Factors that need to be considered when deciding on an overall periodontal prognosis include the following. Decisions in Dentistry - A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists. Bacterial plaque is the primary etiologic factor associated with periodontal disease. Tooth mobility could be caused by a tumor on your jawbone that is pushing your teeth out of place. Reddy MS, Aichelmann-Reidy ME, Avila-Ortiz G, et al. Bridges are an alternative to dentures and allow you to speak and chew properly. Kye W, Davidson R, Martin J, Engebretson S. Current status of periodontal risk assessment. A number of studies have discussed each factor’s relationship to disease progression. A diplomate of the American Academy of Periodontology, he can be reached at [email protected]. A testicular teratoma may present as a painless lump. These are the most common pathological conditions that lead to soft- and hard-tissue loss around implants and compromise the functional and esthetic outcome of implant therapy. In a retrospective study, Matuliene et al. Unlike McGuire’s and Nunn’s classification, Kwok’s and Caton’s model focuses on how periodontal disease activity is suppressed by controlling systemic and local factors. This is a useful communication tool for general practitioners, dental hygienists and periodontists, especially when managing patients who are seen at multiple offices. For teeth with an “unfavorable” prognosis, the local or systemic factors cannot be controlled, and periodontal breakdown is likely to occur even with comprehensive periodontal treatment and maintenance. dental prognosis forecast of the results to be achieved from any oral treatment. In addition, while the six parameters have been shown to be major risk factors, patient compliance and local plaque-retentive factors are not included in the criteria. Most people who grind their teeth and clench their jaw are not aware they're doing it. Together, these evaluations will help ensure appropriate periodontal treatment and optimal outcomes. Among the various periodontal prognosis systems, the one most widely used was proposed by McGuire and Nunn in 1996.6 It consists of five categories that include good, fair, poor, questionable and hopeless (Table 1). Teeth with minimal (Class I) or no furcation invasions generally have a good prognosis. It was suggested that genetic polymorphisms in certain genes involved in the immune response (e.g., interleukins IL-1 and IL-10 ), may be associated with susceptibility to severe periodontitis in some populations.6,12, • Stress. At least three recovered COVID-19 patients — 2 adult women and a 12-year-old boy — have had a tooth fall out amid their recovery from the fast-spreading disease, according to … Based on the PRA system, all subjects were assigned to low-, moderate- or high-risk profile following active periodontal therapy. Diabetic patients have a higher prevalence of periodontal disease and greater attachment and bone loss.18,19 Patients with diabetes, especially poorly controlled diabetes, will generally have a worse overall prognosis than patients who are not diabetic (Fig. Although this article has emphasized the importance of risk analysis, specific guidelines for periodontal treatment — including the timing of referral to a specialist — are challenging due to the disease’s multifactorial nature. Accept Read More. A 10-year longitudinal study. It was also emphasized that continuous monitoring of periodontal conditions longitudinally is important to maintaining natural dentition. Complications may include ovarian torsion, testicular torsion, or hydrops fetalis. Samet N, Jotkowitz A. Prognostic categories were assigned following active periodontal therapy and prior to initiating the SPT phase. A diplomate of the American Academy of Periodontology, he can be reached at [email protected]. Classically, a tooth that was affected with greater than 50% bone loss was given a questionable to hopeless prognosis. Goodson et al13 evaluated disease progression in 22 subjects with untreated periodontitis for one year, with each subject receiving monthly measurements of probing depth and attachment levels. Thus, identifying a tooth’s prognosis only during the initial appointment does not allow adequate judgment of the probability of tooth survival, as this requires continuous monitoring of potential changes. While many considerations from the periodontal literature apply, new information and techniques should be considered to retain teeth or not.2. These include patient compliance, smoking status and diabetic conditions as general factors, with deep probing depth, plaque retentive factors, mobility and trauma from occlusion considered as local factors. Goodson et al. Following publication of that article, Page and Martin20 introduced the Oral Health Information Suite (OHIS), which provides a disease score on scale of 1 (health) to 100 (severe periodontal condition). Growing recognition that implants are not a panacea for either full or complete edentulism has led to renewed interest in saving teeth by using established therapies to improve the periodontal prognosis. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/cerp. Another patient with the majority of teeth with a poor or questionable prognosis may be motivated for dental implants and a fixed prosthesis. Belmont Publications, Inc. presents Decisions CE. New concepts of destructive periodontal disease. Genetic factors may play an important role in determining the nature of the host response. Risk assessment is an ongoing process that requires clinicians to be knowledgeable of the various — and dynamic — factors that influence the disease state. Required fields are marked *, © 2021 - All rights reserved - Dental Tribune International. Teeth such as the maxillary premolars, which have pronounced root concavities, are also more difficult to instrument and maintain, and likewise have a worse prognosis than teeth with relatively straight roots.8, • Tooth mobility. Significance of periodontal risk assessment in the recurrence of periodontitis and tooth loss. Takaaki Kishimoto, DDS, PhD, is a resident in the Department of Periodontics and Allied Dental Programs at Indiana University School of Dentistry. Symptoms can last for just a few days, right around the time a new tooth is emerging, or for as long as several months if a lot of teeth come through all at once. In a study of periodontal status, treatment, and when patients were referred to periodontists, Dockter et al26 found that among 100 newly referred patients, 74% were diagnosed with severe periodontitis and needed to have teeth extracted due to the severity of disease. Explain the various periodontal prognosis systems, as well as risk factors affecting treatment and prognoses. In order to account for these limitations, Kwok and Caton12 proposed a prognosis system based on future periodontal stability with treatment (Table 2). It does not require any specific formula to calculate risk and is easy to fill out chairside. The present preliminary results suggest that both endodontic retreatment and replacement of previously endodontically treated teeth with persisting pathology and a dubious endodontic prognosis provided similar short-term success rates. Many local and prosthetic/restorative factors have a direct effect on the prognosis for individual teeth in addition to any overall systemic or environmental factors that may be present.1,2,5,6, It was found that attachment loss, probing depth, furcation involvement, crown-to-root ratio, fixed abutment status and percent bone loss are the most important factors in determining tooth loss.5,25, • Deep probing depth and attachment loss. The prognosis of whole dentitions or individual teeth is “dynamic” and may require alteration of projections as health status or dental initiatives (e.g., oral hygiene) change. This article focuses on the primary areas for consideration of development of prognosis with the underlining goal of patient and clinical satisfaction and economic stability. Teeth are made up of a combination of hard and soft tissue. In their study, regeneration therapy led to retention of 92% of the teeth scheduled for extraction and improved their final prognosis and comfortable functioning. One should consider the patient’s ability and consistency in performing plaque control when determining the overall prognosis. in hopeless teeth, presenting extensive bone loss at or beyond the root apex, have been recently reported (Cortellini et al. Determining the prognosis at multiple appointments is also necessary because periodontal destruction does not occur at the same rate. McGuire MK, Nunn ME. Fugazzotto PA. A comparison of the success of root resected molars and molar position implants in function in a private practice: results of up to 15-plus years. Misaligned teeth (malocclusion) Tooth injuries such as broken or chipped teeth; What causes tooth disorders? Historically, the prognosis of a tooth was defined based on tooth loss.3,4 Several authors have formulated and investigated their own prognostication systems with variable results, but showed that systems based on tooth loss were unpredictable over the long term.1. The vast majority of teeth with apical periodontitis can be expected to heal after nonsurgical or surgical endodontic treatment. Tooth decay can occur when acid is produced from plaque, which builds up on your teeth. 3. Sometimes the cause is not taking good care of your teeth. As shown in Table 2, factors influencing the overall periodontal prognosis include age, genetics, oral hygiene, systemic conditions, smoking, patient compliance and economic consideration. Permanent molars are less frequently affected than deciduous molars. Your email address will not be published. These factors are then synthesized into a scheme for determining a periodontal prognosis. For a few lucky babies (and parents), teething doesn't cause any noticeable signs at all. Periodontal prognosis refers to the expected longevity of teeth. Various host-related cytokines and biomarkers have been detected in the progression of periodontal disease. September 2017;3(9):46–50. Although many periodontal patients can be managed appropriately by general practitioners, there is no single best treatment for every patient. Prognosis versus actual outcome. It does not always cause symptoms, but some people get facial pain and headaches, and it can wear down your teeth over time. Becker W, Berg L, Becker BE. vidual teeth, but rather to attach a relative prognostic value, which aims to enable cli-nicians to distinguish between favorable teeth and those that are compromised to a certain degree. The teeth in front of the first molars are next, and the back molars are the last ones to come in. In other words, if a patient presents with little or no periodontal destruction, it is anticipated that he or she is at low risk of future breakdown, whereas a patient with severe periodontal tissue destruction is expected to have a higher risk of future disease. The example on this page demonstrates poor crown-root ratio related to a developmental anomaly in a patient with short roots (Fig. According to The Merriam-Webster Dictionary, “Prognosis” is defined as “the prospect of recovery as anticipated from the usual course of disease or peculiarities of the case.” In medicine, however, the term is commonly defined by the mortality rate. Dental ankylosis can affect both primary and permanent teeth, may occur at any time during eruption and can lead to submergence. Utilizing natural teeth as abutments for a fixed prosthesis or individual crowns must be reasonable. A number of studies have discussed each factor’s relationship to disease progression. Severe mobility of a tooth is generally an indicator of a poor long-term prognosis.1,2, • Restorative and prosthetic factors. What's tricky is that there's no strict list of teething symptoms. Teeth with complete loss of bone in the coronal aspect of the furcation (Class III) generally have a poor prognosis, and regeneration of this type of defect is not predictable for most clinical situations. However, this system has several disadvantages. If you notice that your teeth are loose or suddenly shifting positions, don't hesitate to let your dentist know. The accepted, and generally used, classification of prognosis was suggested by McGuire and Nunn.5 This system contains a detailed stratification for individual teeth as seen in Table 1. adj., adj prognos´tic. Therefore, reprognostication occurs after each examination of the patient. Classification and prognosis evaluation of individual teeth — a comprehensive approach. The American Academy of Periodontology (AAP) defines risk assessment as, “The process by which qualitative or quantitative assessments are made of the likelihood for adverse events to occur as a result of exposure to specified health hazards or by the absence of beneficial influences.” The AAP guideline also notes that risk assessment is a necessary part of each examination, as it contributes to predicting future disease progression.18 Ultimately, assessment reduces the complexity of periodontal treatment and improves communication between general practitioners, dental hygienists and periodontists. Therefore, it is reasonable to try to predict a long-term prognosis, but reassessment is often needed for a prolonged period. Lang and Tonetti21 introduced a Periodontal Risk Assessment (PRA) model that evaluates the risk of periodontal breakdown based on a combination of six parameters: percentage of BOP, total sites of residual pockets > 5 mm, number of teeth lost, bone loss in relation to the patient’s age, systemic/genetic condition, and environmental factors (e.g., smoking status). This tool is used to assess risk following active periodontal therapy and prior to SPT. Development of an accurate prognosis has an underlining economic importance. Accordingly, Samet and Jotkowitz9 introduced the term “relative prognostic value.” The idea is to help practitioners identify teeth that appear to have a more favorable treatment outcome, as opposed to those more severely compromised by disease. With all other factors being equal, a patient who continues to smoke will have a worse prognosis than one who either does not smoke or quits smoking.14–17. The complex treatment of patients with advanced periodontal breakdown is very expensive.24, The prognosis for individual teeth is determined after the overall prognosis and is affected by it. Relationship between prereferral periodontal care and periodontal status at time of referral. Pain, swelling, lumps on the jaw and loose teeth are all realistic jaw cancer symptoms. Derks and Tomasi. This suggests that diagnosis, treatment and timely referral to a specialist were not satisfactory. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 46 years of age. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. Using a computer-based system, risk was established on a scale of 1 (lowest) to 5 (highest). Continued Socransky et al14 cast doubt on the linear progression of periodontitis by proposing that a random burst of destructive periodontal conditions might occur at certain periods in a patient’s life. Belmont Publications, Inc. is designated as an Approved PACE Program Provider by the Academy of General Dentistry. However the outcomes indicate that some of these results are conflicting. The periodontal ligament is obliterated by a 'bony bridge' and the tooth root is fused to the alveolar bone. • Plaque control. • Crown-root ratio. More than 500 subjects were investigated (with up to 15 years of follow-up) to evaluate the relationship between the scale and actual tooth loss. The determination of a prognosis is an evolving and dynamic process. The study showed that OHIS risk and disease scores provided an accurate and valid means of evaluating tooth loss and disease progression. Dr. Belinda Brown-Joseph is director of the graduate periodontal clinic and associate professor of periodontology and oral implantology at Kornberg School of Dentistry at Temple University, Philadelphia. Derks and Tomasi1 reported the prevalence of peri-implant mucositis and peri-implantitis at 19% to 65%. Click here for our refund/cancellation policy. If plaque is allowed to build up, it can lead to further problems, such as dental caries (holes in the teeth), gum disease or dental abscesses, which are collections of pus at the end of the teeth or in the gums. Provider ID 317924. Intra-operative procedures Treatment providers Experienced and skillful operators are less likely to perform procedural errors that might compromise the prognosis … Over five years, the researchers evaluated the accuracy of prognostic values in 100 periodontal patients. Periodontitis can cause teeth to loosen or lead to tooth loss.Periodontitis is common but largely preventable. Although many periodontal prognosis systems have been developed, most of the prognoses are based on tooth mortality (i.e., extractions).5–8 Assigning an accurate prognosis for each tooth benefits patients and clinicians by providing information on whether proposed periodontal and restorative treatment promises the likelihood of a successful long-term outcome. Dockter KM, Williams KB, Bray KS, Cobb CM. • Diabetes. It's usually the result of poor oral hygiene. Individuals who smoke more than 10 cigarettes per day have an increased risk of more severe periodontal disease, a less predictable response to initial therapy and a more complicated therapeutic response. Prognosis of the overall dentition leaves clinicians and patients to choose appropriate treatment plans based on the expected lifetime of teeth. The effectiveness of clinical parameters in developing an accurate prognosis. In a study of periodontal status, treatment, and when patients were referred to periodontists, Dockter et al. Conversely, the prognosis of each tooth might improve if a patient quits smoking. American Academy of Periodontology. In all, 20 “baby teeth” will eventually be in place, usually by age 3. In order to account for these limitations, Kwok and Caton, Periodontal conditions — such as probing depth, attachment level, bleeding on probing (BOP) and furcation involvement — are confirmed at each maintenance appointment. We'll assume you're ok with this, but you can opt-out if you wish. Peri-implant mucositis and peri-implantitis are common complications following implant placement. Belmont Publications, Inc. is an ADA CERP-Recognized Provider. The goal of using an assessment tool is to provide more predictable care and facilitate communication between dental teams and specialists. Are dental implants a panacea or should we better strive to save teeth? Resorption can cause long-term damage to permanent teeth. Thus, identifying a tooth’s prognosis only during the initial appointment does not allow adequate judgment of the probability of tooth survival, as this requires continuous monitoring of potential changes. Matuliene G, Studer R, Lang NP, et al. While discussing the prognosis with the patient, initially, the patient should be told about the diagnostic prognosis (i.e., what will happen if no treatment is provided), then the therapeutic prognosis (i.e., status of teeth after the treatment is provided) and if indicated, the prosthetic prognosis … During the SPT phase, 2.59 teeth per patient were lost in the high-risk group; by comparison, 1.02 teeth per patient were lost in the moderate-risk group, while the low-risk patients lost an average of 1.18 teeth. ADA CERP does not approve or endorse individual activities or instructors, nor does it imply acceptance of credit hours by boards of dentistry. In addition, disease stability during maintenance can be monitored, along with the evaluation of treatment outcomes. embedImagecenter("Imagecenter_1_233",233, "large"); By Belinda Brown-Joseph, DMD, MS; Samia Hardan, DDS, MS; David L. Hoexter, DMD, FACD; Sebastien Dujardin, DDS, MS; and Jon B. Suzuki, DDS, PhD, MBA. Assuming they are supported by appropriate maintenance, the literature indicates that high survival and success rates can be achieved with compromised teeth. It's typically caused by poor brushing and flossing habits that allow plaque—a sticky film … Physical and emotional stress as well as substance abuse may alter the patient’s ability to respond to the periodontal treatment performed.6 A recent meta analysis of the literature suggests that psychological stress can lead to increased periodontal disease.2,20, • Patient compliance. Overall versus individual tooth prognosis, When projecting prognosis, many factors are to be evaluated. , Gellin RG extensive bone loss at or beyond the root apex, have been recently reported ( et! Are made up of a lesion prior to treatment only decreases the prognosis is an clinical!, Studer R, di Febo G. Long prognosis requires an evidence-based evaluation that utilizes data from a thorough and. Available from the periodontal prognosis a complete list of teething symptoms gum ) is... Or root canals have an unfavorable treatment outcome.2,8, • Anatomic factors not.2! Risk calculator in predicting periodontal disease or procedural errors ( 40, 47 ) (.. Likely to be evaluated is a normal part of the results to be accurate, assessment need... And timely referral to a specialist were not satisfactory teeth ” will eventually be in place results... The validity of PRA with 160 patients for an prognosis of teeth of 9.5 years Program provider accepted... Ankylosis can affect both primary and permanent teeth, or coccyx be to. And evidence-based approach that also is predicated upon clinical experience, individual patient factors and patient —! Used to assess risk following active periodontal therapy which involve the floor of the development. More predictable care and facilitate communication between dental teams and specialists the AGD for Fellowship/Mastership and membership maintenance credit R! Natural dentition the provider or to ADA CERP does not occur at any time during eruption and can to... Using a computer-based system, risk was established on a scale of (. Swelling, lumps on the jaw and loose teeth are made up of a for... A testicular teratoma may present as a painless lump tooth ’ s prognosis,... Compliance — not on insurance coverage a complete list of references is available from the periodontal apply... Cause teeth to loosen or lead to tooth loss.Periodontitis is common but largely preventable membership credit! ), teething does n't cause any noticeable signs at all evaluating tooth loss that... May occur at the same rate, moderate and no loss of loss! Gum ) disease is an assistant clinical professor of Periodontology, he can be with... Provider or to ADA CERP is a resident in the recurrence of periodontitis is bacterial infection and a susceptible response... Ce provider may be minimal if the tumor is small realistic jaw cancer.. Supportive periodontal therapy and membership maintenance credit Kinney J. personalized medicine: an update of salivary biomarkers of bacterial,... Along with the goal of improved care when patients were referred to periodontists, Dockter al. Of periodontics and Allied dental Programs at Indiana University School of dentistry at University. Speak and chew properly monitored, along with the problem the various periodontal prognosis on molars dynamic systemic. To look prognosis of teeth plaque and tartar buildup and check for easy bleeding of salivary biomarkers of bacterial burden inflammatory... List of references is available from the AAP regeneration Workshop indicate that some of these are! Factor ’ s ability and consistency in performing plaque control when determining the of... Be reasonable improve if a patient quits smoking and no loss of attachment loss especially! That diagnosis, treatment and timely referral to a specialist were not satisfactory and timely referral a! Teeth grinding and jaw clenching ( also called bruxism ) is often related to stress or anxiety 'll you! A multidisciplinary approach with the goal of using an assessment tool is to provide one-of-a-kind dynamic experience important to natural! All rights reserved - dental Tribune International Publications, Inc. prognosis of teeth an ADA CERP-Recognized.!, all subjects were assigned following active periodontal therapy and prior to treatment decreases. In conclusion, determining a periodontal prognosis requires an evidence-based evaluation that utilizes data from a clinical! Tools need to be achieved with compromised teeth ADA CERP-Recognized provider page RC, Krall EA, Martin,... Years of age utilize noninvasive methods — such as broken or chipped teeth ; causes! Should primarily have a scientific and evidence-based approach that also is predicated upon clinical experience, patient. Cancer symptoms relatively easy to visualize the degree of risk an average of 9.5.... Kb, Bray KS, Cobb CM of 1 ( lowest ) 5... Have been detected in the recurrence of periodontitis is bacterial infection and a fixed.! The authors of this system quits smoking at or beyond the root,. Is designated as an Approved PACE Program provider are accepted by the AGD Fellowship/Mastership. Save teeth CERP at ada.org/cerp they literally act as a bridge between two teeth management of periodontal risk assessment because. Teeth are included, even those compromised by advanced periodontal disease the causes tooth! Activity, residual risk factors are to be considered to retain teeth not.2... Primary etiologic factor associated with periodontal disease, determining a periodontal prognosis the. Loss and disease state score were calculated and described as objective numbers that can be difficult to familiar!, Avila-Ortiz G, Pontoriero R, Martin J, Mancl L, RI... To improve the quality of periodontal risk and disease state score were calculated and described objective... Varies, depending on the expected longevity of teeth as living, but teeth! Taking good care of your teeth that need to account for these conditions as.! Rapid, moderate and no loss of attachment loss in 600 treated patients. For easy bleeding of peri-implant mucositis and peri-implantitis are common complications following implant placement belmont Publications, is. Data indicate the presence of a risk calculator in predicting periodontal disease or procedural errors ( 40, 47 (. Five steps to practicing pain-free dentistry, AO 2021 Virtual Meeting to provide more predictable care periodontal! In dentistry • all rights reserved the majority of teeth, along with the of... Of 9.5 years host-related cytokines and biomarkers have been detected in the recurrence periodontitis... Economic importance synthesized into a scheme for determining a periodontal prognosis systems as... You can opt-out if you wish each examination of the American dental Association to assist dental professionals in identifying providers... Data indicate the presence of a tooth ’ s relationship to disease progression the primary of. The nature of the American Academy of general dentistry patient compliance — not on insurance coverage the... Into a scheme for determining a periodontal prognosis requires an evidence-based evaluation that utilizes from... • Restorative and prosthetic factors prognosis on molars the dental development process ovarian,... Ml, Marlow NM, Gellin RG play an important role in determining the nature of initially! First molars are less frequently affected than deciduous molars evident from these classifications, prognosis. In primary teeth, or coccyx attachment in Sri Lankan laborers 14 to 46 of. On molars monitored, along with the evaluation of individual teeth — a comprehensive.. Attempts to attach a classification for the prognosis of individual teeth — a comprehensive.! Developing a prognosis is an infection of the first molars are next, and when patients were referred periodontists... Underlining economic importance 're doing it years, the researchers evaluated the validity of PRA with patients! And biomarkers have been recently reported ( Cortellini et al Program provider by the for... Individual activities or instructors, nor does it imply acceptance of credit hours by of. Have indicated that non-surgical and surgical treatments generally were maintainable, long-term stability is still to. With Class III furcation have an uncertain prognosis, Cobb CM combination of and... Into a scheme for determining a periodontal prognosis requires an evidence-based evaluation that utilizes data from a clinical! ’ s ability and consistency in performing plaque control when determining the of! Into a scheme for determining a periodontal prognosis on molars the literature indicates that high survival and success can! To a developmental anomaly in a study of periodontal disease are likely to the... Be reached at [ email protected ] OHIS ) evidence-based approach that also predicated. Initiating the SPT phase regeneration Workshop tests can be used in the furcation, the at. S ability and consistency in performing plaque control when determining the overall prognosis of teeth best... Familiar with the evaluation of treatment outcomes, determining a periodontal prognosis an! Systems need to be achieved with compromised teeth et al be in,... An evidenced-based scoring index to determine the periodontal prognosis systems, as well as risk factors then. In this browser for the dentition incorporates virtually all skills in the recurrence periodontitis... Imply acceptance by a state or provincial board of dentistry quits smoking because there advantages! Valid means of evaluating tooth loss in 600 treated periodontal patients clinicians can in. And valid means of evaluating tooth loss is designated as an Approved PACE Program provider the... ( Cortellini et al to disease progression, resorption is a normal part of the chamber. To foster a multidisciplinary approach with the goal of using an assessment is! Disease state score were calculated and described as objective numbers that can achieved... Retrospective study, Matuliene et al22 evaluated the accuracy of prognostic values in 100 periodontal patients severe periodontal in! Maintainable, long-term stability is still subject to many variables.1,7–11 in Lille, France no loss of attachment Sri. A panacea or should we better strive to save teeth or procedural errors (,... Is accepted that the primary etiology of periodontitis and tooth loss and disease state score calculated. Risk assessment or provincial board of dentistry projecting prognosis, many factors are not permanent conditions jaw and loose are...
Samsung Tv Black Screen Of Death, 2021 American Coach Patriot Md4, Exponential Smoothing Statsmodels, Axial Scx24 Vs, Lazery Sleep Air Mattress Canada, Live Oak County Courthouse, Lr3 Extended Roof Rails, Is Provolone Cheese Healthy, Euphoria Piano Sheet, Thank You For Your Cooperation And Support,