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de Freitas BN, Capel CP, Vieira MA, Barbin GF, Cardoso L, Tirapelli C. Do intraoral scanning technologies affect the trueness of dental arches with crowding, diastema, and edentulous spaces? A clinical perspective. J Dent 2024; 149:105285. [PMID: 39103077 DOI: 10.1016/j.jdent.2024.105285] [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: 03/18/2024] [Revised: 07/26/2024] [Accepted: 08/02/2024] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVES To evaluate the trueness of dental arches digitised by two intraoral scanning (IOS) technologies from patients presenting crowding, diastema, and bilateral posterior edentulous space with tilted molar. METHODS Conventional impressions and dental stone models were generated from three patients presenting the aforementioned dental arch conditions. These models were digitised on a desktop scanner, and the resulting mesh was used as reference. Subsequently, the patients were scanned using confocal based (CF; iTero Element 2) and blue laser-multiscan (BLM; Virtuo Vivo) imaging IOS technology, totalling thirty scans. The meshes from the scans were exported in Standard Tessellation Language format and analysed using Geomagic Control X software. Root mean square (RMS) indicated deviation magnitude. Differences in IOS technologies were evaluated with paired t-tests, and dental arch conditions compared using ANOVA and post-hoc Tukey tests (α=0.05). RESULTS Digital dental arch from blue laser-multiscan technology showed lower trueness compared to confocal based technology for crowding (p = 0.0084) and edentulous spaces (p = 0.0025) conditions. When the types of oral condition were compared, discrepancies were significantly different for both IOS technologies, featuring the arch with diastema showing the lowest trueness, followed by edentulous spaces and crowding. CONCLUSION Dental arches presenting crowding and edentulous spaces digitised by blue laser-multiscan technology exhibited greater discrepancies compared to confocal based imaging technology. Furthermore, trueness varied among the dental arch conditions. CLINICAL SIGNIFICANCE The IOS technology and patient's dental arch condition can influence the trueness of dental arch digitisation. Being aware of these effects allows clinicians to take them into account during scanning procedures, digital planning and manufacturing.
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Affiliation(s)
- Bruna Neves de Freitas
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Camila Porto Capel
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Marcela Amanda Vieira
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Gabriel Fugita Barbin
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Leandro Cardoso
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Camila Tirapelli
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Srinivasan M, Berisha F, Bronzino I, Kamnoedboon P, Leles CR. Reliability of a face scanner in measuring the vertical dimension of occlusion. J Dent 2024; 146:105016. [PMID: 38679136 DOI: 10.1016/j.jdent.2024.105016] [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: 11/07/2023] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/14/2024] Open
Abstract
OBJECTIVE This study evaluated the reliability of a face scanner in measuring the vertical dimension of occlusion (VDO). METHODS Fully dentate volunteers (n = 20; mean-age = 30.0 ± 10.7 years) were recruited. Clinical facial measurements were obtained using a digital caliper and a face scanner (Obiscanner, Fifthingenium, Italy). The scans were imported into a mesh-processing software, and the distances were measured digitally. Measurements were obtained for each participant with the jaws positioned in maximal intercuspation (MI) and with increased vertical distances of 2, 4, and 6 mm. Vertical and horizontal measures were obtained using facial anatomical landmarks: Glabella (GL), Pronasale (PrN), Subnasale (SbN), inferior border of the right and left Alare, Labiale superius (Ls), right and left Cheilion (Ch), Soft Pogonion (SPg), right and left Tragus of the ear (Tr), for all selected vertical positions. Data analysis included intra-class correlation coefficient (ICC), pairwise comparison tests, Bland-Altman plots, and Passing-Bablok regression. RESULTS 120 VDO measurements (clinical=60, digital=60) were recorded by two independent evaluators. Mean differences between digital and clinical measurements ranged from 0.054 ± 0.14 mm to 0.203 ± 0.13 mm. All parameters were strongly correlated (r > 0.93; p < 0.001). ICC estimates revealed excellent reliability, and the measuring procedure yielded the same results on repeated trials irrespective of the raters and measurement methods. Bland-Altman plots revealed a difference, between digital and clinical measurements, of 1.7 % for the vertical measurements. Regression analysis revealed no significant proportional difference between the two methods, so both can be used interchangeably. CONCLUSIONS The findings of this study demonstrate that VDO can be measured accurately from face scans using 3D mesh-processing software and that even small changes in the VDO could be detected using the digital methods. CLINICAL SIGNIFICANCE Findings provide evidence about the reliability of a digital method for jaw relation registrations and may be applied towards incorporating this method into clinical workflows for computer-aided-design/ computer-assisted-manufacturing (CAD-CAM) dentures.
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Affiliation(s)
- Murali Srinivasan
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.
| | - Florentin Berisha
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Innocenzo Bronzino
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Porawit Kamnoedboon
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Claudio Rodrigues Leles
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland; School of Dentistry, Federal University of Goias, Goiania, Brazil; Department of Reconstructive Dentistry, Division of Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Li P, Wan G, Xu S, Li A. Functional Biomaterials and Digital Technologies in Dentistry: From Bench to Bedside. J Funct Biomater 2024; 15:107. [PMID: 38667564 PMCID: PMC11051381 DOI: 10.3390/jfb15040107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
This Special Issue, "Functional Biomaterials and Digital Technologies in Dentistry: From Bench to Bedside", highlights the integration of advanced materials science and digital technologies in dental and maxillofacial applications [...].
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Affiliation(s)
- Ping Li
- Department of Prosthodontics, School and Hospital of Stomatology, Guangzhou Medical University, Guangzhou 510182, China
| | - Guojiang Wan
- Key Laboratory of Advanced Technologies of Materials (Ministry of Education), School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 611756, China;
| | - Shulan Xu
- Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, China;
| | - An Li
- Department of Periodontology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou 510280, China
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Ashry A, Abdelhamid AM, Ezzelarab S, Khamis MM. Effect of using scan body accessories and inter-implant distances on the accuracy of complete arch implant digital impressions: An in vitro study. J Prosthodont 2024. [PMID: 38594949 DOI: 10.1111/jopr.13856] [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: 11/11/2023] [Accepted: 03/23/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE To introduce a novel design for scan body accessory parts that are reusable, easy to attach and detach without permanent change of the scan body, and can be used with different inter-implant distances to enhance the accuracy of complete arch implant scans. MATERIALS AND METHODS A maxillary polymethylmethacrylate (PMMA) model with a soft tissue replica was fabricated with four implant analogs located at tooth positions 17, 13, 22, and 27 with 18, 25, and 30 mm inter-implant distances. Four scan bodies (SBs) were attached to the implants. The model was scanned with a laboratory scanner to be used as a reference scan. A total of 40 scans were made with the same intraoral scanner and they were divided equally into two groups. Group A: Complete arch implant scans without scan body accessories (n = 20), and Group B: Complete arch implant scans with scan body accessories (n = 20). Intraoral scans were exported and superimposed on the reference scan using reverse engineering inspection software to be evaluated for 3D deviations, angular deviations, and linear deviations. Statistical analysis was performed with student t-test and analysis of variance (ANOVA) with repeated measures followed by post hoc adjusted Bonferroni test. The level of significance was set at P = 0.05. RESULTS The scan body accessories decreased both the 3D and linear deviations, with a statistically significant difference at SB4 for the 3D deviation (P = 0.043) and the linear inter-implant discrepancies between SB1-SB2 and SB3-SB4 (P = 0.029 and < 0.001), respectively. However, there was no statistically significant difference in angular deviation between the study groups. Implant positions had significant differences within each group. CONCLUSIONS A significant improvement in the accuracy of the complete arch implant digital impression was achieved by using the scan body accessories, particularly in reducing the 3D and linear deviations at the most distant implant positions.
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Affiliation(s)
- Amal Ashry
- Department of Prosthodontics, Faculty of Dentistry, Damanhour University, El-Behaira, Egypt
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Ahmed M Abdelhamid
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Salah Ezzelarab
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Moataz Khamis
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Gurgel M, Alvarez MA, Aristizabal JF, Baquero B, Gillot M, Al Turkestani N, Miranda F, Castillo AAD, Bianchi J, de Oliveira Ruellas AC, Ioshida M, Yatabe M, Rey D, Prieto J, Cevidanes L. Automated artificial intelligence-based three-dimensional comparison of orthodontic treatment outcomes with and without piezocision surgery. Orthod Craniofac Res 2024; 27:321-331. [PMID: 38009409 PMCID: PMC10949222 DOI: 10.1111/ocr.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/26/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE(S) This study aims to evaluate the influence of the piezocision surgery in the orthodontic biomechanics, as well as in the magnitude and direction of tooth movement in the mandibular arch using novel artificial intelligence (AI)-automated tools. MATERIALS AND METHODS Nineteen patients, who had piezocision performed in the lower arch at the beginning of treatment with the goal of accelerating tooth movement, were compared to 19 patients who did not receive piezocision. Cone beam computed tomography (CBCT) and intraoral scans (IOS) were acquired before and after orthodontic treatment. AI-automated dental tools were used to segment and locate landmarks in dental crowns from IOS and root canals from CBCT scans to quantify 3D tooth movement. Differences in mesial-distal, buccolingual, intrusion and extrusion linear movements, as well as tooth long axis angulation and rotation were compared. RESULTS The treatment time for the control and experimental groups were 13.2 ± 5.06 and 13 ± 5.52 months respectively (P = .176). Overall, anterior and posterior tooth movement presented similar 3D linear and angular changes in the groups. The piezocision group demonstrated greater (P = .01) mesial long axis angulation of lower right first premolar (4.4 ± 6°) compared with control group (0.02 ± 4.9°), while the mesial rotation was significantly smaller (P = .008) in the experimental group (0.5 ± 7.8°) than in the control (8.5 ± 9.8°) considering the same tooth. CONCLUSION The open source-automated dental tools facilitated the clinicians' assessment of piezocision treatment outcomes. The piezocision surgery prior to the orthodontic treatment did not decrease the treatment time and did not influence in the orthodontic biomechanics, leading to similar tooth movements compared to conventional treatment.
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Affiliation(s)
- Marcela Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Baptiste Baquero
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Maxime Gillot
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Najla Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Felicia Miranda
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Aron Aliaga-Del Castillo
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonas Bianchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Marcos Ioshida
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Diego Rey
- Department of Orthodontics, CES University, Medellin, Colombia
| | - Juan Prieto
- Department of Computer Sciences, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
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Bayraktar ET, Türkmen C, Atali PY, Tarçin B, Korkut B, Yaşa B. In-vitro evaluation of wear characteristics, microhardness and color stability of dental restorative CAD/CAM materials. Dent Mater J 2024; 43:74-83. [PMID: 38072413 DOI: 10.4012/dmj.2023-071] [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] [Indexed: 02/02/2024]
Abstract
The aim of this study was to demonstrate the vertical and volumetric wear characteristics of CAD/CAM materials. The microhardness and color stability were evaluated. A polymer infiltrated ceramic network CAD/CAM block, resin nanoceramic CAD/CAM blocks, a resin composite, and enamel tissue were investigated. Samples were loaded in a chewing simulator. Other samples were aged and immersed in coffee. Color change was evaluated using the digital image analysis and a spectrophotometer. The data were analyzed using Kolmogorov-Smirnov, Kruskal Wallis, Mann Whitney U, Friedman, Spearman's rho tests (p<0.05). The lowest level of wear was obtained in enamel tissue group 0.20 (Q1:0.14; Q3:0.27μm). Resin composite group 2.48 (Q1:2.12; Q3:2.92) showed lower level of discoloration. No agreement was obtained between the digital image analysis and spectrophotometer data (Spearman's rho -0.314, p=0.014). Similar wear rate to the natural enamel tissue was obtained for Vita Enamic. Digital image analysis was considered a promising technique for monitoring the color change.
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Affiliation(s)
| | - Cafer Türkmen
- Department of Restorative Dentistry, Faculty of Dentistry, Marmara University
| | - Pınar Yilmaz Atali
- Department of Restorative Dentistry, Faculty of Dentistry, Marmara University
| | - Bilge Tarçin
- Department of Restorative Dentistry, Faculty of Dentistry, Marmara University
| | - Bora Korkut
- Department of Restorative Dentistry, Faculty of Dentistry, Marmara University
| | - Bilal Yaşa
- Department of Restorative Dentistry, Faculty of Dentistry, İstanbul Kent University
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Chinam N, Bekkali M, Kallas M, Li J. Virtual occlusal records acquired by using intraoral scanners: A review of factors that influence maxillo-mandibular relationship accuracy. J Prosthodont 2023; 32:192-207. [PMID: 37882237 DOI: 10.1111/jopr.13787] [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: 04/30/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE This review aims to provide a comprehensive summary of how much progress has been made in the field of virtual occlusal records (VOR) obtained with intraoral scanners (IOSs), their accuracy, and what factors influence their accuracy. MATERIALS AND METHODS An electronic search was performed in MEDLINE via PubMed and Scopus databases in February 2023. Eligible articles were clinical or in vitro studies evaluating the accuracy of virtual occlusal records with intraoral scanners in completely dentate and partially edentulous arches. RESULTS Virtual occlusal records have shown promising results in terms of accuracy, with some studies reporting a high level of agreement with traditional methods. Key factors influencing the accuracy of VOR through intraoral scanners were identified which encompass multiple parameters such as scanner brands, imaging technology, scan quality, best-fit alignment, software algorithms, intermesh penetrations, and the number of sections and dimensions of the virtual occlusal record. In partially edentate areas, the lack of landmarks in the edentulous area compromises the accuracy of VOR, thus limiting the use of IOS in patients with missing teeth. CONCLUSION Understanding and recognizing these influencing factors will increase the predictability and reliability of dental treatments completed by using digital workflows. However, certain challenges need to be addressed which can influence its accuracy and limit its use in daily practice. Future research should focus on improving these factors to enhance the clinical applicability of virtual occlusal records.
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Affiliation(s)
- Nivedita Chinam
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Mariam Bekkali
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - May Kallas
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Junying Li
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Li S, Yi C, Yu Z, Wu A, Zhang Y, Lin Y. Accuracy assessment of implant placement with versus without a CAD/CAM surgical guide by novices versus specialists via the digital registration method: an in vitro randomized crossover study. BMC Oral Health 2023; 23:426. [PMID: 37370027 PMCID: PMC10294323 DOI: 10.1186/s12903-023-03116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Many studies demonstrated that surgical guides might reduce discrepancies compared with freehand implant placement. This randomized crossover study aimed to assess the effects of approaches, practitioners' experience and learning sequences on the accuracy of single tooth implantation via digital registration method. No similar study was found. METHODS This in vitro randomized crossover study enrolled 60 novice students (Group S) and 10 experienced instructors (Group I). Sixty students were randomly and evenly assigned to two groups (Group SA and SB). In Group SA, 30 students first performed single molar implant on a simulation model freehand (Group SAFH), and then with a CAD/CAM surgical guide (Group SASG). In Group SB, another 30 students first performed guided (Group SBSG) and then freehand (Group SBFH). Ten instructors were also divided into Group IAFH/IASG (n = 5) and IBSG/IBFH (n = 5) following the same rules. The accuracy of implant placement was assessed by the coronal and apical distance (mm) and angular (°) deviations using the digital registration method. T tests and nonparametric tests were used to compare the results among different groups of approaches, experience and sequences. RESULTS For students, the coronal and apical distance and the angular deviations were significantly lower in surgical guide group than freehand group in total and in learning freehand first subgroup, but for learning surgical guide first subgroup the apical distance deviation showed no significant difference between two approaches. For students, the angular deviation of freehand group was significantly lower in learning surgical guide first group than learning freehand first group. For instructors, the coronal and apical distance and angular deviations showed no significant difference between two approaches and two sequences. For freehand approach, the coronal and apical distance and the angular deviations were significantly higher in student group than instructor group, while not significantly different between two groups for surgical guide approach. CONCLUSIONS For novices, using a surgical guide for the first implant placement may reduce the potential deviations compared with freehand surgery, and may reach a comparable accuracy with that of specialists. For simple single molar implantation, the surgical guide may not be significantly helpful for experienced specialists.
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Affiliation(s)
- Sha Li
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, 100081, Beijing, P. R. China
| | - Chun Yi
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, 100081, Beijing, P. R. China
| | - Ziyang Yu
- Department of Oral Implantology, Peking University School and Hospital of Stomatology Center of Digital, Dentistry, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing, P. R. China
| | - Aozhou Wu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yu Zhang
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, 100081, Beijing, P. R. China.
| | - Ye Lin
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, 100081, Beijing, P. R. China.
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