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Patients often report complaining of fractured or decayed teeth with severe morphological deformities. However, all these clinical scenarios require the same level of care and consideration to rehabilitate form, function and esthetics. Some cases have sufficient clinical crown height while others often require an interdisciplinary approach in the form of orthodontic/surgical extrusion or surgical periodontal options. A common factor delaying treatment is soft tissue regrowth after crown lengthening which delays the impression required for final prosthesis. Therefore, it is of interest to compare the prevalence of soft tissue regrowth a week after different crown lengthening techniques including laser gingivectomy, electrocautery gingivectomy, modified Widman flap and apically repositioned. The parameters assessed included 1-week postoperative soft tissue regrowth after crown lengthening, age of patients and gender. It was observed that laser and electrocautery-assisted gingivectomy had a higher rate of soft tissue regrowth as compared to surgical techniques. It was further noted that laser and electrocautery assisted gingivectomy had a higher frequency of soft tissue rebound growth compared to surgical crown lengthening using modified widman flap and apically repositioned flap, which was statistically insignificant. Patients within the age groups of 26-60 years were found to have a higher tendency of soft tissue regrowth, which was found to be clinically and statistically significant (p

Summary Infrastructure must become more resilient as the global climate changes and also more affordable in the economic and political context of a post-COVID world. We can solve this dual challenge and drive global infrastructure investment into a more sustainable direction by taking our cues from Nature.

BACKGROUND The revival of older treatment modalities like splinting requires the assessment of newer patient centric parameters like survival, compliance, anaesthetics apart from changing the biomaterials employed alone. The purpose of this study was to assess the association between type of splint, chief complaint and survival of splint based on different clinical scenarios with long term follow-up. METHODS The present study was a prospective university based clinical trial with convenience sampling to include clinical scenarios which required splinting in a Chennai Dental College. Ninety-five adult patients were included in the study comprising 50 men and 45 women, aged between 19 - 65 years where parameters like demographic distribution, type of splint, location of the splint, patient compliance and survival were included. The primary end point of the present study was recall of patients periodically every month till 6 - 8 months to assess the duration of survival of splints and associate the same with age, gender, patient compliance, type of splint and rationale for splinting. RESULTS Among the 95 patients included (524 teeth splinted together), all patients completed the treatment protocol, stainless steel wire composite splints were given to 70 patients while composite mesh splints were used in 20 patients. A likelihood ratio of 0.024 (P < 0.05) was seen while associating composite mesh splints, rationale for use, survival time and patient compliance. CONCLUSIONS Within the limits of the present study, a conclusion was made that one must emphasise on the importance of retaining natural teeth based on appropriate clinical scenarios where maximum benefit could be obtained among compliant patients. KEY WORDS Periodontal Splints, Survival Rate, Patient Compliance, Rationale for Splinting, Tooth Fractures, Tooth Reimplantation

There is a growing need for coastal and marine restoration, but it is not clear how to pay for it given that environmental funding is low, and national budgets are stretched in response to natural hazards. We use risk-industry methods and find that coral reef and mangrove restoration could yield strong Return on Investment (ROI) for flood risk reduction on shorelines across more than 20 Caribbean countries. These results are robust to changes in discount rates and the timing of restoration benefits. Data on restoration costs are sparse, but the Present Value (PV) of restored natural infrastructure shows that ROI would be positive in many locations even if restoration costs are in the hundreds of thousand per hectare for mangroves and millions per km for reefs. Based on these benefits, we identify significant sources of funding for restoring these natural defenses. This work was supported in part by the Kingfisher Foundation, the World Bank, AXA XL, AXA Research Fund, The Nature Conservancy, and the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU) on the basis of a decision adopted by the German Bundestag. We thank Chris Lowrie for help with the figures.

Malocclusion is any deviation from physiologically acceptable contact between opposing dental arches. Occlusal trauma is a term used to describe injury resulting in tissue change within the attachment apparatus which may occur in a healthy or reduced periodontium. Clinically one of the tests to assess trauma from occlusion is the fremitus test with confirmatory test for trauma from occlusions such as histological evaluation of a block section biopsy or modern aids like T-scan. Considering these findings Angles Class II molar relation with or without skeletal Class II relation has great influence in underlying peridium. The present study was aimed at correlating the relation between angles class II malocclusion treated with orthodontic therapy alone or combined with orthognathic surgery and the periodontal status of mandibular incisors. The study was a single centered retrospective university design, using patient records for the comparison of the entire patient outflow of a dental college in Chennai from 1st June 2019 till 1st March 2020. The included patients were individuals with angles class II malocclusion treated by orthodontic therapy alone or combined with orthognathic surgery. In this study, we observed that the periodontal status of mandibular incisors was mostly healthy with the incidence of gingivitis associated at a higher tendency in patients treated by fixed orthodontic appliance therapy along with orthognathic surgery. There was also a negative correlation of non-extraction cases and periodontal status suggesting orthodontic extraction cases have a relatively healthy periodontium which was both clinically and statistically significant.

Periodontitis is a multifactorial disease, one of the responsible factors include Bacteria present in the oral cavity. Bacteria, like all other organisms, are dependent on the environment for their survival and are influenced by the various host as well as environmental factors for their sustenance. Some of the major environmental factors include nutrition, the presence of oxygen, along with pH, which dictate the nature of the bacteria present as certain bacteria thrive better in acidic environments while others in Alkali environments. In medicine, sutures are extensively used with the aim of post-surgical wound edge approximation or wound healing by the primary union. However, pH is one factor that is constantly changing in the oral cavity due to dietary intake or systemic factors or local accumulation of pus. The present study wished to assess the biohostability of different suture material such as silk, vicryl and chromic gut when pH was changed to 5,6,7 keeping all other environmental factors a constant, including five pieces of sterilised standardised suture lengths & diameter, incubated in ph of 5,6, and 7 exposed to a microbial load of 0.5 McFarland units Lactobacillus subculture in brain heart infusion and incubated at 35 degrees Celsius for four hours to assess the number of bacterial colonies using visual click method. It was found that pH plays a vital role in the Biohostability of suture material as the current study suggests an acidic pH of 5 had more colony-forming units seen among all three suture materials as compared to the other two groups.

Sea-level rise and coastal flooding threaten the lives and assets of millions. Adapting to these hazards is urgent, but to be effective and sustainable, adaptation strategies must be integrated into local contexts, needs, and priorities.

Mangrove forests are found on sheltered coastlines in tropical, subtropical, and some warm temperate regions. These forests support unique biodiversity and provide a range of benefits to coastal communities, but as a result of large-scale conversion for aquaculture, agriculture, and urbanization, mangroves are considered increasingly threatened ecosystems. Scientific advances have led to accurate and comprehensive global datasets on mangrove extent, structure, and condition, and these can support evaluation of ecosystem services and stimulate greater conservation and rehabilitation efforts. To increase the utility and uptake of these products, in this Perspective we provide an overview of these recent and forthcoming global datasets and explore the challenges of translating these new analyses into policy action and on-the-ground conservation. We describe a new platform for visualizing and disseminating these datasets to the global science community, non-governmental organizations, government officials, and rehabilitation practitioners and highlight future directions and collaborations to increase the uptake and impact of large-scale mangrove research.

Coastal hazards pose a serious and increasing threat to the wellbeing of coastal communities. Adaptation responses to these hazards ideally need to be embedded in the local adaptation context. However, there is little understanding of factors that shape local adaptation choices, especially in rural and remote island settings. In this paper, we compile data on adaptation responses to coastal hazards and key factors that shape adaptation across 43 towns and villages in four Pacific island nations. Local communities cite erosion as a critical coastal hazard, even more often than coastal flooding and sea level rise. We find that communities prefer protective adaptation responses that use local knowledge and resources eand protect coastal ecosystems. Our findings reveal differences in preferred versus implemented adaptation responses.Ecosystem-based adaptation is the most commonly implemented response to coastal hazards. Seawalls and other hard structures are widely preferred and perceived as effective adaptation responses but are often not implemented due to a lack of social, institutional and technical capacity. Retreat is a highly unpopular adaptation response, and difficult to implement, as coastal communities in this study indicate a strong place attachment and are deeply embedded in their social and natural environment. Our results suggest that the selection of adaptation responses might involve important trade-offs between multiple, potentially conflicting, local priorities, such as the preference for seawalls and the need to protect coastal ecosystems. Findings emphasize the importance of considering the local context when making adaptation choices and show that even when responding to the same hazard, adaptation responses can vary significantly depending on local priorities and capacities.

Background: Periodontal diseases are multifactorial and while formulating a diagnosis multiple factorsmust be taken into account and considered which may cause the disease or alter the treatment plan andprognosis. Some of the factors affecting surgical prognosis include the gingival biotype and labial frenallevel, type, morphology and attachment. The frenal attachment and level may causes additional pull andforce on gingiva affecting healing, gingival biotype affects the kind of flap to be raised or flapless technique,time taken for healing and also the amount of tissue required while procuring connective tissue and freegingival grafts. The present study was undertaken to get a better understanding of the relation betweenGingival Biotype and Labial Frenal attachment by conducting an Epidemiological survey in a Chennaipopulation. Methodology: A total of one hundred and fifty systemically healthy patients were screenedat random from the outpatients of a dental college and hospital between age groups 22 to 60 years. Eachpatient was screened by a single clinician, where the patients demographic data, type of frenal attachment,the medial maxillary labial frenal classification based on morphology, morphology of labial frenum, level offrenal attachment, Miller`s grade of gingival recession, gingival biotypes, visibility of the periodontal probethrough the gingival sulcus and gingival thickness measured using an endodontic reamer. Conclusion:Among all the patients who had Simple single frenum with no nodule and elongated parallel margins withgingival recession, two thirds of them had a Thin gingival biotype.

Minimally invasive therapeutic approaches have become the standard of care for many medical procedures. Conventional periodontal surgical therapies involve extensive tissue reflection, resulting in increased morbidity which stands to reason out that Minimally invasive surgery (MIS) approach for periodontal therapy would result in less morbidity and better esthetics for the patient. Thus, the aim of this review is to assess the clinical efficacy of MIS periodontal therapy compared to conventional access flap surgery for the treatment of intrabony periodontal defects.An electronic and manual search was done to identify and collect studies evaluating MIS periodontal therapy for the treatment of intrabony periodontal defects in terms of periodontal probing depth (PPD) reduction, clinical attachment level (CAL) gain, and gingival recession (REC) with a minimum of 6 month follow-up published in English. Six studies which satisfied the inclusion criteria were included for the review and the data extracted.The six included studies contributed to a total of 193 patients who underwent 93 MIS therapies for treating intrabony defects with at least a 6-month follow-up. Clinical evaluation showed a PPD reduction ranging from 3.55 ± 0.88 mm to 5.2 ± 1.6 mm, while CAL gain ranged from 2.82 ± 1.19 mm to 4.5 ± 1.1 mm, while the change in gingival margin level ranged from 0.06 mm to 0.5 mm. Only one study directly compared single flap approach (SFA) (a type of MIS) to double flap approach (papilla preservation flap) which reported PPD reduction and CAL gain to be better in SFA.Even though the above evidence compels us to believe that minimally invasive periodontal surgery is less invasive, less time consuming, and less morbid, the lack of enough studies directly comparing MIS with conventional access flap surgeries suggest that these conclusions are arbitrary. Thus, there is currently an absence of adequate evidence to substantiate the beneficial effect of minimally invasive periodontal surgical approach compared to a conventional access flap surgery for the treatment of intrabony periodontal defects.

Mangrove forests are found on sheltered coastlines in tropical, subtropical, and some warm temperate regions. These forests support unique biodiversity and provide a range of benefits to coastal communities, but as a result of large-scale conversion for aquaculture, agriculture, and urbanization, mangroves are considered increasingly threatened ecosystems. Scientific advances have led to accurate and comprehensive global datasets on mangrove extent, structure, and condition, and these can support evaluation of ecosystem services and stimulate greater conservation and rehabilitation efforts. To increase the utility and uptake of these products, in this Perspective we provide an overview of these recent and forthcoming global datasets and explore the challenges of translating these new analyses into policy action and on the ground conservation. We describe a new platform for visualizing and disseminating these datasets to the global science community, non-governmental organizations, government officials, and rehabilitation practitioners and highlight future directions and collaborations to increase the uptake and impact of largescale mangrove research.

In this work we pilot a methodology to value the annual coastal protection benefits provided by mangroves in the Philippines and identify where these natural coastal defenses deliver the greatest protection. This is the first rigorous, engineering-based, nationwide evaluation of the effectiveness of mangrove habitats as natural defenses. By comparing flood damages for scenarios with and without mangroves, the study estimates the socioeconomic benefits for protecting people and property, to inform conservation and disaster risk reduction policies. Without mangroves, flooding and damages to people, property and infrastructure in the Philippines would increase annually around 25%. These habitats reduce flooding to 613,500 people/year, 23% of whom live below the poverty line. They also avert damages to 1 billion US$/year in residential and industrial property. If mangroves were restored to their 1950 distribution, there would be additional benefits to 267,000 people annually, including 61,500 people below poverty and an additional 453 mill. US$ in avoided damages. Currently, mangroves prevent more than 1.7 billion US$ in damages for extreme events (1-in-50-year). Ultimately, rigorous economic estimates of critical ecosystem services like this will help the national government to integrate the value of mangroves to people, into their national accounting systems.

Coastal flood risks are rising rapidly. We provide high resolution estimates of the economic value of mangroves forests for flood risk reduction every 20 km worldwide. We develop a probabilistic, process-based valuation of the effects of mangroves on averting damages to people and property. We couple spatially-explicit 2-D hydrodynamic analyses with economic models, and find that mangroves provide flood protection benefits exceeding $US 65 billion per year. If mangroves were lost, 15 million more people would be flooded annually across the world. Some of the nations that receive the greatest economic benefits include the USA, China, India and Mexico. Vietnam, India and Bangladesh receive the greatest benefits in terms of people protected. Many (>45) 20-km coastal stretches particularly those near cities receive more than $US 250 million annually in flood protection benefits from mangroves. These results demonstrate the value of mangroves as natural coastal defenses at global, national and local scales, which can inform incentives for mangrove conservation and restoration in development, climate adaptation, disaster risk reduction and insurance We thank the supporting provided by the World Bank and the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU) on the basis of a decision adopted by the German Bundestag. We also acknowledge financial support from the Spanish Ministry of Economy and Innovation (BIA2014-59718-R). Authors are grateful to the useful contributions provided by Borja González Reguero (University of Santa Cruz California), Antonio Espejo, Sheila Abad and Pedro Díaz Simal (IH Cantabria). Pelayo Menéndez acknowledge to the FPI grant from the Spanish Ministry of Economy and Innovation (BES-2015-074343). The authors acknowledge to the National Plan “RISKOADAPT” from the Spanish Ministry of Sciences, Innovation and Universities (BIA2017-89401-R).

En un contexto de crecientes impactos y riesgos socio-económicos en las costas del planeta, la protección costera basada en ecosistemas surge como un nuevo paradigma que une los principios de protección, sostenibilidad y resiliencia, a la vez que proporciona múltiples beneficios. Este artículo ofrece una perspectiva sobre qué son y cómo se pueden utilizar las defensas naturales en el diseño, planificación y gestión de costas. La política pública muestra un creciente interés por su implementación general y el cuerpo de conocimiento y experiencia alrededor de la también denominada infraestructura ?verde? es creciente, pero aún existen importantes barreras que salvar. Una de ellas es estandarizar su diseño en términos ingenieriles, así como reconocer los aspectos que los diferencian respecto a enfoques tradicionales. La adaptación climática y la reducción de riesgos son áreas en las que su utilización puede ser más significativa, debido a la variedad de servicios que ofrecen. Tanto desde el punto de vista técnico como económico, existen argumentos sólidos para evitar la degradación de los ecosistemas, avanzando su restauración y conservación, como también desde la perspectiva de la defensa de las costas. In a context of increasing socio-economic impacts and risks in the coastal areas of the planet, coastal protection based on ecosystem features becomes a new paradigm that combines the principles of conservation, sustainability and resilience, while providing multiple benefits. This paper provides a perspective on what these are and how they can be used in the design, planning and management of the coastal zones. Policy-makers are calling for further uptake and implementation across the board and the body of knowledge and experience around the socalled ?green? infrastructure is growing, but there are still major barriers for a widespread uptake. One of them is to standardize designs in engineering terms, recognizing the different characteristics compared to traditional engineering solutions. Climate adaptation and risk reduction are areas where its use may be more significant, for the variety of services they offer. Both technically and economically, there are strong arguments to prevent degradation of ecosystems and to advance in their restoration and conservation, as well as from a coastal defense perspective.

This paper considers an emerging group of coastal management approaches that offer the potential to reduce coastal flood and erosion risks while also providing nature conservation, aesthetic and amenity benefits. These solutions mimic the characteristics of natural features, but are enhanced or created by man to provide specific services such as wave energy dissipation and erosion reduction. Such approaches can include beaches, dunes, saltmarshes, mangroves, sea grasses, coral and oyster reefs. The paper describes a number of innovative projects and the lessons learned in their development and implementation. These lessons include the planning, design and construction of projects, their development following implementation, the engagement of local communities and the cost-effectiveness of solutions.

Coastal flood assessments often require the analysis of a complex system of flood sources, pathways and receptors. This can be challenging for traditional numerical modelling approaches. In this paper we use a Bayesian networks approach to assess coastal floodplains as networks of inter-linked elements. A Bayesian network (Bn) model is built to describe flood pathways and estimate flood extents for different extreme events. The network of the Bn model is constructed from a quasi-2D Source – Pathway – Receptor (SPR) systems diagram. The Bn model is applied in Teignmouth in the UK, a coastal floodplain of typical complexity. It identifies two key flood pathways and assesses their sensitivity to changes in sea levels, beach widths and coastal defences. The advantages, utility and limitations of the Teignmouth Bn model are discussed. The process of 2D SPR and Bn model construction helps identify gaps in floodplain understanding and description. The Bn model quantifies inundation probabilities and facilitates the rapid identification of critical pathways and elements, before committing resources to further detailed analysis. The approach is transferable and can be readily applied in local-scale coastal floodplains to obtain a systems-level understanding and inform numerical modelling assumptions.

As exposure to coastal hazards increases there is growing interest in nature-based solutions for risk reduction. This study uses high-resolution flood and loss models to quantify the impacts of coastal wetlands in the northeastern USA on (i) regional flood damages by Hurricane Sandy and (ii) local annual flood losses in Barnegat Bay in Ocean County, New Jersey. Using an extensive database of property exposure, the regional study shows that wetlands avoided $625 Million in direct flood damages during Hurricane Sandy. The local study combines these models with a database of synthetic storms in Ocean County and estimates a 16% average reduction in annual flood losses by salt marshes with higher reductions at lower elevations. Together, the studies quantify the risk reduction ecosystem services of marsh wetlands. Measuring these benefits in collaboration with the risk modelling industry is crucial for assessing risk accurately and, where appropriate, aligning conservation and risk reduction goals.

Mangroves and other coastal ecosystems act as natural defenses that protect people and property from storms, floods, erosion, and other coastal hazards, reducing coastal risk. Mangroves protect coastlines by decreasing the risk of flooding and erosion. The roots of mangroves retain sediments and prevent erosion, while the prop roots, trunks and canopy reduce the force of incoming wind and waves and reduce flooding. The Philippines has lost hundreds of thousands of hectares of mangroves in the last century. When mangroves are degraded or destroyed, the coast line becomes more exposed to the destructive impacts of waves and storm surge, and coastal communities have greater risks from the impacts of storms, floods, and sea level rise. The Philippines is at high risk from coastal hazards and natural defenses can help reduce these risks. This Technical Report, and its accompanying Policy Brief, provide a social and economic valuation of the flood protection benefits from mangroves in the Philippines. This work aims to support decisions across development, aid, risk reduction and conservation sectors as they seek to identify sustainable and cost-effective approaches for risk reduction. This Technical Report applies the Expected Damage Function approach recommended by the World Bank to quantify the risk reduction benefits from mangroves in the Philippines. Using high-resolution flooding models, the Report examines the flooding that would occur with and without mangroves under different storm conditions throughout the Philippines, and estimates the annual expected benefits of mangroves for protecting people and property in social and economic terms.

Sinus of valsalva aneurysm is considered to be one of the rarest complications of inflammatory aortitis. Herewith, we are reporting a young male patient who presented to us with severe aortic regurgitation. On evaluation, he was found to have unruptured sinus of valsalva aneurysm. CT angiography and magnetic resonance imaging have shown value in the diagnosis of sinus of valsalva aneurysm.

Adaptation planning for flood risk forms a significant part of global climate change response. Engineering responses to higher water levels can be prohibitively costly. Several recent studies emphasize the potential role of ecosystems in flood protection as adaptive risk reduction measures while also contributing to carbon fixation. Here, we use a conceptual model study to illustrate the built-in adaptive capability of ecosystems to reduce a wide range of wave heights, occurring at different water levels, to a narrower range. Our model shows that wave height of waves running through a forested section is independent of initial height or of water level. Although the underlying phenomenon of non-linear wave attenuation within coastal vegetation is well studied, implications of reducing variability in wave heights for design of ecosystem and levee combinations have not yet been properly outlined. Narrowing the range of wave heights by a vegetation field generates an adaptive levee that is robust to a whole range of external conditions rather than only to a maximum wave height. This feature can substantially reduce costs for retrofitting of levees under changing future wave climates. Thereby, in wave prone areas, inclusion of ecosystems into flood defense schemes constitutes an adaptive and safe alternative to only hard engineered flood risk measures.

The energy of waves propagating through vegetation is dissipated due to the work done by the waves on the vegetation. Dalrymple et al. (1984) estimated wave dissipation by integrating the force on a cylinder over its vertical extent. This was extended by Mendez and Losada (2004) to include varying depths and the effects of wave damping due to vegetation and wave breaking for narrow-banded random waves. This paper describes the wave dissipation over a vegetation field by the implementation of the Mendez and Losada formulation in a full spectrum model SWAN, with an extension to include a vertical layer schematization for the vegetation. The present model is validated with the original equation and results from Mendez and Losada (2004) . The sensitivity of the model to the shape of the frequency spectrum, directional spreading and layer schematization are investigated. The model is then applied to field measurements by using a vegetation factor. This model has the ability to calculate two-dimensional wave dissipation over a vegetation field including some important aspects such as breaking and diffraction as used in SWAN model.

Coastal floodplains are complex regions that form the interface between human, physical and natural systems. This paper describes the development, application and evaluation of a conceptual foundation for quantitative integrated floodplain risk assessments using the recently-developed SPR systems model. The SPR systems model is a conceptual model that combines the well-established Source–Pathway–Receptor (SPR) approach with the concept of system diagrams. In comparison to the conventional approach, the systems model provides spatially explicit quasi-2D descriptions of the floodplain in terms of constituent elements and possible element linkages. The quasi-2D SPR, as it will henceforth be referred to in this paper, is not the final product of this work, but is an important intermediate stage which has been pursued as part of a wider European flood risk project THESEUS (www.theseusproject.eu). Further research is currently on-going to provide full quantification of the quasi-2D SPR, and to add further refinements such that hydraulic assessments could follow on easily and rapidly from the results of these appraisals. The first part of the paper synthesises current conceptual treatment of coastal floodplains and identifies areas for improvement in describing coastal floodplains as complex systems. The synthesis demonstrates that the conceptual foundation of a ‘typical’ flood risk study often achieves a less comprehensive and integrated description of the floodplain than the quantitative models which it informs. From this synthesis, the quasi-2D SPR is identified as a more robust and informative conceptual foundation for an integrated risk assessment. The quasi-2D SPR has been applied to seven European coastal floodplains as part of the THESEUS project. The second part of the paper discusses in detail the application of the quasi-2D SPR to three contrasting floodplain systems — an estuary, a coastal peninsula and a mixed open coast/estuary site. The quasi-2D SPR provides a consistent approach for achieving comprehensive floodplain descriptions that are individual to each coastal floodplain. These are obtained through a robust, participatory model-building exercise, that facilitates developing a shared understanding of the system. The constructed model is a powerful tool for structuring and integrating existing knowledge across multiple disciplines. Applications of the quasi-2D SPR provide key insights into the characteristics of complex coastal floodplains — insights that will inform the quantification process. Finally, the paper briefly describes the on-going quantitative extension to the quasi-2D SPR. ispartof: Coastal Engineering vol:87 pages:15-31 status: published

Climate changewith rising sea levels and possible changes in surge levels and wave climate will have a large impact on how we protect our coastal areas and cities. Here the focus is on estuarine locations not only affected by tide and surge propagation, but also potentially influenced by freshwater discharge. Mitigation measures might be diverse ranging from pure hard ‘engineering’ solutions all theway to significant realignment. The variation in the type/origin and extent of the flood sources greatly influences subsequent risk management measures. At the same time, society is increasingly demanding that we take a holistic view on risk management, embracing and balancing safety, ecological and socio-economic aspects. This requires that all these diverse factors need to be considered together and integrated. In this context, the Source–Pathway–Receptor (SPR) approach offers a powerful holistic tool to investigate changing risk connected to extreme events. The traditional SPR approachwith a consecutive treatment of the flood, pathway and receptor is well understood and is widely used in coastal flood risk analysis. Here an enhanced 2D conceptual version of the SPR method is used to better describe the systemand to allow flexibility in considering multiple scales, flood sources and pathways. The newapproach is demonstrated by three estuarine case studies inwestern Europe: the Gironde estuary, France; the Dendermonde region in the Scheldt estuary, Belgium; and HafenCity (Hamburg) in the Elbe estuary, Germany. They differ considerably in the surface area considered, in the type of flood sources, and hence also in the SPR configuration. After a brief introduction of the typical characteristics of the three study sites including some lessons learned from past flood protection measures, the differences in application and results of the SPR approach are discussed. Emphasis is on the specific aspects for each study site, but embedded in a generic SPR framework. The resulting generic lessons learned about the flood sources and how this shapes subsequent analysis are transferable to numerous important estuaries worldwide. ispartof: Coastal Engineering vol:87 pages:32-49 status: published