Effects of relief space and escape holes on pressure characteristics of

maxillary edentulous impressions

Osamu Komiyama, DDS, PhD,a Hiroyuki Saeki, DDS, PhD,b Misao Kawara, DDS, PhD,c
Kihei Kobayashi, DDS, PhD,d and Shigeo Otake, DDS, PhDe
Nihon University of Dentistry at Matsudo, Matsudo City, Chiba, Japan
Statement of problem. The selective pressure technique has been recommended for making impressions of
maxillary edentulous residual ridges. Although various methods for making impressions have been reported,
a definitive procedure has not been clearly elucidated.
Purpose. This in vitro study evaluated changes in impression pressure produced by different types of relief
space and escape holes in the impression tray for making an impression of a simulated maxillary edentulous arch.
Material and methods. Silicone impression material (Exadenture) and a maxillary edentulous acrylic cast
were used. A miniature pressure sensor was embedded at the mid-palatal suture (point-P) and at the left first
molar area on the edentulous ridge (point-R). Three types of tray relief were used: no spacer (NS), a 0.36-mmthick sheet of wax (SS), or a 1.40-mm-thick base plate wax (BS). Four types of escape holes were made: no hole
(NH), or escape holes of 0.5, 1.0, or 2.0 mm in diameter (05H, 10H, and 20H, respectively) in the area
opposing point-P. Twelve trays were formed using these relief space and escape hole combinations. The cast and
tray were attached to a rheometer for applying a continuous isotonic force of 5.0 kgf and compressive speed of
120 mm/min. Impressions were made and measurement of pressure (kPa) began immediately prior to
compression and continued until the materials had polymerized for 2 minutes, with a sampling time of 5 Hz.
Measurements were performed 5 times for each tray. The data were analyzed using 3-way analysis of variance
and the Bonferroni test (a=.05).
Results. At initial pressure, the data obtained at point-P showed significantly higher values for NSNH, NS05H,
SSNH, and SS05H (range: 22.29 6 1.58 kPa to 29.96 6 1.41 kPa) than those at point-R (range:
18.61 6 1.12 kPa to 22.71 6 2.11 kPa). At end pressure, the data obtained from NSNH at point P showed
a significantly higher value (25.36 6 1.69 kPa) than that of point-R (15.36 6 0.99 kPa) (P\.001), whereas
data from NS10H and NS20H at point-P showed a significantly lower value (6.32 6 0.84 kPa and 4.50 6 0.42
kPa) than at point-R (15.50 6 0.49 kPa and 14.98 6 0.88 kPa) (P\.001). The data obtained from SS05H,
SS10H, and NS20H at point-P showed significantly lower values (range: 3.72 6 0.44 kPa to 9.10 6 0.26 kPa)
than those at point-R (range: 13.40 6 1.31 kPa to 14.40 6 0.98 kPa). Moreover, the data obtained from
BSNH, BS05H, BS10H, and BS20H at point-P showed significantly lower values (range: 3.24 6 1.96 kPa to
10.20 6 1.84 kPa) than those of point-R (range: 11.69 6 1.01 kPa to 14.04 6 2.08 kPa).
Conclusion. For making impressions of an edentulous maxilla, the data suggest that a tray with an escape hole
1.0 mm or larger or a spacer thickness of base plate wax (1.40 mm) be used. (J Prosthet Dent 2004;91:570-6.)

CLINICAL IMPLICATIONS
The results of this in vitro study suggest that when making an impression of an edentulous
maxillary arch using the selective pressure technique, optimal pressure can be obtained using
a tray with escape holes 1.0 mm or larger or a 1.40-mm thickness of base plate wax as a spacer.

B
a

Assistant Professor, Department of Comprehensive Clinical

Dentistry.
b
Lecturer, Department of Complete Denture Prosthodontics.
c
Professor and Chair, Department of Comprehensive Clinical
Dentistry.
d
Professor and Head, Department of Complete Denture Prosthodontics.
e
Professor and Head, Department of Comprehensive Clinical
Dentistry.

570 THE JOURNAL OF PROSTHETIC DENTISTRY

oucher recommended the use of the selected

pressure technique for impressions of edentulous residual ridges.1 The outer surface of the bone in the
region of the crest of the maxillary residual ridge is
compact in nature, because it is made up of Haversian
systems.2 Histologically, compact bone, in combination
with the tightly attached mucous membrane, makes the
crest of the maxillary residual ridge most suitable to
provide primary support for the maxillary denture.3
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KOMIYAMA ET AL

Clinicians should take advantage of the nature of this

tissue when making definitive impressions.4-6
The soft tissue covering the hard palate varies significantly in consistency and thickness among different
locations.7 Anterolaterally, the submucosa of the hard
palate contains adipose tissue, and posterolaterally, the
submucosa contains glandular tissue. These tissues
should be recorded in a resting condition, because when
displaced in the impression procedure, these tissues tend
to return to their normal form within the completed
denture base, creating an unseating force on the denture
or soreness.8,9 The submucosa in the region of the
median palatal suture of the maxillary bones is extremely
thin, and the mucosal layer is almost in contact with the
underlying bone.10 Little or no stress should be placed
in this region when making definitive impressions.1
Otherwise, the denture may rock over the center of
the palate when vertical forces are applied to the artificial
teeth. In addition, this part of the mouth is highly
sensitive,1 and excess pressure can be painful. Due to
these variations, the authors recommend selectively
placing pressure on the mucous membrane and bone
in amounts that are compatible with the histologic
tolerances of the supporting tissues for each patient
during impression making.11,12
Although various methods for making selective pressure impressions for edentulous patients have been
reported, a definitive procedure has not been clearly
elucidated.13-15 Minimal pressure impressions16-18 and
selective pressure methods, to obtain the support of
occlusal pressure,15 have been reported to control
pressure to the edentulous ridge. However, success with
these techniques varies according to the clinicians
experience using different impression materials and tray
designs.
The question remains as to the amount of force that
should be applied when using the selective pressure
technique. Frechette19 reported that the load of a denture on the oral mucosa was 50 to 200 kPa during
mastication. In addition, Kydd et al9 reported that it
took up to 4 hours for the residual ridge to completely
recover from a moderate load, approximately 50 kPa,
that lasted for 10 minutes. The authors further stated
that a small amount of occlusal force (2 kPa) could
compress the denture-bearing mucosa to approximately
20% of its thickness at rest. Lindan20 also found that
denture-bearing mucosa might be deformed to 95% of
its usual thickness at rest when occlusal force was
applied.
Frank21 simulated and measured impression pressure
using trays with 5 escape holes placed equidistant from
each other and 0.25 inches from the center of each
pressure gauge with a round bur (number 6), along with
relief provided by a base plate wax spacer. That tray
produced a pressure of 15 to 16 kPa, compared with
approximately 29 kPa in trays without holes and relief.
JUNE 2004

THE JOURNAL OF PROSTHETIC DENTISTRY

Rihani22 measured impression pressure in the edentulous maxilla using zinc oxideeugenol paste and suggested that the primary pressure regions during
impression making were near the center of the palate
and pressure diminished toward the buccal borders.
This in vitro study evaluated changes in impression
pressure produced by various designs of relief space
and escape holes in the impression tray for making an
impression of a simulated maxillary edentulous arch.

MATERIAL AND METHODS

A miniature pressure sensor was embedded into
a maxillary acrylic resin cast, and the 12 impression trays
were formed for each combination of 3 types of relief
space and 4 types of escape hole combinations. The cast
and tray were attached to a rheometer for applying
a continuous compressive isotonic force. Impressions
were made with silicone impression material, and measurement of pressure began immediately prior to compression and concluded when the materials had
polymerized for 2 minutes.

Edentulous cast
A standard maxillary edentulous acrylic resin cast
(G10-402K; Nissin Dental Products Inc, Kyoto,
Japan) was used after eliminating the undercut in the
anterior labial region. Two measuring points were
selected. The first was at the sagittal mid-point (pointP) on the mid-palatal suture and the second at the left
first molar point of the crest on the edentulous residual
ridge (point-R) (Fig. 1). A miniature pressure sensor
(PS-1KD; Kyowa Electronic Instruments Co, Tokyo,
Japan) was embedded into the cast at these points, so
that the surface of the sensor formed a continuous plane
with the cast (Fig. 2).

Impression trays
Each impression tray was fabricated with autopolymerizing acrylic resin (Ostron 100; GC Co, Tokyo,
Japan) using a conventional method.1 The thickness of
the tray at the palatal portion was approximately 3 mm,
and the border of the tray was in contact with the cast.
Three types of tray relief were used: no wax spacer (NS);
sheet wax (No. 28 Sheet Wax; GC Co; 0.36 mm thick)
(SS), or base plate wax (Base Plate Wax, GC Co; 1.40
mm thick) (BS). Four types of escape holes were tested:
no hole (NH) or escape holes of 0.5, 1.0, or 2.0 mm in
diameter (05H, 10H, and 20H, respectively) opposite
point-P. Twelve trays were fabricated for each relief
space and hole-type combinations. Five measurements
were made for each tray, resulting in 60 values (Table I)
per group.
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KOMIYAMA ET AL

Fig. 2. Simulation cast with rheometer. Two pressure sensors

at sagittal center point on mid-palatal suture and at first molar
point of crest on edentulous ridge.

Table I. Abbreviations of tray design used in study

Fig. 1. Maxillary edentulous cast and tray. Miniature pressure
sensor embedded into cast at sagittal mid-point (point-P) on
mid-palatal suture and at first molar point of crest on
edentulous ridge (point-R).

Escape Hole

Spacer

Impression material
Light body silicone impression material (Exadenture,
6.0 g; GC Co) was used for making impressions. The
manufacturer purports the setting time of the material
to be 120 seconds. A cartridge and dispenser were used
to evenly mix and distribute the impression material
throughout the tray, taking care to avoid trapping air
within the materials.

Compression and measurement

The cast and tray were attached to a rheometer (CR200D; SUN Scientific Co. Ltd, Tokyo, Japan) for
application of a continuous isotonic force. For equalization of pressure while compressing the impression
materials to the tray, the plane formed by connecting the
incisive papilla point with the right and left first molar
points was positioned parallel to the floor. The compression force was set at 5.0 kgf and the press speed at
120 mm/min as reported by Frank.21 Measurement
began immediately prior to compression and continued
for 2 minutes with a sampling time of 5 Hz. Data
obtained from the miniature pressure sensor were
calculated using a sensor interface (PCD-300A; Kyowa
Electronic Instruments Co) and then recorded on
a personal computer (VAIO PCG-FX77; Sony Co,
Tokyo, Japan) (Fig. 3). The maximum value immediately after the initial pressure and the value after 120
seconds (end pressure), which allowed the impression
pressure to settle after compression, were determined.
572

No spacer
(NS)
Sheet wax
spacer (SS)
Base plate wax
spacer (BS)

No hole
(NH)

0.5-mm
hole
(05H)

1.0-mm
hole
(10H)

2.0-mm
hole
(20H)

NSNH

NS05H

NS10H

NS20H

SSNH

SS05H

SS10H

SS20H

BSNH

BS05H

BS10H

BS20H

Statistical analysis
The mean values and SD of impression pressure in
each tray were calculated. The effects of the spacers,
escape holes, and measuring points on impression
pressure were analyzed using 3-way analysis of variance
(ANOVA). Simple main effect and multiple comparisons (Bonferroni) were used to test the difference
between the values by analysis of 3-way interaction effect
(a=.05). All analyses were conducted using a computer
software package (SPSS 11.0 for Windows; SPSS,
Chicago, Ill).

RESULTS
Figure 4 indicates the typical pressure changes using
the NSNH and BS20H tray. Immediately after the start
of compression, impression pressure increased rapidly,
and gradually decreased thereafter. The maximum value
immediately after compression (initial pressure) and the
value after 120 seconds (end pressure), which allowed
the impression pressure to settle after compression, were
determined by obtaining continuous data.
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THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 3. Measuring system. Edentulous cast was isotonically compressed by tray with impression material using rheometer.
Impression pressure was detected by pressure sensor embedded into edentulous cast.

Initial pressure

Fig. 4. Typical pressure changes using the NSNH and BS20H

tray. Immediately after start of compression, impression
pressure increased rapidly, and gradually decreased thereafter. Maximum value immediately after compression (initial
pressure) and value after 120 seconds (end pressure), which
allowed the impression pressure to settle after compression,
were determined by obtaining continuous data.

Figure 5, Table II, and Table III show the results of

data from each tray design and relief combination at
point-P and point-R. Tables IV and V show the results
of the ANOVA test. There were significant 3-way
interactions between both initial and end pressure, and
these data were analyzed by using simple main effect and
multiple comparisons (Bonferroni) to test the difference.
JUNE 2004

The data obtained at point-P showed significantly

higher values for NSNH, NS05H, SSNH, and SS05H
(29.96 6 1.41 kPa , 25.90 6 0.59 kPa , 26.22 6 1.09
kPa, and 22.29 6 1.58 kPa, respectively) than corresponding values at point-R (22.72 6 2.12 kPa, 21.22 6
1.99 kPa, 21.49 6 1.48 kPa, and 18.61 6 1.12 kPa,
respectively) (P\.001). However, similar values were
obtained for the other conditions.
By altering the escape hole at point-P from NH to
05H, and further to 10H, the impression pressure
significantly decreased from 29.96 6 1.41 kPa to
25.90 6 0.59 kPa and 20.10 6 0.69 kPa, respectively,
in the NS group, and from 26.22 6 1.09 kPa to
22.29 6 1.58 kPa and 17.31 6 1.28 kPa, respectively,
in the SS group (P\.001). However, there was no
significant reduction between 10H and 20H, and no
significant effect of the escape hole in the BS series. In
NH, by altering the spacer from NS to SS, and further
to BS, the impression pressure was significantly reduced
from 29.96 6 1.41 kPa to 26.22 6 1.09 kPa and 18.76
kPa, respectively (P\.001). A similar tendency was
observed in the 05H series; however, in the 10H and
20H series, there was no significant difference in
pressure associated with altering the spacer. At pointR, no significant reduction in pressure was associated
with changes made to the escape hole and spacers.

End pressure
The data obtained from NSNH at point P showed
a significantly higher pressure value (25.36 6 1.69 kPa)
than that of point-R (15.36 6 0.99 kPa) (P\.001),
whereas data from NS10H and NS20H specimens at
point-P showed a significantly lower pressure value
(6.32 6 0.84 kPa and 4.50 6 0.42 kPa) than point-R
(15.50 6 0.49 kPa and 14.98 6 0.88 kPa) (P\.001).
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THE JOURNAL OF PROSTHETIC DENTISTRY

KOMIYAMA ET AL

Fig. 5. Measurements data in each tray at point-P and point-R: A, initial pressure, B, end pressure. Initially, impression pressure at
point-P (mid-palatal) was higher than or similar to that of point-R (ridge crest). However, end pressure at point-P of tray with
escape hole 1.0 or 2.0 mm in diameter and without spacer, tray with escape hole 0.5 mm or greater in diameter with sheet wax
spacer, and tray with base plate wax spacer were significantly lower than that at point-R. (*P\.05, ANOVA).

Table II. Mean and 95% confidence interval (lower, upper) of initial pressure (kPa) measurements (n=5) from each tray
design and relief combination at sagittal mid-point (point-P) of mid-palatal suture and at left first molar point of crest on
edentulous residual ridge (point-R)
Hole
Point

Spacer

NS
SS
BS
NS
SS
BS

NH

29.96
26.22
18.76
22.72
21.49
18.91

(28.66,
(24.93,
(17.46,
(21.43,
(20.20,
(17.62,

05H

31.25)
27.52)
20.05)
24.01)
22.79)
20.21)

25.90
22.29
17.72
21.22
18.61
18.79

(24.61,
(21.00,
(16.43,
(19.93,
(17.32,
(17.50,

The data obtained from SS05H, SS10H, and NS20H

specimens at point-P showed significantly lower values
than those at point-R (P\.001). Moreover, the data
obtained from BSNH, BS05H, BS10H, and BS20H at
point-P showed significantly lower pressure values than
those of point-R (P\.001).
By altering the escape hole at point-P from NH, 05H,
and further to 10H, impression pressure significantly
decreased from 25.36 6 1.69 kPa to 14.13 6 1.19 kPa
and 6.33 6 0.84 kPa, respectively, in the NS groups,
and from 13.77 6 1.28 kPa to 9.10 6 0.26 kPa and
5.78 6 1.15 kPa, respectively, in the SS groups
(P\.001). However, there was no significant reduction
from 10H to 20H. In the BS groups, a significant
decrease was observed when changed from 05H to
10H (P\.001). Moreover, in NH, by altering the
574

10H

27.18)
23.58)
19.02)
22.51)
19.90)
20.08)

20.10
17.31
17.86
18.66
16.54
17.92

(18.81,
(16.02,
(16.57,
(17.37,
(15.25,
(16.63,

20H

21.39)
18.60)
19.15)
19.95)
17.83)
19.21)

18.08
15.74
14.95
18.14
16.39
14.75

(16.79,
(14.44,
(13.66,
(16.85,
(15.09,
(13.46,

19.37)
17.03)
16.24)
19.43)
17.68)
16.05)

spacer from NS to SS, and further to BS, the impression

pressure was significantly reduced from 25.36 6 1.69
kPa to 13.77 6 1.28 kPa and 10.20 6 1.84 kPa, respectively (P\.001). In 05H, a significant reduction
was observed from NS to SS (P\.001); however, in the
10H and 20H series, there was no significant difference
as a result of altering the spacer. As for point-R, no
significant reductions were observed associated with any
escape hole and spacer changes.

DISCUSSION
Frank21 simulated and measured impression pressure
using trays with 5 escape holes placed equidistant from
each other and 0.25 inches from the center of each
pressure gauge with a round bur (number 6) along with
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THE JOURNAL OF PROSTHETIC DENTISTRY

Table III. Mean and 95% confidence interval (lower, upper) of end pressure (kPa) measurements (n =5) from each tray
design and relief combination at sagittal mid-point (point-P) of mid-palatal suture and at left first molar point of crest on
edentulous residual ridge (point-R)
Hole

Point
P

Spacer

NH

NS
SS
BS
NS
SS
BS

25.36
13.77
10.20
15.36
14.81
13.96

05H

(24.28, 26.45)
(12.68, 14.85)
(9.12, 11.29)
(14.27, 16.45)
(13.73, 15.90)
(12.88, 15.05)

14.13
9.10
7.94
14.62
14.40
13.95

(13.05, 15.22)
(8.02, 10.19)
(6.85, 9.02)
(13.54, 15.71)
(13.31, 15.48)
(12.86, 15.03)

Source

Point
89.666
Spacer
388.157
Hole
777.773
Point*Spacer
67.244
Point*Hole
74.904
Spacer*Hole
130.928
Point*Spacer*Hole
54.478
Model
1583.151a
Error
203.661

Degree
of
freedom

1
2
3
2
3
6
6
23
96

Mean
square

6.33
5.78
4.66
15.50
14.40
14.04

20H

(5.24, 7.41)
(4.69, 6.86)
(3.58, 5.75)
(14.42, 16.59)
(13.32, 15.49)
(12.95, 15.12)

4.50
3.72
3.24
14.98
13.40
11.69

(3.41, 5.58)
(2.63, 4.81)
(2.15, 4.32)
(13.90, 16.07)
(12.32, 14.49)
(10.60, 12.77)

Table V. ANOVA table of end pressure

Table IV. ANOVA table of initial pressure

Type III
sum of
square

10H

F value

89.666 42.266
194.079 91.483
259.258 122.206
33.622 15.848
24.968 11.769
21.821 10.286
9.080
4.280
68.833 32.446
2.121

P value

.001
.001
.001
.001
.001
.001
.001
.001

a 2

R = 0.886.

Source

Type III
sum of
square

Point
810.836
Spacer
316.717
Hole
829.673
Point*Spacer
109.036
Point*Hole
625.464
Spacer*Hole
153.573
Point*Spacer*
207.722
Hole
Model
3053.022a
Error
143.633

Degree of
freedom

Mean
square

F value

P value

1
2
3
2
3
6
6

810.836
158.358
276.558
54.518
208.488
25.596
34.620

541.937
105.842
184.842
36.438
139.347
17.107
23.139

.001
.001
.001
.001
.001
.001
.001

23
96

132.740
1.496

88.719

.001

a 2

R = 0.955.

relief provided by a base plate wax spacer. That tray

design produced a pressure of 15 to 16 kPa, compared
with approximately 29 kPa for trays without holes and
relief. The values of the present experiment are similar,
in that initial pressure ranged from 14 to 30 kPa, and
end pressure ranged from 3 to 25 kPa, when similar
conditions were used. Therefore, it is the authors
opinion that loading force and compression speed used
in the present experimental system was reasonable.
In the present study, it was found that impression
pressure was higher at point-P than at point-R, located
on the ridge crest, when the tray was completely fitted to
the edentulous maxilla. Clinically, attempts to decrease
or release the pressure include using a spacer or placing
escape holes.1 For the trays without a hole or spacer in
the present study, both initial pressure and end pressure
at point-P were higher than those recorded at point-R.
Accordingly, such a tray may not be recommended for
making an impression of the edentulous maxilla. As
Boucher1 suggested, if it is necessary to apply pressure to
the edentulous ridge crest while applying minimal
pressure to the palate, a tray with an escape hole of 1.0
mm or larger, or that with a base plate wax-like spacer in
the palatal area, should be used. If it is necessary to apply
even less pressure to the palate, the concomitant use of
JUNE 2004

a spacer and hole, or an increased number of escape

holes, may be solutions.
With regard to end pressure, pressure concentration
at point-P and point-R was reversed by the effects of
escape holes and spacers. When impression material is
placed in a tray and the cast is compressed, the highest
pressure is located in the central area, and pressure
gradually decreases in the direction of the periphery.22
This is due to the rheological properties of the impression material, as the internal pressure of the material
decreases in the direction of the peripheral area where
pressure escapes. The pressure in the center area was
decreased by the use of escape holes in the present
experiment because the impression material was able to
flow out of the center area, and pressure decreased in the
direction of the peripheral area and also at the escape
hole. Furthermore, the pressure in the central area
also decreased by the use of spacers because the impression material flowed in the direction of not only the
peripheral area but also the space created by the use of
the spacer.
In the present study, the impression was simulated
using silicone impression materials with a standard
edentulous cast. However, clinically, the variability of
the condition of the residual ridge and impression
575

THE JOURNAL OF PROSTHETIC DENTISTRY

material should also be considered. Furthermore, a rigid

acrylic cast is not movable and is different from compressible moist mucosa. The authors speculate that,
intraorally, initial pressure is absorbed by the elasticity
of the mucosa, producing lower pressure, whereas end
pressure may be higher due to the elastic recovery of the
mucosa. Although the impression material was mechanically compressed in this experiment, it is questionable whether clinicians make impressions sensing
differences between 20 and 30 kPa. Furthermore, the
authors speculate that pressure is sufficiently applied in
the early stage by the use of the hand and fingers,
whereas almost no hand pressure is applied in the final
stage. Only 2 sensors were used in this experiment.
By increasing the number of sensors, it would be
possible to investigate the distribution of impression
pressure influenced by the use of escape holes and
spacers. Nevertheless, it appears that a hole placed in
the mid-palatal portion of the tray may significantly alter
impression pressure, with a more ideal result. Future
studies are needed to investigate how impression pressures vary in accordance with the height and hardness of
the edentulous ridge, as well as to investigate a variety of
impression materials and impression-making methods.

CONCLUSIONS
Within the limitations of this in vitro study, it was
found that initially, mid-palatal impression pressure
using a tray with no spacer, a sheet wax spacer and no
hole, or an escape hole 0.5 mm in diameter, was
significantly higher (P\.001) than or similar to the
pressure at the ridge crest. However, a tray with an
escape hole 1.0 or 2.0 mm in diameter and without
a spacer, a tray with an escape hole 0.5 mm in diameter
with a sheet wax spacer, or a tray with a base plate wax
spacer at each mid-palatal point produced end pressures
that were significantly lower than that at the ridge crest
(P\.001). Therefore, it is suggested that an escape hole
1.0 mm or larger, or a spacer with the thickness of a sheet
of base plate wax, may be used to selectively reduce
palatal impression pressure when making an impression
of an edentulous maxilla.
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2. Nanci A, Cate T. Oral Histology. Development, structure, and fundamentals. 5th ed. St. Louis: Mosby; 1998. p. 104-27.

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3. Mohl ND, Drinnan AJ. Anatomy and physiology of the edentulous mouth.
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4. Tomlin HR, Wilson HJ, Osborne J. The thickness and hardness of soft
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7. DuBrul EL. Sicher and DuBruls Oral Anatomy. 8th ed. St. Louis: Ishiyaka
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Reprint requests to:
DR OSAMU KOMIYAMA
DEPARTMENT OF COMPREHENSIVE CLINICAL DENTISTRY
NIHON UNIVERSITY SCHOOL OF DENTISTRY AT MATSUDO
2-870-1 SAKAECHO-NISHI, MATSUDO
CHIBA 271-8587
JAPAN
FAX: 81-47-360-9615
E-MAIL: komiyama@mascat.nihon-u.ac.jp
0022-3913/$30.00
Copyright 2004 by The Editorial Council of The Journal of Prosthetic
Dentistry

doi:10.1016/j.prosdent.2004.03.020

VOLUME 91 NUMBER 6