Aesthetic Concern Research Articles

Comparison of the Effectiveness of CO2 and Diode Lasers for Gingival Melanin Depigmentation: A Randomized Clinical Trial.

Introduction: Gingival hyperpigmentation is an esthetic concern for some individuals. This study compared the effectiveness of CO2 and diode lasers for gingival depigmentation. Methods: This randomized, split-mouth, clinical trial consisted of 12 patients with the chief complaint of hyperpigmented gingival areas. The upper right and left anterior segments and the mandibular anterior segment were randomly allocated to one of the treatment groups. The segments in group 1 underwent gingival depigmentation with a diode laser (810 nm) at 6 W and pulsed mode, whereas group 2 was ablated with a diode laser at 3 W and continuous mode. The removal of gingival pigments in group 3 was contemplated with a CO2 laser (10600 nm, 3 W, continuous mode). The operation chair time, bleeding during the procedure and post-operative pain were recorded. The gingival color and esthetic appearance were measured before the operation and at 1 week and 6 months later. Results: There was no significant difference in the bleeding scores, pain level, and color alteration values between the groups (P>0.05). The operation chair time was significantly shorter when the diode laser was applied at pulsed mode (P<0.05). The segments treated with the diode laser (pulsed or continuous mode) showed a higher esthetic appearance at the 6-month follow-up compared to those ablated with the CO2 laser (P<0.05). Conclusions: Higher esthetic appearance is expected when using the diode laser for gingival depigmentation compared to the CO2 laser. The application of the diode laser at pulsed mode could be recommended for gingival depigmentation, as it produced pleasing esthetic outcomes at reduced chair time.

A NOVEL PERIODONTAL PLASTIC SURGICAL PROCEDURE FOR PAPILLA RECONSTRUCTION IN ANTERIOR AESTHETIC REGION WITH A VARIANT BEAGLE'S TECHNIQUE- A CASE REPORT

Black triangle, an open interproximal space between maxillary anterior teeth can create aesthetic concern among patients specially while smiling and during speech. There are several risk factors leading to the development of black triangle and the most common among them includes aging, periodontal disease, length of embrasure area, interproximal contact position, triangular- shaped crowns and root angulations. Various techniques like orthodontic correction, prosthetic veneers and various periodontal surgical methods have been used to cover these unesthetic open embrasures. Treating this black triangle can be best done by surgical techniques but it is challenging and very unpredictable. The purpose of this case report is to present a papilla regeneration technique with minimal surgical trauma in the reconstruction of papilla in the maxillary anterior region of a 36-year-old woman who presented with class II interdental papilla loss in 21 and 22 regions according to Nordland and Tarnow's classification. In the present study, a variant technique given by Beagle in 1992 was used to cover this open gingival embrasure. The technique uses a gingival flap from the labial aspect to close the open gingival embrasures thus improving the aesthetic as well as smile of the patient. The results obtained with this technique were satisfactory.

Cellulite: Presentation and management.

Cellulite is a common dermatological condition with a female preponderance, affecting up to 90% post-pubertal females. It is characterized with dimpling and denting of the skin surface, giving it a Peau d'orange appearance. Once considered to be a benign physiological isolated skin condition of only an esthetic concern, cellulite is now considered a pathological entity with systemic associations and a negative psychological impact on patients. The objective of this article was to discuss etiology, pathophysiology, and treatment of cellulite. Literature was screened to retrieve articles from PubMed/Medline and Google Scholar and related websites. Cross-references from the relevant articles were also considered for review. Review articles, clinical studies, systematic reviews, meta-analysis, and relevant information from selected websites were included. Several treatment options from lifestyle modifications and topical cosmetic therapies to energy-based devices have been studied for its treatment. However, treatment remains a challenge despite many new modalities in the armamentarium. Laser and light therapies along with radiofrequency are useful treatment options with good safety profile. Acoustic wave therapy, subcision, and 1440-nm Nd:YAG minimally invasive laser are beneficial in cellulite reduction. Methodological differences in the trials conducted make it difficult to compare different treatment modalities. Overall, treatment needs to be individualized based on the patient characteristics and severity of the condition. A combination of treatments is often required in most patients for reducing cellulite.

Influence of personality traits on a patient's decision to accept orthognathic surgery for correction of dentofacial deformity.

To investigate the influence of personality traits in addition to quality of life (QoL) on the decision to accept orthognathic surgery. A total of 108 patients (68% female) aged 14-53 years (median, 18 years; interquartile range, 17-25.75 years), with skeletal malocclusions of Index of Orthognathic Functional Treatment Need grades 3-5 (moderate to very great need for surgery) were included in this cross-sectional study. Personality traits of extraversion, neuroticism, agreeableness, openness, consciousness, perfectionism, and self-esteem and dimensions of Orthognathic Quality of Life Questionnaire were compared between patients who accepted orthodontic preparation for orthognathic surgery and those who refused (n = 55 vs 53). Patients who accepted the suggested surgical procedure had higher age, perfectionism, facial esthetic (FE) concern, social aspect, and impairment of oral function (OF) as well as lower self-esteem with small to medium effect sizes (P ≤ .040; r = 0.198-0.399). Other personality traits and awareness of dentofacial deformity did not differ between the groups. In multiple logistic regression analysis, while controlling for sex, perfectionism, and self-esteem, the following predictors of acceptance of orthognathic surgery were higher: FE concern (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.3-9.1), OF (OR, 3.0; 95% CI, 1.0-8.6), and age ≥18 years (OR, 2.7; 95% CI, 1.0-7.1; P < .001). Extraversion, neuroticism, agreeableness, conscientiousness, and openness do not significantly affect a patient's decision to accept orthognathic surgery. The influence of self-esteem and perfectionism is primarily on perception of alteration of QoL induced by dentofacial deformity.

Periodontics-Prosthodontics - An Interdisciplinary Approach

As the mean age of the population is increasing and the current therapeutic concerns is for teeth to be retained. It isnow quite common to encounter complex clinical situations like severe tooth-tissue loss, advanced periodontal diseasealong with significant esthetic concerns. Dentists now a days, not just restore teeth to make them better for functioning,but also cater an increased esthetic concern of the patients.Thus, many a times, patients who present with a complexrestoration also require an esthetic rehabilitation. Although periodontal factors do not usually have a direct effect onthe survival of fixed prosthesis however a harmony between prosthesis and periodontium remains critical, affecting thelongevity, esthetics and to prevent unsatisfactory treatment outcomes. The present article addresses and summarizes thecurrent knowledge of Prosthetic and Periodontic clinical procedures that play a role in any clinician’s attempt to createbiologically acceptable and aesthetically pleasing long-lasting restorations.

Microabrasion plus resin infiltration in masking white spot lesions.

Enamel opacities or white spot lesion is a result of enamel demineralization due to cariogenic activity or fluorosis, or enamel hypo-plastic/hypo-mineralized, which are an esthetic concern. A recent evidence base of dentistry has been focused on the Minimal Invasive Dental (MID) approach for treating such lesions. The aim of the study is to evaluate the esthetic improvement of white spots lesion using microabrasion and resin infiltration in upper permanent incisors, immediately and up to six months follow-up. For the present case with enamel opacities, the minimal invasive therapy resin infiltration was chosen, preceded by microabrasion technique, to improve the teeth aesthetic appearance of the affected teeth. An excellent improvement in 11 and 21 teeth esthetic. However, we still found good outcome in the enamel surfaces after six months follow-up, which became hard to detect, except in the near inspection. The patient was delighted with the well-defined enhancement in his esthetics smile and was mentioned no postoperative sensitivity immediately or in the recall evaluation. The resin infiltration showed significant teeth esthetic improvement immediately and good follow-up outcome for six months, preceded by microabrasion. More high-quality and long-term clinical studies are needed to verify durability and factors that may affect treatment quality.

Postburn neck contracture reconstruction by interval skin grafting

Introduction: Delayed burn wound healing, due to lack of proper initial treatment, especially in deep partial-thickness and full-thickness burns leads to the formation of burn scar contracture. Because of the loose tissue in the anterior neck and also due to habitual and ignorant use of a pillow in burnt patients during the postburn recovery phase, contracture of the neck is a common sequela. Many reconstructive modalities have been described in the literature which include skin grafting, pedicle flap with or without expansion, and free flap. Keeping the esthetic concern in mind, we modified the method of contracture release and skin grafting into two stages. Materials and Methods: This is a prospective study conducted on 15 patients with extensive postburn contracture of the neck during the period ranging from January 2020 to August 2021. Results: In our study, 80% of the patients were females. The mean age was 25.9 years. The number of type 2 and type 3 neck contractures was 7 and 8, respectively. The mean duration of contracture was 8.26 months. Graft loss was the only complication seen and that too was &lt; 10% in all cases (mean - 4.46). At 6 months, mandibular border and thyroid bulge were distinctly visible, and cervicomental angle was within the normal range (mean - 110.46) giving a youthful and appealing esthetic appearance. The mean of the Patient and Observer Scar Assessment Scale score was 2.06 for the observer component and 3 for the patient component. Conclusion: Interval skin grafting can be undertaken following postburn neck contracture release for better functional and esthetic outcomes.

Implementing the Medical Model in Aesthetic Consultation.

Throughout the process of building a new medical spa, it is important to standardize and implement safe, evidenced-based practice standards. As medical spas and aesthetic services become more prevalent and popular, it is more important than ever for providers to ensure that patient safety is a top priority. Integrating a structured medical model into the aesthetic consultation and treatment ensures that a mutual decision-making process is shared between the provider and the patient. Together, the provider and the patient can determine whether the treatment will improve the patient's overall health and well-being. The patient is given the opportunity to fully understand and choose which procedure will best address their overall psychological health, aesthetic concern, and anatomical diagnosis. In establishing agreement with the patient on a common goal, the provider can first assess the risks and benefits, and then determine which intervention or treatment will provide the patient with the greatest benefit. When providers establish and adhere to an easy-to-use, decision-making algorithm, patients are empowered in the decision-making process. This helps build a working, trusting relationship between the patient and the provider, which leads to greater patient satisfaction and patient loyalty. Sharing this medical model algorithm will greatly benefit other aesthetic providers by helping to create a standardized evaluation process in a medically based aesthetic practice.

Finite element evaluation to compare stress pattern in bone surrounding implant with carbon fiber-reinforced poly-ether-ether-ketone and commercially pure titanium implants.

Background:Titanium allergy is a main reason for failure of dental implant. Hence, newer implant biomaterials have emerged such as zirconia and carbon or glass fiber reinforced poly-ether-ether-ketone (CFR-PEEK)-based materials. The aim of the present study was to compare the stress pattern in bone surrounding implant with CFR-PEEK and commercially pure titanium implant.Materials and Methods:Three-dimensional formal model of mandibular first molar partsubstituting with implant supported crown was generated. Implant with dimensions of 10 mm length and 4.3 mm diameter was used in this study. Finite element models of CFR-PEEK and commercially pure titanium implant assemblies were generated. A 100 Newton (N) force was implemented along the long axis and obliquely at 30° to the long axis of implant. Von Mises pressures generated in the bone surrounding implant were analyzed using ANSYS workbench 16.0 and other finite element software.Results:Similar stress distribution was detected in bone surrounding implant with CFR-PEEK implant and commercially pure titanium implant assembly under 100 N force applied vertically and obliquely.Conclusion:PEEK reinforced with carbon or glass fiber implants can be a viable alternative in individuals who are more of esthetic concern and who demonstrate allergy to metallic implants.

Comparison of Effectiveness of Novel Vestibular Incision for Papilla Reconstruction with Semilunar Flap Technique. A Randomized Controlled Study

Background: The presence or absence of the interdental papilla is a topic of great esthetic concern. Several surgical and nonsurgical techniques have been proposed to rebuild lost papilla. However, there is a paucity in the literature assessing comparative studies. Aims and Objective: The aim to evaluate and compare the effectiveness of novel vestibular incision for papilla reconstruction with semilunar flap technique. Objectives: To compare effectiveness of novel vestibular incision for papilla reconstruction with semilunar flap technique. Material and Methods: Fourteen patients with the age range of 20–40 years who were conscious for their esthetics with total or partial loss of the interdental papilla were selected for the study. The patients were randomly divided into two groups, namely Group A (vestibular incision subperiosteal tunnel access [VISTA] technique) and Group B (semilunar flap technique). Result: At 6-month postsurgery, there was a statistically significant reduction in vertical dimension, mesiodistal dimension, and area of the papilla defect in Group A as compared to Group B. At 6-month postsurgery, there was an increase in the height of the papilla in Group A, whereas there was a decrease in the height of the papilla in Group B. Both the techniques exhibited satisfactory results in terms of papillary defect fill over a 6-month period. Conclusion: The novel VISTA approach for papillary reconstruction could be a better alternative owing to less postoperative scarring and predictable results.

Paediatric Prosthetic Rehabilitation using Decoronated Avulsed Teeth

Traumatic Dental Injury (TDI) mostly occurs as a result of any sports injury or an accident. The prognosis of teeth following injury is determined by the kind of TDI, emergency treatment, and the amount of time between emergency treatment and definitive care. Patients with missing anterior teeth lack an impressive appearance aesthetically as well as psychologically. Speech issues and some loss of function can lead to a decline in oral health, which can affect one's quality of life. This case addresses the patient aesthetic concern in anterior region of maxilla of 15-year-old male due to trauma which resulted in avulsion of both centrals and lateral incisor. Patient’s own completely displaced teeth placed in biological tooth functional space maintainer was planned. The use of natural tooth as functional space maintainer method is less expensive, easy to fabricate, easy to modify according to age and produces better aesthetics. It also maintains space loss in growing children.

Staging Atmospheres: Editorial introduction to the second volume

In this second special issue of Ambiances on Staging Atmospheres, we return to the material and metaphorical felicity by which theatrical performance, design and their reception, present themselves to critical and political thinking in relation to atmosphere. We note, amongst other factors, the particular significance of scenography – at once an intellectual and aesthetic concern – in providing a framework by which to consider the material presence of atmospheres within theatrical events themselves, and by extension, in quotidian and other milieux beyond them. Moreover, we consider how, across the considerable range of examples offered by our contributors, the heuristic of staging is released from a somewhat moribund connection to the ‘stage set’ and instead becomes a process of lived encounters with the affects and affordances of social and material environments.

Awareness and Knowledge of the Adult Population in Saudi Arabia on Teeth Discoloration and Treatment Options: A Cross-Sectional Study

Background: Tooth discoloration is a common condition. Discoloration can be a major aesthetic concern for some people and it can indicate pathology, so it needs to be addressed. The success of treatment of tooth discoloration is largely dependent on the knowledge and attitude of people towards it. Hence the aim of this cross-sectional questionnaire-based study was to evaluate knowledge and awareness of the adult Saudi population about the causes of tooth discoloration and its treatment options.&#x0D; Materials and Methods: An online close-ended questionnaire consisting of 21 questions about tooth discoloration causes and treatment options were uploaded in Google Forms and was sent to 2000 adults in Saudi Arabia via email and social media websites. The questions were designed to evaluate patients’ knowledge about the various causes of tooth discoloration.&#x0D; Results: A total of 1041 participants responded to our questionnaire. The study included 560 females (53.79%), and 448 participants aged between 18 and 24 years (43.04%), 192 (18.44%) between 25 and 35 years, 246 (23.63%) between 36 and 51 years, and 155 (14.89%) above 51 years. Most of the participants (n= 649; 62.34%) had a bachelor's degree. The most common answer to the type of teeth discoloration was internal and surface discoloration (n= 511; 49%). There was a positive response to the effect of diet, smoking, aging, and bacteria on tooth discoloration. 79% of the participants did not know what dental fluorosis is. The response to the effect of drugs on teeth discoloration split between "Yes" and "I don't know," and 688 of the participants (66.09%) did not know which drugs cause teeth discoloration. The personal effort was the most common way to obtain information about teeth discoloration (n= 678; 65.13%).&#x0D; Conclusion: Within the limitations of this study, the level of knowledge about tooth discoloration was more concentrated on extrinsic factors, and the majority of the participants demonstrated poor knowledge about the intrinsic causes of tooth discoloration. The preferred treatment option of teeth discoloration was in office bleaching.

Clinical and primary evidence of silver diamine fluoride on root caries management.

Root caries is a growing problem for the worldwide aging population. Silver diamine fluoride (SDF) contains high concentrations of silver and fluoride ions, which prevents and arrests root caries, as well as dentin caries in the primary teeth of young children. Unlike other fluoride products that mainly reduce the formation of new carious lesions, 38% SDF is an effective agent that can efficiently arrest the carious process, remineralize the decayed dental tissues, and protect the tooth structure against the formation of new caries lesions. The use of SDF can result in more caries-resistant tooth structures. Despite these merits, its clinical disadvantages are the deep penetration of silver ions and sequential formation of silver compounds, which cause esthetic concern due to the discoloration and impaired efficacy of dentin bonding after using SDF. Thus, this narrative review, by addressing the primary experimental results and clinical applications of SDF on root caries, proposes management methods for root caries in conjunction with the application of SDF. We propose a two-visit treatment protocol to take advantage of the SDF application for root surface caries and utilize the discoloration caused by SDF.

Physical/Mechanical and Antibacterial Properties of Orthodontic Adhesives Containing Calcium Phosphate and Nisin.

Enamel demineralization around orthodontic adhesive is a common esthetic concern during orthodontic treatment. The aim of this study was to prepare orthodontic adhesives containing monocalcium phosphate monohydrate (MCPM) and nisin to enable mineralizing and antibacterial actions. The physicomechanical properties and the inhibition of S. mutans growth of the adhesives with added MCPM (5, 10 wt %) and nisin (5, 10 wt %) were examined. Transbond XT (Trans) was used as the commercial comparison. The adhesive containing a low level of MCPM showed significantly higher monomer conversion (42–62%) than Trans (38%) (p < 0.05). Materials with additives showed lower monomer conversion (p < 0.05), biaxial flexural strength (p < 0.05), and shear bond strength to enamel than those of a control. Additives increased water sorption and solubility of the experimental materials. The addition of MCPM encouraged Ca and P ion release, and the precipitation of calcium phosphate at the bonding interface. The growth of S. mutans in all the groups was comparable (p > 0.05). In conclusion, experimental orthodontic adhesives with additives showed comparable conversion but lesser mechanical properties than the commercial material. The materials showed no antibacterial action, but exhibited ion release and calcium phosphate precipitation. These properties may promote remineralization of the demineralized enamel.

A first report on the identification of a novel archaea, Methanospirillum lacunae from spoilt paints in Lagos, Nigeria using a metagenomic approach

Paint deterioration is a serious esthetic and economic concern attributed to microbial activity.Identifying these microbes is crucial to mitigating their deleterious effects. This paper assessed the bacterial community and population of fresh and spoilt water-based paints from a reputable paint company in Lagos, Nigeria using culture-dependent and metagenomic approaches. Gas Chromatography Mass Spectrophotometry (GCMS) was used to elucidate components of the samples. The bacterial population ranged from 1.4 × 106 to 4.4 × 108 and from 2.3 × 106 to 6.8 × 108 CFU/ml in fresh and spoilt samples respectively. Culture-based technique revealed Bacillus spp. as the dominant bacteria in fresh paint along with Paenibacillus macerans, Corynebacterium striatum, Enterobacter cloacae and Clostridium sphenoides while Pseudomonas spp. were predominant in spoilt paints together with Arthrobacter globiformis, Azotobacter chroccoccum, Burkholderia mallei, Alcaligenes faecalis, Enterobacter amnigenus and Bacillus megaterium. Microbiome sequencing of extracted DNA from spoilt paint revealed a rich bacterial diversity and a surprising archaea population of Methanospirillum lacunae belonging to phylum Euryarchaeota. GC-MS analysis revealed esters as dominant compounds in fresh paints while acids and alcohols suggest that degradation of the components predominate in the spoilt paints. Metagenomic approach thus revealed for the first time, the co-existence of M.lacunae,an archaea with other bacteria in paints.

An Investigation in Terms of Binding Art of Printed Books Dated 1830-1840 in Marmara University Library

As in many branches of art within the Ottoman Empire, very valuable works have been produced in the field of book arts. When it comes to the arts of the book, the bookbinding art is understood as well as the arts such as calligraphy, illumination and miniature. Making covers that surround a book or even protect the book is a practice that has been going on since ancient times. These covers, called bindings, are known to vary depending on the material reached. Books are bound with materials such as leather, fabric, marbling, cardboard. It is seen that such a functional application is subjected to various ornaments with aesthetic concern. Although the bindings of carefully prepared manuscript books are decorated with unique ornaments, the same care has not been taken in many printed books. Nevertheless, aesthetics is not abandoned and decoration is included in printed book covers. Printed books belonging to the years 1830-1840 in Marmara University Library were examined in terms of binding arts. It is seen that the binding of the books is mostly made of leather. In addition, there are works with fabric, marbling and cardboard bound. Again, in these books, the decorations are generally formed in the form of central medallion, pendant, bracket and borders on the lower and upper covers. Ebru art has also been used both as a cover and as an ornamental element in bindings, as well as being used as inner covers and side paper of books.

The Influence of Three Root Canal Irrigation Methods on PostThe Influence of Three Root Canal Irrigation Methods on PostOperative Pain “Randomized Clinical Trial”

Introduction: Facial soft tissue changes in relation to hard tissue movements after orthognathic surgery cases is always of concern to patients , surgical and orthodontics teams. The aim of the present study was to assess facial soft tissue changes and stability using 3D facial laser scanner after orthognathic surgery Le Forte I maxillary impaction in excessive gingival display patients. Methods: The subjects consisted of 12 patients with skeletal vertical maxillary excess (VME) causing an aesthetic concern to the patients in the form of “Gummy smile”, who underwent LeFort I osteotomy with maxillary impaction, Three-dimensional images of the patients were acquired with a 3D laser scanner preoperatively and postoperatively. The changes in facial soft tissue were detected using a colour coded map for analysis. Results: Significant change was recorded in the upper lip, alar base, nasolabial fold and nasal tip areas, without specification of this change in direction. Conclusions: The 3D images captured using the laser scanner in this study can be a useful tool for communication with both patients and professionals but cannot be relied upon solely for accurate analysis of the facial soft tissue changes. The colour coded map analysis cannot be relied upon solely as a method of analysis as it lacks an important aspect of the change which is the direction.

CLOSURE OF MIDLINE DIASTEMA BY DIRECT COMPOSITE RESIN BUILD-UP USING PUTTY INDEX- A CASEREPORT

A common aesthetic concern among patient is maxillary anterior space or diastema. Labial frenulum, microdontia, mesiodens, peg-shaped lateral incisors, agenesis, cysts, habits such as finger sucking, tongue thrusting, or lip sucking, dental malformations, genetics, proclinations, dental-skeletal discrepancies, and imperfect coalescence of the interdental septum are some of the causes of midline diastema. For diastema closure there are a variety of therapy options. Many novel therapies have been applied, ranging from restorative procedures to surgery (frenectomies) and orthodontics for closure of diastema or a combination of procedures to meet the aesthetic and functional needs of patient’saesthetic. Recent advancement in direct dental composite resin allows dentists to do minimally invasive cosmetic dentistry that is both conservative and time-consuming. In diastema cases, direct composite resins give the dentist and patient entire control over the restriction and the construction of a natural smile. The purpose of this study is to present a case report of aesthetic management using putty index of maxillary anterior space, which includes the midline.

Validation of the Psychosocial Impact of Dental Aesthetics Questionnaire in the Australian population

The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument to assess the subjective perception need for orthodontic treatment. The study aimed to determine the psychometric validity and reliability of PIDAQ in Australian adults. Data were collected from the National Dental Telephone Interview Survey in 2013. The PIDAQ was used, comprising 4 conceptual domains: self-confidence, social impact, psychological impact, and esthetic concern. Psychometric sensitivity was estimated for each item. Confirmatory factor analysis was performed to determine factorial validity in which the ratio of chi-square by degrees of freedom, comparative fit, and root mean square error of approximation were used as indexes of the goodness of fit. Convergent validity was estimated from the average variance extracted and composite reliability, whereas internal consistency was estimated by Cronbach standardized alpha. The dataset comprised 2936 Australian adults aged ≥18 years and separated randomly into 2 subdata sets. The kurtosis and skewness values indicate an approximation to a normal distribution for each item, with acceptable thresholds for the goodness of fit and convergent validity (average variance extracted ≥0.50 and composite reliability ≥0.70), and discriminant validity was also demonstrated. Internal consistency was adequate in the 4 conceptual domains for PIDAQ for both subdata sets, with Cronbach standardized alpha being ≥0.70. The psychometric sensitivity, validity, and reliability of the PIDAQ instrument in a sample of the Australian adult population were found to be adequate. Both subdata sets drawn from the sample demonstrated acceptable goodness of fit and internal consistency.