Peri-implant MucositisNCT06305000
Impact of Keratinized Mucosa Augmentation on Treatment Outcomes of Peri-implant Mucositis
A study testing Non-surgical treatment and Free gingival graft in people with Peri-implant Mucositis, run by Biruni University at 1 site in Turkey (Türkiye).
Trial summary
This study aims to observe the effects of keratinized mucosa width on peri-implant tissues by evaluating clinical and biochemical parameters. The main question it aims to answer is: Would increasing the width of the keratinized mucosa with free gingival graft (FGG) in peri-implant mucositis be beneficial in terms of… Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Peri-implant Mucositis
- What is being tested?
- Non-surgical treatment and Free gingival graft
- Type of treatment
- Pill or oral medicine, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 48 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 27 Mar 2024to 10 Sep 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Individual dental implants with a fixed prosthetic restoration that has been functional for at least 1 year
- No systemic disease and medication use that may affect periodontal or peri-implanter tissues
- Not receiving periodontal treatment in the last 6 months
- Volunteering to participate in the study
Who cannot join
- Prosthetic restorations with an excessive contour which do not allow peri-implant pocket measurement
- Being pregnant or breastfeeding,
- Autoimmune and/or inflammatory diseases of the oral cavity,
- Active periodontal disease
- Smokers (≥ 10 cigarettes per day)
- Improperly positioned implants
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
Biruni University
Istanbul
Ayse E Selman, +905366393184, aselman@biruni.edu.tr
About this study
Official title: Impact of Keratinized Mucosa Augmentation Following Non-surgical Therapy on Treatment Outcomes of Peri-implant Mucositis.
This study aims to observe the effects of keratinized mucosa width on peri-implant tissues by evaluating clinical and biochemical parameters. The main question it aims to answer is:
Would increasing the width of the keratinized mucosa with free gingival graft (FGG) in peri-implant mucositis be beneficial in terms of clinical periodontal parameters and peri-implant crevicular fluid levels of inflammatory cytokines compared to non-surgical therapy alone?
Read more
Our study consists of 4 groups:
Peri-implant healthy group with sufficient keratinized mucosa (≥ 2mm) (n=16), peri-implant mucositis group with sufficient keratinized mucosa (n=16), peri-implant mucositis group with insufficient keratinized mucosa (< 2mm) receiving only non-surgical treatment (n=16), peri-implant mucositis group with insufficient keratinized mucosa receiving FGG in addition to non-surgical treatment (n=16). Clinical and biochemical measurements will be recorded at the baseline, 1st month, 4th month and 7th month of the study. Peri-implant crevicular fluid samples will be collected at baseline, 1st month, 4th month and 7th month. IL-1β, RANKL, OPG levels, and RANKL/OPG ratio will be analyzed from collected samples.
Researchers will evaluate the possible benefits of FGG application in addition to non-surgical therapy by comparing the biochemical and clinical changes in areas with and without FGG application in the treatment of peri-implant mucositis.
- Conditions
- Peri-implant Mucositis
- Being tested
- Non-surgical treatment, Free gingival graft
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Non-surgical treatmentProcedure or surgery
Non-surgical treatment consists of oral hygiene instructions, full mouth supragingival scaling using titanium hand instruments, ultrasonic devices, and subgingival debridement under local anesthesia with titanium curettes and ultrasonic instruments in a single appointment.
Free gingival graftProcedure or surgery
After adequate local anesthesia is achieved. A horizontal incision is placed mucogingival junction level to prepare the recipient bed. A split-thickness flap is raised without disturbing the periosteum. FGG is obtained from the palate, extending from the mesial surface of the second premolar to the middle of the first molar. The graft is shaped and stitched on the recipient surface.
| Study group | Role | What they receive |
|---|---|---|
| Peri-implant healthy group with sufficient keratinized mucosa (≥ 2mm) | No intervention | Not described |
| Peri-implant mucositis group with sufficient keratinized mucosa (≥ 2mm) | Experimental | Only non-surgical therapy will apply Receives: Procedure: Non-surgical treatment |
| Peri-implant mucositis group with insufficient keratinized mucosa (< 2mm) receiving FGG | Experimental | Free gingival graft will apply following non-surgical therapy Receives: Procedure: Non-surgical treatment; Procedure: Free gingival graft |
What is being measured
The primary outcome is the main question the study is designed to answer.
Inflammatory parameter levels in peri-implant crevicular fluid
Peri-implant crevicular fluid samples will be collected from 3 sites (mesiobuccal, buccal, distobuccal) of the implants using methylcellulose strips PerioPaper® (Oralflow Inc., Smithtown, NY, USA) gently placed into the cleansed and dried pocket for 30 sec. Interleukin-1beta, RANKL and OPG levels and RANKL/ OPG ratio will be evaluated.
Measured: Baseline (prior to therapy)
Inflammatory parameter levels in peri-implant crevicular fluid
Peri-implant crevicular fluid samples will be collected from 3 sites (mesiobuccal, buccal, distobuccal) of the implants using methylcellulose strips PerioPaper® (Oralflow Inc., Smithtown, NY, USA) gently placed into the cleansed and dried pocket for 30 sec. Interleukin-1beta, RANKL and OPG levels and RANKL/ OPG ratio will be evaluated.
Measured: 1st month
Inflammatory parameter levels in peri-implant crevicular fluid
Peri-implant crevicular fluid samples will be collected from 3 sites (mesiobuccal, buccal, distobuccal) of the implants using methylcellulose strips PerioPaper® (Oralflow Inc., Smithtown, NY, USA) gently placed into the cleansed and dried pocket for 30 sec. Interleukin-1beta, RANKL and OPG levels and RANKL/ OPG ratio will be evaluated.
Measured: 4th month
Inflammatory parameter levels in peri-implant crevicular fluid
Peri-implant crevicular fluid samples will be collected from 3 sites (mesiobuccal, buccal, distobuccal) of the implants using methylcellulose strips PerioPaper® (Oralflow Inc., Smithtown, NY, USA) gently placed into the cleansed and dried pocket for 30 sec. Interleukin-1beta, RANKL and OPG levels and RANKL/ OPG ratio will be evaluated.
Measured: 7th month
Secondary outcomes (20)
Plaque index (Silness & Löe, 1964)
0: Absence of microbial plaque
- Thin plaque layer at the mucosal margin, only detectable by scraping with a probe
- Moderate layer of plaque in the along the mucosal margin; interdental spaces free, but plaque is visible to naked eye
- Abundant plaque along with the mucosal margin; interdental places filled with plaque
Measured: Baseline (prior to therapy)
Plaque index (Silness & Löe, 1964)
Plaque index (Silness \& Löe, 1964):
0: Absence of microbial plaque
- Thin plaque layer at the mucosal margin, only detectable by scraping with a probe
- Moderate layer of plaque in the along the mucosal margin; interdental spaces free, but plaque is visible to naked eye
- Abundant plaque along with the mucosal margin; interdental places filled with plaque
Measured: 1st month
Plaque index (Silness & Löe, 1964)
0: Absence of microbial plaque
- Thin plaque layer at the mucosal margin, only detectable by scraping with a probe
- Moderate layer of plaque in the along the mucosal margin; interdental spaces free, but plaque is visible to naked eye
- Abundant plaque along with the mucosal margin; interdental places filled with plaque
Measured: 4th month
Plaque index (Silness & Löe, 1964)
0: Absence of microbial plaque
- Thin plaque layer at the mucosal margin, only detectable by scraping with a probe
- Moderate layer of plaque in the along the mucosal margin; interdental spaces free, but plaque is visible to naked eye
- Abundant plaque along with the mucosal margin; interdental places filled with plaque
Measured: 7th month
Gingival Index ( Löe & Silness,1963)
0: normal gingiva
- mild inflammation - slight change in color and slight edema but no bleeding on probing
- moderate inflammation - redness, edema and glazing, bleeding on probing
- severe inflammation - marked redness and edema, ulceration with tendency to spontaneous bleeding
Measured: Baseline (prior to therapy)
Gingival Index ( Löe & Silness,1963)
0: normal gingiva
- mild inflammation - slight change in color and slight edema but no bleeding on probing
- moderate inflammation - redness, edema and glazing, bleeding on probing
- severe inflammation - marked redness and edema, ulceration with tendency to spontaneous bleeding
Measured: 1st month
Gingival Index ( Löe & Silness,1963)
0: normal gingiva
- mild inflammation - slight change in color and slight edema but no bleeding on probing
- moderate inflammation - redness, edema and glazing, bleeding on probing
- severe inflammation - marked redness and edema, ulceration with tendency to spontaneous bleeding
Measured: 4th month
Gingival Index ( Löe & Silness,1963)
0: normal gingiva
- mild inflammation - slight change in color and slight edema but no bleeding on probing
- moderate inflammation - redness, edema and glazing, bleeding on probing
- severe inflammation - marked redness and edema, ulceration with tendency to spontaneous bleeding
Measured: 7th month
Bleeding on probing (Ainamo & Bay 1975)
Bleeding on probing A bleeding-on-probing percentage score assessed as the proportion of bleeding sites (dichotomous yes/no evaluation) when stimulated by a standardized manual probe with a controlled (~25 g) force to the bottom of the sulcus/pocket at six sites (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, distolingual) on all present teeth/ implants.
Measured: Baseline (prior to therapy)
Bleeding on probing (Ainamo & Bay 1975)
Bleeding on probing A bleeding-on-probing percentage score assessed as the proportion of bleeding sites (dichotomous yes/no evaluation) when stimulated by a standardized manual probe with a controlled (~25 g) force to the bottom of the sulcus/pocket at six sites (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, distolingual) on all present teeth/ implants.
Measured: 1st month
Bleeding on probing (Ainamo & Bay 1975)
Bleeding on probing A bleeding-on-probing percentage score assessed as the proportion of bleeding sites (dichotomous yes/no evaluation) when stimulated by a standardized manual probe with a controlled (~25 g) force to the bottom of the sulcus/pocket at six sites (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, distolingual) on all present teeth/ implants.
Measured: 4th month
Bleeding on probing (Ainamo & Bay 1975)
Bleeding on probing A bleeding-on-probing percentage score assessed as the proportion of bleeding sites (dichotomous yes/no evaluation) when stimulated by a standardized manual probe with a controlled (~25 g) force to the bottom of the sulcus/pocket at six sites (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, distolingual) on all present teeth/ implants.
Measured: 7th month
Keratinized mucosa width
The apical-coronal distance from the mucosal margin to the mucogingival junction (MGJ) Measurements will be made at three points on implants (mesiobuccal, midbuccal, distobuccal) using a periodontal probe.
Measured: Baseline (prior to therapy)
Keratinized mucosa width
The apical-coronal distance from the mucosal margin to the mucogingival junction (MGJ). Measurements will be made at three points on implants (mesiobuccal, midbuccal, distobuccal) using a periodontal probe.
Measured: 1st month
Keratinized mucosa width
The apical-coronal distance from the mucosal margin to the mucogingival junction (MGJ). Measurements will be made at three points on implants (mesiobuccal, midbuccal, distobuccal) using a periodontal probe.
Measured: 4th month
Keratinized mucosa width
The apical-coronal distance from the mucosal margin to the mucogingival junction (MGJ). Measurements will be made at three points on implants (mesiobuccal, midbuccal, distobuccal) using a periodontal probe.
Measured: 7th month
Probing depth
Probing pocket depth: The distance from the base of the pocket to the mucosal margin. Measurements will be made at six points on all teeth/ implants (mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual) using a periodontal probe.
Measured: Baseline (prior to therapy)
Probing depth
Probing pocket depth: The distance from the base of the pocket to the mucosal margin. Measurements will be made at six points on all teeth/ implants (mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual) using a periodontal probe.
Measured: 1st month
Probing depth
The distance from the base of the pocket to the mucosal margin. Measurements will be made at six points on all teeth/ implants (mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual) using a periodontal probe.
Measured: 4th month
Probing depth
The distance from the base of the pocket to the mucosal margin. Measurements will be made at six points on all teeth/ implants (mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual) using a periodontal probe.
Measured: 7th month
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Mar 2024
- Study start27 Mar 2024
- Primary completion10 Sep 2026 (estimated)
- Study completion10 Sep 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Peri-implant MucositisStudies of the same condition, open and under way.
- More trials run by Biruni UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 48 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Biruni University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Ayse Ege SELMAN, Biruni University
- Investigators
- Ayse E Selman, Principal investigator, Biruni University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06305000
- Sponsor's protocol ID
- 2015-KAEK-80-23-25
- Status last verified
- Feb 2026
- First submitted
- 5 Mar 2024
- Last updated
- 10 Feb 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 10 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Impact of Keratinized Mucosa Augmentation Following Non-surgical Therapy on Treatment Outcomes of Peri-implant Mucositis.
- ClinicalTrials.gov ID
- NCT06305000
- Acronym / sponsor ID
- 2015-KAEK-80-23-25
- Conditions
- Peri-implant Mucositis
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 48 participants (estimated)
- Lead sponsor
- Biruni UniversityUniversity, hospital or other
- Study start
- 27 Mar 2024 (actual)
- Primary completion
- 10 Sep 2026 (estimated)
- Study completion
- 10 Sep 2026 (estimated)
- First posted
- 12 Mar 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aims to observe the effects of keratinized mucosa width on peri-implant tissues by evaluating clinical and biochemical parameters. The main question it aims to answer is:
Would increasing the width of the keratinized mucosa with free gingival graft (FGG) in peri-implant mucositis be beneficial in terms of clinical periodontal parameters and peri-implant crevicular fluid levels of inflammatory cytokines compared to non-surgical therapy alone?
Our study consists of 4 groups:
Peri-implant healthy group with sufficient keratinized mucosa (≥ 2mm) (n=16), peri-implant mucositis group with sufficient keratinized mucosa (n=16), peri-implant mucositis group with insufficient keratinized mucosa (< 2mm) receiving only non-surgical treatment (n=16), peri-implant mucositis group with insufficient keratinized mucosa receiving FGG in addition to non-surgical treatment (n=16). Clinical and biochemical measurements will be recorded at the baseline, 1st month, 4th month and 7th month of the study. Peri-implant crevicular fluid samples will be collected at baseline, 1st month, 4th month and 7th month. IL-1β, RANKL, OPG levels, and RANKL/OPG ratio will be analyzed from collected samples.
Researchers will evaluate the possible benefits of FGG application in addition to non-surgical therapy by comparing the biochemical and clinical changes in areas with and without FGG application in the treatment of peri-implant mucositis.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Peri-implant healthy group with sufficient keratinized mucosa (≥ 2mm) | No intervention | – |
| Peri-implant mucositis group with sufficient keratinized mucosa (≥ 2mm) | Experimental | Procedure: Non-surgical treatmentOnly non-surgical therapy will apply |
| Peri-implant mucositis group with insufficient keratinized mucosa (< 2mm) receiving FGG | Experimental | Procedure: Non-surgical treatment, Procedure: Free gingival graftFree gingival graft will apply following non-surgical therapy |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Individual dental implants with a fixed prosthetic restoration that has been functional for at least 1 year
- No systemic disease and medication use that may affect periodontal or peri-implanter tissues
- Not receiving periodontal treatment in the last 6 months
- Volunteering to participate in the study
Key exclusion criteria (6 listed)
- Prosthetic restorations with an excessive contour which do not allow peri-implant pocket measurement
- Being pregnant or breastfeeding,
- Autoimmune and/or inflammatory diseases of the oral cavity,
- Active periodontal disease
- Smokers (≥ 10 cigarettes per day)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Non-surgical treatmentNon-surgical treatment consists of oral hygiene instructions, full mouth supragingival scaling using titanium hand instruments, ultrasonic devices, and subgingival debridement under local anesthesia with titanium curettes and ultrasonic instruments in a single appointment. | Procedure or surgery | Peri-implant mucositis group with insufficient keratinized mucosa (< 2mm) receiving FGG, Peri-implant mucositis group with sufficient keratinized mucosa (≥ 2mm) |
| Free gingival graftAfter adequate local anesthesia is achieved. A horizontal incision is placed mucogingival junction level to prepare the recipient bed. A split-thickness flap is raised without disturbing the periosteum. FGG is obtained from the palate, extending from the mesial surface of the second premolar to the middle of the first molar. The graft is shaped and stitched on the recipient surface. | Procedure or surgery | Peri-implant mucositis group with insufficient keratinized mucosa (< 2mm) receiving FGG |
Primary outcome
Inflammatory parameter levels in peri-implant crevicular fluid
Time frame: Baseline (prior to therapy)
Peri-implant crevicular fluid samples will be collected from 3 sites (mesiobuccal, buccal, distobuccal) of the implants using methylcellulose strips PerioPaper® (Oralflow Inc., Smithtown, NY, USA) gently placed into the cleansed and dried pocket for 30 sec. Interleukin-1beta, RANKL and OPG levels and RANKL/ OPG ratio will be evaluated.
Inflammatory parameter levels in peri-implant crevicular fluid
Time frame: 1st month
Peri-implant crevicular fluid samples will be collected from 3 sites (mesiobuccal, buccal, distobuccal) of the implants using methylcellulose strips PerioPaper® (Oralflow Inc., Smithtown, NY, USA) gently placed into the cleansed and dried pocket for 30 sec. Interleukin-1beta, RANKL and OPG levels and RANKL/ OPG ratio will be evaluated.
Inflammatory parameter levels in peri-implant crevicular fluid
Time frame: 4th month
Peri-implant crevicular fluid samples will be collected from 3 sites (mesiobuccal, buccal, distobuccal) of the implants using methylcellulose strips PerioPaper® (Oralflow Inc., Smithtown, NY, USA) gently placed into the cleansed and dried pocket for 30 sec. Interleukin-1beta, RANKL and OPG levels and RANKL/ OPG ratio will be evaluated.
Inflammatory parameter levels in peri-implant crevicular fluid
Time frame: 7th month
Peri-implant crevicular fluid samples will be collected from 3 sites (mesiobuccal, buccal, distobuccal) of the implants using methylcellulose strips PerioPaper® (Oralflow Inc., Smithtown, NY, USA) gently placed into the cleansed and dried pocket for 30 sec. Interleukin-1beta, RANKL and OPG levels and RANKL/ OPG ratio will be evaluated.
20 secondary outcomes
Plaque index (Silness & Löe, 1964)
Time frame: Baseline (prior to therapy)
Plaque index (Silness & Löe, 1964)
Time frame: 1st month
Plaque index (Silness & Löe, 1964)
Time frame: 4th month
Plaque index (Silness & Löe, 1964)
Time frame: 7th month
Gingival Index ( Löe & Silness,1963)
Time frame: Baseline (prior to therapy)
Gingival Index ( Löe & Silness,1963)
Time frame: 1st month
Gingival Index ( Löe & Silness,1963)
Time frame: 4th month
Gingival Index ( Löe & Silness,1963)
Time frame: 7th month
Bleeding on probing (Ainamo & Bay 1975)
Time frame: Baseline (prior to therapy)
Bleeding on probing (Ainamo & Bay 1975)
Time frame: 1st month
Bleeding on probing (Ainamo & Bay 1975)
Time frame: 4th month
Bleeding on probing (Ainamo & Bay 1975)
Time frame: 7th month
Keratinized mucosa width
Time frame: Baseline (prior to therapy)
Keratinized mucosa width
Time frame: 1st month
Keratinized mucosa width
Time frame: 4th month
Keratinized mucosa width
Time frame: 7th month
Probing depth
Time frame: Baseline (prior to therapy)
Probing depth
Time frame: 1st month
Probing depth
Time frame: 4th month
Probing depth
Time frame: 7th month
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Feb 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Ayse E Selman principal investigator
Biruni University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Non-surgical treatment and Free gingival graft in people with Peri-implant Mucositis, run by Biruni University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 10 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Ayse E Selman (+905366393184, aselman@biruni.edu.tr), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Inflammatory parameter levels in peri-implant crevicular fluid (time frame: Baseline (prior to therapy)). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Feb 2026.