IPR2017-01829, No. 1021 Exhibit - Exhibit 1021 (P.T.A.B. Jul. 20, 2017) (2024)

`

`
`Herausgeber; H. W. Haase
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`
`Inhalt
`
`B. Kuen Cha/ R.-R. Miethke / P-G. Jost-Brinkmann
`Mehr HygienemaBnahmensind angebracht —
`Patienten erwarten es
`
`V. Cacciafesta / R.-R. Miethke / B.-G. Jost-Brinkmann
`Bending Art System — State of the art and first impressions
`
`Ch. Opitz/ P. Ring/ D. Subklew
`Auswirkungen der praoperativen kieferorthopadischen Beeinflussung der
`Préimaxilla-Position auf das Wachstum bei Patienten mit doppelseitigen
`Lippen-Kiefer-Gaumenspalten - eine Longitudinaluntersuchung
`
`M. Korn
`
`Interview: A new aspect in orthodontics: Posture!
`
`P-G. Jost-Brinkmann
`Kurskritik: Scherpf, Organisierte Systematische Individualprophylaxe —
`Basis einer zukunftsorientierten Zahnheilkunde
`
`P-G. Jost-Brinkmann
`Buchbesprechung: Stein/Specke, Handbuch der zahnmedizinischen
`Gruppenprophylaxe
`
`M. Zellmann
`
`Buchbesprechung: Akademie Praxis und Wissenschaft in der DGZMK,
`Kinderzahnheilkunde
`
`paneneneen
`
`November 1995
`
`
`
`
`
`235
`
`247
`
`255
`
`275
`
`287
`
`293
`
`295
`
`297
`Fortbildungsveranstaltungen
`
`
`Beilage dieser Ausgabe(nur Inland):
`Quintessenz Verlags-GmbH,Berlin (2 Beilagen)
`Edition q Verlags-GmbH,Berlin
`
`233
`
`ClearCorrect Exhibit 1021, pg. 2
`
`ClearCorrect Exhibit 1021, pg. 2
`
`

`

`Cacciafesta et al, Bending Art System
`
`Kieferorthop 9: 247-254, 1995
`
`Bending Ari System — State of the art
`andfirst impressions
`
`The Bending Art System is the first computer aided device for bending individual orthodontic arch-
`wires. It consists of three components: a(n)(intraoral) stereoscopic camera, « computer program and
`a wire bending unit. Thus,it allows to manufacture individual archwires with Ist, 2nd and 3rd order
`bends, which have provento be very accurate,After exact registration of the bracket position andits
`confirmation bythe user the resulting occlusal scans of the maxillary and mandibular dental arches
`are displayed on the computer monitor. The orthodontist then determines tooth by tooth the desired
`three dimensional tooth position which in turn produces the appropriate wire design.
`(Kieferothop 9: 247-254, 1995)
`
`Key words: Bending Art System, computer aided design, computer aided manufacturing,
`orthodontic wire bending, individual archwires
`
`
`‘This material may beprotected byCopyrightlaw (Title 17 U.S. Code)
`
`
`
`
`
`
`Vittorio Cacciafesta
`Odontoiatra
`
`Rainer-Reginald
`Miethke
`Prof. Dr. med. dent.
`
`Paul-Georg
`Jost-Brinkmann
`Dr. med. dent.
`Abteilung fiir Kieferorthapadie
`und Orthodontie
`Zentrum fiir Zahnmedizin
`Universitatsklinikum Charité
`Medizinische Fakultat der
`Humboldt-Universitdt zu Berlin
`Address:
`Féhrer Stra8e 15
`13353 Berlin
`
`
`
`Introduction
`
`During the last 20 years the use of computers
`has become more and more popular in all areas
`of our life including orthodontics. The reasons
`for this are due to the ever decreasing price of
`hardware, coupled with an increased efficiency
`of those machines, which have also become
`easier to handle. Furthermore, the reservation
`against these devices, which still partly exists,
`has declined ®.
`In 1993 Josf-Brinkmann and Miethke evaluated
`the role of computers at present and in the
`future, asking computer specialists in Japanese
`and German orthodontic departments about
`their electronic data processing resources and
`how according to their opinion they would pos-
`sibly develop within the next 10 years. The spe-
`cialists were also asked if they could imagine
`that an orthodontic archwire bending device
`would be constructed within the near future,
`and one third of them was positive.
`The first idea for the Bending Art System (BAS)
`came from Prof. Dr. Fischer-Brandies and Dr.
`Orthuber in 1984. Together with the Geyer
`Company * they developed both a(n) (intraoral)
`camerato register the exact three dimensional
`bracket position and the software, which en-
`ables the orthodontist to design an appropri-
`ate archwire®. In 1993 the first prototype of the
`
`BAS was manufactured andsince 1994, only im-
`provements of the software were carried out.
`The Straight Wire Appliance (SWA)is the most
`widely used technique in orthodontics. All wire
`bends in the three dimensions of space are
`replaced by a sophisticated bracket
`(band
`attachment) design. However, onlyif all brack-
`ets of a SWA are in their optimal position on
`ideally configurated teeth, an archwirewithjust
`the 2nd order archwire form would bring all
`ieeth of a jaw into their perfect position 7,
`Since the above mentioned two prerequisites
`are seldom fulfilled, individual bending of arch-
`wires or repositianing of brackets become often
`necessaryto fully meet the needs of a superior
`treatment result.
`To use a computer to fabricate archwires has
`most of all the advantage to accomplish all
`bends with utmost accuracy thus even over-
`coming inadequate dexterity.
`
`Components of the Bending Art System
`
`The BAS consists of three components: a(n)
`(intraoral) camera, a computer (program) anda
`bending machine. As a wholeit is designed in
`modules. That means all components havetheir
`own housings and are connected only by
`cables. Therefore, if a problem occurs with one
`of the components, it can be easily exchanged
`(no more than 30 minutes).
`
`Manuscript received: X/3/1995
`
`* Geyer Medizintechnik, D-10961 Berlin.
`
`
`
`247
`
`ClearCorrect Exhibit 1021, pg. 3
`
`

`

`Cacciafesta et al., Bending Art System
`
`
`
`Kieferorthop 9: 247-254, 1995
`
`
`
`(Intraoral) stereoscopic camera withslim glass case that protects
`Fig. 1:
`the camera's mirror and allows it to be desinfected.
`
`Partial scans of the right and left sides of a dental arch are joined
`Fig. 2:
`together by the system. and displayed as one occlusal photograph.
`
`Stereoscopic camera
`
`The CCD (charge coupled device) camera pro-
`duces occlusal scans of the upper or lower den-
`tal arch intraorally as well as from model casts
`of a patient. The surface of the camerais pro-
`tected by a thin glass case (Fig. 1).
`To program any wire it always takes an image
`of the right and left side of a given arch. These
`partial scans of both sides of a jaw arelater
`combined by the computer program so that
`only one occlusal photograph is displayed on
`the monitor (Fig. 2). The time needed for scan-
`ning one quadrantis approximately 4 seconds.
`During this time the camera's mirror moves four
`times: the first forward movement is at 25°, the
`first backward one at 5°, whereas the second
`cycle only is a repetition of the first one which
`allows to detect movements of
`the patient
`during scanning (Fig. 3).
`According to the patient's position the camera can
`be rotated and adjusted in height. The camera
`works with a normal electric light source, whichis
`installed in the camera's body.It also should be
`pointed outthat the stereoscopic camera does not
`take a real three dimensional scan of the dental
`arch. The reason is that this would require too
`muchtime (at least 20 minutes per jaw).
`248
`
`For taking intraoral pictures, the glass case is
`inserted into the mouthof the patient so that the
`occlusal surfaces of the upper or lower teeth
`contact it. At the same time the patient's fore-
`head is supported by two posts with forked
`extensions the ends of which have a ball like
`configuration and are cushionedwith soft latex
`(Fig. 4. and b).
`Before taking the occlusal scans, measuring
`plates must be inserted into the bracket slots
`and secured byelastic ligatures(Fig. 5).
`These stainless steel measuring elements, which
`are available for 0.018” or 0.022” bracket
`systems, are used to calculate the angulation,
`torque and rotation of every individual bracket
`irrespectiveof its type. This becomesfeasible by
`four reference punch marks, which are to be
`identified by the user during the registration
`process (Fig. 6 to 8).
`the stereoscopic camera
`On the image of
`depicted on the monitor the orthodontist con-
`firms per mouseclick the position of all ref-
`erence marks on the measuring plates which
`are always primarily suggested by the com-
`puter. Consequently,
`the computer program
`exactly calculates angulation and torque of the
`bracketslot, relative to the occlusal plane as the
`common reference.
`
`ClearCorrect Exhibit 1021, pg. 4
`
`ClearCorrect Exhibit 1021, pg. 4
`
`

`

`Cacciafesta et al., Bending Art System
`
`Kieferorthop 9: 247-254, 1995
`
`Schematic illustration of
`Fig.3:
`movements of the BAS-camera’s
`mirror at different angulations
`providing the basis for calculat-
`ing the third dimension.
`
`Position of the
`Fig.4a and b:
`patient during exposure;
`a: occlusal view,b: lateral view.
`
`Insertion and ligation of
`Fig.5:
`the measuring plates into the
`
`bracketslots (typodont).
`
`camera.
`andfirst molar tubes.
`
`Fig.6: Measuring plates of
`different sizes for brackets:
`small, medium, large. The upper
`left measuring plate is extended
`buccally to serve in teeth which
`are extremely displaced, that
`is to say in teeth where the
`bracket/ measuring plate may
`be in an undercut area for the
`
`Typodontwith the
`Fig.8:
`measuring plates correctly
`inserted into the bracket slots
`
`Fig.7: Measuring plates for molar tubes. The upper
`plates are again extended buccally for the same
`reason as mentioned in legendof figure 6. They can
`be regarded as the measuring plates mostly used,
`
`249
`
`ClearCorrect Exhibit 1021, pg. 5
`
`ClearCorrect Exhibit 1021, pg. 5
`
`

`

`
`
` ae
`
`
`Fig. 9:
`picture.
`
`List and choice of the ideal arch shapes directly on the occlusal
`
`bending-head
`
`wire
`
`bending-
`cone
`
`holding
`—— mechanism
`
`|
`
`guicling-
`cone
`
`Waowmiolms(ellal=bs
`cone
`
`Fig. 10: Components of the bending unit.
`
`Cacciafesta et al., Bending Art System
`
`Kieferorthop 9: 247-254, 1995
`
`Computer program
`
`The software was exclusively developed by the
`Geyer Company in cooperation with the Uni-
`versity of Kiel to meet the orthodontist's needs.
`The database is based on SQL.
`After the identification procedure the orth-
`odontist can determine the size and the shape
`of the ideal arch directly on the occlusal image
`(Fig. 9).
`As already stated, the system is mostly con-
`trolled by pull down menues and a PC mouse.
`The representation of each treatment step is
`clearly arranged on the screen in order to make
`the application of the program easy even to
`users without any detailed knowledge of com-
`puters,
`
`076
`AO fs}
`, O16 x 016
`016 x 022
`
`017 x 025
`| ,098'x 078
`BO AOL
`079 x025
`
`Fig.11: Cross sections of stainless steel wires that
`can be bent by the BAS.
`
`250
`
`Bendings and torquings
`Fig. 12:
`performed by the machine.
`
`End of bending process.
`Fig. 13:
`The wire is ready to be inserted
`into the patient's mouth.
`
`ClearCorrect Exhibit 1021, pg. 6
`
`ClearCorrect Exhibit 1021, pg. 6
`
`

`

`Cacciafesta et al., Bending Art System
`
`
`
`Occlusal view of a patient's upper jaw with the ideal arch
`shape (violet).
`
`Kieferorthop 9: 247-254, 1995
`
`————————= Gberkiefer
`
`Sweep. Expansions
`
`Bagel, Wih
`
`Fig. 15: Occlusal view of a patient's upper jaw with the ideal arch
`shape(violet) and the actual arch designed by the orthodontist (green).
`
`Bending machine
`
`The bending machine itself consists again of
`three components: an outer bending (or hold:
`ing) cone, aninnertorquing cone and abending
`finger (Fig. 10). Every wire is exactly shaped as a
`series of consecutive bends(including torque)
`according to the geometric data calculated by
`the computer program.
`The machine works with straight segments of
`stainless
`steel wires of various dimensions
`(Fig. 11). The wireis inserted from aboveinto the
`central hole of the bending cone and then
`retracted automatically in gradual steps down
`to the apex of
`the cone before the actual
`bending process starts (Fig. 12 and 13).
`Bending of the wire is achieved by moves of the
`bending finger, while the wire is held by the
`cone. Torquing, on the other hand,is produced
`by a rotation of the torquing cone in relation to
`the holding cone.
`Since the wire is bent (torqued) in just one
`single movement
`the stress within the wire
`is diminished. Overall, it takes approximately
`5 to 6 minutes to manufacture a complex arch-
`wire.
`
`At the beginning of treatment the orthodontist
`has to design the individual
`ideal arch on
`the monitor, then the computer calculates the
`amountof tooth movementfor everyindividual
`tooth.
`It
`is then up to the orthodontist to de-
`cide in how many steps/archwires he wants
`to break up these movements. (Fig. 14 to 18).
`Specifically, that means he can choose the num-
`ber, the size, and the shape (passive, active,
`utility arch, segmented arches,
`loops) of the
`archwires, having also the opportunity to pro-
`gram tooth movements from 0% (no move-
`ment) to 100 %(full movement) correcting at the
`same time the sweep or the width of a patient's
`arch,
`The BASis able to take into account corrective
`data for the position of any single tooth mesio-
`distally, oro-vestibularly,
`intrusive-extrusively,
`as well as for the appropriate torque, angula-
`tion and rotation (Fig. 19).
`Since the bending machine contains its own
`computer,
`the bending process is done in-
`dependently of the main computer, so even
`during manufacturing of an archwire
`all
`other functions of the system are fully avail-
`able.
`
`251
`
`ClearCorrect Exhibit 1021, pg. 7
`
`ClearCorrect Exhibit 1021, pg. 7
`
`

`

`Kieferorthop 9: 247-254, 1995
`
`Itung
`
`konera
`
`COOenen
`Identifizierang Behandiuny Bicyen Opti
`
`|
`|
`
`}
`
`—
`
`ie bogen
`c aktuet
`Teas
`Mull
`bogen
`
`Cacciafesta et al., Bending Art System
`
`Fig. 16:
`Occlusal view of the patient's upper jaw with the designed
`archwire inserted into the attachments.
`
`
`
`
`Fig. 18:
`Occlusal view of the patient's lower jaw with the designed
`archwire inserted into the attachments.
`
`aanunee
`
`
`'
`Fig.17: Occlusal view of a patient's lower jaw with the ideq |
`shape (violet) and the actual arch designed by the orthodontist (
`aoe
`green),
`
`Fig. 19:
`Opportunity to correct the position of any single tooth me Slo-
`distally, oro-vestibularly, intrusive-extrusively,
`as well as for the ais pre.
`priate torque, rotation, and angulation.
`
`First impressions and discussion
`
`A clear definition of the treatment goals is
`extremely important in order to carefully design
`an individual orthodontic archwire that will
`successfully achieve the desired tooth move-
`mentsin all three dimensions of space. The BAS
`is
`the most advanced computer-controlled
`system to bend such wires. The opportunity to
`correct precisely the position of each single
`252
`
`tooth in the Ist, 2nd and 3rd order, makes it
`an ideal device when finishing archwires are
`needed.
`
`Who has not painfully experienced how much
`work it is to bend a new ideal arch when one
`suddenly realizes after two or three appoint-
`ments with wire individualization, that the wire
`does notfit into the mouth any moresince Ist
`and 2nd order bends have consumed wire
`length thereby causing a shift of the bends rela-
`
`ClearCorrect Exhibit 1021, pg. 8
`
`ClearCorrect Exhibit 1021, pg. 8
`
`

`

`Kieferorthop 9: 247-254, 1995
`
` Cacciafesta et al., Bending Art System
`
`able side effects, very little unwanted can hap-
`tive to the brackets? This is no problem with the
`pen withastainless steel wire. Of course, one
`BAS. Its ability to bend wire much moreprecisely
`needs more wires for the same amountof tooth
`than it is possible manually®, allows to bend a
`movement than with flexible archwires. But
`is
`new ideal arch every appointment and add new
`this really a disadvantage sincestainlesssteelis
`features while exactly reproducing the previous
`cheap and bending the wiresis done by the BAS
`ones as stored in the patient's database.
`without consuming the orthodontist's time?
`Furthermore, the ability of the system to bend
`The bending mechanism ofthe system meetsits
`completely passive archwires is remarkable.
`limit when loops are to be bent. Since during
`Suchstiff and passive archwires are required,
`bending the wire rotates aroundthe outer cone,
`in particular, during treatment of orthodontic-
`a total bend of more than180° results in a colli-
`surgical patients.
`sion between bending cone and wire, especially
`Another feature of the BASis the opportunity to
`if a curvature of less than 15mm radius is re-
`consolidate teeth into units. This helps the ortho-
`quired. The consequenceis that, at the moment,
`dontist to carefully separate teeth that must
`the BAS cannot bend T- or L-loops completely,
`be moved (active unit) from the ones that are
`but is only able to produce a rough shapeof the
`used as anchorage (passive unit), a treatment
`loop, which must be finished manually by
`approach commonly known as segmented arch
`accentuating each bend.
`technique’.
`One misunderstanding that often occursis that
`To achieve a more advantageous stress pattern
`the BASis just a copy of the Straight Wire Appli-
`in the periodontium of
`the anchorage unit,
`ance (SWA) concept, since the orthodontist
`heavy rigid passivestainless steel segments can
`needs to design an ideal arch shape. In case of
`be bent to make all teeth involved in the passive
`BAS the values for rotation, angulation, torque,
`unit react uniformly, without any undesirable
`and inset/ offset are included in the archwires,
`side effects.
`whereas the SWAputs them in the brackets. The
`Since tooth alignment maydiffer a lot from one
`consequenceis thatit is not necessary, as it often
`tooth unit to another,itseems very useful to vary
`occurs with the SWA technique, to debond and
`the shape and the cross section of the wires
`then rebond brackets if teeth are notin the de-
`within the different units of an arch. So optimal
`sired position. With the BAS the orthodontist will
`properties of elastic and stiff wires can be used
`achieve it by a careful and precise design of
`to achieve the desired treatment goal: stiff wires
`the wire, avoiding possible enamel damages
`for anchorage units, more flexible ones for
`active units.
`caused by repeated bracket debonding’.
`Furthermore, rebonding of lost brackets is no
`At the moment the BASis able to bend only
`problem with the BAS, even in the finishing
`stainless steel wires. Therefore, currently only
`phase of therapy,since, after rebonding, a new
`passive segments can be bentin the segmented
`occlusal scan of the teeth is performed and, sub-
`arch technique. But this does not impair its value
`sequently, the corrective data of the wires are
`since bending passive stainless steel wires with
`adjusted and stored automatically so that the
`full bracket engagement
`in
`segments with
`treatment can go on without any negative
`irregular tooth position requires a lot
`of skill
`influence. In contrast, with a conventional tech-
`and plenty of
`time - with the result rarely
`nique, rebonding of a bracket during the final
`being totally passive. In contrast, with the BASit
`stage of treatment with a 0.017” x 0.025” stain-
`is fast, precise, reproducible and passive - pure
`fun.
`less steel wire may necessitate to temporarily go
`Stainless steel wire even with a small cross sec-
`back to a moreflexible archwire.
`The BAS allows to bypass a couple of bracketsin
`tion has a high load/ deflection ratio, in compa-
`order to bend for instance utility arches. But
`rison with, for instance nickel titanium and beta
`unfortunately it is not yet possible to produce
`titanium wires, which have a lower modulus of
`free shape archwires such as bonded lingual
`elasticity and superior springback properties.
`retainers for teeth without brackets; not bend-
`Therefore, in patients with severe tooth malalign-
`ing but designing the archwire is
`the prob-
`ment and/or crowding it seems reasonable to
`lem.
`correct them with elastic wires, before using the
`Using a BAS first of all means to put extra time
`BAS. On the other hand, stainless steel wires
`into fixing the measuring elements, scanning
`with small activations, as available from the
`and designing the wires. If this pays out later by
`BAS, have the advantage of providing maxi-
`saving time for wire bending is something thatis
`mum control over every tooth movement. While
`difficult to predict from a university environ-
`flexible leveling arches may produce consider-
`253
`
`ClearCorrect Exhibit 1021, pg. 9
`
`ClearCorrect Exhibit 1021, pg. 9
`
`

`

`Cacciafesta et al, Bending Art System
`
`Kieferorthop 9; 247-254, 1995
`
`ment where the orthodontist can rely verylittle
`on chairside assistants. Matter of fact, the BAS
`offers several ways to legitimately delegate
`manytasks. One may also save some money by
`using the cheapest standard edgewise brack-
`ets — thanks to BAStreatmentis as easy as with
`preadjusted appliances.
`One thing is obvious already from our limited
`experience with the BAS: the quality of occlusal
`interdigitation at the end of treatment is better
`thereby reducing the necessity for expensive
`finishing appliances, for instance positioner.
`
`Summary
`
`The Bending Art System is the first computer
`aided device for bending individual ortho-
`dontic archwires.
`It consists of three compo-
`nents: a(n intraoral) stereoscopic camera, a
`computer program and a wire bending unit.
`Thus, it allows to manufacture individual arch-
`wires with Ist, 2nd and 3rd order bends, which
`have proven to be very accurate. After exact
`registration of the bracket position and its con-
`firmation by the user the resulting occlusal scans
`of the maxillary and mandibular dental arch
`are displayed on the computer monitor. The
`orthodontist then decides which tooth he likes
`
`to move mesio-distally, oro-vestibularly or
`occluso-gingivally, as well as what will be the
`appropriate torque, angulation and rotation.
`
`References
`
`1. BalutN, Klapper t, Sandrik J, Bowman D: Variations
`in bracket placement in the preadjusted orth-
`odontic appliance. Am J Orthod Dentofac
`Orthop 102: 62-67, 1992.
`2. Burstone C J, Hanley K J: Modern edgewise
`mechanics segmented arch technique. Syllabus,
`Ormco Corporation, 1989.
`3. Dellinger EL: Ascientitic assessment ofthe straight
`wire appliance. Am J Orthod Dentofac Orthop
`73: 290-299, 1978.
`4. Fischer-Brandies H, Monsees M: Schmelzschaden
`bei Mehrfachdebonding in der Bracketadhasiv-
`technik. Fortschr Kieferorthop 54: 143-147, 1993,
`5. Fischer-Brandies H, Orthuber W, Boch R: MeBge-
`navigkeit der Intraoral-Kamera des Bending Art
`System (BAS) - erste Ergebnisse. Poster 29, Jah-
`restagung DGZMK und DGKFO, Wiesbaden,
`27.9. bis 1.10. 1995.
`Jost-Brinkmann P-G, Miethke R-R: Electronic data
`processing in orthodontics ~ state of the art and
`future development. Prakt Kieferorthop
`7:
`53-62, 1993.
`7. Magness W B: The straight wire concept. Am J
`Orthod Dentofac Orthap 73: 541-550, 1978.
`8. OrthuberW, Fischer-Brandies H: Dental apparatus
`for bending and twisting wire pieces. United
`States Patent, Patent number: 4,656,860, 1987.
`
`6.
`
`Bending Art System (BAS) — Gegenwéartiger Stand und erste Erfahrungen
`
`Zusammenfassung
`
`Das Bending Art System ist die erste computer-
`gestiitzte Drahtbiegemaschine zum Herstellen
`individueller orthodontischer Bogen. Es setzt
`sich aus drei Teilen zusammen: einer (intraora-
`len}
`stereoskopischen CCD-Kamera,
`einem
`Computerprogramm und der Drahtbiegevor-
`richtung. Im Zusammenwirken aller Komponen-
`ten ist das BASin der Lage, individuell geformte
`Dra&hte mit Biegungen 1., 2. und 3. Ordnung her-
`zustellen, die GuBerst prazise und reproduzier-
`bar sind. Nach stereoskopischer Erfassung der
`
`okklusalen Ansichten und Bestimmung der
`3D-Bracketposition in
`einem halbautomati-
`schen Verfahren werden die Zahnbégen auf
`einem Monitor dargestellt. Der Kieferortho-
`pdde kann dann unter Zuhilfenahme zahlrei-
`cher Computermenis fur jeden einzelnen Zahn
`die gewinschte Bewegungen in allen drei
`Raumdimensionen definieren und festlegen, mit
`welchen Drahten und in wie vielen Einzelschrit-
`ten/Drahtbégen aufgeteilt das Ziel erreicht
`werden soll.
`
`254
`
`
`
`ClearCorrect Exhibit 1021, pg. 10
`
`ClearCorrect Exhibit 1021, pg. 10
`
`