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If your piano is more than about 4% (8¢) from Concert Pitch, additional pre-tuning services will be needed:

 

There are over 200 piano strings in every piano, and these are actually made of steel wire.​  An adjustment of more than 4% requires substantial tightening and recalibration of the steel wire tension. This process is intensive, and takes time.

 

And this step must be done first, so that the piano is able to accommodate the precise, fine adjustments of a standard Piano Tuning procedure.

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