Can Waterpipe Smoking cause Oral Cancer?
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:1] [Pages No:1 - 1]
DOI: 10.5005/jp-journals-10015-1496 | Open Access | How to cite |
Abstract
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:6] [Pages No:2 - 7]
DOI: 10.5005/jp-journals-10015-1497 | Open Access | How to cite |
Abstract
This study aims to investigate the differences in osteoprotegerin (OPG) concentrations in early aligning and leveling of orthodontic treatments using self-ligating and conventional preadjusted brackets. Three groups consisting of two experimental groups and one control group participated in this study. A total of 18 patients were selected according to the following inclusion criteria: Little's irregularity index on maxillary anterior teeth ranging from 4 to 9 mm, nonextraction orthodontic treatment on the experimental group, and no previous orthodontic treatment. The experimental group received orthodontic treatment with either a passive self-ligating or conventional preadjusted bracket system, while the control group did not receive orthodontic treatment. Gingival crevicular fluid (GCF) collection was done at baseline, 1, 24, and 168 hours on five points of maxillary anterior proximal sites, from the mesiolabial side of the canine to the mesiolabial side of its contralateral side. The OPG concentration was assessed by enzyme-linked immunoabsorbent assay (ELISA). The OPG concentration on both bracket systems was decreased in a time-dependent manner. Decreasing concentration was maintained up until 168 hours on the self-ligating bracket, while conventional preadjusted bracket showed significantly increasing concentration at 168 hours (p = 0.004). Levels of OPG were significantly lower on self-ligating bracket compared with the conventional bracket at 1, 24, and 168 hours (p < 0.005). Both bracket systems showed decreasing OPG concentration up to 24 hours after orthodontic activation. A maintained decreasing level of OPG was observed on the self-ligating bracket group at 168 hours, and it showed significant lower OPG concentration compared with the conventional preadjusted bracket group at 1, 24, and 168 hours after initial force application. The maintained decreasing level of OPG could indicate bone resorption that allows tooth movement into correct alignment that still occurs on self-ligating bracket up to 168 hours after initial activation. Widayati R, Adiwirya MSK, Soedarsono N. Osteoprotegerin Level Differences in Orthodontic Treatment with Self-ligating and Conventional Preadjusted Brackets at Early Aligning and Leveling Phase. World J Dent 2018;9(1):2-7.
Factors affecting the Duration of Surgical Extraction of Impacted Mandibular Third Molars
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:5] [Pages No:8 - 12]
DOI: 10.5005/jp-journals-10015-1498 | Open Access | How to cite |
Abstract
The aim of this study is to evaluate the effect of demographic, clinical, and radiographic factors on the duration of surgical extraction of impacted lower third molars. This retrospective study included patients who underwent surgical removal of impacted lower third molars, and the investigated factors were demographic data including age and gender, radiographic data including the impacted tooth angulation and depth of impaction and ramus relation, and clinical data including the state of eruption of the impacted teeth. These factors were evaluated for association with the duration of surgery. Descriptive statistical analysis included percentages and mean ± standard deviation (SD). Student's t-test was used to compare means between two groups, while for comparing the means among three or more groups for statistical significance, analysis of variance (ANOVA) test was used. Forty patients were included: 20 (50%) males and 20 (50%) females. The age range was from 17 to 37 years with a mean ± SD of 23.4 ± 5.016 years. The duration of surgery (± SD) in all the patients ranged from 10 to 40 minutes with a mean of 25.8 ± 8.56 minutes. Clinically unerupted teeth and deep ramus relationship were associated with statistically significant increase in duration of surgical extraction. This study identifies state of eruption and ramus relation to be significant predictive factors, whereas other investigated factors, namely, age of patient, sex, angulation of teeth, and depth of impaction, were found to be not significant in determining the duration of surgery and hence, the difficulty of extraction. Duration of surgical extraction of impacted mandibular third molars can be considered as an indicator for difficulty of surgical extraction. Difficult surgical extraction of impacted mandibular third molars can be anticipated in clinically unerupted teeth and those with deep ramus relationship. Bede SY. Factors affecting the Duration of Surgical Extraction of Impacted Mandibular Third Molars. World J Dent 2018;9(1):8-12.
Methodology for Stress Measurement by Transparent Dental Aligners using Strain Gauge
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:6] [Pages No:13 - 18]
DOI: 10.5005/jp-journals-10015-1499 | Open Access | How to cite |
Abstract
Orthodontic tooth movement is a pressing issue nowadays. An increased esthetic demand during orthodontic treatment has resulted in several alternative treatments. However, the need to avoid conventional fixed orthodontic prosthesis has led to the usage of computer-aided scanning, imaging, and printing technology along with the emergence of transparent dental aligners. The motive of this study is to present methodology of measurement of the stress applied by transparent dental aligners on human teeth using a strain gauge-based measurement device. Three dimensional (3D) scanner, 3D printer, thermoforming machine, strain gauge, data acquisition device, 3Shape Ortho Analyzer software were used. For a full-bridge Wheatstone bridge data acquisition system (DAQ), a standard aligner can strain a constantan-based strain gauge by nearly 2.5 × 10—4. This is based on the strain gauge factor of 2, input voltage 5 V for which a change in voltage of 2.5 mV was detected. Young's modulus for constantan strain gauge is given as 17.5 MPa; hence, this produced a stress of nearly 4.38 × 10—3 MPa. This article describes an effective and convenient methodology for orthodontic treatment design for patients with crowding problem using computer-aided design (CAD) and computer-aided manufacturing (CAM) software and, thereafter, printing different stages of maxilla and mandible using fused deposition modeling (FDM) rapid prototyping technique. A transparent aligner is fabricated using thermoforming process, and the applied stresses on manipulated teeth by aligner can be evaluated using a strain gauge-based DAQ. This approach is expected to understand the efficacy of the thermoformed aligners for teeth movements by calculating applied forces and stresses. Bajaj D, Madhav I, Juneja M, Tuli R, Jindal P. Methodology for Stress Measurement by Transparent Dental Aligners using Strain Gauge. World J Dent 2018;9(1):13-18.
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:5] [Pages No:19 - 23]
DOI: 10.5005/jp-journals-10015-1500 | Open Access | How to cite |
Abstract
The aim of the study was to evaluate if vinegar and vinegar with 3.5% sodium chloride could be used as an alternative to chlorhexidine gluconate for disinfection of toothbrushes. The study consisted of three groups: group I: 0.12% chlorhexidine digluconate, group II: 38% white vinegar, and group III: 38% white vinegar with 3.5% sodium chloride. Two new toothbrushes were cultured to check their sterility before use. Eight children in the age group of 6 to 12 years were given oral hygiene instructions and four sets of oral hygiene kits. At the end of the 1st week, one set of used toothbrushes was cultured to check for total viable count. Again at the end of the 2nd, 3rd, and 4th weeks, the 2nd, 3rd, and 4th sets of brushes were collected, subjected to respective decontamination treatment for 12 hours, and then cultured for microbial analyses. The obtained data were analyzed using Fisher's exact test. In group I, three out of eight brushes showed 1 to 10,000 colonies, in group II, one out of eight cases showed >10,000 colonies and two out of eight showed 1 to 10,000 colonies, and in group III, all the eight cases showed no colonies upon culturing. Out of all the tested decontaminating agents, combination of 38% white vinegar and 3.5% sodium chloride was found to be the most efficient. Toothbrushes become contaminated upon use and act as a reservoir for microorganisms. Thus, toothbrush decontamination should become a routine practice. Testing the disinfecting efficacy of vinegar and common salt is, thus, beneficial as they are available in every kitchen. Mavani V, Mahabala KY, Suman E, Natarajan S, Nayak PA, Srikrishna SB, Rao A. Evaluation of Effectiveness of Home Remedies for Toothbrush Decontamination using Vinegar and Vinegar with Common Salt. World J Dent 2018;9(1):19-23.
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:5] [Pages No:24 - 28]
DOI: 10.5005/jp-journals-10015-1501 | Open Access | How to cite |
Abstract
Loss of teeth is a condition where one or several teeth are lost from the socket. Loss of one or several anterior teeth can cause esthetic disruption, loss of confidence, concerns about appearance, and lost function of the teeth, thereby greatly affecting an individual's mind and activity. The loss of some or all of the teeth has many impacts, one of which is the emotional impact. Emotional impact is a feeling or assessment reaction that is derived from the nervous system in response to stimuli from the outside or inside due to loss of teeth, which is known through the categories affected, avoidance, depression, irritability, embarrassment, and feeling old. This study aimed to describe the emotional impact of tooth loss in patients at Unsyiah Dental Hospital, Banda Aceh, Indonesia. This research was a descriptive, cross-sectional design. Sampling was done by random sampling method, which included 100 respondents. The results showed that the emotional impact that can be caused by tooth loss in patients at Unsyiah Dental Hospital in the period from January to March is as follows: 50% classified as mild, 39% moderate, and 11% severe. Emotional effects of losing a tooth are as follows: 49% disturbed category, 7% avoidance, 7% depression, 4% offended, 30% embarrassed, and 54% feeling old. The emotional impact of tooth loss in patients at our dental hospital is classified as mild to severe, of which a mild emotional impact was found often. Tooth loss is one of the common problems that often occurred at the dental clinic, and loss of teeth function can greatly affect an individual's mind and activity. Rahmayani L, Novita CF, Ahya W. Emotional Impact Survey of Dental Patients with Tooth Loss in Unsyiah Dental Hospital, Banda Aceh, Indonesia. World J Dent 2018;9(1):24-28.
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:5] [Pages No:29 - 33]
DOI: 10.5005/jp-journals-10015-1502 | Open Access | How to cite |
Abstract
Practitioners in the dental field carry an occupational risk of injuries when performing routine procedures and hence the possible contraction of serious infections. Dental college students are considered at a higher risk because they start performing such procedures with no or very little experience. Although needlestick injuries (NSIs) are preventable, they are still a common happening and the main concern is the risk of transfer of more than 20 pathogens. The most serious are hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). The aim of this study is to evaluate the incidence and patterns of NSIs sustained by undergraduate dental students in Oral Surgery Clinics at College of Dentistry (Jazan University), Jazan, Kingdom of Saudi Arabia. This was a retrospective epidemiological investigation conducted among 230 undergraduate dental students studying at College of Dentistry (Jazan). Fourth, fifth, and sixth year undergraduate dental students and interns working in the Department of Oral Surgery were included. Those who were not willing to participate were excluded from the study. An anonymous questionnaire proforma was prepared including closed- and open-ended questions divided into two parts. Data were entered into Statistical Package for the Social Sciences (SPSS, version 17.0) statistical software for analysis. More than half of the sample size (54.8%) had suffered sharp instruments injury in different anatomical sites, and of these, 67.4% were pricked with gloves on. Only 27% of the students reported to the faculty after being pricked. Most of the participants (55.3%) had a single incidence of injury during the past 1 year and 16.2% were stuck for several times. Fingers (60.7%) were the most commonly affected anatomical site pricked by sharp instruments, followed by the thumb (22.2%), hand (9.6%), and palm (7.4%). Infection control teaching and training should be an integral part of the curriculum of all disciplines in health care including medical, dental, and paramedics. Ali FM, Al-Iryani GM, Mdabesh HY, Essa AA, Nammazi AM, Kariri MA, Somaili DMY. Incidence of Needlestick Injuries in Oral Surgery Clinic among Dental Students: A Retrospective Study. World J Dent 2018;9(1):29-33.
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:4] [Pages No:34 - 37]
DOI: 10.5005/jp-journals-10015-1503 | Open Access | How to cite |
Abstract
The aim of our study was to measure the frontal sinus morphology that could aid us in gender determination and also to assess the difference in measurements between the right and left frontal sinus. A retrospective study was done using 100 cone beam computed tomography (CBCT) images (50 males and 50 females) matched with age and gender with full field of view (FOV). The examinations were carried out using Promax 3DMid (Planmeca Oy., Helsinki, Finland) CBCT unit. The frontal sinus was assessed in coronal, sagittal, and axial planes, and the maximum measurements in each section were recorded. The results to compare the right and left frontal sinus were analyzed using paired t-tests, and independent Student's t-test was used to compare the difference in measurements of frontal sinus between males and females. We found that the left side of the frontal sinus was bigger than the right side, and while comparing between the genders, it was found that the measurements were greater in males. Statistically significant results were obtained on comparing between the sides and gender. As mentioned in previous studies, frontal sinus measurements are significantly higher in males compared with females which can, therefore, be used in gender identification in cases of mass disasters. Frontal sinus measurements can be used as an adjunct in gender identification in mass disasters and with advances in technology. Cone beam computed tomography, in addition to providing accurate measurements, has overcome all the disadvantages with two-dimensional imaging. Denny C, Jacob AS, Ahmed J, Natarajan S, Binnal A, Sujir N. Frontal Sinus as an aid in Gender Identification in Forensic Dentistry: A Retrospective Study using Cone Beam Computed Tomography. World J Dent 2018;9(1):34-37.
Effect of Prolonged Endodontic Treatment on Temporomandibular Joint and Masticatory Muscles
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:5] [Pages No:38 - 42]
DOI: 10.5005/jp-journals-10015-1504 | Open Access | How to cite |
Abstract
The objective of the study is to assess the outcome of lengthy root canal sessions (more than 2 hours) on temporomandibular joint (TMJ) and its associated structures. Totally, 250 patients who had undergone root canal treatment that lasted for more than 2 hours were examined for the status of TMJ and masticatory muscles. The second part of the examination was performed after 1 week to check for any pain and tenderness. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Results showed that patients of older age suffered from more pain postoperatively. Similarly, women experienced more pain than males. Those patients who were treated for their posterior teeth complained of more pain than those treated for anterior teeth. Prolonged root canal sessions result in longer and wider opening of mouth for longer period of time, thus causing harm to TMJ and associated masticatory structures and may give rise to sign and symptoms of temporomandibular disorder (TMD). It is prudent to break treatment sessions into shorter appointments and let patients relax during the treatment to prevent any extra stress on the TMJ and associated masticatory apparatus. Siddiqui TM, Wali A, Siddiqui F, Naireen D. Effect of Prolonged Endodontic Treatment on Temporomandibular Joint and Masticatory Muscles. World J Dent 2018;9(1):38-42.
Esthetic Multidisciplinary Rehabilitation of Patient with Central Incisor Agenesis
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:5] [Pages No:43 - 47]
DOI: 10.5005/jp-journals-10015-1505 | Open Access | How to cite |
Abstract
The aim of this case report was to restore the esthetic smile of a patient with agenesis of maxillary right central incisor, while discussing the most important topics in a multidisciplinary approach. Due to the absence or loss of some teeth in the anterior region, it becomes a challenge in oral rehabilitation. Restoration of function and esthetics may require a multidisciplinary treatment that can start with periodontal, orthodontic, surgical, implantology, or restorative evaluation. A 28-year-old patient with agenesis of the maxillary right central incisor was looking to improve the esthetics of his smile. The patient had right superior lateral incisor positioned in place of the central and the canine in the position corresponding to the lateral incisor, which compromised the dental and gingival esthetics. After analyses and digital smile design (DSD), surgeries for gingival smile correction, gingivectomy (teeth 12, 14, and 15), and gingival tissue grafts (tooth 13) were made. After a period of 2 months, preparations were made on teeth 12, 13, and 14 for ceramic laminates following the initial DSD. After 1 year of cementation, maintenance and stability of gingival margin, as well as the integrity of laminate ceramic were observed. In conclusion, a correct prior planning of esthetic rehabilitation is the best way to achieve excellent results to meet the needs and objectives of each patient. Often, a multidisciplinary treatment involving surgical and restorative procedures should be taken into consideration, with the appropriate choice of techniques and materials to be used. The treatment performed on the patient allowed the esthetic improvement of gingival architecture and installation of ceramic restorations with function and esthetics similar to natural teeth. Mascarenhas VI, Leandrin TP, Lorenzetti CC, de Castro CL, Saad JRC. Esthetic Multidisciplinary Rehabilitation of Patient with Central Incisor Agenesis. World J Dent 2018;9(1):43-47.
Staged Minimally Invasive Surgical Approach in the Management of Glandular Odontogenic Cyst
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:5] [Pages No:48 - 52]
DOI: 10.5005/jp-journals-10015-1506 | Open Access | How to cite |
Abstract
The aim of the study was to report a unique case of glandular odontogenic cyst (GOC) in an unusual location of anterior maxilla. Considering the age, sex, and location of the lesion, a minimally invasive surgical procedure was opted considering esthetics, such as decompression followed by enucleation and fresh frozen bone (FFB) grafting. To arrive at the diagnosis, cytokeratin (CK)-19 was employed to differentiate from suspected intraosseous mucoepidermoid carcinoma. With the evidence of pre- and post treatment histopathological changes, the lesion appeared less aggressive justifying the treatment executed. Glandular odontogenic cyst is a locally aggressive jaw cyst, which has a high rate of cortical perforation and recurrence that poses both diagnostic and therapeutic challenges. Treatment of decompression, followed by enucleation may be considered as an effective option in comparison to aggressive surgical intervention. Kumari K, Sowmya SV, Vineeth K, Rao RS, Lalitha RM, Augustine D, Haragannavar VC, Nambiar S, Abraham M. Staged Minimally Invasive Surgical Approach in the Management of Glandular Odontogenic Cyst. World J Dent 2018;9(1):48-52.
Diagnostic Panel of Markers CD45, CD20, CD3, CD138, and CD56 for Oral Solitary Plasmacytoma of Bone
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:6] [Pages No:53 - 58]
DOI: 10.5005/jp-journals-10015-1507 | Open Access | How to cite |
Abstract
The present case aims to emphasize on the role of immunophenotyping in plasmacytic malignancies. Solitary plasmacytoma of bone (SPB) is a rare entity often encountered in vertebrae and less frequently in long bones. Its presence in jaws is extremely rare, accounting for 4.4% of cases only. About 5% of patients with plasma cell dyscrasias present with SPB. An elderly male patient reported with a chief complaint of growth in the anterior region of the lower jaw since 3 months. The histopathological features following an incisional biopsy were suggestive of pyogenic granuloma. Serological investigations revealed seropositivity for human immunodeficiency virus (HIV)-1 antibody with hypergammaglobulinemia and hypoalbuminemia. Histopathology of excisional biopsied tissue revealed a round cell malignancy with plasmacytic morphology. Further, to arrive at a specific final diagnosis, immunohistochemistry (IHC) was employed with a panel of markers CD45, CD20, CD3, CD138, and CD56. This panel enabled us to establish a final diagnosis of SPB with clinicopathologic correlation. The present case posed a diagnostic dilemma as it presented with overlapping features of non-Hodgkin's lymphoma (NHL), multiple myeloma (MM), extramedullary plasmacytoma (EMP), and plasmablastic lymphoma (PBL). A thorough clinical, radiological, serological, and IHC panel helped to diagnose the present case. The CD56 enabled differentiation between SPB and PBL. Thereby, this article emphasizes on the need for a panel of IHC markers that permit definitive diagnosis of lymphopoietic malignancies. Timely diagnosis of malignant lesions is an essential concern for effective management. Thus, we emphasize that the IHC is a valuable investigative tool in the diagnosis of round cell tumors with plasmacytoid morphology. Abraham M, Augustine D, Sagar P, Rao RS, Prasad K, Sowmya SV, Haragannavar VC, Nambiar S. Diagnostic Panel of Markers CD45, CD20, CD3, CD138, and CD56 for Oral Solitary Plasmacytoma of Bone. World J Dent 2018;9(1):53-58.
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:9] [Pages No:59 - 67]
DOI: 10.5005/jp-journals-10015-1508 | Open Access | How to cite |
Abstract
Antithrombotic medication represents a challenge for any dental practitioner due to the possible hemorrhage complications that can be associated with an important morbidity/mortality risk. The objective of the present literature review is to establish which dental procedures have a risk to increase the incidence of hemorrhage in patients on antithrombotic therapy. A systematic review of the literature was conducted using MEDLINE, PubMed, and DiscoverEd databases. The inclusion criteria used were as follows: Current antithrombotic therapy, invasive dental procedures, and postoperative incidence of bleeding follow-up. A total of 14 clinical studies and 5 literature reviews were selected after the initial screening. The incidence of hemorrhage was assessed for dental implant placements, dental extractions, simple dental procedures, and periodontal treatment. A well-coagulated patient can safely have invasive dental procedures in a hospital environment or nonhospital setting without having their antithrombotic therapy altered. Local hemostatic measures can offer a proper hemorrhage control. Pirlog CD, Pirlog AM, Maghiar T. A Systematic Review of the Hemorrhage Risk for Patients on Antithrombotic Medication after Dental Procedures. World J Dent 2018;9(1):59-67.
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:8] [Pages No:68 - 75]
DOI: 10.5005/jp-journals-10015-1509 | Open Access | How to cite |
Abstract
Various anthropometric measurements have been used to determine the size of maxillary anterior teeth. However, which anthropometric measurement is the most reliable indicator to determine the width of maxillary anterior teeth remains unclear. To evaluate which anthropometric measurement is the most reliable indicator in determining the width of maxillary anterior teeth. An electronic search was conducted for scholarly articles discussing various anthropometric measurements used for determination of width of maxillary anterior teeth, written in English or translated into English listed with PubMed, Cochrane Library, ScienceDirect, Wiley Online Library, and Google scholar databases. The search strategy yielded 119 articles. Out of them, 70 were excluded following reading of abstract, and 49 were selected for full-text reading. Of these, 21 were excluded based on exclusion criteria. Finally, 28 articles were included for final search. Due to heterogenicity of studies, a meta-analysis was not performed. High degree of correlation was seen between interalar width (IAD), interpupillary distance (IPD), bizygomatic width (BW), and width of maxillary anterior teeth, in Indian population, whereas in Saudi population, intercanthal distance (ICD) has high degree of correlation to the width of maxillary anterior teeth, and in Brazilian (mulatto and blacks) population, high degree of correlation was seen between intercommissural width (ICOW) and width of maxillary anterior teeth. The anthropometric measurement used depends on the population group in which it is being used. There is no single anthropometric measurement that can be used to determine the width of maxillary anterior teeth. Hence, more studies with large sample size and different population groups need to be conducted. In Indian population, high degree of correlation was seen between IAD, IPD, BW, and width of maxillary anterior teeth. The results of the previous study should be validated by including a large population size spread over entire Indian subcontinent. This would also help to generate multiplication factor for various anthropological measurements for use limited to the Indian population. Jain AR, Nallaswamy D, Ariga P, Ganapathy DM. Determination of Correlation of Width of Maxillary Anterior Teeth using Extraoral and Intraoral Factors in Indian Population: A Systematic Review. World J Dent 2018;9(1):68-75.
[Year:2018] [Month:January-February] [Volume:9] [Number:1] [Pages:3] [Pages No:76 - 78]
DOI: 10.5005/jp-journals-10015-1510 | Open Access | How to cite |
Abstract
With the growth in implant application and observing complications associated with nonpassively fit prostheses, various techniques have been proposed to enhance the accuracy of transferring implants’ position from the patient mouth to laboratory worktable. The present article introduces an applicable method for the same purpose. The present study aims to introduce an easy and applicable method to achieve a precise impression of multiple implants in the logical timeframe with minimal effort. Acrylic resin bars were fabricated in different widths and kept to be adapted to the position of implant impression copings for accurate impression. The explained method could facilitate precise transferring of implants’ position from the mouth to laboratory in a practical and predictable manner. Introduction of a method providing an accurate impression of the implants with accessible equipment will significantly improve the treatment quality and prognosis. Aghandeh R, Rasaeipour S, Ghodsi S. Introducing a Method to facilitate making Acrylic Resin Bars for Splinting Multiple Implant Impression Copings. World J Dent 2018;9(1):76-78.