See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/321843102

Evaluation of the Periodontal Status of Abutment Teeth in Removable Partial

Dentures

Article  in  The International journal of periodontics & restorative dentistry · December 2017

DOI: 10.11607/prd.2855

CITATIONS READS

2 1,345

5 authors, including:

André Correia Filipe Araújo

Faculdade de Medicina Dentária da Universidade Católica Portuguesa Universidade Católica Portuguesa
170 PUBLICATIONS   315 CITATIONS    48 PUBLICATIONS   64 CITATIONS   

SEE PROFILE SEE PROFILE

Tiago Miguel Marques

Universidade Católica Portuguesa
122 PUBLICATIONS   55 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Soft Tissue Grafting View project

Digital Dentistry View project

All content following this page was uploaded by Tiago Miguel Marques on 14 February 2018.

The user has requested enhancement of the downloaded file.

 1

Evaluation of the Periodontal Status of

Abutment Teeth in Removable
Partial Dentures

André Ricardo Maia Correia, DMD, PhD1 Removable partial denture (RPD)
Fábio Daniel da Silva Lobo, DMD2 is an effective treatment option for
Mónica Célia Pereira Miranda, DMD3 partially edentulous patients when
Filipe Miguel Soares Framegas de Araújo, DMD4 the treatment plan and prosthe-
Tiago Miguel Santos Marques, DMD5 sis design and manufacturing are
correctly performed based on the
The purpose of this study was to evaluate whether the use of removable partial partial edentulism present and the
dentures affects the periodontal status of abutment teeth. An observational cross- status of the hard and soft tissues of
sectional study was done on a sample of patients rehabilitated with removable the oral cavity. If the biomechanical
partial dentures (2010 to 2013). At a recall appointment, a clinical examination
principles of the rehabilitation are
was done to collect data related to the rehabilitation and periodontal status of
the abutment teeth. Of 145 invited patients, 54 attended the requested follow-up not respected and oral hygiene is
appointment (37.2%). Mean patient age was 59.1 years, and the study population not good, there is an increased risk
was 42.6% male and 57.4% female. The mean follow-up time for the prosthesis of periodontal disease and dental
was 26 months. Abutment teeth had higher values in all periodontal variables caries in the abutment teeth that
(P < .001). Occlusal clasps had the worst results in relation to clasps with a gingival may ultimately lead to a failure of
approach (P < .005). Significant differences were also found in mandibular
the prosthetic rehabilitation.1–13
abutment teeth of Kennedy Class I and II compared to Class III (P < .048).
The periodontal status of the abutment teeth of removable partial dentures is Several types of RPD designs
affected by these rehabilitations. A recall program for these patients involving associated with insufficient oral hy-
removable prosthodontics and periodontology appointments is mandatory. giene and low frequency of regular
Int J Periodontics Restorative Dent 2017 (6 pages). doi: 10.11607/prd.2855 appointments may raise or change
the bacterial flora present in the
oral cavity, promoting an increase
of plaque formation. The plaque
increase can impair the abutment
teeth/periodontal support in di-
rect contact with the prosthesis.
Patients with regular follow-up af-
Chair of the DMD Course, Head of Oral Rehabilitation Sciences, Institute of
1
ter RPD placement showed less
Health Sciences – Viseu, Universidade Católica Portuguesa, Porto, Portugal.
2Private Practice, Paris, France.
plaque accumulation and gingival
3Private Practice, Aveiro, Portugal. bleeding.11,12,14,15
4Lecturer of Removable Prosthodontics, Integrated Master in Dental Medicine, Institute of
The aim of this study was to
Health Sciences – Viseu, Universidade Católica Portuguesa, Porto, Portugal. evaluate whether the use of RPD af-
5Lecturer of Periodontology, Integrated Master in Dental Medicine, Institute of Health

Sciences – Viseu, Universidade Católica Portuguesa, Porto, Portugal.

fects the periodontal status of the
abutment teeth when compared
Correspondence to: Dr André Ricardo Maia Correia, Institute of Health Sciences – Viseu, to nonabutment teeth and if there
Universidade Católica Portuguesa, Estrada da Circunvalaçao, 3504-505, Viseu, Portugal.
was any relationship between the
Fax: +351 232428344. Email: acorreia@viseu.ucp.pt
type of edentulism and the clinical
 ©2018 by Quintessence Publishing Co Inc. periodontal parameters examined.

doi: 10.11607/prd.0000

© 2017 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
2

sis), regular (presence of a visible

145 patients with RPD done between plaque film on the denture surface
2010 and 2013 contacted by phone or detected with a probe), and bad
(abundance of soft matter on the
46 did not answer phone denture surface).
All the RPDs were done accord-
99 patients invited to ing to the teaching methodology of
follow-up appointment
the Unit. All teeth included as abut-
ments were considered capable of
27 declined invitation
withstanding the support, stabil-
ity, and retention of the prosthesis.
72 patients (49.7%) accepted
All teeth were periodontally stable.
Restorations of abutment teeth
16 did not attend appointment
were not considered an excluding
factor, as long as the restoration ful-
56 patients (38.6%) attended
follow-up appointment and were filled all its biologic and functional
clinically evaluated criteria. None of the abutment teeth
had full-contour crowns.
2 were excluded due to
systemic disease The same dental technician did
the RPDs, and the frameworks were
54 patients (37.2%) were all done in a cobalt-chromium alloy.
included in the study
To verify the periodontal sta-
tus of abutment and nonabutment
Fig 1  Flowchart of the recall appointment procedure. teeth, a periodontal examination
was conducted, following the meth-
odology described by Zlatarić et al.5
The periodontal variables analyzed Prosthodontics Unit of the Univer- The following variables were deter-
in this study were probing depth sity Clinic of the Catholic University mined:
(PD), gingival recession (GR), Plaque of Portugal, in Viseu, between 2010
Index (PI), tooth mobility (TM), and and 2013 were contacted by phone • Plaque Index (PI) was assessed
Gingival Index (GI), which were mea- and invited to participate in the according to the Silness/Loe
sured on abutment and nonabut- present study. Of these patients, 54 Index.18
ment teeth. (37.2%) were enrolled in the study • Gingival Index (GI): assessing
(Fig 1). the state of gingival
The measurements were done inflammation. Measurements
Materials and Methods by a single examiner according to were conducted at six points
the methodology described by of the tooth, and the results
The research methodology was Zlatarić 5 to reduce bias. were considered according
accepted by the local ethics com- For each patient the following the following criteria: 0 – no
mittee of the Health Sciences De- data was collected: RPD hygiene, bleeding when a probe is
partment of the Catholic University RPD habits of use, and Kenne- passed along the gingival
of Portugal, and written consent was dy partial edentulism classifica- margin; 1 – isolated bleeding
obtained from each patient. tion.16,17 The hygiene classification spots visible; 2 – blood forms a
A total of 145 patients with was determined as follows: good confluent red line in the margin;
RPD performed in the Removable (no plaque on the dental prosthe- 3 – heavy or profuse bleeding.19

The International Journal of Periodontics & Restorative Dentistry

© 2017 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
 3

Table 1 Distribution by Table 2 Distribution by Prosthesis Use

Hygiene of Prosthesis To leave home During meals During the day At all times
n % n % n % n % n %
Bad 20 37.0 Maxillary 2 4.9 2 4.9 33 80.5 4 9.8
Regular 29 53.7 RPD
Good 5 9.3 Mandibular 2 4.2 4 8.3 39 81.2 3 6.2
Total 54 100.0 RPD

• Probing pocket depth (PD)

Table 3 Distribution by Kennedy Classification
was measured at six points of
the tooth from the crest of the Class I Class II Class III Class IV
gingival margin to a probable n % n % n % n %
pocket depth using a Williams Maxillary 8 19.5 16 39.0 17 41.5 0 0.0
Probe, and the highest value Mandibular 21 43.8 8 16.7 19 39.6 0 0.0
was recorded for each tooth.5
• Gingival recession (GR) was
measured at six points of the
tooth from the cementoenamel To compare the distributions in the ber of abutment and nonabutment
junction to the gingival margin, variables with three or more sam- teeth to ease statistical analysis, it
and the highest value was ple groups, analysis of variance or was found that most patients had 5
recorded for each tooth.5 its nonparametric equivalent, the to 8 abutment teeth (59.3%; n = 32).
• Tooth mobility (TM) was Kruskal-Wallis test, was used. P < .05 On the other hand, most of the pa-
recorded according to a scale was considered significant. tients had 9 to 12 nonabutment
from 0 to 3: 0 – no mobility; Statistical analysis was done teeth (31.5%; n = 17), followed by
1 – < 1 mm movement in the using IBM SPSS Statistics version 13 to 16 (25.9%; n = 14) and 4 to 8
horizontal plane; 2 – > 1 mm 21.0.0 and Microsoft Excel. (24.0%; n = 13).
movement in the horizontal The great majority of patients
plane; 3 – movement in the had regular hygiene for the prosthe-
apical direction.5 Results sis (Table 1). Most patients used the
prosthesis correctly, using it during
Study Population and Dentures the day and removing it overnight
Data Analysis Characteristics (Table 2). A total of 41 maxillary
and 46 mandibular RPDs were ex-
Several descriptive statistics (abso- Of the 145 contacted patients, 54 amined. The most prevalent type
lute and relative frequencies, aver- were included in this study (37.2%). of partial edentulism was Kennedy
ages, standard deviation, maximum There were 23 males (42.6%) and 39 Class III (Table 3). The mean time of
and minimum values) were calculat- females (57.4%) with a mean age of RPD use was 2.2 years.
ed for each variable. For each of the 59.09 ± 11.12 years.
quantitative variables, assumption A total of 87 RPDs were exam-
of normal distribution was analyzed ined, and each RPD was considered Clinical Periodontal Parameters
using Kolmogorov-Smirnov test, a statistically independent case.
considering that adherence to nor- When distributing the sample Comparing abutment teeth with
mality was ensured when P > .05. by groups according to the num- nonabutment teeth, it was possible

doi: 10.11607/prd.0000

© 2017 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
4

Only the mobility of mandibular

Table 4 Comparative Analysis of Periodontal Variables of
abutment teeth showed statistically
Abutment Teeth Compared to Nonabutment Teeth
significant differences (P = .048).
Mean SD Max Min P The mandibular abutment teeth
PD abutment (mm) 3.21 0.82 5.88 2.00 < .001 classified as Kennedy Class I and II
PD nonabutment (mm) 2.25 0.52 3.50 1.17 showed higher values compared to
GR abutment (mm) 1.83 1.20 4.50 0.00 < .001 Kennedy Class III (Table 7).
GR nonabutment (mm) 0.87 0.92 5.50 0.00
PI abutment 1.90 0.54 3.00 1.00 < .001
Discussion
PI nonabutment 1.49 0.52 3.00 0.92
TM abutment 0.52 0.43 1.50 0.00 .011
This study was performed to com-
TM nonabutment 0.39 0.42 2.00 0.00
pare five periodontal variables (PD,
GI abutment 1.77 0.61 3.00 0.75 < .001 GR, PI, GI, and TM) between the
GI nonabutment 0.89 0.56 3.00 0.00 abutment teeth of a RPD and non-
PD = pocket probing depth; GR = gingival recession; PI = Plaque Index; abutment teeth. Statistically signifi-
TM = teeth mobility; GI = Gingival Index.
cant differences were found for all
variables (P < .001). The mean PD,
Table 5 Comparative Analysis of Periodontal Variables of GR, PI, TM, and GI were significantly
Abutment Teeth with Occlusal Clasps and higher for the abutment teeth when
Abutment Teeth with Gingival Clasps compared with the average ob-
tained for the nonabutment teeth.
Mean SD Max Min P
A study with a similar methodol-
PD occlusal clasps (mm) 3.43 0.96 2.00 7.00 .002
ogy by Zlatarić et al5 noted that the
PD gingival clasps (mm) 2.96 0.83 2.00 6.00 values obtained for the abutment
GR occlusal clasps (mm) 2.05 1.29 0.00 5.00 .037 teeth were significantly higher for
GR gingival clasps (mm) 1.61 1.29 0.00 5.00 all periodontal variables when com-
PI occlusal clasps 2.10 0.57 1.00 3.00 < .001 pared with the values obtained for
PI gingival clasps 1.67 0.67 1.00 3.00 nonabutment teeth. Amaral,20 after
TM occlusal clasps 0.56 0.42 0.00 1.60 .770 a longitudinal assessment over 12
TM gingival clasps 0.54 0.59 0.00 2.00 months of periodontal condition
GI occlusal clasps 2.02 0.78 0.00 3.00 .003 of the abutment and nonabutment
teeth in patients with RPD, found
GI gingival clasps 1.47 0.93 0.00 3.00
that the abutment teeth showed
PD = pocket probing depth; GR = gingival recession; PI = Plaque Index;
TM = teeth mobility; GI = Gingival Index. higher values for PD, GR, GI, and PI.
Yeung et al11 showed that there was
a higher prevalence of plaque, gin-
to verify that the values of all peri- to the abutment teeth with gingival givitis, and gingival recession, espe-
odontal parameters (PD, GR, PI, GI, clasp (P < .01) (Table 5). cially on surfaces in proximity to the
and TM) showed statistically signifi- No statistically significant dif- RPD elements (< 3 mm).
cant differences, with worst results ferences were found for any of However, there is no consensus
for the abutment teeth (Table 4). the variables when relating Ken- in the literature regarding possible
The mean PD, GR, PI, and GI nedy classes with periodontal vari- harm that RPD might cause to the
were superior for the abutment ables for maxillary abutment teeth periodontal health of the remain-
teeth with occlusal clasp compared (P > .05) (Table 6). ing teeth. Vanzeveren et al10 did not

The International Journal of Periodontics & Restorative Dentistry

© 2017 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
 5

obtain statistically significant differ-

Table 6 Descriptive Statistics for PD, GR, and TM of
ences when comparing the values
Maxillary Abutment Teeth in Each Kennedy Class and
obtained for the abutment teeth
Comparison Tests of Distribution
and nonabutment teeth. Piwowarc-
zyk et al21 did not find differences Maxillary Kennedy Classification
in terms of PD but obtained differ- I (n = 8) II (n = 16) III (n = 17) IV (n = 0) P
ences in TM. PD abutment teeth (mm)
In the present study, no statisti-  Mean 3.15 3.47 3.35 – .738
 SD 1.06 1.05 0.81 –
cally significant results were obtained  Max 4.50 6.00 5.60 –
(P > .05) for PD, GR, and TM in the  Min 2.00 2.00 2.30 –
mandibular abutment teeth with dif- GR abutment teeth (mm)
ferent Kennedy classifications. How-  Mean 2.30 1.50 1.52 – .291
 SD 1.57 0.91 1.38 –
ever, in repeating the procedures  Max 4.30 3.00 3.50 –
for the mandibular abutment teeth  Min 0.00 0.00 0.00 –
it was found that TM was signifi- TM abutment teeth
cantly influenced (P < .05). Kennedy  Mean 0.71 0.61 0.67 – .972
 SD 0.64 0.41 0.52 –
Class I and II had the highest values  Max 1.70 1.30 2.00 –
compared to patients with Class III,  Min 0.00 0.00 0.00 –
which can be explained by the fact PD = pocket probing depth; GR = gingival recession; TM = tooth mobility.

that these rehabilitations have free

saddles. If these saddles are not con-
trolled and properly adjusted over Table 7 Descriptive Statistics for PD, GR, and TM of
time, a lever effect can be exerted by Mandibular Abutment Teeth in Each Kennedy Class and
this distal part of the prosthesis over Comparison Tests of Distribution
the abutment teeth. Using a different Mandibular Kennedy Classification
methodology, Jorge et al7 observed I (n = 21) II (n = 8) III (n = 19) IV (n = 0) P
changes in the TM values of the abut-
PD abutment teeth (mm)
ment teeth in patients with Kennedy  Mean 3.03 3.26 3.30 – .911
Class I, II, and III over a period of 6  SD 0.87 0.57 0.75 –
 Max 6.00 4.00 4.75 –
months using the Periotest. There  Min 2.00 2.30 2.30 –
were minimal changes with increased
GR abutment teeth (mm)
mobility of the abutment teeth, par-  Mean 2.63 2.10 1.68 – .054
ticularly in Kennedy Class I and II.  SD 1.45 1.08 0.89 –
 Max 5.00 4.00 3.30 –
The results obtained in the  Min 0.00 0.30 0.30 –
present study can be explained by TM abutment teeth
higher plaque accumulation values,  Mean 0.78 0.50 0.33 – .048
demonstrated in the high PI values  SD 0.61 0.41 0.37 –
 Max 2.00 1.00 1.00 –
for the abutment teeth, that conse-  Min 0.00 0.00 0.00 –
quently led to an increase in inflam- PD = pocket probing depth; GR = gingival recession; TM = tooth mobility.
mation of the gingival margin, also
demonstrated by a higher GI in the
abutment teeth.
The present study also evaluat- teeth with occlusal clasps and those had statistically significant differ-
ed possible differences in periodon- with gingival approach clasps. All ences, with the worst results for the
tal variables between abutment periodontal variables except TM abutment teeth with occlusal clasps.

doi: 10.11607/prd.0000

© 2017 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
6

Jorge et al22 compared the results Acknowledgments 11. Yeung AL, Lo EC, Chow TW, Clark RK.
obtained for TM of abutment teeth Oral health status of patients 5-6 years
after placement of cobalt-chromium re-
with occlusal clasps and gingival ap- The authors reported no conflicts of interest movable partial dentures. J Oral Rehabil
proach clasps and found no statisti- related to this study. 2000;27:183–189.
12. Wagner B, Kern M. Clinical evaluation
cally significant differences. of removable partial dentures 10 years
The periodontal variable with after insertion: Success rates, hygienic
the most statistically significant dif- References problems, and technical failures. Clin
Oral Investig 2000;4:74–80.
ference was PI (P < .001). As men- 13. Dula LJ, Ahmedi EF, Lila-Krasniqi ZD,
tioned in the literature,23 the authors  1. Preshaw PM, Walls AW, Jakubovics NS, Shala KSh. Clinical evaluation of remov-
Moynihan PJ, Jepson NJ, Loewy Z. Asso- able partial dentures on the periodontal
of the present study believe this health of abutment teeth: A retrospec-
ciation of removable partial denture use
may be associated with a greater with oral and systemic health. J Dent 2011; tive study. Open Dent J 2015;9:132–139.
accumulation of plaque related to 39:711–719. 14. Akaltan F, Kaynak D. An evaluation of the
 2. Bilhan H, Erdogan O, Ergin S, Celik M, effects of two distal extension remov-
the clasp design. The two arms in Ates G, Geckili O. Complication rates able partial denture designs on tooth
the occlusal clasps (retentive and re- and patient satisfaction with remov- stabilization and periodontal health.
able dentures. J Adv Prosthodont 2012; J Oral Rehabil 2005;32:823–829.
ciprocal) have more surface area in 15. Müller S, Eickholz P, Reitmeir P, Eger T.
4:109–115.
contact with the tooth, which may   3. Budtz-Jørgensen E. Age-related chang- Long-term tooth loss in periodontally
promote more plaque accumulation es in the masticatory apparatus. In: compromised but treated patients ac-
Prosthodontics for the Elderly: Diagnosis cording to the type of prosthodontic
when compared to the simple gingi- and Treatment. Chicago: Quintessence, treatment. A retrospective study. J Oral
val clasp design. 1999:23–48. Rehabil 2013;40:358–367.
 4. Mine K, Fueki K, Igarashi Y. Microbio- 16. Carr AB, Brown DT, McCracken WL (eds).
The main limitation of this study Classification of partially edentulous
logical risk for periodontitis of abutment
was related to the sample size and teeth in patients with removable par- arches. In: McCracken’s Removable Par-
its source. Further work should be tial dentures. J Oral Rehabil 2009;36: tial Prosthodontics, ed 12. St Louis: Else-
696–702. vier Mosby, 2011:15–20.
done with a larger sample to obtain   5. Zlatarić DK, Celebić A, Valentić-Peruzović 17. Phoenix RD, Cagna DR, DeFreest CF.
conclusions that could be extrapo- M. The effect of removable partial den- Introduction and classification. In: Stew-
tures on periodontal health of abutment art’s Clinical Removable Partial Prosth-
lated to the general population. odontics, ed 3. Chicago: Quintessence,
and non-abutment teeth. J Periodontol
2002;73:137–144. 2003:1–18.
 6. Priest G. Revisiting tooth preservation 18. Löe H. The gingival index, the plaque
in prosthodontic therapy. J Prosthodont index and the retention index systems.
Conclusions 2011;20:144–152. J Periodontol 1967;38(suppl):s610–s616.
 7. Jorge JH, Giampaolo ET, Vergani CE, 19. Newbrun E. Indices to measure gingival
Machado AL, Pavarina AC, Cardoso de bleeding. J Periodontol 1996;67:555–561.
Within the limitations of this study, it 20. Amaral BA. Avaliação Clínica Longitu-
Oliveira MR. Clinical evaluation of abut-
can be concluded that no relation- ment teeth of removable partial den- dinal do Periodonto de Dentes Pilares
ship exists between partial eden- ture by means of the Periotest method. e Não Pilares de Próteses Parciais Re-
J Oral Rehabil 2007;34:222–227. movíveis [thesis]: Natal: Universidade
tulism type and RPD abutments in  8. Patel PM, Lynch CD, Sloan AJ, Gilmour Federal Rio Grande do Norte, 2007.
PD and GR, lower abutments had a AS. Treatment planning for replacing 21. Piwowarczyk A, Köhler KC, Bender R,
missing teeth in UK general dental prac- Büchler A, Lauer HC, Ottl P. Prognosis
higher average mobility in Kennedy for abutment teeth of removable den-
tice: Current trends. J Oral Rehabil 2010;
Classes I and II, the periodontal sta- 37:509–517. tures: A retrospective study. J Prostho-
tus of abutment teeth is more com-  9. Frechette AR. The influences of partial dont 2007;16:377–382.
denture design on distribution of force 22. Jorge JH, Quishida CC, Vergani CE,
promised than that in nonabutment to abutment teeth. 1956. J Prosthet Dent Machado AL, Pavarina AC, Giampaolo
teeth, and the periodontal status of 2001;85:527–539. ET. Clinical evaluation of failures in re-
10. Vanzeveren C, D’Hoore W, Bercy P. In- movable partial dentures. J Oral Sci 2012;
abutment teeth with occlusal clasps 54:337–342.
fluence of removable partial denture on
is more compromised than in gingi- periodontal indices and microbiological 23. Carr AB, Brown DT, McCracken WL (eds).
val approach clasps, except for TM. status. J Oral Rehabil 2002;29:232–239. Direct retainers. In: McCracken’s Remov-
able Partial Prosthodontics, ed 12. St
Louis: Elsevier Mosby, 2011: 67–95.

The International Journal of Periodontics & Restorative Dentistry

© 2017 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
View publication stats NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.