Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

July 27, 2017

This is too much sensitivity – you need a root canal


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Dear Dr. Hall:
On June 26, my dentist prepared my cracked tooth number 30 (lower right first molar) for a crown. I had several problems with the temporary crown including very sore gum and pain with biting and cold sensitivity. However, since the pain was not lingering, my dentist placed my permanent crown on July 12. But it didn’t subside and in fact, it got worse. After one week, I visited him again and he took X-ray and did cold test and pressure test. He also knocked at my tooth which was not painful. My tooth was very sensitive to cold but it went away in less than 30 seconds. Also, I didn’t feel pain with pressure test although I felt pain when I bit on hard things. So my dentist said I had to wait and I had high chances to get better. He said sensitivity to pressure is normal even for 30 to 90 days. Now 10 days has passed and from my permanent crown placement, but I don’t see any improvement. Also, today I discovered my tooth is sensitive to hot food too although it doesn’t linger for a long time after the hot food is removed. I think once I realized this sensitivity with that temporary crown but didn’t care about it.
Are these reversible pulpitis symptoms? Does that heat sensitivity show my tooth nerve is dying? How long do you think I must wait before I see an endodontist?
Thanks a lot.
– Bita from Iowa

Bita,
Thanks for the clear description of your symptoms! You told me what kind of pain, what provokes it, and gave me a clear history, which makes it much easier to figure out what is going on with your tooth.
I would call the endodontist today. There are a couple of red flags here and I’d get an expert diagnosis before this tooth gets any worse. It doesn’t look good.
I don’t want to be too critical of your dentist, because I don’t know the whole story of your tooth—just what you’ve told me. But just taking what you’ve told me, some additional caution in your case seems like it would have been wise, and I’ll explain why. It also isn’t normal for a tooth with a new crown to be sensitive to pressure for more than a few days, if the occlusion is adjusted correctly.
First, you had a cracked tooth. A crack can easily involve the pulp of a tooth and by itself can cause a tooth to become infected and the pulp to die.
On top of this, you had significant cold sensitivity after the crown preparation. This could have been due to an incompletely sealed temporary crown, or it could have been due to the extra irritation to which the tooth was subjected from the crown preparation, or a combination of the two. It would have been wise to have coated the tooth with some type of desensitizing product at this point. Maybe that was done.
Also, given those two things, it would have been prudent to have temporarily cemented the crown. This is a lower first molar, so the crown would have to be made out of some strong material that could have been cemented with a soothing type of cement in hopes that it would settle down, or, if it didn’t, to allow easy removal of the crown for root canal treatment. Permanently cementing a crown is usually an additional irritation which can push a borderline tooth over the edge to needing root canal treatment.
So your dentist permanently cemented the crown and the pain got worse. Your sensitivity is headed in the wrong direction and appears that it will end up in irreversible pulpitis, requiring root canal treatment.
And now it is getting sensitive to heat. I wouldn’t go quite so far as to say that it’s absolutely certainly suffering from irreversible pulpitis at this point, but if not, it’s awfully close. The endodontist should be able to tell you for certain. There would be subtle changes in the ligament of the tooth around the end of the root that most general dentists wouldn’t see but the endodontist should.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

August 1, 2016

Can broken-off teeth be restored?


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Dr. Hall,
My husband has 2 front teeth that are broken off. The roots are intact. Other than a partial plate or a bridge is it possible to have root canals and caps?
– Jen from Ontario

Jen,

Yes, it may be possible to save a front tooth that is broken off, by doing a root canal, putting a post in that root canal, and putting a crown [cap] on the post, if there isn’t too much of the tooth broken off. It depends on the kind of bite your husband has. And it depends on the attitude of the dentist. Many dentists, I can tell you, may not want to attempt that. And recently, as dental implants have become more reliable and more popular, there may be less tendency of dentists to want to try to save teeth like this.

The mechanics of fixing a front tooth like this are tricky. A lot of dentists won’t realize that the main force working against them is a rotational force on the tooth. The front teeth are kind of roundish at the root. Then if the dentist puts a round post into the root, the resultant restoration doesn’t offer much resistance to rotational forces. Over time, then, those rotational forces can work the post loose. A way to brace against those rotational forces is to put two posts into the root.

Another problem that many dentists may not realize about this situation is that the post can end up cracking the root. There is a tendency to think that a rigid post would be stronger, and it may be stronger. But when tipping forces occur against the root, a rigid post will transfer those forces to deep inside the root where the tooth is thinner and they can crack the root. So flexible posts, such as carbon fiber or fiberglass posts should be used on front teeth.

Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 30, 2016

My tooth was fine until my dentist worked on it


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Dr. Hall,
I went to my dentist recently and he filled a front tooth. While in the chair he stated that he saw a small crack on the rear molar on the left side, and he said it needed to be repaired. He drilled the tooth out, banded it, and filled it with composite. I called him the next day because the tooth was extremely painful. Two days after he did the procedure I was back in his office, and after a cold test he said that I needed a crown and a root canal. I had him pull the tooth. Should I pay him for the extraction when there was no issue with the tooth, before he removed half of it, other than a small crack?
– Mark from Georgia

Mark,

Nothing you told me indicates to me that your dentist did anything wrong. Yes, it’s possible, because I don’t know the whole story. But I’ve seen this sort of thing many times, and it sounds to me like your dentist did the right thing.

When you say that there was nothing wrong with this molar but a small crack, that’s not the complete story. A crack is almost always a symptom of a major underlying problem with the tooth. A tooth that is otherwise healthy will not have a small crack in it. From subsequent events, it seems clear to me that this tooth was already infected. Yes, working on it irritated it a little more and placing a well-sealed filling over the infected pulp of the tooth caused an immediate painful reaction. Had your tooth been healthy before your dentist worked on it and had merely had some accident during the procedure, your tooth would have started to get diseased and it would have taken some time for it to flare up. The fact that it was immediately painful indicates that this disease process was probably already pretty advanced.

The reason your dentist was concerned when he saw this “small crack” was that the tooth probably had a large filling in it. You didn’t say what type of filling, but almost all teeth with cracks have large fillings in them, usually amalgam fillings. The crack would probably indicate that there is some leakage around the filling, meaning that decay will be able to leak through and get under the filling.

Not being able to see the x-ray, and not having looked over the shoulder of your dentist while he was working on your tooth, I can’t say with certainty what happened, but let me tell you what probably happened, based on my experience with many of these situations. Your dentist removed the old, leaky filling, likely with some decay underneath it. The dentin that was left between the bottom of your cavity and the pulp of the tooth was thin but intact. However, dentin is porous, and because of how the tooth reacted it appears to be clear that bacteria from the decay had been able to penetrate that porous dentin to infect the pulp of the tooth, causing it to be slightly inflamed. Working on the tooth irritated it somewhat, as it always does. Your dentist then replaced the old leaky filling with a new composite resin filling, bonded to the tooth and tightly sealed. The well-sealed filling now caused the internal pressure of the inflamed pulp to increase, which is what caused your immediate painful reaction.

I’m sorry for your sake that you had the tooth pulled when it could have been saved, but that is water under the bridge now. If it was the tooth furthest back in your arch, that shouldn’t have a serious impact on your bite, but you might eventually end up also losing the opposing tooth because it now may have no tooth to chew against and will hyper-erupt.

My recommendation to you would be to have your dentist look at your entire mouth and all your old dental work with a new set of eyes, and replace any old, suspicious fillings with new, well-sealed composite fillings, to help prevent this from happening again.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

December 21, 2015

Sensitivity after a small composite filling on a back tooth, and a dentist who won’t fix it

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Dr. Hall, I recently had a small composite filling done on tooth 14 [upper left first molar] and am experiencing the exact symptoms you describe as:

“With composite fillings, there is an unusual kind of sensitivity that sometimes occurs. With this sensitivity, the tooth is not sensitive when you clench your teeth together but will experience a sharp pain when food is chewed. . . . Curiously, it tends to occur most often in smaller fillings. When it occurs, replacing the filling with another composite filling can eliminate the sensitivity.”

My question is, can you point me towards any documentation or research concerning this unusual sensitivity? My dentist has checked for a cracked tooth, adjusted my bite twice and yet my extreme sharp sensitivity to chewing food still exists. He states he sees 5 or 6 patients a year with this type of sensitivity (all in small fillings he claims) but still insists that my bite is off and is suggesting a crown/root canal if the pain does not go away. I have searched the internet for more information about this unusual sensitivity but have not found much other than your website. When I suggested he redo the filling, he stated composite material bonds excellent and that could not be the cause. Can you help provide me with more information or a piece of your own knowledge regarding this?

Thanks for you time.
Matthew from Arkansas

Matthew,
Do a root canal and a crown? You have to be kidding me! When all you need is a small composite filling?

You’re asking me about documentation for this. I’m guessing that what you want to do is take that documentation to your dentist and convince him that replacing the filling is the way to solve this. The problem is I have never seen this approach work where the patient tries to become the teacher. Plus, you already have documentation on this sensitivity—my web page you reference that explains tooth sensitivity after a composite filling. The page should have pretty good credibility with you and your dentist because it nails your problem exactly—small composite filling, pain when you chew, no pain when you bite, the bite adjustment didn’t solve it, checking for a cracked tooth doesn’t turn up anything. What more does your dentist need? Look up my CV and check my credentials. Not only have I heard other lecturers talk about this, I had a fair amount of experience with this. Replacing the filling does work, as I did that every time I saw this sensitivity and it worked every time.

The problem may actually be that your dentist doesn’t WANT to replace the filling. What he appears to want is to do a root canal and a crown. The crown and root canal will likely be near $2000, but he’d have to replace the filling for free. He’s leaving me wondering if that isn’t what he’s really concerned about.

No, I don’t think you’re going to persuade your dentist, no matter what you do. I think you need to get a little assertive with him. Here’s what I recommend doing: Take a printed copy of my web page (assuming he hasn’t seen it yet), and maybe a copy of my CV (you can find that on our infinitydentalweb.com website). Show that to him and then tell him you and he can fix this one of two ways. Either he can replace the filling himself, putting in a glass ionomer base that completely covers the dentin before the tooth is etched (that’s the best guarantee for eliminating the sensitivity). Or, if he won’t do that, you’ll go to another dentist to have that done, which will solve the problem and prove him wrong. And then you will demand that he pay for it or you will report him to the dental board and take your complaint public on Yelp or Google reviews.

And I’d love to know how this turns out.

Dr. Hall

Do you have a comment? We’d love to hear from you. Enter your comment below.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

November 30, 2012

How to treat a cracked tooth

Filed under: Fractured teeth — Tags: , , , , — mesasmiles @ 6:15 pm

I have cracked a tooth. It is on the bottom next to the back. An endodontist looked at it and suggested a crown. but was asked by my regular dentist to take out the filling to see how deep the crack was.This was not done.So my dentist tried to mend the crack.I cannot stand pressure on one side of tooth and it did not work. Since one side of tooth feels strong we are now considering an onlay. Do you feel a cracked tooth can be mended like this? Or should I go with the crown. I hated drilling away so much of my tooth that was not damaged.
– Pamela from Kentucky

Pamela,

I’m not going to be able to give you a certain answer to your particular situation. There are many degrees of cracks in teeth, from a superficial crack that is just in the enamel, to a deep crack that goes all the way into the dentin and could even involve the pulp of the tooth. And there are different places a tooth could be cracked. The crack could be horizontal, involving a cusp or a corner of the tooth, or it could be vertical, down the middle.

And to be clear, here, we’re talking about cracks and not fractures. If the pieces of a tooth move independently, then the tooth is fractured. The idea of treating a cracked tooth is to keep it from fracturing.

And there are different kinds of onlays. Some would work well for any type of crack and some would have restrictions.

An onlay covers all or most of the chewing surface of a tooth. It is a very nice restoration. It is hard to do, so a lot of dentists don’t do them. Since it doesn’t go down below the gumline except between the teeth, it is very gentle to the gums and helps promote good gum health. They can be made out of gold, porcelain, or hardened composite.

A gold onlay covering the entire chewing surface of a tooth would completely protect any type of cracked tooth. I would feel very comfortable with that. If the onlay is made of porcelain, I would only use it to protect the tooth in the case of a minor crack – either a superficial crack or a horizontal crack involving just a cusp or a corner of the tooth. The porcelain is not strong enough to hold a tooth together that has a serious vertical crack. Some supposed experts teach that the bonding strength of porcelain to the tooth is strong enough for this situation, and I believed that at one time, until I used an all-porcelain crown on a tooth that had a serious vertical crack. The porcelain crown and the tooth both ended up cracking all the way through, and I ended up repairing the situation at my own expense.

And hardened composite is considerably weaker than porcelain. I would not recommend that for any type of crack in a tooth.

This idea of repairing the crack with some other technique than a crown – no, that wouldn’t work. It might hold for a short period, but it’s not a long-term solution. Now if you were putting pressure on your dentist to find a more economical solution, then I understand. But if this was the dentist’s first choice of treatment, it makes me a little skeptical. I’m not sure what you’re meaning when you say that this treatment didn’t work, and I’m not following you when you talk about the pressure on one side of the tooth. I can’t visualize what you’re saying. And I don’t understand what that means, that a side of the tooth feels strong. So maybe your dentist is right. But I have this skepticism and would suggest a second opinion.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

May 11, 2012

Serious pain to biting on my tooth with the new filling

Filed under: Pain in teeth — Tags: , , , — mesasmiles @ 3:40 pm

Hi Dr. Hall
In February I went to my dentist and she told me I needed my first two fillings (I’m 23). She told me my top first left molar would be just a spot filling and my bottom first right molar wasn’t deep. On my bottom molar I opted to get a composite white filling (now I wish I had of opted for an amalgam one instead).

Everything was great for about two weeks until I would wake up during the night with pressure shocks when biting down but it did subside over time, but then it got worse. I did make an appointment with my dentist and she shaved down some of my white filling.

I went back four days ago. She said to me that she was going to take out my white filling and have a look because what I was describing to her sounded like a crack in the tooth and she would ether put in another composite or a temporary filling. Once she got into my tooth she said my filling was deep after all and it was now even deeper after her taking out the white composite filling, she went on to say there was a small crack in the tooth. She then went on to say that she would just fill it up again with a composite.

Once the procedure was done she told me that she didn’t know what the out come would be and that if it didn’t get any better I would need root canal treatment. This I am really scared of.

Since then it has been giving me shocks when I bite, and sometimes if I just touch it with my tongue. Today it’s not as bad.

What should I do from here? Should I be so scared of getting a root canal? And should I just get my tooth pulled instead? (My wisdom teeth are still coming through)

Thanks in advance
Suzanne, Northern Ireland

Suzanne,
I’m not sure what’s wrong with your tooth. It could be a crack in your tooth. It could be traumatic occlusion, meaning that the adjustment should do. Or it could be that the tooth is infected. The fact that there was no pain until a couple of weeks after the filling was done seems to suggest a cracked tooth or an infected tooth. That would mean that the cavity was deeper than you had been led to believe. But I’d have to see the x-ray and do an examination to know for sure. In the case of a deep filling or a tooth that could potentially crack, you are better off with a white composite filling than with an amalgam filling. Amalgam weakens the tooth and is more irritating to the tooth.

I’m skeptical of the skills of your dentist, so if you do end up needing a root canal treatment, I would recommend seeing a root canal specialist. Do they have those (endodontists) in your health care system? With modern root canal techniques, getting a root canal treatment is usually fairly routine. but it does have to be done carefully or there can be a risk of failure of the treatment and you could lose the tooth anyway.

Do not have the tooth pulled. Without a replacement tooth being placed immediately, at your age with your wisdom teeth still coming through, your second molar will tip forward and throw your bite permanently out of alignment, and you could end up with a lifetime of troubles, especially if you tend to grind your teeth.

But I’m puzzling over what your dentist said, that she saw a crack in your tooth when she went back in. That certainly makes it seem like that’s the cause of your pain. But if your tooth is cracked to the point where that is causing you pain, you should have a crown on the tooth, and not just a filling. It seems like she should have recommended a crown. Without a crown, sooner or later, your tooth will break. And if you don’t need a root canal yet, after it breaks you probably will.

I would ask around for recommendations and find another dentist for a second opinion. If the tooth is cracked but it isn’t yet hurting on its own, doing a crown to cover the tooth could prevent any further problems.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

August 11, 2011

I brush and floss every day but still need root canals. What can I do?

Filed under: Root canals — Tags: , , , , , , — mesasmiles @ 7:40 pm

Dear Dr. Hall,
I am 27 years old in the middle of two root canals. The first one was a tooth whose white filling had begun to fail. The second was a crown placed a year and half ago that started to become sensitive to temperature and could not be used to chew with. I have become very worried about the health of my teeth. I have quite a few old (ten years or more) silver filings in the back of my mouth. These two root canals had fillings that were very close to the root of the tooth. I am also a stress grinder which has led to the cracking of at least two teeth. It seems like all my teeth hurt at this moment. Especially the canine on the side of my first root canal treatment. What can I do about the future of my teeth? I don’t want a bridge or implant so young. I brush and floss everyday, sometimes three times a day.
– Janie from New Hampshire

Janie,
I can relate to your experiences. In my late forties, I got my first toothache. It surprised me, because as a dentist, I have taken very good care of my teeth and have sought out the best care I could get from the best dentists. While I had a fair amount of decay in my young adult years, I hadn’t had dental problems for quite some time. The toothache came because I got little cracks in my teeth from the old fillings. Over the next ten years I ended up needing root canal treatments in most of my molars, and all of my molars now have crowns on them.

Still, I don’t have any serious worries about losing my teeth or needing bridgework or implants. Root canal treatments, once they are successful, last for a lifetime. And if crowns are done well and are well cared for, they will last 20, 30, maybe 40 years.

Your problems are not the usual but are not uncommon either. After a tooth has been worked on several times, it is easy for it to develop sensitivity. And grinding your teeth puts a lot of stress on them.

My advice is to be sure you get good dental care. Don’t look for cheap care. Cheap care ends up being very expensive in the long run. Look for a quality dentist who is trustworthy and stays abreast of the latest techniques. Then, if you trust this dentist, stay regular with your checkups and do what the dentist recommends. Follow through with your home care. And to keep tooth decay down, avoid frequent snacking. Most people, and even some dentists, don’t realize how much damage frequent snacking during the day does to your teeth.

For your grinding (dentists call it bruxism), a nightguard can do wonders to provide considerable protection to your teeth.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

June 17, 2011

Thank you, Dr. Hall

Filed under: Thank yous — Tags: , , , — mesasmiles @ 9:43 am

I had a correspondence back and forth with Cortney from Maryland.
She first wrote to me bothered because her dentist had said she had a little cavity, which he filled. The tooth then became sensitive and the dentist wanted to do a root canal. See the original post: “It was a small cavity – now he says I need a root canal!”

I questioned the dentist’s recommendation, advised her to get a second opinion, and gave her some guidelines on how to tell if the tooth is infected.

She responded with the following:

Thank you Dr. Hall. I did take your advice to seek a second opinion and she took 2 digital xrays and saw no sign of infection. She did visually inspect a hairline fracture on the back of tooth #2 and her plan is to crown the tooth to hold it together. She didnt seem to think it needed a root canal either at this point since the sensitivity is to cold and air stimulus and lasts less than 10 sec. I really appreciate all your advice and credit you with helping solve my tooth dilemma. Now my mind is at ease and I can focus on the rest of my pregnancy. Thank you Dr Hall!
 – Cortney from Maryland

 

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

October 16, 2010

Can you tell a cracked tooth from an x-ray?

Filed under: Fractured teeth — Tags: , , , — mesasmiles @ 9:58 pm

Is it easy for an x-ray to miss detecting a cracked tooth? I had full mouth x-rays-taken at two different dental offices within a month of each other. Neither set of x-rays detected a cracked tooth. But when I changed to another dental office and that dentist referred me to an Endodontist, from the x-rays the Endo took, he told me I had a cracked tooth that needed a root canal right away. I’m wondering why the other two dental offices missed seeing that cracked tooth in the x-rays, and am wondering if it is common for an x-ray and/or dentist to miss detecting a cracked tooth?
– Grace from California

Grace,
I would put the answer to your question this way – it is very difficult to detect a cracked tooth on an x-ray. Unless the x-ray is taken at the exact angle of the crack, it won’t show up.

I suspect that the endodontist didn’t actually see the crack, but saw some subtle evidence that suggested a crack.

I have four molars of my own that all ended up needing root canal treatments because of cracks developing in them. But none of the cracks have ever shown up on an x-ray.

Dr. Hall

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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