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ORIENTATION

JAW
RELATION
PART -1

GUIDED BY – PRESENTED BY -
DR AJAYKUMAR NAYAK
DR SHILPA SOMAN
PROFESSOR
III MDS
2

Contents
• Introduction • Plane of orientation
• Jaw relation • Types of facebow
• Orientation jaw relation • Compatibility of specific
articulators with facebows
• Mandibular movements
• Facebow transfer
• Hinge Axis, terminal hinge
axis & centric relation • Recent advances
• True vs arbitrary hinge axis • Conclusion
• Opinion regarding location of • References
transverse hinge axis
• Facebow
4

Jaw relation

Boucher divided
DEFINITION jaw relation into:

“Any spatial relationship of 1. Orientation


the maxillae to the 2. Vertical
mandible; 3. Horizontal
Any one of the infinite
relationships of the
mandible to the maxillae”

GPT 9
5

Orientation Jaw Relation


DEFINITION – Bouchers:

• The orientation relations are those that orient the mandible


to the cranium in such a way that,
• when the mandible is kept in its most posterior position,
• the mandible can rotate in the sagittal plane around an
imaginary transverse axis passing through or near the
condyles.
6

Importance of orientation jaw


relation

• Relationship of maxilla to TMJ and base of skull is


not same in all persons
• Radius is not constant for all the patients, it has to
be determined for every patient
Mandibular 7

movements

Transverse horizontal Sagittal axis


axis(hinge axis) Vertical axis
8

Terminal
hinge
axis
Centric
relation
9

Hinge axis
(transverse horizontal axis)

• An imaginary line around which the


GPT9 mandible may rotate within the saggital
plane

Includes rotation as well as


translation
10

Hinge axis
(transverse horizontal axis)

• If the path of motion of the object is a part of ellipse, the hinge


axis itself must move.
• Clinically the condyles would be translating as the patient
opened the jaw.
11

Centric relation
(GPT 9)
A maxillomandibular relationship, independent of tooth contact, in which the
condyles articulate in the anterior-superior position against the posterior
slopes of the articular eminences;
in this position, the mandible is restricted to a purely rotary movement;
from this unstrained, physiologic, maxillomandibular relationship, the patient
can make vertical, lateral or protrusive movements;
it is a clinically useful, repeatable reference position

Learnable
Repeatable
Recordable
12

Terminal hinge axis


• The axis when mandible
undergoes rotation when in
CR
• Purely rotation and no
translation
• Part of posterior border
movement of the mandible
13

Terminal hinge axis


• The condyles are in definitive position in fossae during terminal hinge movement
• The relation of mandible to maxilla is same at terminal hinge position as at CR

• Maximum range of terminal hinge rotation: about 12˚

• Inter incisal opening: 18-25 mm

18- 25 cm
14

Therefore,

When the mandible opens and closes, rotation


occurs around a transverse axis, called the
hinge axis

It is called terminal hinge axis when the


mandible undergoes rotation when in the
centric relation
Opinion regarding
15

location of transverse
hinge axis :
Absolute
location

Arbitrary
Split axis
location

Non believers
16

1. Believers in Absolute location


• Lucia, McCollum, Stuart
• A single intercondylar transverse axis
• With facebow, it is possible to relate the exact transverse axis
to the articulator
17

2. Believers in Arbitrary location


• Determination of true hinge axis is not required when one looks
at the effort required to find it
• Found by simple palpation or 10 mm anteriorly along a line
drawn from the upper free margin of the tragus to the corner of
the eye
18

3. Non believers
• Bohr, Posselt, Beck
• Believes that it is impossible to locate transverse axis with
accuracy (theoretical but not practical)
• Hinge movement of the mandible, together with its fragmentary
movements, cannot be repeated by the opening and closing
movements of an articulator which is about one axis only
19

4. Believers in split axis


• Slavens, Frank
• Each condyle rotates independently of the other
• Terminal hinge position mark on one side is usually a little higher
than it is on the other
• There must be two axis parallel to each other with both axes at
right angle to the opening and closing movements of the mandible.

Singh S, Rehan S, Palaskar J, Mittal S. Hinge axis-location, clinical use and controversies. Journal of
Research in Dentistry. 2017 Oct 3;4(6):158-61.
20

Facebow
21

Facebow

Winkler: Boucher GPT 9:


(9th ed):

A caliper- like instrument A caliper like device Caliper like instrument


used to orient the maxillary used to record the used to record the
cast on the articulator so relationship of the jaws spatial relationship of
that it has the same to the TMJs or the the maxillary arch to
relationship to the opening opening axis of the jaws some anatomic
axis that the maxilla has to & to orient the casts in reference point or points
the opening axis of the this same relationship to and then transfer this
jaw. the opening axis of the relationship to an
articulator. articulator; it orients the
dental cast in the same
relationship to the
opening axis of the
articulator
22

History of facebow
1866- Balkwill

1880- Hayes

1890- Walker

1899- George B. Snow

1905- Gysi

Wadsworth
23

1866- Balkwill
• Bite-frame
• Measured the angle formed by the occlusal plane & a plane passing
through the lines extending from the condyles to the incisal line of the
lower teeth.
22-30°
24

1880- Hayes
• Caliper- a tong like device

• Median incisal point


25

1890- Walker
• Clinometer
• Position of the lower cast in relation to the condylar
mechanism.
26

1899- George B. Snow


• Recognized the importance of hinge
axis and invented a device for
transferring this axis
• Estimated located marks on skin
• Prototype for all later constructions
27

Wadsworth
• Employed a different plane,
which extends from the
condyle area and runs at right
angles to a line that connects
the most prominent points of
the chin and forehead
28

PARTS OF THE
FACEBOW
Constructed as 3 bars: 2 lateral & 1 anterior
29

U SHAPED
FRAME

Cast
support
BITE FORK
Mounting 3RD REFERENCE
platform POINT

Anterior
elevator
LOCKING
DEVICE
30

INDICATIONS OF FACEBOW NOT


FACEBOW: REQUIRED:

1. When balanced occlusion is 1. No alterations to occlusal surface


desired. of teeth are done

2. When cusp form teeth are used. 2. Monoplane teeth are used

3. When interocclusal check records 3. No interocclusal check records

are used. that would be at a different vertical


dimension from that in the original
4. When occlusal vertical dimension is
interocclusal record.
to be changed during teeth setting.
4. Articulators that do not accept
5. For diagnostic mounting and
facebow transfer
treatment planning.
31

ADVANTAGES
OF FACEBOW:

1. Reduces errors in occlusion.

2. Permits accurate programming of articulator.

3. Supports the cast while mounting on the articulator.

4. The vertical dimension may be increased or decreased directly on


the articulator without having to recall the patient and make new
centric records.
32

Failure to use face


bow:

1. The arcs of movement in the articulator will differ from that of the
patient.

2. Verification of the mandibular cast position by using interocclusal


records made at increased vertical dimension of occlusion will be
difficult or impossible.

3. Deflective contacts are also present in functional and parafunctional


lateral movements and these deflective contacts cause periodontal
trauma, muscle spasm ,TMJ pain and loss of supporting edentulous
tissues.
33

When the CD patients perform chewing with these


errors in the dentures, it may lead to :

Denture Increased
instability RRR

Path of Pain,
TMJ
closure crepitus,
affected
altered subluxation
34
Errors of tooth movement associated with axis other
than actual terminal hinge axis
35

TYPES OF FACEBOW

Fascia
type
Arbitrary
Earpiece
Facebow
Kinemati type
c
36

PLANE OF
ORIENTATION
The maxillary cast is orientated in relation to a plane known
as the plane of orientation.
Formed by:
1. Anterior reference point
2. Posterior reference point
37

Orbitale
Anterior reference points

Beyron

Posterior reference points


Orbitale – 7mm
Bergstrom

Nasion Gysi

Teteruck and
Ala of nose
Lundeens point

43mm superior to lower


Dawson’s
border of upper lip method
38

Posterior Reference
Points
39

Gysi point
11-13 mm anterior to the upper third of the tragus of the ear on a
line extending from upper margin of the external auditory meatus
to the outer cantus of the eye

11-13mm
40

Beyron’s point
13mm anterior to the posterior margin of tragus on a line from centre of
tragus to outer canthus of eye
Closest to the true hinge axis

13mm
41

Bergstrom’s point:
About 10mm anterior to the centre of the spherical insert for the
external auditory meatus and 7mm below the FH plane.
Teteruck and 42

Lundeens point
13mm anterior of tragus on line joining base of tragus to outer
canthus of eye.
By palpation: 43

(Dawson’s method)
 From behind the patient, place the index finger tip over the joint
area and ask the patient to open his mouth wide.

 As the condyle translates forward, the finger will drop into a


depression where the condyle was.

 The patient should then close.

 As the condyle translates back into centric, its position can be


located by finger tip. Mark this point.
44

Anterior reference
points
45

Significance
• Provides the anterior point for establishing
the AP tilt of the plane of orientation
• Determines the level at which the casts are
mounted
• To establish baseline for comparative studies
between patients
• Can visualize anterior teeth and occlusion in
the articulator in the same reference as the
face
46

Orbitale:
In the skull, orbitale is the lowest point of the infra orbital rim.
On a patient it can be palpated through the overlying tissue and the skin.
One orbitale and the two posterior points that determine the horizontal axis
of rotation will define the axis orbital plane.
Used in Hanau facebow
47

Orbitale minus 7mm


Represents Frankfort horizontal plane when plane posterior point
of plane is at hinge axis
48

Nasion minus 23mm


Deepest part of the midline depression just below the level of the
eyebrows. The nasion guide fits into this depression.
Guide can be moved in and out but not up and down from its
attachment to the facebow crossbar. The crossbar is located
23mm below the midpoint of the nasion positioner.
49

Ala of nose
The right or left ala is marked on the patient and the anterior
reference pointer of the face-bow is set.
This method uses the Campers Plane as the plane of orientation
50

43mm superior from lower


border of upper lip:

Denar Reference plane indicator


51

Commonly used planes


of orientation
52

Ala-tragus line
Line drawn from the upper part of the tragus to the lower edge of
the nostrils
53

Prosthetic plane
Is another oriention plane use by gysi
It is the line drawn from the lower part of the tragus to the lower
edge of nose.
54

Frankfort’s plane
Orbitale plane
Line drawn from the upper part of the tragus to the orbitale
Establishing Plane 55

Of Orientation
Maxillary occlusal rim is contoured to provide lip support

Facial profile is checked

Fox plane is placed to check the occlusal surfaces of rim


parallel to camper’s line

Anteriorly it should be parallel with interpupillary line

After recording the tentative occlusal vertical relation & the


CR, the maxillary rim is oriented to the hinge axis with the
help of a FACE BOW
56

PART – 2
ORIENTATION JAW
RELATION
GUIDED BY –DR AJAYKUMAR NAYAK PRESENTED BY – DR SHILPA
PROFESSOR SOMAN
Methods of
57

Locating Hinge
Axis

ARBITRARY KINEMATIC
METHOD METHOD
58

TRUE HINGE AXIS ARBITRARY HINGE AXIS


• Precisely located hinge • Locating hinge axis within
axis 5mm of error is
• Kinematic facebow acceptable
• Facebow attached to • Arbitrary facebow
mandible • Facebow attached to
maxilla
• Easier to locate

Weinberg concluded that


terminal hinge axis location
& facebow transfer within a
5mm is a dependable
method to orient the
maxillary cast
59

Arbitrary face bow


Arbitrary facebows uses arbitrary or approximate points on the face as the posterior
reference points

Earpiece
type
Facia
type
60

Facia type

It utilizes approximate posterior reference points on


the skin over the temporomandibular region.

Uses condylar rods instead of earpiece inserts.

CONDYLAR RODS

• Hanau fascia type facebow


• Denar fascia face bow
• Standard Denar D31AB
• Panamount face bow
61

Hanau fascia type


facebow
• Posterior reference point: Richey
condylar marker is used to scribe
an arc about 13 mm anterior to the
external auditory meatus
• Using a ruler, from the corner of
the eye to the top of the tragus,
mark a plane where this line
intersects the arc made by the
condylar mark
62

Ear piece type


• First described by Dalbey in 1914.
• It uses external auditory meatus as the arbitrary
posterior reference point as it is assumed to have
a fixed relationship to the hinge axis.
• Uses round nylon ear piece

Advantages:
• Simple
• Does not require measurements or
marks on the face.
• Accuracy is similar to facia type
method
63

Ear piece type


1. Hanau ear piece type 153 series

2. Hanau Spring bow

3. Denar slidematic ear bow

4. Whip-Mix quick mount

5. Artex facebow
Hanau ear piece 64

type 153 series


• Utilizes the external auditory canals
as posterior reference points
• When transferring the earpiece face-
bow to the articulator the earpieces
are seated on the auditory pins of
the centric locks
• Uses the orbitale as an anterior
reference point for face-bow
transfer
65

Hanau Spring Bow

• Spring steel design


• No assistant required
• Posterior reference point: porion
• Anterior reference point: orbitale
• Plane of orientation: FH plane
• Self centering
66

Facebow transfer
67

Impression compound loaded


onto bite fork Bite fork midline aligned to
facial midline
68

Insert the vertical rod of the assembly


into the bow socket on the underside
of the black center piece on the front of
the face bow

Flat surface on the front of the rod


should face you as you place it in socket.
69

The assembly should be to your


right with the knobs facing
you.

Tighten the thumb screw on


front of the center piece.
70

Then guide the clamp into the bitefork


stem gripped between the patients
maxillary and mandibular teeth at a
distance of 4cm ( 1.5 inches ).

FB should be pointed upwards during this action. Open the bow by pulling
outward and swing it down into position placing ear pieces gently into
71

The infra orbital notch ( orbitale ) is


located and marked
72
73

1 2

3
74
Denar Slidematic 75

Face-bow:
 Allows the maxillary arch to be
transferred to the articulator without
Reference plane
attaching the Face-bow to theindicator
articulator with the help of transfer
jig.

Bitearms
 The Earpiece fork open and close
simultaneously and equidistantly by
a horizontal sliding gear
mechanism

Facebow with
 Anterior point of reference- Marked
slidematic gear
using Denar Reference Plane
Locator
Whip-Mix quick
76

mount facebow
• Anterior reference point: nasion

• The intercondylar distance can


be determined from the scale
on the front of the Face-bow as
S, M & L (Small, Medium &
Large)
77

Artex facebow
• The entire fork assembly
tightens with a single thumb
screw. This eliminates tilted
mountings.
• Very simple to use.
• There is a matching transfer
stand that eliminates sending
the facebow to the lab
• The maxillary model can also
be mounted by attaching the
facebow directly to the
instrument.
78

Kinematic facebow
• Hinge bow, adjustable axis facebow
• A facebow with adjustable caliper ends used to locate the
exact transverse axis of the mandible
• It is used with Fully adjustable articulator
• Used in full mouth rehabilitation
79

• Clutch is attached to
mandibular teeth with putty

• Transverse rod is attached


to portion of clutch that
protrudes from the mouth

• Side arms are attached to


transverse rod
80

• Side arms adjusted so that styli are


close to joint area (graph sheet)

• Mandible manipulated to produce


terminal hinge movement

• Stylus locations adjusted until they


make pure rotational movement

• Position of terminal hinge axis


marked/ tattooed on patients skin
81

Trained movement of the mandible


Styli remains stationery at actual hinge axis.
If the styli is positioned at a direction from actual axis it travels in an arc
indicating the direction when the mandible moves.

.
82

Disadvantages of kinematic
facebow

1. Resiliency of the oral mucosa.


2. The weight of the recording clutch, which tends to shift
the denture base.
3. The time-consuming nature of the procedure.
4. The kinematic method requires more elaborate
equipment
KINEMATIC ARBITRARY 83

Accurate Less Accurate

Records hinge axis arbitrarily using


Records true hinge axis
anatomic average values.

Time consuming Less time consuming

Requires assembly to customized


Self centering
accordingly

Error of 1mm is expected Error of 5mm is expected

Assembly is attached to the mandible Assembly is attached to the maxilla

Requires articulator to have extendible Doesn’t require any modification in


condylar shaft articulator
84

OTHER INSTRUMENTS USED


TO DETERMINE TRUE HINGE
AXIS

PANTOGRAPH

 2 face bows
 6 records
 3 tracings
 Records centric
relation with terminal
hinge axis
Compatibility of specific 85

facebows with articulators


FACEBOW ARTICULATORS

Hanau Springbow Hanau and Denar


articulators
(except Hanau Model
145 or Denar Mark 300
Series)

Hanau Earpiece All current Hanau


Facebow articulators

Denar Slidematic Adaptable to most Denar,


Facebow Hanau and Whip Mix
Articulators
(Except Whip Mix 8500
or Hanau-Mate)
Compatibility of specific 86

facebows with articulators


FACEBOW ARTICULATORS

Whip Mix Direct All Whip Mix articulators


Mounting Facebow

Whip Mix Indirect 2000, 3000, 4000 Series


Mounting Facebow Whip Mix articulators
(Adaptable to Whip Mix
8500, Hanau Wide-Vue
and Modular articulators
with additional
accessories)
RECENT ADVANCES
88

Virtual facebow technique

Phase1 – image acquisition

Armamentarium :
an intraoral scanner, a digital camera, and specific
software (Agisoft).

Solaberrieta E, Garmendia A, Minguez R, Brizuela A, Pradies G. Virtual facebow technique. The Journal
of prosthetic dentistry. 2015 Dec 1;114(6):751-5.
89

Phase 2 – alignment of the


facebow impression fork and
maxillary digital cast

Solaberrieta E, Garmendia A, Minguez R, Brizuela A, Pradies G. Virtual facebow technique. The Journal
of prosthetic dentistry. 2015 Dec 1;114(6):751-5.
90

Solaberrieta E, Garmendia A, Minguez R, Brizuela A, Pradies G. Virtual facebow technique. The Journal
of prosthetic dentistry. 2015 Dec 1;114(6):751-5.
91

References
1. Contemporary fixed Prosthodontics, Stephen F. Rosenstiel, 3 rd edition.
2. Fundamentals of fixed Prosthodontics, Herbet Shillinburg, 3rd edition
3. Essentials of complete denture Prosthodontics, Sheldon Winkler, 2 nd edition
4. Hickey J, Zarb G, Bolender C. Boucher’s Prosthodontic Treatment for Edentulous
Patients : 9th ed.
5. Textbook of complete dentures, Rahn A, Heartwell C, 4 th edition
6. The concept of complete dentistry, Peter E Dawson
7. Jayachandran S, Ramachandran CR, Varghese R. Occlusal plane orientation: a
statistical and clinical analysis in different clinical situations. Journal of Prosthodontics:
Implant, Esthetic and Reconstructive Dentistry. 2008 Oct;17(7):572-5.
8. Solaberrieta E, Garmendia A, Minguez R, Brizuela A, Pradies G. Virtual facebow
technique. The Journal of prosthetic dentistry. 2015 Dec 1;114(6):751-5.
9. Shetty S, Shenoy KK, Sabu A. Evaluation of accuracy of transfer of the maxillary
occlusal cant of two articulators using two facebow/semi-adjustable articulator systems:
An in vivo study. The Journal of the Indian Prosthodontic Society. 2016 Jul;16(3):248.
10. Singh S, Rehan S, Palaskar J, Mittal S. Hinge axis-location, clinical use and
controversies. Journal of Research in Dentistry. 2017 Oct 3;4(6):158-61.
92

THANK YOU !
93
94
95
96
97
98
99

Review of
literature
Evaluation of accuracy of transfer of the maxillary occlusal cant100
of
two articulators using two facebow/semi-adjustable articulator
systems

AIM
To compare the accuracy of the angle made by Frankfort horizontal plane-occlusal
plane on maxillary casts, mounted using the respective facebows on Artex Amann
Girrbach and Hanau Wide-vue semi-adjustable articulators with cephalometrically
derived Frankfort horizontal plane-occlusal plane angle as a control.

METHODOLOGY

Maxillary casts of 30 subjects were mounted on Hanau Wide-vue and Artex


Amann Girrbach semi-adjustable articulators following facebow transfer using
respective facebows.
• The Frankfort horizontal plane-occlusal plane angles of these casts were
measured using Wixey's digital angle gauge.
• Subjected to a lateral cephalogram, and the occlusal cant was measured using
RadiAnt DICOM software.

Shetty S, Shenoy KK, Sabu A. Evaluation of accuracy of transfer of the maxillary occlusal cant of two
articulators using two facebow/semi-adjustable articulator systems: An in vivo study. The Journal of the Indian
Prosthodontic Society. 2016 Jul;16(3):248.
101

Facebow transfer with Rotofix Artex and Spring-Bow Hanau facebows

Pictorial representation of the angle formed between Frankfort horizontal Plane (a) Occlusal, Plane (b)
measured using RadiAnt DICOM software on a cephalogram. Insert (c) represents a parallel line to insert (b)

Shetty S, Shenoy KK, Sabu A. Evaluation of accuracy of transfer of the maxillary occlusal cant of two
articulators using two facebow/semi-adjustable articulator systems: An in vivo study. The Journal of the Indian
Prosthodontic Society. 2016 Jul;16(3):248.
102

RESULT

A mean difference of 1.9° was found between Hanau Wide-vue articulator


and lateral cephalogram and a mean difference of 3.6° was found between
Artex Amann Girrbach articulator and lateral cephalogram.

CONCLUSION

Frankfort horizontal plane-occlusal plane angle of the casts articulated on


Hanau Wide-vue articulator was more accurate in comparison to that on
Artex Amann Girrbach articulator.

Shetty S, Shenoy KK, Sabu A. Evaluation of accuracy of transfer of the maxillary occlusal cant of two
articulators using two facebow/semi-adjustable articulator systems: An in vivo study. The Journal of the Indian
Prosthodontic Society. 2016 Jul;16(3):248.
103

Occlusal Plane Orientation: A Statistical and Clinical


Analysis in Different Clinical Situations

AIM

• Orientation of the occlusal plane is important in a number of clinical situations.


Using the reported soft and hard tissue landmarks is difficult and requires
experience, as the landmarks are located on the face or by use of a
cephalometric radiograph.
• Improper use of these landmarks may compromise the functional and esthetic
result of prosthetic restorations.
• This study evaluated the reliability of the hamular notch/incisive papilla plane
(HIP) in establishing the occlusal plane

Jayachandran S, Ramachandran CR, Varghese R. Occlusal plane orientation: a statistical and clinical
analysis in different clinical situations. Journal of Prosthodontics: Implant, Esthetic and Reconstructive
Dentistry. 2008 Oct;17(7):572-5.
104

METHODOLOGY

• The occlusal plane of ninety adults were compared with their HIPs.
• In dentulous subjects, the maxillary stone cast was mounted on the Wills
surveyor with HIP, which was made parallel to the horizontal plane using
the tripoding method.
• The vertical distance between the occlusal plane and floor of the surveyor
was measured at four points. When the measured values were equal, the
two planes were confirmed to be parallel for that situation. In turn, this
relation confirmed the parallelism between the occlusal plane and HIP.
• In the edentulous subjects, the occlusal plane, established clinically using
the ala tragal line, was compared with the HIP radiographically using lateral
cephalograms.
• Paired t-test was used to test the equality of the mean differences at a 0.05
significance level.

Jayachandran S, Ramachandran CR, Varghese R. Occlusal plane orientation: a statistical and clinical
analysis in different clinical situations. Journal of Prosthodontics: Implant, Esthetic and Reconstructive
Dentistry. 2008 Oct;17(7):572-5.
105

The cast fixed on the surveyor using the Lateral cephalograph of the edentulous patient
tripoding method with occlusion rims (metal balls and the central
bearing plate attached to the maxillary record
base and occlusion rim, respectively) in place.
106

RESULTS

• The mean differences from the right canine were: 0.055 cm at the left
canine, 0.05 cm at the right molar, and 0.065 cm at the left molar in
dentate subjects and 0.001 cm between the incisive papilla and hamular
notch in edentulous subjects.
• The HIP appeared parallel to the occlusal plane as the paired t-test
showed no statistically
• significant difference (p > 0.05).

CONCLUSION

In the population tested, the HIP was parallel to the occlusal plane.
Therefore, this may be a viable reference in complete denture
prosthodontics.

Jayachandran S, Ramachandran CR, Varghese R. Occlusal plane orientation: a statistical and clinical
analysis in different clinical situations. Journal of Prosthodontics: Implant, Esthetic and Reconstructive
Dentistry. 2008 Oct;17(7):572-5.
107

Conclusion

The use of face bow is indispensable for diagnosis, treatment planning &

treatment procedures.

By using face bow the risk of occlusal errors are minimized thereby

enhancing the accuracy of occlusion of new restoration or oral appliances

which facilitates patient comfort and acceptance of the prosthesis.

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