Upload
phungcong
View
235
Download
2
Embed Size (px)
Citation preview
2/5/2015
1
Extraction in the
Mixed Dentition ─
1
A Reasonable
Alternative for
Selected Patients?
2
I declare that neither I, nor any member of my
family, has a financial arrangement or affiliation
with any corporate organization which offers
financial support or grant monies for this
continuing education presentation, nor do I have a
financial interest in any commercial product(s) or
services I will discuss in this presentation.
3 4
“War of Roses” Tennessee
Governor's Race 1886
The Taylor Brothers
5 N. Nash
2/5/2015
2
N. Nash N. Nash
N. Nash N. Nash
11
N. Nash Pretreatment FMIA 70
FMA 20
IMPA 90
SNA 83
SNB 80
ANB 3
AO-BO 4mm
OCC 0
Z 90
Options
1.Space Management
2.Expansion – Arch
Development
3.Extraction in the Mixed
Dentition
12
2/5/2015
3
13
But ─ Before Options Are
Considered ─
How Much Space
Is Needed?
How Much Space is Needed?
Space Available
4mm
4mm
20.0mm 18.5mm
Totals
Maxillary Arch
Space Required 16.5mm
Space Available 8.0mm
Deficit 8.5mm
16
Mandibular Arch
Space Required 46.1mm
Space Available 38.5mm
Deficit 7.6mm
Option
17
Space
Management
Maxillary Arch ─ Must
Have 8.5mm
18
No Space
to Manage
4mm
4mm
2/5/2015
4
Space Management Mandibular Arch
19
Left side ─
Yes
Right side
20.0mm 18.5mm
- 4.6mm
? 20
Space Management
Plus
Interproximal
Reduction?
21
Space Needed
Interproximal
Reduction???
Maxillary Arch ─ 8mm
Mandibular Arch ─ 7.6mm
Option
Make Space for
the Teeth
22
N. Nash
Space Space
24
Make Space for the Teeth
Expansion ─ Arch
Development
Yes!
Does Our Science
Need to be Consulted?
2/5/2015
5
What Happens
With No Treatment?
25 26
Sinclair and Little (1983)
• Sinclair and Little (1983) Reported on a
Sample of 65 Subjects With Normal
Occlusions For Changes in the Dental
Arch From the Mixed Dentition, to Early
Permanent Dentition, and into Early
Adulthood.
• Arch Length Decreased From the Mixed
Dentition into Early Adulthood While
Incisor Irregularity Increased From 13 to
20 Years of Age.
27
Richardson (1999)
• Evaluated the Changes in Alignment in the
Untreated Lower Arch at Various
Developmental Stages: 7 to 15 Years, 13 to
18 Years, 18 to 21 Years, and 18 to 50
Years.
• After Evaluation of the Dental Arch at
Various Developmental Stages, Richardson
(1999) Concluded That the Greatest
Increase in Amount of Lower Incisor
Crowding Occurs Between the Ages of 13
and 18 Years of Age (= 2.3 mm).
28
Yes!
Does Arch Length Inevitably Decrease
From Mixed Dentition to Adult Dentition? Barrow & White, AJO 1952
Brown, et al, Act. O Scand 1951
Little, et al, AJO 1990
Lundstrom, Dent Pract 1969
Moyers, HandBK of Ortho 1985
Moorees, Harv Univ Press 1959
Nance, AJO 1947
Sinclair, et al, AJO 1983
Sillman, AJO 1964
What Happens
With Treatment?
29 30
When Mandibular Incisors Are Proclined
During Treatment, Do They Tend to
Upright? Nance, AJO 1947
Mills, Brit Ortho Jrn 1966
Litowitz, Angle Ortho July-Oct 1948
Cole, Angle Ortho July-Oct
Hixon, AJO 42:898, 1956
Hixon, Angle Ortho 42:200, 1972
Weinstein, Angle Ortho 33: 1, 1963
Miller, U of Oregon Thesis 1971
Boley, UMKC Thesis 1966
Yes!
2/5/2015
6
31
Do Expanded Mandibular Canines
Typically Constrict After the Removal of
Retention? Bishara, et al, AJO1989
Glenn, et al, AJO 1987
Little, et al, AJO 1981
McCauley, AJO 1944
Riedel, Angle Ortho 1966
Sandusky, Thesis 1983
Shapiro, AJO 1974
Sondhi, et al, AJO 1980
Steadman, Angle Ortho 1961
Strang, Angle Ortho 1949, 1952
Yes!
• Arch form tended to return toward the
pretreatment shape after retention.
• Greater the treatment change, the greater the
tendency for postretention change.
• However, individual variation was considerable.
• Patient's pretreatment arch form appeared to be
the best guide to future arch form stability.
32
de la Cruz A, Sampson P, Little RM, Artun J, Shapiro PA.
Long-term Changes In Arch Form After Orthodontic
Treatment And Retention. Am J Orthod Dentofacial Orthop. 1995 May;
107(5):518-30.
Over expansion was found to be a
factor in mandibular incisor
relapse.
33
Kahl-Nieke B, Fischbach H, Schwarze CW. Post-retention
Crowding And Incisor Irregularity: A Long-term Follow-up
Evaluation Of Stability And Relapse. Orthod. 1995
Aug;22(3):249-57.
El-Mangoury NH. Orthodontic Relapse In Subjects With Varying
Degrees Of Anteroposterior And Vertical Dysplasia. AJO/DO, Vol. 75,
#5, May 1979, pp 548-561.
• In both the- stable and the relapse groups, the mandibular intercanine width decreased postretention. This decrease was associated more with the relapse group than with the stable group.
• The mandibular intercanine width tended to relapse toward its original pretreatment value. This suggests that, at the end of active treatment, the mandibular intercanine width should be maintained as originally presented.
• There was no significant interaction between orthodontic relapse (or stability) and whether or not extraction was included as a part of the mechanotherapy.
34
35
The Washington Studies Should
Not Be Interpreted to Mean That
The Position of the Teeth
Does Not Matter
36
• Twenty-two of the 30 cases (73%) demonstrated clinically
unsatisfactory mandibular anterior alignment postretention.
• Intercanine width and arch length decreased in 29 of the 30
cases by the postretention stage.
Little RM, Riedel RA, Enqst ED. Serial extraction of first premolars-
postretention evaluation of stability and relapse. Angle Orthod. 1990
Winter;60(4):255-62.
• At post-retention, 9.0% had irregularity index values of 6.5
mm or more and 47.4% had values equal to 3.5 mm or less.
• Treatment increase of intercanine width and post-retention
decrease of intercanine width and arch length were
associated with relapse.
Artun J, Garol JD, Little RM. Long-term stability of mandibular incisors
following successful treatment of Class II, Division 1, malocclusions.
Angle Orthod. 1996;66(3):229-38.
2/5/2015
7
37
There Are No Studies of
Patients Treated With
Expansion Who Have Been
Recalled Twenty Five Years
After Treatment
So — What Should We
Do? 38
Treatment Plan With
Strang, Nance, Tweed,
Merrifield, Mangoury,
Blake & Bibby, & Boley!
39
Strang, R.H.W. “The Fallacy Of Denture
Expansion As A Treatment Procedure.”
The Angle Orthodontist, 1949: 49: 12 -
17.
Nance, H. “The Limitations of Orthodontic Treatment”, Am J of Ortho & Oral Surg 33:253-301, 1947.
40
Tweed, CH. “Indication for the
Extraction of Teeth in Orthodontic
Procedures,” AM J of Ortho Oral Surg
30:405, 1944.
Tweed, CH. “A Philosophy of Orthodontic Treatment”, Am J of Ortho & Oral Surg 31:74, 1945.
41
Merrifield, LL. “Differential
Diagnosis,” Seminars in
Orthodontics #2, 241, 1996.
Merrifield, LL. “The Dimension
of the Denture: Back to the
Basics,” AJO/DO Vol106:535,
1994.
42
Boley JC, Mark JA, Sachdeva RC, Buschang PH.
"Long-term stability of Class I premolar extraction
treatment." Am J Orthod Dentofacial Orthop. 2003
Sep;124(3):277-87.
Paquette DE, Beattie JR, Johnston LE Jr. "A long-
term comparison of nonextraction and premolar
extraction edgewise therapy in "borderline" Class II
patients." Am J Orthod Dentofacial Orthop. 1992
Jul;102(1):1-14.
2/5/2015
8
43
Does Expansion
Compromise Facial
Esthetics?
The Face ─
44
Many Times It
Does
It Can!
Expansion Can Harm
Facial Esthetics
45 46
Is There An
ANTERIOR LIMIT
OF THE DENTITION?
47
Merrifield’s Z Angle
48
2/5/2015
9
49
STEINER
50
Tweed, CH. “The Frankfort Mandibular Incisor Angle (FMIA) In Orthodontic Diagnosis, Treatment Planning and Prognosis”, Am J of Ortho & Oral Surg 24:121, 1954.
Burrow, SJ. “Smile Esthetics After Orthodontic Treatment With and Without Extraction of Four First Premolars,” Seminars in Orthod, Vol 18, #3, Sept 2012 pp 201-209.
Expansion – Arch Development
Maxillary Arch ─ Must have 8.5mm
51
4mm
4mm
52
Now ─
Some Specific
Questions
53
Can We
Expand the
Maxillary Arch?
54
─ Yes ─
But Should We?
2/5/2015
10
55
Adkins MD, Nanda RS,
Currier GF. Arch Perimeter
Changes on Rapid Palatal
Expansion. Am J Orthod
Dentofacial Orthop. March
1990;97(3);194-199.
56
1mm of Lateral Expansion
Expansion Required ≈ 12mm
Yields .66 mm of Arch
Perimeter Gain
57
Schiffman PH, Tuncay OC. Maxillary
expansion: a meta analysis. Clin Ortho Res,
2001 May;4(2); 86-96.
The mean expansion after adjustment according to
the principles of meta analysis was 6.00 mm with a
standard deviation of 1.29 mm. Of the 6-mm average,
4.89 mm was retained while wearing retainers…
Finally, in the long-term post-retention study period
only 2.4 mm of the residual expansion was reported
to have remained. This 2.4 mm of expansion
remaining after more than a year or more of post-
retention period was no greater than what has been
documented as normal growth. 58
Gianelly AA. Rapid Palatal
Expansion in the Absence of
Crossbites: Added Value?
Am J Orthod Dentofacial
Orthop. October 2003;
124(4);362-365.
59
If We Expand the
Maxillary Dentition in the
Absence of Crossbite ─
We MUST EXPAND
the Mandibular
Dentition 60
Gianelly – “One conclusion is
that the use of the maxillary
arch as the template for the
mandibular arch might
jeopardize the stability of the
mandibular arch by expanding
it in areas that are known to be
unstable.”
2/5/2015
11
61
Is It Prudent to
Expand the
Mandibular
Dentition? 62
Burke SP, Silveira AM,
Goldsmith LJ, Yancey JM, Van
Stewart A, Scarfe WC. “A
Meta-Analysis of Mandibular
Intercanine Width in Treatment
and Postretention", Angle
Ortho. February 1998; 68:53-
60.
63
Burke et al Performed a
Meta-Analysis of 26 Articles –
Evaluated 1233 Patients
Conclusion: Most Prudent
Course Is to Maintain the
Original Intercanine Dimension
Conclusion – Lateral Maxillary
Expansion is Probably Not a
Good Solution for Our Patient
64
4mm
4mm
65
Lateral Mandibular
Expansion is Not a
Prudent Option
20.0mm 18.5mm
66
What About
Moving the Teeth
Distally?
Not Laterally?
2/5/2015
12
67
Is There a
Posterior Limit of
the Dentition?
Yes!! 68
THE POSTERIOR LIMIT OF
THE DENTITION
69
A Modern
“Widget”
70
This Patient is
17 years old.
The second
molars are
impacted due to
distalization
mechanics.
71
We Can Easily Push the
Maxillary Teeth Distally
But What About
the Mandibular
Teeth?
AJO/DO Vol 146, No 2
72
2/5/2015
13
73 74
What About
Maintaining the
Position of the
Mandibular
Posterior Teeth?
75
K. Cox
76
K. Cox
14 Months into Treatment
77
K. Cox
AJO/DO Vol 141, No 2
78
2/5/2015
14
79
Rebecca Lash Rubin, Tiziano Baccetti, and
James A. McNamara, Jr
80
300 Patients ─ Four Groups
– Schwarz
– Lingual holding Arch
– Combination of Schwarz
& Holding Arch
– Control
81
Findings / Conclusions
Orthodontic Appliances
Intended to Maintain Arch
Perimeter in the Mixed
Dentition Increase the
Probability of Eruption
Disturbances of the
Mandibular Second Molars. 82
Findings / Conclusions
“All 3 Treatment Groups
Had a Higher Incidence
of Mandibular Second
Molar Eruption Difficulty
When Compared with the
Controls.”
83
The Bottom Line
on Arch
Development
84
“Most Often the Arch Length Gain
Occurs by Lower Incisor
Proclination and/or An Increase in
Intercanine Width, Both Being
NOTORIOUSLY Unstable.”
David Kennedy
Early Treatment Options
PCSO Bulletin – Summer 2010
2/5/2015
15
85 86
87
Bowman SJ. “Pulsus a
Mortuus Equus”
(Beating a Dead Horse)
Seminars in Orthodontics, Vol 20,
#1, 2014, pp 36-45.
Arguments About Age – Appropriate
Arch Length Alternatives. 88
Lysle E. Johnston Jr
MORE Bone or
LESS Teeth!
That is the Choice!
Peck, Sheldon. “The Current Fashion of Nonextraction Dental
Arch Expansion in Orthodontics: A Critique” Seminars in
Orthodontics, Vol 18, #2, June 2012, pp 126-127.
89
Today, conscientious orthodontists are
being challenged by commercially
marketed appliance systems that promise
easy solutions and are based on
nonextraction dental arch expansion. This
is a throwback to orthodontic methods
advocated a century ago, long before the
evidence-based era of orthodontics,
radiography, and periodontology. 90
Arch Development
Little RM, Riedel RA, Stein A.
Mandibular Arch Length Increase During
Mixed Dentition: Postretention
Evaluation of Stability and Relapse. Am
J Ortho Dentofacial Orthop. May
1990:97 (5):393-404.
It is a FAILURE 87%
of the Time
2/5/2015
16
91
“…this strategy shows
greater relapse than other
samples we have
collected.”
Little RM, Riedel RA, Stein A. Mandibular arch length
increase during the mixed dentition: postretention evaluation
of stability and relapse. Am J Orthod Dentofacial Orthop.
1990; 97(5);393-404. 92
Am J Orthod Dentofacial Orthop
2006; 130:202-13
93 94
95
Mandibular Arch
Perimeter
Decreased in Both
Treated Samples What is the Best
Choice for Natalie?
2/5/2015
17
Options
1.Space Management
2.Expansion – Arch
Development
3.Extraction in the Mixed
Dentition 97 98
Option
Extraction in the
Mixed Dentition
99
Age 6
100
..."It is better to have one or two
teeth less in each jaw, provided it
can be compensated by a suitable
arrangement, than to have the
entire set of teeth poorly arranged
and ill at ease…”
Bunon R. Essay sur las maladies des dents. Conference. In:
Paris; 1743.
101
“By sacrificing the (deciduous)
canine teeth to the incisors and
the small molars (premolars) to the
(permanent) canines it will be
possible to leave free space to
make an attractive arrangement."
Bunon R. Essay sur las maladies des dents. Conference. In:
Paris; 1743.
102
In 1896, J.F. Colyer advocated extractions “to
gain room for the crowns and roots, to
decrease mechanical treatment and in many
cases to abolish it as well as to relieve the
pressure on the teeth and prevent caries, to
improve the bite, and finally to have the teeth
naturally assuming a better position”.
Colyer J. Discussion on the early treatment of crowded
mouths. Odont Soc Trans. 1896;28(2):215–33.
2/5/2015
18
103
Kjellgren B. Serial Extraction as a
Corrective Procedure in Dental
Orthopedic Therapy, Eur. Orthod.
Soc. Trans p134, 1947–1948.
Special Knowledge is
Required
104
The phrase Serial
Extraction has resulted in
the poorly planned
removal of teeth by people
who do not have the
necessary knowledge. Jack Dale
105
Hotz’s Guidance of Eruption
implies that knowledge of
growth and development is
necessary to direct the teeth
as they erupt.
Hotz R. Guidance of eruption
versus serial extraction, Am J
Orthod 58:1, 1970.
106
“Guidance of Occlusion –
an even better term
because occlusion is the
final destination of a tooth
that is erupting.” ─ Jack Dale
107 108
2/5/2015
19
This chapter is THE State of
the Art work on extraction of
teeth in the mixed dentition.
• Fabulous Illustrations
• Impeccably Referenced
• Meticulous Explanations
109
This chapter is a
MUST reference for
every clinical
orthodontist.
110
111
Graber TM. Serial extraction: a continuous
diagnostic and decisional process. Am J Orthod.
1971;60:541-75.
Heath J. The interception of
malocclusion by planned serial
extraction. New Zealand J.
1953;49:77-88.
112
Dewel BF. Serial extraction; its
limitations and contraindications.
Ariz Dent J. 1968;14(6):14-30.
Dewel BF. Prerequisites in serial
extraction. Am J Orthod. 1969;55:533-9.
113
Dewel BF. Editorial. A question of
terminology: serial extraction or
guidance of eruption. Am J Orthod.
1970;58:78-9.
Dewel BF. Precautions in serial
extraction. Am J Orthod. 1971;60:615-8.
Lloyd ZB. Serial extraction as a
treatment procedure. Am J Orthod.
1956;42:728-39.
114
Tweed CH. Treatment planning and
therapy in the mixed dentition. Am J
Orthod. 1963;49:881-906.
Jacobs J. Cephalometric and clinical
evaluation of class I discrepancy cases
treated by serial extraction. Am J Orthod.
1965;51:401-11.
2/5/2015
20
Dale JG, Brandt S. Dr. Jack G. Dale on
serial extraction. J Clin Orthod.
1976;10(1):44-60.
115
Dale JG, Brandt S. Dr. Jack G. Dale on
serial extraction. 2. J Clin Orthod.
1976;10(2):116-36.
Dale JG, Brandt S. Dr. Jack G. Dale on
serial extraction. 3. J Clin Orthod.
1976;10(3):196-217.
Proffit WR. The timing of
early treatment: an
overview. AM J Orthod
Dentofac Orthop. 2006;
129:47-49.
116
117
Prior to ANY
Extraction Decision
Complete Records
Treatment Plan
A Careful Analysis
• Face
• Skeletal Pattern
• Teeth
118
119
Mixed dentition
extraction procedures
seem to work best when
the face has balance or is
at best, mildly protruded.
The Face The Face
Mixed dentition
extractions are generally
contraindicated in a
convex or concave face.
120
2/5/2015
21
The Face
121
The Skeletal Pattern
Vertical
Dimension
should be within
NORMAL Limits 122
The Skeletal Pattern
Mixed dentition
extractions are generally
contraindicated in patients
with hyperdivergent or
hypodivergent skeletal
patterns. 123 124
The Skeletal Pattern
The anteroposterior relationship
of the maxilla to the mandible
should be “normal.” If the
mandible is either retrognathic
or prognathic, mixed dentition
extractions are generally not
indicated. 125
2/5/2015
22
What About
Mixed Dentition
Extraction in the
Class II Dental
Relationship? 127
Proceed with
Caution!
128
Be Prepared to
1) Correct the Class II
Molar Relationship with
Mandibular Extraction
2) Treat to a Class I
Canine / Class II Molar 129 130
HB Byers
HB
Bye
rs
131 132
HB Byers
2/5/2015
23
HB Byers 133 134
HB
Bye
rs
135
HB Byers 136
Dugoni SA. Comprehensive mixed dentition
treatment. Am J Orthod Dentofac Orthop. 1998;113,
p75–84.
Dugoni SA, Aubert M, Baumrind S. Differential
diagnosis and treatment planning for early mixed
dentition malocclusions. Am J Orthod Dentofac
Orthop. 2006; 129, Issue 4, S80–S81.
The Dentition The Clinician MUST ascertain
the space required and the
space available.
137
And Other Factors?
Arch Length/Tooth Size Deficiency
• How much crowding would indicate that
extractions of permanent teeth may be
indicated?
• 7mm or more of crowding was an
indication (Ringenberg)
• 10 mm or more of crowding (Proffitt)
138
Ringenberg Q. Serial extraction: Stop, look, and be certain.
Am J Orthod. 1964;50:327–36.
Proffit WR. The timing of early treatment: an overview. Am J
Orthod Dentofac Orthop. 2006;129:47–49.
2/5/2015
24
The Dentition There are several methods that
can be used to predict the
space needed and the space
required.
Whatever the method of choice,
139
USE IT!
Hixon EH, Oldfather RE.
Estimation of the sizes of
unerupted cuspid and bicuspid
teeth, Angle Ortho 28:236, 1958.
Huckaba GW. Arch size analysis
and tooth size prediction. Dent
Clin North Am 431, 1964. 140
Gardner RA. “A Comparison of
Four Methods of Predicting
Arch Length” Am J Orthod,
1979, 75(4) 387-398.
141
“Tanaka and Johnston Analysis
seems to be the one most
frequently used since it is a pure
calculation.”
The “Dale” Method
• Space Available vs Space Required
• Curve of Spee Correction
• Evaluation of Protrusion
(Its Correction Requires Space)
• Posterior Dentition Area Evaluation
Jack Dale, Chapter 11 142
Therefore, a THOROUGH Study of:
The Face
The Skeletal Pattern
The Dentition
MUST Be Done in Order to
Formulate a Mixed Dentition
Extraction Treatment Plan. 143 144
Age 9
2/5/2015
25
145 146
Four First Premolars Were Removed
During the Mixed Dentition.
147
Age 11
What is the Best
Choice for Natalie?
Four First
Premolars and
Mandibular
Deciduous Teeth
Were Removed 149
N. Nash
2/5/2015
26
N. Nash N. Nash
N. Nash N. Nash
N. Nash N. Nash
2/5/2015
27
N. Nash N. Nash
N. Nash Pretreatment N. Nash Progress FMIA 70
FMA 20
IMPA 90
SNA 83
SNB 80
ANB 3
AO-BO 4mm
OCC 0
Z 90
FMIA 70
FMA 20
IMPA 90
SNA 83
SNB 80
ANB 3
AO-BO 4mm
OCC 0
Z 90
N. Nash
Pretreatment
Progress 160
N. Nash N. Nash
162
2/5/2015
28
N. Nash 163
N. Nash 164
N. Nash 165
N. Nash 166
N. Nash 167
N. Nash 168
2/5/2015
29
N. Nash N. Nash
N. Nash Pretreatment N. Nash Posttreatment FMIA 70
FMA 20
IMPA 90
SNA 83
SNB 80
ANB 3
AO-BO 4mm
OCC 0
Z 90
FMIA 69
FMA 19
IMPA 92
SNA 83
SNB 80
ANB 3
AO-BO 0mm
OCC 0
Z 90
N. Nash
Pretreatment
Progress
Posttreatment 172
173
N. Nash
174
N. Nash
2/5/2015
30
N. Nash
176
Is Mixed Dentition
Extraction Expedient
For the Majority of
Crowded Class I
Dentitions?
NO!!!!
M. Denman 177
M. Denman 178
M. Denman 179
FMIA 77
FMA 21
IMPA 82
SNA 78
SNB 78
ANB 0
AO-BO -4mm
OCC 10
Z 79
UL 16mm
TC 14mm
PFH 43mm
AFH 60mm
INDEX .70
M. Denman Pretreatment
180
2/5/2015
31
M. Denman 181
M. Denman 182
M. Denman 183
M. Denman 184
M. Denman 185
M. Denman Pretreatment
FMIA 77
FMA 21
IMPA 82
SNA 78
SNB 78
ANB 0
AO-BO -4mm
OCC 10
Z 79
UL 16mm
TC 14mm
PFH 43mm
AFH 60mm
INDEX .70 186
FMIA 77
FMA 21
IMPA 82
SNA 78
SNB 79
ANB -1
AO-BO -4mm
OCC 8
Z 80
UL 16mm
TC 14mm
PFH 47mm
AFH 62mm
INDEX .75
M. Denman Recall
2/5/2015
32
Pretreatment
Posttreatment
Recall
M. Denman
187 M. Denman
188
M. Denman 189
190
191
192
Extraction of Teeth in the
Mixed Dentition ─
A Reasonable Option for
Selected Patients?
2/5/2015
33
Two Key Words
•Reasonable
•Selected
193
In My Caveman Practice ─
Less Than 10%!! of the
Patients Between the Ages
of 8 and 12 Have Mixed
Dentition Extractions
194
195
If It Is
Reasonable ─ And If
the Patient Has the
Criteria
IT IS A GREAT PATIENT
SERVICE! 196
Age 15
197
Fifty-Eight Years After
Mixed Dentition
Extraction
No Other Treatment 198
2/5/2015
34
199 200
201
Thank You!
Age 68