Broken teeth and their repair. -

How teeth that have cracked, chipped, have missing pieces, lost fillings or at-the-gum-line fractures can be fixed. | How are repairs made? | When is a damaged tooth hopeless? | Managing symptoms - pain / sharpness / hot, cold or air sensitivity. | Broken tooth first aid.

When a tooth breaks, there are things you need to know. This page explains:

  • The different ways teeth tend to break. - Did your tooth chip, crack, loose a filling, have a part come loose or fall off, or maybe even break off right at the gum line? For each of these situations we explain what's usually going on, as well as what consequences the event may have for the tooth.
  • How different types of tooth fractures are dealt with as an emergency. - We cover this subject from two angles: a) How dentists manage tooth pain, sharp edges, loose parts, missing pieces, as well as hot, cold and air sensitivity.   b) First aid remedies you may be able to do on your own.
  • Methods dentists use to repair broken teeth. - What kind of restoration is needed? When is the damage too great? Which teeth can be saved?

    Most teeth can be repaired by placing a filling or dental crown. However, some fractures may be so severe that root canal treatment or gum surgery is required first. In some cases, the tooth's damage may be so extensive that a repair isn't possible and it must be extracted.


Ways that teeth tend to break.

What you experience when your tooth fractures will be unique to you. But more than likely you'll find a scenario we cover below that's similar in nature to your situation.

Possible scenarios involving broken teeth.

1) The tooth has fractured, a portion has come off or is loose.

Some traumatic events result in outright tooth fracture (meaning that a part has physically separated from the remainder of the tooth). The piece that has come loose may:

  1. Break off cleanly.
  2. Remain tethered in place due to the fact that a portion of it is still attached to gum tissue.
Timely attention is needed.

Any tooth that has fractured needs to be inspected by your dentist. And doing so promptly may play an important role in how simple or successful its repair is.

  • Broken teeth that aren't tended to in a timely fashion may fracture further, possibly catastrophically.

    It may be that the event has weakened the tooth, or what's left of it now receives the forces applied to it differently. It's possible that hard foods might wedge in the void left by the missing piece, thus splitting the tooth further.

  • Since the tooth now has a missing section, dental plaque and debris will tend to accumulate in this void. Over the coming weeks and months, tooth decay may form.

The level of urgency involved will vary with each person's case. Certainly if you're experiencing symptoms you'll be inclined to act promptly.

But even if you're not, you should still be prompt to contact your dentist's office. Let them determine the urgency of your situation. And always, avoid using your tooth until it can be repaired, or at least temporized.

Reasons why a fractured tooth might, or might not, hurt.

The level of discomfort associated with a tooth that has had a piece break off will vary depending on the specifics of the situation. Here are some possible scenarios:

a) Situations where the tooth may not be painful at all.

Not all teeth that break end up hurting. Here are some explanations why:

  • The break may just involve tooth enamel. - If a chip is relatively small or shallow, it may be confined to just the tooth's enamel covering. This layer, which is around 98% mineral in content, has little association with the tooth's nerve. Because of this, feeling pain, or sensitivity to hot, cold or air, would be relatively unexpected.

    Chips like this are common in areas where tooth wear has resulted in the formation of a thin, brittle enamel edge. For example, minor chipping frequently takes place on the biting edges of front teeth (incisors, canines).

    With back teeth (premolars and molars), since everything feels bigger to your tongue, if it discovers something that it interprets as being just a small chip or area of roughness, it's quite possible that it's extent is just confined to enamel.

  • The involved portion of the tooth is relatively distant from its nerve. - The closer the bottom-most aspect of a void created by a lost piece of tooth is to its nerve, the more likely it will be that the tooth will experience some level of sensitivity. Responses to hot, cold or air (explained below) would be commonplace with this type of scenario.

    Don't be too surprised if the size of the void doesn't seem to correlate with the level (lack) of discomfort you feel. It's common that the nerve space inside a tooth will shrink in size, either due to age or in response to an event (such as advancing tooth decay or having had a filling placed).

    If that's the case, the base of a seemingly deep void may in actuality still be relatively distant from the tooth's nerve. This situation is common with back teeth (molars, premolars) that have a long history of having a large filling in place, but could also apply to any tooth with this type of history.

  • The tooth may not contain live nerve tissue. - In some cases the lack of sensation, even after the loss of a massive amount of tooth structure, might be due to the fact that the nerve inside the tooth at some point has already died. A clue suggesting this would be if the tooth has a previous history of displaying signs characteristic of a tooth needing root canal treatment.

    In other cases, the tooth may have already had root canal treatment completed. If so, any hot, cold, or air stimuli that reach the tooth wouldn't be expected to trigger a response.

b) Situations where the tooth may be painful.

Some broken teeth may be spontaneously painful.

A tooth that hurts on its own without any provocation suggests that its pulp tissue (nerve) has been substantially traumatized by the event that has caused its fracture. (This condition is referred to as pulpitis, which means inflammation of the tooth's pulp tissue.)

Generally, situations involving spontaneous tooth pain after fracture don't bode well for the outlook of the tooth's nerve. As possible outcomes:

  • There's some (marginal) potential that the tooth will gradually settle down during the days that follow and return to normal. (This situation is referred to as "reversible pulpitis" and is discussed in more detail below.) The chances of this outcome may be enhanced if steps are taken that can potentially assist with the nerve's recovery.
  • If a tooth doesn't settle down (irreversible pulpitis), or the dentist's diagnosis is one where its nerve has been severely compromised, root canal treatment will be required before the broken tooth can be rebuilt.
  • Some teeth may seem to settle down, although in actuality it's only because the trauma has been too much for its nerve tissue and it has subsequently died.

    These teeth too will require root canal treatment before they can be rebuilt. Since the tooth is now symptomless, it will take a dentist's evaluation to discover that this scenario has occurred.

Due to the range of possible outcomes, it's easy to see why teeth that have broken and hurt spontaneously need to be evaluated promptly by your dentist.

In this situation, their role would be that of either assisting your tooth's nerve in recovery, dealing with nerve tissue that is compromised and currently causing you pain, or treatment planning your tooth's future work so it won't cause you further problems on down the road.

Some broken teeth may be painful to biting pressure.

Experiencing this symptom may be an indication of more than one scenario.

  • It may suggest that beyond just being fractured (having had a piece break off) the tooth is cracked too.

    With this scenario, when pressure is applied the cracked portions shift, thus causing pain.

  • Another explanation could be that the tooth has fractured but the loose portion is still attached to gum tissue and therefore hasn't fallen off yet.

    In this case, when pressure is applied, the position of the loose fragment shifts and causes gum-tissue pain. (In some cases, pain from the tooth itself may be a factor too.)

  • In yet other cases, the tooth may have just happened to break coincident with having developing symptoms signaling the need for root canal treatment. If so, the pain may be a sign of that underlying condition.
The tooth may have sensitivity to hot or cold stimuli or air.

Some fractured teeth will hurt more so, or are only painful, when exposed to hot and cold temperature extremes, such as those noticed when consuming foods and beverages. Or are sensitive when air is drawn across them.

  • The situation where your tooth is irritated by thermal insult, or air, but then when the stimulus is removed it immediately settles back down typically suggests that its nerve is still healthy and once a repair is made the tooth will likely be fine.
  • At the other extreme, a painful response that lingers (especially to temperature extremes) may indicate that the tooth's nerve is compromised and will require root canal treatment before it can be rebuilt.
Broken teeth may irritate soft tissues.
  • The pain associated with a fractured tooth may come from the soft tissues (cheek, tongue, lips) that rub against its sharp edges.
  • In the case where a piece of tooth is loose but hasn't come off yet, its attached gum tissue may be the source of pain every time the fragment shifts in position.

Animation showing tooth cusp fracture.

A tooth fracture where a piece has separated off.

Methods of repair for broken teeth.

It's not always a catastrophic event when a tooth breaks. And in fact, in most cases it usually isn't. This can even include cases where the tooth has broken off, all of the way down right at the gum line.

a) Cases where just minor repair is needed.

  • It's conceivable that such a small portion of the tooth has fractured off that it only requires some minor smoothing using a dental drill.

    Cases most likely to involve this simple remedy would be those where the entire depth of the chip is confined within the tooth's enamel layer (described above).

  • With smallish yet larger defects, just placing a small, conservative filling may make a satisfactory fix.

    Bonded restorations (a type of filling that creates a bond with tooth enamel) often make an especially good choice for this type of repair because they can be placed without a need for extensive, or possibly any, tooth trimming first.

  • It's not impossible that your dentist may feel that simply bonding the broken fragment back into place makes the quickest, simplest and best color-matching repair.

    Don't expect this remedy to be offered in all cases. But sometimes doing so can make a serviceable solution.

  • While not likely, after their evaluation your dentist may conclude that although the amount of damage you've experienced seems small that your tooth is now at great risk for further damage.

    As an example, possibly they've identified what they interpret as being a significant crack in the tooth that at this stage is symptomless. If so, they may recommend the placement of a dental crown (see next section).

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b) More extensive fractures.

Teeth that have larger sections missing will require more extensive work. But you don't necessarily have to be concerned that a repair can't be made.

Even teeth that have had a substantial portion break off are usually salvageable, even including those that appear to be broken off flat at the gum line. And actually, making these types of repair are probably pretty routine for your dentist.

Types of restorations that may be needed for teeth with comparatively large portions missing.
  • It may be that placing a filling can provide a suitable repair. However, durability issues may be a concern with large fillings. Additionally, just placing a filling may still leave the tooth at risk for further breakage.
  • Dental crown placement can help to reinforce and strengthen a tooth. And for teeth that have already experienced an initial catastrophic event, choosing this option frequently makes the prudent choice.

    (This page explains the benefits of a crown vs. just placing a large filling.)

    In cases where a substantial portion of a tooth has been lost (like when broken off at the gum line), simply being able to successfully anchor a filling in the tooth may pose a substantial challenge. If so, placing a crown may be the only way to successfully rebuild it.

  • The possibility does exist that the treating dentist may feel that bonding the fractured remnant back in place makes a reasonable repair.

    One might anticipate that this would be the exception rather than the rule. And more likely with comparatively smaller broken pieces than larger ones. It also might be more likely with broken front teeth (incisors, possibly canines) rather than back ones (molars, premolars) where the level of chewing forces involved are greater.

c) Problematic cases.

Certain characteristics about the way a tooth has broken may complicate its repair.

  • The piece that's fractured extends far below the tooth's gum line. - If so, gum surgery will be needed.

    A tip-off that this condition might exist is when a loose tooth fragment remains stubbornly attached to gum tissue.

  • The fracture has resulted in serious damage or insult to the tooth's pulp tissue (nerve). - In these cases, root canal treatment will be required.
1) Cases where gum surgery is required.

This complication arises when the fractured piece extends far below the tooth's gum line and therefore involves its root (see animation).

A fracture that involves the tooth's root.

Animation showing a tooth fractured below the gum line.

(Note: The tooth's nerve seems involved too, see below.)

The problem.

The difficulty associated with below-the-gum-line fractures can be twofold:

  • If the edge of the dental restoration placed to repair the damage lies too close to the level of the bone around the tooth, the gum tissue in that area will remain persistently irritated and inflamed.

    This could result in gum recession, or even the loss of supporting bone around the tooth. Both symptoms might affect neighboring teeth too.

  • If too little tooth structure extends above the gum line, the dentist may not be able to adequately anchor a new restoration (crown or filling).
The solution - Crown lengthening.

A type of gum surgery termed "crown lengthening" is the solution usually used to resolve either of the issues just mentioned.

  • This is a minor surgical procedure where the level of the gum and bone tissue surrounding the tooth is lowered, thus revealing more of it.
  • After healing has occurred, a restoration can then be placed under more favorable conditions.
  • [With teeth toward the front of the mouth (incisors, canines, possibly premolars), the appearance of the repositioned gum line must be considered before this approach is chosen.]

If the extent of the fracture is too extensive (extends too far below the gum line), crown lengthening may not be possible. If not, then extracting the tooth may be the only solution.

X-ray of fractured tooth that required root canal and a crown.

This broken tooth required root canal and a crown.

2) Cases where root canal treatment will be required.

In situations where a tooth's nerve has been damaged or severely compromised as a result of its fracture, root canal therapy will need to be performed before its permanent restoration can be placed.

  • Clearly your tooth's level of symptoms (pain especially) will hint to you that a nerve problem exists or is developing, although not all teeth that require root canal treatment display obvious signs.
  • Other than that, it's not really possible for a lay person to know, just by looking at their tooth, whether this step will be required or not. Even teeth that seem to be broken off even with the gum line may not have a complication involving their nerve, whereas much smaller looking fractures do.
 

How dentists temporize fractured teeth and manage their symptoms.

Until that time when arrangements can be made to permanently repair your tooth, your dentist will take steps to help alleviate whatever symptoms you are experiencing. If direct attention from them is not possible, they may instruct you in how to perform steps on your own using OTC (over-the-counter) products.

Tooth pain.

Anti-inflammatory medications.

In some cases, a tooth's discomfort may be associated with a condition termed to as "reversible pulpitis" (reversible nerve inflammation). This involves a state where the tooth's pulp tissue is healthy (this includes that it has not been directly affected by the fracture), just temporarily irritated due to the level of trauma the tooth received when it fractured.

In treating these types of cases, a dentist may suggest the use of a NSAID medication (non-steroidal anti-inflammatory drug). You may be familiar with this drug class as pain relievers. But just as important they can help to prevent/minimize/reduce the level of the tooth's pulp tissue inflammation, and therefore the complications it brings during the nerve's attempted recovery.

  • Examples of NSAIDs include: ibuprofen (Motrin, Advil), aspirin, naproxen (Aleve). (Each is available as an OTC product.)
  • As an example of the use of a NSAID with the goal of settling down the level of pulp tissue inflammation, with the added benefit of controlling discomfort: 200 to 400 mg every 6 hours for the first 1 or 2 days following the event.

(Haas 2002, Hargreaves 2005)

Of course when any type of medication is considered, its appropriateness for use by the patient must be evaluated. A common issue of concern is the potential for the NSAID to create gastrointestinal problems. Also, taking NSAIDs may inhibit the blood clotting process, a factor that would need to be known/considered/managed by the person's dentist in the event that the tooth's extraction is indicated.

Temporary / Sedative fillings.
  • Some types of temporary filling materials have anti-inflammatory and anesthetic properties. As such, they can be used to help sedate/sooth/aid in the recovery of teeth experiencing reversible pulpitis (healthy but irritated pulp tissue, the cracked or fractured portion of the tooth has no direct connection with the pulp).
  • As an added benefit, placement of the filling seals and protects the tooth from added insult, like that experienced with hot or cold foods and beverages. The filling may also help to protect oral soft tissues from irritation from sharp edges.

The kind most commonly placed by dentists is a mixture of zinc oxide (powder) and eugenol (liquid). It's the very low level of eugenol that seeps from the restoration through tooth tissues (dentin) toward the tooth's pulp that provides the benefits. (Abbott 2009, Markowitz 1992)

A dentist will trim away portions of the fractured tooth that have associated pathology (cracks, decay, etc...). The temporary filling is then placed and the tooth is monitored over a series of days and weeks as its recovery is evaluated. (Abbott 2009)

After discussing matters with their patient, and if their direct attention isn't possible, a dentist might deem that placing zinc oxide and eugenol, mixed into a paste that then hardens (available as an OTC product), may provide benefit in helping the broken tooth settle down, protect it from added insult or to protect soft tissues from its sharpness.

Initiating root canal treatment.

In cases where the above possibilities either can't, aren't expected to, or else aren't an appropriate means for controlling the pain from the fractured tooth, a dentist will initiate root canal therapy.

(These situations would be classified as involving irreversible pulpitis, meaning cases where the level of nerve tissue insult/inflammation that exists is so great that recovery to a healthy state is not possible.)

If for whatever reason root canal treatment is indicated but not opted for, the only other appropriate option is to extract the tooth.

Prescription pain relievers.

In cases where direct (hands-on) attention from your dentist isn't possible, they may prescribe a narcotic (prescription) pain reliever for you.

Unlike NSAID products, narcotic compounds only help to control pain. They have no anti-inflammatory effect. Using them is simply a temporary means of keeping a patient comfortable until more definitive treatment can be performed.

Since narcotics do nothing on their own to aid in the recovery of a tooth's pulp tissue, in cases where that possibility exists (reversible pulpitis), they are sometimes prescribed in combination with a NSAID.

Temporizing loose but still attached tooth fragments.

In some cases, a person's tooth may have fractured but the part that has separated hasn't come completely loose yet.

What you may notice.
  • Usually the piece that's fractured hasn't fully separated because it still has an attachment to gum tissue that tends to hold it in place.
  • Frequently the patient won't experience pain unless they bite down on (or otherwise manipulate) the piece, thus causing it to shift. It's possible that the discomfort noticed is actually coming from the gum tissue rather than the tooth.
Temporization.

As approaches for temporizing a tooth broken in this fashion, your dentist will have two options.

  • They can either attempt to temporarily splint the tooth back together.

    Preparing (trimming down) the tooth and then placing a temporary dental crown could accomplish this goal. Possibly bonding the broken piece back into place might also serve as a temporary solution.

  • Or they can remove the fragment, and then place some type of filling (see below).
Removing the broken part.
  • With small pieces, a dentist may be able to just twist the loose part off with their fingers. (If your piece is just flapping in the breeze and a nuisance, your dentist may instruct you to do the same.)
  • With more stubborn or larger fragments, they may need to use small dental forceps (pliers) or an elevator to get hold of, or pry off, the piece.

Depending on how extensively the gum tissue has been attached, you can expect that there will be some minor bleeding (best controlled with finger pressure onto a pad of moist gauze) and soreness after the fragment has been removed.

While probably not of great importance, your dentist can learn details about the way in which your tooth has fractured from the broken bit, like how much of the tooth at a level below the gum line is involved.

Numbing your gums.

Numbing up the gum tissue attached to the loose fragment may or may not be needed. If it is, dabbing on a topical anesthetic gel or liquid (benzocaine, available OTC) may suffice. If not, local anesthetic (a dental injection) will be necessary.

Temporizing missing tooth parts.

Especially if your broken tooth is sensitive (like in response to hot and cold foods) or has sharp edges, your dentist will fill in the missing fragment's space by placing a temporary dental filling.

Temporary fillings for tooth voids.
  • As discussed above, a common choice is zinc oxide and eugenol paste (available OTC).

    As alternatives, for teeth that show (incisors, canines, premolars) a dentist may place some type of restorative (dental composite usually) that matches the color of the tooth more closely.

    Or they may choose a material that has the ability to adhere to tooth structure (glass ionomer or composite), possibly allowing it to be placed without a need to trim/reshape the tooth first.

  • If they can't provide direct (hands-on) attention, a dentist will sometimes instruct their patient in how to place dental wax, or possibly zinc oxide and eugenol paste, (both available OTC) in their tooth's broken area as a temporary measure to alleviate both tooth sharpness and thermal sensitivity.
Your tooth will remain at risk.

Of course, even after any type of temporary repair has been made for your tooth it will remain fragile and vulnerable to further breakdown.

The tooth must be favored so the level of pressure it's exposed to doesn't damage it further (like when you're eating). As a way of helping to minimize the amount of force that the tooth receives, your dentist may trim it so it's slightly shorter (referred to as "taking the tooth out of occlusion or contact").


2) The tooth has cracked but no piece has come off or become mobile.

Animation showing how the wedging effect of fillings can crack a tooth.

This tooth has cracked but no piece has come off.

Instead of experiencing outright fracture, a tooth may crack instead. Unfortunately, and unlike with bones, cracks in teeth don't heal.

In fact, once one has formed it may increase in size over time due to repeated exposure to biting forces. If it advances far enough, tooth fracture or nerve damage (irreversible pulpitis) may occur. (Abbott 2009)

a) Cases where a tooth has cracked - Some pain or discomfort is felt.

Cracked teeth can be sensitive. When biting pressure is applied, if a portion of the tooth on either side of the crack shifts (even ever so minutely), a painful response can be triggered.

Signs and symptoms of a cracked tooth.
  • The tooth gives a sudden sharp pain in response to biting pressure.
  • The pain subsides immediately once the biting pressure has been released, possibly eliciting another sharp painful response as you do.
  • You may not feel the pain every time you close down. Sometimes it takes biting or biting on something, at just the right angle, to trigger the response.
  • More than likely, you will not be able to visualize the crack or feel it with your tongue.

b) Cases where a tooth has cracked - Little or no pain is felt.

Not all cracked teeth produce consistent symptoms. In fact, with some cases it can be very difficult for the dentist to diagnose exactly which tooth lies at fault.

  • It may take some time, including investigating on your own at home, to identify which tooth is the culprit.
  • Tooth cracks can be exceedingly difficult, if not impossible, to visualize. Dentists sometimes apply a dye that seeps into cracks to make them more obvious.
  • It can be difficult to identify a crack on routine dental x-rays. To be visible, the crack would have to lie in perfect alignment with the orientation of the x-ray machine's rays. While possible, having this alignment occur isn't so common.

    Identifying cracks, especially those that extend into a tooth's root, typically involves taking multiple x-rays from different angles and comparing them. Sometimes advanced 3-D imaging is needed.

  • "Cracks" that are obvious but produce no symptoms are often just tooth enamel craze lines that require no attention other than being monitored by your dentist over time. (Abbott 2009)

While identifying the problem tooth is of great importance, identifying the crack itself is somewhat less so. Even if the crack can be identified, knowing its full extent or nature usually isn't possible.

The dentist simply treats the tooth based on the way they interpret the evidence they have. They then proceed with additional treatment solutions if the tooth's symptoms continue or change.

How dentists repair cracked teeth.

There are a range of solutions that dentists use to treat cracked teeth.

Minor cases.

If your symptoms are just minimal, it's possible that your dentist may determine that your tooth requires little or no treatment. Sometimes just buffing the tooth down so it's a tiny bit shorter than its neighbors (so it receives less biting pressure) provides a lasting solution. (This is referred to as "taking the tooth out of occlusion.")

When more major repair is needed.

Especially in the case where your symptoms are persistent or severe, your dentist will need to provide some type of fix.

  • It's possible that placing a filling as a repair might suffice. This would be more likely in the case where the dentist feels they have identified the crack and anticipate that they understand its full extent.
Animation showing how a crown can splint a cracked tooth together.

A crown acts as a splint that holds a cracked tooth together.

  • In cases where the extent of the crack can't be interpreted or the patient's symptoms are severe, the dentist may feel that a dental crown should be placed. This approach probably makes the safest and most predictable choice.

    Doing so will help to splint the tooth together so its cracked parts can't shift and cause pain. This same splinting effect can also help to prevent the crack from progressing further.

  • In some cases (often those that are most painful), the dentist may determine that the crack reaches deep into the interior of the tooth and involves its nerve. If so, root canal treatment will be required before a dental crown can be placed.

    Or root canal may be needed because the tooth's nerve tissue has been too traumatized by its ordeal and not able to recover (irreversible pulpitis).

  • It's possible that even after placing a dental crown and performing root canal treatment that the tooth's symptoms continue or new ones crop up. If so, the tooth will need to be extracted.

    As examples: 1) Crown placement may not provide enough splinting effect that the tooth's cracked segments are prevented from shifting when pressure is applied. 2) The crack may be colonized by bacteria. If so, they will cause persistent infection that can't be resolved.

How dentists manage and temporize cracked teeth.

Just as with broken ones, a dentist's initial treatment of a cracked tooth will be to attempt to alleviate the patient's pain and stabilize the tooth.

Reducing the tooth.

In cases where symptoms are relatively minor, the dentist may just buff the tooth down so it receives less biting pressure (take it out of occlusion).

Doing so can provide enough relief for the tooth that its symptoms subside. It can also help to reduce the risk of further tooth damage (crack propagation).

Temporary restoration placement.

When symptoms are more severe, the dentist may feel that they need to place some type of restoration promptly.

  • They may remove the tooth's permanent filling, trim away the portion of the tooth they interpret as being involved with the crack, and place a temporary restoration. As explained above, if the type selected has sedative properties it may help the tooth to settle down and avert pulp tissue (nerve) damage.
  • In other cases the dentist may feel that the tooth requires the protection of a crown promptly. If so, they may begin the crowning process so a temporary one can be placed immediately. Similar to above, they may choose a cement that has sedative properties.
Anti-inflammatory medications.

As discussed above, a dentist may recommend taking a NSAID medication. Doing so can both help to control the patient's pain and be instrumental in helping their tooth's nerve to recover from the insult it has received.

Allow your tooth some rest.

No matter what treatment has been provided, giving your tooth some rest will almost certainly be recommended.

Continually testing your tooth (like by biting on it) may only serve to aggravate or damage it further. Simply staying off it may substantially increase the odds that your tooth's traumatized nerve will be able to recover from its ordeal.

 

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