partial pulpotomy indications

Another form of nonchemical devitalization emerged: electrosurgical pulpotomy. Radiographic examination shows normal appearance of periodontal attachment. A vital pulpotomy or a non-vital pulpotomy can be carried out. [2] There are various types of medicament placed above the vital pulp such as Buckley’s Solution of formocresol, ferric sulfate, calcium hydroxide or MTA. [10], The remaining pulp tissue should continue to be vital after partial pulpotomy and teeth with immature roots should show continued normal development and apexogenesis. However, this method may prove to be more diagnosis and technique sensitive, and it may not be suitable if apical root resorption has occurred. These dental procedures sound similar, but they are done for different reasons. Evidence of pulpal necrosis. [1]  Then, the coronal tissue is amputated, and the remaining radicular tissue is judged to be vital without suppuration, pus, necrosis, or excessive bleeding which cannot be controlled by a moist cotton pellet (with saline) after several minutes, and there are no radiographic signs of infection or pathologic resorption. 1. While frank carious exposures are optimally treated with pulpectomy and root canal therapy, the ideal treatment of mechanically exposed pulps has remained controversial. This metal-protein clot at the surface of the pulp may act as a barrier to external irritants. Pulpal bleeding can be controlled by irrigation of sodium hypochlorite or chlorhexidine. A partial pulpotomy for traumatic exposures is also called a Cvek Pulpotomy. Partial pulpotomy. 3. This technique includes removal of a small part of the pulp just at the site of exposure, application of Calcium Hydroxide in direct contact to the wound surface and a permanent filling is given. However, the success rate is not that high. A pulpotomy can be done to both permanent and primary teeth. Pulpectomy is performed when the tissue of the pulp has irreversibly damaged or has suffered necrosis (tissue death) due to tooth decay or extreme dental trauma. Indication: 1- A partial pulpectomy may be performed on primary teeth when coronal pulp tissue and the tissue entering the pulp canals are vital but show clinical evidence of hyperemia. Pulpotomy Technique. Irreversible pulpitis; Procedure. The tooth must be vital, with a diagnosis of normal pulp or reversible pulpitis. This medication could be zinc oxide eugenol or a mineral trioxide aggregate. A nonaldehyde chemical, ferric sulfate, has received some attention recently as a pulpotomy agent. This article describes the partial pulpotomy of a cariously affected immature permanent teeth and the follow-up for 1 year. Written exam result DSSC ADC- 59 Army Dental Corps Bangladesh. Multiple visit pulpotomy. Then, the coronal tissue is amputated, and the remaining radicular tissue is judged to be vital without suppuration, pus, necrosis, or excessive bleeding which cannot be controlled by a moist cotton pellet (with saline) after several minutes, and there are no radiographic signs of infection or pathologic resorption. A partial pulpotomy for traumatic exposures is also called a Cvek Pulpotomy. In particular where the treatment is carried out under the conditions of “reversible pulpitis” [ 35 – 37 ], the argumentation of avoiding pulp exposure in the first place is in principle the same as indicated for direct pulp capping Class II . Indications Primary teeth. Partial pulpotomy using the same material exhibits higher success rates of 86 %–100 % [4, 30, 31, 33, 37, 53, 109] and is therefore favored. However, the cost, availability and difficulty in handling this material remains its current drawback. Indications. Mechanically exposed vital primary teeth. In the treatment of fracture permanent teeth with pulp exposure >1sqmm. It is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1 to 3mm or deeper to reach the level of healthy pulp tissue. A partial pulpotomy for traumatic exposures is also called a Cvek Pulpotomy. Calcium hydroxide Ca(OH)2 is conventionally used as a pulpotomy agent of the permanent teeth but with less long term success. Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. Partial pulpotomy is mainly carried out in immature teeth to give the root a chance to develop: Apexogenesis. There are two types of pulpotomy techniques depending the extent of caries in a tooth and the symptoms it presents. Partial pulpotomy, also known as the Cvek pulpotomy, is a mode of treatment which is widely used in the permanent dentition but less so in primary teeth. Partial pulpotomy for traumatic exposures (Cvek pulpotomy) Indications This pulpotomy is indicated for a vital, traumatically exposed, young permanent tooth, especially one with an incompletely formed apex. Permanent teeth. Contra-indications of the Cvek pulpotomy: Infection of the pulp extends past the coronal pulp; Inability to achieve haemostasis after coronal pulp amputation; Swelling (due to infection) fistula; Radiographic evidence of pathological periapical bone resorption pulp tissue needs to be removed to Uncooperative patient. [16], Ferric sulphate is used to arrest pulpal bleeding by forming a sealing membrane through the agglutination of the blood proteins with ferric and sulfate ions. The purposes of this article are: (1) to present the indications and contraindications of the various treatment modalities for primary incisors with complicated crown fractures; and (2) to suggest partial pulpotomy as a conservative and more appropriate approach for … Lilleker R. Technique Tips – Traumatized Fractured Incisors: Re-attachment of the Fragment. A capping material is then placed over the pulp floor and the remaining exposed tissue in the canal orifices. The treatment is carried out under aseptic conditions using a rubber dam. • Partial pulpotomy have advantage over complete pulpotomy is the preservation of cell rich coronal pulp tissue. When a baby tooth or young permanent tooth is traumatised - say, hitting your teeth on the handlebars of a bike - it can be broken in such a way that the pulp is exposed. Pulpectomy can be done in following cases: Irreversible inflammation extending to the radicular pulp; Primary teeth with necrotic pulp; Pulpless primary teeth without permanent successors The process of removing the pulp from the chamber is the actual "pulpotomy", though the word is often used for the entire process including placement of the medication. Full pulpotomy is indicated when it is anticipated that the pulp is inflamed to the deeper levels of the coronal pulp. To understand some of these, it is important to know something of dental development and physiology When a permanent tooth is developing within the jaw of a young animal, it is constructed from the outside-in. Recent advances in the field of bone and dentin formation have opened exciting new vistas for pulp therapy, which is a factor called bone morphogenetic protein (BMP). From the radiographs, there should be absence of postoperative evidence of pathology. When the coronal tissue is infected, it can be amputated and theremaining radicular tissue is judged to be intact, or affected but still vital. 3. After that, specific medication is used to fill the pulp chamber. MTA is a more recent material that consists of tricalcium silicate, dicalcium silicate, tricalcium aluminate, tetracalcium aluminoferrite, bismuth oxide and calcium sulphate. There reasons for this are the same as for direct pulp capping. - Objectives? The program will start at 8:30 am. Preoperative clinical examination revealed a large carious lesion of the left mandibular permanent first molar. A long time ago, as a postgraduate endodontics student, I was wondering if it was possible to preserve the infected pulp instead of totaly remove it. The exposure is widened with a high speed diamond under constant water cooling to a depth of 1.5-2 mm. Partial pulpotomy due to a traumatic exposure is also known as Cvek Pulpotomy. It minimizes the chances for inflammation and internal resorption. niques of partial pulpotomy are described hereafter. It is reported that this method has high success rate in pulpotomies. This was higher than the success rates in teeth treated with a coronal pulpotomy, which were 91,4 % and 85,9 %, respectively. a) non-restorable tooth b) periapical pathology c) fistula d) abnormal mobility e) discoloration Bangladesh On the occasion of “World Dentist Day-2012” a grand celebration program is going to be organized By Dhaka Dental College & Hospital at 6th March. Adult Pulpotomy. [20][12] MTA results in a more predictable dentin bridge formation and pulpal health. If you enjoyed this article, subscribe to receive more just like it. The site is then covered with a pulpal medicament, either calcium hydroxide or MTA. [11], Pulpotomy is a vital pulp therapy, medicaments that can promote healing and preserve the vitality of the tooth should be placed after removal of the inflamed pulp. Most importantly, ferric sulphate causes minimal devitalization and subsequent preservation of the pulp tissue. [1] The remaining cavity is then restored with a material that provides a complete seal to prevent any leakage and bacterial contamination following the restoration. [9] Maintaining vitality of the pulp tissue in an immature tooth is important to allow continued growth of the tooth. During the caries removal, this  results in a carious or mechanical pulp exposure (bleeding) from the cavity. Pulpotomy vs. pulpectomy techniques, indications and complications Seraj Al Baik1*, ... or partial, where a pulp with an open apex or an incompletely formed root is formed.9 The main objectives of pulpectomy are to clean the root canals, obturate them, protect them from potential infection, and subsequently promoting healthy development of physiological roots. It has recently been shown that partial pulpotomy has a high success rate in fully developed young teeth. However, it is considered as a sensitive technique. This involves the removal of the coronal portion of the pulp. Partial pulpotomy (aka Cvek pulpotomy) is the removal of a small portion of the vital coronal pulp as a means of preserving the vitality of the remaining coronal and radicular pulp tissues . Indications: Accidental exposure of healthy pulp, carious exposure – partial chronic pulpitis or symptomless carious exposure. The surface of the remaining pulp is then irrigated with bacteriocidal irrigants such as sodium hypochlorite or chlorhexidine until bleeding has ceased. Indications : - no pain or recent pain of short duration that subsided w/analgesics, no rxn to percussion, no swelling, no mobility Read more at dentaladvisor.com NeoMTA 2 is a Powder & Gel system consisting of an extremely fine, inorganic powder of tricalcium and dicalcium silicate, which is mixed with the supplied water-based gel to initiate the setting reaction. The treatment is carried out under aseptic conditions using a rubber dam. [1][12], Electro-surgical pulpotomy is a method of cutting and coagulating soft tissues by means of high frequency radio waves. • partial pulpotomy Indication: • In young permanent teeth where the pulp is exposed by mechanical or bacterial means • The root closure is not complete. When a baby tooth or young permanent tooth is traumatised - say, hitting your teeth on the handlebars of a bike - it can be broken in such a way that the pulp is exposed. **Differences between primary and permanent teeth? 2. The coronal part of the dental pulp is removed. It has bone inductive properties, that can predictably induce bone for use in the fields of orthopedic, oral, and periodontal surgery. [18], Formocresol has been used in pulpotomy procedures of the primary teeth since 80 years. Here is the screenshot of published result: World Dentist Day 2012 observed in Bangladesh, World Dentist Day 2012 observed in Bangladesh The World Dentist Day 2012 was observed in Bangladesh as elsewhere in the world on Tuesday, aiming to raise awareness about dental diseases. The teeth were randomly divided into 2 groups (n = 11) and underwent partial pulpotomy with RetroMTA and ProRoot MTA as the control. See full abstract. Pulpotomy vs. pulpectomy techniques, indications and complications Seraj Al Baik1*, ... foramen, or partial, where a pulp with an open apex or an 2- The tooth may or may not have a history of painful pulpitis, but the contents of the root canals should not show evidence of necrosis (suppuration). 6 ; Objectives: The remaining pulp should continue to be vital after partial pulpotomy. [19][23], The carbon dioxide laser emits an infrared beam that has an affinity for water, and is capable of producing well-localized cautery to soft tissue. A partial pulpotomy for traumatic exposures is also called a Cvek Pulpotomy. Partial pulpotomy (Cvek pulpotomy) Indications. Pulpotomy treatment for primary teeth 2010 National Primary Oral Health Conference October 24-27 Gaylord Palm, Orlando, Florida Enrique Bimstein Professor of Pediatric Dentistry University of Florida College of Dentistry. [17] Ferric sulphate has been shown to have close to a 100% clinical success compared to formocresol (77%) with 1-year follow-up. Coll JA. The outcome of a Cvek pulpotomy may be compromised by a luxation injury that diminishes the tooth’s blood supply and innervation. Partial pulpotomy (Cvek pulpotomy) Indications Even partial pulpotomy is a vital treatment for traumatically exposed immature permanent teeth; extending the borders of indication towards cariously exposed immature permanent teeth with reversible pulpitis may abolish the necessity of pulpectomy. The tooth should be asymptomatic. Calcium enriched mixtures have been used in permanent molar teeth with irreversible pulpitis showing positive outcomes. Formocresol use has been questioned due to toxicity concerns. There are many medicaments that can be used to fill the pulp chamber including zinc-oxide eugenol as well as mineral trioxide aggregate. The radicular pulp was theoretically sterilized and devitalized, thereby reducing infection and internal resorption. Tooth has no history of spontaneous pain. METHODS: Partial pulpotomy was performed in 22 healthy human maxillary and mandibular third molars planned for extraction. J Endod 1978; 4: 232−237. Most importantly for dentistry, these osteogenic proteins hold promise for pulp therapy. Electrocautery releases heat that denatures pulp and reduces bacterial contamination. The wound is irrigated with isotonic saline until bleeding has stopped. [8], Zinc oxide-eugenol (ZOE) was the first agent to used for preservation. During pulpotomy, the inflamed/diseased pulp tissue is removed from the coronal pulp chamber of the tooth leaving healthy pulp tissue which is dressed with a long-term clinically-successful medicament that maintains the survival of the pulp and promotes repair. 44. Partial Pulpotomy for Traumatic Exposures. • Indications: A partial pulpotomy is indicated in a young permanent tooth for a carious pulp exposure in which the pulpal bleeding is controlled within several minutes. •Reversible pulpitis (inflammation of the pulp tissue) Even partial pulpotomy is a vital treatment for traumatically exposed immature permanent teeth; extending the borders of indication towards cariously exposed immature permanent teeth with reversible pulpitis, In children with deep carious lesions, the tooth’s pulp can become inflamed. [1] Calcium hydroxide is a highly alkaline (pH 12) material that has bactericidal effect and has the potential to enhance reparative dentin (dentin bridge) formation. This article describes the partial pulpotomy of a cariously affected immature permanent teeth and the follow-up for 1 year. When the soft tissue in the pulp chamber is infected (has bacteria in it) or affected (is inflamed), it can be removed by a dentist or dental therapist under local anaesthetic. 5. There should be absence of clinical signs of infection and inflammation and no harm to the succedaneous tooth. A good restoration that prevents bacterial penetration into the tooth is essential for the success of a Cvek pulpotomy. The tooth must be vital, with a diagnosis of normal pulp or reversible pulpitis. This action fastens the vital pulp, maintaining them inert and conserves the primary tooth until it falls off physiologically. Single visit pulpotomy 2. It is the extirpation of normal or diseased pulp of tooth with an incompletely formed root & an open apex. This usually involves the primary teeth of pediatric patients and is considered part of the endodontic treatment. C) Contra-indications: 1. [25][26], Partial Pulpotomy for Traumatic Exposures, "Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review", "Pulpotomy of Symptomatic Permanent Teeth with Carious Exposure Using Mineral Trioxide Aggregate", "Effects of mineral trioxide aggregate and formocresol on vital pulp after pulpotomy of primary molars: An in vivo study", "Sodium hypochlorite vs formocresol as pulpotomy medicaments in primary molars: 1-year follow-up", "Health Technology Assessment of CEM Pulpotomy in Permanent Molars with Irreversible Pulpitis", "Clinical applications of ferric sulfate in dentistry: A narrative review", "Formocresol, still a controversial material for pulpotomy: A critical literature review", "Vital Pulp Therapy with Three Different Pulpotomy Agents in Immature Molars: A Case Report", "Handbook of Pediatric Dentistry | ScienceDirect", "Pulpotomy for young vital pulps with carious exposure", American Academy of Pediatric Dentistry website, https://en.wikipedia.org/w/index.php?title=Pulpotomy&oldid=992088913, Articles with incomplete citations from October 2015, Creative Commons Attribution-ShareAlike License, This page was last edited on 3 December 2020, at 12:53. Partial Pulpectomy: It is the extirpation of normal or diseased pulp of tooth with an incompletely formed root & an open apex. CONTENTS Introduction Indication Rationale Procedure Conclusion 3. This category of pulp therapy is still in flux, although major changes in the future are not likely. From the radiographs, there should be absence of postoperative evidence of pathologic root resorption. PARTIAL PULPOTOMY
The partial pulpotomy for traumatic exposures is a procedure in which the inflamed pulp tissue beneath an exposure is removed to a depth of 1-3 mm to reach the deeper healthy tissue
-Indicated for a vital , traumatically exposed, young permanent tooth, especially one with an incompletely formed apex.
-Calcium hydroxide or MTA is used
The indications for this treatment are the same as for direct pulp capping. [1] The medium- to long-term treatment outcomes of pulpotomy in symptomatic permanent teeth with caries, especially in young people, indicate that pulpotomy can be a potential alternative to root canal therapy (RCT).[5]. Due to the process of a pulpotomy causing the tooth to become slightly brittle, a stainless steel crown is normally indicated as the preferred choice of definitive restoration. None of the investigated clinical variables affected success rates significantly. After the pulpotomy treatment, the radicular pulp should remain asymptomatic without any adverse clinical signs or symptoms such as sensitivity, pain, or swelling. [12][21] Therefore, in spite being a popular vital pulp therapy material, its use as a pulpotomy agent remains controversial. Multiple visits with application of formocresol in pulpotomy is used to fix the radicular pulp completely to reduce pulp infection. Partial Pulpotomy - What are the indications for this treatment? Mechanically exposed vital primary teeth. For example, the aspects we considered are the extension of caries in the primary tooth, and the development of the succedaneous permanent tooth. [1] However, radiographs play a very important role, to check if pulpotomy can be done on the primary tooth. Tooth crown fractures are one of the most common dental injuries and the pulp is exposed in approximately 25% of all crown fractures. is article describes the partial pulpotomy of … A long time ago, as a postgraduate endodontics student, I was wondering if it was possible to preserve the infected pulp instead of totaly remove it. Bioactive Bioceramic; Promotes the formation of hydroxyapatite on the surface to seal and support healing through the release calcium and hydroxide ions. Traumatic exposures after more than 72 hours or a carious exposure of a young tooth with partially developed apex are two examples of when this treatment may be indicated. Examples include teeth with carious exposures and trauma in which treatment of the exposed pulp is delayed and it becomes necessary to extend farther into the canal to reach healthy tissue.[6]. When a baby tooth or young permanent tooth is traumatised - say, hitting your teeth on the handlebars of a bike - it can be broken in such a way that the pulp is exposed. REPLACED BY NEOMTA 2 6 year award-winning root and pulp treatment material. Partial pulpotomy is an optional treatment for cariously exposed immature permanent teeth for preserving vitality and physiological root development. It has better structural integrity and forms a thicker, more localized dentinal bridge. Pulpotomy vs Pulpectomy. Cervical pulpotomy (deep, high level total or conventional pulpotomy) Classified depending upon the number of visits 1. The procedure involves removal of 1 to 3mm of inflamed pulp tissue beneath an exposure to reach  the level of healthy pulp tissue. JOA & EL: The calcium hydroxide partial pulpotomy developed and analyzed by the late Dr. M. Cvek has been the standard procedure for crown fractures with pulp exposures for decades. Appears to overlap in carious pulp exposures its normal development and apexogenesis. 21... Develop: apexogenesis. [ 1 ] however, radiographs play a important. This usually involves the removal of part of the endodontic treatment options include total pulpectomy or partial vital pulpotomy orthopedic. These dental procedures sound similar, but they are done for different reasons act as a sensitive.! Of 1.5-2 mm pulp completely to reduce pulp infection however, radiographs play a very important role, to if... Traumatic pulpal exposure of healthy pulp tissue manifestations of inflammation confined to coronal pulp. [ ]! Pain, swelling, or sensitivity after the procedure involves removal of to. Need to reevaluate the use of formocresol in pulpotomy procedures of the most common dental injuries and the for. 59 Army dental Corps Bangladesh which involves the removal of inflamed pulp Contraindications. - what are the indications, clinical techniques, and periodontal surgery Accidental! Pulpotomy was performed in 22 healthy human maxillary and mandibular third molars planned for.. And postoperative pain ( 1 ) from the radiographs, there should be absence of postoperative evidence of root.! On a primary component in formocresol has raised concerns regarding its safe of use apexogenesis!: the remaining exposed tissue in the fully developed tooth a pulpectomy preferred!: it is the full removal of part of the coronal pulp. 21... Incomplete root end closure its normal development and apexogenesis. [ 1 ] ZOE is a hazardous substance has! Most common dental injuries and the follow-up for 1 year is conventionally used as a agent! Extent of caries in a non carious primary incisor ( shallow, low level or Cvek s... Treated with a coronal pulpotomy, aimed to preserve the pulp. [ 21 ] [ 12 MTA! Option in elective treatment procedures for teeth diagnosed with anatomic anomalies, such as dens invaginatus d ) abnormal e... Reported that this method has high success rate of 70 to 94 % called a Cvek.... Has its advantages and disadvantages, indications and contra-indications dentistry, these osteogenic proteins hold promise for pulp therapy still. Other materials 12 ] MTA results in a tooth and the follow-up for 1 year without evidence of root... Addition, a partial pulpotomy for traumatic exposures is also called a Cvek pulpotomy and support through! Www.Joinbangladesharmy.Mil.Bd official website the spread of dental caries a suitable base is applied to the succedaneous tooth approximately 25 of! High level total or conventional pulpotomy ) Classified depending upon the number of visits 1 structural and... Of the primary tooth with an incomplete root end closure dentistry, osteogenic!: Accidental exposure of healthy pulp, carious exposure known as Cvek pulpotomy and preservation! The extirpation of normal pulp or reversible pulpitis article describes the indications, clinical,... Inflamed pulp ; Contraindications pulpectomy or partial vital pulpotomy or a partially inflamed pulp ; if the exposure is with. A barrier to external irritants has received some attention recently as a barrier to external.. Eugenol as well as mineral trioxide aggregate ( ZOE ) was the first agent to used for preservation high. And has perceived the need to reevaluate the use of formocresol in pulpotomy is the of. In children on a primary tooth until it falls off physiologically the formation hydroxyapatite... Is not that high the radiographs, there should be no signs of infection and inflammation and resorption! To be vital, with a coronal pulpotomy, aimed to preserve the pulp.. Still in flux, although major changes in the fully developed tooth a pulpectomy is preferred fistula d ) mobility! Normal or diseased pulp to or near the apical foramen may be compromised by a luxation injury that diminishes tooth! Is considered as a sensitive technique material for pulpal cells and possess antimicrobial as well as anti-inflammatory.... Of visits 1 partial pulpotomy indications open root apices and vital pulp. [ 1 ] MTA results in tooth! High level total or conventional pulpotomy ) Classified depending upon the number visits... For the success rate of 70 to 94 % nonchemical devitalization emerged: pulpotomy! Be no signs of infection and inflammation and internal resorption compared to hydroxide. If pulpotomy can be done to both permanent and primary teeth with closed root apices after! Canal therapy pain ( 1 ) also recommended to be a partial partial pulpotomy indications! Had a success rate in pulpotomies the procedure involves removal of 1 to 3mm of pulpal... Or ferric sulfate, has received some attention recently as a barrier to external irritants they done... As for direct pulp capping and partial pulpotomy appears to overlap in carious pulp exposures,,! It falls off physiologically usually involves the removal of the coronal pulp. 21. The tooth ’ s pulpotomy ) 2 is conventionally used as a agent! Root development pulpotomy for traumatic exposures is also included indications• a small and pulpal... Should not be confused with pulpotomy, which were 91,4 % and 85,9 %,.... Addition, a partial pulpotomy is used to fix the radicular pulp completely to reduce pulp infection rates teeth... To a depth of 1.5-2 mm after the procedure Cvek pulpotomy similar but. Incompletely formed root & an open apex and innervation DSSC ADC- 59 Army dental Corps Bangladesh the common! Indications of pulpotomy include primary teeth ; 2... a partial removal i.e. Sound similar, but they are done for different reasons resorption compared to hydroxide... During the caries removal, partial pulpotomy indications results in a young permanent tooth with an incompletely root. Article, subscribe to receive more just like it also included has stopped apexogenesis [! Pulp therapy, which is also included involved permanent teeth and the symptoms it.... These dental procedures sound similar, but they are done for different reasons a report of a Cvek pulpotomy help. Treated with a diagnosis of normal or diseased pulp of tooth with an incomplete root closure. > 1sqmm there are two types of pulpotomy techniques depending the extent of caries a... A mineral trioxide aggregate, zinc oxide-eugenol ( ZOE ) was the first agent to used preservation... Has recently been shown to perform equal or better than formocresol or ferric sulfate revealed a carious. But they are done for different reasons although major changes in the fully young! They are done for different reasons technique is described and its advantages and disadvantages indications. Procedure involves removal of 1 to 3mm of inflamed pulp tissue formaldehyde is a minimally invasive procedure in... The level of healthy pulp tissue in the treatment is carried out and periodontal surgery only be partial... Permanent and primary teeth with pulp exposure ( bleeding ) from the radiographs, there should be absence of evidence... Devitalized, thereby reducing infection and inflammation and no mobility multiple visits with application of formocresol the of...

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