The Journal of Craniofacial Surgery & Volume 23, Number 6, November 2012
16. Van Sickels JE, Peterson GP, Holms S, et al. An in vitro comparison
of an adjustable bone fixation system. J Oral Maxillofac Surg
2005;63:1620Y1625
17. Ellis E. Condylar positioning devices for orthognathic surgery: are
they necessary? J Oral Maxillofac Surg 1994;52:536Y552
18. Kleier C, Kleinheinz J, Stamm T, et al. Prospective cephalometric
evaluation of an adjustable bone fixation system for the sagittal split
ramus osteotomy [in German]. Mund Kiefer Gesichtschir 2000;4:
296Y300
19. Landes CA, Stübinger S, Rieger J, et al. Critical evaluation of
piezoelectric osteotomy in orthognathic surgery: operative technique,
blood loss, time requirement, nerve and vessel integrity.
J Oral Maxillofac Surg 2008;66:657Y674
Elements of Implant-Supported
Rehabilitation Planning in
Patients With Bruxism
Hugo Ramalho Sarmento, DDS,
Raquel Venâncio Fernandes Dantas, DDS, MSc,
Tatiana Pereira-Cenci, DDS, PhD, Fernanda Faot, DDS, PhD
Abstract: The rehabilitation of partial or completely edentulous
patients with implant-supported prostheses has been widely used,
achieving high success rates. However, many studies consider the
presence of bruxism as a contraindication for this treatment modality.
The purpose of this study was to revise the literature and identify risk
factors in implant-supported rehabilitation planning in subjects with
bruxism. Available literature was searched through Medline, with no
time limit, including only studies in English. Topics discussed were
etiology of bruxism and its implications on dental implants, biome-
chanical considerations regarding the overload on dental implants, and
methods to prevent the occurrence of overloads in implant-supported
prostheses. The rehabilitation of bruxers using implant-supported
prostheses, using implants with adequate length and diameter, as well as
proper positioning seems to be a reliable treatment, with reduced risks
of failure. Bruxism control through the use of a nightguard by rigid
occlusal stabilization appliance relieved in the region of implants is
highly indicated. Although it is clear that implant-supported rehabili-
tation of patients with bruxism requires adequate planning and follow-
up, well-designed randomized controlled trials are needed to provide
reliable evidence on the long-term success of this treatment modality.
Key Words: Dental implants, implant-supported dental prosthesis,
mouth rehabilitation, tooth diseases
From the Graduate Program in Dentistry, Federal University of PelotasV
UFPEL, Pelotas, Brazil.
Received May 30, 2012.
Accepted for publication July 24, 2012.
Address correspondence and reprint requests to Fernanda Faot, DDS,
MSc, PhD, School of Dentistry, Federal University of Pelotas,
Gon0alves Chaves St., 457, Center, 96015560 Pelotas, RS, Brazil;
E-mail: fernanda.faot@gmail.com
The authors report no conflicts of interest.
Copyright * 2012 by Mutaz B. Habal, MD
ISSN: 1049-2275
DOI: 10.1097/SCS.0b013e31826b8267
* 2012 Mutaz B. Habal, MD
Copyright © 2012 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Brief Clinical Studies
T ooth and supporting structure loss has traditionally been reha-
bilitated using partial or complete dentures. However, patients
who have undergone these treatment modalities may not be satisfied
with function,1 and for these complaints, dental implants have shown
advantages associated with implant-supported prostheses such as im-
proved retention, stability, chewing efficiency, and quality of life.2
Despite all the advantages presented by the implant anchorage
and its high success rates in clinical trials, osseointegration failures
and complications have been reported. Failures are usually associ-
ated with bone loss around the implant platform,3,4 which occurs at
early stages related to surgical procedures or, later, associated with
function overload.5
Bone loss around the implant platform may be caused by bac-
terial infection, trauma, or overload.3,4 As bacterial infection is
linked to poor hygiene habits of the individual and trauma to the
patient’s particular circumstances, both factors are poorly influenced
by the actions of a dentist. However, in bruxers, the main cause of
failure could be related to implant overload, a factor that can be
controlled by proper clinical management.4,6 When overload occurs,
the level of stress concentration at the implant-bone interface depends
on several factors related to load transfer, such as the direction of
the functional loads, ie, axial and oblique forces, the resiliency
properties of the implant and alveolar bone, the implant macro-
geometry and microgeometry, and the quality of the bone support.4,6
Several studies have associated implant fractures or failures of
implant-supported prostheses with occlusal overload related to para-
functional habits or bruxism.7Y11 Bruxism is described as a diur-
nal or nocturnal parafunctional activity that includes clenching,
locking, and grinding between dental arches, characterized by re-
petitive (phasic) or sustained (tonic) contractions of the masticatory
muscles.12,13 In implant-supported rehabilitation treatment plan-
ning, bruxism should be considered a determining factor since the
consequences of parafunctional movements over dental implants
may compromise their longevity through marginal bone loss and the
impairment of osseointegration.
Considering the necessity of gaining knowledge of and dealing
with bruxism in patients with the necessity of implant-supported
prosthesis, this study aimed to systematically search and critically
review the literature to identify the factors that should be consid-
ered when planning implant-supported rehabilitations in subjects
with bruxism. A literature search was conducted using the Med-
line database from January 1949 to October 2011. Full papers or
reviews in English were included. The following search strategy
was employed using Mesh terms: ((((‘‘Dental Implants’’[Mesh])
OR ‘‘Dental Abutments’’[Mesh]) OR ‘‘Dental Prosthesis, Implant-
Supported’’[Mesh]) OR ‘‘Dental Implantation’’[Mesh]) AND
‘‘Bruxism’’[Mesh]. Among 62 retrieved documents, 3 full papers
and 8 reviews were included in this review. The excluded documents
were case reports, case series, or did not fit into the scope of this
review. A hand search was performed from the reference lists of
these included documents. This paper includes a discussion of topics
related to the etiology of bruxism and its impact on dental implants,
biomechanical considerations regarding implant overload, and guide-
lines for clinical practice.
ETIOLOGY OF BRUXISM AND ITS
INFLUENCE ON DENTAL
IMPLANT PLANNING
Bruxism is often considered a contraindication for implant ther-
apy.11 However, practical guidelines are available to minimize the
risk of failure. Although the etiology of bruxism is not yet well
established in the literature, there is a consensus about its multi-
factorial nature.13 Researchers used to believe that peripheral factors,
1905
Brief Clinical Studies The Journal of Craniofacial Surgery
mainly occlusal interference, were determinants in bruxism etio-
logy,14 with treatment based primarily on irreversible occlusal inter-
ventions15 or the use of occlusal splints.16,17 Nowadays, a minor role
has been attributed to peripheral factors,13 with increasing importance
of psychosocial (stress and level of education) and pathophysiolog-
ical (excitation during sleep and central nervous system disorders)
factors,18 which has resulted in the modification of treatment
recommendations.13
Some studies have sought to investigate the prevalence of symptoms
of emotional background and its association with bruxism. Emotional
stress and a high prevalence of bruxism in police officers has been
50.25%,19 with slightly more than half aware of the disease. Emotional
stress was observed in 45.69% of police officers, while almost half of
those said to grind their teeth during sleep or while awake. There was a
significant association between bruxism and emotional stress, regard-
less of the type of work performed by the professional. However, an-
other study20 pointed out that the prevalence of self-reported stress was
not significantly different in healthy or bruxer men.
Currently, the treatment of bruxism by conservative and revers-
ible measures has become a consensus among researchers.12,13
Thus, conflicting results regarding the clinical efficacy of occlusal
splints21,22 and a lack of knowledge about the potential mechanisms
that explain its apparent successful treatment for bruxism led to the
observation that these devices represent a nonspecific therapy.22
Thus, it has been suggested that occlusal splints are restricted to the
prevention and/or limitation of dental wear potentially induced by
bruxism.13,22,23
In a study performed in the USA in 1995,24 380 general dentists and
specialists were interviewed to determine what type of occlusal appli-
ance was most prescribed and the number of occlusal splints made in the
previous year for patients with bruxism. The results indicated that, on
average, 11 occlusal splints were indicated, and 14.5% of professionals
indicated soft occlusal devices only, while 59.4% used rigid devices.
Another study23 showed that 8% of dentists in Germany indicated soft
splints to bruxers, and 15% of specialists and 52% of generalists
presented mistaken scientific knowledge regarding the etiology of the
disease. This shows the need for continued education among dental
professionals concerning this disorder,23 as there is an increase in
electromyographic activity in bruxers who wear soft splints.16
OVERLOAD ON IMPLANTS
Nervous System Modifications After
Implant Placement
When tooth loss occurs, even when replaced by implants, mechano-
receptors present on the periodontal ligament are lost. Clinical studies
have clearly demonstrated that patients with oral implants have im-
portant missing or injured sensory-motor functions when the peri-
odontal receptors are removed during tooth extraction since the
functional reinnervation around implants is uncertain.18
Although it is important to consider the clinical consequences of
deficient motor control in the jaws of patients with oral implants,18
the number of studies evaluating the reflex function caused by the
stimulation of functional oral implants in animal and human models
is very limited.25 Nevertheless, it is known that some brain stem reflexes
cannot be caused by stimuli on implants. Thus, although at the histo-
logical level the innervation of the bone-implant interface increases
rapidly after implant installation, these free nerve endings do not trigger
a reflex when activated by low-intensity mechanical stimuli.18
Anatomical and Functional Alterations After
Implant Placement
Anatomically, it has been observed that natural teeth are narrower in
the anterior region of the mouth in relation to the posterior region,
1906
Copyright © 2012 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
& Volume 23, Number 6, November 2012
and the amount of force applied is lower in the anterior region. In
addition, the teeth increase in diameter in the premolars and again
in molar region, with an increasing volume of incident forces. To
support the higher loads in the posterior region, the number of roots
on natural teeth increases the more posterior they are located. These
factors result in a 300% increase in the surface area of molars com-
pared to anterior teeth.26
In contrast, most available implant systems have increased sur-
face area of only around 25% to 50% when the narrow and wider
diameters are compared.26 Thus, although large implants have a
greater surface area, it is lower compared to that of the natural posterior
teeth,27 which could explain the less efficient transmission of stress
between dental implants and the alveolar bone surface.
In addition, prosthetic loads may be different in partially eden-
tulous patients compared to edentulous patients and in the different
regions of the maxilla and mandible.28 A study evaluating single-
tooth implant prostheses found that implant fractures have occurred
only in the molar region and especially in the area of the first molar.29
In the posterior region, the combination of increased mechanical load,
buccolingual jaw movement, and the orientation of ridges and cusps
can originate excessive force obliquely.8
While the average masticatory occlusal force in a dentate subject
varies by around 450 to 550 N in the second molar region, the force
decreases to 200 and 300 N in patients with an implant-supported
removable prosthesis.30 However, the compressive strength of cor-
tical bone is approximately 100 MPa,31 and what causes bone loss
in the region of the alveolar crest is, to some extent, predictable in
patients rehabilitated by means of oral implants. A logical explana-
tion for this is the absence of the periodontal ligament in implants,
which is responsible for the absorption and dissipation of incident
forces to the alveolar bone.
Overload and Dental Implants on Bruxers
The limited proprioception around dental implants results in limited
jaw reflex response mechanisms and, consequently, the elevator
muscles.32 Thus, it is possible to assume that the forces applied to
the implants during bruxism are higher than those exerted during
chewing, which can cause an overload and the consequent failure
of the implant.11 Warning signs for the failure of osseointegrated
implants are recognized by loosening or fracture of screws or abut-
ments, swelling or bleeding of peri-implant soft tissues, purulent
exudate in the peri-implant pockets, superstructure fractures or
cracks, vertical bone loss radiographically observed, and chronic
infection and necrotic soft tissue during the healing phase after the
first-stage surgery. Pain has been reported as a rare symptom but
may be present.33
The forces imposed on dental implants are characterized by their
magnitude and direction. The stress forces directed obliquely outside
the long axis of the implant are considered the most harmful.34 In
vivo studies with subjects with dental implants have shown that
higher vertical load is received in the premolars during daily chewing,
ranging from 60 to 120 N (semisolid to solid food). It has also been
observed that the maximum intercuspal clenching between natural
teeth and implants results in maximum vertical forces of around
50 N on the implant.35
A study performed using finite element analysis showed that the
horizontal components of forces applied to a superstructure resulted
in moments of force ranging from about 90 N/mm for the palato-
buccal forces to about 170 N/mm for the buccolingual direction.
Thus, the forces in the buccolingual direction generated the highest
values of stress in the alveolar bone, reaching values greater than
6 MPa in the alveolar crest on its buccal surface. On the other hand,
mesiodistal forces resulted in a maximum tension of only 1 MPa.
However, the values of horizontal and vertical load on implants were
* 2012 Mutaz B. Habal, MD
The Journal of Craniofacial Surgery & Volume 23, Number 6, November 2012
measured considering conscious regular motor activity, while the
values for patients who presented unconscious motor activity and
bruxism are not yet well defined.36
Another factor that can cause overload is the inadequate design
of the prosthesis since a superstructure with cantilevers has been
associated with implant fractures.28,37 Authors have recommended
minimizing or, when possible, eliminating cantilevers, allowing the
directing of occlusal forces to the long axis of the implant.37,38 In
addition, lack of passive fit of prosthesis causes stress on the screw
combined with a constant shear load on the implant, predisposing
it to fracture, usually preceded by fracture or loosening of the
screw.7,28 A superstructure with nonpassive entry creates undesir-
able stress, which has often been linked to implant fractures.2,39,40 In
short, the diameter and length of implant,4,41Y43 thread pitch, and
shape surface-treated implants44 are morphological parameters that
affect load transfer characteristics.
Biomechanical Considerations
Severe bruxism modifies the normal chewing forces in duration
(hours rather than minutes), direction (lateral instead of axial), type
(shearing rather than compressive force), and magnitude (4 to 7 times
higher).45 The overload on dental implants leads to consequences
defined as biological and mechanical complications. Biological com-
plications can be divided into premature or late failure.5 In cases of
premature failure with insufficient osseointegration, the implant is
lost before the prosthetic treatment.11 However, a recent systematic
review46 concluded that implants that were immediately loaded
(within up to 2 weeks after surgery) failed more often than those
loaded in the conventional way but less frequently than those who
received early loading (6 to 8 weeks after surgery). Thus, it seems
more appropriate to indicate the use of immediate rather than early
loading since a high degree of primary stability is achieved. On the
other hand, premature failure can occur with immediate or early
loading in patients with bruxism.11
Late biological failures are characterized by pathological bone
loss after complete osseointegration. This bone loss is usually located
around the initial thread of the implant and is considered excessive
when it is greater than 0.2 mm per year, even after a year under
functional load.47 Animal studies have shown that dynamic overload
generated by the grinding of teeth results in severe angular bone loss.48
Mechanical complications occur when 1 or more implants fail,
which may occur by fracture of the prosthesis, loosening or fracture
of screws, loosening or excessive wear of overdenture components,
or excessive wear and fracture of porcelain or acrylic resin.49 The
loosening of screws is a frequent failure, especially when occlusal
forces exceed the stabilizing forces, which often occurs in cases of
overload generated by parafunction.50 Fractures of implants and
their components, though they are considered infrequent,49 have
been associated with overloads created by a combination of para-
functional stresses, cantilevers, posterior implant location and di-
ameter, bone resorption, and possible misfit in superstructures.7
Balshi7 divided the causes of implant or abutment fractures into
3 categories: defects in the design of the implant or material, non-
passive fit of prosthetic infrastructure, and physiological or bio-
mechanical overloads. A tendency for posterior contact during the
execution of eccentric bruxism and a consequent increase in trans-
lational forces may be relevant factors in this type of failure. Thus,
it has been suggested that, in bruxers, balanced bilateral contacts
may be modified for posterior disocclusion to avoid side contacts
in this region.9
From a biological and biomechanical perspective, even minor
occlusal discrepancies appear to be acceptable, and the occlusal
scheme on implant-supported restorations must be designed and
carefully balanced.35 In addition, premature occlusal contacts should
* 2012 Mutaz B. Habal, MD
Copyright © 2012 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Brief Clinical Studies
be avoided since their presence has been suggested as a possible
trigger of bruxism.14 In Tosun et al,9 a clinical study with sleep
bruxism patients, mutually protected occlusion was employed to-
gether with the use of occlusal splints during sleep. Although
patients continued to perform grinding, mechanical complications
were avoided by adopting occlusal schemes that uniformly distrib-
uted masticatory forces.
HOW TO REDUCE STRESS ON IMPLANTS
Rehabilitation Planning
When an implant-supported rehabilitation is considered in bruxers,
occlusal examination is essential. Premature and posterior contacts
during mandibular excursions increase the potential for excessive
loads on teeth and implants.51 Thus, it is important to emphasize
the importance of clinical evaluation and accurate anamnesis to
identify the disease and, hence, to improve the longevity of implant-
supported rehabilitation treatment.52
Regarding doubts about the load time determination, though a
recent systematic review1 has evaluated the load protocols for dental
implants and concluded that there is no predictability in the use of
immediate or early loading on dental implants, it is recommended
to use caution when using any of these techniques, especially in
bruxers. Although there is no conclusive scientific evidence that
bruxism causes overload on dental implants and their superstructure,
professionals should proceed cautiously when planning implant-
supported restorations in bruxers, mainly due to the severity of pos-
sible complications. All preventive measures should be aimed at
minimizing the forces that are applied to implants.11
A bruxer patient presents an increased risk of implant fracture
over time since the magnitude of forces increases as the muscles
become stronger. Therefore, when a source of additional load on the
implant is identified, the treatment plan must be changed to mini-
mize adverse effects on the alveolar bone, implant, and definitive
restoration.27
A significant number of general dentists still use irreversible
techniques such as occlusal adjustment, prosthetic restorations, or
orthodontic procedures for bruxism control, trying to act preven-
tively.12 However, these techniques are contraindicated, as there is
weak evidence to indicate the need for irreversible techniques in
bruxism control.21
Occlusal Devices
While a number of authors have reported the effectiveness of hard
occlusal stabilization devices, minimizing the damage caused by
parafunction on the oral tissues, clinical results have shown no
differences compared to other types of devices.17 The only exception
is soft splints. Studies have indicated that soft splints can increase
muscular activity in some patients with bruxism,16 although the
literature is still controversial.21 A recent systematic review showed
that rigid occlusal appliances can be effective in controlling pain in
patients with temporomandibular disorders.21 A clinical study53
evaluated the effect of rigid or soft occlusal appliances in subjects
without tooth loss. The use of soft occlusal splints led to a feeling of
muscle fatigue that was accompanied by a decrease in bite force after
removal of the device, while the use of rigid devices on natural teeth
did not cause tiredness or modification of the bite force.
When considering only natural teeth, nightguard occlusal splints
used on the upper arch can be a useful diagnostic tool in evaluating
occlusal disharmony and its relationship with sleep bruxism. These
devices also promote centric occlusal contacts along the arch and
posterior disocclusion during the anterior guidance at all mandibular
excursions and should be made of acrylic resin with a thickness of
0.5 to 1 mm on the occlusal surface. If the occlusal splint becomes
1907
Brief Clinical Studies The Journal of Craniofacial Surgery
worn in a month, the influence of occlusion in bruxism should be
directly observed in the patient. In this case, an occlusal adjustment
should have little influence on bruxism reduction, as a proper occlu-
sion provided by the splint failed to reduce the habit. If the acrylic
resin is not worn, the parafunction is reduced and occlusal protec-
tion becomes significant. Thus, the reconstruction or modification
of occlusal restorations is justified.27
In contrast to teeth, implants do not extrude in the absence of
occlusal contact. Thus, in partially edentulous patients, occlusal
devices can be relieved around implant-supported restorations, with
the remaining natural teeth supporting the entire load. Thus, the
implant is protected from any load incidence in both centric and man-
dibular excursions during the use of occlusal appliances.27
The teeth are more efficient in dealing with stress than occlusal
implants, ie, because of the periodontal ligament. A mandibular pos-
terior cantilever in an overdenture can also be maintained in infra-
occlusion during the use of occlusal splints. Although soft occlusal
splints are not indicated, when posterior implants are supporting a
maxillary fixed partial denture, a soft liner material can be used in
the relieved region of the occlusal splint and around the crowns to
alleviate stress and decrease the impact force.
However, when implant prostheses are in both the maxilla and
mandible, the splints must be made with occlusal contact only in
the anterior region during occlusion and mandibular excursions. The
amount of muscular force remains low while bilateral posterior areas
are out of occlusion, which decreases stress on implants.27 Rigid
stabilization splints contribute to optimally distributed loads and the
redirecting of incident vertical forces during night habits of grinding
and clenching.33,34,50
Number and Location of Implants
When rehabilitating bruxers, calculation of the number of implants
is mandatory since most authors have recommended more implants
than necessary to obtain favorable biomechanics.33,50 This recom-
mendation is justified by studies that indicate a reduction of forces
received on each implant individually when the number of implants
is increased.54 Nevertheless, considering the financial costs and the
irreversible nature of the placement of a greater number of implants,
a careful clinical decision-making process should be built into the
treatment plan. The mechanical union of 2 or more implants is also
an interesting measure, leading to better force distribution and stress
reduction in the bone around implants.55
The use of 1 implant for each absent element also avoids canti-
lever situations,33,50 reducing or eliminating the occlusal contacts in
lateral movements and reducing the risk of fractures.56 The proper
positioning and alignment of implants is also desirable to decrease
the incidence of nonaxial loads and the flexion of components of
the prosthesis-implant system.10 Regarding implant positioning, a
straight line may favor the incidence of fractures under severe oc-
clusal force.28 Furthermore, in patients who lack natural anterior
teeth and posterior teeth, a slight increase in the canine to eliminate
lateral torque on posterior implants may be advisable except when
poor alveolar bone supports a natural canine.38
Diameter, Length, and Connection of Implants
The use of implants with a diameter as large as possible should be
considered, as well as the longest length allowed by the remaining
bone to reduce stress in the cortical bone.4,6,10,41,42 The size directly
affects its resistance, and the formula that describes the fracture
resistance of solid metals with a diameter D is (P/4)ID4.57 Thus, if
the diameter is 2 times wider, the strength will be 16 times greater.
The larger-diameter implants not only have more surface area to
dissipate stress but are more resistant to fracture.27 These observa-
tions have been corroborated by the literature, which has shown that
1908
Copyright © 2012 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
& Volume 23, Number 6, November 2012
more implants with a larger diameter help to maintain tension on the
bone on the smallest possible magnitude.33
With respect to the implant/abutment connection, the implants
are hollow, so the fracture resistance of hollow tubular bodies has to
be considered using the formula P/4I(Ed4 j Id4), where Ed is the
outer diameter and Id is the inner diameter. Therefore, an increase
in the internal opening of the body of an implant decreases the
implant resistance to the fourth part. Thus, an implant with an in-
ternal hexagon connection with the largest internal diameter avail-
able is 40% less resistant compared to an external hexagon implant
with the same diameter. This makes an external hexagon more in-
dicated in patients with bruxism.27 It is important to highlight,
however, that clinical trials have not yet considered the use of the
Morse taper in patients with bruxism.
Prosthesis Design
Prostheses should be designed with the purpose of improving the
stress distribution on implants, ie, implants must be installed per-
pendicularly to the curves of Spee and Wilson to favor direct con-
tacts generated during the vertical function to the long axis of the
implants.45 Occlusal contacts must be precise on the antagonist arch
and carefully informed to laboratory technicians in all laboratory
steps.27
The occlusal surfaces of posterior teeth can be reduced from the
palatal surface of maxillary implants or the buccal surface of man-
dibular implants to prevent excessive lateral forces to reduce tension
during chewing, leaving more space for the tongue and cheek. The
cusp slope reduction of antagonistic natural teeth has often been
indicated to improve vertical force distribution on implants.27 Most
authors agree that prosthetic rehabilitation must provide single-point
contact close to the implant center whenever possible. The articu-
lation shall be marked by cusps with mild slopes to protect the
implant system against the transverse components of forces that are
common during the gnashing of teeth.34
CONCLUSIONS
The rehabilitation of bruxer patients through the use of implants is
a feasible alternative when implants present adequate length and di-
ameter and correct positioning, reducing the risk of treatment failure.
However, control of bruxism manifestations is important, and the
use of a hard occlusal stabilization splint relieved in the region of
the implants during sleep is recommended. In addition, before any
treatment is conducted, patients should be warned about the need for
regular maintenance to avoid complications and accept the possi-
bility of technical complications that may generate additional costs
of maintenance in either implant-supported or implant-retained crowns
in partial or complete dentures.
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