Upper Airway Changes following Functional Treatment with the Headgear Herbst or Headgear Twin Block Appliance Assessed on Lateral Cephalograms and Magnetic Resonance Imaging.

OBJECTIVE: The present study compared the changes in the upper airway dimensions and sleep-related breathing disorder (SRBD) condition between functional treatment with the headgear Herbst (HG-Herbst) and headgear Twin Block (HG-TB) appliance. Soft tissues were assessed on lateral cephalometric X-ray and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Consecutive patients who sought orthodontic treatment at the Faculty of Dentistry of The University of Hong Kong were screened. Adolescents (12-17 year sold for boys and 10-15 years old for girls), with class II molar relationship and overjet >5 mm, with no severe transverse maxillary deficiency, were recruited. Patients were assigned either to the HG-Herbst or to the HG-TB treatment by stratified block randomisation, with sex as the stratification factor. Lateral cephalograms, magnetic resonance imaging (MRI), and the Paediatric Sleep Questionnaire (PSQ) were obtained at baseline and after treatment. RESULTS: 28 patients were enrolled, and 26 patients (13 in each group) completed the treatment. Following 1 year of functional appliance treatment, a significantly lower increase of the lower anterior facial height was observed in the HG-Herbst group compared to the HG-TB group (p = 0.024). However, no significant differences were observed in the upper airway structures or SRBD between the two groups. CONCLUSION: The changes in upper airway dimensions and SRBD condition were not significantly different between the HG-Herbst and the HG-TB appliance treatment. Additional studies with larger sample size are warranted.

Natural compounds containing mouthrinses in the management of dental plaque and gingivitis: a systematic review.

OBJECTIVES: To evaluate the effectiveness of natural compounds containing mouthrinse (NCCM) as an adjunct to unsupervised oral hygiene in the management of dental plaque and gingivitis. MATERIALS AND METHODS: An electronic search for clinical studies of NCCMs was conducted in Medline-PubMed, the Cochrane Central Register of Controlled Trials and EMBASE for a period spanning from the earliest available date in each database up to February 2013. Plaque index, gingival index, and gingival bleeding index were selected as primary outcomes. The methodological quality of the studies was assessed according to the "Levels of Evidence" outlined by the Center of Evidence-Based Medicine, and to the Jadad scale. RESULTS: The screen yielded 2,236 titles and abstracts that met the inclusion criteria. These identified 11 clinical trials testing 13 different NCCMs, and were used for data extraction. Heterogeneity and the limited number of studies on any individual NCCM precluded a formal meta-analysis. Of the 13 NCCMs tested, eight demonstrated positive results, and few reported any adverse effects or events. CONCLUSIONS: Evidence proving the effectiveness of NCCM as an adjunct to unsupervised oral hygiene for plaque and gingivitis control is still insufficient. However, some natural products (compounds) may have oral health benefits, so further high-quality study is warranted. CLINICAL RELEVANCE: This review provides an overview of the strength of clinical evidence regarding the effectiveness of natural compounds containing mouthrinses in promoting gingival health.

The effects of natural compounds-containing mouthrinses on patients with fixed orthodontic appliance treatment: clinical and microbiological outcomes.

AIM: To investigate the effects of two natural compounds-containing mouthrinses (NCCMs) (a fructus mume (FM) extract-containing mouthrinse and an essential oil (EO)-containing mouthrinse) on gingival health and microbial profiles in young orthodontic patients. DESIGN: This 6-month randomized, single-blinded, parallel-controlled clinical trial consists of 90 patients with fixed appliance treatment. The subjects were allocated to (1) negative control group: oral hygiene instruction (OHI) alone; (2) test group 1: OHI plus EO mouthrinse; and (3) test group 2: OHI plus FM mouthrinse. Clinical examinations included plaque index (PI), bleeding index (BI) and modified gingival index (MGI). Salivary microbial quantifications included total aerobic and anaerobic bacteria, Streptococci and Lactobacilli counts. Clinical and microbiological examinations were conducted at baseline, 3rd and 6th months (T1, T2, and T3). RESULTS: BI was significantly reduced in both the FM mouthrinse and EO mouthrinse groups compared with the negative control group at T3 (P < 0.05). There were no significant intergroup differences in salivary bacteria counts in all groups (P > 0.05). CONCLUSION: Both NCCMs effectively reduced gingival bleeding without causing significant alterations of microbial profile in young orthodontic patients.

Altered serum levels of the osteoclast-specific TRACP 5b isoform in Chinese children undergoing orthodontic treatment.

Orthodontic tooth movement is dependent upon the ability of mechanical forces to induce remodelling activity within the tooth-supporting alveolar bone. In view of the importance of bone resorption in mediating tooth movement, the aim of this study was to establish if alterations in the osteoclast-specific bone marker tartrate-resistant acid phosphatase (TRACP) 5b could be detected in the sera of patients undergoing orthodontic treatment. The sample consisted of 14 subjects (10 girls and 4 boys) aged 10.5-16.5 years (mean 12.6 years) being treated with fixed appliances and a distalizing headgear. Venous blood samples (3 ml) were collected from the cubital vein pre-treatment (T0) and 2, 4, and 6 months into treatment (T1-T3); serum TRACP 5b levels were quantified using a solid-phase immunofixed enzyme activity assay. When the data were pooled and treated cross-sectionally, a significant increase in immunoreactive TRACP 5b was detected at 2 months (T1) indicating increased bone resorptive activity. However, when the serum profiles of individual patients were recorded longitudinally, a very different pattern emerged, not all patients following the same trend. This is not surprising given normal anatomical variation and differences between the patients in age, gender, and mechanotherapy. Designed as a pilot to demonstrate 'proof of principle', this study is the first to show that the TRACP 5b isoform can be detected in the sera of patients undergoing orthodontic treatment. It further suggests that serum bone marker measurements offer a simple and minimally invasive method for correlating the findings of laboratory and animal experimentation with clinical data.

Prunus mume extract exhibits antimicrobial activity against pathogenic oral bacteria.

OBJECTIVES: Prunus mume is a common fruit in Asia, which has been used in traditional Chinese medicine. In this study, we focused on the antimicrobial properties of Prunus mume extract against oral pathogens related to dental caries and periodontal diseases. STUDY DESIGN: A total of 15 oral pathogens including Streptococcus mutans, S. sobrinus, S. mitis, S. sanguinis, Lactobacillus acidophilus, P. gingivalis, Aggregatibacter actinomycetemcomitans, and Candida species were included in the study. Initially, agar diffusion assay was performed to screen the antimicrobial activities of Prunus mume extract. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were then determined for sensitive species. Effect of Prunus mume extract on human oral keratinocytes (HOK) viability was also tested. RESULT: In the agar diffusion assay, drug suspension of 2 g/mL was able to inhibit all the bacterial species tested, but not the fungal species. MIC and MBC range of Prunus mume extract against the oral bacteria was 0.15625-0.0003 g/mL and P. gingivalis being the most susceptible species. Prune extract did not cause any detrimental effect on HOK. CONCLUSION: Prunus mume extract may be a potential candidate for developing an oral antimicrobial agent to control or prevent dental diseases associated with oral pathogenic bacteria.

Comparison of oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances.

INTRODUCTION: Our objective was to compare the oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances. METHODS: This was an age- and sex-matched prospective longitudinal study of 60 adult patients treated with either labial or customized lingual fixed orthodontic appliances over a 3-month period. Ratings of oral impacts experienced and satisfaction were made on visual analog scales at 3 time points after appliance fixation. Variations in oral impacts and satisfaction over the trajectory of treatment were assessed. Area-under-the-curve analyses were conducted to assess variations in oral impacts and satisfaction between the groups. RESULTS: All patients experienced oral impact disturbances, although these disturbances decreased over time (P < 0.001). Patients treated with customized lingual appliances reported more oral discomfort (P < 0.001), dietary changes (P < 0.001), swallowing difficulty (P < 0.001), speech disturbances (P < 0.001), and social problems (P < 0.001) than did those in the other group. There was no significant difference between the groups regarding ratings of oral self-care, mastication, and satisfaction level of treatment (P > 0.05). CONCLUSIONS: The findings indicate that oral impacts are commonly experienced during both labial and customized lingual fixed orthodontic therapies. However, the oral impacts decreased over the observational period. Patients treated with customized lingual appliances experienced more oral impacts. Both groups had similar levels of treatment satisfaction.

Comparison of the antimicrobial activity of Listerine and Corsodyl on orthodontic brackets in vitro.

INTRODUCTION: The aim of this study was to evaluate the antimicrobial efficacy of 2 commercially available mouth rinses on a monospecies-biofilm model on orthodontic brackets in vitro. METHODS: The antimicrobial effects of the 2 mouth rinses, Listerine (tartar control; IDS Manufacturing, Bangkok, Thailand) and Corsodyl (SmithKline Beecham, Maidenhead, United Kingdom), on the planktonic Streptococcus mutans were tested by maximum inhibitory dilution assay. The cell viability of S mutans biofilm on Damon3 MX brackets (Ormco, Glendora, Calif) after exposure to the 2 mouth rinses was quantified by 2,3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide (XTT) reduction assay. Visualization of the biofilm samples was performed by fluorescence microscopy and confocal laser scanning microscopy. RESULTS: The maximum inhibitory dilution assays of S mutans were 1:5 for Listerine and 1:320 for Corsodyl. The optical density values, which were measured by XTT reduction assay from S mutans biofilms after 1 minute of exposure to the different test agents, demonstrated that the cell viability of S mutans biofilms exposed to Listerine was less than that for Corsodyl, which was less than that for brain-heart infusion (P <0.001). Listerine caused more dead cells on the surface of the brackets than did Corsodyl when examined with the 2 microscope systems. CONCLUSIONS: Both mouth rinses showed marked antimicrobial effects on the monospecies biofilm in vitro. Listerine showed a stronger bactericidal effect but had less bacterial inhibitory effect than did Corsodyl.

Evaluation of bone thickness around the mental foramen for potential fixation of a bone-borne functional appliance: a computer tomography scan study.

AIM: A mandible bone-borne Herbst appliance (MBBHA) would avoid the proclination of the lower incisors that occurs with any teeth-borne functional appliance. But mapping of the bone characteristics at potential fixation areas around the mental foramen has not been carried out so far. The aim of this computer tomographic (CT) study was to evaluate bone thickness at specific positions around the mental foramen. MATERIAL AND METHODS: CT scans of 60 randomly chosen adult Hong Kong Chinese subjects (mean age 28 ± 6.3 years) were used to measure the bi-cortical bone thickness in the mandible in the mental foramen area. The thickness of buccal and lingual cortical and cancellous bone was assessed at the following locations: 10 mm (A10 mm) and 5 mm (A5 mm) anterior, 10 mm (P10 mm) and 5 mm (P5 mm) posterior, and 5 mm (Inf5 mm) below the mental foramen. RESULTS: The amount of buccal cortical bone thickness ranged between 1.89 mm, 10 mm anterior of the mental foramen, and 2.16 mm, 10 mm posterior to its location. At the A10 mm level, cortical thickness showed a marginal statistically significant difference between A5 and A10 mm. The total amount of bone thickness ranged from 10.19 to 12.06 mm. CONCLUSION: At the locations studied around the mental foramen, a mean bicortical bone thickness of 10-12 mm was measured. No large variation in the thickness was found between bicortical bone thicknesses in the measured locations around the mental foramen. Thorough evaluation on a case-by-case basis is advisable.

A comparison of pain experienced by patients treated with labial and lingual orthodontic appliances.

SUMMARY: The aim of this prospective longitudinal study was to compare pain experiences among Chinese adult patients treated with labial and lingual orthodontic appliances. Sixty patients, 30 with labial appliances (18 females and 12 males, mean age 20.33 years, SD +/- 4.205) and 30 with lingual appliances (22 females and 8 males, mean age 21.63 years, SD +/- 2.236), rated their overall pain experience on a 100 mm visual analogue scale (VAS) at three time points: 1 week (T(1)), 1 month (T(2)), and 3 months (T(3)) after bracket placement. In addition, on a separate 100 mm VAS, they rated their pain experience at the locations of the tongue, lips, cheeks, gums, face, and jaw at T(1), T(2), and T(3). Changes in pain VAS were conducted using Friedman analysis of variance, area under the curve (AUC) analysis and the data were compared using a t-test. There was no significant difference in global ratings of pain among those treated with labial or lingual appliances (P > 0.05). Among both groups, global ratings of pain decreased over the study period (P < 0.001). Patients treated with lingual appliances reported higher ratings of tongue pain (P < 0.001), while those treated with labial appliances reported higher ratings of lip (P < 0.001) and cheek (P < 0.001) pain. The findings indicate that patients treated with labial and lingual appliances rate similarly the level of overall pain they experience during treatment. Ratings of overall pain experienced decreased for both treatment groups with time. However, ratings of pain differed at various sites with respect to the type of orthodontic appliance. These findings have implications in informing patients' treatment decision-making processes regarding labial and lingual appliances and in the management of discomfort associated with different treatment modalities.

Virtual model analysis as an alternative approach to plaster model analysis: reliability and validity.

The objective of this study was to assess the feasibility of virtual models as an alternative to orthodontic plaster models. Virtual dental models (obtained from OrthoCAD) and corresponding plaster models of 80 patients in the permanent dentition were randomly selected from patients seeking orthodontic care. Inter-examiner error was assessed by measuring tooth width, overjet, overbite, intermolar width, intercanine width, and midline discrepancy. Criterion validity of virtual model analysis was determined by the agreement between the measurements from virtual and plaster models. Test-retest reliability was determined by remeasuring 10 virtual models 1 week later. Comparison analysis was assessed by calculating the mean directional differences and standardized directional differences. Correlation analysis was determined by calculating the intraclass correlation coefficients (ICCs). Both intra- and inter-examiner reliability and test-retest reliability of virtual model analysis were acceptable in measuring intercanine, intermolar, overjet, overbite, midline discrepancy, space analysis, and tooth width (ICC > 0.7). Good criterion validity was indicated by agreement between the results from the plaster and virtual models (ICC > 0.8). There were substantial agreements for canine and molar relationship classifications (κ > 0.70). The results suggest that analysis performed on virtual models is as valid as traditional plaster models for intra- and inter-arch relationship.

The effects of orthodontic appliances on Candida in the human mouth.

BACKGROUND: Candida is an opportunistic pathogen present in about 50-60% of the healthy human population, and becomes pathogenic when the host immune defence is undermined such as in HIV infection. Adhesion and colonization of the oral cavity by Candida albicans is an initial step in candidosis, and the presence of orthodontic and other oral appliances seems to alter the oral ecological environment, hence may tip the balance to favour the candidal presence. OBJECTIVE: The purpose of this paper was to review the literature with specific attention to prevalence; intra-oral density of the candidal organisms; and Candida carriage status in orthodontic patients before, during, and after treatment. CONCLUSIONS: The limited amount of literature demonstrated that the density of Candida increases; the most common Candida species isolated in the orthodontic patients was C. albicans; and that there seems to be a direct relationship between the presence of a removable appliance, Candida, and low salivary pH levels. No healthy patients developed Candida infection from the orthodontic appliances. However, there seems to be a trend that some non-Candida carriers converted to Candida carriers following the insertion of the appliances by unknown mechanism. This may indicate a more cautious approach when providing orthodontic treatments to immunocompromised children concerning the possible increased risk of candidal infection.

Dental arch widths of Southern Chinese.

OBJECTIVE: To investigate the dental arch width of the Southern Chinese across buccal cusps, central fossae, or lingual cusps and compare these values with study findings in different populations and using different definitions. MATERIALS AND METHODS: The dental arch dimensions of study casts of an unselected sample from a 12-year-old Hong Kong Oral Health Survey of 12-year-old children (n = 358; 210 boys and 148 girls) were measured. RESULTS: When compared with Caucasians, the Southern Chinese were characterized by a wider dental arch width. However, variations were great. All maxillary and mandibular male arch widths were significantly larger than female arch widths, except at the incisor regions. CONCLUSION: This study yielded a database about dental arch widths by which different studies on these widths can be compared.

Stepwise advancement Herbst appliance versus mandibular sagittal split osteotomy. Treatment effects and long-term stability of adult Class II patients.

OBJECTIVE: To compare the treatment effects and long-term stability of the stepwise Herbst appliance and mandibular sagittal split osteotomy in skeletal Class II adult patients. MATERIALS AND METHODS: Subjects comprised 16 patients in the Herbst group and another 16 patients in the surgery (mandibular sagittal split osteotomy) group. Lateral head films were taken before treatment (T0), after removal of the Herbst appliance/surgery (T1), after the fixed appliance treatment (T2), and 3 years after treatment (T3). All films were analyzed by standard cephalometrics and SO-analysis (analysis of changes in sagittal occlusion). RESULTS: All Herbst and surgery patients were treated successfully to Class I occlusal relationships with normal overjet and overbite. Both groups showed a significant change in mandibular base advancement (SNB, SNPg, Pg/OLp), which resulted in a decrease in the ANB angle, the Wits appraisal, and facial convexity. However, the surgery group showed larger changes in the parameters mentioned above. In terms of long-term stability, both groups achieved stable results, and no significant difference occurred over time. CONCLUSION: Stepwise advancement Herbst appliance therapy can be used to treat borderline skeletal Class II adult patients with long-term stability.

Complications of orthodontic treatment: are soft drinks a risk factor?

Soft drink consumption has steadily increased in recent decades in both western and developing countries. The trend is most apparent among children and adolescents. This rise in soft drink consumption has raised concerns among health care professionals, including dental practitioners. Accordingly, the effects of soft drinks on dental health have been investigated. Several studies have shown that dental problems, such as caries, enamel erosion, and corrosion of dental materials, may be associated with soft drink consumption. Because orthodontic appliances restrict toothbrush access, patients undergoing orthodontic treatment need special oral care and advice. This article reviews the risks and implications of soft drink consumption for orthodontic patients.

Condylar growth and mandibular positioning with stepwise vs maximum advancement.

INTRODUCTION: The aim of this study was to compare the effects of several Class II malocclusion treatments on condylar growth and positioning of the mandible. METHODS: The material comprised series of lateral cephalograms obtained at the start, after about 6 months, and after about 12 months of treatment from 3 groups of consecutively treated patients who used a headgear-activator with stepwise mandibular advancement (HGA-S), a headgear-activator with maximum jumping of the mandible (HGA-M), and a headgear-Herbst appliance with stepwise advancement (HGH-S), respectively. Six-month growth data from matched controls were used to calculate the net treatment effects. RESULTS: Mandibular prognathism was enhanced after stepwise advancement but not after maximum jumping, and only during the initial phase of therapy; the effect was significantly greater for the fixed functional appliance than for the removable functional appliance. Lower-facial height was increased by the HGA-S, unchanged by the HGA-M, and restrained by the HGH-S. The low construction bite of the HGH-S meant that the extent of bone apposition on the posterior and superior parts of the condyle was similar, whereas the high construction bite of the HGA-S and the HGA-M meant that the effect on the superior part was greater, but only significantly so after stepwise advancement. CONCLUSIONS: The mode of jumping, the vertical opening, and whether the functional appliance is fixed or removable affect the amount and pattern of condylar growth, and the position of the mandible.

Patients' perceptions regarding microimplant as anchorage in orthodontics.

OBJECTIVE: To determine patients' expectations, acceptance, and experience of pain with microimplant surgery compared to other orthodontic procedures. MATERIALS AND METHODS: Seventy-eight microimplants were placed in 37 patients as an anchorage unit for orthodontic treatment. Patients were asked to rate anticipated pain and pain experienced with various orthodontic procedures (tooth extraction, insertion of separators, initial tooth alignment, and microimplant surgery) on a visual analog scale (VAS) over a 7-day period. One month after insertion of microimplants, patients were asked to rate their acceptance of the procedure using a structured questionnaire. RESULTS: Unlike other orthodontic procedures, patients expected to experience a significantly higher level of pain with microimplant surgery than they experienced (P < .001). The postoperative pain experienced decreased continuously from day 1 to day 7 for all orthodontic procedures (P < .05). The total area under the curve (AUC) of pain experienced over the 7-day period was significantly larger for initial tooth alignment than for microimplant surgery (P < .05). Most patients were satisfied with the microimplant surgery (76%) and would recommend it to a friend or family member (78%). CONCLUSIONS: Patients tended to overestimate the pain anticipated with microimplant surgery. Patients were accepting of the surgery and would recommend it to others.

Stability of connected mini-implants and miniplates for skeletal anchorage in orthodontics.

The aim of this study was to examine the primary stability of connected mini-implants and miniplates. Three different skeletal anchorage systems were investigated: (1) two 1.5 mm diameter cylindrical mini-implants connected with a 0.021 x 0.025 inch stainless steel (SS) wire, (2) two 1.6 mm diameter tapered mini-implants connected with a 0.021 x 0.025 inch SS wire, and (3) two 2.0 mm diameter cylindrical mini-implants connected by a titanium locking miniplate. Fifteen standardized bovine bone specimens were prepared, five specimens for each experimental group. The connected mini-implants were fixed on the bone specimens. The systems underwent uniaxial pull-out tests at the midpoint of the connecting wire or miniplate using a mechanical testing machine. One-way analysis of variance was used to determine the difference of the pull-out test results between the groups. Both the titanium miniplate and SS wire connection systems showed severe deformation at the screw head, which broke before the mini-implants failed. The 2.0 mm miniplate system showed the highest pull-out force (529 N) compared with the other two wire connection systems (P < 0.001). The 2.0 mm system was also stiffer than the 1.6 and 1.5 mm systems (P < 0.001). The yield force of the 2.0 mm miniplate (153 N) was significantly higher than the 1.5 mm (88 N) and 1.6 mm (76 N) systems (P < 0.001). This in vitro study demonstrated that the connection of two mini-implants with a miniplate resulted in higher pull-out force, stiffness, and yield force to resist pulling force and deformation. Such a set-up could thus provide a stable system for orthodontic skeletal anchorage.

Severe transposition, ectopic eruption, and orthodontic alignment: a long-term appraisal.

A female patient, 13 years of age, with severe localized crowding and transposition of the right maxillary canine and ectopic eruptions of premolars and incisors, desired treatment. The treatment plan consisted of extraction of 1 displaced premolar and correction of the transposition and crowding by orthodontic means. Crowding correction using the Begg appliance was the technique employed. The case report includes a 12-year posttreatment review, and demonstrates that, with careful planning and close monitoring, it is possible to correct complex transposition problems by orthodontic methods.

Effect of naringin collagen graft on bone formation.

Naringin is a flavonoid available commonly in citrus fruits and is also a HMG-CoA reductase inhibitor. Our laboratory compared the amount of new bone produced by naringin in collagen matrix to that produced by bone grafts and collagen matrix. Twenty bone defects, 5 mm x 10 mm were created in the parietal bone of 14 New Zealand White rabbits. In the experimental group, 5 defects were grafted with naringin solution mixed with collagen matrix, 5 defects were grafted with autogenous endochondral bone. In the control groups, 5 defects were grafted with collagen matrix alone (active control) and 5 were left empty (passive control). Animals were killed on day 14 and the defects were dissected and prepared for histological assessment. Serial sections were cut across each defect. Quantitative analysis of new bone formation was made on 150 sections (50 sections for each group) using image analysis. A total of 284% and 490% more new bone was present in defects grafted with naringin in collagen matrix than those grafted with bone and collagen, respectively. No bone was formed in the passive control group. In conclusion, naringin in collagen matrix have the effect of increasing new bone formation locally and can be used as a bone graft material.

Tanaka-Johnston mixed dentition analysis for southern Chinese in Hong Kong.

OBJECTIVE: To compare the prediction of unerupted permanent canine and premolar size of a comparable sample size of southern Chinese population with that of the study of Tanaka and Johnston. MATERIALS AND METHODS: Teeth on study casts of an unselected sample from a 12-year-old Hong Kong Oral Health Survey of 12-year-old children (n = 459; 295 males and 164 females) were measured in the mesiodistal dimension. A Chinese mixed dentition analysis based on the Tanaka and Johnston method was constructed with linear regression equations for prediction of the mesiodistal widths of unerupted canines and premolars. RESULTS: Sexual dimorphism was evident between southern Chinese males and females in incisors, canines, and premolars in the mesiodistal dimension. CONCLUSIONS: To predict the space (in mm) required for alignment of unerupted canine and premolars in southern Chinese children, halve the sum of the mesiodistal dimensions of the four mandibular incisors and add the respective constants for males (upper, 11.5; lower, 10.5) or females (upper, 11.0; lower, 10.0).