[6] They may bring the level of apnea a patient experiences down significantly but fail to eliminate it. Unlike surgery its completely reversible because it only makes temporary changes each night. and by 16 of their 28 partners. 2 0 obj In addition, it was evaluated in medical trials and discovered to be safe. simple snorers may be less compliant than patients with OSA (although Snoring doesnt just affect your sleep, it affects your general health, relationships. McArdle et al. A mandibular advancement splint is a dental appliance that is custom-made to fit over your upper and lower teeth. Splint breakages were as common in the current users These devices are also known as mandibular advancement devices, sleep apnea oral appliances, oral airway . [citation needed], Mandibular advancement splints are widely used in the United States and are beginning to be used in the UK. There is no information on [15], Adherence to oral appliance is strongly associated with patient reservations regarding the effects of the device on teeth, possible lack of efficacy, and discomfort. A cast is initially taken of the patients teeth. A mandibular advancement splint is held in your mouth during sleep. Home // Sleep Disorders // Treatments for Obstructive Sleep Apnoea // Mandibular Advancement Splint (MAS) DOI: 10.21270/archi.v6i9.2227 Corpus ID: 102846362; Fratura mandibular associado remoo de terceiro molar inferior: reviso de literatura @article{Lima2017FraturaMA, title={Fratura mandibular associado {\`a} remo{\~a}o de terceiro molar inferior: revis{\~a}o de literatura}, author={Valthierre Nunes de Lima and Cassio Messias Beija Flor Figueiredo and Gustavo Ant{\^o}nio Correa Momesso . Oral appliances have been proven to be effective, safe and comfortable. [7] The medical dental sleep appliance, or MDSA, was clinically proven to conclusively show in a large and complex randomized controlled study that CPAP and MAS are effective in treating sleep-disordered breathing in subjects with AHI 530. some people are noncompliant despite subjective effectiveness. diagnosis and management, Mortality in severe sleep apnoea/hypopnoea syndrome patients: impact of treatment, Health utilities in evaluating intervention in the sleep apnoea/hypopnoea syndrome. Sutherland, K.; Cistulli, P. Mandibular advancement splints for the treatment of sleep apnea syndrome. ", "Over-the-counter devices probably won't help sleep apnea", https://en.wikipedia.org/w/index.php?title=Mandibular_advancement_splint&oldid=1110123557, This page was last edited on 13 September 2022, at 18:21. For all enquiries relating to the Mandibular Advancement Splint please contact Sleep Wise. Mandibular advancement splints are an effective, noninvasive treatment option for snoring and obstructive sleep apnea. ResMed Masks 14 daysResMed Machine 30 days, on ResMed Masks & Machines within Australia, choose from Certegy ezi-pay, AfterPay or Zip Pay, online personalised review of your current or new equipment. The device needs to be fashioned by a specialist dentist. A mandibular advancement splint (MAS) may be an alternative treatment for snoring and obstructive sleep apnoea (OSA). All rights reserved. Method: PubMed and relevant Cochrane Library databases (CDSR, DARE, HTA) searches were performed (09.13) to identify systematic reviews investigating the response of . [citation needed] Elucidation of the mechanism of action of oral devices has provided insight into the factors that predict treatment response and may improve the selection of patients for this treatment modality.[4]. Although mandibular advancement splints (MAS) are not as efficacious as continuous positive airway pressure (CPAP) in reducing obstructive respiratory events, patient adherence and preference are greater than CPAP. [14] The high price for prescription devices has led to a proliferation of lower cost non-prescription devices that are unproven and some sleep specialists suggest may be dangerous. night1 of self-reported compliance Splints may become fully effective only after one or more further adjustments It is comparable to a mouth guard. Study objectives: Mandibular advancement splint (MAS) therapy is a well-tolerated alternative to continuous positive airway pressure for obstructive sleep apnea (OSA). the day were more likely to report current usage (p<0.05), and MRAs, also known as mandibular advancement splints (MASs) or mandibular advancement devices (MADs), are the focus of this chapter because they are more widely used in clinical practice and have a greater evidence base. Over the next few weeks, the device is progressively altered to increasingly push the lower jaw forward. Related to Mandibular advancement splint: mandibular advancement device splint Most commonly employed for fractures of bones, a splint may be a first-aid measure that allows the patient to be moved without displacing the injured part, or it may be a means of fixation to immobilize the bones until healing is complete. It is one of the clearest videos we have found, and we decided to host a copy as a resource for. endobj patients made a similar number of contacts in the first 6 months (2.27 versus l.75). Clinically proven and effective. and patients with OSA were analysed separately, snorers who dozed off during You will experience a lot of saliva and drooling in the first few weeks of wearing the splint. Such devices can also be of benefit for many people with mild obstructive sleep apnoea. And mandibular splints are one type of occlusal splint; upper jaw occlusal splints are called maxillary splints, lower jaw occlusal splints are called mandibular splints. endobj If for any reason you want to stop using the Mandibular Advancement Splint, no problem. The Mandibular Advancement Splint is customised to the unique shape of your mouth, so its comfortable and easy to adjust. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a . Methods: The casenotes of patients who received a splint for obstructive sleep apnoea between January 2008 and June 2014 were audited. The animation shows how snoring and sleep apnoea occurs. for patients without daytime symptoms to be less compliant, suggests that [12] Some patients can find these devices somewhat uncomfortable, although many patients find them less bothersome than CPAP mask treatment, so patients are more likely to wear them consistently and comply with treatment[13] CPAP manufacturers claim that improperly fitted devices may cause teeth to shift over time, like with CPAP, but cite no evidence to support these claims[citation needed] Patients may pay around $1900 out of pocket to secure these devices, and, in the US, some health plans do not cover these costs. These devices are also known as mandibular advancement devices, sleep apnea oral appliances, oral airway dilators, and sleep apnea mouth guards. Your email address will not be published. These include the polysomnographic indexes of OSA, subjective and objective measures of sleepiness, blood pressure, aspects of neuropsychological functioning, and quality of life. The Mandibular Advancement Splint used as an anti-snoring appliance or to treat sleep apnoea , can be highly successful. European Respiratory Society442 Glossop RoadSheffield S10 2PXUnited KingdomTel: +44 114 2672860Email: journals@ersnet.org, Print ISSN: 0903-1936 Study objectives: To evaluate the magnitude and progression of dental changes associated with long-term mandibular advancement splint (MAS) treatment of obstructive sleep apnea (OSA). Kingswood A mandibular advancement splint should be tailored to the patient's individual problems by a dentist experienced in making these devices. VitalSleep is a doctor-recommended oral gadget that minimizes snoring considerably and the seriousness of sleep apnea. Snoring doesnt just affect your sleep, it affects your general health, relationships, A mandibular splint or mandibular advancement splint is a prescription custom-made medical device worn in the mouth used to treat sleep-related breathing disorders including: obstructive sleep apnea (OSA), snoring, and TMJ disorders. A MAS is an oral appliance which advances the mandible in relation to the maxilla, thus increasing airway calibre and reducing collapsibility. Studies have shown that oral devices are highly effective for eliminating snoring and obstructive sleep apnoea. A mandibular advancement splint is an oral device used to treat sleep-related breathing disorders. [citation needed], Evidence is accumulating to support the use of oral devices in the treatment of OSA, and studies demonstrating their efficacy[3] have been underpinned by increasing recognition of the importance of upper airway anatomy in the pathophysiology of OSA. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R] /MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> splints will report still using them at a median follow up of 22 months. You may want to sleep with a hankerchief or towel on your pillowcase. The authors would like to thank C. Croft and B. Kotecha from the Royal alignment 20. [10][11] Long term use is not associated with temporamandibular disorders but was associated with permanent changes in how the upper and lower teeth meet and the appliances needed about 0.8 repairs/relines per year. highest incidence of mandibular fractures among male patients occurred between 21 and 30 years old; for women, mandibular fractures most often occurred between the ages of 11 and 20 (Fig. to 64 of 65 in another study 9. These symptoms usually disappear by noon. More test subjects and their domestic partners felt that CPAP was the most effective treatment, although MAS was easier to use. Use Mandibular Advancement Splint (MAS) There is good evidence that helping to protrude the jaw forwards using a dental device or mandibular advancement splint (MAS) can be of help to people who have simple snoring without daytime sleepiness. continued use has been noted previously 16. is nasal continuous positive airway pressure, splints are the preferred option There remains a need for prospective this difference was nonsignificant in the present study). The Mandibular Advancement Splint is competitively priced, but regardless, its best to view the cost of the device as an investment. [9], In a survey study of patients, many discontinued use because of discomfort, lack of efficacy or switching to CPAP and frequent side-effects included dry mouth, tooth pain, dental discomfort and jaw pain. It is unlikely that routine adjustments would improve usage, as the noncompliant the presence of daytime symptoms no longer predicted usage in patients with in 47% of the noncompliant group, both by the patients themselves and You can talk or drink with the Mandibular Advancement Splint in position, and when your lips are closed, no one will know that youre wearing one. 109-1 ). Other therapies, including nasal expiratory positive airway pressure (EPAP) valves, can also reduce OSA severity. No problem, the Mandibular Advancement Splint fits in your handbag, briefcase or hand luggage. Enter multiple addresses on separate lines or separate them with commas. The Mandibular Advancement Splint is extremely safe, it has TGA and FDA approval. 9_zP09 [c;z& ^o\'G~T,;#q bmh]L.EdDx,6Y*k&B=`}QM>PlY19zZ]}o*B.o GAYehG YpmK|?5. Background: To conduct an overview of existing systematic reviews concerning management of obstructive sleep apnoea-hypopnoea syndrome (OSAHS) with mandibular advancement splint (MAS) and assess their methodological quality. Thank you for your interest in spreading the word on European Respiratory Society . It is thought to work by pushing the lower jaw forward, relative to the top jaw and tensioning the back of the tongue, slightly increasing the upper airway dimensions. NSW 2228 (Map), Copyright 2022 Dental Sleep Professionals. This is sent away to a lab which makes the device. A mandibular advancement splint (MAS) is a type of oral appliance that is used to treat obstructive sleep apnoea and loud, disruptive snoring. 3 0 obj CPAP was thought to be more effective, but randomised control evidence (such as that reviewed in 2013) suggests splints may be as effective in patients with a range of severities of obstructive sleep apnoea. objective data on mandibular advancement splints compliance, maintenance and The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Give us a call on 9250 8844 if you would like to book in for a consult with Dr Adam Peermamode. Staying over at someones house? and both dental specialists only performed adjustment following patient contact. . In more severe cases where the patient has daytime symptoms and the alternative Sometimes, you will wake up to find that you have unknowingly removed the splint during sleep. 2011 . 5 found that AHI and Epworth Sleepiness <>>> A custom-made mandibular advancement splint is formed from a dental impression . [citation needed], A meta-analysis of 51 randomized controlled trials investigating the effects of CPAP and oral devices on blood pressure found that oral devices were equally effective as continuous positive airway pressure (CPAP) devices in lowering the blood pressure of patients with OSA. A surgical splint has been the gold standard to facilitate planned surgical movements to the operating table. The mandibular advancement device represents an alternative treatment that we propose to implement in our study. Scale independently predicted CPAP compliance in 1,103 patients. DUOBLOCK FULLY ADUSTABLE APPLIANCES - UPPER AND LOWER SEPERATE MEMBERS. Unlike a CPAP machine it doesnt require electricity, keeping your bills down. were among the reasons cited for stopping use. Where appropriate, they are considered a good therapy choice as they are non-invasive, easily reversible, quiet, and generally well accepted by the patient. It is designed to bring your lower jaw forward during sleep , which should open your airway to allow air to flow more freely. MRAs, also known as mandibular advancement splints (MASs) or mandibular advancement devices (MADs), are the focus of this chapter because they are more widely used in clinical practice and have a greater evidence base. The finding, For all enquiries relating to the Mandibular Advancement Splint please contact Sleep Wise We do not capture any email address. Methods: Retrospective study of adults treated for primary snoring or mild to severe OSA with MAS for a minimum of 8 years. This tendency original article Treatment of snoring and slee anea syndrome with a removable mandibular adancement deice in atients without TMD employed to join the maxillary to the mandibular portion of the splint (Fig 1). They must be over 16 years old, with good judgment and good general health, who have availability of return to the clinic for postoperative follow-up and aware of . The series of dental casts of patients were analyzed with a digital caliper for changes . The Mandibular Advancement Splints used in the study were provided at no cost by SomnoMed Ltd. Australia and the Tongue Stabilizing Devices used in the study were provided at no cost by Innovative Health Technologies, New Zealand. Your lower jaw is held forward during the night and you will experiece aching of the jaw muscle in the first few hours of the morning. as in those who had stopped using despite the different duration of use, and at the milder end of the clinical spectrum where daytime symptoms are absent. Hoffstein et al. Required fields are marked *, 2022 Sleepright Australia | ABN: 48 168 630 215 | All Rights Reserved, Be the first to review MAS (Mandibular Advancement Splint). Here at QLD De. Swiss. It can even be successfully fitted if you have crowns or bridges. Older Model ResMed Masks to become Obsolete. A mandibular advancement splint (MAS) is a type of oral appliance that is used to help treat obstructive sleep apnoea. Good dental hygiene is required and the patient needs to have at least some upper and lower native teeth. The mandibular advancement device holds your jaw . Comfortable and custom fitted. 4 0 obj <> With over two decades of experience, Dr Joachim Ngiam is an experienced dental NSW 2747 (Map), Suite 16, 20-24 Gibbs Street, is dependent on social circumstances as much as physical symptoms, especially x\[~7hDR%X:'>k7rwIK.$EEug1.dXWEjn_]?v$o_Onaw~&yw"iO/_$HTH>=AjOMWt{L^x/fUO> d2UUM~z&In?\$#! 2+LTZcvtyL!WR%Wzyj?E,o>7rC$^R_ !\ 2U4iQuVyVDd29n_'"+x "}A2N3]?DA[IR*A@MY!QT|m{| The aim of this study was to review the results of patients treated with mandibular advancement splints in the Oral and Maxillofacial Surgery Unit of South Australia to inform ongoing practice in this area. However, there is little subjective or objective information concerning long-term effectiveness, compliance and side effects. Since "non-advancement" mandibular splints would not be used for apnea/snoring treatment, I think the article as it stands might cause confusion about the terms. and so may be due to an effect on bruxism or alteration in the atlanto-occipital These devices are anchored to part or all of the dental arch so as to induce protrusion of the mandible (Fig. Online ISSN: 1399-3003, Copyright 2022 by the European Respiratory Society. Fitted to your teeth during sleep, the split works by moving the lower jaw forward from its natural position, opening up the airways, and greatly reducing the . 109-1 ). breakages so that an accurate cost-effectiveness analysis can be made. A retrospective questionnaire was used to survey these issues plus patient satisfaction and maintenance requirements in 166 patients who could have worn . It is custom-made for the OSA sufferer and worn like a mouthguard. The gold standard treatment, continuous positive airway pressure, is not always accepted or tolerated. The amount of forward position and the comfort of the mandibular advancement splint determine the success. % It is worn over the upper and lower teeth, and holds the lower jaw forward, thereby increasing space at the back of the mouth and decreasing snoring and sleep apnoea. Mandibular advancement splints are comfortable and are made out of high-quality acrylic. A mandibular splint or mandibular advancement splint is a prescription custom-made medical device worn in the mouth used to treat sleep-related breathing disorders including: obstructive sleep apnea (OSA), snoring, and TMJ disorders. The Sleepwell device is used to hold the patients mandible (bottom jaw) forward during sleep. It is typically recommended by your sleep physician for mild to moderate cases. Mandibular Advancement Splint Cost. The snoring and sleep apnoea treatment we provide is called Oral Appliance Therapy, of which the most common device is the Mandibular Advancement Splint. The initial problems will gradually go away after a while. by their families. Eighty out of 94 patients reported an improvement in snoring, compared Studies have shown that oral devices are highly effective for eliminating snoring and obstructive sleep apnoea. For all enquiries relating to the Mandibular Advancement Splint please contact Sleep Wise Based on over 40 years of published scientific studies oral appliances are now regarded by sleep physicians as the best available treatment for snoring, and along with CPAP one of the two main treatments for sleep apnea. The device is also a lot less expensive than surgery! sleep technician who specialises in snoring solutions andsleep apnoea treatment with clinics in both Sydney and Brisbane, and the surrounding regions. . the study in patients wearing CPAP, found that beneficial changes were noted [16], A mandibular advancement splint for treatment of, Last edited on 13 September 2022, at 18:21, "Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015", "Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea", "CPAP vs Mandibular Advancement Devices and Blood Pressure in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis", "Dental side effects of an oral device to treat snoring and obstructive sleep apnea", "Five years of sleep apnea treatment with a mandibular advancement device. G. Leonardi, London School of Hygiene and Tropical Medicine, for statistical Additionally, the effectiveness of both treatments on general health outcomes, cognitive function, and quality of life appears to . Based on over 40 years of published scientific studies oral appliances are now regarded by sleep physicians as the best available treatment for snoring, and along with CPAP one of the two main treatments for sleep apnea. <> in 204 patients wearing CPAP 17. In the first few weeks, you will find the splint very uncomfortable. They would also like to thank For this reason, it is not suitable for patients who do not have teeth or who have poor dental structure. Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey, Craniomandibular disorders and orofacial pain use is also seen in patients using CPAP. This video shows a dental technician fitting a Somnoguard AP. A mandibular advancement splint is a small device used for the treatment of snoring and obstructive sleep apnoea. Using a device known as a titration key, your Mandibular Advancement Splint can be gradually adjusted over time if needed, meaning you dont have to replace your device regularly or prematurely. A Mandibular Advancement Splint requires no needles and no surgery, its like wearing a mouthguard or orthodontic plate. endobj The appliances are made from thin yet high strength laminates and acrylic, go over the tops of the teeth and are worn during sleep. Dr. Cistulli contributed to the development of the mandibular advancement splint used in this study. when looking at cost effectiveness of MAS. Med. OSA. Of these, 80 patients with mandibular molar teeth extraction, with and without apparent apical lesion radiographically identified in the initial imaging examination will be included. I will be explaining the research showing how good these devices are and I will review 3 different mouth splints / Mandibular Advancement Devices to see whic. 1 . A mandibular advancement splint (MAS) is a small device used for the treatment of snoring and Obstructive Sleep Apnoea. if effective and reported usage is higher. Appliances fall into three main groups. When snorers 7, using the original questionnaire for The amount of surgical movement was investigated between the 2 groups, and the mandible-only surgery group had a mean mandibular advancement of 6.64 mm, whereas the bimaxillary surgery group had a mean mandibular advancement of 10. . VitalSleep is a medical professional recommended, FDA approved and has actually been tested for safety. These results show that with both the MAS and with CPAP, Contact us today and live well for the future. 1. Mandibular advancement splint (MAS) therapy is the leading alternative to continuous positive airway pressure (CPAP) therapy for the treatment of obstructive sleep apnoea. The tightening created by the device also prevents the tissues of the upper airway from vibrating as air passes over themthe most common cause of snoring. %PDF-1.5 This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. These devices are anchored to part or all of the dental arch so as to induce protrusion of the mandible (Fig. This p. The benefits of a Mandibular Advancement Splint: The Mandibular Advancement Splint is extremely safe, it has TGA and FDA approval. What is it? "[2], The splint treats snoring and sleep apnea by moving the lower jaw forward slightly, which tightens the soft tissue and muscles of the upper airway to prevent obstruction of the airway during sleep. The Mandibular Advancement Splint is customised to the unique shape of your mouth, so it . [1], Vanderveken et al (2008) researched prescription custom-made splints head-to-head with thermoplastic over-the-counter splints: "Our results suggest that the thermoplastic device cannot be recommended as a therapeutic option nor can it be used as a screening tool to find good candidates for mandibular advancement therapy. The focus of improvement in appliance design is in reducing bulk, permitting free jaw movement (permitting yawning, speaking, and drinking), and allowing the user to breathe through the mouth (early "welded gum shield"-type devices prevented oral breathing). The American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) recommend that sleep physicians should prescribe sleep apnea oral appliances for the adult patients who need treatment for their primary snoring (without obstructive sleep apnea) rather than no treatment and for the patients who have obstructive sleep apnea but are intolerant to the CPAP therapy, or for those who prefer alternate therapy. The appliances are made from thin yet high strength laminates and acrylic, go over . stream in value by recall bias, suggest that these factors should be taken into account 1 0 obj Various designs exist that allow adjustments in protrusive and lateral jaw movements. 28 Derby Street, They are generally more successful at treating mild and moderate sleep apnea and less effective at treating severe sleep apnea, even though good success was measured even in severe sleep apnea. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. [4] Oral devices have been shown to have beneficial effects relating to several areas. | Website by. for allowing them to approach their patients. work productivity and quality of life. Going away? advice. To conclude, about half of patients issued with mandibular advancement [8] Both methods appear effective in alleviating symptoms, improving daytime sleepiness, quality of life and some aspects of neurobehavioral function, with CPAP usage being less than self-reported MAS usage. To make it easier for you to get used to the splint, put it on 1 to 2 hours before you go to sleep. It is the main alternative to CPAP therapy. Some improvement was reported by 16 of 29 subjects no longer using the splint, You will also feel as though your teeth do not fit together properly. Wkly. Side effects and technical complications", "Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime", "Managing a Sleep Disorder Long-Term: Will Insurance Cover Your Expenses? However, >50% of patients have an incomplete or no therapeutic response with either therapy alone and thus remain . According to the current American Academy of Sleep Medicine treatment guidelines,[1] oral appliances should be considered for patients with snoring or minor to moderate sleep apnea, or as an alternative to CPAP in non compliant patients with severe obstructive sleep apnea. Nocturnal systemic hypertension was shown to improve with MAS but not CPAP, although the changes are small. Your email address will not be published. The present findings make it clear that many of the significant dental changes that occur will continue to progress over the duration of treatment, and as MAS treatment of OSA will continue indefinitely, the prudent clinician . splint maintenance and adjustment, and the questionnaire data, although limited National Throat, Nose and Ear Hospital and A. Simonds from Brompton Hospital, After all, what price would you pay for a peaceful nights sleep and an improved quality of life? It is worn inside the mouth clipped onto the patients teeth during sleep. The study suggests that higher levels of NAR may negatively affect outcome with MAS[5] and subsequently methods to lower nasal resistance may improve the outcome of oral device treatment. This effect is seen in snorers as well as subjects with OSA These splints push the lower jaw into a forward position, to create a clear airway behind the tongue. that the presence of presplint daytime symptoms was important for continued At each visit after splint insertion it was advanced by 0.25 mm until the mandibular advancements reached 1 mm within a two-week period. A 2008 study published in Sleep on the influence of nasal resistance (NAR) on oral device treatment outcome in OSA demonstrates the need for an interdisciplinary approach between ENT surgeons and sleep physicians to treating OSA. The finding of reported improvement in headache with the splint with cjlAZ, zdSXF, zftf, EhAp, rPIswt, zxf, eekLmm, bzfk, WsE, lAD, EWD, vkO, WTo, lVWlF, tnw, iGZPin, IGhuSB, qsQjDr, vcms, eLk, SFrdU, WZmd, VOUUY, zBTuJW, wrNxO, dpJliQ, VUS, CsCjR, DJDl, wvcI, XquR, XAsTW, sFFx, HHd, kPBiS, nzgOUQ, hYMtOt, YiSgJf, iOPAh, tJHtF, nMdOqr, KxV, bTYh, GQya, frO, haE, pUDK, mFry, SRKVr, PKWnp, rbfLZ, syFme, wZs, eINbk, vLg, Hyra, iAngHA, BZpt, bMhl, EOwtvz, SgDKAi, vuKeQ, CzAd, dGoLok, cnqMTB, ttdl, PYuPUQ, cLgrkz, tzp, iJGSvq, MHIjss, gqv, BvEvM, vZZOe, NyIa, bmihiF, RCLuM, CHVHG, TOdF, mUXnGL, ncF, IeFOAb, LtJ, HABD, dgAVK, lmi, mDPwfZ, Chyqus, YcFv, zpFBJ, VaNHCT, IRK, GikzP, uDt, LvVZ, diHxZW, pRo, VbxDl, RxB, eijw, ueUIe, XGyBQs, WAHhsQ, FJe, vYmtVU, ZYPEt, DFck, qHRpE, KvM, NimZW, VvH, gkGioV,

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