Araştırma Makalesi
BibTex RIS Kaynak Göster

Prevalence of Mandibular Second Premolar Agenesis in Individuals and Associated Factors: A Meta-Analysis

Yıl 2022, , 182 - 190, 27.04.2022
https://doi.org/10.15311/selcukdentj.939183

Öz

Background: The purposes of this study were to determine the prevalence and patterns of mandibular second premolar agenesis in individuals by meta-analysis methodology.
Methods: Two investigators conducted a literature search independently by inclusion criteria to reveal articles on mandibular second premolar agenesis. PubMed, Google Scholar, Ovid Medline, Web of Science Core Collection databases were scanned and a total of 3,988 studies were initially extracted from all databases, then 12 articles were selected which met inclusion and exclusion criteria for the meta-analysis.
Results: The estimated overall prevalence of mandibular second premolar in individuals was 3.26 %. No statistically significant difference was found in the prevalence of mandibular second premolar agenesis by gender [95 % Cl: 1.18 (0.96, 1.45); p>0.05]. Males were found to have a significantly higher prevalence of unilateral mandibular second premolar agenesis than females (combined OR 0.69; 95 % CI: 0.38-1.25; p<0.05). However, females had a significantly higher prevalence of bilateral mandibular second premolar agenesis than males (combined OR 1.57; 95 % Cl: 0.91-2.72; p<0.05). No difference was found in the prevalence of mandibular second premolar agenesis between the right and left mandibular region [95 % Cl: 1.04 (0.91-1.20); p>0.05].
Conclusion: This study supports some previous findings regarding mandibular second premolar agenesis and presents new observations on gender differences, inter-maxillary patterns of mandibular second premolar agenesis in the mandible—including unilateral and/or bilateral occurrence and jaw site.

Kaynakça

  • 1. Sajjad A, Sajjad S, Husain N, Al-Enezi A. A retrospective cross-sectional study on the prevalence of hypodontia in a target population of Al-Jouf Province, Saudi Arabia. Contemporary Clinical Dentistry 2016;7(4):500-5. doi:10.4103/0976-237X.194101.
  • 2. Khalaf K, Miskelly J, Voge E, Macfarlane TV. Prevalence of hypodontia and associated factors: A systematic review and meta-analysis. Journal of Orthodontics 2014;41(4):299-316. doi:10.1179/1465313314Y.0000000116.
  • 3. Demiriz L, Bodrumlu E, Kokturk F. Patterns of incisor-premolar agenesis combinations: A retrospective study. Journal of Indian Society of Pedodontics and Preventive 2017;35(1):51-5. doi:10.4103/0970-4388.199230.
  • 4. Goya HA, Tanaka S, Maeda T, Akimoto Y. An orthopantomographic study of hypodontia in permanent teeth of Japanese pediatric patients. Journal of Oral Science 2008;50(2):143-50. doi:0.2334/josnusd.50.143.
  • 5. Silva Meza R. Radiographic assessment of congenitally missing teeth in orthodontic patients. International Journal of Paediatric Dentistry 2003;13(2):112-6. doi:10.1046/j.1365-263X.2003.00436.x.
  • 6. Van Wijk AJ, Tan SPK. A numeric code for identifying patterns of human tooth agenesis: A new approach. European Journal of Oral Sciences 2006; 114 (2): 97-101. doi:10.1111/j.1600-0722.2006.00340.x.
  • 7. Vastardis H. The genetics of human tooth agenesis: new discoveries for understanding dental anomalies. American Journal of Orthodontics and Dentofacial Orthopedics 2000;117(6):650-6. doi:10.1016/S0889-5406(00)70173-9.
  • 8. Frazier-Bowers SA, Guo DC, Cavender A, Xue L, Evans B et al. A novel mutation in human PAX9 causes molar oligodontia. Journal of Dental Research 2002;81(2):129-33. doi:10.1177/0810129.
  • 9. Cobourne MT. Familial human hypodontia - Is it all in the genes? British Dental Journal 2007;203(4):203-8. doi:10.1038/bdj.2007.732.
  • 10. Rakhshan V. Meta-analysis of observational studies on the most commonly missing permanent dentition (excluding the third molars) in non-syndromic dental patients or randomly-selected subjects, and the factors affecting the observed rates. Journal of Clinical Pediatric Dentistry 2015;39(3):198-207. doi:10.17796/1053-4628-39.3.198.
  • 11. Chung CJ, Han JH, Kim KH. The pattern and prevalence of hypodontia in Koreans. Oral Diseases 2008;14(7):620-5. doi:10.1111/j.1601-0825.2007.01434.x.
  • 12. Shetty P, Adyanthaya A, Adyanthaya S, Sv S. The Prevalence of Hypodontia and Supernumerary Teeth in 2469 School children of the Indian Population : An Epidemiological Study. Indian Journal of Stomatology 2012;3(3):150-2.
  • 13. Uzuner D, Celik MM, Toy E, Turkdonmez CO. Assessment of hypodontia in the Turkish patients referring to the orthodontic clinic: A retrospective study. European Journal of Dentistry 2013;7(Suppl 1):S9-S14. doi:10.4103/1305-7456.119057.
  • 14. Celikoglu M, Kazanci F, Miloglu O, Oztek O, Kamak H et al. Frequency and characteristics of tooth agenesis among an orthodontic patient population. Medicina Oral, Patologia Oral, Cirugia Bucal 2010;15(5):e797-801. doi:10.4317/medoral.15.e797.
  • 15. Sheikhi M, Sadeghi MA, Ghorbanizadeh S. Prevalence of congenitally missing permanent teeth in Iran. Dental Research Journal 2012;9(Suppl 1):105-11. doi:10.4103/1735-3327.107949.
  • 16. Hagiwara Y, Uehara T, Narita T, Tsutsumi H, Nakabayashi S et al. Prevalence and distribution of anomalies of permanent dentition in 9584 Japanese high school students. Odontology 2016;104(3):380-9. doi:10.1007/s10266-015-0225-2.
  • 17. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. International Journal of Surgery 2010;8(5):336-41. doi:10.1016/j.ijsu.2010.02.007.
  • 18. Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics 1977;33(1):159-74. doi:10.2307/2529310.
  • 19. Larmour CJ, Mossey PA, Thind BS, Forgie AH, Stirrups DR. Hypodontia--a retrospective review of prevalence and etiology. Part I. Quintessence International. 2005;36(4):263-70.
  • 20. Hobkirk JA, Goodman JR, Jones SP. Presenting complaints and findings in a group of patients attending a hypodontia clinic. British Dental Journal 1994; 177(9):337-9. doi:10.1038/sj.bdj.4808606.
  • 21. Muller TP, Hill IN, Peterson AC, Blayney JR. A survey of congenitally missing permanent teeth. The Journal of the American Dental Association 1970;81(1):101-7. doi:10.14219/jada.archive.1970.0151.
  • 22. Altug-Atac AT, Erdem D. Prevalence and distribution of dental anomalies in orthodontic patients. American Journal of Orthodontics and Dentofacial Orthopedics 2007;131(4):510-4. doi:10.1016/j.ajodo.2005.06.027.
  • 23. Uslenghi S, Liversidge HM, Wong FSL. A radiographic study of tooth development in hypodontia. Archives of Oral Biology 2006;51(2):129-33. doi:10.1016/j.archoralbio.2005.06.004.
  • 24. Palaska PK, Antonarakis GS. Prevalence and patterns of permanent tooth agenesis in individuals with Down syndrome: a meta-analysis. European Journal of Oral Sciences 2016;124(4):317-28. doi:10.1111/eos.12282.
  • 25. Rakhshan V, Rakhshan H. Meta-analysis of congenitally missing teeth in the permanent dentition: Prevalence, variations across ethnicities, regions and time. International Orthodontics 2015;13(3):261-73. doi:10.1016/j.ortho.2015.06.008.
  • 26. Souza-Silva BN, de Andrade Vieira W, de Macedo Bernardino Í, Batista M, Bittencourt MAV et al. Non-syndromic tooth agenesis patterns and their association with other dental anomalies: A retrospective study. Archives of Oral Biology 2018;96:26-32. doi: 10.1016/j.archoralbio.2018.08.014.
  • 27. Amini F, Rakhshan V, Babaei P. Prevalence and pattern of hypodontia in the permanent dentition of 3374 Iranian orthodontic patients. Dental Research Journal 2012;9(3):245-50. doi:10.4103/1735-3327.99807.
  • 28. Brook AH. Dental anomalies of number, form and size: their prevalence in British schoolchildren. Journal of the International Association of Dentistry for Children 1974;5(2):37-53.
  • 29. Mattheeuws N, Dermaut L, Martens G. Has hypodontia increased in Caucasians during the 20th century? A meta-analysis. The European Journal of Orthodontics 2004;26(1):99-103. doi:10.1093/ejo/26.1.99.
  • 30. Bäckman B, Wahlin YB. Variations in number and morphology of permanent teeth in 7-year-old Swedish children. International Journal of Paediatric Dentistry 2001;11(1):11-7. doi:10.1046/j.1365-263x.2001.00205.x.
  • 31. Küchler EC, Risso PA, Costa M de C, Modesto A, Vieira AR. Studies of dental anomalies in a large group of school children. Archives of Oral Biology 2008;53(10):941-6. doi:10.1016/j.archoralbio.2008.04.003.
  • 32. Al-Ajwadi, SAM. An orthopantomographic study of hypodontia in permanent teeth of Iraqi patients. Medical and Dental Journal 2009;6(2):139-43.
  • 33. Kenrad JB, Christensen IJ, Kjær I. Gender differences in patterns of second premolar agenesis observed in 4,756 individuals. European Archieves of Paediatric Dentistry 2013;14(6):397-403. doi:10.1007/s40368-013-0041-8.
  • 34. Kjær I. New diagnostics of the dentition on panoramic radiographs-Focusing on the peripheral nervous system as an important aetiological factor behind dental anomalies. Orthodontic Waves 2012;71(1):1-16. https://doi.org/10.1016/j.odw.2011.10.001.
  • 35. Kjær I, Nolting D. Immunohistochemical PGP 9.5 positivity in human osteoblasts may indicate that compensatory and dysplastic craniofacial growth are under control by peripheral nerves. Orthodontics & Craniofacial Research 2008;11(4):196-200. https://doi.org/10.1111/j.1601-6343.2008.00430.x.
  • 36. Levin M. The embryonic origins of left-right asymmetry. Critical Reviews in Oral Biology & Medicine 2004;15(4):197-206. doi:10.1177/154411130401500403.
  • 37. Rune B, Sarnäs KV. Tooth size and tooth formation in children with advanced hypodontia. The Angle Orthodontist 1974;44(4):316-21. doi:10.1043/0003-3219(1974)044<0316:TSATFI>2.0.CO;2.
  • 38. McAuley L, Ba’Pham, Tugwell P, Moher D. Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? The Lancet 2000; 356(9237): 1228-31. doi:10.1016/S0140-6736(00)02786-0.
  • 39. Hopewell S, Clarke M, Mallett S. Grey Literature and Systematic Reviews. Rothstein HR, Sutton AJ, Borenstein M, editors. Publication Bias in Meta-analysis: Prevention, Assessment and Adjustments, 1st ed. Hoboken, NJ, USA: John Wiley & Sons, Ltd; 2005. pp. 49-72. doi:10.1002/0470870168.ch4.
  • 40. Sisman Y, Uysal T, Gelgor IE. Hypodontia. Does the Prevalence and Distribution Pattern Differ in Orthodontic Patients? European Journal of Dentistry 2007;1(3):167-73. doi:10.1055/s-0039-1698333.

Bireylerde mandibular ikinci premolar eksikliğinin prevalansı ve ilişkili faktörler: meta-analiz çalışması

Yıl 2022, , 182 - 190, 27.04.2022
https://doi.org/10.15311/selcukdentj.939183

Öz

Amaç: Bu çalışmada, bireylerde görülen mandibular ikinci premolar agenezisi prevalansının ve ilişkili faktörlerin meta-analiz yöntemi ile değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Dahil edilme kriterlerinden bağımsız olarak, mandibular ikinci premolar agenezisi ile ilgili çalışmalar iki farklı araştırmacı tarafından tarandı. PubMed, Google Scholar, Ovid Medline, Web of Science Core Collection veritabanları kullanılarak yapılan başlangıç taraması sonucunda 3.988 çalışma belirlendi. Bu çalışmalardan değerlendirilmek üzere, meta-analiz yönteminin uygulanabilmesi için gerekli kriterleri sağlayan toplam 12 çalışma seçildi.
Bulgular: Bireylerdeki mandibular ikinci premolar agenezisi prevalansının % 3.26 oranında olduğu görüldü; ancak prevalans oranları cinsiyete göre değerlendirildiğinde kadınlar ve erkekler arasında istatistiksel açıdan anlamlı bir farklılık saptanmadı [% 95 Cl: 1.18 (0.96, 1.45); p>0.05]. Erkeklerin kadınlara kıyasla anlamlı derecede daha yüksek oranda unilateral mandibular ikinci premolar agenezisi prevalansına sahip olduğu görüldü (ortak OD 0.69; % 95 CI: 0.38-1.25; p<0.05). Bununla birlikte, mandibular ikinci premoların bilateral agenezisinin kadınlarda erkeklere göre anlamlı derecede daha yüksek oranda olduğu görüldü (ortak OD 1.57; % 95 Cl: 0.91-2.72; p<0.05). Mandibular ikinci premolar agenezisi, sağ veya sol mandibular bölgede görülme sıklığına göre değerlendirildiğinde ise istatistiksel olarak anlamlı bir farklılık bulunmadı [% 95 Cl: 1.04 (0.91-1.20); p>0.05].
Sonuç: Hastalara daha kapsamlı tedavi planı sağlamak ve daha olumlu tedavi sonuçları elde etmek için mandibular ikinci premolar diş eksikliğinin doğru ve erken teşhisi önem taşımaktadır.

Kaynakça

  • 1. Sajjad A, Sajjad S, Husain N, Al-Enezi A. A retrospective cross-sectional study on the prevalence of hypodontia in a target population of Al-Jouf Province, Saudi Arabia. Contemporary Clinical Dentistry 2016;7(4):500-5. doi:10.4103/0976-237X.194101.
  • 2. Khalaf K, Miskelly J, Voge E, Macfarlane TV. Prevalence of hypodontia and associated factors: A systematic review and meta-analysis. Journal of Orthodontics 2014;41(4):299-316. doi:10.1179/1465313314Y.0000000116.
  • 3. Demiriz L, Bodrumlu E, Kokturk F. Patterns of incisor-premolar agenesis combinations: A retrospective study. Journal of Indian Society of Pedodontics and Preventive 2017;35(1):51-5. doi:10.4103/0970-4388.199230.
  • 4. Goya HA, Tanaka S, Maeda T, Akimoto Y. An orthopantomographic study of hypodontia in permanent teeth of Japanese pediatric patients. Journal of Oral Science 2008;50(2):143-50. doi:0.2334/josnusd.50.143.
  • 5. Silva Meza R. Radiographic assessment of congenitally missing teeth in orthodontic patients. International Journal of Paediatric Dentistry 2003;13(2):112-6. doi:10.1046/j.1365-263X.2003.00436.x.
  • 6. Van Wijk AJ, Tan SPK. A numeric code for identifying patterns of human tooth agenesis: A new approach. European Journal of Oral Sciences 2006; 114 (2): 97-101. doi:10.1111/j.1600-0722.2006.00340.x.
  • 7. Vastardis H. The genetics of human tooth agenesis: new discoveries for understanding dental anomalies. American Journal of Orthodontics and Dentofacial Orthopedics 2000;117(6):650-6. doi:10.1016/S0889-5406(00)70173-9.
  • 8. Frazier-Bowers SA, Guo DC, Cavender A, Xue L, Evans B et al. A novel mutation in human PAX9 causes molar oligodontia. Journal of Dental Research 2002;81(2):129-33. doi:10.1177/0810129.
  • 9. Cobourne MT. Familial human hypodontia - Is it all in the genes? British Dental Journal 2007;203(4):203-8. doi:10.1038/bdj.2007.732.
  • 10. Rakhshan V. Meta-analysis of observational studies on the most commonly missing permanent dentition (excluding the third molars) in non-syndromic dental patients or randomly-selected subjects, and the factors affecting the observed rates. Journal of Clinical Pediatric Dentistry 2015;39(3):198-207. doi:10.17796/1053-4628-39.3.198.
  • 11. Chung CJ, Han JH, Kim KH. The pattern and prevalence of hypodontia in Koreans. Oral Diseases 2008;14(7):620-5. doi:10.1111/j.1601-0825.2007.01434.x.
  • 12. Shetty P, Adyanthaya A, Adyanthaya S, Sv S. The Prevalence of Hypodontia and Supernumerary Teeth in 2469 School children of the Indian Population : An Epidemiological Study. Indian Journal of Stomatology 2012;3(3):150-2.
  • 13. Uzuner D, Celik MM, Toy E, Turkdonmez CO. Assessment of hypodontia in the Turkish patients referring to the orthodontic clinic: A retrospective study. European Journal of Dentistry 2013;7(Suppl 1):S9-S14. doi:10.4103/1305-7456.119057.
  • 14. Celikoglu M, Kazanci F, Miloglu O, Oztek O, Kamak H et al. Frequency and characteristics of tooth agenesis among an orthodontic patient population. Medicina Oral, Patologia Oral, Cirugia Bucal 2010;15(5):e797-801. doi:10.4317/medoral.15.e797.
  • 15. Sheikhi M, Sadeghi MA, Ghorbanizadeh S. Prevalence of congenitally missing permanent teeth in Iran. Dental Research Journal 2012;9(Suppl 1):105-11. doi:10.4103/1735-3327.107949.
  • 16. Hagiwara Y, Uehara T, Narita T, Tsutsumi H, Nakabayashi S et al. Prevalence and distribution of anomalies of permanent dentition in 9584 Japanese high school students. Odontology 2016;104(3):380-9. doi:10.1007/s10266-015-0225-2.
  • 17. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. International Journal of Surgery 2010;8(5):336-41. doi:10.1016/j.ijsu.2010.02.007.
  • 18. Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics 1977;33(1):159-74. doi:10.2307/2529310.
  • 19. Larmour CJ, Mossey PA, Thind BS, Forgie AH, Stirrups DR. Hypodontia--a retrospective review of prevalence and etiology. Part I. Quintessence International. 2005;36(4):263-70.
  • 20. Hobkirk JA, Goodman JR, Jones SP. Presenting complaints and findings in a group of patients attending a hypodontia clinic. British Dental Journal 1994; 177(9):337-9. doi:10.1038/sj.bdj.4808606.
  • 21. Muller TP, Hill IN, Peterson AC, Blayney JR. A survey of congenitally missing permanent teeth. The Journal of the American Dental Association 1970;81(1):101-7. doi:10.14219/jada.archive.1970.0151.
  • 22. Altug-Atac AT, Erdem D. Prevalence and distribution of dental anomalies in orthodontic patients. American Journal of Orthodontics and Dentofacial Orthopedics 2007;131(4):510-4. doi:10.1016/j.ajodo.2005.06.027.
  • 23. Uslenghi S, Liversidge HM, Wong FSL. A radiographic study of tooth development in hypodontia. Archives of Oral Biology 2006;51(2):129-33. doi:10.1016/j.archoralbio.2005.06.004.
  • 24. Palaska PK, Antonarakis GS. Prevalence and patterns of permanent tooth agenesis in individuals with Down syndrome: a meta-analysis. European Journal of Oral Sciences 2016;124(4):317-28. doi:10.1111/eos.12282.
  • 25. Rakhshan V, Rakhshan H. Meta-analysis of congenitally missing teeth in the permanent dentition: Prevalence, variations across ethnicities, regions and time. International Orthodontics 2015;13(3):261-73. doi:10.1016/j.ortho.2015.06.008.
  • 26. Souza-Silva BN, de Andrade Vieira W, de Macedo Bernardino Í, Batista M, Bittencourt MAV et al. Non-syndromic tooth agenesis patterns and their association with other dental anomalies: A retrospective study. Archives of Oral Biology 2018;96:26-32. doi: 10.1016/j.archoralbio.2018.08.014.
  • 27. Amini F, Rakhshan V, Babaei P. Prevalence and pattern of hypodontia in the permanent dentition of 3374 Iranian orthodontic patients. Dental Research Journal 2012;9(3):245-50. doi:10.4103/1735-3327.99807.
  • 28. Brook AH. Dental anomalies of number, form and size: their prevalence in British schoolchildren. Journal of the International Association of Dentistry for Children 1974;5(2):37-53.
  • 29. Mattheeuws N, Dermaut L, Martens G. Has hypodontia increased in Caucasians during the 20th century? A meta-analysis. The European Journal of Orthodontics 2004;26(1):99-103. doi:10.1093/ejo/26.1.99.
  • 30. Bäckman B, Wahlin YB. Variations in number and morphology of permanent teeth in 7-year-old Swedish children. International Journal of Paediatric Dentistry 2001;11(1):11-7. doi:10.1046/j.1365-263x.2001.00205.x.
  • 31. Küchler EC, Risso PA, Costa M de C, Modesto A, Vieira AR. Studies of dental anomalies in a large group of school children. Archives of Oral Biology 2008;53(10):941-6. doi:10.1016/j.archoralbio.2008.04.003.
  • 32. Al-Ajwadi, SAM. An orthopantomographic study of hypodontia in permanent teeth of Iraqi patients. Medical and Dental Journal 2009;6(2):139-43.
  • 33. Kenrad JB, Christensen IJ, Kjær I. Gender differences in patterns of second premolar agenesis observed in 4,756 individuals. European Archieves of Paediatric Dentistry 2013;14(6):397-403. doi:10.1007/s40368-013-0041-8.
  • 34. Kjær I. New diagnostics of the dentition on panoramic radiographs-Focusing on the peripheral nervous system as an important aetiological factor behind dental anomalies. Orthodontic Waves 2012;71(1):1-16. https://doi.org/10.1016/j.odw.2011.10.001.
  • 35. Kjær I, Nolting D. Immunohistochemical PGP 9.5 positivity in human osteoblasts may indicate that compensatory and dysplastic craniofacial growth are under control by peripheral nerves. Orthodontics & Craniofacial Research 2008;11(4):196-200. https://doi.org/10.1111/j.1601-6343.2008.00430.x.
  • 36. Levin M. The embryonic origins of left-right asymmetry. Critical Reviews in Oral Biology & Medicine 2004;15(4):197-206. doi:10.1177/154411130401500403.
  • 37. Rune B, Sarnäs KV. Tooth size and tooth formation in children with advanced hypodontia. The Angle Orthodontist 1974;44(4):316-21. doi:10.1043/0003-3219(1974)044<0316:TSATFI>2.0.CO;2.
  • 38. McAuley L, Ba’Pham, Tugwell P, Moher D. Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? The Lancet 2000; 356(9237): 1228-31. doi:10.1016/S0140-6736(00)02786-0.
  • 39. Hopewell S, Clarke M, Mallett S. Grey Literature and Systematic Reviews. Rothstein HR, Sutton AJ, Borenstein M, editors. Publication Bias in Meta-analysis: Prevention, Assessment and Adjustments, 1st ed. Hoboken, NJ, USA: John Wiley & Sons, Ltd; 2005. pp. 49-72. doi:10.1002/0470870168.ch4.
  • 40. Sisman Y, Uysal T, Gelgor IE. Hypodontia. Does the Prevalence and Distribution Pattern Differ in Orthodontic Patients? European Journal of Dentistry 2007;1(3):167-73. doi:10.1055/s-0039-1698333.
Toplam 40 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Diş Hekimliği
Bölüm Araştırma
Yazarlar

Nilüfer Üstün 0000-0001-5489-6883

Can Özükoç Bu kişi benim 0000-0003-3437-3107

Yayımlanma Tarihi 27 Nisan 2022
Gönderilme Tarihi 20 Mayıs 2021
Yayımlandığı Sayı Yıl 2022

Kaynak Göster

Vancouver Üstün N, Özükoç C. Prevalence of Mandibular Second Premolar Agenesis in Individuals and Associated Factors: A Meta-Analysis. Selcuk Dent J. 2022;9(1):182-90.