term>
<term>Pose d'implant dentaire endo-osseux</term>
<term>Reproductibilité des résultats</term>
<term>Valeurs de référence</term>
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<front>
<div type="abstract" xml:lang="en">In the literature intraoral periapical radiographs are commonly used for densitometric measurements of the mandible with implants. These films give detailed information of the implant and the surrounding bone. However, in extreme mandibular atrophy it can be difficult to obtain intraoral radiographs of adequate diagnostic quality. Extraoral Oblique Lateral Cephalometric Radiographs (OLCRs) can then be the alternative: reproducible images of large parts of the mandible can be obtained. In vitro, the results of densitometry using periapical films and OLCRs were shown to be similar. The present study aims to determine the measurement error of densitometry with OLCRs in vivo. In 16 patients (group I) with atrophic mandible and implants, duplicate OLCRs of one side of the jaw were obtained. The error of measurement for the densitometric measurements of the mandibular bone was 5.5%. The use of a specially developed correction program to compensate for undesired variations in the projection of the soft tissues of the face (tongue, lips, cheek and neck) on the radiographs resulted in a 40% reduction of that measurement error to 3.5%. This remaining error is mainly brought about by an imperfect repositioning of the patient when the duplicate OLCRs are obtained. The error caused by the image acquisition, processing and measurement is less than 1%. Deliberate variation up to 7.5 degrees of the horizontal angle wherein the OLCRs are made, results in a large error of measurement of 13.5% (group II: 17 patients). To reduce this variation the additional soft tissue correction program is unsuitable. It is concluded from this study that the described radiographic and image analysis technique is a promising tool for prospective densitometric studies of the mandible with or without implants. Especially in mandibles with bone grafts and implants, substantial changes in the graft can occur. The described technique may be particularly valuable in analyzing these changes.</div>
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