CLINICAL RESEARCH

Evaluation of the intaglio surface shape of implant-supported

complete-arch maxillary prostheses and its association with
biological complications: An analytical cross-sectional study
Francine Baldin Able, MSD,a Nara Hellen Campanha, PhD,b Ibrahim Abazar Younes, DDS,c and
Ivete Aparecida de Mattias Sartori, PhDd

The rehabilitation of edentu- ABSTRACTS

lous patients with implant-
supported prostheses has
been reported to provide a
successful treatment with high
rates of survival for both im-
plants and prostheses.1-4 The
prosthesis can be fixed or
removable,5-8 according to the
needs of each patient.7,9,10
However, anatomic factors,
the ability to carry out hygiene,
patient expectations, and
financial commitments must
be considered.3,5,6 Hygiene
procedures are easily per-
formed for removable pros-
theses, but for fixed prostheses
the ease of cleaning varies
with the prosthetic design.5,6
Phonetic changes, contours
that make cleaning difficult,
and biological complications
have been reported for
complete-arch implant-sup-
ported maxillary prosthe-
ses.3,11 If a significant space is
provided between the base of
the prosthesis and the mucosa,
air and saliva can escape,
Statement of problem. Whether the shape of the intaglio surface of fixed implant-supported
maxillary prostheses is associated with the occurrence of biological is unclear.
Purpose. The purpose of this cross-sectional study was to evaluate the shape (convex or concave)
of the intaglio surface of complete-arch implant-supported maxillary fixed prostheses and to assess
the association with biofilm accumulation, hyperemia, bone loss, and patient satisfaction.
Material and methods. Study participants consisted of 56 individuals with fixed complete implant-
supported maxillary prosthesis attending follow-up appointments. The 56 prostheses supported by
388 implants had been in place for an average of 5.5 years (range 1-14 years). The intaglio surface
was divided into areas corresponding to the cantilever regions and between implants (n=442)
and was assessed for shape (concave or convex) and biofilm index (0 to 3). Tissue hyperemia
(redness) was assessed as absent or present. Bone loss (mm) was measured from digital
periapical radiographs by 2 calibrated evaluators (kappa=94.9%). Study participant satisfaction
was investigated by using a visual analog scale. Association assessments (a=.05) between the
shape of each area and all these parameters were performed with the Friedman, linear
regression, and logistic regression tests.
Results. Of the analyzed areas, 58 (13.1%) were concave, and 384 (86.9%) were convex. Biofilm was
absent on 3.5% of the concave and 5.5% of the convex areas. Biofilm was detectable with a probe
on 12% of the concave and 22.4% of the convex areas and clinically visible in 58.6% of the concave
and 57.8% of the convex areas. Abundant biofilm was seen in 25.9% of the concave and 14.3% of
the convex areas and was associated with hyperemia (P=.003). A statistically significant association
was found between the shape and biofilm accumulation (P=.009). Hyperemia was present in 199
(45%) areas. The association analysis between the shape of the area and the presence of
hyperemia was not significant (P>.05). The mean bone loss was 0.71 mm (0.91 mm). Implants
placed near concave areas underwent greater bone loss (P=.001). Study participants reported a
high level of satisfaction with the esthetics, mastication, speech, and smile provided by the
prosthesis, with satisfaction scores ranging between 8.46 and 8.77. However, in relation to ease
of cleaning, only 19.6% were fully satisfied.
Conclusions. The shape of the intaglio surface of prostheses influenced the occurrence of biofilm
accumulation and bone loss, and concave areas showed greater biofilm accumulation and bone
resorption. High rates of satisfaction with treatment were identified. (J Prosthet Dent 2022;128:174-80)

Supported in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.
a
Postgraduate student, PhD Program in Dentistry, General Dentistry Area, State University of Ponta Grossa (UEPG), Ponta Grossa, Brazil.
b
Professor, MSD and PhD Program in Dentistry, General Dentistry Area, State University of Ponta Grossa (UEPG), Ponta Grossa, Brazil.
c
Postgraduate student, Masters Degree Program in Dentistry, Implantology Area, Faculdade ILAPEO, Curitiba, Brazil.
d
Professor, MSD and PhD Program in Dentistry, Implantology Area, Faculdade ILAPEO, Curitiba, Brazil.

174 THE JOURNAL OF PROSTHETIC DENTISTRY

August 2022 175

Clinical Implications
Knowing the impact of the intaglio surface shape of
implant-supported fixed prostheses on the behavior
of soft and hard peri-implant tissues is important for
clinicians to be able to determine the most
appropriate form and to help patients perform
hygiene procedures correctly and attend periodic
follow-up appointments.

impeding phonetics. However, reducing this space

makes it more difficult to perform hygiene procedures.11
Controlling biofilm accumulation is essential to reduce Figure 1. Representative prosthesis with demarcation of intaglio areas
the incidence of peri-implant disease,12 since poor oral identified; in this example 7 areas. Red lines show difference in length of
hygiene is a risk factor for the development of mucositis areas.
and peri-implantitis.13,14 Access to hygiene can be
planned in implant-supported prostheses15 that have a
and 2018, who had attended follow-up appointments,
convex shape and a smooth and polished surface.16,17
and who had consented to be part of the research. All
The intaglio surface of an implant-supported pros-
prostheses were a combination of resin and metal. The
thesis rehabilitating an edentulous maxilla should not
metal bar was cast in cobalt-chromium alloy to cylinders
have concavities, porosities, or a flange but should have a
using the passive fit cementation technique.23 The in-
convex profile with minimal contact with the mucosa to
taglio surfaces in contact with soft tissue were made of
enable the use of dental floss and interdental brushes.18-
20 heat-polymerized acrylic resin, and the denture teeth
In addition to the intaglio surface contour, the distance
were made of acrylic resin. Exclusion criteria included the
between implants also affects hygiene access; implants
presence of segmented, cemented, or metal-ceramic
that are close together impede biofilm control.12 For
prostheses.
treatment to be successful with few complications, reg-
The study assessed the association between the shape
ular professional follow-up and self-performed hygiene
of the intaglio surface of maxillary implant-supported
procedures are essential.2,6,21,22
prostheses and biofilm accumulation, hyperemia, and
Information on how the shape of the intaglio surface
bone loss and also measured study participants’ satis-
of complete-arch implant-supported prostheses affects
faction with the rehabilitation. The data were obtained
treatment outcomes is scarce. Therefore, the objective of
during follow-up appointments carried out between May
the present study was to assess the association of the
and September 2019. These appointments were part of a
intaglio surface of the prosthesis (concave and convex)
follow-up program established 14 years earlier for pa-
with biofilm accumulation, bone loss, and hyperemia and
tients rehabilitated with osseointegrated implants at
to assess patient satisfaction with maxillary complete-
ILAPEO College. During the appointment, the prosthesis
arch implant-supported fixed prostheses. The null hy-
was removed for clinical evaluation of the condition of
potheses were that the presence/abundance of biofilm,
the peri-implant tissues, the prosthesis, the implants, and
hyperemia, or bone loss would not be related to the
the occlusion, and a radiographic examination was made
shape of the intaglio surface of maxillary complete-arch
to determine the condition of the peri-implant bone
implant-supported fixed prostheses.
condition. In addition, study participants received a
prophylaxis and guidance on hygiene procedures.
MATERIAL AND METHODS
For the purposes of evaluation, the intaglio surface of
This cross-sectional analytical study had been approved the prosthesis was divided into the cantilever areas and
by the Ethics Committee of Hospital Paranaense de the regions between the implants (Fig. 1). They were
Otorrinolaringologia Ltda. (IPO) 3 350 864, and the numbered from right to left; whenever a right cantilever
Strengthening the Report of Observational Studies in was present, it was numbered area 1. The unit of analysis
Epidemiology (STROBE) initiative was followed. The was not “participant” but “area” because the same
study participants consisted of those female and male prosthesis had different intaglio surface shapes, classified
individuals aged between 36 and 71 years who had been as concave or convex, determined from the relationship it
treated with fixed complete-arch implant-supported presented with dental floss (Fig. 2). In the convex profile,
maxillary prostheses at ILAPEO College between 2005 the dental floss has full contact with the intaglio surface

Able et al THE JOURNAL OF PROSTHETIC DENTISTRY

176
Figure 2. Relationship between dental floss and prosthesis intaglio
surface. A, Convex surface. B, Concave surface.
of the prosthesis, presumably allowing the hygiene pro-
cedures to be performed satisfactorily. Two calibrated
independent evaluators (F.B.A., I.A.Y) classified the areas
as concave or convex. Examiners were calibrated through
prior training to standardize evaluation. Preliminary data
from 79 areas were analyzed by using the kappa test to
verify consistency, which resulted in a concordance cor-
relation of 94.9%.
The first analysis performed was the identification of
the presence of biofilm. Each area of the intaglio surface
of the prosthesis received a score for the amount of
biofilm according to an adaptation of the modified
plaque index used by Mombelli et al24: score 0 -
absence of biofilm; score 1 - biofilm detected with the
aid of a probe; score 2 - clinically visible biofilm; score 3
- abundant biofilm. The presence or absence of tissue
hyperemia was visually assessed by the redness or not
of the peri-implant tissue in each portion of the bone
ridge corresponding to the areas of the intaglio of the
prosthesis. These analyses were performed on all study
participants by a single experienced periodontist
(F.B.A.).
Peri-implant bone loss was assessed from periapical
radiographs (Heliodent Vario; Dentsply Sirona) made
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 128 Issue 2
Figure 3. Representative bone loss measurement of implant with mesial
bone loss and adjacent implant with no bone loss.
with a sensor (Xios Supreme; Dentsply Sirona) using the
paralleling technique with positioners (XCP DS; Dentsply
Sirona). The quality of the radiographs was considered
acceptable when all mesial and distal implant threads
could be clearly seen. Dimensional distortions were
corrected by using a software tool (Sidexis; Dentsply
Sirona) based on the actual measurement of the implant
platform. The platform was also used as a reference in
determining the presence or absence of bone loss, which
was measured in millimeters from the platform to the
level of the first visible contact between the bone and the
implant (Fig. 3). The measurements were performed on
the mesial and distal part of the implants by using the
same magnification and by 2 examiners (F.B.A., I.A.Y.)
who were calibrated by an experienced radiologist
(F.N.G.K.F.). The Spearman correlation was used to
calculate agreement between the examiners and resulted
in 97.5%. The bone loss for each implant was calculated
as the mean of the measurement of each evaluator whose
measurement value was, in turn, the mean between the
mesial and distal part of the implant. To assess the as-
sociation between the shape of the prosthesis intaglio
surface and bone loss, the implants were classified ac-
cording to the shape of the adjacent areas (mesial e
distal) were as convex × convex, convex × concave, or
concave × concave.
Study participants’ satisfaction with the rehabilitation
at the time of the examination was assessed by using a
questionnaire adapted from that used by Vieira et al25
with a visual analog scale (VAS). The scale ranged from
0 (totally dissatisfied) to 10 (completely satisfied). The
questionnaire consisted of the following questions: 1) Are
you satisfied with your maxillary prosthesis? 2) Are you
satisfied with the esthetics of your prosthesis? 3) How do
you assess your ability to chew food? 4) How satisfied are
you with your prosthesis when you talk? 5) How satisfied
are you with your dentures when you smile? 6) How easy
is it to clean your prosthesis?
Able et al
August 2022 177

Table 1. Description of biofilm accumulation per prosthesis intaglio Table 2. Analysis of relationship between prosthesis intaglio surface
surface area and analysis of relationship between prosthesis intaglio shape and tissue hyperemia
surface shape and presence of biofilm Shape
Biofilm Hyperemia Convex Concave Total
Visualization Clinically Absence 203 (52.9%) 40 (69%) 243 (55%)
Shape Absence With Probe Visible Abundant Total Presence 181 (47.1%) 18 (31%) 199 (45%)
Convex 21 (5.5%) 86 (22.4%) 222 (57.8%) 55 (14.3%) 384 (100%) Total 384 (100%) 58 (100%) 442 (100%)
Concave 2 (3.5%) 7 (12.1%) 34 (58.6%) 15 (25.9%) 58 (100%)
Friedman test. Q(1)=1.6755, P= .195.
Total 23 (5.20%) 93 (21.0%) 256 (57.9%) 70 (15.8%) 442 (100%)

Friedman test. Q(1) = 4.7571, P=.029.

Table 4. Mean (standard deviation) bone loss among different area

Table 3. Evaluation of positive relationship between presence of biofilm combinations for each implant
at prosthesis intaglio surface and hyperemia of tissue adjacent to Convex×convex 0.686 (0.050)
prosthesis Convex×concave 0.562 (0.119)
Biofilm Visualization Biofilm Clinically Biofilm Concave×concave 1.367 (0.247)
Logistic Regression With probe Visible Abundant
Coefficient 0.396 0.869 1.567
P .448 .077 .003
Table 5. Bone loss analysis between groups
Group Coefficient Standard Error P
Implant_adjacent area - - d
Convex×concave -0.125 0.133 .349
Data were statistically analyzed and described as
Concave×concave 0.675 0.194 .001
mean, standard deviation, median, minimum, and
Participant -0.002 0.002 .442
maximum. For qualitative variables, frequencies and Constant 0.748 0.095 <.001
percentages were used. Association was assessed by
using the Friedman and Linear Regression tests (a=.05
Linear regression.

for all tests). Logistic regression (±95%) was also used.

The analyses were performed by using a statistical soft-
ware package (STATA).
RESULTS
Fifty-six study participants, 42 women and 14 men,
mean age 57 years, were enrolled into the study with 56
fixed complete-arch implant-supported maxillary pros-
theses and 388 implants (Neodent). The dental status of
the study participants’ mandibular arch was 22 (39.3%)
were partially edentulous restored with implant-
supported partial prostheses, 20 (35.7%) had
complete-arch implant-supported fixed prostheses, 8
(14.3%) were partially dentate, 5 (8.9%) were
completely dentate, and 1 (1.8%) used a removable
partial prosthesis. The mean ±standard deviation (SD)
time since placement of the maxillary prosthesis was 5.5
(3.69) years. The classification of the intaglio surface of
the prosthesis resulted in 442 areas, of which 384
(86.9%) were classified as convex and 58 (13.1%) as
concave.
The result of the evaluation of biofilm accumulation is
shown in Table 1. A statistically significant (P<.05) as-
sociation was detected between the shape of the intaglio
and the presence of biofilm as assessed by the Friedman
test (Table 1). From the logistic regression analysis, the
concave shape had a significant and slightly positive in-
fluence (coefficient: 0.73; odds ratio: 2.07; P=.009), and
the participant variable showed no significant influence
(coefficient -0.007; odds ratio: 0.99; P=.195). Hyperemia
was present in 199 (45%) areas and absent in 243 (55%)
areas and was not significantly different between the
intaglio contour shapes (P>.05) (Table 2). A positive as-
sociation was found between the presence of abundant
biofilm and hyperemia, as assessed with logistic regres-
sion (Table 3).
The mean (SD) bone loss was 0.71 (0.91) mm, with a
maximum mean value of 4.96 mm and a minimum of
0 mm. The implants were classified according to the
shape of the adjacent areas, resulting in 313 (80.7%)
implants in the convex × convex group, 52 (13.4%) in the
convex × concave group, and 23 (5.9%) in the concave ×
concave group. The mean (SD) bone loss of each group is
shown in Table 4. The linear regression analysis showed
a significant coefficient for the variable Implant_Adjacent
Area (Coef = 0.184; P=.027) but was not significant for
the patient variable (P=.427). The group concave ×
concave had a positive and significant influence on
increased bone loss, but the patient variable had no
significant coefficient (Table 5).
Study participants’ satisfaction with the treatment is
shown in Figure 4. Most participants were completely
satisfied with the esthetics, mastication, phonetics, and
smiling (between 62.5% to 73.2%). The mean score
attributed to these factors varied between 8.46 and 8.77.
Regarding the ease of cleaning the prosthesis, only 19.6%
of study participants were fully satisfied. The mean score

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178 Volume 128 Issue 2

45 41
40 36 37 37
35
Number of Participants

35
30
25
20

15 13 12
10 11
9
10 77 77 7 7
56 5 44 6
5 2 3 22 2
00000 11 000 10 10 1 0001010 00000 1 1 0 00 100 001 1
0
Satisfaction with Satisfaction with Satisfaction with Satisfaction with Satisfaction with Ease of cleaning
prosthesis esthetics mastication phonetics smiling

0 - Totally dissatisfied 1 2 3 4 5 6 7 8 9 10 - Completely satisfied

Figure 4. Summary of participants’ satisfaction with treatment and reported complaints.

attributed to this item was 6.86. Patient satisfaction with Table 6. Analysis of relationship between prosthesis intaglio surface
cleaning the prosthesis was statistically similar (P>.05) in shape and satisfaction regarding ease of cleaning prosthesis
both groups (concave and convex) according to the Ease of Cleaning
Friedman test (Table 6). Areas Mean (SD) Min. Max. N
Convex 7.11 (12.07) 2 10 384

DISCUSSION Concave 7.24 (1.52) 3 10 58

Friedman test. Q (1) =0.019, P=.89.

The results of this study determined that the intaglio
surface shape (concave or convex) of the prosthesis af-
fects biological complications; therefore, the null increasing the probability of changes in peri-implant
hypothesis was rejected. The success of a prosthetic tissues.12,13
treatment depends on comprehensive planning, design Biofilm accumulation on the protheses has been re-
of the prosthesis, and quality in the execution of the ported to play an important role in the initiation and
procedures.3,5 In addition, the maintenance of adequate progression of inflammation and infection in the denture
oral hygiene is fundamental to the long-term success of bearing area. Poor hygiene is a major factor predisposing
any dental treatment.26 Causes of the accumulation of denture surfaces to biofilm accumulation.27 Surface
biofilm in implant-supported prostheses include lack of roughness and other physical characteristics of the in-
motivation or awareness, lack of ability to perform hy- taglio surface may favor the biofilm accumulation. In the
giene procedures, and the design of the prosthesis that present study, all prostheses were made at the same
connects the implants.26 dental laboratory with heat-polymerized acrylic resin
The success of complete-arch implant-supported denture base material and denture teeth. Heat-
fixed maxillary rehabilitation and the high degree of polymerized acrylic resin has been reported to be
satisfaction of individuals treated with this type of biocompatible with oral tissues and cell cultures
prosthesis has been reported.1-4,18,20 The same was in vitro.28
observed in the present study, since study participants Information regarding the relationship between the
assigned a score between 8.46 and 8.77 for satisfaction soft tissue and the intaglio surface of the pontic areas of
with the prosthesis, esthetics, mastication, phonetics, implant-supported fixed prostheses is sparse.13 However,
and smiling. This value was close to that obtained in a concavities in the intaglio surface must be avoided to
retrospective study in which satisfaction ranged from 8.4 facilitate hygiene and avoid complications induced by
to 8.826; however, the assessment of satisfaction is biofilm.18,19 Studies that used prostheses with convex,
subjective. Regarding ease of cleaning, only 19.6% of smooth, and polished surfaces had high rates of reha-
study participants were fully satisfied, and the mean bilitation survival.18,20 The number of concave areas in
score was 6.86. This finding is consistent with other the present study was low in comparison with the
findings13,18,26 that reported that fixed prostheses can number of convex areas, because the concept of a
present contours and spaces that are difficult to clean, concavity-free intaglio surface is recommended in the

THE JOURNAL OF PROSTHETIC DENTISTRY Able et al

August 2022
educational institution where the participants were
rehabilitated. Nevertheless, concave areas were present,
because, in some situations, the shape of the residual
ridge prevented a convex contour. In prostheses where a
convex shape is not prioritized, the number of concave
areas may be greater.
The authors are unaware of a previous study that
compared the convex and concave intaglio surfaces of
implant-supported maxillary fixed prostheses. The anal-
ysis of the presence of biofilm showed significant dif-
ferences between the contours. Greater biofilm
accumulation was found in concave areas: 25.9% of the
concave and 14.3% of the convex areas had abundant
biofilm accumulation. In addition, the number of biofilm-
free regions in the convex and concave areas was 21
(5.5%) and 2 (3.5%), respectively. A clinical study12 that
evaluated the presence of biofilm on the surface of the
intaglio surface of the prosthesis found that about one
third was covered with biofilm. The accumulation of
biofilm was also widespread in this study, since only
5.2% of the regions, were free of biofilm. Regarding
satisfaction with ease of cleaning reported by study
participants, no difference was found between the
concave and convex shapes, suggesting that the intaglio
surface contour is just one factor in biofilm accumula-
tion.26 Other factors include the patients ability to
perform hygiene procedures and biocompatible materials
that allow good polishing, avoiding porosities and biofilm
accumulation. The importance of informing patients of
the hygiene procedures and follow-up appointments to
reinforce these guidelines, of carrying out professional
hygiene, and of polishing the prosthesis is stressed.
Follow-up appointments are also important for reducing
the risk or severity of mucositis and peri-implantitis, bone
loss, and bleeding and, therefore, for reducing the
complication rates.2,6,19,21,22
Oral mucosal lesions associated with the use of a
prosthesis may be related to the presence of biofilm, to
reaction to the prosthetic material, or to mechanical
trauma.29 In the present study, hyperemia was the oral
condition evaluated. Since no reaction to the prosthesis
material was identified for any study participant, the most
likely cause of the hyperemia was a reaction to biofilm or to
excessive contact of the prosthesis with the mucosa. This
hypothesis explains the absence of significant differences
between groups (concave and convex), since concave areas
were more associated with biofilm accumulation during
clinical evaluations. However, in some convex regions, the
intaglio surface of the prosthesis was in strong contact with
the mucosa of the bone crest, making it difficult to floss. It
is possible that the strong contact was provided to ensure
good phonetics, as a space between the soft tissue and the
intaglio surface of the prosthesis can lead to changes in
speech.11 However, the combination of a convex outline
and light contact with the mucosa has been reported to
Able et al
179
enable proper oral hygiene procedures without compro-
mising phonetics.18 The association found between the
presence of biofilm and hyperemia suggests a significant
influence of the abundant accumulation of biofilm. This
result reinforces the need to avoid making prostheses with
plaque-retentive areas.
Implants associated with concave adjacent areas
showed a higher bone loss when compared with those
adjacent to convex areas. The presence of at least 1 convex
area next to the implant was associated with a lower bone
loss. In regions with concavity, hygiene procedures are
challenging with increased biofilm, a risk factor for the
development of peri-implantitis.13,14,18,19 The mean (SD)
bone loss measured in the present study was 0.71 (0.91)
mm, similar to the 0.3 (0.72) mm18 and 0.7 (0.6 to 0.8)
mm4 found in previous long-term studies. The greatest
bone loss recorded was 4.96 mm, a finding similar to that
of a study in which the mean bone loss of implants
identified as having advanced bone loss was 5.2 mm.30
With the cross-sectional design, it was not possible to
determine whether bone loss occurred because of the
presence of biofilm, in response to surgical trauma, or was
associated with the type of implant.
Limitations of the present study included its cross-
sectional design. Therefore, it was not possible to
control all the factors related to the different surface
characteristics, the processing of the prostheses, or the
capacity of the participants to clean their prosthesis.
Additionally, the number of concave areas was not
controlled or randomized. Additional studies examining
the contours of the intaglio surface of complete-arch
implant-supported maxillary fixed prostheses are
needed to provide detailed evidence on this topic.
CONCLUSIONS
Based on the findings of this cross-sectional analytical
study, the following conclusions were drawn:
1. The shape of the intaglio surface of fixed maxillary
implant-supported prostheses influenced the
occurrence of biological complications.
2. Concave areas presented greater biofilm accumula-
tion and bone loss.
3. Study participants showed a high level of satisfac-
tion with the prosthesis for esthetics, mastication,
smiling, and speaking. However, few participants
reported being completely satisfied with the ease of
cleaning.
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Corresponding author:
Dr Nara Hellen Campanha
Universidade Estadual de Ponta Grossa
Av. General Carlos Cavalcanti, 4748
CEP 84.030-900
Campus de Uvaranas
Bloco M - Sala 64
Ponta Grossa, PR
BRAZIL
Email: narahell@yahoo.com.br
Acknowledgments
The authors thank the Faculdade ILAPEO for making possible the development of
this study and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- Brasil (CAPES) for supporting in part this study - Finance Code 001.
CRediT authorship contribution statement
Francine Baldin Able: Conceptualization, Methodology, Investigation, Valida-
tion, Writing - original draft, Writing - review & editing. Nara Hellen
Campanha: Methodology, Validation, Writing - review & editing. Ibrahim
Abazar Younes: Conceptualization, Methodology, Investigation, Validation,
Writing - review & editing. Ivete Aparecida de Mattias Sartori: Methodology,
Validation, Writing - review & editing.
Copyright © 2021 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2020.12.028
Able et al