ORIGINAL ARTICLE

Dynamic smile analysis in young adults

Christopher Maulika and Ravindra Nandab
San Diego, Calif and Farmington, Conn

Introduction: Current trends in orthodontics place greater emphasis on smile esthetics, yet few studies
provide averages and norms for the smile. The purposes of this study were to provide averages for various
components of the smile and to compare some of these in orthodontically treated and untreated groups.
Also, smiles of patients with and without rapid maxillary expansion (RME) were compared. Methods: Video
equipment was used to capture smiles in 230 subjects. Results: The majority of subjects showed on smile
flat smile arc, back to the second maxillary premolar, and an 11% buccal corridor. The orthodontically treated
group showed a statistically significant more parallel smile arc compared with the untreated group. The RME
group had statistically significant less buccal corridor compared with the nonexpanded subjects.
Conclusions: This study helps to establish dynamic norms for the smile and shows that orthodontic
treatment might not flatten the smile arc as previously suggested, and, furthermore, that RME appears to be
associated with a decreased buccal corridor. (Am J Orthod Dentofacial Orthop 2007;132:307-15)

T
he value of an attractive smile is undeniable. A
smile is considered the universal friendly greet-
ing in all cultures. An attractive smile in mod-
ern society is often considered an asset in interviews,
work settings, social interactions, and even the quest to
attract a mate.1-3 Despite the importance we assign to
the smile and our society’s increasing emphasis on
esthetics, a perusal of the dental and orthodontic liter-
ature shows that, although there is much conjecture
about “smile design” and treatment for smile esthetics,
sound scientific data are actually quite sparse.
Most scientific studies examining smile esthetics
used static photographs.4-7 However, recent articles
described a new method of capturing and analyzing the
smile with videography and computer software.8-12
Ackerman et al,8 Ackerman and Ackerman,9 and
Sarver and Ackerman,10,11 are pioneers in the use of
videography to analyze smiles. With video (about 30
frames per second) rather than static photographs, it can
be argued that one can attain a much more predictable,
standardized smile,13 and the use of computer software
to extract the frame of the widest smile can reduce
measurement error and allow for relative ease in
analysis and measurements. Analyzing the smile and
obtaining averages for various components can shed
a
Private practice, San Diego, CA.
b
Orthodontic Alumni Endowed Chair, Professor and head, Department of
Craniofacial Sciences; Chair, Division of Orthodontics, University of Connect-
icut School of Dental Medicine, Farmington, CT.
Reprint requests to: Ravindra Nanda, Department of Orthodontics, OMFS,
Pediatric Dentistry and Advanced General Dentistry, University of Connecti-
cut, Farmington, CT 06030-1725; e-mail, Nanda@nso.uchc.edu.
Submitted, August 2005; revised and accepted, November 2005.
0889-5406/$32.00
Copyright © 2007 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2005.11.037
light on a standard of normalcy to serve as a guideline
for the creation of an esthetic smile.7
The first aim of this study was to establish dynamic
(produced by video) norms for the following smile
measurements: anterior smile height, smile arc, and
most posterior maxillary tooth visible. The second aim
was to introduce norms for 2 additional smile measure-
ments—posterior smile height and buccal corridor. We
also sought to analyze and quantify the differences in
the smile components between the sexes. Furthermore,
we examined the influence of orthodontic treatment and
rapid maxillary expansion (RME) on some dynamic
smile measurements.
MATERIAL AND METHODS
Our sample consisted of 230 subjects and was
divided into 3 groups: nonorthodontically treated (n ⫽
73), orthodontically treated with RME (n ⫽ 70), and
orthodontically treated without RME (n ⫽ 87).
The subjects were retention patients at the Univer-
sity of Connecticut orthodontic clinic, and students,
employees, and residents of the Schools of Dental
Medicine and Medicine; retention patients from local
orthodontic offices were also included.
The inclusion criteria were age 14 to 35 years of
any race and either sex. The orthodontically treated
group consisted of extraction and nonextraction pa-
tients. In addition, the nontreated subjects were not
limited to only Class I normal occlusion patients.
Exclusion criteria were gross asymmetries, craniofacial
syndromes, and active orthodontic treatment.
A mini DV video camera (GL-2, Canon, Tokyo,
Japan) was placed on a tripod approximately 4 feet
from the standing subjects, who were instructed to hold
307
308 Maulik and Nanda
Fig 1. Examples of data collected: A, low, average, and high anterior and posterior smile heights;
B, parallel, flat, and reverse smile arcs; C, large (18%), medium (12%), and small (2%) buccal
corridors.
their heads naturally by looking forward as if they were
looking at their eyes in the mirror.14 The camera lens
was adjusted to be parallel to the apparent occlusal
plane. Each subject was instructed to say, “Chester eats
cheesecake by the Chesapeake” and then smile.9 Re-
cording began approximately 1 second before each
subject began speaking and ended after the smile.
(Video) The subjects’ ages and sexes were recorded,
and they were also asked whether they had had orth-
odontic treatment, including RME.
The video clip was then downloaded by using Scena-
lyzer (Scenalyzer, Vienna, Austria), a video-editing soft-
ware program. With it, each frame of the video could be
visualized, 1 frame at a time. The frame with the widest
commissure-to-commissure smile was captured. The
smile frame was converted into a JPEG file by Scenalyzer.
Each JPEG image was then opened in Photoshop
(Adobe, San Jose, Calif). The following data were
recorded:
1. The anterior height of the smile (Fig 1), entered as
either high smile (a contiguous band of gingiva
above the maxillary central incisor), average smile
(showing 75% to 100% of the maxillary central
incisors), or low smile (showing less than 75% of
the maxillary central incisors).
2. The posterior height of the smile (Fig 1), entered as
either high smile (a contiguous band of gingiva
above the maxillary first premolar), average smile
(showing 75% to 100% the maxillary first premo-
American Journal of Orthodontics and Dentofacial Orthopedics
September 2007
lars), or low smile (less than 75% of the maxillary
first premolars visible).
3. The parallelism of the smile arc in relation to the
lower lip line (Fig 1) was entered as parallel
(maxillary incisal edges, canine and premolar cusp
tips, from mesial to distal, followed the curvature of
the lower lip), flat (maxillary incisal edges, canine
and premolar cusp tips had no curvature relative the
lower lip line), or reverse (incisal edges, canine and
premolar cusp tips had a reverse curve relative the
lower lip line).
4. The most posterior maxillary tooth visible (Fig 2),
entered as either canine, first premolar, second
premolar, or first molar. In case of a discrepancy
between the 2 sides, the most posterior tooth was
entered.
5. The buccal corridor percentage (Fig 1). For this
measurement, the ruler tool in Adobe Photoshop
was drawn from the widest point of the most
posterior tooth on 1 side to the same point on the
contralateral side (maxillary interdental width). The
ruler tool was then drawn from the narrowest point
visible in the inner commissure of the buccal
mucosa to the same point on the opposite side. This
measurement was divided by the visible maxillary
interdental width. The result was a ratio of the
maxillary teeth in the smile minus the buccal
corridor. For example, 0.88 meant that the maxil-
lary dentition occupied 88% of the inner intercom-
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 132, Number 3
Fig 2. Examples of most posterior maxillary tooth visible on smiling: A, canine; B, first premolar;
C, second premolar; D, first molar.
missure width; the buccal corridor would then
occupy 12% (100%-88%) of the smile. This num-
ber was recorded.
For the first 4 smile components listed (most
posterior tooth visible, anterior and posterior smile
heights, and smile arc), the frequencies were reported.
The buccal corridor average and the standard deviation
were obtained. Smile arc was compared between the
orthodontically treated and the nontreated groups. The
most posterior visible tooth and the buccal corridor
were compared between the RME and nonexpanded
groups. Comparisons by sex for all 5 variables were
made. Finally, comparisons were made between the 5
variables. For example, posterior smile height was
compared with smile arc to determine whether there
was a relationship between those data.
Statistical analysis
To test the statistical significance of the difference
in smile heights, smile arc, and most posterior tooth
visible between the orthodontically treated and non-
treated subjects, the Pearson chi-square test was used.
This was also used to test the significance of the
difference of the most posterior tooth visible between
the RME and the nonexpanded subjects, and also for
determining the significance of relationships between
smile heights, smile arc, and most posterior tooth
visible. The independent-sample t test was used to test
the statistical significance of the difference in buccal
corridor between the RME and the nonexpanded
groups. The independent-sample t test was also used
when comparing the buccal corridor with the other
variables. ANOVA was used to control for sex differ-
ences when comparing buccal corridors between the
RME and the nonexpanded subjects. The kappa statistic
was used to evaluate the agreement among the exam-
iners of the smile arc measurement.
RESULTS
The frequencies for anterior and posterior smile
heights, smile arc, and most posterior maxillary visible
tooth for the entire sample are shown in Figure 3.
Maulik and Nanda 309
The average buccal corridor for the entire sample
was 11.0% (SD, 3.9%; range, 2%-24%).
Females (n ⫽ 131) had a larger percentage of
subjects with high anterior and high posterior smile
heights compared to males (n ⫽ 99). Males had a
greater percentage of subjects with low anterior and
posterior smile heights (Fig 4). These difference are
statistically significant (P ⫽ .000 and P ⫽ .005,
respectively). Furthermore, females had a greater per-
centage of subjects displaying a parallel smile arc, the
maxillary first molar, and less buccal corridor (Fig 4).
The corresponding P values are .000, .008, and .000,
respectively.
The orthodontically treated group (n ⫽ 157) had
more subjects with parallel smile arc than the non-
treated group (n ⫽ 73). The percentage of subjects with
reverse smile arc was 3-fold greater in the nontreated
group compared with the orthodontically treated group
(Fig 5). These differences in smile arcs of the orthodon-
tically treated and nontreated subjects were statistically
significant (P ⫽ .009).
The average buccal corridor for the RME group
(n ⫽ 70) was 9.6% (SD, 3.96%; range, 2%-19%).
The average buccal corridor for the nonexpanded
group (n ⫽ 160) was 11.5% (SD, 3.79%; range,
4%-24%) (Fig 6). The difference between the 2
groups was statistically significant (P ⫽ .001). Be-
cause 70% of the RME group was female, and
females display less buccal corridor than males, a
univariate ANOVA was done to control for this. This
analysis showed that the difference in buccal corri-
dor between the RME and the nonexpanded groups
was still statistically significant, after controlling for
sex differences. The corresponding P value for the
univariate analysis of variance was .000.
Both the RME and the nonexpanded groups showed
the maxillary second premolar as the most frequently
visible posterior maxillary tooth. No subjects in the
RME group had canines as the most posterior visi-
ble tooth, but 2.5% of the nonexpanded group did. The
nonexpanded group had more subjects showing the
maxillary first molars on smiling (Fig 6). The differ-
310 Maulik and Nanda American Journal of Orthodontics and Dentofacial Orthopedics
September 2007

A Anterior Smile Height B Posterior Smile Height

60 57 50
43

35
Subjects (%)

Subjects (%)
40

25 23
22 21
20

21 0
0
Low Average (75%-100% High Low Average (75% -100% High
Central Incisor) 1st Premolar)

C Smile Arc D Most Posterior Tooth Visible

60 60

49 51

40

Subjects (%)
Subjects (%)

40 40

25
22
20 20
10

2
0 0
Reverse Flat Parallel Canine 1st Premolar 2nd Premolar 1st Molar

Fig 3. Frequencies for 4 smile measurements.

ence between these groups was statistically significant
(P ⫽ .01).
The relationship between anterior smile height and
smile arc (Fig 7) was not statistically significant (P ⫽
.755).
The relationship between posterior smile height and
smile arc (Fig 7) was statistically significant at P ⫽
.000. Of particular note is the coincidence of high
posterior smile height and reverse smile arc; 79% of
those with reverse smile arc also had high posterior
smile height.
The orthodontically treated group had more sub-
jects displaying high anterior smile height (24.8%)
compared with the nontreated group (13.7%), whereas
the nontreated group had a much larger percentage
exhibiting low anterior smile height (Fig 5).
The relationship between anterior smile height and
orthodontic treatment was statistically significant (P ⫽
.021).
The relationship between posterior smile height and
orthodontic treatment (Fig 5) was not statistically
significant (P ⫽ .115).
Three examiners scored the smile arc data (Fig 8)
because of the inherent subjectivity of this measure-
ment. The kappa statistic was used to examine their
agreement, and a score of 0.6639 was obtained. This
correlates to substantial agreement among the examin-
ers.15
DISCUSSION
The establishment of norms is important in orth-
odontic diagnoses and treatment planning. This study is
the first to provide dynamic norms for anterior smile
height, smile arc parallelism, and most posterior max-
illary teeth visible. Also, this is the first study in which
norms have been obtained for the buccal corridor ratio.
Furthermore, a new measurement has been intro-
duced—posterior smile height—and its corresponding
dynamic norms. Traditionally, norms established in
orthodontics have focused heavily on profiles and the
use of the lateral cephalometric radiograph. In this
study, frequencies were reported to help establish
averages for various parameters of the smile. The only
other studies that provide averages for several smile
components are those by Tjan et al7 and Dong et al.5
Although these studies were valuable as a springboard
for future studies, each has some drawbacks that our
study sought to address. Both studies used static pho-
tographs. The use of static photographs rather than a
American Journal of Orthodontics and Dentofacial Orthopedics Maulik and Nanda 311
Volume 132, Number 3

A dynamic medium to study the smile might not be as

Gender Differences in Anterior Smile Height***
70
reliable or valid as video capture.13
60 56.6 57.3
Tjan et al7 and Dong et al5 both reported that most
50 patients (68.9% and 56%, respectively) had average
Sujects (%)

40
males
females
(75%-100% of central incisors) anterior smile height.
32.3
30 29.0 Our report of 56.9% for anterior smile height is similar
20
13.7
to the finding of Dong et al.5 It can be concluded that
11.1
10 our dynamic data for anterior smile height support
0
low average high
those of both studies.
Anterior Smile Height No comparable study in the literature has ad-
B dressed posterior smile height; therefore, it cannot be
Gender Differerences in Posterior Smile
60 Height** compared to any previous norms. It might not be
50
49.6 surprising to find that more subjects show high
posterior smile height (42.6%) than average or low.
Subjects (%)

40
34.3 35.1
30
32.3 33.3 males
females
Several reasons can explain this finding. The anat-
omy of the smile could be an explanation. The center
20
15.3
of the lip is often more inferior than the lateral
10
aspects during a smile because of the thickness and
0
low average high shape of the philtrum, which is often referred to as
Posterior Smile Height having a cupid’s bow shape (Fig 9). This type of
C smile, in which the lateral aspects of the lips raise
Gender Differerences in Smile Arc***
70 more than the center, has been called a Mona Lisa
60
59.6 smile.16 Another reason that more subjects displayed
50
51.1
high posterior smile height could be because of smile
Subjects (%)

41.2
40 males arc parallelism. There was a strong association be-
females
30 26.3 tween reverse smile arc and high posterior smile
20
14.1 height; 79% of the subjects with reverse smile arc
10 7.6
had high posterior smile height. The next highest
0
reverse flat parallel percentage of those with high posterior smile height
Smile Arc was the flat smile-arc group; 46.9% showed high
D Gender Differences in Most Posterior Tooth
posterior smile height. Thus, from these data, it can
Visible** be deduced that if patients have reverse or flat smile
60
50.5 51.1
arcs (possibly due to overeruption of the maxillary
50
posterior teeth or vertical maxillary excess), they
Subjects (%)

40
32.1 males
will most likely show more posterior gingiva on
30 29.3
females
smiling. Since 59% of all subjects in this study had
20 17.2
16.0
either reverse or flat smile arc, it is not surprising that
10
3.0
0.8
more high posterior smile heights vs average or low
0
canine 1st premolar 2nd premolar 1st molar posterior smile heights were noted.
Most Posterior Maxillary Tooth Visible When looking at the smile arc (parallel, flat, and
reverse), we found that approximately half (49%) of the
E Gender Differences in Buccal Corridor*** total sample had flat smile arc. This disagrees with the
14% findings Tjan et al7 and Dong et al,5 who both found
12.3%
12% the parallel smile arc to be most frequent in their
10.0%
subjects. This difference could be due to the smile arc
Buccal Corridor

10%

8% measurement process, which can be considered subjec-

6%
tive. Great care was taken to keep the measurement and
4%
data-gathering processes as standardized and objective
2%
as possible. For example, to obtain natural head posi-
0%
males females tion, the subjects were asked to look straight forward as
if they were looking at their eyes in a mirror.14
Fig 4. Sex differences in 5 smile arc measurements. **P Furthermore, to standardize the measurement pro-
⬍.01; ***P ⬍.005. cess during data analysis, 3 uniformly trained examin-
312 Maulik and Nanda American Journal of Orthodontics and Dentofacial Orthopedics
September 2007

A B
Smile Arc Comparison** Anterior Smile Height Comparing
60 70 OrthodonticTreatment*
49.7 47.9 58.0
54.8
43.9 Orthodontically

Subjects (%)
Subjects (%)

40 Treated
32.9 Non-Treated
Orthodontically 35
Treated 31.5
Non-Treated 24.8
20 19.2
17.2
13.7
6.4

0 0
Reverse Flat Parallel Low Average High
Anterior Smile Height

C
Posterior Smile Height Comparing
Orthodontic Treatment
50
45.2
41.4
40 38.9
Subjects (%)

Orthodontically
30 28.8 Treated
26
Non-Treated
19.7
20

10

0
Low Average High
Posterior Smile Height

Fig 5. Comparisons between orthodontically treated and nontreated groups. *P value ⬍.05; **P
⬍.01.

Difference in Buccal Corridor* Most Posterior Visible Tooth

A B Comparison*
12
70
11.5 63
Buccal Corridor %

Expanded
46 Non-Expanded
Subjects (%)

35 31
9.6
24
21
13

3
0
8 0
Non-expanded RME Canine 1st Premolar 2nd Premolar 1st Molar

Fig 6. Comparison between RME and nonexpanded groups. *P ⬍.05.

ers followed specific instructions on how to compare were relatively small; the kappa statistic showed sub-
the parallelism of the smile arc with the lower lip. A stantial agreement among them.17
line was drawn in Adobe Photoshop that connected the Our results for the most posterior maxillary tooth
incisal edges and the cusp tips. This line was then visible showed that 51% of the sample displayed the
compared with the curvature of the upper border of the maxillary second premolars; Dong et al5 found similar
lower lip. Overall, the variations between the examiners results, with 57% of their sample showing maxillary
American Journal of Orthodontics and Dentofacial Orthopedics Maulik and Nanda 313
Volume 132, Number 3

Smile Arc vs. Anterior Smile Height Smile Arc vs. Posterior Smile Height***
70
90
58 58 79
56

Low Low
Subjects (%)

Subjects (%)
Average 60 Average
High 47 High
35 43
29
23 34
22 22 29 28
19 30
13 20
13
8
0 0
Reverse Flat Parallel Reverse Flat Parallel

Fig 7. Relationship between smile arc measurement and anterior and posterior smile heights for
entire sample. ***P ⬍.001.

Multiple Raters for the Smile Arc smiling. One reason for this could be that, as the
140 maxilla is expanded, the molars are moved transversely
120 117 114
toward the cheeks and are therefore more apt to be
120 113
107 hidden by the cheeks during the smile. Additionally, the
100 93 97 95 93
87 anterior maxilla is also expanded with RME, and this
Subjects

80
60
40
24 23
20
0 percentage of total smile width, the same definition
Measurer#1 Measurer#2 Measurer#3 Measurer#4
Fig 8. Several raters for smile arc measurements.
second premolars. A surprising result, which did not
agree with either Dong et al5 or Tjan et al,7 was that
25% of our sample showed the maxillary first molars on
smiling. Tjan et al7 found that only 4% of their subjects
showed the maxillary first molars on smiling. This is a
notable difference, and one of the largest differences of
all variables between our study and the others. An
argument could be made that this difference was due to
lighting. Neither Tjan et al7 nor Dong et al5 described
in detail how they gathered their data or the lighting
situation when they photographed the smiles. In our
study, however, all video recording took place indoors,
with ambient light to emulate everyday natural sur-
roundings in which people’s smiles are viewed. No
supplemental light was directed into the mouth; there-
fore, artificially placed lighting was not a factor in the
number of teeth visible in the smile.
A statistically significant difference was found in
the most posterior tooth visible between the RME and
the nonexpanded groups. The nonexpanded group had
more subjects showing the first maxillary molar on
reverse might lead to the anterior teeth blocking the view of the
flat
parallel posterior teeth.
Similar to posterior smile height, no norms for
26
18
23 buccal corridor exist in the literature. In the study by
Moore et al,18 buccal corridor was represented as a
Average
used in our study. By trial and error, those authors
developed and defined a range of buccal corridors and
described them by the corresponding smile fullness.
They defined buccal corridors of 28% as medium-
narrow, 15% as medium, 10% as medium-broad, and
2% as broad smile fullness.18 What they produced by
trial and error was similar to the results we obtained
experimentally for buccal corridor. We found an aver-
age of 11.0% buccal corridor for the entire sample; this
falls between medium and medium-broad smile full-
ness as defined by Moore et al.18 Those authors defined
patients with narrow smile fullness as those with 28%
buccal corridor. Similarly, we found the largest buccal
corridor to be 24%. At the opposite end of the spec-
trum, Moore et al defined patients with broad smile
fullness as those who exhibited 2% buccal corridor; 2%
is the upper limit that we found; it occurred only in the
RME subjects.
A main objective of this study was to provide
scientific data as part of an evidence-based assessment
of whether RME subjects display less buccal corridor
than nonexpanded subjects. We found a statistically
significant (P ⫽ .001) difference in the size of the buccal
corridors between the RME (9.6%) and the nonexpanded
subjects (11.5%). A limitation in the study design was that
it was cross-sectional, and thereby correlative; thus,
314 Maulik and Nanda
Fig 9. Examples of curvature of upper lip related to high posterior smile height.
cause and effect could not be clearly established.
However, our data clearly demonstrate that the RME
group showed less buccal corridor than the nonex-
panded group. Therefore, scientific evidence now es-
tablishes a link between RME and smaller buccal
corridor. Another primary objective of this study was to
use video to further examine the work of Ackerman et
al8 (n ⫽ 30) on the comparison of smile arcs in
orthodontically treated vs nontreated patients. Interest-
ingly, our results differed substantially from theirs.
Ackerman et al8 found flatter smile arcs in orthodonti-
cally treated vs nontreated patients, whereas we found
that orthodontically treated patients showed a greater
percentage of parallel smile arcs compared with non-
treated patients. These differences migth be due to
patient population differences or our dynamic rather
than static capture of the smiles.
Another objective was to compare the smile
components between the sexes. We found a statisti-
cally significant difference between them in every
smile component analyzed. Peck and Peck19 estab-
lished that females display higher anterior smile line
than males. Our dynamic results support theirs.
Furthermore, we found that females have higher
posterior smile height than do males. Females also
showed a higher percentage of parallel smile arc;
males showed a higher percentage of reverse smile
arc. Moreover, we found that females display less
buccal corridor than males.
A difference also worth noting was that of anterior
smile height between orthodontically treated and non-
treated subjects. Of those who were orthodontically
treated, 24.8% showed high anterior smile height com-
pared with only 13.7% in the nontreated group. Addi-
tionally, only 17.2% of orthodontically treated patients
demonstrated low anterior smile height compared with
31.5% in the nontreated group. It is possible that the
nontreated subjects do not feel as confident about their
smiles and therefore show less teeth when smiling.
CONCLUSIONS
Norms have been dynamically introduced for vari-
ous components of the smile. We found that, on
American Journal of Orthodontics and Dentofacial Orthopedics
September 2007
smiling, most subjects displayed an average anterior
smile height, a high posterior smile height, a flat smile
arc, teeth visible to the maxillary second premolar, and
11% buccal corridor.
Females showed higher anterior and posterior smile
heights, more parallel smile arc, and less buccal corri-
dor than males.
The orthodontically treated group demonstrated
significantly more parallel smile arcs compared with
the nontreated group; therefore, it can be argued from
our sample that orthodontic treatment might not flatten
the smile arc.
The RME group showed significantly less buccal
corridor on smiling. This introduces evidence to sup-
port the long-standing claim that RME decreases the
buccal corridor.
The RME group had significantly fewer posterior
maxillary teeth visible on smile compared to the non-
expanded group.
The coincidence of high posterior smile height and
reverse smile arc is statistically significant. There might
be a causal relationship between these 2 parameters.
We thank Linda Krebs, Sunil Wadwa, Bruce Ha-
vens, and Carolyn Lucey for critical reading of the
manuscript and Jonny Feldman, Jeffery Bert, and Colin
Kong for assistance with data collection.
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SUPPLEMENTARY DATA
Supplementary data associated with this article can
be found, in the online version, at doi:10.1016/j.
ajodo.2005.11.037