{"id":22764,"date":"2023-04-17T21:51:55","date_gmt":"2023-04-17T14:51:55","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22764"},"modified":"2023-05-02T13:50:52","modified_gmt":"2023-05-02T06:50:52","slug":"implant-gioi-thieu-so-luoc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/implant-gioi-thieu-so-luoc\/","title":{"rendered":"Implant – Gi\u1edbi thi\u1ec7u s\u01a1 l\u01b0\u1ee3c."},"content":{"rendered":"

B\u00e0i vi\u1ebft sau s\u1ebd t\u00f3m t\u1eaft s\u01a1 l\u01b0\u1ee3c v\u1ec1 nh\u1eefng kh\u1ea3 n\u0103ng c\u1ee7a Implant trong nha khoa, \u0111\u1ed3ng th\u1eddi v\u1edbi \u0111\u00f3 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c ti\u00eau chu\u1ea9n c\u1ee7a s\u1ef1 th\u00e0nh c\u00f4ng t\u1ed1i thi\u1ec3u tr\u00ean l\u00e2m s\u00e0ng. Nha s\u0129 c\u1ea7n n\u1eafm v\u1eefng v\u00e0 c\u00f3 c\u00e1i nh\u00ecn \u0111\u00fang \u0111\u1eafn v\u1ec1 Implant Nha khoa, g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a b\u1ec7nh nh\u00e2n. C\u00f9ng t\u00ecm hi\u1ec3u.<\/strong><\/p>\n

1. Gi\u1edbi thi\u1ec7u s\u01a1 l\u01b0\u1ee3c v\u1ec1 Implant nha khoa<\/h2>\n

Trong h\u01a1n hai th\u1eadp ni\u00ean v\u1eeba qua, c\u1ea5y gh\u00e9p implant trong x\u01b0\u01a1ng \u0111\u00e3 c\u00f3 nh\u1eefng b\u01b0\u1edbc ph\u00e1t tri\u1ec3n nhanh ch\u00f3ng. Hi\u1ec7n nay c\u00f3 kh\u00e1 nhi\u1ec1u h\u1ec7 th\u1ed1ng c\u00f3 th\u1ec3 mang \u0111\u1ebfn cho b\u00e1c s\u0129 l\u00e2m s\u00e0ng:<\/p>\n

\u2022 Kh\u1ea3 n\u0103ng t\u00edch h\u1ee3p x\u01b0\u01a1ng t\u1ed1t<\/p>\n

\u2022 Kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt linh ho\u1ea1t, h\u1ed7 tr\u1ee3 l\u1eadp k\u1ebf ho\u1ea1ch ph\u1ee5c h\u00ecnh<\/p>\n

\u2022 \u0110\u01b0\u1ee3c thi\u1ebft k\u1ebf gi\u00fap d\u1ec5 thao t\u00e1c v\u00e0 \u0111\u1ea1t th\u1ea9m m\u1ef9<\/p>\n

\u2022 Gi\u1ea3m t\u1ef7 l\u1ec7 bi\u1ebfn ch\u1ee9ng v\u00e0 s\u1eeda ch\u1eefa d\u1ec5 d\u00e0ng<\/p>\n

\u2022 H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng c\u1ee5 th\u1ec3<\/p>\n

\u2022 M\u1ed9t c\u00f4ng ty cung c\u1ea5p c\u00f3 uy t\u00edn v\u00e0 ch\u1ebf \u0111\u1ed9 ch\u0103m s\u00f3c kh\u00e1ch h\u00e0ng t\u1ed1t<\/p>\n

Kh\u00f4ng c\u00f3 h\u1ec7 th\u1ed1ng implant n\u00e0o l\u00e0 ho\u00e0n h\u1ea3o tuy\u1ec7t \u0111\u1ed1i c\u1ea3 v\u00e0 do \u0111\u00f3 g\u00e2y cho b\u00e1c s\u0129 kh\u00f4ng \u00edt b\u1ed1i r\u1ed1i khi ph\u1ea3i l\u1ef1a ch\u1ecdn. M\u1ed9t b\u00e1c s\u0129 l\u00e2m s\u00e0ng th\u01b0\u1eddng cho r\u1eb1ng m\u1ed9t h\u1ec7 th\u1ed1ng m\u1edbi th\u00ec t\u1ed1t h\u01a1n v\u00e0 \u00edt t\u1ed1n k\u00e9m h\u01a1n. Tuy nhi\u00ean \u0111i\u1ec1u tr\u1ecb c\u1ea5y gh\u00e9p nha khoa th\u00e0nh c\u00f4ng hay kh\u00f4ng l\u1ea1i ph\u1ee5 thu\u1ed9c v\u00e0o tr\u00ecnh \u0111\u1ed9 v\u00e0 kinh nghi\u1ec7m c\u1ee7a ph\u1eabu thu\u1eadt vi\u00ean. Do \u0111\u00f3, ph\u1ea7n l\u1edbn chi ph\u00ed \u0111i\u00eau tr\u1ecb kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o vi\u1ec7c s\u1eed d\u1ee5ng h\u1ec7 th\u1ed1ng Implant n\u00e0o m\u00e0 li\u00ean quan nhi\u1ec1u h\u01a1n \u0111\u1ebfn th\u1eddi gian thao t\u00e1c tr\u00ean l\u00e2m s\u00e0ng v\u00e0 labo.<\/p>\n

2. Ti\u00eau chu\u1ea9n c\u1ee7a s\u1ef1 th\u00e0nh c\u00f4ng t\u1ed1i thi\u1ec3u<\/h2>\n

Nhi\u1ec1u ti\u00eau chu\u1ea9n v\u1ec1 s\u1ef1 th\u00e0nh c\u00f4ng c\u1ee7a c\u1ea5y gh\u00e9p nha khoa \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1. V\u00ed d\u1ee5, Albrektsson v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 \u0111\u1ec1 ra nh\u1eefng ti\u00eau chu\u1ea9n th\u00e0nh c\u00f4ng t\u1ed1i thi\u1ec3u:<\/p>\n

1. Implant t\u00edch h\u1ee3p c\u1ee9ng ch\u1eafc trong x\u01b0\u01a1ng<\/p>\n

2. Tr\u00ean phim X quang kh\u00f4ng c\u00f3 v\u00f9ng th\u1ea5u quang quanh implant<\/p>\n

3. Sau n\u0103m \u0111\u1ea7u ti\u00ean ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng, m\u1ee9c \u0111\u1ed9 ti\u00eau x\u01b0\u01a1ng theo chi\u1ec1u d\u1ecdc \u00edt h\u01a1n 0.2 mm m\u1ed7i n\u0103m<\/p>\n

4. Kh\u00f4ng c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111au, nhi\u1ec5m tr\u00f9ng, d\u1ecb c\u1ea3m ho\u1eb7c x\u00e2m l\u1ea5n v\u00e0o \u1ed1ng th\u1ea7n kinh r\u0103ng d\u01b0\u1edbi.<\/p>\n

5. N\u1ebfu \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u1ea7y \u0111\u1ee7 c\u00e1c ti\u00eau ch\u00ed tr\u00ean th\u00ec t\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng s\u1ebd \u0111\u1ea1t kho\u1ea3ng 85% sau 5 n\u0103m, v\u00e0 80% sau 10 n\u0103m theo d\u00f5i.<\/p>\n

Ti\u00eau chu\u1ea9n ti\u00ean quy\u1ebft \u0111\u00f3 l\u00e0 implant kh\u00f4ng \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ed9ng (ti\u00eau chu\u1ea9n 1). Theo \u0111\u1ecbnh ngh\u0129a, qu\u00e1 tr\u00ecnh t\u00edch h\u1ee3p x\u01b0\u01a1ng t\u1ea1o ra m\u1ed9t t\u1ed5 h\u1ee3p c\u1ea5u tr\u00fac ch\u1ee9c n\u0103ng gi\u1eefa b\u1ec1 m\u1eb7t x\u01b0\u01a1ng v\u00e0 b\u1ec1 m\u1eb7t implant.<\/p>\n

\"implant-1\"
L\u00e1t c\u1eaft m\u00f4 h\u1ecdc c\u1ee7a s\u1ef1 t\u00edch h\u1ee3p x\u01b0\u01a1ng: (A) B\u1ec1 m\u1eb7t titanium c\u1ee7a implant c\u00f3 c\u00e1c ren v\u00e0 x\u01b0\u01a1ng ti\u1ebfp x\u00fac b\u1ec1 m\u1eb7t tr\u00ean m\u1ed9t v\u00f9ng l\u1edbn. M\u1ed9t \u00edt t\u1ee7y x\u01b0\u01a1ng hi\u1ec7n di\u1ec7n v\u00e0 ti\u1ebfp x\u00fac v\u1edbi b\u1ec1 m\u1eb7t implant. (B) G\u00f3c nh\u00ecn c\u1eadn c\u1ea3nh c\u1ee7a x\u01b0\u01a1ng khi ti\u1ebfp x\u00fac b\u1ec1 m\u1eb7t titanium.<\/figcaption><\/figure>\n

Implant v\u00ec v\u1eady \u0111\u01b0\u1ee3c gi\u1eef m\u1ed9t c\u00e1ch c\u1ee9ng ch\u1eafc trong x\u01b0\u01a1ng m\u00e0 kh\u00f4ng c\u1ea7n s\u1ef1 tr\u1ee3 gi\u00fap c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac s\u1ee3i (hay d\u00e2y ch\u1eb1ng nha chu) v\u00e0 do \u0111\u00f3 s\u1ebd kh\u00f4ng c\u00f3 s\u1ef1 chuy\u1ec3n \u0111\u1ed9ng ho\u1eb7c v\u00f9ng th\u1ea5u quang quanh implant (ti\u00eau chu\u1ea9n 2). Tuy nhi\u00ean mu\u1ed1n ki\u1ec3m tra s\u1ef1 di \u0111\u1ed9ng c\u1ee7a m\u1ed9t implant \u0111ang mang c\u1ea7u r\u0103ng c\u1ed1 \u0111\u1ecbnh th\u00ec ph\u1ea3i th\u00e1o c\u1ea7u r\u0103ng ra. Do \u0111\u00f3 th\u1eed nghi\u1ec7m n\u00e0y r\u1ea5t kh\u00f3 s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng c\u0169ng nh\u01b0 trong nh\u1eefng nghi\u00ean c\u1ee9u d\u00e0i h\u1ea1n, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi c\u00e1c ph\u1ee5c h\u1ed3i th\u01b0\u1eddng \u0111\u01b0\u1ee3c g\u1eafn b\u1eb1ng cement h\u01a1n l\u00e0 l\u01b0u gi\u1eef b\u1eb1ng v\u00edt. M\u1ee9c x\u01b0\u01a1ng tr\u00ean phim tia X c\u0169ng r\u1ea5t kh\u00f3 \u01b0\u1edbc l\u01b0\u1ee3ng b\u1edfi v\u00ec n\u00f3 ph\u1ee5 thu\u1ed9c v\u00e0o ph\u00e9p \u0111o theo chi\u1ec1u d\u1ecdc t\u1eeb m\u1ed9t \u0111i\u1ec3m m\u1ed1c \u0111\u1eb7c bi\u1ec7t n\u00e0o \u0111\u00f3.<\/p>\n

\"implant-2\"
(A) Implant Branemark d\u00f9ng \u0111\u1ec3 thay th\u1ebf r\u0103ng c\u1eeda gi\u1eefa h\u00e0m tr\u00ean. M\u1ee9c x\u01b0\u01a1ng ph\u00eda g\u1ea7n v\u00e0 ph\u00eda xa n\u1eb1m c\u00f9ng m\u1ee9c v\u1edbi ren \u0111\u1ea7u ti\u00ean c\u1ee7a implant. \u0110i\u1ec3m m\u1ed1c th\u01b0\u1eddng \u0111\u01b0\u1ee3c ch\u1ecdn \u0111\u1ec3 \u0111o m\u1ee9c x\u01b0\u01a1ng ch\u00ednh l\u00e0 \u0111\u1ea7u c\u1ee7a implant – v\u1edbi h\u00ecnh d\u1ea1ng ph\u1eb3ng t\u1ea1i v\u00f9ng k\u1ebft n\u1ed1i v\u1edbi abutment titanium. (B) Implant Astra Tech d\u00f9ng \u0111\u1ec3 thay th\u1ebf r\u0103ng c\u1eeda gi\u1eefa tr\u00ean. X\u01b0\u01a1ng ph\u00eda g\u1ea7n v\u00e0 ph\u00eda xa n\u1eb1m c\u00f9ng m\u1ee9c v\u1edbi \u0111\u1ea7u c\u1ee7a implant. \u0110\u00e2y l\u00e0 m\u1ed1c th\u01b0\u1eddng d\u00f9ng \u0111\u1ec3 \u0111o s\u1ef1 thay \u0111\u1ed5i x\u01b0\u01a1ng c\u1ee7a h\u1ec7 th\u1ed1ng implant n\u00e0y. Abutment titanium c\u00f3 \u0111\u01b0\u1eddng k\u00ednh nh\u1ecf h\u01a1n \u0111\u1ea7u tr\u1ee5 cho ta th\u1ea5y m\u1ed9t \u0111\u01b0\u1eddng vi\u1ec1n \u00e2m<\/figcaption><\/figure>\n

\u0110i\u1ec3m m\u1ed1c n\u00e0y c\u00f3 th\u1ec3 kh\u00e1c nhau gi\u1eefa c\u00e1c h\u00e3ng v\u00e0 \u0111\u00f4i khi kh\u00f3 x\u00e1c \u0111\u1ecbnh. Th\u00ed d\u1ee5, \u0111\u1ec9nh ph\u1eb3ng c\u1ee7a implant h\u1ec7 th\u1ed1ng c\u1ee7a Branemark \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh m\u1ed9t c\u00e1ch d\u1ec5 d\u00e0ng tr\u00ean m\u1ed9t phim tia X v\u00e0 \u0111\u01b0\u1ee3c d\u00f9ng nh\u01b0 m\u1ed9t m\u1ed1c \u0111\u1ec3 \u0111o \u0111\u1ea1c s\u1ef1 thay \u0111\u1ed5i c\u1ee7a x\u01b0\u01a1ng. Trong nhi\u1ec1u thi\u1ebft k\u1ebf implant, ng\u01b0\u1eddi ta hy v\u1ecdng c\u00f3 s\u1ef1 t\u00e1i c\u1ea5u tr\u00fac x\u01b0\u01a1ng trong n\u0103m \u0111\u1ea7u ti\u00ean c\u1ee7a ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng \u0111\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi l\u1ef1c nhai v\u00e0 s\u1ef1 t\u00e1i l\u1eadp k\u00edch th\u01b0\u1edbc b\u00ecnh th\u01b0\u1eddng c\u1ee7a m\u00f4 m\u1ec1m quanh tr\u1ee5. V\u1ec1 sau, m\u1ee9c x\u01b0\u01a1ng s\u1ebd \u1ed5n \u0111\u1ecbnh \u1edf ph\u1ea7n l\u1edbn c\u00e1c implant trong nhi\u1ec1u n\u0103m. M\u1ed9t t\u1ec9 l\u1ec7 nh\u1ecf implant b\u1ecb ti\u00eau x\u01b0\u01a1ng v\u00e0 m\u1ed9t gi\u00e1 tr\u1ecb trung b\u00ecnh \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 trong y v\u0103n. S\u1ef1 ti\u1ebfn tri\u1ec3n hay ti\u1ebfp t\u1ee5c ti\u00eau x\u01b0\u01a1ng l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u th\u1ea5t b\u1ea1i trong implant. Tuy nhi\u00ean g\u1ea7n nh\u01b0 kh\u00f4ng th\u1ec3 t\u00ecm th\u1ea5y m\u1ed9t s\u1ef1 th\u1ed1ng nh\u1ea5t chung gi\u1eefa nh\u1eefng nh\u00e0 nghi\u00ean c\u1ee9u v\u00e0 b\u00e1c s\u0129 l\u00e2m s\u00e0ng r\u1eb1ng m\u1ee9c \u0111\u1ed9 ti\u00eau x\u01b0\u01a1ng n\u00e0o l\u00e0 th\u1ea5t b\u1ea1i. V\u00ec th\u1ebf implant ch\u1ec9 b\u1ecb cho l\u00e0 th\u1ea5t b\u1ea1i khi n\u00f3 b\u1ecb l\u1ea5y ra kh\u1ecfi mi\u1ec7ng. Nh\u1eefng implant v\u1eabn ho\u1ea1t \u0111\u1ed9ng ch\u1ee9c n\u0103ng nh\u01b0ng kh\u00f4ng \u0111\u1ea1t \u0111\u1ee7 ti\u00eau chu\u1ea9n th\u00e0nh c\u00f4ng th\u00ec \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u201cc\u00f2n s\u1ed1ng s\u00f3t\u201d. M\u1ee9c \u0111\u1ed9 ti\u00eau x\u01b0\u01a1ng tr\u00ean phim tia X c\u0169ng l\u00e0 1 trong nh\u1eefng ti\u00eau chu\u1ea9n c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng \u201cvi\u00eam quanh implant\u201d, ngo\u00e0i s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a vi\u00eam m\u00f4 m\u1ec1m. M\u1ee9c \u0111\u1ed9 ti\u00eau x\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c t\u00ednh ra s\u1ed1 c\u1ee5 th\u1ec3, v\u00ed d\u1ee5 >=1.8 mm, h\u01a1n l\u00e0 \u01b0\u1edbc l\u01b0\u1ee3ng s\u1ef1 ti\u1ebfn tri\u1ec3n ti\u00eau x\u01b0\u01a1ng so v\u1edbi 1 \u0111i\u1ec3m m\u1ed1c n\u00e0o \u0111\u00f3. Khi \u0111\u1ecdc c\u00e1c t\u00e0i li\u1ec7u, ph\u1ea3i l\u01b0u \u00fd hi\u1ec3u \u0111\u00fang nh\u1eefng thu\u1eadt ng\u1eef m\u00f4 t\u1ea3 s\u1ef1 thay \u0111\u1ed5i x\u01b0\u01a1ng, v\u00ed d\u1ee5, \u201cm\u1ee9c x\u01b0\u01a1ng\u201d di\u1ec5n t\u1ea3 v\u1ecb tr\u00ed c\u1ee7a x\u01b0\u01a1ng so v\u1edbi \u0111i\u1ec3m m\u1ed1c t\u1ea1i 1 th\u1eddi \u0111i\u1ec3m n\u00e0o \u0111\u00f3, trong khi \u201cti\u00eau x\u01b0\u01a1ng\u201d ch\u1ec9 s\u1ef1 suy gi\u1ea3m v\u1ec1 m\u1ee9c x\u01b0\u01a1ng trong 1 kho\u1ea3ng th\u1eddi gian.<\/p>\n

Implant \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1edf h\u00e0m d\u01b0\u1edbi (\u0111\u1eb7c bi\u1ec7t l\u00e0 ph\u00eda tr\u01b0\u1edbc l\u1ed7 c\u1eb1m) c\u00f3 t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng cao, nh\u01b0 v\u1eady s\u1ebd kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t r\u00f5 r\u00e0ng gi\u1eefa c\u00e1c h\u1ec7 th\u1ed1ng implant kh\u00e1c nhau. Ng\u01b0\u1ee3c l\u1ea1i, khi c\u1eafm gh\u00e9p Implant \u1edf v\u00f9ng r\u0103ng sau h\u00e0m tr\u00ean ph\u1ea3i \u0111\u1eb7t implant ng\u1eafn h\u01a1n, x\u01b0\u01a1ng l\u1ea1i m\u1ec1m h\u01a1n n\u00ean \u0111\u00e3 cho th\u1ea5y nh\u1eefng t\u1ef7 l\u1ec7 th\u00e0nh c\u00f4ng kh\u00e1c nhau. \u0110i\u1ec1u n\u00e0y v\u1eabn c\u00f2n \u0111\u01b0\u1ee3c ch\u1ee9ng minh trong c\u00e1c nghi\u00ean c\u1ee9u th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng. Hi\u1ec7n t\u1ea1i kh\u00f4ng c\u00f3 c\u01a1 s\u1edf \u0111\u1ec3 cho r\u1eb1ng c\u00f3 m\u1ed9t h\u1ec7 th\u1ed1ng \u01b0u vi\u1ec7t h\u01a1n.<\/p>\n

Ngu\u1ed3n: Implant trong th\u1ef1c h\u00e0nh Nha khoa – Richard D.Palmer\/Nh\u00f3m d\u1ecbch SYD Vi\u1ec7t Nam<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

B\u00e0i vi\u1ebft sau s\u1ebd t\u00f3m t\u1eaft s\u01a1 l\u01b0\u1ee3c v\u1ec1 nh\u1eefng kh\u1ea3 n\u0103ng c\u1ee7a Implant trong nha khoa, \u0111\u1ed3ng th\u1eddi v\u1edbi \u0111\u00f3 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c ti\u00eau chu\u1ea9n c\u1ee7a s\u1ef1 th\u00e0nh c\u00f4ng t\u1ed1i thi\u1ec3u tr\u00ean l\u00e2m s\u00e0ng. Nha s\u0129 c\u1ea7n n\u1eafm v\u1eefng v\u00e0 c\u00f3 c\u00e1i nh\u00ecn \u0111\u00fang \u0111\u1eafn v\u1ec1 Implant Nha khoa, g\u00f3p ph\u1ea7n v\u00e0o s\u1ef1 […]<\/p>\n","protected":false},"author":21,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[28,33],"tags":[3],"yoast_head":"\nImplant - Gi\u1edbi thi\u1ec7u s\u01a1 l\u01b0\u1ee3c. - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft t\u00f3m t\u1eaft s\u01a1 l\u01b0\u1ee3c kh\u1ea3 n\u0103ng c\u1ee7a Implant trong nha khoa, v\u00e0 n\u00f3i \u0111\u1ebfn ti\u00eau chu\u1ea9n th\u00e0nh c\u00f4ng t\u1ed1i thi\u1ec3u tr\u00ean l\u00e2m s\u00e0ng. 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