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Table 6 Correlations between PPD and the other par...

Parameters H group correlation (R s ) HP group correlation (R s ) PPD-mPI 0.182 n.s. ...

Table 5 Correlations between PPD and characteristi...

Characteristics H group correlation (R s ) HP group correlation (R s ) Age 0.040 n.s. 0.209* Number of teeth (at the beginning o...

Table 4 Value of each clinical parameter : Correla...

Clinical parameters H group (n = 39) mean ± SD/median HP group (n = 91) mean ± SD/median Significance difference between H and HP group ...

Table 3 Prevalence of peri-implantitis and periodo...

Diagnosis in HP group (37 patients, 91 implants) Localized: ≤ 30% of site involved, generalized: > 30% of site involved Numbers of peri-implantitis and prevalence in diagnosis n = 14, 15.4% of HP group ...

Table 2 Characteristics of the study population : ...

  H group mean ± SD, or n (median) HP group mean ± SD, or n (median) Significant difference between H and HP group Age 56.0 ± 11.8 (57.9) ...

Table 1 Implant systems used : Correlations betwee...

Implant Number Replace select ™ 44 Novel Replace ® 31 ...

About this article : Correlations between clinical...

Seki, K., Nakabayashi, S., Tanabe, N. et al. Correlations between clinical parameters in implant maintenance patients: analysis among healthy and history-of-periodontitis groups. Int J Implant Dent 3, 45 (2017). https://doi.org/10.1186/s40729-017-0108-0 Download citation Received: 25 July 2017 Accepted: 19 October 2017 Published: 30 October 2017 DOI: https://doi.org/10.11...

Rights and permissions : Correlations between clin...

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...

Ethics declarations : Correlations between clinica...

Patient recruitment and data collection for this study took place at Nihon University School of Dentistry Dental Hospital, Japan. The research was approved by the Nihon University School of Dentistry Ethics Committee (2013-15) and all activities were conducted in full accordance with ethical principles, including the World Medical Association Declaration of Helsinki. We described the purpose of th...

Author information : Correlations between clinical...

Implant Dentistry, Nihon University School of Dentistry Dental Hospital, Tokyo, 101-8310, Japan Keisuke Seki, Shinya Nakabayashi, Atsushi Kamimoto & Yoshiyuki Hagiwara Department of Comprehensive Dentistry and Clinical Education, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8310, Japan Keisuke Seki & Atsushi Kamimoto Department of Applied Mathemati...

References : Correlations between clinical paramet...

Download references

References : Correlations between clinical paramet...

Karousis IK, Salvi GE, Heitz-Mayfield LJ, Brägger U, Hämmerle CH, Lang NP. Long-term implant prognosis in patients with and without a history of chronic periodontitis: a 10-year prospective cohort study of the ITI Dental Implant System. Clin Oral Implants Res. 2003;14:329–39. Mengel R, Flores-de-Jacoby L. Implants in patients treated for generalized aggressive and chronic periodontitis: a 3-y...

References : Correlations between clinical paramet...

Monjie A, Aranda L, Diaz KT, Alarcón MA, Bagramian RA, Wang HL, et al. Impact of maintenance therapy for the prevention of peri-implant diseases: a systematic review and meta-analysis. J Dent Res. 2016;95:372–9. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4:1–6. Lang NP, Berglundh T; Working group 4 of Seventh European W...

References : Correlations between clinical paramet...

Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (I) Success criteria and epidemiology. Eur J Oral Sci. 1998;106:527–51. Ogata Y, Nakayama Y, Tatsumi J, Kubota T, Sato S, Nishida T, et al. Prevalence and risk factors for peri-implant diseases in Japanese adult dental patients. J Oral Sci. 2017;59:1–11. Heitz-Mayfield L...

Abbreviations : Correlations between clinical para...

Bleeding on probing Modified plaque index Probing pocket depth

Conclusions : Correlations between clinical parame...

We examined clinical parameters in patients receiving long-term implant maintenance. There were significant differences between the H and HP groups in age at the time of maintenance, number of natural teeth at the beginning of implant treatment, total number of extracted teeth, and maintenance. The prevalence of implant-based peri-implantitis was 10.8% of all the implants. All implants with peri-i...

Discussion : Correlations between clinical paramet...

A correlation between the PPD of the peri-implant tissue and lesion progression has been reported, similar to that seen with periodontitis [27]. Probing around the implant is useful for evaluating soft tissue inflammation and is considered reproducible [36]. Examination of peri-implant bleeding is reported to have higher diagnostic accuracy than probing around natural teeth [37]. However, because ...

Discussion : Correlations between clinical paramet...

BoP has been used to evaluate inflammatory conditions of periodontal tissue [33] and can also be an important evaluation item for peri-implant tissues. To avoid diagnosing bleeding resulting from strong probing as a false positive, we set the probing pressure to 0.15 N [34]. BoP values were low, with no significant difference between the groups (H group, 0.30; HP group, 0.28). This result was sim...

Discussion : Correlations between clinical paramet...

All the implants with peri-implantitis came from the HP group, not the H group, thus supporting the view that a history of periodontitis is a risk indicator for peri-implantitis. In the diagnosis of periodontitis within the HP group, it is notable that peri-implantitis increased as periodontitis become more severe. This supports the findings of a previous study that reported that the survival rate...

Discussion : Correlations between clinical paramet...

In this study, we reviewed the clinical parameters of 130 implants in 55 patients during ongoing long-term maintenance. We focused on the history of periodontitis and compared the parameters in two groups classified according to a history of periodontitis. A previous study on the prevalence of periodontitis revealed that moderate or severe periodontitis was observed in 64% of people over 65 years...

Results : Correlations between clinical parameters...

Because normality and homoscedasticity were not obtained for each clinical parameter between the two groups, a statistical study was conducted using the nonparametric test (Mann–Whitney U test) for the difference test between the two groups. PPD was recognized to be significantly greater (p 

Results : Correlations between clinical parameters...

Of the 55 subjects, 25 were male and 30 were female (H group: 8/10, HP group: 17/20, respectively). A total of 130 implants (H group 39, HP group 91) were included in the analysis (Table 2). The mean maintenance period was 6 years and 6 months. The average number of natural teeth at the first visit and at the beginning of implant treatment were 25.3 ± 2.9 and 22.4 ± 4.5, respectively. Com...

Methods : Correlations between clinical parameters...

At the time of optional maintenance, the following parameters were measured for each implant. Data collection and analysis were conducted by two operators who were blind to the research purpose and methods. One operator statistically analyzed the final data set. Plaque adhesion (modified Plaque Index: mPI) on the superstructure of the implant was measured on a 4-point scale (0, no plaque; 1, plaq...

Methods : Correlations between clinical parameters...

This study enrolled 55 patients (25 men, 30 women; mean age, 63.53 ± 10.51 years) who visited Nihon University School of Dentistry Dental Hospital for implant maintenance from April to September 2016. The inclusion criteria were treatment at the same hospital with two-stage implant placement before 2015, and ongoing maintenance at 3–6-month intervals after superstructure placement. Patients ...

Background : Correlations between clinical paramet...

Peri-implant diseases are the main biological complication of implant treatment and greatly influence treatment success [1]. Risk indicators for peri-implantitis include a history of periodontitis, poor oral hygiene, and smoking [2,3,4]. Peri-implantitis is often encountered clinically, occurring in 12 to 43% of implants and 28 to 47% of implant patients [5,6,7,8]. Similarities between the patholo...

Abstract : Correlations between clinical parameter...

The pathophysiology and pathology of peri-implantitis remain unclear; however, its similarity to periodontitis has been described. The evaluation of peri-implant tissue and the diagnostic criteria of peri-implant disease are not currently standardized as they are for periodontitis. In this study, we evaluated clinical parameters during the implant maintenance period to determine significant correl...

Table 6 Correlations between PPD and the other par...

Parameters H group correlation (R s ) HP group correlation (R s ) PPD-mPI 0.182 n.s. ...

Table 5 Correlations between PPD and characteristi...

Characteristics H group correlation (R s ) HP group correlation (R s ) Age 0.040 n.s. 0.209* Number of teeth (at the beginning o...

Table 4 Value of each clinical parameter : Correla...

Clinical parameters H group (n = 39) mean ± SD/median HP group (n = 91) mean ± SD/median Significance difference between H and HP group ...

Table 3 Prevalence of peri-implantitis and periodo...

Diagnosis in HP group (37 patients, 91 implants) Localized: ≤ 30% of site involved, generalized: > 30% of site involved Numbers of peri-implantitis and prevalence in diagnosis n = 14, 15.4% of HP group ...

Table 2 Characteristics of the study population : ...

  H group mean ± SD, or n (median) HP group mean ± SD, or n (median) Significant difference between H and HP group Age 56.0 ± 11.8 (57.9) ...

Table 1 Implant systems used : Correlations betwee...

Implant Number Replace select ™ 44 Novel Replace ® 31 ...

About this article : Correlations between clinical...

Seki, K., Nakabayashi, S., Tanabe, N. et al. Correlations between clinical parameters in implant maintenance patients: analysis among healthy and history-of-periodontitis groups. Int J Implant Dent 3, 45 (2017). https://doi.org/10.1186/s40729-017-0108-0 Download citation Received: 25 July 2017 Accepted: 19 October 2017 Published: 30 October 2017 DOI: https://doi.org/10.11...

Rights and permissions : Correlations between clin...

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...

Ethics declarations : Correlations between clinica...

Patient recruitment and data collection for this study took place at Nihon University School of Dentistry Dental Hospital, Japan. The research was approved by the Nihon University School of Dentistry Ethics Committee (2013-15) and all activities were conducted in full accordance with ethical principles, including the World Medical Association Declaration of Helsinki. We described the purpose of th...

Author information : Correlations between clinical...

Implant Dentistry, Nihon University School of Dentistry Dental Hospital, Tokyo, 101-8310, Japan Keisuke Seki, Shinya Nakabayashi, Atsushi Kamimoto & Yoshiyuki Hagiwara Department of Comprehensive Dentistry and Clinical Education, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8310, Japan Keisuke Seki & Atsushi Kamimoto Department of Applied Mathemati...

References : Correlations between clinical paramet...

Download references

References : Correlations between clinical paramet...

Karousis IK, Salvi GE, Heitz-Mayfield LJ, Brägger U, Hämmerle CH, Lang NP. Long-term implant prognosis in patients with and without a history of chronic periodontitis: a 10-year prospective cohort study of the ITI Dental Implant System. Clin Oral Implants Res. 2003;14:329–39. Mengel R, Flores-de-Jacoby L. Implants in patients treated for generalized aggressive and chronic periodontitis: a 3-y...

References : Correlations between clinical paramet...

Monjie A, Aranda L, Diaz KT, Alarcón MA, Bagramian RA, Wang HL, et al. Impact of maintenance therapy for the prevention of peri-implant diseases: a systematic review and meta-analysis. J Dent Res. 2016;95:372–9. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4:1–6. Lang NP, Berglundh T; Working group 4 of Seventh European W...

References : Correlations between clinical paramet...

Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (I) Success criteria and epidemiology. Eur J Oral Sci. 1998;106:527–51. Ogata Y, Nakayama Y, Tatsumi J, Kubota T, Sato S, Nishida T, et al. Prevalence and risk factors for peri-implant diseases in Japanese adult dental patients. J Oral Sci. 2017;59:1–11. Heitz-Mayfield L...

Abbreviations : Correlations between clinical para...

Bleeding on probing Modified plaque index Probing pocket depth

Conclusions : Correlations between clinical parame...

We examined clinical parameters in patients receiving long-term implant maintenance. There were significant differences between the H and HP groups in age at the time of maintenance, number of natural teeth at the beginning of implant treatment, total number of extracted teeth, and maintenance. The prevalence of implant-based peri-implantitis was 10.8% of all the implants. All implants with peri-i...

Discussion : Correlations between clinical paramet...

A correlation between the PPD of the peri-implant tissue and lesion progression has been reported, similar to that seen with periodontitis [27]. Probing around the implant is useful for evaluating soft tissue inflammation and is considered reproducible [36]. Examination of peri-implant bleeding is reported to have higher diagnostic accuracy than probing around natural teeth [37]. However, because ...

Discussion : Correlations between clinical paramet...

BoP has been used to evaluate inflammatory conditions of periodontal tissue [33] and can also be an important evaluation item for peri-implant tissues. To avoid diagnosing bleeding resulting from strong probing as a false positive, we set the probing pressure to 0.15 N [34]. BoP values were low, with no significant difference between the groups (H group, 0.30; HP group, 0.28). This result was sim...

Discussion : Correlations between clinical paramet...

All the implants with peri-implantitis came from the HP group, not the H group, thus supporting the view that a history of periodontitis is a risk indicator for peri-implantitis. In the diagnosis of periodontitis within the HP group, it is notable that peri-implantitis increased as periodontitis become more severe. This supports the findings of a previous study that reported that the survival rate...

Discussion : Correlations between clinical paramet...

In this study, we reviewed the clinical parameters of 130 implants in 55 patients during ongoing long-term maintenance. We focused on the history of periodontitis and compared the parameters in two groups classified according to a history of periodontitis. A previous study on the prevalence of periodontitis revealed that moderate or severe periodontitis was observed in 64% of people over 65 years...

Results : Correlations between clinical parameters...

Because normality and homoscedasticity were not obtained for each clinical parameter between the two groups, a statistical study was conducted using the nonparametric test (Mann–Whitney U test) for the difference test between the two groups. PPD was recognized to be significantly greater (p 

Results : Correlations between clinical parameters...

Of the 55 subjects, 25 were male and 30 were female (H group: 8/10, HP group: 17/20, respectively). A total of 130 implants (H group 39, HP group 91) were included in the analysis (Table 2). The mean maintenance period was 6 years and 6 months. The average number of natural teeth at the first visit and at the beginning of implant treatment were 25.3 ± 2.9 and 22.4 ± 4.5, respectively. Com...

Methods : Correlations between clinical parameters...

At the time of optional maintenance, the following parameters were measured for each implant. Data collection and analysis were conducted by two operators who were blind to the research purpose and methods. One operator statistically analyzed the final data set. Plaque adhesion (modified Plaque Index: mPI) on the superstructure of the implant was measured on a 4-point scale (0, no plaque; 1, plaq...

Methods : Correlations between clinical parameters...

This study enrolled 55 patients (25 men, 30 women; mean age, 63.53 ± 10.51 years) who visited Nihon University School of Dentistry Dental Hospital for implant maintenance from April to September 2016. The inclusion criteria were treatment at the same hospital with two-stage implant placement before 2015, and ongoing maintenance at 3–6-month intervals after superstructure placement. Patients ...

Background : Correlations between clinical paramet...

Peri-implant diseases are the main biological complication of implant treatment and greatly influence treatment success [1]. Risk indicators for peri-implantitis include a history of periodontitis, poor oral hygiene, and smoking [2,3,4]. Peri-implantitis is often encountered clinically, occurring in 12 to 43% of implants and 28 to 47% of implant patients [5,6,7,8]. Similarities between the patholo...

Abstract : Correlations between clinical parameter...

The pathophysiology and pathology of peri-implantitis remain unclear; however, its similarity to periodontitis has been described. The evaluation of peri-implant tissue and the diagnostic criteria of peri-implant disease are not currently standardized as they are for periodontitis. In this study, we evaluated clinical parameters during the implant maintenance period to determine significant correl...

Fig. 8. PPD on natural teeth. No significant diffe...

Fig. 8. PPD on natural teeth. No significant differences appreciable Fig. 8. PPD on natural teeth. No significant differences appreciable

Fig. 7. PPD on dental implants. No significant dif...

Fig. 7. PPD on dental implants. No significant differences appreciable Fig. 7. PPD on dental implants. No significant differences appreciable

Fig. 6. BoP on natural teeth. While the control gr...

between 1 month and 3 months, the test group values decrease during all the duration of the study Fig. 6. BoP on natural teeth. While the control group shows a mild increase between 1 month and 3 months, the test group values decrease during all the duration of the study

Fig. 5. BoP on dental implants. It can be observed...

Fig. 5. BoP on dental implants. It can be observed how the values keep decreasing after 1 month only in the test group Fig. 5. BoP on dental implants. It can be observed how the values keep decreasing after 1 month only in the test group

Fig. 4. PI on natural teeth. After 1 month, the t...

Fig. 4. PI on natural teeth. After 1 month, the test group showed mild reduction while control a light improvement Fig. 4. PI on natural teeth. After 1 month, the test group showed mild reduction while control a light improvement

Fig. 3. PI on dental implants. Test values keep re...

Fig. 3. PI on dental implants. Test values keep reducing after 1 month while control maintains the same level Fig. 3. PI on dental implants. Test values keep reducing after 1 month while control maintains the same level

Fig. 2. Patients’ population flow chart : Effect...

Fig. 2. Patients’ population flow chart Fig. 2. Patients’ population flow chart

Fig. 1. Electric toothbrush heads: on the left is ...

Fig. 1. Electric toothbrush heads: on the left is the one designed for natural teeth, and on the right is the one designed for dental implants Fig. 1. Electric toothbrush heads: on the left is the one designed for natural teeth, and on the right is the one designed for dental implants

Table 1 BoP, PI, and PPD mean values at baseline, ...

  Baseline 1 month 3 months T0 T1 T2 BoP implants, t...

About this article : Effectiveness and compliance ...

Allocca, G., Pudylyk, D., Signorino, F. et al. Effectiveness and compliance of an oscillating-rotating toothbrush in patients with dental implants: a randomized clinical trial. Int J Implant Dent 4, 38 (2018). https://doi.org/10.1186/s40729-018-0150-6 Download citation Received: 12 April 2018 Accepted: 24 October 2018 Published: 10 December 2018 DOI: https://doi.org/10.11...

Rights and permissions : Effectiveness and complia...

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...

Ethics declarations : Effectiveness and compliance...

Not applicable This study was conducted in compliance with the principles of the Declaration of Helsinki, and the approval of the ethics committee required for the study was obtained from the Ethics Committee of the IRCCS Ospedale Maggiore Policlinico di Milano, Fondazione Ca’ Granda. The procedures to be performed were explained in detail, and the patients signed the consent form. Not applica...

Author information : Effectiveness and compliance ...

Center for Edentulism and Jaw Atrophies, Maxillofacial Surgery and Dentistry Unit, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, University of Milan, Via Commenda 10, 20122, Milan, Italy Giuseppe Allocca, Diana Pudylyk, Fabrizio Signorino & Carlo Maiorana Oral Surgery, Maxillofacial Surgery and Dentistry Unit, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Un...

Acknowledgements : Effectiveness and compliance of...

Not applicable The authors declare no funds for the research. Mean data of PI, BoP, and PPD collected from 80 periodontal charts are shown in Table 1.

References : Effectiveness and compliance of an os...

Download references

References : Effectiveness and compliance of an os...

Berglundh T, Lindhe J. Dimension of the periimplant mucosa. Biological width revisited. J Clin Periodontol. 1996;23(10):971–3 PubMed PMID: 8915028. Berglundh T, Lindhe J, Ericsson I, Marinello CP, Liljenberg B, Thomsen P. The soft tissue barrier at implants and teeth. Clin Oral Implants Res. 1991;2(2):81–90 PubMed PMID: 1809403. Berglundh T, Abrahamsson I, Welander M, Lang NP, Lindhe J. Morp...

References : Effectiveness and compliance of an os...

Quirynen M, De Soete M, van Steenberghe D. Infectious risks for oral implants: a review of the literature. Clin Oral Implants Res. 2002;13(1):1–19 PubMed PMID: 12005139. Roos-Jansåker AM, Renvert S, Egelberg J. Treatment of peri-implant infections: a literature review. J Clin Periodontol. 2003;30(6):467–85 PubMed PMID: 12795785. Ho HP, Niederman R. Effectiveness of the Sonicare sonic toothb...

References : Effectiveness and compliance of an os...

Pjetursson BE, Lang NP. Prosthetic treatment planning on the basis of scientific evidence. J Oral Rehabil. 2008;35(Suppl 1):72–9. https://doi.org/10.1111/j.1365-2842.2007.01824.x PubMed PMID: 18181936. Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP. A systematic review of the 5-year survival and complication rates of implant-supported single crowns. Clin Oral Implants Res. 2008...

Abbreviations : Effectiveness and compliance of an...

Bleeding on probing Plaque index Pocket probing depth

Conclusion : Effectiveness and compliance of an os...

The oscillating-rotating toothbrush can be used for the plaque and bleeding control around both natural teeth and dental implants. It has also been shown how the toothbrush head designed for dental implant can be effective in plaque removing of the peri-implant tissues.

Discussion : Effectiveness and compliance of an os...

At the end of the present study, electric toothbrush groups showed plaque and bleeding values lower (PI and BoP on teeth) or at least without significative differences (BoP on implants) than the control group. These data may suggest how the use of electric toothbrush, associated to the dedicate heads, can be an effective method for plaque and bleeding reduction.

Discussion : Effectiveness and compliance of an os...

This 3-month study aimed to demonstrate the efficacy of an electric toothbrush in reducing plaque and gingival inflammation around dental implants and natural teeth. To better understand the different data collected around two different anatomical structures, we decided to collect data separately. Analyzing our results, it is possible to observe how the mean values for probing, bleeding, and plaqu...

Results : Effectiveness and compliance of an oscil...

The difference between the BoP recorded on dental implant sites at baseline and the end of the study showed statistical significance for both the test and control groups (P 

Results : Effectiveness and compliance of an oscil...

Seventy-eight patients successfully completed the study (45 women and 33 men aged from 31 to 76 years old) (Fig. 2). Two patients of test group did not show up both at the first and second controls. No patients were excluded or showed complications or adverse reaction. Results are shown in Table 1. The average number of implants per patients was 4.8 ± 3.4 in the control group and 4.4 ±â...

Methods : Effectiveness and compliance of an oscil...

Mean scores of all clinical indices for each subject were calculated separately for dental implants and natural teeth. The final data analysis was performed for those subjects who completed the study. The Student’s t test and the Mann-Whitney U test were used to evaluate whether any statistically significant differences were present between the two groups at each time point, and the Wilcoxon sig...

Methods : Effectiveness and compliance of an oscil...

The study was conducted between September 2015 and June 2017 at Implantology Department of Policlinic Hospital, University of Milan, Milan. It was designed as a monocentric randomized clinical study according to the STROBE criteria. Eighty patients who underwent dental implant rehabilitation were selected for this study. At the screening visit, subjects were asked to read and sign a written inform...

Background : Effectiveness and compliance of an os...

Dental implants became one of the most accepted treatments for the rehabilitation of partial or complete edentulism [1]. However, inflammatory processes may still occur due to the presence of the implant itself [2]. It is well known that peri-mucositis and peri-implantitis are strictly related to the presence of plaque on the surface of the implant-prosthetic complex, which lead respectively to th...

Abstract : Effectiveness and compliance of an osci...

The aim of this randomized clinical trial was to assess the efficacy of an oscillating-rotating toothbrush in reducing plaque and inflammation around dental implants. Eighty patients presenting dental implants were enrolled in this study and assigned randomly to two different groups: 40 patients in the test group and 40 in the control one. Each patient in the test group received an oscillating-ro...