CLINICAL RESEARCH

Comparing the use of static versus dynamic

images to evaluate a smile
Eduardo Mahn, PhD,a Camila S. Sampaio, PhD,b Bruno Pereira da Silva, PhD,c Kyle Stanley, DDS,d
Ana María Valdés, DDS,e Javiera Gutierrez, DDS,f and Christian Coachman, DDSg

When starting esthetic dental ABSTRACT

treatment, the patient’s ex-
Statement of problem. Smile analysis, as part of the overall facial analysis, is an important
pectations, the patient’s component of diagnosis and treatment planning in the esthetic rehabilitation of a patient. Most
individual anatomic charac- studies that refer to smile analysis are based on static images. A more comprehensive evaluation
teristics, and possible thera- can be made with dynamic video images that can be stopped at the most appropriate frame to
peutic solutions should be ensure the best static images for analysis.
considered.1 Facial features Purpose. The purpose of this clinical study was to evaluate the posed and dynamic smiles
and lip movements should be of both sexes, considering the type of smile, prevalence of gingival display, dental display
analyzed in relation to teeth at rest, dentogingival display at posed and spontaneous smile, and lip mobility, through
when facial, dentolabial, and digital image acquisition (photographs and video clips) manipulated by using a software
phonetic parameters are eval- program.
uated1,2 by directly measuring Material and methods. Three photographs and 1 video clip were made for each of the 380
the lip-tooth relationships voluntary participants aged between 18 and 32 years by using an iPhone 6 iSight 8 MP camera,
both dynamically and at rest.3 Moment lens, and artificial 5500 Kelvin light (IceLight). Digital files were evaluated by using a
A pleasing smile has been software program (Keynote), determining each point to be evaluated with posed and spontaneous
shown to depend not only on smiles.
tooth position, color, size, and Results. With static images, 90% of women and 74% of men had gingival display, with only
shape but also on the amount 35% of women and 21% of men having continuous gingival display. With dynamic analysis,
of gingival display and the these values increased to 100% of women and 95% of men having gingival display and 62%
framing of the lips.4 Clinical of men and 81% of women having a continuous gingival display (P<.05). The difference
between dentogingival display during posed and spontaneous smiles was clear, with 68% of
decisions could be affected by the participants having 2.25 mm more gingival display. Women tend to show slightly more
soft tissue display, which is dental display at rest, posed and spontaneous dentogingival display, as well as lip mobility,
normally measured from than men.
posed photographs.
Conclusions. The type of smile changes significantly when posed and spontaneous smiles are
The visibility of the compared. Women generally show more gingiva and teeth in all the parameters evaluated than
gingival tissues depends on men. Dental treatments should be individually planned according to each patient’s smile
the position of the smile line characteristics. (J Prosthet Dent 2019;-:---)

This work was partially supported by the Fondo Nacional de Desarrollo Científico y Tecnológico, Chile (FONDECYT Project 11170920).
a
Research Professor and Director of the Esthetic Dentistry Program, Department of Restorative Dentistry, Universidad de los Andes, Santiago, Chile.
b
Research Professor, Department of Restorative Dentistry, Universidad de los Andes, Santiago, Chile.
c
Collaborator Professor, Department of Prosthodontics and Periodontology, University of Sevilla, Sevilla, Spain.
d
Adjunct Professor, Department of Restorative Sciences, Herman Ostrow School of Dentistry of USC, University of Southern California, Los Angeles, Calif.
e
Professor, Department of Restorative Dentistry, Universidad de los Andes, Santiago, Chile.
f
Professor, Esthetic Dentistry Program, Universidad de los Andes, Santiago, Chile.
g
Adjunct Professor, Department of Preventive and Restorative Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, Pa.

THE JOURNAL OF PROSTHETIC DENTISTRY 1

2 Volume - Issue -

metabolism18,19; thus, a high smile line has been

Clinical Implications described as a sign of youth.8,13
Clinicians have based their treatment and research Paradigms regarding smile line and the shape of teeth
and their difference in men and women still exist in
on a static analysis of patient smiles, which
esthetic dentistry.20 The concept that oval teeth were
represents a posed smile. However, this could lead
characteristic of women and square teeth of men has
to false diagnosis and nonideal treatment because
been disproven recently.20 Moreover, the concept of the
the patients’ spontaneous smiles might differ
smile line and the normal or average display obtained
significantly from the posed smiles by showing
from static photographs5,10,18 may also require revision.
more maxillary and mandibular teeth and more
Videos, made with several frames per second, allow the
gingival display. Dynamic smile evaluations should
be used to determine the full range of a smile in clinician to choose the optimal smile display and provide
a more accurate and natural assessment than static
motion.
photography.
Therefore, the purpose of this clinical study was to
evaluate the smile in static and video images. The null
and the relationship between the upper lip and the size
hypotheses tested were that no difference would be
and visibility of teeth.5 Smile types can be classified as
found in posed and spontaneous smiles and that women
follows: a very high smile line, high smile line, average
and men would not show differences in the different
smile line, and low smile line.5 For this analysis, both
smile parameters evaluated.
posed and spontaneous smiles need to be defined and
considered. The posed or static social smile is a voluntary
MATERIAL AND METHODS
smile a person uses in social settings or when being
photographed, while a spontaneous smile is involuntary This study was performed according to protocols
and represents the emotion a person is experiencing at approved by the institutional review board of the Uni-
that moment.6,7 Gingival displays within 0 to 2 mm8 and versidad de los Andes, Chile. Three hundred and eighty
2 to 4 mm4 have been reported to be esthetically dental students (227 women and 153 men) from the
pleasing, while higher or lower smile lines may present University of Los Andes, Chile, were selected; research
esthetic issues.4,8 details were explained, and the participants signed a
Digital imaging has been used to evaluate different consent agreement. Inclusion criteria specified partici-
aspects of a smile, initially with static photographs.5,8-10 pants should be between 18 and 32 years because
However, a spontaneous smile is difficult to obtain with different ages might affect gingival display.13
static photographs,11 and capturing and quantitatively The operator (J.G.) was calibrated by a specialist
analyzing digital images acquired from videos in com- (E.M.) to standardize and ensure the quality control of
puter software may improve the esthetic assess- the photographs and video clips. Files used for this
ment.3,4,7,11-16 calibration were not used in the results of this study.
Dentolabial parameters vary according to lip mobility Photographs and video clips were made by using an
in both a static posed smile and a smile in motion as 8-MP camera (iPhone 6 iSight; Apple Inc) and a
captured in video.17 The use of dynamic documentation 60-mm Moment lens (Moment Inc) in artificial and
of the smile (DDS) allows esthetic rehabilitative plan- standardized light calibrated in 5500 Kelvin (Ice Light;
ning from a facial perspective, improving communica- Westcott Co).
tion with the patient, integration among specialists, and Digital imaging was made with standardized param-
the predictable quality of the treatment.17 In addition, eters: participants were requested to stand in front of a
the improvements in video and photographic quality in black screen, and those with long hair were asked to tie it
modern smartphones make them useful for clinicians.17 back, with the ears showing. The digital camera was
This is why, recently, protocols have been developed positioned 40 cm from the tip of the participant’s nose for
using smartphones, demonstrating the simplicity of the photographs and 70 cm for the video clips. Lights
their application.17 It may no longer be essential for were positioned on tripods at 45 degrees from the medial
dentists to purchase expensive and bulky photographic sagittal plane and 15 cm from the tip of the participant’s
equipment. nose. The digital files obtained were the following:
Digital analysis has revealed that women have a photographs (posed smile): 1 frontal photograph with
higher smile line than men.5,14 Moreover, incisor display the participant’s mouth closed in maximum inter-
changes with age, and no individuals older than 50 years cuspation; 1 frontal photograph at rest (after swallowing);
presented a high smile line.13 This change can be and 1 frontal photograph in posed smile. Participants
explained by the elasticity of soft tissues, which decreases were requested to keep their eyes focused on the hori-
with age-related alterations in the connective tissue zon. Video clips (spontaneous smile): a 30-second video

THE JOURNAL OF PROSTHETIC DENTISTRY Mahn et al

- 2019 3

Figure 1. Representative digital images from video clip. Observe how smile line changes from first (A, posed smile) to last image (F, spontaneous smile).

clip was made for each participant, aiming to make them The type of smile parameter was classified according
smile spontaneously. The selected image was the one to the study by Liébart et al5 who determined 4 types of
with the most dentogingival smile display (Fig. 1). smile: class I, very high smile line (more than 2 mm of
After the standardized protocol for the imaging, static marginal gingiva visible, or more than 2 mm apical to the
and dynamic digital images were analyzed by using a cement-enamel junction visible for reduced but healthy
presentation software program (Keynote v6.6.1; Apple periodontium); class II, high smile line (between 0 to 2
Inc). Measurements were performed in the captured dig- mm of marginal gingiva visible or between 0 to 2 mm
ital files by means of an electronic millimeter ruler (Fig. 2) apical to the cement-enamel junction visible for reduced
that was calibrated in the photograph according to the but healthy periodontium); class III, average smile line
actual width of the maxillary left central incisor. Different (gingival embrasures only visible); and class IV, low smile
aspects were analyzed in the photographs and video clips. line (gingival embrasures and cement-enamel junctions

Mahn et al THE JOURNAL OF PROSTHETIC DENTISTRY

4 Volume - Issue -

Figure 2. Different aspects measured in captured digital files by electronic millimeter ruler calibrated according to actual width of maxillary left central
incisor. A, Dental display at rest measured in millimeters in frontal photograph at rest calculated from incisal edge to stomion of upper lip. B,
Dentogingival display in social smile expressed by measuring (mm) distance from incisal edge of left maxillary central incisor to lower edge of upper lip
following vertical line. C, Digital ruler calibrated with conventional ruler. D, Dentogingival display in spontaneous smile expressed by measuring (mm)
distance from incisal edge of left maxillary central incisor to lower edge of upper lip following vertical line.

not visible). Figure 3 shows the type of smile considered at rest from the dentogingival display distance in the
for each of the 4 classifications. The type of smile was spontaneous smile (maximum dentogingival display) for
calculated as percentages for women and men at spon- women and men. The data of prevalence of gingival
taneous and posed smiles. The prevalence of gingival smile display regarding the sexes at posed and sponta-
smile display considered all the classes where gingiva neous smiles were analyzed by using a statistical software
was present (classes I, II, and III) and was compared program (IBM SPSS Statistics, v23.0; IBM Corp) by 1-way
between sexes for posed and spontaneous smiles. ANOVA and the Tukey HSD post hoc test (a=.05).
Dental display at rest was measured in millimeters in
the frontal photograph at rest and calculated from the
RESULTS
incisal edge to the stomion of the upper lip. The mea-
surements for women and men were compared. Den- The type of posed and spontaneous smiles regarding
togingival display in posed and spontaneous smiles was women and men is presented in Table 1. In general, the
expressed by measuring (mm) the distance from the posed smile type most frequently seen was class III
incisal edge of the left maxillary central incisor to the (53.9% total) for both sexes, women (54.6%) and men
lower edge of the upper lip following a vertical line. (52.9%). The least frequently seen type was class I (5%
Dentogingival display was observed for posed and total) for both women (7.9%) and men (0.6%). Regarding
spontaneous smiles for women and men, and the dif- the spontaneous smile seen through dynamic videos, the
ference in gingival display was calculated in millimeters previous trend changed, and more gingiva was displayed,
by subtracting posed smile dentogingival display from presenting class II smile as the most frequently seen one
spontaneous dentogingival display. Lip mobility was (45.3% total) for both sexes (women 44.9%; men 45.7%),
calculated in millimeters by subtracting the dental display followed by class I (women 36.1% and men 16.3%), class

THE JOURNAL OF PROSTHETIC DENTISTRY Mahn et al

- 2019 5

Figure 3. Types of smile evaluated. A, class I: very high smile line. B, class II: high smile line. C, class III: average smile line. D, class IV: low smile line.

III (women 18.9% and men 32.7%), and finally, class IV Table 1. Prevalence of type of smile (%) with respect to sexes with posed
(2.1% total; 0% women and 5.2% men). It was observed and spontaneous smiles
that 68.4% of the sample (64.0% from men; 71.4% from Type of Smile
women) showed a change (P<.05) in the type of smile Posed Spontaneous
from posed to spontaneous smile, whereas in 31.6%, the Type of smile Women (%) Men (%) Women (%) Men (%)
smile type was maintained (Fig. 4). Class I 7.9 0.6 36.1 16.3
The prevalence of gingival smile display considered Class II 27.7 20.3 44.9 45.7

class I, II, and III, which were all classifications that show Class III 54.6 52.9 18.9 32.7
Class IV 9.7 26.1 0 5.2
gingiva with the different types of smile and are shown in
Table 2. For the posed smile, a statistically significant
difference was seen (P<.05) when compared with spon-
DISCUSSION
taneous smiles in both men and women. For both posed
and spontaneous smiles, women presented a higher The first null hypothesis tested was rejected because the
percentage of gingival display than men. For the posed predominant types of smiles changed from posed to
smile, a total of 83.7% (318 of 380 participants) showed spontaneous. In posed smile, the highest prevalence of
papillae or more, whereas for spontaneous smiles, this type of smile was the average (53.9%), but when evalu-
value increased to 97.9% (372 out of 380). ated in spontaneous smile, a greater part of the teeth
Dental display at rest, posed and spontaneous den- started to show in the smile, and most of the participants
togingival display, lip mobility, and difference in gingival presented a high smile line (45.3%; 2 to 4 mm gingival
display between posed and spontaneous smiles exposure). In total, most participants presented a change
regarding the sexes are shown in Table 3. Slightly higher in type of smile from posed to spontaneous (68.4%).
values were found for all factors in women. Moreover, Different studies have observed the importance of
the minimum and maximum values (lower standard type of smile and smile lines.1,3-5,7-13,16 For posed smiles,
deviation) were closer to each other for women for all the low smile line was the most frequent, whereas the
factors when compared with men. average smile line was the most frequent in spontaneous

Mahn et al THE JOURNAL OF PROSTHETIC DENTISTRY

6 Volume - Issue -

Figure 4. Observed changes in women and men. Posed smile visualized through digital photographs and spontaneous smile through video clips.
Observe that photographs from A to D did not show change in type of smile from posed to spontaneous smile, whereas photographs from E to H
showed changes. Change in type of smile corresponds to bigger lip movement from posed to spontaneous smile. A-D, “no change in type of smile” and
“change in type of smile” images from women. E-H, “no change” and “change” images from men.

THE JOURNAL OF PROSTHETIC DENTISTRY Mahn et al

- 2019 7

Table 2. Prevalence of gingival smile display with respect to sexes with Table 3. Dental display at rest, posed and spontaneous dentogingival
posed and spontaneous smiles display, lip mobility, and difference in gingival display between posed
Type of Smile and spontaneous smiles with respect to sexes (mm) (minimum to
Gingival Smile Display Posed (%) Spontaneous (%) maximum)
Men 73.8B 94.8B Smile Characteristic Men Women
A A
Women 90.3 100 1. Dental display at rest 1 (0-6.5) 1.2 (0-6.5)
2. Posed dentogingival display 7.8 (2-12.5) 8.8 (4-14)
Means followed by different superscript uppercase letters vertically differ statistically from
each other (P<.05). 3. Spontaneous dentogingival display 10.1 (3.5-16.5) 11 (6-17)
4. Lip mobility (subtraction 3-1) 9.1 (3.5-18) 9.8 (5-15)
5. Difference in gingival display 2.2 (0-9) 2.2 (0-8)
smiles.9 Another study reported the average smile line as (spontaneous minus posed)
the most frequent for both posed and spontaneous smile
lines.5 All these studies are consistent with the present
study if the posed static smile is considered. If any of the dentogingival display and lip mobility was about 1 mm.
classifications of Tjan et al,10 Liebart et al,5 and Jensen Moreover, although more women than men were eval-
et al18 are used, a total of 81% of women and 62% of men uated in this study (227 to 153), which could be reflected
show a gingival display, making this group the most in higher differences between the maximum and mini-
common and not in need of any kind of correction. mum values of the parameters evaluated, this was not
Nevertheless, there is a threshold of display that tends to found, indicating that women had more standardized
be less attractive, which the authors believe lies at 4 mm smile patterns than men. One millimeter can be the
of display. The evaluation of this threshold should be a difference between an esthetically favorable and unfa-
matter for future investigations. However, when in- vorable smile because the type of smile classification
dividuals smile spontaneously, this pattern changes, and varies from 0 to 4 mm, and values within those limits are
what was previously considered a high smile line is considered extremes. These results are also consistent
predominant, corroborating the importance of the dy- with those of previous studies showing that women
namic assessment. It is nearly impossible to capture the display more gingiva than men.10,14
highest smile line of a patient in a single photographic When gingival display in women and men was
image,11 which is why video recording is indicated. evaluated, similar mean values were obtained (2.24 mm
Studies that used videography also reported changes gingival display for men and 2.25 mm for women). This
when smile parameters were evaluated between posed mean is consistent with the esthetic smile as defined in
and spontaneous smiles.11,13 This is consistent with this previous studies. These studies reported that a gingival
study and demonstrates that a video recording is indi- display of between 0 and 2 mm is acceptable to dentists
cated when the spontaneous smile requires evaluation. and lay people8 and that a smile line height of between 2
Such information is relevant for patients with exces- and 4 mm is perceived most favorably.4 Therefore, with
sively short teeth, excessive gingival display, or lack of the average increase in the spontaneous smile of around
tooth display frequently associated with esthetic prob- 2.24 mm for men and 2.25 mm women, most of the
lems.21 The results of the present study show that participants evaluated in this study would be considered
gingival display is normal for most individuals, which will as having an esthetically favorable smile.
help the clinician look for other discrepancies such as Although gingival display appears to have a negative
tooth length-width ratio, wear, altered passive eruption, social connotation, 36.1% of women exposed more than
alveolar extrusion, or skeletal vertical maxillary excess. In 2 mm of gingival tissue in spontaneous smiles. Addi-
the authors’ clinical experience, when a patient com- tional studies are needed to determine the threshold of
plains of excessive gingival display, the problem is often gingival display for an esthetically unpleasant smile.
because of other undetected problems such as uneven This study used the technology of videographic im-
gingival zeniths or tooth ratio discrepancy. Treatment aging, which provides the opportunity to select images
options might involve crown lengthening alone or in that best reflect the specified function among numerous
conjunction with restorative treatment.21 frames that are obtained over time.6,11-13 Videography
The second null hypothesis was also rejected because appears to be reliable, reproducible, and valid for use in
for all parameters evaluated, (dental display at rest, clinical practice.22 After making the videos, analysis and
posed dentogingival display, spontaneous dentogingival measurements can be performed by using a software
display, lip mobility, and the difference between posed program.
and spontaneous dentogingival display), women This study was limited to a single age range because it
showed higher values for visible teeth. Although the has been shown that maxillary incisor display changes
dental gingival display difference at rest between women with age.13 Further studies should focus on type of smiles,
and men was only about 0.23 mm, the difference be- changes during spontaneous and posed smiles, and smile
tween the sexes regarding posed and spontaneous characteristics such as lip mobility and dental and

Mahn et al THE JOURNAL OF PROSTHETIC DENTISTRY

8 Volume - Issue -

dentogingival display in different age ranges. This study 3. Sarver DM, Ackerman MB. Dynamic smile visualization and quantification:
part 1. Evolution of the concept and dynamic records for smile capture. Am J
showed that the use of digital photographs alone for Orthod Dentofacial Orthop 2003;124:4-12.
evaluation and treatment planning is incomplete because 4. Van der Geld P, Oosterveld P, Van Heck G, Kuijpers-Jagtman AM. Smile
attractiveness. Self-perception and influence on personality. Angle Orthod
most of the participants showed a change in the type of 2007;77:759-65.
smile from posed to spontaneous records. Moreover, 5. Liébart MF, Fouque-Deruelle C, Santini A, Dillier FL, Monnet-Corti V,
Glise JM, et al. Smile line and periodontium visibility. Perio 2004;1:
treatments should be planned individually because a wide 17-25.
range of maximum and minimum values for lip mobility, 6. Ackerman JL, Ackerman MB, Brensinger CM, Landis JR. A morphometric
analysis of the posed smile. Clin Orthod Res 1998;1:2-11.
dental and dentogingival displays at rest, and posed and 7. Sarver DM, Ackerman MB. Dynamic smile visualization and quantification:
spontaneous smiles was observed. Women usually pre- Part 2. Smile analysis and treatment strategies. Am J Orthod Dentofacial
Orthop 2003;124:116-27.
sent higher dentogingival display in both posed and 8. Akhare PJ, Daga A. Effect of the gingival display on posed smile with
spontaneous smiles than men. different facial forms: A comparison of dentists and patients concepts. Indian
J Dent Res 2012;23:568-73.
9. Sepolia S, Sepolia G, Kaur R, Gautam DK, Jindal V, Gupta SC. Visibility of
CONCLUSIONS gingiva-An important determinant for an esthetic smile. J Indian Soc
Periodontol 2014;18:488-92.
From the findings of this clinical study, the following 10. Tjan AH, Miller GD, The JG. Some esthetic factors in a smile. J Prosthet Dent
1984;51:24-8.
conclusions were drawn: 11. Dindaro g lu F, Dogan S, Erdinç AM. Smile esthetics: age related changes, and
objective differences between social and spontaneous smiles. J Clin Pediatr
1. Unlike previous reports, a high smile line (class II) Dent 2011;36:99-106.
12. Ackerman MB, Brensinger C, Landis JR. An evaluation of dynamic lip-tooth
was the most frequent type of spontaneous smile characteristics during speech and smile in adolescents. Angle Orthod
seen (45.3%) in this young population (18 to 32 2004;74:43-50.
13. Desai S, Upadhyay M, Nanda R. Dynamic smile analysis: changes with age.
years old), while an average smile (class III) was the Am J Orthod Dentofacial Orthop 2009;136:310.e1-10.
most frequently seen one when the smile was posed 14. Maulik C, Nanda R. Dynamic smile analysis in young adults. Am J Orthod
Dentofacial Orthop 2007;132:307-15.
(59.9%). 15. McNamara L, McNamara JA Jr, Ackerman MB, Baccetti T. Hard-and soft-
2. Around two-third (68.4%) of the participants tissue contributions to the esthetics of the posed smile in growing patients
seeking orthodontic treatment. Am J Orthod Dentofacial Orthop 2008;133:
changed the type of smile when posed and spon- 491-9.
taneous smiles were compared, showing a higher 16. Van der Geld P, Oosterveld P, Schols J, Kuijpers-Jagtman AM. Smile line
assessment comparing quantitative measurement and visual estimation. Am
smile line when a spontaneous smile was presented. J Orthod Dentofacial Orthop 2011;139:174-80.
3. Women tended to display more teeth than men, 17. Coachman C, Calamita MA, Sesma N. Dynamic documentation of the smile
and the 2D/3D digital smile design process. Int J Periodontics Restorative
reflected in the higher percentages of gingival smile Dent 2017;37:183-93.
display. 18. Jensen J, Joss A, Lang NP. The smile line of different ethnic groups in relation
to age and gender. Acta Med Dent Helv 1999;4:38-46.
4. Women tended to present slightly higher dental 19. Neumann LM, Christensen C, Cavanaugh C. Dental esthetic satisfaction in
display at rest, posed and spontaneous dentogin- adults. J Am Dent Assoc 1989;118:565-70.
20. Mahn E, Walls S, Jorquera G, Valdés AM, Val A, Sampaio CS. Prevalence of
gival display, lip mobility, and difference in gingival tooth forms and their gender correlation. J Esthet Restor Dent 2018;30:
display between posed and spontaneous smiles 45-50.
21. Arias DM, Trushkowsky RD, Brea LM, David SB. Treatment of the patient
than men. with gummy smile in conjunction with digital smile approach. Dent Clin
5. The present study demonstrated that gingival tis- North Am 2015;59:703-16.
22. van der Geld PA, Oosterveld P, van Waas MA, Kuijpers-Jagtman AM. Digital
sue is typically shown when people smile naturally, videographic measurement of tooth display and lip position in smiling and
a fact that should lead the clinician to consider it speech: reliability and clinical application. Am J Orthod Dentofacial Orthop
2007;131:301.e1-8.
standard and not in need of treatment. When
patients complain about excessive gingival display,
Corresponding author:
the clinician should look for other responsible Dr Camila S. Sampaio
elements. Department of Restorative Dentistry
Universidad de los Andes
Avenida Monseñor Alvaro del Portillo
REFERENCES 12455 Santiago
CHILE
1. Fradeani M. Evaluation of dentolabial parameters as part of a comprehensive Email: [email protected]
esthetic analysis. Eur J Esthet Dent 2006;1:62-9.
2. Fradeani M, Barducci G. Esthetic rehabilitation in fixed prosthodontics. Vol 2. Copyright © 2019 by the Editorial Council for The Journal of Prosthetic Dentistry.
Illinois: Quintessence Publishing; 2004. p. 125-7. https://doi.org/10.1016/j.prosdent.2019.02.023

THE JOURNAL OF PROSTHETIC DENTISTRY Mahn et al