Ağız, Diş ve Çene Cerrahisi/Makale

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Maksiller sinüste ektopik üçüncü molar diş: Bir olgu sunumu
(Selçuk Üniversitesi, 2014) Küçükkolbaşı, Hasan; Esen, Alparslan
Ektopik dişler alveolar ark dışında sürmüş veya farklı bir bölgede gömülü olarak kalmış dişler olarak tanımlanmaktadır. Ektopik dişlerin görülme sıklığı %0,1-1 arasında değişmektedir. Etiyolojisinde gelişimsel düzensizlikler, enfeksiyon, travma ve idiyopatik nedenler gösterilmektedir. Mandibular kondil, koronoid çıkıntı, nazal kavite, sert damak ve maksiler sinüs en sık görüldüğü anatomik bölgelerdir. Bu olguda rutin alınan radyografiler sonucu teşhis edilmiş, 24 yaşında bir kadın hastanın sol maksiller sinüsünün posterior duvarında lokalize olmuş ektopik üçüncü molar dişin Caldwell-Luc yöntemiyle çekimi sunulmaktadır.
Süt dişleriyle ilişkili kompound odontoma: İki olgu
(Selçuk Üniversitesi, 2014) Küçükyılmaz, Ebru; Savaş, Selçuk; Kalaycı, Abdullah; Yıldırım, Sibel
Çenelerde görülen odontojenik kaynaklı tümörlerin % 22’sini oluşturan odontomalar, mine, dentin ve pulpa dokusu içeren hamartamatöz lezyonlardır. Odontomalar benign odontojenik tümörler olarak sınıflandırılmaktadır. Morfolojik olarak kompleks ve kompound odontoma olarak ikiye ayrılmaktadır. Kompound odontomalar yaygın olarak maksillada keser-kanin bölgesinde gelişmektedirler ve kompleks odontomalara göre iki kat daha fazla görülürler. Genellikle asemptomatiktirler ve rutin dental radyografi esnasında teşhis edilirler. Odontomalar diş sürme bozuklukları, komşu dişlerde konjenital eksiklik, rezorpsiyon ve malpozisyon gibi durumlarla ilişkilendirilmektedir ve sıklıkla daimi dentisyonda görülürken, nadir olarak süt dentisyonda da görülebilmektedir. Bu vaka raporunda; süt dişleriyle ilişkili iki kompound odontoma vakasının sunulması amaçlanmıştır.
Alveolar proses fraktürünün semi-rijid fiksasyon ile tedavisi: Bir olgu sunumu
(Selçuk Üniversitesi, 2017) İrdem, Hatice Özlem; Canpolat, Naci; Yıldırım, Gülsün
Alveol proses kırıkları künt veya penetran travma sonucu oluşabilmektedir. Yetişkinlerde künt travmaların en yaygın etyolojileri yumruk kavgaları ve motorlu taşıt kazalarıdır. Yüz travmasının diğer nedenleri arasında atletik yaralanmalar, düşmeler ve endüstriyel kazalar bulunur. Alveol kret fraktürü olan bir hasta pratikte en kısa sürede tedavi edilmelidir. Alveolar proses kırıklarında kırığın redüksiyonu ve immobilizasyonu zorunludur. Bu olgu sunumunda mandibula anterior bölgede meydana gelen alveolar segmental kırığın redüksiyonu ve Ribbond ile tedavisi anlatılmaktadır.
İlerletme genioplastisinde kullanılan 5 farklı fiksasyon sisteminin stabilite ve stres dağılımlarının sonlu elemanlar analizi ile değerlendirilmesi
(Selçuk Üniversitesi, 2020) Aktı, Ahmet; Kalaycı, Abdullah
Amaç: Bu genioplasti çalışmasının amacı; segmentlerinin fiksasyonunda kullanılan titanyum monokortikal miniplak ve bikortikal vida sistemlerinin deplasman miktarı, kemikte oluşturduğu asal stresler ile plak ve vidalarda oluşan von-mises stres dağılımlarının sonlu elemanlar analizi ile karşılaştırılmasıdır. Gereç ve Yöntemler: Çalışmamızda alt çene ucunda genioplasti osteotomisi yapılarak distal fragman anteriora doğru 5 mm ilerletilmiştir. Fiksasyon olarak tek genioplasti plağı, 2 adet düz plak, 3 adet düz plak, 2 adet bikortikal vida ve 3 adet bikortikal vida fiksasyon modellerinin kullanıldığı 5 farklı modelde, alt segmente linguale doğru horizontal yönde 80 N’ luk kuvvet uygulanarak ortaya çıkan deplasman ve stres değerleri sonlu elemanlar analizi ile değerlendirilmiştir. Bulgular: En az deplasman üç adet titanyum bikortikal vida ile yapılan fiksasyon modelinde izlenirken, en fazla deplasman tek genioplasti plağı fiksasyon modelinde izlenmiştir. Materyallerde en az von-mises stres üç adet titanyum bikortikal vida ile yapılan fiksasyon modelinde, en fazla von-mises stres tek genioplasti plağı fiksasyon modelinde izlenmiştir. Kemikte en fazla gerilme stresi (Pmax) üç adet düz plak fiksasyon modelinde izlenirken en az gerilme stresi plak kullanılan fiksasyon modellerinde izlenmiştir. Kemikte en fazla sıkışma stresi (Pmin) iki adet bikortikal vida fiksasyon modelinde izlenirken en az sıkışma stresi iki ve üç adet düz plak fiksasyon modellerinde izlenmiştir. Sonuç: Bikortikal vida grupları, deplasman ve von-mises gerilme stresleri açısından daha iyi sonuç vermekle birlikte, plak grupları gerilme ve sıkışma stresleri açısından daha elverişli bulunmuştur. Tüm bunlarla birlikte sonuçlar tüm gruplar için fizyolojik sınırlar içerisindedir.
Endodontik sebeplerle çekilmiş dişlerin mineral içeriğinin SEM-EDX yöntemi ile incelenmesi
(Selçuk Üniversitesi, 2016) Olcay, Keziban; Ataoğlu, Hanife; Belli, Sema
Amaç: Bu araştırmanın amacı; endodontik tedavi sonrasında diş dokularının mineral içeriğinde meydana gelen değişikliklerin, dişin farklı bölgelerinde Taramalı Elektron Mikroskobu-Enerji Dağılımlı X Işını Analizi (SEM-EDX) yöntemi kullanılarak incelenmesidir. Gereç ve Yöntemler: Bu çalışmada başarısız olmuş kanal tedavili dişler arasından çekim endikasyonu konulan, 20 adet tek köklü insan daimi dişi ve 20 adet kök kanal tedavisi görmemiş, ortodontik veya periodontal nedenlerle çekilmiş, çürüksüz, restorasyonsuz, sağlam tek köklü insan daimi dişi olmak üzere toplam 40 adet diş kullanılmıştır. Dişler kanal tedavisi sonrasında yapılarındaki mineral miktarında olası değişikliklerin endodontik tedavide başarısızlık ile ilişkisinin araştırılması amacıyla SEM-EDX analizine gönderilmek üzere %10’luk formalin solüsyonunda bekletildi. SEM-EDX analizi sırasında, her dişin bir yarısı, apikal, orta ve koronal olmak üzere standardize edilmiş 3 ayrı noktadan, elementel içerik ve elementel dağılım açısından 300 büyütme altında analiz edildi. Dişin diğer yarısı ölçüm amacıyla kullanılmadı. Bu analiz sırasında, oksijen, karbon, kalsiyum, fosfor, magnezyum, sodyum, sülfür, çinko, alüminyum, klor ve Ca/P ile ilgili veriler değerlendirildi. SEM-EDX ile elde edilen verilerin istatistiksel analizi ise tek yönlü varyans analizi ile yapıldı. Bulgular: SEM-EDX analizinin sonuçlarına göre kök kanal tedavisi olan dişler ve kontrol grubu arasında karbon, kalsiyum, fosfor, alüminyum ve klor ile ilgili anlamlı fark bulunmuştur (p<0,01). İki grup arasında oksijen, magnezyum, sodyum, sülfür, çinko ve Ca/P miktarı ile ilgili anlamlı bir fark bulunamamıştır (p>0,05). Apikal, orta ve koronal bölgeler açısından hiçbir grupta anlamlı bir farklılık yoktur (p>0,05). Sonuç: Bu çalışmada, kök kanal tedavisi sonrasında, dişin farklı bölgelerinde bir fark gözlenmezken, diş dokusunda karbon, kalsiyum, fosfor, alüminyum ve klor mineralleri açısından anlamlı farklılıklar olduğu sonucuna varılmıştır.
Evaluation of related factors in the failure of endodontically treated teeth: a cross-sectional study
(ELSEVIER SCIENCE INC, 2018) Olcay, Keziban.; Ataoglu, Hanife.; Belli, Sema.
Introduction: The aim of this study was to review the factors related to the failure and extraction of unsuccessful endodontically treated teeth. Methods: A total of 1000 teeth treated with nonsurgical root canal therapy were analyzed, and the following information was recorded for each patient: reasons for failure and extraction, type of tooth, presence and type of coronal restoration, smoking status, age, gender, and level of education. One main reason was recorded for each failed tooth. The associations between reasons for failure, patient, and tooth were tested by using chi(2) analysis. Results: Of the 1000 endodontically failed teeth analyzed in this study, 28.1% (n = 281) were extracted, 66% (n = 660) were re-treated, and 5.9% (n = 59) were treated with apical surgery. Among the reasons for failure, restorative and endodontic reasons were seen most frequently (43.9%, n = 439), whereas orthodontic reasons were seldom seen (0.1%, n = 1). The most common reason for extraction was for prosthetic reasons (40.8%), and perforation/stripping was the least common (2.9%). The mandibular first molars were the most frequently extracted teeth (27.4%, n = 77). Conclusions: The most common reason for the extraction of endodontically treated teeth was for prosthetic reasons. Among the reasons for failure, restorative and endodontic reasons were the most frequently seen, and orthodontic reasons were the most seldom. The teeth that failed most frequently were mandibular first molars, and the teeth that failed least frequently were maxillary third molars. The most common reason for the extraction of failed endodontically treated teeth was for prosthetic reasons.
Alternative prosthodontic rehabilitation of traumatic patients with tooth, bone and soft tissue loss: Two clinical reports
(2018) Özel, Gülsüm Sayın; İnan, Özgür; Dolanmaz, Doğan
Acquired defects typically result from traumatic injuries such as falls, motor vehicle accidents, gunshot injuries or radiation injuries. Those maxillofacial defects resulting from motor vehicle accidents in particular often involve various soft and hard-tissue injuries such as fractures or avulsions of the maxillary or mandibular teeth or fractures of the temporomandibular joints. For a patient suffering such injuries, the retention and stabilization of a prosthesis that contributes to the patient's physical and psychological well-being are often difficult to achieve due to the nature of the moveable tissue beds involved and the resulting lack of support from the remaining teeth and bones. This clinical report describes the treatments of two partially edentulous patients with traumatic injuries that resulted from motor vehicle accidents. The prosthetic rehabilitations were accomplished through the manufacture of (1) a mandibular prosthesis with an extracoronal bar attachment, and (2) a maxillary implant-supported removable prosthesis.
Prevalence of vertical root fracture in extracted endodontically treated teeth: A prospective study
(Cumhuriyet University Faculty of Dentistry, 2017) Olcay K.; Ataoğlu H.; Belli S.
Objectives: Vertical root fracture (VRF) is one of the complications of endodontic treatment which results extraction of the related tooth. The purpose of this prospective study was to evaluate prevalence of VRF in extracted endodontically treated teeth. Materials and Methods: During a 1 year period 241 teeth were observed. All of the cases were from extracted teeth after endodontic treatment. Clinical signs, symptoms, the informations about patient and related tooth were recorded. Results: A total of 17 (7.02%) cases of VRF occurring among 241 cases were observed. The VRF occurred most frequently in the mesial roots of the mandibular first molars (23.5%) and they were the most frequently extracted teeth (35.2%). The VRF prevalence of maxillary first molars was 23.5%, maxillary first and second premolars with a same frequency (11.7%) were the following most fractured teeth. The fractures were predominantly buccolingual and were more frequent in female patients (58.8%). The mean patient age was 36 years and the mean time to VRF was 45 months. Most of the teeth which undergo VRF had a composite restoration (41.1%). 23.5% of the teeth had a post restoration and from among these posted teeth 75% were fully crowned. VRF was found similar frequency in mandibular teeth and in maxillary teeth (p > 0.05). Conclusions: After average of 45 months from endodontic treatment, mandibular first molar teeth were found most frequently prone to extraction due to VRF. Further investigation is necessary to determine the possible causes and evidence of fracture development. © 2017 Cumhuriyet University Faculty of Dentistry.
Endodontik tedavi görmüş çekim endikasyonu olan dişlerde dikey kök kırığı görülme sıklığı: İleriye dönük bir çalışma
(2017) Olcay, Keziban; Ataoğlu, Hanife; Bellı, Sema
Amaç: Dikey kök kırığı (VRF), ilgili dişin çekimini gerektiren, endodontik tedavinin komplikasyonlarından biridir. Bu ileriye dönük çalışmanın amacı, çekim endikasyonu bulunan endodontik tedavi görmüş dişler değerlendirmektir. Gereç ve Yöntem: 1 yıllık bir süre boyunca 241 diş gözlendi. Tüm vakalar çekim endikasyonu bulunan endodontik tedavi görmüş dişler arasından seçildi. Hasta ve ilgili diş ile ilgili klinik belirtiler, işaretler ve bilgiler kaydedildi. Bulgular: 241 vaka arasında toplam 17 (%7,02) VRF vakası gözlendi. VRF, en sık alt çene birinci büyük azı dişlerin mesial köklerinde (% 23,5) meydana gelmiş ve bu dişlerin en sık çekilen dişler olduğu bulunmuştur (%35,2). Üst çene birinci büyük azı dişlerde VRF görülme sıklığı % 23,5; takiben, üst çene birinci ve ikinci küçük azı dişler aynı oranla (% 11,7), en sık kırılan dişler olmuştur. Kırıklar ağırlıklı olarak bukko-lingual idi ve kadın hastalarda daha sıktı (% 58,8). Ortalama hasta yaşı 36 idi ve VRF oluşana dek geçen ortalama sure 45 ay idi. VRF görülen dişlerin çoğunda kompozit onarım (% 41,1) vardı. Dişlerin % 23,5'inde post restorasyon vardı ve bu postlu dişlerin % 75'inde tam kron vardı. VRF alt çenedeki dişlerde ve üst çenedeki dişlerde benzer frekansta bulundu (p0,05). Sonuç: Endodontik tedaviden ortalama 45 ay sonra, alt çene birinci büyük azı dişler VRF nedeniyle sıklıkla çekime daha yatkın bulundu. Kırık gelişiminin olası nedenlerini ve kanıtlarını belirlemek için daha ileri araştırmalar gereklidir.
New Treatment Modalities by Disease-Specific and Patient-Specific Induced Pluripotent Stem Cells
(Humana Press Inc., 2012) Yıldırım, Sibel
The broadly accepted and deeply rooted belief in developmental biology was that terminally differentiated cells had lost the potential to produce other cell types. In 2006, however, mouse somatic cells were reprogrammed as induced pluripotent stem (iPS) cells that resembled embryonic stem cells. This therapeutic promise is being challenged by thousand of researchers worldwide to understand the ability of these cells to reverse biological clocks. Utilizing both ''forward'' and ''reverse'' genetic approaches with the aid of iPS cells offers exciting prospects for dissecting molecular mechanisms of commitment and differentiation in a cell lineage. This discovery will help clarify our understanding of the rewired regulatory networks active in somatic and pluripotent cells.
Moderate to Severe Anterior Open-Bite Cases Treated Using Zygomatic Anchorage
(2012) İleri, Zehra; Karacam, Nejla; Isman, Eren; Kalaycı, Abdullah; Sarı, Zafer
Anterior open bite is often characterized by excessive vertical development of the posterior maxilla and by excessive eruption of the posterior teeth. Intrusion of the over-erupted molar teeth by traditional orthodontic methods is hardly possible; it requires orthognathic surgery or an absolute skeletal anchorage. These three case reports demonstrate the impaction of the upper molars by using zygomatic miniplates and fixed orthodontic treatment. After treatment, in all cases, the upper molar intrusions and significant correction of open bite were achieved by using zygomatic anchorage, and reduction of vertical dimensions enhanced facial aesthetics.
Dental Implants in Posterior Maxilla: Diagnostic and Treatment Aspects
(2012) Dolanmaz, Doğan; Çizmeci Şenel, Figen; Pektaş, Zafer Özgür
Dental implantology is one of the most popular and intensively researched topics of current dental medicine. The necessity for the former complicated preprosthetic surgical procedures to facilitate the partial dentures has recently been decreased with the widespread construction of implantsupported prosthesis. Nevertheless, the alveolar deficiency that impedes the insertion of dental implants makes a number of similar reconstructive procedures inevitable. The posterior maxilla is one of the most challenging anatomic locations for the implant placement that requires adjunctive surgical procedures. This special issue covers leading researches and reviews on this topic that we believe would contribute to clinicians.
Histomorphometric Examination of Long-term Changes in Temporomandibular Joints After Mandibular Lengthening by Distraction Osteogenesis in Rabbits
(Elsevier Science Inc, 2012) Mihmanlı, Ahmet; Dolanmaz, Doğan; Tüz, Hakan; Pampu, Alper; Dönmez, Hasan Hüseyin
Objective. The purpose of this study was to evaluate long-term histomorphometric changes in temporomandibular joints (TMJs) of rabbits after mandibular distraction osteogenesis (DO). Study Design. Twenty-six rabbits were used in this study. Two of them served as control subjects, and the remaining 24 underwent DO procedures in their left mandibular bodies. After a latency period of 5 days, 5 mm lengthening was performed at a rate of 1 mm/d. The rabbits in the experimental group were randomly divided into 4 subgroups and killed after 1, 2, 4, and 6 months. TMJs from both sides were harvested and prepared with hematoxylin and eosin stain for histomorphometric examination under an optical microscope. Results. Compared with control subjects and nondistracted sides, fibrous articular, proliferative, and hypertrophic areas were significantly increased (P < .05) in the first 2 months in distracted sides. The changes were insignificant in the fourth and sixth postoperative months. Conclusion. Unilateral mandibular distraction of 5 mm was found to be well tolerated and no degenerative changes were observed histologically in the rabbit TMJs in the long-term period.
Six Year Follow-Up of a Patient Treated with Mandibular Symphyseal Distraction Osteogenesis
(CHURCHILL LIVINGSTONE, 2010) Şukurica, Yusuf; Gürel, Hakan Gürcan; Mutlu, Necip
In this report, treatment and long term effects of mandibular symphyseal distraction osteogenesis (MSDO) on dentofacial structures are presented. The distraction device used in the present case was a custom made tooth- and bone-borne distractor. Post-treatment records revealed elimination of mandibular anterior crowding, no temporomandibular joint (TMJ) disorder, no periodontal pathology and no root resorption. Follow-tip records taken 6 years after the completion of the treatment indicated no mandibular anterior crowding or TMJ disorder. Treatment and long term results of this case suggest that mandibular widening with distraction osteogenesis is an efficient, safe and stable treatment modality for patients presenting transverse mandibular deficiency and/or mandibular anterior dental crowding. However, large sample studies are required to draw substantial conclusions about the long term effects of the MSDO on dentofacial structures.
Orthodontic Treatment of an Ankylosed Maxillary Central Incisor Through Osteogenic Distraction
(E H Angle Education Research Foundation, Inc, 2010) Dolanmaz, Doğan; Karaman, Ali İhya; Pampu, Ali Alper; Topkara, Ahu
Tooth ankylosis is one of the various problems in dentistry and requires special treatment approaches for satisfactory results. In the orthodontic treatment of an ankylosed tooth, different treatment modalities have been put into practice including both orthodontic and orthodontic-surgical approaches. For favorable results, gingival margin esthetics must be considered as much as leveling the ankylosed tooth in the arch. Distraction osteogenesis accompanied by orthodontic mechanics is a sensible way of achieving this goal. However, devices used in the distraction protocol are high in price and bulky in shape, causing functional and esthetic problems for the patient. This report describes treatment of an infrapositioned ankylosed incisor with continuous distraction forces produced by conventional orthodontic mechanics. In conclusion, the ankylosed tooth was leveled in the upper arch successfully with a harmonic gingival margin.
Experimental Evaluation of Acute Molding of the Regenerate in Mandibular Distraction Osteogenesis in a Rabbit Model
(Mosby-Elsevier, 2010) Çandırlı, Celal; Dolanmaz, Doğan; Etöz, Osman A.; Avunduk, Mustafa Cihat
Objectives. The aim of this study was to investigate the possible effect of acute regenerate molding (ARM) on bone healing in mandibular distraction osteogenesis (DO). Study design. Nine white New Zealand rabbits underwent unilateral mandibular lengthening via DO. Three groups were created: The first underwent 15 degrees ARM, the second group underwent 30 ARM after the distraction period, and the third group served as control without molding. After 1 month of consolidation, all of the animals were killed and histomorphometric evaluation was performed. Results. New bone formation was uneventful in all of the groups. In the ARM groups, the amounts of osteoblasts and newly formed bone areas were higher in compressed areas than in stretched ones (P < .05). The regenerates in the control group and stretched regenerate areas of the ARM groups were similar regarding new bone formation (P > .05). Conclusion. Acute regenerate molding could be safely applied immediately after the distraction period to correct postdistraction deformities without compromising bone healing.
Evaluation of Osteoblastic Activity Around Dental Implants Using Bone Scintigraphy
(Wiley, 2010) Kalaycı, Abdullah; Durmuş, Ercan; Taştekin, Güngör; Işık, Kubilay; İnan, Özgür
Objectives: The aim of this study was to evaluate the osteoblastic activity around delayloaded intraosseous dental implants using nuclear medicine imaging techniques. Material and methods: Seven totally edentulous patients (two females and five males, between 48 and 57 years of age) were included in the study. Two implants were inserted into mandibular canine regions and removable prostheses were produced after 3 months. Whole-body bone scintigraphies with 20 mCi technetium 99m labelled methylene diphosphonate were taken from the patients before implant insertion, 3 months after implant placement just before the prostheses were made and 1 year after implant placement. Standardized count/pixel (SC/P) rates were calculated for each patient. Preimplantation SC/P values were compared with the 3- and 12-month values. Three-month values were compared with the 12-month values as well. Results: SC/P rates in the third month were significantly higher (Po0.05) than preoperative values and the SC/P rates of the 12th month were significantly lower (Po0.05) than 3-month values. The SC/P rates of the 12th month were relatively higher than first scintigraphies but the difference was insignificant (P40.05). Conclusions: Within the limitations of this study, in which delayed loading was applied, we showed that osteoblastic activity persisted more in delay loaded implants than immediate and early loading. After 1 year, there was no cellular activity around two implants and this implied that two implants were sufficient for a total prosthesis.
Retrotracheal Parathyroid Adenoma Presenting With Mandibular Giant Cell Granuloma
(Turkiye Klinikleri, 2009) Çakır, Mehtap; Gönen, Sait; Öz, Gülsün
For the past two decades, primary hyperparathyroidism generally has been diagnosed at an asymptomatic stage because of routine biochemical screening. Bone involvement and dental changes are late manifestations of primary hyperparathyroidism, and brown tumors are seen rarely. We present here a case who admitted to the dentistry clinic with left mandibular swelling diagnosed on pathologic examination as giant cell granuloma. Further investigation revealed brown tumors localized to the mandible and was secondary to primary hyperparathyroidism. Primary hyperparathyroidism can present in a variety of ways and should be included in the differential diagnosis of cystic bone lesions, although at present, these lesions are seen rarely.
Desmoplastic Ameloblastoma of the Maxilla: A Case Report
(2009) Çelik, S.; Kalaycı, Abdullah; Işık, K.; Dolanmaz, Doğan; Günhan, O.
Ameloblastomas are the most common neoplasms affecting the jaws and are benign, locally aggressive, polymorphic lesions of proliferating odontogenic epithelial origin. Several variants exist. Desmoplastic ameloblastoma is a less-known variant amongst them. This paper reports the case of a desmoplastic ameloblastoma occurred in maxilla and managed with curettage.
Diagnosis of Stafne's Bone Cavity With Dental Computerized Tomography
(2009) Dolanmaz, Doğan; Etöz, Osman A.; Pampu, Alper A.; Kılıç, Erdem; Şişman, Yıldıray
Stafne's bone cavity(SBC) is asymptomatic radiolucent lesion of the lower jaw and generally seen incidentally during routine radiographic examinations. Diagnosis of this lesion is essential because of its similarity with other odontogenic pathologies. We present three cases of SBC which was firstly diagnosed with plain radiographs that were confirmed with dental computerized tomography. Asymptomatic radiolucent lesions of the mandible should be confirmed with advanced imaging techniques in order to avoid unnecessary surgery.

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