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Aggarwal V, Singla M, Gupta A, Saatchi M, Nabi S, Rastogi S, Ansari I, Miglani S. Effect of Back-Pressure Anesthesia on Postoperative Pain after the Endodontic Treatment in Patients with Symptomatic Irreversible Pulpitis: Randomized Double-Blind Clinical Trial. J Endod 2024; 50:1037-1043. [PMID: 38768707 DOI: 10.1016/j.joen.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/31/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION The present study evaluated the effect of 2 different back pressure-based supplemental anesthesia on postoperative pain in patients receiving endodontic treatment for a mandibular molar with symptomatic irreversible pulpitis. METHODS One-hundred-thirty-five adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial inferior alveolar nerve block (IANB) injection with 2% lidocaine with 1:80,000 epinephrine. Ten minutes following the injection, access to cavity preparation began. Lip numbness was a must for all patients. The Heft-Parker visual analogue scale (HP-VAS) was used to measure pain during endodontic therapy. Success of primary injections was defined as no or mild pain (less than 55 mm on HP-VAS) during access preparation. The patients with initial successful anesthesia served as control and received endodontic treatment. Ninety-five patients with unsuccessful primary anesthesia randomly received either intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine or intrapulpal injections with similar anesthetic solution. Endodontic treatment was re-initiated and canals were instrumented till working length under copious irrigation. Intracanal medicament of calcium hydroxide was placed and teeth received a temporary restoration. Postoperative pain was measured at 2 hours, 4 hours, 6 hours, 24 hours, and 3 days. Data were analyzed using the Pearson chi-square test, one-way analysis of variance, and one-way repeated measures analysis of variance. RESULTS The initial initial inferior alveolar nerve block was successful in 40 cases (out of 135). The intraligamentary injections were successful in 33 out of 47 cases (70%), and intrapulpal injections were successful in all cases (45/45). The patients receiving intraligamentary injections reported significantly higher pain scores at all intervals till 24 hours. After 3 days, the pain significantly reduced in all the groups with no significant difference between them. CONCLUSIONS Patients receiving supplementary intraligamentary injections can experience increased postoperative pain till 24 hours after the endodontic treatment. The pain scores reduced to the level of the control group after 3 days.
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Affiliation(s)
- Vivek Aggarwal
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India.
| | - Mamta Singla
- Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, Haryana, India
| | - Alpa Gupta
- Department of Conservative Dentistry & Endodontics, Manav Rachna Dental College, Faridabad, India
| | - Masoud Saatchi
- Professor of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Nabi
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Shweta Rastogi
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Irfan Ansari
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Sanjay Miglani
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
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Comparison of the effectiveness of intraligamentary anesthesia and inferior alveolar nerve block on mandibular molar teeth in pediatric patients: a randomized controlled clinical study. Clin Oral Investig 2023:10.1007/s00784-023-04911-9. [PMID: 36773129 DOI: 10.1007/s00784-023-04911-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES The study aimed to compare the two local anesthetic techniques: inferior alveolar nerve block (IANB) and intraligamentary anesthesia (ILA) during the restorative treatment of mandibular first permanent molars in pediatric patients. MATERIALS AND METHODS In this randomized, controlled, cross-over, single-blind, split-mouth study, participants were divided into two groups: group 1, ILA in the first session and IANB in the second session, and group 2, IANB in the first session and ILA in the second session. The pain perception was analyzed using the visual analog scale (VAS) and Wong-Baker FACES pain rating scale (WBFPRS). Heart rate, arterial oxygen saturation (SpO2), and postoperative complications were recorded. The data were analyzed with the Brunner-Langer model, Spearman correlation analysis, Fisher's exact t-test, chi-square, and McNemar tests. RESULTS Seventy-eight patients aged between 6 and 12 years were included. The session effect was not statistically significant in ILA (p = 0.762 and p = 0.411) for pain scores while it was significant in IANB (p < 0.001 for each score). There was no significant difference in the VAS, WBFPRS, heart rate, and SpO2 between the anesthesia techniques (p = 0.454, p = 0.436, p = 0.406, p = 0.285, respectively). Postoperative complications increased in the IANB technique in the first session. CONCLUSIONS Intraligamentary anesthesia may be an alternative technique to IANB for the restorative treatment of mandibular first permanent molars in pediatric patients. In the first session, clinicians may choose the ILA instead of IANB. CLINICAL RELEVANCE In clinical procedures, administering anesthesia, which is effective, is less painful, and poses relatively low complication risk, has significant importance in sustaining children's cooperation with dental treatment.
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A Prospective Clinical Study Evaluating the Efficacy of Intra-Ligamentary Anesthetic Solutions in Mandibular Molars Diagnosed as Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis. Healthcare (Basel) 2022; 10:healthcare10081389. [PMID: 35893211 PMCID: PMC9330541 DOI: 10.3390/healthcare10081389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Accomplishing painless endodontic treatment, especially in the mandibular molar region, is challenging. Hence, the aim of the study was to compare the efficacy of 2% lidocaine and 4% articaine when used as supplemental intra-ligamentary (IL) anesthesia in mandibular molars having symptomatic irreversible pulpitis with symptomatic apical periodontitis after failed Inferior Alveolar Nerve Block (IANB) injection. In this prospective study, one-hundred and forty-seven adult patients diagnosed with irreversible pulpitis in a mandibular tooth were included who received IANB with 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Patients who experienced pain were recorded using the Heft–Parker visual analog scale (HP-VAS score ≥ 55 mm) and received supplement intra-ligament injection with either4% articaine or 2% lidocaine with 1:100,000 epinephrine. Supplementary intra-ligament injections resulted in 82.6% and 91.3% of profound anesthesia in the first molar region for 2% lidocaine and 4% articaine, respectively. Similarly, an additional IL injection of articaine success percent (78.9%) in the second molar region was higher than lidocaine (63.1%). The overall success ratio revealed no significant difference in achieving profound anesthesia of either solution. In this study population, there was no difference in the success ratio of anesthesia between 2% lidocaine and 4% articaine when used as supplemental IL injection.
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The Effect of the Anatomic Variables on the Success Rate of Anesthesia in Maxillary Molars with Irreversible Pulpitis. J Endod 2022; 48:707-713. [DOI: 10.1016/j.joen.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022]
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Parirokh M, Abbott P. Present status and future directions - Mechanisms and management of local anaesthetic failures. Int Endod J 2022; 55 Suppl 4:951-994. [PMID: 35119117 DOI: 10.1111/iej.13697] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/05/2022]
Abstract
Pain control during root canal treatment is of utmost importance for both the patient and the dental practitioner and many studies have investigated ways of overcoming problems with gaining adequate anaesthesia during treatment. The PubMed and Cochrane databases were searched for evidence-based studies regarding local anaesthesia for root canal treatment. Many variables, including premedication, pain during needle insertion, pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions, may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. There are several concerns regarding the methodologies used in studies that have evaluated anaesthesia success rates. There are some conditions that may help to predict a patient's pain during root canal treatment and these conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary anaesthetic techniques before or during the treatment. However, authors need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.
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Affiliation(s)
- Masoud Parirokh
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Paul Abbott
- School of Dentistry, University of Western Australia, Perth, Australia
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Gupta A, Wadhwa J, Aggarwal V, Mehta N, Abraham D, Aneja K, Singh A. Anesthetic efficacy of supplemental intraligamentary injection in human mandibular teeth with irreversible pulpitis: a systematic review and meta-analysis. J Dent Anesth Pain Med 2022; 22:1-10. [PMID: 35169615 PMCID: PMC8814730 DOI: 10.17245/jdapm.2022.22.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, Haryana, India
| | - Jitesh Wadhwa
- Department of Orthodontics and Dentofacial Orthopedics, Manav Racha Dental College, Faridabad, Haryana, India
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Jamia Milia Islamia, New Delhi, India
| | - Namrata Mehta
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, Haryana, India
| | - Dax Abraham
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, Haryana, India
| | - Kritika Aneja
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, Haryana, India
| | - Arundeep Singh
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, Haryana, India
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Chen LS, Nusstein J, Drum M, Fowler S, Reader A, Guo X. Effect of a Combination of Nitrous Oxide and Intraligamentary Injection on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis. J Endod 2021; 47:1890-1895. [PMID: 34492232 DOI: 10.1016/j.joen.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The purpose of this prospective study was to determine the effect of a combination of nitrous oxide/oxygen and 1 set of supplemental intraligamentary/periodontal ligament (PDL) injections followed by a second set of PDL injections on anesthetic success in patients with symptomatic irreversible pulpitis (SIP). METHODS Ninety-four patients with a mandibular posterior tooth diagnosed with SIP received nitrous oxide/oxygen and an inferior alveolar nerve block (IANB) with 2% lidocaine with 1:100,000 epinephrine. Patients rated the pain of PDL injections and endodontic access on a visual analog scale. If moderate to severe pain was felt during treatment, the operator administered 1 set of supplemental PDL injections with 4% articaine with 1:100,000 epinephrine. If moderate to severe pain was felt again during treatment, the operator administered a second set of supplemental PDL injections. Anesthetic success was defined as having no to mild pain during endodontic treatment. RESULTS The success of the IANB with nitrous oxide was 44% (95% confidence interval [CI], 34%-54%). The overall anesthetic success rate (IANB with PDL injections) was increased from 69% (95% CI, 60%-78%) with 1 set of PDL injections to 80% (95% CI, 72%-88%) with a second set of PDL injections. CONCLUSIONS Although the second set of PDL injections increased anesthetic success, it was not sufficient to ensure complete pulpal anesthesia.
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Affiliation(s)
- Lo-Shen Chen
- Practice Limited to Endodontics, Worthington, Ohio
| | - John Nusstein
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Division of Endodontics, The Ohio State University, Columbus, Ohio.
| | - Sara Fowler
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Xiaohan Guo
- Division of Biostatistics, The Ohio State University, Columbus, Ohio
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Anaesthetic Efficacy of 4% Articaine in Comparison with 2% Lidocaine as Intraligamentary Injections after an Ineffective Inferior Alveolar Nerve Block in Mandibular Molars with Irreversible Pulpitis: A Prospective Randomised Triple-Blind Clinical Trial. Pain Res Manag 2021; 2021:6668738. [PMID: 34055121 PMCID: PMC8131152 DOI: 10.1155/2021/6668738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/11/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022]
Abstract
The objective of the current study was to compare the anaesthetic efficacy of supplemental intraligamentary (IL) injection of 4% articaine with that of 2% lidocaine in the mandibular first and second molars with irreversible pulpitis after an ineffective inferior alveolar nerve block injection (IANB) using the same anaesthetic in a randomised triple-blind clinical trial. Seventy-six adult patients, who were diagnosed with irreversible pulpitis in the mandibular first or second molars, were divided into 2 groups and received IANB randomly. In patients with lip numbness, anaesthesia was evaluated with the cold and electrical pulp (EPT) tests, and if the reported number on EPT was below 100, supplemental IL injection was administered using the same anaesthetic. The teeth were retested after 5 minutes. The Heft-Parker visual analogue scale was used to evaluate pain after IANB and IL injections. Statistical analysis was performed using repeated measures ANOVA, chi-square, and independent-sample and paired-sample t-tests. The results showed that there was no significant difference in the success rates of supplemental IL and IANB injections between articaine and lidocaine. Furthermore, there was no significant difference in the success rates of supplemental IL injection with lidocaine between the mandibular first and second molars. However, there was a significant difference in the success rates of supplemental IL injection with articaine between the mandibular first and second molars. Moreover, supplemental IL injections indicated no significant difference in the anaesthetic efficacy between articaine and lidocaine; nevertheless, they were more effective in the mandibular second molars, especially with articaine.
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Aggarwal V, Singla M, Saatchi M, Hasija M. Anaesthetic efficacy of 2% lidocaine with different concentrations of epinephrine (1:80,000 and 1:200,000) in intraligamentary injection after a failed primary inferior alveolar nerve block: a randomized double-blind study. Acta Odontol Scand 2020; 78:275-280. [PMID: 31821059 DOI: 10.1080/00016357.2019.1700302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The present study evaluated the anaesthetic efficacy of 2% lidocaine with 1:80,000 epinephrine vs. 2% lidocaine with 1:200,000 given as supplemental intraligamentary injections after a failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. The effect of these solutions on the heart rate was also evaluated.Methods: One-hundred-eighteen adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial IANB with 2% lidocaine with 1:80,000 epinephrine. Pain during the endodontic treatment was assessed using a visual analogue scale (Heft-Parker VAS). Eighty-eight patients with unsuccessful anaesthesia were randomly allocated to one of the two treatment groups: one group received 0.6 mL/root of supplementary intraligamentary injection of 2% lidocaine with 1:80,000 epinephrine; while the second group received 2% lidocaine with 1:200,000 epinephrine. Endodontic treatment was re-initiated. Success after primary injection or supplementary injection was defined as no or mild pain (pain score ≤54 mm on HP VAS) during access preparation and root canal instrumentation. Heart rate was monitored using a finger pulse oximeter. The anaesthetic success rates were analyzed with the Pearson chi-square test at 5% significance levels. The heart rate changes were analyzed using the t-test.Results: The anaesthetic success rate in patients receiving supplementary intraligamentary injections in 1:80,000 epinephrine group was 82%, while the intraligamentary injections with 2% lidocaine with 1:200,000 epinephrine were successful in 57% of cases. The difference was statistically significant (χ2=6.4, p = .011). There was no significant effect of both the anaesthetic agents on the mean heart rate.Conclusions: Both 2% lidocaine with 1:80,000 epinephrine and 2% lidocaine with 1:200,000 epinephrine improved the success rates after a failed primary anaesthetic injection. The 1:80,000 epinephrine group was significantly more successful.
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Affiliation(s)
- Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Mamta Singla
- Department of Conservative Dentistry and Endodontics, SGT Dental College, Gurgaon, Haryana, India
| | - Masoud Saatchi
- Professor of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mukesh Hasija
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
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Efficacy and Safety of Pulpal Anesthesia Strategies during Endodontic Treatment of Permanent Mandibular Molars with Symptomatic Irreversible Pulpitis: A Systematic Review and Network Meta-analysis. J Endod 2019; 45:1435-1464.e10. [DOI: 10.1016/j.joen.2019.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022]
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Sokhov ST, Rabinovich SA, Bogaevskaya OY. [Comparative evaluation of P.M. Egorov and modified G. Gow-Gates mandibular block efficacy]. STOMATOLOGII︠A︡ 2019; 98:46-49. [PMID: 31701928 DOI: 10.17116/stomat20199805146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To assess the efficacy and safety of mandibular block performed by two different techniques. MATERIAL AND METHODS The study involved 92 patients divided in two groups according to mandibular block technique: method of P.M. Egorov (45 patients) and G. Gow-Gates modified by S.A. Rabinovich and O.N. Moskovets in 1999 (47 patients). RESULTS The number of local complications was reduced to 1/9% when modified Gow-Gates mandibular block technique was used with anesthesia efficacy of 98%. CONCLUSION Modified Gow-Gates mandibular block technique shows better efficacy and is associated with lower complications rate for oral surgical procedures and inflammatory oral diseases treatment in mandible.
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Affiliation(s)
- S T Sokhov
- Moscow State Medical and Dental University named after A.I. Evdokimov, Moscow, Russia
| | - S A Rabinovich
- Moscow State Medical and Dental University named after A.I. Evdokimov, Moscow, Russia
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Efficacy of Articaine Versus Lidocaine Administered as Supplementary Intraligamentary Injection after a Failed Inferior Alveolar Nerve Block: A Randomized Double-blind Study. J Endod 2019; 45:1-5. [DOI: 10.1016/j.joen.2018.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022]
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Donovan TE, Marzola R, Murphy KR, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2018; 120:816-878. [DOI: 10.1016/j.prosdent.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 02/08/2023]
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