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The European Journal of Orthodontics Advance Access published online on September 4, 2008
The European Journal of Orthodontics, doi:10.1093/ejo/cjn035
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© The Author 2008. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Non-nutritive sucking habits, dental malocclusions, and facial morphology in Brazilian children: a longitudinal study

Mônica Vilela Heimer, Cintia Regina Tornisiello Katz and Aronita Rosenblatt

Department of Preventive and Social Dentistry, Faculty of Dentistry of Pernambuco State University, Brazil

Address for correspondence, Mônica Vilela Heimer, Av. Bernardo Vieira de Melo 6447/801—Candeias, 54450-020 Jaboatão dos Guararapes—PE, Brazil, E-mail: monica{at}heimer.com.br


   Summary
Top
 Summary
Introduction
 Subjects and methods
 Results
 Discussion
 Conclusions
 References
 
The aim of this longitudinal study was to assess the relationship between non-nutritive sucking habits and the presence of anterior open bites (AOBs) and posterior crossbites and their association with facial morphology among 4- to 6-year-old children attending state schools in the city of Recife, Brazil. The sample comprised 287 children, both males and females. The proportion of boys to girls was approximately 50 per cent. The average age was 4 years 5 months at the beginning and 6 years 6 months at the end of the study. Data were collected from interviews with mothers or carers, and the clinical examination was carried out by two calibrated examiners. Statistical analysis was undertaken using bivariate analysis, Pearson’s chi-square, McNemar, and Stuart–Maxwell tests.

The results revealed a significant reduction in AOB (P < 0.001) and a slight increase in the prevalence of posterior crossbites. Both occlusal traits were associated with a previous history of sucking habits. The most prevalent morphological facial type, assessed using the morphological facial index, was high (≥88 mm) and a statistically significant (P = 0.02) association was found between facial morphology and an AOB. Children with an average or high facial morphology measurement exhibited a greater prevalence of AOB when compared with those with lower measurements. Self-correction of AOB was associated with cessation of sucking habits but facial morphology remained unaltered.


   Introduction
Top
 Summary
 Introduction
Subjects and methods
 Results
 Discussion
 Conclusions
 References
 
Sucking habits and associated occlusal anomalies have been studied extensively. It has been demonstrated that an anterior open bite (AOB) and posterior crossbite are the most frequent malocclusions associated with prolonged sucking habits (Larsson, 2001Go; Warren and Bishara, 2002Go; Burford and Noar, 2003Go; Katz et al., 2004Go).

Katz et al. (2004)Go assessed the relationship between non-nutritive sucking habits, facial morphology, and malocclusion in 330 Brazilian 4-year olds. The results demonstrated that a large percentage (67.9 per cent) of children exhibited non-nutritive sucking habits at some point in their lives. AOB and posterior crossbites were found in 36.4 and 12.1 per cent of the children, respectively. An association was also observed between malocclusions and non-nutritive sucking habits. The authors drew attention to the magnitude of the problem and emphasized the need for more longitudinal studies to allow clinical practice guidelines to be developed.

Farsi and Salama (1997)Go studied 583 Saudi children aged 3–5 years and found posterior crossbites in 5.5 per cent of the group. However, they noted that crossbites were equally prevalent in children with and without sucking habits, suggesting that factors other than the habit may be responsible for this occlusal trait.

It has been shown that self-correction of an AOB may occur following cessation of a sucking habit during the primary dentition (Fields, 1986Go; Larsson, 2001Go; Katz and Rosenblatt, 2005Go) although the same does not apply to a posterior crossbite (Infante, 1976Go; Kurol and Berglund, 1992Go). However, it must be noted that a posterior crossbite is more frequent in the primary than in the mixed and permanent dentitions, suggesting that some crossbites in the primary dentition are self-correcting (Thilander et al., 1984Go; Thilander and Lennartsson, 2002Go).

A randomized clinical trial carried out in Stockholm followed 76 children with a unilateral posterior crossbite from 4 to 9 years of age and found that 17 per cent of the crossbites showed self-correction (Lindner, 1989Go).

The aetiology of malocclusion is primarily genetic with environmental influences (Vig and Fields, 2000Go). It is believed that the facial growth pattern is an important genetic factor which contributes to the development of malocclusions and also influences the treatment of such anomalies (Moyers, 1988Go; Enlow, 1993Go). According to Proffit and Fields (1986)Go, children who have a balanced, or horizontal, growth pattern are more likely to experience self-correction of an open bite than those with a long face or vertical growth pattern.

There are few Brazilian studies in the literature which have investigated the most prevalent malocclusions and their associated aetiological factors. Thus, the aim of the present longitudinal study was to assess the relationship between non-nutritive sucking habits and the presence of AOB and posterior crossbites, as well as their association with facial morphology.


   Subjects and methods
Top
 Summary
 Introduction
 Subjects and methods
Results
 Discussion
 Conclusions
 References
 
This longitudinal study was conducted in public schools in the city of Recife, the capital of Pernambuco, a state in the northeast of Brazil. The project was approved by the Ethics Committee of Pernambuco State University. The sample comprised children from 4 to 6 years of age; the average age was 4 years 5 months at the beginning and 6 years 6 months at the end of the study.

Children were excluded from the study if their parents did not agree to their participation; they had cavities and/or extensive restorations; marked occlusal wear or early loss of primary teeth; alterations in the number, size, and shape of teeth and syndromes or systemic problems affecting craniofacial growth.

To determine the sample size and validity of the methodological procedures, a pilot study was conducted that included 100 children from 4 to 6 years of age attending two state schools. The prevalence of malocclusions associated with sucking habits found in the pilot study was then used to calculate the sample required for the main investigation. Using a formula for cohort studies in the Statcalc of Epi Info Version 2000 (Atlanta, Georgia, USA) software package, it was estimated that 252 children would be required, with an additional 30 per cent to compensate for possible dropouts during the study period. Hence, the initial sample comprised 330 children (Katz et al., 2004Go).

The children were randomly selected from 14 of 153 nursery schools by a stratified randomized sampling technique. The nursery schools were randomly selected from each administrative region in proportion to the number of schools in each region.

The data were collected with a questionnaire, completed during personal interviews with each child's mother or carer, which included questions on gender, date of birth, and the presence or absence of non-nutritive sucking habits such as dummy and/or digit (thumb or finger) sucking. Data regarding the duration of sucking habits, i.e. the number of years between start and cessation, were not considered because most mothers were uncertain about this. Two calibrated examiners carried out the clinical examinations; the first examination was in 2002 and the second in 2004.

Dental examinations were performed under natural light in a classroom environment, using tongue depressors, gloves, and masks in compliance with the infection control protocol of the Brazilian Ministry of Health. The occlusion was assessed in centric occlusion, and the examiner was blinded to the information collected from the parental interviews. An AOB was recorded when there was lack of vertical overlap of more than 3 mm between the primary incisors with the posterior teeth in occlusion. When a physiological AOB, related to eruption of the central permanent incisors, was observed, it was recorded as an absence of malocclusion. A posterior crossbite was recorded when one or more of the maxillary molars occluded palatal to the buccal cusp of the opposing mandibular teeth.

Facial morphology was assessed using the morphological facial index (MFI) defined as the ratio of morphological face height and the bizygomatic width. Morphological face height is defined as the distance between nasion and gnathion and the bizygomatic width as the distance between the zygoma points (Martin and Saller, 1959Go). The measurements were taken directly on the patient's face with a 6 inch Digimatic calliper accurate to 0.02 mm (Mitutoyo Sul Americana Ltda, São Paulo, Brazil) and recorded in millimetres. Facial morphology was categorized as low (≤83.9 mm), average (84.0–87.9 mm), or high (≥88.0 mm).

To ensure standardization of the diagnostic criteria during the two phases of the study, calibration of the examiners was performed using the Kappa ({kappa}) test (Bulman and Osborn, 1989Go). The {kappa} coefficients for inter- and intra-examiner calibration were 0.96 and 1.0, respectively.

The data were statistically analysed using the Statistical Package for Social Sciences Version 7.5 (SPSS Inc., Chicago, Illinois, USA) and SAS System, Version 8.2 (Cary, North Carolina, USA). Bivariate analysis, Pearson’s chi-square, McNemar, and Stuart–Maxwell tests were used for statistical analysis. Significance was predetermined at P < 0.05.


   Results
Top
 Summary
 Introduction
 Subjects and methods
 Results
Discussion
 Conclusions
 References
 
At the end of the 2-year follow-up, the dropout rate was 13 per cent (n = 43) with the 287 children remaining. The ratio of boys to girls was approximately 1:1.

A statistically significant reduction in the prevalence of sucking habits (P < 0.001) and AOB (P < 0.001) was observed with age. The prevalence of a posterior crossbite increased slightly from 9.1 to 10.4 per cent, but this was not statistically significant (Table 1).


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  		Table 1 Prevalence of sucking habits, anterior open bite, posterior crossbite, and facial morphology in the two phases of the study.

 
There was a statistically significant change in facial morphology throughout the study and an increased MFI was the most prevalent, although the percentage of those with average and low measurements increased over the 2-year period (Table 1).

The prevalence of an AOB was higher among children with sucking habits. A statistically significant association between these two variables was established in the two phases of the study (P < 0.001; Table 2). Table 3 shows the assessment of AOB according to facial morphology. At the second examination, there was a significant association between the MFI and the occurrence of an AOB (P = 0.0227). There was also a statistically significant association between a posterior crossbite and sucking habits at 4 years of age (P = 0.0027; Table 4). However, the MFI was not associated with the occurrence of a posterior crossbite (P = 0.4968 and P = 0.1786 for the initial and final examinations, respectively; Table 5).


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  		Table 2 Prevalence of an anterior open bite according to sucking habit.

 

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  		Table 3 Prevalence of an anterior open bite according to the morphological facial index.

 

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  		Table 4 Prevalence of a posterior crossbite according to sucking habit.

 

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  		Table 5 Prevalence of a posterior crossbite according to the morphological facial index.

 
AOBs showed an 18.8 per cent level of self-correction (n = 54) with two new cases (0.7 per cent). Only 0.4 per cent of posterior crossbites self-corrected (n = 1) and there were five new cases (1.7 per cent).

Table 6 shows the analysis of self-correcting AOBs according to cessation of sucking habits and the facial morphology type in those children who, at the first examination, exhibited both sucking habits and an AOB. A statistically significant association was found between the cessation of sucking habits and self-correction of an AOB (P < 0.001). The greatest prevalence of self-correction was recorded in children with a low MFI (77.8 per cent); however, this was not statistically significant (Table 6).


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  		Table 6 Assessment of the incidence of self-correction of an anterior open bite (AOB) according to cessation of sucking habit and facial morphology.

 

   Discussion
Top
 Summary
 Introduction
 Subjects and methods
 Results
 Discussion
Conclusions
 References
 
The prevalence of sucking habits in the current study was higher than that found in previous research (Øgaard et al., 1994Go; Adair et al., 1995Go; Farsi and Salama, 1997Go; Keski-Nisula et al., 2003Go). According to Jenkins et al. (1984)Go and Massler (1963)Go, sucking habits appear to be related to socio-economic status as well as to cultural features. The difference may also be explained by the level of heterogeneity in the target population. The population in the northeast of Brazil is a mixture of Negroes, Indians, and those of Portuguese ancestry. The population heterogeneity in Pernambuco contrasts with that of other studies involving relatively homogeneous populations (Øgaard et al., 1994Go; Farsi and Salama, 1997Go; Keski-Nisula et al., 2003Go). In one study (Adair et al., 1995Go) involving Afro- and Euro-Americans, the time of cessation of sucking habits was said to be related to such heterogeneity.

Although there was no professional intervention during the period between the first and second examinations, a significant reduction in the prevalence of sucking habits was observed, reflecting a natural tendency among school-age children towards habit cessation (Katz and Rosenblatt, 2005Go; Bishara et al., 2006Go). The cessation of sucking habits was also associated with a significant reduction in AOB. These findings are in agreement with Fields (1986)Go, Moyers (1988)Go, and Larsson (1985)Go, who found that the cessation of sucking habits between 4 and 6 years of age can result in an improved occlusion. Levine (1998)Go suggested that if the habit persists beyond this stage, and especially if a forward tongue thrust develops, there is less possibility of improvement.

The results (Table 2) show a statistically significant association between an AOB and the presence of sucking habits, which is in agreement with Øgaard et al. (1994)Go, Adair et al. (1995)Go, Svedmyr (1979)Go, Karjalainen et al. (1999)Go, and Larsson (1975)Go. The presence of a continuing sucking habit was not associated with a posterior crossbite, but it is of note that sucking habits were risk factors for the presence of the two occlusal traits studied. This finding is in agreement with Infante (1976)Go, Svedmyr (1979)Go, Modéer et al. (1982)Go, Øgaard et al. (1994)Go, and Warren et al. (2005)Go.

The prevalence of a posterior crossbite increased slightly, despite the reduction in sucking habits, suggesting that a posterior crossbite may be associated with exposure to sucking habits before 4 years of age and that its maintenance does not, as suggested by Svedmyr (1979)Go, depend on a continued habit after this age.

The Brazilian population has cultural habits similar to those of other developing countries. This is evidenced in this investigation since the prevalence of posterior crossbites is in agreement with studies conducted both in developed and developing countries (Modéer et al., 1982Go; Øgaard et al., 1994Go; Warren and Bishara, 2002Go; Warren et al., 2005Go). On the other hand, primitive societies show a lower prevalence of malocclusions, especially posterior crossbites, which are usually correlated with higher masticatory frequency and different nutrition (Larsson, 1983Go; Corruccini et al., 1985Go; Thilander et al., 1991Go).

Only one subject showed self-correction of a posterior crossbite during the 2-year follow-up. These results are in agreement with Infante (1976)Go, Proffit and Fields (1986)Go, and Karjalainen et al. (1999)Go, who stated that spontaneous correction of a posterior crossbite rarely occurs. In contrast, Lindner (1989)Go, Kurol and Berglund (1992)Go, and Thilander and Lennartsson (2002)Go reported that a percentage of self-correction does occur. These studies were carried out over a longer period (5–10 years), which may explain the difference in the results.

Further research, including cephalometric evaluation of patients with and without sucking habits, is needed to clarify why a large number of children who have sucking habits do not develop a malocclusion (Farsi and Salama, 1997Go) and also why children without such a habit have this disorder (Paredes Galardo and Paredes Cencillo, 2005Go).

In this cohort study, the majority of the children (84.0 per cent), in spite of having sucking habits at the first examination, did not develop a posterior crossbite and only 10.4 per cent presented with this occlusal trait at the 2-year follow-up. The low prevalence of a posterior crossbite does not characterize the problem as a public health issue and only a longer follow-up of the sample would be able to justify the need for early treatment. There is no evidence at present to support the routine correction of a posterior crossbite in the primary dentition (Malandris and Mahoney, 2004Go).

In a large number of children with a posterior crossbite associated with an AOB at the start of the study, the AOB self-corrected after cessation of the sucking habit, which suggests that correction of an AOB is associated with a reduction in face height and may account for the changes in the MFI values.

The facial morphological analysis was based on anthropometric measurements. While cephalometric analysis would have allowed definition, localization, and quantification of skeletal disharmonies, due to ethical, operational, and financial difficulties, these analyses were not possible.

At the second examination, an association was found between facial morphology and AOB (P = 0.02). Children with an average or high MFI exhibited a higher prevalence of AOB compared with those with a low MFI. These findings are in agreement with Almeida and Ursi (1990)Go and Ngan and Fields (1997)Go. Self-correction of an AOB was not associated with facial morphology but with cessation of the sucking habit.

A longitudinal study of this type was appropriate for investigating the effect of non-nutritive sucking habits and facial morphology in the presence of malocclusions, especially since there was no professional intervention which could have distorted the results. This cohort was representative of the population and the relatively low dropout of 13 per cent should not affect the findings of the present investigation.


   Conclusions
Top
 Summary
 Introduction
 Subjects and methods
 Results
 Discussion
 Conclusions
References
 

  1. Non-nutritive sucking habits are risk factors for the occurrence of an AOB and a posterior crossbite.
  2. AOBs were associated with the presence of continuing sucking habits, whereas the same was not true for posterior crossbites.
  3. There was a significant reduction in the prevalence of AOBs with age, suggesting the self-corrective nature of this malocclusion.
  4. A statistically significant association was found between facial morphology and AOB among 6-year-old children.
  5. Self-correction of an AOB was associated with the cessation of sucking habits but not with facial morphology.
  6. There was no association between sucking habits and facial morphology in the assessment of the two occlusal traits studied.


   References
Top
 Summary
 Introduction
 Subjects and methods
 Results
 Discussion
 Conclusions
 References
 

    Adair SM, Milano M, Lorenzo I, Russel C. Effects of current and former pacifier use on the dentition of 24- to 59-month-old children. Pediatric Dentistry (1995) 17:437–444.[Medline]

    Almeida RR, Ursi WJS. Anterior open bite: etiology and treatment. Oral Health (1990) 80:27–31.[Medline]

    Bishara SE, Warren JJ, Broffitt B, Levy SM. Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life. American Journal of Orthodontics and Dentofacial Orthopedics (2006) 130:31–36.[CrossRef][Web of Science][Medline]

    Bulman JS, Osborn JF. Statistics in dentistry. Brazil Dental Journal (1989) 166:78–90.

    Burford D, Noar JH. The causes, diagnosis and treatment of anterior open bite. Dental Update (2003) 30:235–241.[Medline]

    Corruccini RS, Flander LB, Kaul SS. Mouth breathing, occlusion, and modernization in a north Indian population. An epidemiologic study. Angle Orthodontist (1985) 55:190–196.[Web of Science][Medline]

    Enlow DH. Facial growth (1993) 3rd edn. Philadelphia: Saunders Company. 1–23.

    Farsi NM, Salama FS. Sucking habits in Saudi children: prevalence, contributing factors and effects on the primary dentition. Pediatric Dentistry (1997) 19:28–33.[Medline]

    Fields HW. Treatment of nonskeletal problems in preadolescent children. In: Profft W R (ed). Contemporary orthodontics—Profft WR, ed. (1986) Philadelphia: Mosby. 342–384.

    Infante PF. An epidemiologic study of finger habits in preschool children, as related to malocclusion, socioeconomic status, race, sex and size of community. Journal of Dentistry for Children (1976) 1:33–38.

    Jenkins PM, Feldman BS, Stirrups DR. The effect of social class and dental features on referral for orthodontic advice and treatment. British Journal of Orthodontics (1984) 11:185–188.[Abstract]

    Karjalainen S, Rönning O, Lapinleimu H, Simell O. Association between early weaning, non-nutritive sucking habits and occlusal anomalies in 3-year-old Finnish children. International Journal of Paediatric Dentistry (1999) 9:169–173.[CrossRef][Medline]

    Katz CRT, Rosenblatt A. Nonnutritive sucking habits and anterior open bite in Brazilian children: a longitudinal study. Pediatric Dentistry (2005) 27:1–5.

    Katz CRT, Rosenblatt A, Gondim PPC. Nonnutritive sucking habits in Brazilian children: effects on deciduous dentition and relationship with morphology. American Journal of Orthodontics and Dentofacial Orthopedics (2004) 126:53–57.[CrossRef][Web of Science][Medline]

    Keski-Nisula K, Lehto R, Lusa V, Keski-Nisula L, Varrela J. Occurrence of malocclusion and need of orthodontic treatment in early mixed dentition. American Journal of Orthodontics and Dentofacial Orthopedics (2003) 124:631–638.[CrossRef][Web of Science][Medline]

    Kurol J, Berglund L. Longitudinal study and cost-benefit analysis of the effect of early treatment of posterior cross-bites in the primary dentition. European Journal of Orthodontics (1992) 14:173–179.[Abstract/Free Full Text]

    Larsson E. Dummy- and finger-sucking habits in 4-year-olds. Swedish Dental Journal (1975) 68:219–224.

    Larsson E. Malocclusion in juvenile medieval skull material. Swedish Dental Journal (1983) 7:185–190.[Web of Science][Medline]

    Larsson E. The prevalence and aetiology of prolonged dummy and finger-sucking habits. European Journal of Orthodontics (1985) 7:172–176.[Abstract/Free Full Text]

    Larsson E. Sucking, chewing, and feeding habits and the development of crossbite: a longitudinal study of girls from birth to 3 years of age. Angle Orthodontist (2001) 71:116–119.[Web of Science][Medline]

    Levine RS. Oral aspects of dummy and digit sucking. British Dental Journal (1998) 186:108.[Web of Science]

    Lindner A. Longitudinal study on the effect of early interceptive treatment in 4-year-old children with unilateral crossbite. Scandinavian Journal of Dental Research (1989) 97:432–438.[Web of Science][Medline]

    Malandris M, Mahoney EK. Aetiology, diagnosis and treatment of posterior cross-bites in the primary dentition. International Journal of Paediatric Dentistry (2004) 14:155–166.[CrossRef][Medline]

    Martin R, Saller K. Lehrbuch der antropologie. In: Orthodontic-diagnosis. Color atlas of dental medicine—Rakosi T, Jonas I, Graber TM, eds. (1959) New York: Thieme. 109.

    Massler M. Oral habits, origin, evolution and current concepts of management. Alpha Omega (1963) 56:127–134.

    Modéer T, Odenrick L, Lindner A. Sucking habits and their relation to posterior crossbite in 4-year-old children. Scandinavian Journal of Dental Research (1982) 90:323–328.[Web of Science][Medline]

    Moyers RE. Handbook of orthodontics (1988) Philadelphia: Year Book Medical Publishers. 127–140.

    Ngan P, Fields HW. Open bite: a review of etiology and management. Pediatric Dentistry (1997) 19:91–98.[Medline]

    Øgaard B, Larsson E, Lindsten R. The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3-year-old children. American Journal of Orthodontics and Dentofacial Orthopedics (1994) 106:161–166.[Web of Science][Medline]

    Paredes Gallardo V, Paredes Cencillo C. Prevalencia de los hábitos bucales y alteraciones dentarias en escolares Valencianos. Anales de Pediatria (Barcelona) (2005) 62:261–265.

    Proffit WR, Fields HW. The development of orthodontic problems. In: Contemporary orthodontics (1986) Philadelphia: Mosby. 95–119.

    Svedmyr B. Dummy sucking. A study of its prevalence, duration and malocclusion consequences. Swedish Dental Journal (1979) 3:205–210.[Web of Science][Medline]

    Thilander B, Lennartsson B. A study of children with unilateral posterior crossbite, treated and untreated, in the deciduous dentition—occlusal and skeletal characteristics of significance in predicting the long-term outcome. Journal of Orofacial Orthopedics (2002) 63:371–383.[CrossRef][Medline]

    Thilander B, Wahlund S, Lennartsson B. The effect of early interceptive treatment in children with posterior cross-bite. European Journal of Orthodontics (1984) 6:25–34.[Abstract/Free Full Text]

    Thilander B, Mohlin B, Engermark I. Orthodontic aspects on a skull collection from the Carmelite monastery in New Varberg. Proceedings of the Finnish Dental Society (1991) 87:115–125.

    Vig KWL, Fields HW. Facial growth and management of orthodontic problems. Pediatric Clinics of North America (2000) 47:1085–1123.[CrossRef][Web of Science][Medline]

    Warren JJ, Bishara SE. Duration of nutritive and nonnutritive sucking behaviors and their effects on the dental arches in the primary dentition. American Journal of Orthodontics and Dentofacial Orthopedics (2002) 121:347–356.[CrossRef][Web of Science][Medline]

    Warren JJ, Slayton RL, Bishara SE, Levy SM, Yonezu T, Kanellis MJ. Effects of nonnutritive sucking habits on occlusal characteristics in the mixed dentition. Pediatric Dentistry (2005) 27:445–450.[Web of Science][Medline]


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