Alessandra Reis

State University of Ponta Grossa | UEPG · Department of Restorative Dentistry

Objective This randomized controlled trial aimed to evaluate the equivalence in the color change, adverse effects, self-perception (AS) and the impact on oral condition (IO) of participants submitted to different application protocols of in-office dental bleaching. Materials and methods 165 participants were bleached with a 35% hydrogen peroxide g...

Background: At low concentrations used for in-office bleaching gels, such as 6% HP, gingival barrier continues to be performed. If we take into account that, in the at-home bleaching technique, no barrier is indicated, it seems that the use of a gingival barrier fails to make much sense when bleaching gel in low concentration is used for in-office...

Objectives To evaluate the bleaching efficacy and permeability of hydrogen peroxide (HP) in the pulp chamber of human teeth bleached with lower concentrations of carbamide peroxide gel (4%, 5% and 7% CP). Materials and methods Bleaching gels with lower concentrations were formulated and a commercial standard gel, 10% CP, was used as a reference. F...

Objectives Evaluate the bleaching efficacy (BE) and tooth sensitivity (TS) of in‐office bleaching using different application tips. Methods Forty‐eight participants were selected (split‐mouth), one to receive bleaching with an attached brush tip and one with a conventional tip. The procedure was performed with Whiteness Automixx Plus 35%. The BE w...

Objectives: To evaluate the effect of the absence of HEMA in commercial universal adhesives containing MDP on the adhesive properties of dentine and enamel immediately and after one year of water storage. Methods: 144 third molars were used to evaluate bonding to dentine (n = 64) and enamel (n = 80). For each substrate, teeth were divided into eigh...

Objective To compare the color change, the risk and intensity of tooth sensitivity (TS), and gingival irritation (GI) of at‐home bleaching applied on the buccal surface only or the buccal and lingual surfaces. Materials and Methods Sixty patients with canines A 2 or darker were selected and their superior arches were randomized in two groups: at‐h...

Objectives This study aims to assess hydrogen peroxide (HP) penetration within the pulp chamber, color change (CC), physical–chemical properties, and temperature using in-office different concentration bleaching gels with or without violet light. Materials and methods Fifty teeth were divided into five groups (n = 10) based on the HP concentration...

Objective Assess color alteration and hydrogen peroxide (HP) penetration in human and bovine teeth using various in‐office bleaching protocols with different application times. Materials and Method s Thirty healthy human premolars and 30 healthy bovine incisors were divided into five groups and subjected to different bleaching protocols: 2 × 15 mi...

Objective: The application of anti-inflammatories as topical desensitizers before dental bleaching is an approach to reduce bleaching-induced tooth sensitivity (TS). This randomized controlled trial compared the risk and intensity of TS and the color change resulting from in-office dental bleaching after using an experimental desensitizing gel cont...

Purpose The objective of this double-blind, split-mouth, randomized clinical trial was to evaluate the color match of a single-shade composite resin Admira Fusion X-tra in comparison with a multi-shade composite resin Admira Fusion in non-carious cervical lesion restorations (NCCLs). Methods and Materials One hundred and twenty restorations were p...

In this chapter we will present the step-by-step procedure of in-office whitening (or in-office bleaching) and the respective efficacy and side effects. We will also address other characteristics of in-office bleaching, including the number of clinical appointments required to reach effective whitening, the concentration of the peroxide-based bleac...

Introduction. Dental bleaching is the first choice to improve smile esthetics, but, in some cases, it needs to be associated with resin composite restoration to obtain a satisfactory result. Unfortunately, the bonding of resin-based materials can be impaired due to residual oxygen molecules, which can decrease the durability of the restoration. Obj...

Objective: Despite the availability of in-office bleaching gels with a 6% concentration of hydrogen peroxide (HP), these gels have not been evaluated in younger patients. They are commercially available with a tip, associated or not with a brush, where the tip with a brush spreads the gel over the entire surface to have a smaller thickness (thin l...

Objectives This study aimed to evaluate the bleaching efficacy and hydrogen peroxide permeability in the pulp chamber by the at-home bleaching gel in protocols applied on different dental surfaces. Materials and Methods Forty premolars were randomly into 4 groups: control group no bleaching, only application on the buccal surface (OB), only applic...

This study aimed to evaluate the effects of the application of 10% sodium ascorbate (SA) after in-office bleaching on the penetration of hydrogen peroxide (HP) into the pulp chamber, color change, and microtensile bond strength (µTBS) to the resin-enamel interface. Thirty premolars and thirty molars were randomly divided into three groups (n = 20 e...

Objective This study aims to assess hydrogen peroxide (HP) penetration into the pulp chamber, color change (CC), physical–chemical properties, and material wastage (MW) and material used (MU) in mixing tips when using in‐office bleaching gels with two different mixing tips. Materials and Methods Forty teeth were divided into five groups ( n = 8) b...

Objectives This in vitro study aimed to evaluate the bleaching efficacy (BE), hydrogen peroxide penetration into the pulp chamber (HPP), and physical–chemical properties (concentration, pH, and viscosity) of in-office bleaching gels immediately and after 1 week of mixing. Methods and Materials We randomly divided 49 premolars into seven groups: co...

Objective: To evaluate the penetration of hydrogen peroxide (HP) into the pulp chamber and the color change of different bleaching varnishes in low concentrations used for at-home bleaching. Materials and methods: Ninety healthy premolars were used, randomly distributed into nine groups (n = 10) according to bleaching varnish (PL, PolaLuminate;...

Objective This study aims to evaluate the effects of exposure time and irradiance on the dentin bonding properties (microtensile bond strength (μTBS) and nanoleakage (NL)) of the Clearfil Universal Bond Quick (CUQ) adhesive and Scotchbond Universal Adhesive (SBU) immediately and after 2 years of water storage. Material and methods Hence, 128 human...

Objectives: This study aimed to evaluate the effect of copper nanoparticles (CuNp) on the clinical performance of a universal adhesive system used as an etch-and-rinse or self-etch strategy. Methods: A total of 216 class V (non-carious lesions) restorations were randomly placed in 36 subjects according to the following groups: ERcu, adhesive in...

Objectives: To evaluate the microtensile bond strength (µTBS) and nanoleakage (NL) of several universal adhesives to eroded dentine (ED) using etch-and-rinse (ER) and self-etch (SE) strategies, immediately and after 6 years of water storage. Material and methods: Four hundred and eighty human molars were distributed into 60 groups according to d...

Objective: The objective of the study is to evaluate through a randomized clinical trial the best method to preheat a composite resin, if using a Caps dispenser device associated with Caps Warmer (CD) or with a VisCalor Caps dispenser/warmer (VD) for restorations in non-carious cervical lesions (NCCLs). Material and methods: One hundred and twen...

Objectives: To evaluate the clinical performance of a universal adhesive system (Futurabond U, Voco) when applied following different adhesive strategies in non-carious cervical lesions (NCCLs) after 5 years. Methods: Fifty participants were included. Futurabond U (Voco) was applied in NCCLs using four adhesive strategies (n = 50 each): only sel...

Abstract The purpose of this study was to evaluate the effect of dentin moisture (moist and dry) on the bonding of fiber posts to root dentin with different adhesive strategies (etch-and-rinse, self-etch, and self-adhesive). Seventy-two extracted single-rooted human teeth were endodontically treated and divided into six groups (n = 12) according to...

Objective This in vitro study aims to evaluate of hydrogen peroxide (HP) diffusion into the pulp chamber, bleaching efficacy (BE), and pH stability (pH) of single-application high concentrated in-office bleaching gels. Materials and methods Eighty-eight healthy premolars were randomly into eleven groups (n = 8) according to the in-office dental bl...

Objectives: To compare the bleaching efficacy and tooth sensitivity (TS) of 4% hydrogen peroxide (HP) in adults using a continuous or fractioned protocol. Methods and materials: A single-blind randomized controlled trial with a parallel design was conducted. Eighty-six patients with upper canines A2 or darker were submitted to bleaching with 4%...

Purpose: The objective of this study was to evaluate if the application method (tip with brush or tip without brush) and hydrogen peroxide (HP) concentration (6% or 35% self-mixing) of in-office bleaching gel influences the penetration of HP into the pulp chamber, color change, and the amount of bleaching gel used. Methods: Forty healthy premola...

Background: Topical application of calcium-containing bioactive desensitizers (CBs) has been used to minimize bleaching-induced tooth sensitivity (TS). This study answered the research question "Is the risk of TS lower when CBs are used with dental bleaching in adults compared with bleaching without desensitizers?" Types of studies reviewed: The...

Laboratory investigations are essential models responsible for science development. However, laboratory discoveries must be confirmed in a clinical environment where many known and unknown variables and complex mechanisms are involved. Using conclusions from laboratory studies to make clinical recommendations can lead to widespread “unreliable trut...

Unlabelled: This systematic review and network meta-analysis aimed to answer the following focused research question: "Does the type of endodontic sealer affect the postoperative pain in patients who received endodontic treatment?" Different databases and grey literature were surveyed. Only one randomized controlled trial were included. The risk o...

The purpose of this study is to evaluate the use of infrared photobiomodulation with low-level laser therapy (PBM) to reduce bleaching-induced tooth sensitivity (TS) after in-office bleaching. Eighty-three participants were randomized in blocks into two groups. In the experimental group, the patients received an application after each session of in...

Objectives: To evaluate the clinical performance of two methacrylate-based flowable composites and an Ormocer-based flowable composite in non-carious cervical lesions (NCCLs) in adult participants. Method and materials: One hundred eighty-three restorations were performed on NCCLs. All cavities were restored using a universal adhesive system (Fu...

Purpose: To evaluate the microtensile bond strength (μTBS) and silver nitrate uptake (SNU) of three universal adhesives used in etch-and-rinse (ER) and self-etch (SE) modes on dry, wet, and oversaturated dentin surfaces after 24 h and 1 year of water storage. The morphology of the hybrid layer (MHL) and the degree of conversion (DC) were also eval...

Background: To evaluate the effects of the repeated use of hydrogen peroxide (HP)-based mouthwashes on the bonding efficacy of universal adhesives for bonding to dentin surfaces. Methods: In this study, 384 human third molars were divided into 48 experimental groups according to the application of two HP-based mouthwashes for 1, 7, 15, and 30 days...

Objective: Our randomized, parallel and single-blinded clinical trial evaluated patient level of discomfort during at-home bleaching testing the equivalence between two different protocols for the use of bleaching trays (simultaneous vs. single arch), as well as tooth sensitivity (TS), gingival irritation, (GI) and bleaching efficacy (BE). Materi...

Objectives To compare the risk and intensity of tooth sensitivity (TS) as well the effectiveness of at-home bleaching using two carbamide peroxide bleaching gels, specifically a novel polymeric nanoparticle gel (experimental) and a commercial gel (Opalescence PF, Ultradent, South Jordan, Utah, USA), applied at two application times. Methods This m...

Objectives This study evaluated the influence of irradiance/exposure time on the Knoop hardness (KHN) and polymer cross-linking density (PCLD), as well as microtensile bond strength (μTBS), nanoleakage (NL), and in situ degree of conversion (DC) of universal adhesives. Methods and Materials Two universal adhesive systems, Clearfil Universal Bond Q...

Objective To evaluate the effect of the addition of copper nanoparticles (CuNp) at different concentrations in an etch-and-rinse (ER) adhesive on the resin-dentin bond strength (μTBS), nanoleakage (NL) and presence of copper nanoparticles within the hybrid layer, in the immediate time (IM) and after 4 years of water storage (4y). Material and meth...

Objectives: To evaluate the risk and intensity of tooth sensitivity (TS), and the efficacy of in-office bleaching after applying an experimental desensitizing gel composed of 10% calcium gluconate, 0.1% dexamethasone acetate, 10% potassium nitrate, and 5% glutaraldehyde. Material and Methods: In a split-mouth, double-blind, placebo-controlled study...

Objective: To compare the efficacy, color stability, and tooth sensitivity (TS) of combined bleaching, using a modified protocol with at-home bleaching. Methods: Eighty participants were randomized into two groups. In the combined group, a desensitizing gel was applied (10 minutes) prior to in-office bleaching (35% hydrogen peroxide (H2O2), 2×15 mi...

The objective of this double-blind, randomized controlled clinical trial was to evaluate the clinical performance of two methacrylate-based flowable composite and ormocer-based flowable composite in non-carious cervical lesions (NCCLs) of adult patients. 183 restorations were performed on NCCLs using the Futurabond U adhesive system, applied in the...

Objectives To evaluate in vitro two high concentration self-mix bleaching gels (35% or 37.5%) with different application tips (with or without an applicator brush) during in-office bleaching. Materials and methods Healthy premolars were randomly assigned to five groups (n = 8): no treatment; 35% HP without applicator brush, 35% HP with applicator...

This paper evaluates the effect of an additional hydrophobic resin coat (extra HL) associated with universal adhesives on sound and eroded dentin and evaluated immediately or after 2 years of water storage to improve the microtensile bond strength (μTBS) and nanoleakage (NL) when compared to the use of universal adhesives only. Sixty-four molars we...

Objective: To compare the efficacy, color stability, and tooth sensitivity (TS) of combined bleaching, using a modified protocol with at-home bleaching. Methods: Eighty participants were randomized into two groups. In the combined group, a desensitizing gel was applied (10 minutes) prior to in-office bleaching (35% hydrogen peroxide (H2O2), 2×15 mi...

Objective: Few studies evaluated low concentrations of hydrogen peroxide protocols. The aim of this paper was evaluated two application protocols using 4% hydrogen peroxide in at-home bleaching. Materials and methods: Eighty-six patients with upper canines' shade A2 or darker were randomly allocated under two experimental conditions: two daily a...

Objectives This split-mouth randomized, single-blind clinical trial evaluated the gingival irritation (GI) of at-home bleaching with individual trays of different cutouts, as well as the tooth sensitivity (TS) and color change. Materials and methods One hundred and twenty patients were randomized as to which side would receive the type of bleachin...

Objectives To evaluate the influence of different application strategies on the clinical behavior of an MDP-free universal adhesive placed in non-carious cervical lesions (NCCLs) over the course of 36 months. Materials and methods Thirty-one patients participated in this study (N = 31). One hundred twenty-four restorations were assigned to four gr...

Objectives To evaluate the clinical performance of a new dual-cure universal adhesive system (Futurabond U, Voco) when applied using different application strategies in non-carious cervical lesions (NCCLs) after 36 months. Material and Methods Futurabond U was applied in NCCLs of 50 subjects using four adhesion strategies (n = 50 restorations per...

Background: The clinical performance of new restorative materials must be evaluated before recommending its use in primary teeth. Aim: This randomized clinical trial evaluated the survival rates of restorations in single and occluso-proximal cavities of primary teeth performed with a new dual-cure resin-based material in comparison with a resin-...

Objectives To evaluate if the topical application of Otosporin® before in-office bleaching with a 35% hydrogen peroxide (HP) gel reduces the risk and intensity of tooth sensitivity (TS), as well as the bleaching effectiveness.Materials and methodsTwenty participants were selected for this split mouth, triple-blind, multicenter randomized clinical t...

Objectives A systematic review was performed to analyze the clinical performance of class I and II restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The primary outcome was retention/fracture rate, and the secondary outcomes evaluated were anatomical form, surface texture, color match, marginal adaption, ma...

Objectives: To evaluate the influence of the sonic device on the clinical performance of one-step self-etch adhesive systems in non-carious cervical lesions (NCCLs) after 18 months. Materials and methods: Forty patients participated in this study. Eighty restorations were assigned to two groups (n = 40): Sonic application and Manual application....

Appropriate research reports are important to facilitate the evaluation of studies and the decision-making by dentists and policymakers. This meta-research study assessed the conformity of randomized clinical trials (RCTs) on atraumatic restorative treatment (ART) restorations with the CONSORT recommendations and their risk of bias (RoB). Cochrane...

Objective The present review is an update of a systematic review that has been published in 2012. Meanwhile, many new clinical trials on resin composites had been published. New materials such as bulk fill resin composites and new glass-ionomer (GIC) based materials had been introduced. The focus of this review was to evaluate the longevity in rela...

Objective: This double-blind, split-mouth randomized clinical trial evaluate the clinical performance of a new preheating (PHT) thermoviscous composite compared to a non-heating (NHT) composite resin in restorations of non-carious cervical lesions (NCCLs) over a period of 6-month. Material and Methods: 120 restorations were performed on NCCLs with...

Objective This study was aimed at comparing the bleaching efficacy and bleaching sensitivity (BS) of two higher-concentration in-office bleaching gels (37% carbamide peroxide [CP] and 38% hydrogen peroxide [HP]) applied under two conditions: alone or in association with sonic activation. Methods Fifty-six volunteers were randomly assigned in the s...

Objectives: To evaluate the 5-year clinical performance of two-step etch-and-rinse adhesives in noncarious cervical lesions (NCCL). Methods and Materials: The sample comprised 35 adults with at least two similar-sized NCCL. Seventy restorations were placed, according to one of the following groups: Adper Single Bond 2 (SB) and Ambar (AM). The resto...

Purpose: To evaluate the effect of dimethyl sulfoxide (DMSO) on the microtensile bond strength (µTBS), nanoleakage (NL), and degree of conversion (DC) of universal adhesives on eroded dentin. Materials and methods: One hundred thirty-four extracted (134) human third molars were selected for the study. After the dentin surface was exposed, 128 te...

Objective: The objective of this double-blind, randomized controlled clinical trial was to evaluate the clinical performance of two methacrylate-based flowable composite and ormocer-based flowable composite in non-carious cervical lesions (NCCLs) of adult patients. Material and Methods: 183 restorations were performed on NCCLs using the Futurabond...

Objective This study aimed to evaluate the effect of prolonging polymerization time on the 18 months clinical performance of a universal adhesive system used as etch-and-rinse (ER) and self-etch (SE). Methods 140 restorations were randomly placed in 35 subjects according to the following groups: ER10 (light-curing for 10 s); ER40 (light-curing for...

This clinical trial evaluated the effect of the coadministration of ibuprofen/caffeine on bleaching-induced tooth sensitivity (TS). A triple-blind, parallel-design, randomized clinical trial was conducted on 84 patients who received ibuprofen/caffeine or placebo capsules. The drugs were administered for 48 hours, starting 1 hour before the in-offic...

This study evaluated the matrix metalloproteases (MMP) inhibition of the copper nanoparticles (CuNp), and the effects of their addition into a universal adhesive system on antimicrobial activity (AMA), ultimate tensile strength (UTS), water sorption (WS), solubility (SO), as well as the 24h and 1y microtensile bond strength (μTBS), nanoleakage (NL)...

To investigate the effect of the dimethyl sulfoxide combined with cross-linking agents on microtensile bond strength, silver nitrate penetration and in situ degree of conversion analysis of adhesives to the erosive dentin treatment with Cola-based soft drink. One hundred and sixty-six molars were assigned to 20 groups: (1) Treatment: Sound dentin;...

Purpose: This study evaluated hydrogen peroxide (HP) diffusion within the pulp chamber, as well as color change and the surface morphology of teeth subjected to various microabrasion (MA) protocols associated or not with in-office (IO) bleaching. Methods: Forty sound premolars were randomly divided into the following four groups (n=10): no treat...

Purpose: To evaluate the bleaching sensitivity and the bleaching effectiveness of in-office bleaching, following a protocol of complete cervical third protection with gingival dam in comparison with a traditional manner of applying gingival dam (used only in the gingival sulcus area). Methods: 35 participants were selected for this double-blind...

Statement of problem Intraoral scanning has been reported to be preferred by patients over conventional impression making. Nevertheless, information regarding patient-related outcomes for conventional impression making and digital scanning is sparse. Purpose The purpose of this systematic review and meta-analysis was to analyze patient-related out...

Objectives This study aims to investigate the compliance of randomized controlled trials (RCTs) in posterior restorations with the Consolidated Standards of Reporting Trials Statement (CONSORT) statement and to analyze the risk of bias (RoB) of these studies.MethodsA systematic search was performed in PubMed, Scopus, Web of Science, LILACS/BBO, and...

Clinical Relevance Although color change was slightly lower in a 3-week 30-minutes/day protocol, than in the 120-minute protocol, this could be compensated by an extra week of bleaching. The advantage of the shorter protocol is the reduced daily application, making the procedure more comfortable for the patients. SUMMARY Objective: Compare the ris...

Objectives: The aim of this randomized double-blind controlled clinical trial was to evaluate different protocols for at-home use of 10% hydrogen peroxide in whitening effectiveness and tooth sensitivity. Methods: Seventy-two patients were selected according to the inclusion and exclusion criteria, with the upper central incisors having color A2 or...

Objectives: This clinical trial evaluated the effects of red wine exposure on the effectiveness of at-home bleaching with 10% carbamide peroxide, degree of tooth sensitivity, and levels of periodontal inflammatory markers. Method and materials: Eighty participants were assigned to two groups, namely, those who drank red wine (experimental group)...

Purpose: To evaluate the effect of different concentrations of ethylene-diamine-tetra acetic acid (EDTA) on bond strength (BS) and nanoleakage (NL) of fiber posts bonded into root canals. Materials and methods: Seventy-two single roots were endodontically treated and divided into six groups (n = 12), according to the combination of the followi...

This systematic review aimed to evaluate the adherence to the CONSORT Statement in clinical studies comparing different instrumentation techniques in Endodontics. Methodology: A systematic search was carried out through Medline databases. There was no restriction on publication year or idiom. Solely randomized controlled trials (RCTs) were included...

Objectives To conduct a systematic review and meta-analysis to evaluate the risk and intensity of tooth sensitivity (TS) after topical application of desensitizers containing potassium nitrate before dental bleaching. Methods We searched PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE. We also surveyed gray literature with...

Objective: To evaluate the color change stability and patient satisfaction after one-year of at-home bleaching with 10% carbamide peroxide (CP) in trays with or without reservoirs. Materials and methods: Forty-six patients were subjected to bleaching with CP (3 h/daily; 21 days) with a bleaching tray with or without reservoirs. The color was mea...

Objective: This single-blind, split-mouth, randomized trial was aimed at evaluating the bleaching efficacy (BE) and tooth sensitivity (TS) of a 20% hydrogen peroxide (HP) bleaching agent used under active or passive application. Methods and Materials: Twenty-two patients with canines darker than C2 were selected. Teeth were bleached in two sessions...

Purpose: A systematic review and meta-analysis was conducted to compare the retention rates of 3-step etch-and-rinse (3ER) adhesives with 1-step self-etch (1SE) adhesives in noncarious cervical lesions (NCCLs). The secondary outcomes were marginal integrity and marginal discoloration. Materials and methods: Only randomized clinical trials (RCTs)...

Objectives This clinical study aimed to evaluate the effect of incorporating bioactive nanoparticles (n-Bm) inside an in-office bleaching gel on the risk and intensity of tooth sensitivity (TS) and on bleaching effectiveness. Materials and methods Sixty-six participants were selected and randomly assigned into two groups: control–only in-office ge...

Carbodiimide (EDC)–based dentin primers preserve hybrid layer (HL) integrity. However, aging >1 y has not been investigated. The present study examined whether the cross-linking effect of EDC was reflected in dentin bond strength, endogenous enzymatic activity, and the chemical profile of the HL after 5-y aging in artificial saliva. Noncarious huma...

Objectives A network meta-analysis (NMA) was performed to assess which adhesive strategy is most clinically effective in treating non-carious cervical lesions (NCCLs). Material and methods Studies were identified by a systematic search of electronic databases including MEDLINE via PubMed, Brazilian Library in Dentistry (BBO), Cochrane Library, EMB...

Purpose: To evaluate the effect of inclusion of two dimethyl sulfoxide (DMSO) concentrations in simplified etch-and-rinse adhesives on dentin bonding durability after three years of water storage. Materials and methods: Forty-two caries-free third molars were divided into six experimental groups (n = 7) according to the following factor...

Objectives This double-blind, randomized clinical trial evaluated the influence of dentin moisture on postoperative sensitivity (POS), as well as, on clinical performance in posterior bulk-fill composite restorations, using a universal adhesive, until 12 months after clinical service. Methods and Materials In accordance with a split-mouth design,...

Objective: To evaluate the microshear bond strength (mSBS) of 10 universal adhesive systems applied on five different CAD/CAM restorative materials, immediately and after thermal aging. Methods and materials: Five CAD/CAM materials were selected: 1) feldspathic glass ceramic (FeCe); 2) pre-polymerized reinforced resin composite (ReRC); 3) leucit...

This systematic review and meta-analysis evaluated if ketorolac reduces the intensity of postoperative pain after impacted third molars surgery in adults compared to the use of tramadol. A comprehensive search was performed in the MEDLINE/PubMed, Scopus, Web of Science, LILACS, BBO, EMBASE, Cochrane Library, SIGLE and grey literature, in accordance...