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Yuan X, Liu L, Fan Q, Zhou H, Wang Y, Lai W, Long H. Uprighting and protraction of two unilateral mandibular molars using a cantilever arm through a sophisticated biomechanical system with clear aligner: A case report. Int Orthod 2024; 22:100893. [PMID: 38996691 DOI: 10.1016/j.ortho.2024.100893] [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: 06/08/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024]
Abstract
Although clear aligner can be efficient and predictable in some tooth movements, mandibular molar protraction is the least predictable owing to biological and biomechanical limitations. This case report presents a 20-year-old female with poor prognosed left mandibular first molar (#36), deviated dental midline and mild crowding. After extraction of #36, clear aligners and an Albert cantilever were used for treatment. Through carefully designed dual mechanical system, we achieved uprighting and protraction of #37 within 27 months, with crown and root movements of 9.9mm and 12.1mm, respectively. The predictability of the crown and root movement was 107.6% and 84.6%. Coincident dental and facial midline, class I molar and canine relationship and good root parallelism were also achieved. Large-distance mandibular molar protraction can be achieved effectively with a combination of Albert cantilever arm and clear aligner.
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Affiliation(s)
- Xuechun Yuan
- Department of Orthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China; State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lu Liu
- Department of Orthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China; Department of Maxillofacial Orthognathics, Graduate school, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8510 Tokyo, Japan
| | - Qi Fan
- Department of Orthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China; State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hong Zhou
- Department of Orthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China; State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yan Wang
- Department of Orthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China; State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Wenli Lai
- Department of Orthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China; State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hu Long
- Department of Orthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China; State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Koru Akan BE, Hancıoğlu Kircelli B, Paşaoğlu Bozkurt A, Gögen H. Evaluation of the effects of semipontic design on tooth movements during mesialization of mandibular second molar performed with clear aligner treatment by finite element analysis. Am J Orthod Dentofacial Orthop 2024:S0889-5406(24)00277-4. [PMID: 39140924 DOI: 10.1016/j.ajodo.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/11/2024] [Accepted: 07/01/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Loss of the mandibular first molar is common in orthodontic patients. One treatment option is the mesialization of the second and third molars. This study aimed to investigate the displacement and type of movement in the second molar during mandibular second molar mesialization with clear aligner treatment using finite element analysis in configurations with or without pontic, semipontic, and anatomic pontic for the edentulous space. METHODS Mesialization of the mandibular second molar with clear aligner treatment was simulated using the AlGOR Fempro program (ALGOR, Inc, Pa) with 3 different configurations. RESULTS In the transverse direction, the highest rotation occurred in the anatomic pontic model, whereas the lowest rotation was in the semipontic model. In the sagittal axis, although tooth movement was realized by tipping in all scenarios, the semipontic model showed the closest movement to translation because of a higher rate of crown-root movement. In the vertical axis, although extrusion occurred in all configurations, the semipontic model showed the least extrusion forces, whereas the anatomic pontic model showed the most. CONCLUSIONS Mesiobuccal rotation, mesial tipping, and extrusion were observed in all models. However, the semipontic design had the closest movement to translational. Further randomized, controlled clinical trials are needed to evaluate the effects of different pontic designs on tooth movements.
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Affiliation(s)
- Burcu Ece Koru Akan
- Department of Orthodontics, Faculty of Dentistry, Istanbul Aydin University, Istanbul, Turkey.
| | | | - Aylin Paşaoğlu Bozkurt
- Department of Orthodontics, Faculty of Dentistry, Istanbul Aydin University, Istanbul, Turkey
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Xiao T, Su JY, Lei J, Zhang X, Yu J, Nie XP, Ying QH, Hou JX, Guo J. Effectiveness of different intrusion modes of maxillary anterior teeth with mini-implants in clear aligner treatment: a three-dimensional finite element analysis. BMC Oral Health 2024; 24:758. [PMID: 38956625 PMCID: PMC11218253 DOI: 10.1186/s12903-024-04537-7] [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: 01/18/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The intrusion of maxillary anterior teeth is often required and there are various intrusion modes with mini-implants in clear aligner treatment. The objective of this study was to evaluate the effectiveness of maxillary anterior teeth intrusion with different intrusion modes, aiming to provide references for precise and safe intrusion movements in clinical practice. METHODS Cone-beam computed tomography and intraoral optical scanning data of a patient were collected. Finite element models of the maxilla, maxillary dentition, periodontal ligaments (PDLs), clear aligner (CA), attachments, and mini-implants were established. Different intrusion modes of the maxillary anterior teeth were simulated by changing the mini-implant site (between central incisors, between central and lateral incisor, between lateral incisor and canine), loading site (between central incisors, on central incisor, between central and lateral incisor, between lateral incisor and canine), and loading mode (labial loading and labiolingual loading). Ten conditions were generated and intrusive forces of 100 g were applied totally. Then displacement tendency of the maxillary anterior teeth and CA, and stress of the PDLs were analyzed. RESULTS For the central incisor under condition L14 and for the canine under conditions L11, L13, L23, and L33, the intrusion amount was negative. Under other conditions, the intrusion amount was positive. The labiolingual angulation of maxillary anterior teeth exhibited positive changes under all conditions, with greater changes under linguoincisal loading. The mesiodistal angulation of canine exhibited positive changes under labial loading, while negative changes under linguoincisal loading except for condition L14. CONCLUSIONS The intrusion amount, labiolingual and mesiodistal angulations of the maxillary anterior teeth were affected by the mini-implant site, loading site, and loading mode. Labial and linguoincisal loading may have opposite effects on the intrusion amount of maxillary anterior teeth and the mesiodistal angulation of canine. The labiolingual angulation of the maxillary incisors would increase under all intrusion modes, with greater increases under linguoincisal loading.
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Affiliation(s)
- Tian Xiao
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Jing-Yuan Su
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Jie Lei
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Xin Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Jian Yu
- Department of Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Xiu-Ping Nie
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Qiao-Hui Ying
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Jun-Xiang Hou
- R&D center, Wuxi EA Medical Instruments Technologies Ltd, Wuxi, 214174, China
| | - Jie Guo
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China.
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Zhang Y, Wang K, Li M, Liu C, Tang L, Wan C, Fan C, Liu Y. Effects of different intrusion patterns during anterior teeth retraction using clear aligners in extraction cases: an iterative finite element analysis. Front Bioeng Biotechnol 2024; 12:1388876. [PMID: 38903188 PMCID: PMC11186992 DOI: 10.3389/fbioe.2024.1388876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Background Overtreatment design of clear aligner treatment (CAT) in extraction cases is currently primarily based on the clinical experience of orthodontists and is not supported by robust evidence on the underlying biomechanics. This study aimed to investigate the biomechanical effects of overtreatment strategies involving different maxillary anterior teeth intrusion patterns during anterior teeth retraction by CAT in extraction cases. Materials and methods A finite element model of the maxillary dentition with the first premolar extracted was constructed. A loading method of clear aligners (CAs) based on the initial state field was proposed. The iterative method was used to simulate the long-term orthodontic tooth movement under the mechanical load exerted by the CAs. Three groups of CAs were utilized for anterior teeth retraction (G0: control group; G1: incisors intrusion group; G2: anterior teeth intrusion group). Tooth displacement and occlusal plane rotation tendency were analyzed. Results In G0, CAT caused lingual tipping and extrusion of the incisors, distal tipping and extrusion of the canines, mesial tipping, and intrusion of the posterior teeth. In G1, the incisors showed minimal extrusion, whereas the canines showed increased extrusion and distal tipping tendency. G2 showed the smallest degree of posterior occlusal plane angle rotation, while the inclination tendency of the canines and second premolars decreased. Conclusion 1. In CAT, tooth displacement tendency may change with increased wear time. 2. During anterior teeth retraction, the incisor intrusion pattern can provide effective vertical control for the lateral incisors but has little effect on the central incisors. Anterior teeth intrusion patterns can alleviate the inclination of canines and second premolars, resulting in partial relief of the roller-coaster effect.
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Affiliation(s)
- Yiyan Zhang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Stomatology, Qingdao University, Qingdao, Shandong, China
| | - Kaixin Wang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Stomatology, Qingdao University, Qingdao, Shandong, China
| | - Mengyu Li
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Stomatology, Qingdao University, Qingdao, Shandong, China
| | - Cuiyu Liu
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Stomatology, Qingdao University, Qingdao, Shandong, China
| | - Li Tang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Stomatology, Qingdao University, Qingdao, Shandong, China
| | - Chunyan Wan
- School of Stomatology, Qingdao University, Qingdao, Shandong, China
- Department of Endodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Cunhui Fan
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Stomatology, Qingdao University, Qingdao, Shandong, China
| | - Yang Liu
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- School of Stomatology, Qingdao University, Qingdao, Shandong, China
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Traversa F, Chavanne P, Mah J. Biomechanics of clear aligner therapy: Assessing the influence of tooth position and flat trimline height in translational movements. Orthod Craniofac Res 2024. [PMID: 38685814 DOI: 10.1111/ocr.12796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The present clear aligner therapy (CAT) research focuses on isolating and reporting the biomechanical performance for three separate teeth, three translational movements and two flat trimlines at different heights. By identifying key patterns, the research seeks to inform the development of improved aligner designs, ultimately enhancing the effectiveness of clinical orthodontic treatments. MATERIALS AND METHODS In an in vitro setting using the Orthodontic Force Simulator (OFS), the biomechanical response of 30 aligners was investigated on three different teeth of a straight symmetric maxillary dentition (central incisor, canine and first molar). Each tooth was tested under two flat trimline conditions (trimmed at gingival margin, TL0; extended 2.0 mm below, TL2) and for three types of translational movements (palatal translation, mesial translation and intrusion). Forces and moments were reported at the centre of resistance for each displaced tooth as well as the two neighbouring teeth, evaluating a total of 18 distinct scenarios. RESULTS Findings indicate significant variability in the biomechanical responses based on tooth location in the arch, trimline height and movement performed. For palatal translations, the palatal force required to perform the movement was observed highest in molar cases, followed by canine and incisor cases, with a notable difference in the distribution of side effects, indicating a strong influence of tooth anatomy and position in the arch. Similarly, in mesial translations and intrusions molars experienced greater forces and moments than the corresponding movements applied on canines and incisors, but uniquely dispersed for each configuration tested. Regarding the shape of the aligner, TL2 consistently showed improved control over orthodontic movements compared to TL0. Neighbouring teeth frequently displayed compensatory reactions up to about half of the intensity observed on the tooth being moved, with notable variations from case to case. CONCLUSIONS This research supports fundamental factors impacting CAT: Characteristic patterns in the direction and intensity of forces and moments are associated with each of the three translational movements tested. Tooth anatomy and arch location significantly influence the biomechanical performance of aligners, with an observed trend for molars to display higher forces and moments over canines and incisors, but distributed differently. The height of a flat trimline, specifically TL2, shows enhanced control over orthodontic movements. Additional findings revealed a compensatory activity of neighbouring teeth, which varies based on tooth region and movement type. It potentially could influence CAT outcomes negatively and merits attention in future investigations. These results support a tailored CAT method that improves aligner design for better force application. This method needs to be used alongside, and confirmed by, clinical knowledge. Future research should extend these findings to a wider range of clinical conditions for greater applicability in the day-to-day orthodontic practice.
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Affiliation(s)
- Flavio Traversa
- Orthodontic Business Unit, Institut Straumann AG, Basel, Switzerland
| | - Philippe Chavanne
- Orthodontic Business Unit, Institut Straumann AG, Basel, Switzerland
| | - James Mah
- School of Dental Medicine, University of Nevada, Las Vegas, Nevada, USA
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Inchingolo AM, Inchingolo AD, Carpentiere V, Del Vecchio G, Ferrante L, Di Noia A, Palermo A, Di Venere D, Dipalma G, Inchingolo F. Predictability of Dental Distalization with Clear Aligners: A Systematic Review. Bioengineering (Basel) 2023; 10:1390. [PMID: 38135981 PMCID: PMC10740623 DOI: 10.3390/bioengineering10121390] [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: 10/05/2023] [Revised: 11/02/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
The current review aims to evaluate the scientific evidence relating to the effectiveness of treatment with clear aligners (CAs) in controlling distalization orthodontic tooth movement. "Orthodontics, aligners" and "distalization" were the search terms used on the Scopus, Web of Science and Pubmed databases with the Boolean operator "AND". The results of the last ten years of research were 146 studies; of these, 19 publications were included for this review. The distalization movement is possible with invisible masks alone, but the risk of losing anchorage in the anterior sectors is very probable. The stability of the results and the reduction of unwanted effects can be guaranteed by the use of skeletal anchoring devices and interproximal enamel reduction (IPR), with which compensations are obtained to reduce the initial overjet. Temporary anchorage devices (TADs) can be used to manage posterior anchorage after distalization of maxillary molars with aligners. This hybrid approach has demonstrated the greatest orthodontic success. TADs are useful aids to provide direct and indirect skeletal anchorage. The opposite effect must be considered when planning dental distalization, especially of the molars, in patients with large overjet, and corrective measures or the use of auxiliaries may be necessary to prevent midcourse corrections. This systematic review provides a critical evidence-based assessment of the predictability of dental distalization with CAs, an ever-evolving orthodontic technique.
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Affiliation(s)
- Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (V.C.); (G.D.V.); (L.F.); (A.D.N.); (D.D.V.); (F.I.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (V.C.); (G.D.V.); (L.F.); (A.D.N.); (D.D.V.); (F.I.)
| | - Vincenzo Carpentiere
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (V.C.); (G.D.V.); (L.F.); (A.D.N.); (D.D.V.); (F.I.)
| | - Gaetano Del Vecchio
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (V.C.); (G.D.V.); (L.F.); (A.D.N.); (D.D.V.); (F.I.)
| | - Laura Ferrante
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (V.C.); (G.D.V.); (L.F.); (A.D.N.); (D.D.V.); (F.I.)
| | - Angela Di Noia
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (V.C.); (G.D.V.); (L.F.); (A.D.N.); (D.D.V.); (F.I.)
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (V.C.); (G.D.V.); (L.F.); (A.D.N.); (D.D.V.); (F.I.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (V.C.); (G.D.V.); (L.F.); (A.D.N.); (D.D.V.); (F.I.)
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (V.C.); (G.D.V.); (L.F.); (A.D.N.); (D.D.V.); (F.I.)
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