Management of Tooth fracture

Introduction
Classification of tooth fracture
Longitudinal tooth fracture
Craze lines
Cuspal fracture
Crack tooth to split tooth
Vertical fracture
Risk factors
Diagnosis
Management
Transverse tooth fracture
Horizontal root fracture
Classification of the horizontal fracture
Diagnosis
Treatment based on location
Splinting
Types of healing
Factors influence healing and prognosis
IATD Guidelines
Enamel fracture
Enamel-dentin fracture
Enamel-dentin-pulp fracture
Crown-root fracture without pulpal involvement
Crown-root fracture with pulpal involvement
Conclusion
References

1. MANAGEMENT OF FRACTURED TOOTH Dr Urvashi Sodvadiya

2. Flow Chart Introduction Classification of tooth fracture Longitudinal tooth fracture Craze lines Cuspal fracture Crack tooth to split tooth Vertical fracture Risk factors Diagnosis Management Transverse tooth fracture Horizontal root fracture Classification of horizontal fracture Diagnosis

3. Treatment based on location Spliting Types of healing Factors influences healing and prognosis IATD Guidelines Enamel fracture Enamel-dentin fracture Enamel-dentin-pulp fracture Crown-root fracture without pulpal involvement Crown-root fracture with pulpal involvement Conclusion References

4. Introduction

5. Longitudinal fracture Classified by AAE Transverse fracture craze lines; fractured cusp; cracked tooth; split tooth; and vertical root fracture Enamel fracture Enamel-Dentin fracture Enamel- dentin- pulp fracture Crown-root fracture without pulpal involvement Crown-root fracture with pulpal involvement Horizontal root fracture Bader JD, Martin JA, Shugars DA. Preliminary estimates of the incidence and consequences of tooth fracture. J Am Dent Assoc 1995: 126 : 1650–1654.

6. Longitudinal tooth fracture Linear fractures that tend to grow and change over time The keys to saving these teeth are to know: 1. How to identify and classify cracks; 2. The characteristic signs and symptoms; and 3. How to detect the crack as early in its development as possible Bader JD, Martin JA, Shugars DA. Preliminary estimates of the incidence and consequences of tooth fracture. J Am Dent Assoc 1995: 126 : 1650–1654.

7. Classification From least to most severe: craze lines; fractured cusp; cracked tooth; split tooth; and vertical root fracture Incidence of the tooth fracture

8. Step 1: where is crack/ fracture located? Facial or lingual in enamel only - Also common on marginal ridges Step 2: Are these separable segments? Non-separable (Incomplete fracture) Step 3: What type of crack/ fracture is it? Craze line Step 4: How to treat? No treatment or esthetic treatment only Craze lines

9. Step 1: where is crack/ fracture located? F-L and M-D in enamel and dentin of the crown and root Step 2: Are these separable segments? Non-separable (Incomplete fracture) Separable (Complete fracture) Step 3: What type of crack/ fracture is it? Incomplete Cuspal fracture ( Cuspal crack) Complete cuspal fracture Step 4: How to treat? Retain or remove cusp RCT if pulp is exposed Cuspally reinforced restoration - Remove cusp RCT if pulp is exposed Cuspally reinforced restoration Cuspal fracture

10. Incidence Etiopathogenesis Clinical features Diagnosis Treatment & Prognosis Prevention extensive deep interproximal caries or a subsequent large Class II restoration Unsupported and Undermined tooth structure Subjective findings Objective tests Radiographic findings Other findings Separable Non-separable Removal of the cusp Followed by placement of 3/4 th crown/ onlay / full coverage crown Cusp need not be removed - Cuspally reinforced restoration is indicated (crown/ onlay ) Root canal treatment: if pulp is exposed Remove fracture segment using a bur rather than extraction forcep

11. Crack tooth to split tooth Step 1: where is crack/ fracture located? M-D in enamel and dentin of the crown only or crown and root Step 2: Are these separable segments? Non-separable (Incomplete fracture) Separable (Complete fracture) Step 3: What type of crack/ fracture is it? Crack tooth Split tooth Step 4: How to treat? RCT if pulp is exposed Cuspally reinforced restoration Extraction - Extraction followed by FPD or Implant

12. Incidence (Rivera et al) Etiopathogenesis Clinical features Diagnosis Prevention Radiographic findings Subjective findings Objective tests Other findings Transillumination Staining with methylene blue dye Wedging forces to differentiate separable or non-separable fracture Surgical microscope Treatment & Prognosis Study Conclusion Tan et al. N=50 of root-filled cracked teeth with a diagnosis of irreversible pulpitis and determined a 2-year survival rate of 85.5%. Krell & Rivera 127 patients with teeth diagnosed with reversible pulpitis that had a cracked tooth placement of a crown restoration without performing root canal treatment - Within 6 months: 20% irreversible pulpitis or necrosis

13. MANAGEMENT OF FRACTURED TOOTH Dr Urvashi Sodvadiya

14. Flow Chart Introduction Classification of tooth fracture Longitudinal tooth fracture Craze lines Cuspal fracture Crack tooth to split tooth Vertical fracture Risk factors Diagnosis Management Transverse tooth fracture Horizontal root fracture Classification of horizontal fracture Diagnosis

15. Treatment based on location Spliting Types of healing Factors influences healing and prognosis IATD Guidelines Enamel fracture Enamel-dentin fracture Enamel-dentin-pulp fracture Crown-root fracture without pulpal involvement Crown-root fracture with pulpal involvement Conclusion References

16. Incidence Etiopathogenesis Clinical features Diagnosis Treatment & Prognosis Prevention Extraction (If fracture is deep apically) or Remove the fractured segment and perform crown lengthening or orthodontic extrusion Split tooth

17. Step 1: where is crack/ fracture located? F-L in root only Step 2: Are these separable segments? Non-separable (Incomplete fracture) - Involves one root surface Separable (Complete fracture) - Involves both root surfaces Step 3: What type of crack/ fracture is it? Incomplete vertical fracture Complete vertical fracture Step 4: How to treat? Extraction / removal of involved root followed by prosthesis Vertical fracture “Third most common” cause of tooth loss ( Kishen A; 2006) Prevalence: 2%-20% (Chang E et al;2016) Incidence: 1.4 times higher for men (Chan CP et al; 1999) No significant difference ( Seo DG et al; 2012)

18. Related to Dentist Risk Factors Related to tooth - Reduced mechanical properties of tooth structure - Tooth form ( Lertchirakarn V et al; 2003) - Anatomical location - Changes in dentinal Microstructure - Post endodontic restoration - Type of endodontic treatment ( Karygianni L et al; 2014) - Immature teeth with incomplete root formation - Endodontic access cavity preparation ( Seo et al; 2012) - Root canal preparation - Root canal obturation - Post space preparation - Coronal restoration - ETT as abutment

19. Diagnosis Patient’s symptoms Location of Sinus tract Periodontal probing Surgical exploration Radiograph

20. Conventional Radiography

21. Abscess may “come and go” Periodontal abscess At the time of completion of RCT After 6 years Meister Jr F, Lommel TJ, Gerstein H. Diagnosis and possible causes of vertical root fractures. Oral Surgery, Oral Medicine, Oral Pathology. 1980 Mar 1;49(3):243-53 .

22. Management Extraction Hemisection Sealing the Gap of Vertical Root Fracture through the Root Canal Replantation after binding the fracture fragments using adhesive resin

23. Hemisection 2 years follow up Agrawal VS, Kapoor S, Shah NC. An innovative approach for treating vertically fractured mandibular molar- hemisection with socket preservation. Journal of Interdisciplinary Dentistry. 2012 May 1;2(2):141 .

24. The exclusion criteria of the study were as follows: the fracture gap was already wide, granulation tissue had penetrated into the fracture gap, and the fracture line could not be verified because of root curvature Sugaya T, Natatsuka M, Motoki Y, Inoue K, Tanaka S, Miyaji H. Sealing the gap of vertical root fracture through the root canal. Dentistry. 2016;6(354):2161-1122. Sealing the Gap of Vertical Root Fracture through the Root Canal

25. Alsani A, Balhaddad A, Nazir MA. Vertical root fracture: a case report and review of the literature. Giornale italiano di endodonzia . 2017 Jun 1;31(1):21-8. Replantation after binding the fracture fragments using adhesive resin

26. Transverse fracture

27. Horizontal root fracture ( Transverse/ Intraalveolar fracture) Prevalence: 0.5%-7.0% Commonly affected region: Maxillary front region (Andersen FM et al; 2007) Commonly affected part of the root: middle third 57% and apical third 34% ( Hovland EJ; 1992) “ Highest chances of preservation of pulp vitality” (Mata E et al; 1985) Andreasen FM, Andreasen JO, Cvek M. Root fractures. In: Textbook and Color Atlas of Traumatic Injuries to Teeth. Andreasen FM, Andreasen JO, eds. Copenhagen: Blackwell Publishing Ltd, 2007: pp337– 371. Hovland EJ. Horizontal root fractures: treatment repair. Dent Clin North Am 1992; 36: 509–525 Mata E, Gross MA, Koren LZ. Divergent types of repair associated with root fractures in maxillary incisors. Endod Dent Traumatol 1985; 1: 150–153

28. Classification of Horizontal root fracture Feiglin B. The management of horizontal root fractures – a treatment dilemma. Ann R Aust Coll Dent Surg 1981; 7: 81.

29. Diagnosis History Clinical examination Pulpal status Radiographic examination

30. Treatment APICAL Cvek M, Mejare I, Andreasen JO: Conservative endodontic treatment of teeth fractured in the middle or apical part of the root, Dent Traumatol 20:261-269, 2004.

31. Treatment MIDDLE

32. Treatment CORONAL Cvek M, Mejare I, Andreasen JO: Healing and prognosis of teeth with intra-alveolar fractures involving the cervical part of the root, Dent Traumatol 18:57-65, 2002.

33. Splinting Küçükyılmaz E, Botsalı MS, Keser G. Treatments of horizontal root fractures: Four case reports.

34. Treatment of horizontal root fracture associated root resorption Pasha S, Valli SK, Raza MZ. Nonsurgical management of horizontal root fracture associated external root resorption and internal root resorption. Indian Journal of Dental Sciences. 2016 Jul 1;8(3):150.

35. 22 year old male Reported after 3 weeks of accident 6 months follow up Kunhappan S, Patil S, Agrawal P. Conservative management of displaced horizontal root fracture. Journal of the International Clinical Dental Research Organization. 2011 Jan 1;3(1):48.

36. Healing in root fracture (Andreasen and Hjorting -Hansen) Andreasen JO, Hjorting -Hansen E. Intraalveolar root fractures: Radiographic and histologic study of 50 cases. J Oral Surg 1967;25:414-26.

37. “Healing by interposition of bone and connective tissue” Rothom R, Chuveera P. Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography. Case reports in dentistry. 2017;2017.

38. “Healing by calcification” Martos J, Amaral LP, Silveira LF, Damian MF, Xavier CB, Lorenzi A. Clinical management of horizontal root fractures aided by the use of cone-beam computed tomography. Giornale italiano di endodonzia. 2017 Nov 1;31(2):102-8. A 16-year-old male patient was referred to the Department of Clinics with pain in the region of the upper incisors. After 2 years

39. Martos J, Amaral LP, Silveira LF, Damian MF, Xavier CB, Lorenzi A. Clinical management of horizontal root fractures aided by the use of cone-beam computed tomography. Giornale italiano di endodonzia . 2017 Nov 1;31(2):102-8. “Healing by interposition of connective tissue” Because of a motorcycle accident, a 39-year-old female presented with facial trauma 10 days before After 24 months

40. Indicators of favourable outcomes Factors that influence healing and prognosis Asymptomatic status Positive response to pulp testing Continuing root development in immature teeth Signs of repair between fractured segments Absence of apical periodontitis Position and mobility of coronal segment after trauma Status of the pulp Position of the fracture line Treatment time Communication with the oral environment Age

41. Synopsis of effect of pre-injury factors on root fracture healing Andreasen JO, Andreasen FM, Mejàre I, Cvek M. Healing of 400 intra‐alveolar root fractures. 1. Effect of pre‐injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation. Dental Traumatology. 2004 Aug;20(4):192-202.

42. DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12. “IADT Guidelines (2012) ”

43. Ellis and Davey’s Classification of tooth fracture (1970)

44. Type of fracture Clinical findings Enamel fracture • A complete fracture of the enamel • Loss of enamel. No visible sign of exposed dentin • Not tender. If tenderness is observed, evaluate the tooth for a possible luxation or root fracture injury • Normal mobility • Sensibility pulp test: usually positive Radiographic findings Enamel loss is visible • Radiographs recommended: periapical, occlusal, and eccentric exposures. They are recommended in order to rule out the possible presence of a root fracture or a luxation injury • Radiograph of lip or cheek lacerations to search for tooth fragments or foreign materials Treatment If the tooth fragment is available, it can be bonded to the tooth Contouring or restoration with composite resin depending on the extent and location of the fracture Outcome Favourable: • Asymptomatic • Positive response to pulp testing • Continuing root development in immature teeth • Continue to next evaluation Unfavourable : • Symptomatic • Negative response to pulp testing • Signs of apical periodontitis • No continuing root development in immature teeth • Endodontic therapy appropriate for stage of root development is indicated DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12. Enamel fracture

45. Fragment reattachment Martos J, Pinto KV, Miguelis TM, Xavier CB. Management of an uncomplicated crown fracture by reattaching the fractured fragment—Case report. Dental Traumatology. 2017 Dec;33(6):485-9.

46. “Comparative evaluation of fracture resistance using two rehydration protocols for fragment reattachment in uncomplicated crown fractures” Madhubala A, Tewari N, Mathur VP, Bansal K. Comparative evaluation of fracture resistance using two rehydration protocols for fragment reattachment in uncomplicated crown fractures. Dental Traumatology. 2019 Jun 1.

47. Type of fracture Clinical findings Enamel–dentin fracture • A fracture confined to enamel and dentin with loss of tooth structure, but not exposing the pulp • Percussion test: not tender. If tenderness is observed, evaluate the tooth for possible luxation or root fracture injury • Normal mobility • Sensibility pulp test: usually positive Radiographic findings Enamel–dentin loss is visible • Radiographs recommended: periapical, occlusal, and eccentric exposure to rule out tooth displacement or possible presence of root fracture • Radiograph of lip or cheek lacerations to search for tooth fragments or foreign materials Treatment - Fragment reattachment: if available - Provisional restoration: Glass inomer cement - Final restoration: composite resin - If the exposed dentin is within 0.5 mm of the pulp (pink, no bleeding): place calcium hydroxide base and cover with a material such as a glass ionomer Outcome Favourable: • Asymptomatic • Positive response to pulp testing • Continuing root development in immature teeth • Continue to next evaluation Unfavourable : • Symptomatic • Negative response to pulp testing • Signs of apical periodontitis • No continuing root development in immature teeth • Endodontic therapy appropriate for stage of root development is indicated DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12. Enamel-Dentin fracture

48. Type of fracture Clinical findings Enamel–dentin pulp fracture A fracture involving enamel and dentin with loss of tooth structure and exposure of the pulp. • Normal mobility • Percussion test: not tender. If tenderness is observed, evaluate for possible luxation or root fracture injury • Exposed pulp sensitive to stimuli Radiographic findings Enamel–dentin loss visible • Radiographs recommended: periapical, occlusal, and eccentric exposures to rule out tooth displacement or possible presence of root fracture • Radiograph of lip or cheek lacerations to search for tooth fragments or foreign materials Treatment Immature teeth: pulp capping/ partial pulpotomy Mature teeth: RCT recommended Fragment reattachment: if available DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12. Enamel-Dentin-Pulp fracture

49. Enamel-Dentin-Pulp fracture PREOPERATIVE PHOTOGRAPH PREOPERATIVE PHOTOGRAPH

50. PRESERVATIVE MANAGEMENT OF TRAUMATIZED MAXILLARY CENTRAL INCISOR USING FIBER REINFORCED COMPOSITE PRE-OPERATIVE PHOTOGRAPHS- FRACTURE WRT 11 EXTENDING INTO CERVICAL REGION PALATALLY PRE-OPERATIVE RADIOGRAPH

51. STABILIZATION OF THE FRACTURED FRAGMENT USING FLOWABLE COMPOSITE REHABILITATION OF 11 USING FIBER POST

52. Type of fracture Clinical findings Enamel–dentin pulp fracture • Crown fracture extending below gingival margin - Percussion test: tender • Coronal fragment mobile • Sensibility pulp test usually positive for apical fragment Radiographic findings Apical extension of fracture usually not visible • Radiographs recommended: periapical, occlusal, and eccentric exposures to rule out tooth displacement or possible presence of root fracture Crown root fracture without pulp exposure T treatment • As an emergency treatment : temporary stabilization Non-emergency treatment: fragment removal only Followed by: subsequent restoration of the apical fragment exposed above the gingival level subsequent endodontic treatment and restoration with a post-retained crown. - Preceded by a gingivectomy, and sometimes ostectomy with osteoplasty Orthodontic extrusion of apical fragment - Extraction: inevitable in crown–root fractures with a severe apical extension DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12.

53. Type of fracture Clinical findings Crown root fracture with pulp exposure - A fracture involving enamel, dentin, and cementum and exposing the pulp - Percussion test: tender - Coronal fragment mobile Radiographic findings • Apical extension of fracture usually not visible • Radiographs recommended: periapical, occlusal radiograph Treatment Emergency treatment: - temporary stabilization of the loose segment Tooth with open apices: - preserve pulp vitality by a partial pulpotomy Completely formed teeth: - In young patient: partial pulpotomy - In older patient: Root canal treatment DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12. Crown root fracture with pulp exposure Non-emergency treatment alternatives : Removal of the coronal fragment with subsequent endodontic treatment and restoration with a post-retained crown. Orthodontic extrusion of apical fragment Extraction is inevitable in very deep crown-root fractures

54. MANAGING SUBGINGIVAL FRACTURE BY MULTI-DISCIPLINARY APPROACH CLASS VII FRACTURE OF 21 AND 22 DUE TO TRAUMA PRE-OPERATIVE RADIOGRAPH REMOVAL OF THE FRACTURED FRAGMENT SUBGINGIVAL EXTENSION OF THE FRACTURE LINE IN THE PALATAL REGION

55. POST SPACE PREPARATION WRT 21 AND 22 FABRICATION OF PROVISIONAL RESTORATION CEMENTATION OF PROVISIONAL RESTORATION

56. FABRICATION OF J HOOK USING 1 MM WIRE AND CEMENTATION INTO THE CANAL USING ZINC PHOSPHATE CEMENT ACTIVATION USING ELASTICS 45 DAYS AFTER ORTHODONTIC EXTRUSION PLACEMENT OF FIBER POST AND CORE BUILD UP WITH RESPECT TO 21

57. Conclusion

58. References DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatology. 2012 Feb;28(1):2-12. Bader JD, Martin JA, Shugars DA. Preliminary estimates of the incidence and consequences of tooth fracture. J Am Dent Assoc 1995: 126: 1650–1654. Andreasen JO, Andreasen FM, Mejàre I, Cvek M. Healing of 400 intra‐alveolar root fractures. 1. Effect of pre‐injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation. Dental Traumatology. 2004 Aug;20(4):192-202. Küçükyılmaz E, Botsalı MS, Keser G. Treatments of horizontal root fractures: Four case reports. Cvek M, Mejare I, Andreasen JO: Healing and prognosis of teeth with intra-alveolar fractures involving the cervical part of the root, Dent Traumatol 18:57-65, 2002.

59. References Feiglin B. The management of horizontal root fractures – a treatment dilemma. Ann R Aust Coll Dent Surg 1981; 7: 81. Andreasen FM, Andreasen JO, Cvek M. Root fractures. In: Textbook and Color Atlas of Traumatic Injuries to Teeth. Andreasen FM, Andreasen JO, eds. Copenhagen: Blackwell Publishing Ltd, 2007: pp337– 371. Hovland EJ. Horizontal root fractures: treatment repair. Dent Clin North Am 1992; 36: 509–525 Sugaya T, Natatsuka M, Motoki Y, Inoue K, Tanaka S, Miyaji H. Sealing the gap of vertical root fracture through the root canal. Dentistry. 2016;6(354):2161-1122. Agrawal VS, Kapoor S, Shah NC. An innovative approach for treating vertically fractured mandibular molar- hemisection with socket preservation. Journal of Interdisciplinary Dentistry. 2012 May 1;2(2):141 Meister Jr F, Lommel TJ, Gerstein H. Diagnosis and possible causes of vertical root fractures. Oral Surgery, Oral Medicine, Oral Pathology. 1980 Mar 1;49(3):243-53 Pasha S, Valli SK, Raza MZ. Nonsurgical management of horizontal root fracture associated external root resorption and internal root resorption. Indian Journal of Dental Sciences. 2016 Jul 1;8(3):150.

60. References Alsani A, Balhaddad A, Nazir MA. Vertical root fracture: a case report and review of the literature. Giornale italiano di endodonzia . 2017 Jun 1;31(1):21-8. Mata E, Gross MA, Koren LZ. Divergent types of repair associated with root fractures in maxillary incisors. Endod Dent Traumatol 1985; 1: 150–153 Martos J, Amaral LP, Silveira LF, Damian MF, Xavier CB, Lorenzi A. Clinical management of horizontal root fractures aided by the use of cone-beam computed tomography. Giornale italiano di endodonzia . 2017 Nov 1;31(2):102-8. Rothom R, Chuveera P. Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography. Case reports in dentistry. 2017;2017. Andreasen JO, Hjorting -Hansen E. Intraalveolar root fractures: Radiographic and histologic study of 50 cases. J Oral Surg 1967;25:414-26. Kunhappan S, Patil S, Agrawal P. Conservative management of displaced horizontal root fracture. Journal of the International Clinical Dental Research Organization. 2011 Jan 1;3(1):48. Küçükyılmaz E, Botsalı MS, Keser G. Treatments of horizontal root fractures: Four case reports.

61. Thank you!