Biomedical subjects

Tancan Uysal

Publications and source records attributed to Tancan Uysal.

At least 19 recordsLinked to original sources

PubMed2006

Relationship between static natural head position and head position measured during walking.

INTRODUCTION: The aim of this project was to determine whether there is a statistically significant difference between the means of static and dynamic (measured during walking) measurements of head posture. METHODS: The sample consisted of 50 subjects, 25 women and 25 men, 20 to 25 years of age. None had a history of orthodontic treatment, head or neck injury, or nasal breathing problems, and none wore eyeglasses to correct vision. Static measurement of head position was recorded by using the self-balance position. Dynamic measurements of head position were made with an inclinometer device with the subject walking in a relaxed manner for 5 minutes. The data, measured in degrees, were stored in a pocket data logger. Recorded static and dynamic head posture data were transferred to a computer for analysis. The means of the measurements were statistically compared with the t test (alpha = .05). The mean walking head position was tipped forward relative to the mean static head position. RESULTS: The mean value of static position minus walking head position measurements was +4.60 degrees . The differences between the 2 recordings were statistically significant (P < .001). CONCLUSIONS: Static and walking head position measurements are not interchangeable. Therefore, it might be advisable to use the mean dynamic measurement of head position to represent natural head position for positioning when taking case records such as lateral and posteroanterior cephalograms, clinical extraoral photography, or 3-dimensional imaging.

Adult↗

PubMed2006

Chronologic age and skeletal maturation of the cervical vertebrae and hand-wrist: is there a relationship?

INTRODUCTION: The aims of this study were (1) to investigate the relationship between chronologic age and maturation of cervical vertebrae, (2) to identify the relationship between chronologic age and maturation stage evaluated by hand-wrist radiographs, and (3) to determine whether the maturation of cervical vertebrae correlates with maturation indicated by hand-wrist radiographs in a Turkish population. METHODS: The samples were derived from lateral cephalometric and hand-wrist radiographs of 503 subjects (213 male, 290 female; ages, 5.3-24.1 years). Cervical vertebral development was evaluated by the method of Hassel and Farman. Skeletal maturation of each hand-wrist radiograph was determined according to the method described by Björk and Grave, and Brown's system. The Spearman rank-order correlation coefficients were estimated separately for males and females to measure the relationships among chronologic age, cervical vertebral maturation, and the skeletal maturation measured at the hand-wrist. RESULTS: The Spearman correlation coefficients were 0.72 (P <.001) between chronologic age and cervical vertebrae skeletal maturation, and 0.79 (P < .001) between chronologic age and maturation via hand-wrist radiographs. The correlation coefficient between hand-wrist and cervical-vertebrae maturation was 0.86 (P <.001). CONCLUSIONS: The cervical-vertebrae maturation stages are clinically useful maturity indicators of the pubertal growth period Turkish subjects.

Adolescent↗

PubMed2006

Conventional and high-intensity halogen light effects on polymerization shrinkage of orthodontic adhesives.

The objectives of this study were to compare the polymerization shrinkage of three orthodontic adhesives. In addition we wanted to determine the effectiveness of the high-intensity quartz tungsten halogen (HQTH) in curing orthodontic adhesives on polymerization shrinkage with that of the quartz tungsten halogen (QTH). A total of 120 glass ring molds were prepared using a low-speed saw. The internal surface of the glass rings were roughened and etched. Adhesive pastes were placed into the glass molds, which were sandwiched between two glass slides. Samples were divided into six groups according to the combination of three orthodontic adhesives (Kurasper F, Light Bond, and Transbond XT) and two light intensities. One half of each 40 samples of three adhesive pastes was polymerized for 20 seconds by a QTH (Hilux 350), and the other half was polymerized for 10 seconds by a HQTH (Optilux 501). The volumetric polymerization shrinkage for each system was measured through the specific density method modified by Puckett and Smith. Statistical analysis was performed using two-way analysis of variance for intergroup comparisons. The HQTH-curing unit resulted in a more polymerization shrinkage than did the QTH for all investigated adhesives. However, no statistically significant differences were found. The highest shrinkage was observed for Light Bond cured with HQTH (1.59 +/- 0.82%), and the lowest value was observed for Transbond XT cured with QTH (1.23 +/- 0.60%). There are no significant differences in polymerization shrinkage of the three investigated orthodontic adhesives when polymerized with a QTH or a HQTH.

Acid Etching, Dental↗

PubMed2005

Effect of cervical headgear wear on dynamic measurement of head position.

The aim of this study was to identify the effect of cervical headgear (CHG) wear on dynamic measurement of head posture during walking. Six male and 10 female patients (mean age, 11.9 +/- 1.9 years) who were receiving CHG therapy for correction of a Class II molar relationship as part of their orthodontic treatment were included in this study. Dynamic head posture measurements were recorded using an inclinometer and data logger apparatus during a walking session of 5 minutes. This procedure was repeated before (T1) and after (T2) insertion of CHG. The T1 and T2 measurements were repeated twice at 30-minute intervals. The mean dynamic head posture was calculated for each subject using the collected data. The means of these measurements were statistically compared using a paired t-test. Of the 16 subjects, 14 showed a cranial flexion with CHG wear in relation to T1 (1.4 to 8.9 degrees). The other two subjects showed a cranial extension of -1.6 and -3.8 degrees. The mean values at T1, T2 and T1-T2 were 1.4, -1.8, and 3.1 degrees, respectively, which indicated a mean cranial flexion at T2 in relation to T1. According to the paired sample t-test, there were statistically significant differences between the two measurements of dynamic head posture recorded before and after CHG insertion (P < 0.001). CHG wear causes a significant cranial flexion which may be responsible for its effects on the mandible.

Cervical Vertebrae↗

PubMed2005

Effects of camouflage treatment on dentofacial structures in Class II division 1 mandibular retrognathic patients.

The aims of this study were to determine the changes in the dentofacial structures of Class II division 1 mandibular retrognathic patients treated with bilateral extraction of the upper first premolars, and to compare pre- and post-treatment values with the cephalometric norms of Anatolian Turkish adults. The Class II division 1 subjects included 20 males and 33 females (mean age: 17.08 +/- 1.03 years). All received comprehensive orthodontic treatment using an edgewise appliance and appropriate headgear. Lateral cephalograms were taken at the beginning and end of treatment. Twenty-five (14 linear and 11 angular) measurements were analysed on each radiograph. Each cephalogram was traced and digitized. For statistical evaluation, paired and independent-samples t-tests were performed. When the pre- and post-treatment measurements were compared, statistically significant differences were found for nine of 25 measurements. During treatment the facial axis, U1-SN ( degrees ), U1-NA (mm), U1-NA ( degrees ), H angle and upper lip to E plane measurements decreased, while N-ANS, interincisal angle and upper lip to Steiner S line increased. No statistically significant gender differences were found. Significant improvements were determined in ANS-Me and L1-APo measurements compared with Turkish norms. However, statistically significant deterioration was found in values related to point A, upper incisor and lower lip measurements. The findings demonstrates that camouflage treatment in Class II, mandibular retrognathic subjects has characteristic skeletal, dental and soft tissue effects on the dentofacial complex.

Adolescent↗

PubMed2005

Posteroanterior cephalometric norms in Turkish adults.

PURPOSE: The aims of this study were to establish cephalometric norms from posteroanterior cephalograms for Turkish adults, identify possible gender differences in these norms, compare Turkish norms with the norms of other groups, and identify possible correlations between all investigated transverse linear measurements. MATERIAL: The subjects included 46 Turkish men (mean age, 26.06 +/- 2.10 years) and 54 Turkish women (mean age, 24.10 +/- 3.04 years). Each subject had ideal occlusion and a well-balanced face. Nineteen linear measurements were determined on each radiograph. For each variable, the arithmetic mean, the standard deviation, and the minimum and maximum values were calculated. For statistical evaluation, an independent-samples t test was performed. The Pearson product-moment correlation coefficient was calculated to indicate the relationship between all investigated linear dimensions. RESULTS: Posteroanterior transverse linear norms for Turkish adults were generally similar to Ricketts' clinical norms. Of the 19 craniofacial transverse measurements, 15 showed significant sexual dimorphism. All investigated measures were higher in Turkish men than in women, with the exception of the distance from the intersection of the processus zygomaticus and the processus alveolaris maxillae on the right side and the frontal facial plane. Statistically significant correlations were determined in most measurements. CONCLUSIONS: These Turkish posteroanterior cephalometric norms can be used in the treatment of Turkish patients.

Adult↗

PubMed2005

Intermaxillary tooth size discrepancy and mesiodistal crown dimensions for a Turkish population.

INTRODUCTION: The aims of this study were to determine the size of individual permanent teeth, tooth-size ratios for the maxillary and mandibular dentitions, and sex differences for those variables in a Turkish population, and to compare the figures obtained with those of the Bolton analysis. METHODS: The data were derived from dental casts of 150 Turkish subjects (72 men, mean age 22.09 +/- 3.11 years; 78 women, mean age, 21.11 +/- 2.08 years) with normal occlusions. The mean, standard deviation, and minimum and maximum values were calculated for individual tooth size, and overall and anterior ratios, separately for men and women. To determine whether there are sex differences in intermaxillary tooth size discrepancies, an independent samples t test was performed. RESULTS: The mesiodistal dimensions of the maxillary teeth showed greater variability than the mandibular teeth, with the first molar dimensions having the greatest variability. The overall and anterior ratios were found to be 89.88 +/- 2.29 and 78.26 +/- 2.61, respectively. A statistically significant sex difference was found only in overall ratio (P < .001). According to Bolton's mean values, a discrepancy in the overall ratio was found in 18% of Turkish normal occlusion subjects, and anterior ratios outside 2 standard deviations from the Bolton mean were found in 21.3% of our sample. CONCLUSIONS: These findings indicate that population-specific standards are necessary for clinical assessments. Bolton's original data do not represent Turkish people, and therefore it is appropriate to use Turkish norms in daily orthodontic practice for Turkish patients.

Adult↗

PubMed2005

Submentovertex cephalometric norms in Turkish adults.

INTRODUCTION: The aims of this study were (1) to establish cephalometric norms from submentovertex (SMV) radiographs for young Anatolian Turkish adults and (2) to identify possible sex differences between men and women. METHODS: SMV cephalograms were taken of 50 nongrowing Turkish adults (25 men, mean age, 23.06 +/- 2.30 years; 25 women, mean age, 22.10 +/- 2.04 years). All had normal occlusions and well-balanced faces. Five angular and 10 linear measurements were made on each radiograph. For each variable, arithmetic mean and standard deviation minimum and maximum values were calculated. Independent-sample t tests were performed for the sex comparisons. Cephalometric angular and linear norms for Turkish adults were determined by using the Lew-Tay SMV cephalometric analysis. SMV cephalometric standards for Turkish adults were also developed. RESULTS: Generally, our measurements were similar to the Lew-Tay SMV norms. Most Turkish SMV cephalometric measurements showed statistically significant sex differences. Comparison between Turkish men and women indicated larger measurements for men in all investigated linear measurements. CONCLUSIONS: SMV cephalometric norms are useful in the diagnosis of mandibular asymmetries and the treatment of dentofacial orthopedics in Turkish patients.

Adult↗

PubMed2005

The association of occlusal factors with masticatory muscle tenderness in 10- to 19-year old Turkish subjects.

The aims of this study were (1) to investigate the relationship between occlusal factors and masticatory muscle tenderness among 10- to 19-year-old (mean 14 years eight months) Turkish subjects and (2) to identify possible sex differences between them. The sample consisted of 716 individuals (355 male and 361 female subjects). Tenderness with palpation of masseter and temporalis muscles and functional manipulation of lateral and medial pterygoid muscles was registered. The examiners recorded the Angle classification bilaterally for molars, presence of anterior and posterior crossbites, excessive overjet, open and deep bites, functional shift, and severity of anterior crowding. Associations between the occlusal factors and muscle tenderness according to sex were evaluated with chi-square analysis. Statistically significant associations were found between masticatory muscle tenderness and all the investigated occlusal factors except posterior crossbite and functional shift. Masseter, medial, and lateral pterygoid muscle tenderness was higher in female subjects. Medial and lateral pterygoid muscle tenderness in Class I cases and masseter and medial pterygoid muscle tenderness in Class II, division 1 malocclusion cases were higher in female subjects (P < .05). In open-bite cases, medial pterygoid muscle tenderness (P < .05), in deep-bite cases, masseter (P < .01) and medial pterygoid (P < .05) muscle tenderness, and in excessive overjet cases, masseter muscle tenderness (P < .05) were also higher in female subjects. These results suggest that greater masticatory muscle tenderness in female subjects may contribute to the greater prevalence of temporomandibular disorders in them.

Adolescent↗

PubMed2005

Intermaxillary tooth size discrepancy and malocclusion: is there a relation?

The aims of this study were to identify the possible sex differences in tooth size ratios between males and females, to determine whether there is a difference in the incidence of tooth size discrepancies for both the anterior and overall ratios when comparing with Angle Class I; Class II, division 1; Class II, division 2; and Class III malocclusion groups, to compare the tooth size ratios of different malocclusion groups with the anterior and overall tooth size ratios of 150 untreated normal occlusion subjects. In addition, the aim was to determine the percentage of tooth size discrepancies outside 2 SD from Bolton means for tooth ratios present in each malocclusion group and in the overall sample of this study. This study consisted of 150 subjects who served as the normal occlusion group and 560 patients who showed four different malocclusion characteristics (Angle Class I; Class II, division 1; Class II, division 2; and Class III). Tooth size measurements were performed on the models of normal occlusion and pretreatment models. For statistical evaluation, Student's t-test, analysis of variance and Tukey Honestly Significant Difference tests were performed. A significant sex difference was found only in the overall ratio for normal occlusion subjects (P < .001). All malocclusion groups showed statistically significant higher overall ratios than the normal occlusion group (P < .001). There were no statistically significant differences among malocclusion groups; however, there were a large number of patients within each group who had discrepancies greater than 2 SD from the mean. Further investigations are needed to explain the probable racial differences and relationships between malocclusion and tooth size measurements.

Adult↗

PubMed2005

Thermal changes in the pulp chamber during different adhesive clean-up procedures.

The aim of this in vitro study was to measure the temperature changes in the pulpal chamber when different adhesive clean-up procedures were used. Ninety intact extracted human maxillary central incisors were used in the study. The teeth were divided into six groups of 15 teeth each. The removal of the remaining composite on the tooth surface was performed with a tungsten carbide bur. The residual adhesive was removed using a high-speed handpiece with and without water cooling and a contra-angle handpiece with and without water cooling at high and low speeds. A J-type thermocouple wire was positioned in the center of the pulp chamber. The results were analyzed with analysis of variance (ANOVA) and the Tukey-honestly significant difference test. Two-factor ANOVA revealed significant interaction between the handpiece type and water cooling. In this study, the high-speed contra-angle handpiece without water cooling group had the highest deltaT values (7.58 degrees C+/-1.84 degrees C) among all the clean-up procedures. The decrease in pulpal temperature with water cooling was -5.34 degrees C for the handpiece, -5.36 degrees C for the low-speed contra-angle handpiece and -4.98 degrees C for the high-speed contra-angle handpiece. Clinicians should be aware of the potential thermal damage to the pulp, which may result from long clean-up procedures without water cooling. Adhesive removal procedures should be performed with adequate water cooling to prevent temperature increases that might be harmful to pulpal tissues.

Analysis of Variance↗

PubMed2005

Effects of a chlorhexidine varnish on shear bond strength in indirect bonding.

The purpose of this study was to evaluate the effects of an antimicrobial varnish on the shear bond strength (SBS) of metallic orthodontic brackets bonded with an indirect bonding resin. For this purpose, 60 noncarious human premolars were divided into three equal groups. Group 1 was an indirect bonding control group and, after acid etching of the enamel, the brackets were indirectly bonded to the teeth with an indirect bonding resin. In group 2, before bonding, an antimicrobial varnish was painted on the etched enamel and indirect bonding was carried out as in group 1. In group 3, Transbond MIP primer and the antimicrobial varnish were thoroughly mixed in a 1:2 proportion, applied to the enamel surface, light cured for 20 seconds, and the brackets were direct bonded. A universal testing machine was used to determine the maximum load necessary to debond the brackets, the SBS values recorded, and the adhesive remnant index scores determined. Data were analyzed using analysis of variance (ANOVA), Tukey HSD, and chi-square tests. Results of ANOVA revealed statistically significant differences in the SBS among the various groups tested (P < .05). Indirect bonding of brackets with Sondhi Rapid Set after the application of the antimicrobial varnish showed significantly lower SBS when compared with both the group 2, indirect bonding control group, and the group 3, direct bonded-antimicrobial varnish group.

Acid Etching, Dental↗

PubMed2005

Dental and alveolar arch widths in normal occlusion and Class III malocclusion.

The aim of this study was to compare the transverse dimensions of the dental arches and alveolar widths of Class III malocclusion group with a group of untreated normal occlusion subjects. This study was performed using measurements on dental casts of 150 normal occlusion (mean age, 21.6 +/- 2.6 years) and 100 Class III malocclusion (mean age, 15.4 +/- 2.2 years) subjects. Independent samples t-test was applied for comparing the groups. The findings of this study indicated that the mandibular intercanine and intermolar alveolar widths were significantly larger in the Class Ill group when compared with the normal occlusion sample (P < .001). Maxillary interpremolar, intermolar widths and all maxillary alveolar width measurements were significantly narrower in the Class III group (P < .001). In addition, the lower canine and premolar alveolar width measurements were also statistically significantly larger in the normal occlusion group when compared with the Class III malocclusion group (P < .001). Subjects with Class III malocclusion tend to have the maxillary teeth inclined to the lingual and mandibular teeth inclined to the buccal direction because of the restriction of maxillary growth and development according to dental arch width measurements. Therefore, rapid maxillary expansion should be considered before or during the treatment of a Class III patient with or without face-mask therapy.

Adult↗

PubMed2005

Dental and alveolar arch widths in normal occlusion, class II division 1 and class II division 2.

The aim of this study was to compare the transverse dimensions of the dental arches and alveolar arches in the canine, premolar, and molar regions of Class II division 1 and Class II division 2 malocclusion groups with normal occlusion subjects. This study was performed using measurements on dental casts of 150 normal occlusion (mean age: 21.6 +/- 2.6 years), 106 Class II division 1 (mean age: 17.2 +/- 2.4 years), and 108 Class II division 2 (mean age: 18.5 +/- 2.9 years) malocclusion subjects. Independent-samples t-test was applied for comparisons of the groups. These findings indicate that the maxillary interpremolar width, maxillary canine, premolar and molar alveolar widths, and mandibular premolar and molar alveolar widths were significantly narrower in subjects with Class II division 1 malocclusion than in the normal occlusion sample. The maxillary interpremolar width, canine and premolar alveolar widths, and all mandibular alveolar widths were significantly narrower in the Class II division 2 group than in the normal occlusion sample. The mandibular intercanine and interpremolar widths were narrower and the maxillary intermolar width measurement was larger in the Class II division 2 subjects when compared with the Class II division 1 subjects. Maxillary molar teeth in subjects with Class II division 1 malocclusions tend to incline to the buccal to compensate the insufficient alveolar base. For that reason, rapid maxillary expansion rather than slow expansion may be considered before or during the treatment of Class II division 1 patients.

Adolescent↗

PubMed2005

Does orthodontic treatment affect patients' and parents' anxiety levels?

The aims of this study were (1) to determine and compare the anxiety levels of two groups of patient and parents, (2) to identify possible gender differences between male and female subjects and (3) to evaluate any changes in anxiety levels after 1 year of treatment. The first group consisted of 40 subjects with a mean age of 15.6 +/- 1.2 years awaiting orthodontic treatment, plus one parent of each subject (mean age 43.4 +/- 2.3 years). The second group comprised 43 patients with a mean age of 16.0 +/- 1.1 years who had been undergoing treatment for a period of 1 year, plus one parent of each patient (mean age 41.0 +/- 1.9 years).Personal information forms and Spielberger's 'State and Trait Anxiety Inventory' (STAI) were applied to both groups. To compare the two groups and to determine the differences between males and females, independent-sample t-tests were used. Internal consistencies for the two scales of the STAI were evaluated with Cronbach's alpha coefficient. Trait anxiety levels of parents (51.05 +/- 5.1) and state anxiety levels of subjects (58.57 +/- 6.73) who were about to start orthodontic treatment were both high. The difference between the groups was statistically significant (P < 0.05). In patients who had undergone treatment for 1 year, the scores were found to be normal (43.28 +/- 5.91). However, their parents' high levels of trait anxiety remained unchanged (50.41 +/- 4.2).

Adolescent↗

PubMed2004

Craniofacial structure of Anatolian Turkish adults with normal occlusions and well-balanced faces.

This study aimed to develop cephalometric standards for Anatolian Turkish men and women. Fifty young men (mean age [+/- standard deviation], 22.61 +/- 1.22) and 55 young women (mean age, 22.14 +/- 1.44 years) were studied. All subjects were born to Turkish parents and grandparents and were 19 to 25 years old. All had Class I occlusions with minor or no crowding, normal growth and development, well-aligned maxillary and mandibular dental arches, all teeth present except third molars, good facial symmetry determined clinically and radiographically, no significant medical history, no history of trauma, no previous orthodontic or prosthodontic treatment, and no maxillofacial or plastic surgery. Twenty-five measurements (14 linear and 11 angular) were analyzed on each radiograph. Arithmetic mean and standard deviation were calculated for each measurement. For statistical evaluation, independent-samples t tests were performed. Our established values were compared with the norms of other investigators who studied facial esthetics. Significant racial differences were found in skeletal measurements (anterior nasal spine [ANS] to menton), dental measurements (maxillary incisor to sella-nasion plane, mandibular incisor to nasion-Point B line, and mandibular incisor to mandibular plane), and soft tissue measurements (H angle, upper lip to E plane, and upper lip to Steiner S line). Significant sex differences were found in the measurements condylion to A point, condylion to gnathion, ANS to menton, and nasion to ANS. It is appropriate to put these cephalometric norms into daily orthodontic practice when an Anatolian Turkish population is being treated.

Adult↗

PubMed2004

The influence of extraction treatment on Holdaway soft-tissue measurements.

The aims of this study were (1) to determine the changes in the soft-tissue measurements of orthodontic patients treated with four first premolars extractions as determined by the Holdaway Analysis, (2) to investigate the sexual differences between pre- and posttreatment values, and (3) to compare the Holdaway soft-tissue norms with findings in Anatolian Turkish adults. Pretreatment and posttreatment lateral cephalograms of 58 patients (26 boys and 32 girls) were evaluated. During treatment, the H angle, soft tissue subnasale to H line, and upper-lip strain decreased, and the upper-lip thickness, inferior sulcus to H line, and nose prominence increased. No statistically significant sex differences were found between the pre- and posttreatment values of the four premolar extraction cases. When the pretreatment values were compared with the Holdaway soft-tissue norms of Anatolian Turkish adults, seven variables showed statistically significant differences. When the posttreatment values were compared, six measurements showed statistically significant differences. It was determined that some measurements (H angle, inferior sulcus to H line, upper-lip thickness) moved closer to the Anatolian Turkish norms with extraction of four first premolars. However, upper-lip strain measurement changed in an undesirable direction during the treatment. In this study, the sample began treatment with greater facial imbalance, and the facial esthetics improved during treatment. It is necessary to investigate this difference in future studies using larger sample sizes.

Adolescent↗

PubMed2004

Effectiveness of a hydrophilic primer when different antimicrobial agents are mixed.

The purpose of this study was to determine whether different types of antimicrobial agents with hydrophilic primer applied to etched enamel surfaces will affect the shear bond strength (SBS) and the bracket/adhesive failure modes of metallic orthodontic brackets. Eighty noncarious human premolars were divided into four groups of 20 each. A composite resin (Transbond XT) was used to bond stainless steel brackets. Teeth in the first group were used as a control and bonded with standard procedures. For the other three groups, mixtures containing a hydrophilic primer (Transbond MIP) and one of three anti-microbial agents were prepared (Cervitec: in 1:2 ratio; chlorhexidine mouthwash and EC40 varnish in 1:1 ratio). These mixtures were applied to the etched enamel surfaces and thoroughly light cured for 20 seconds, and the brackets were bonded and light cured for 40 seconds. The SBS values of these brackets (Mpa) were recorded using a universal testing machine. Adhesive Remnant Index scores were determined after failure of the brackets. Data were analyzed using analysis of variance (ANOVA), Tukey honestly significant difference, and chi-square tests. Results of ANOVA revealed statistically significant differences in bond strengths among the various groups tested (P < .05). The bond strength values in these four groups compared favorably with those from other studies and the minimal bond strength values that are clinically acceptable. However, results of this study demonstrated that groups 1 (control) and 2 (Cervitec varnish) had higher SBS values than the other applications. Application of different antimicrobial agents may result in differences in the site of failure.

Analysis of Variance↗