RESEARCH AND EDUCATION

Effects of thickness of different types of high-translucency

monolithic multilayer precolored zirconia on color accuracy: An
in vitro study
Chien-Ming Kang, CDT, MS,a Tzu-Yu Peng, CDT, PhD,b,c and Her-Hsiung Huang, PhDd,e,f,g,h,i

Zirconia is an attractive restor- ABSTRACT

ative dental material with good Statement of problem. High-translucency monolithic multilayer precolored zirconia provides
mechanical properties, acceptable esthetics and eliminates chipping of the veneering porcelain. However, the color is
biocompatibility, and es- not always consistent with the standard Vita shade guide, and the color saturation may vary
thetics.1-3 Yttria (Y2O3)-stabi- with the thickness of the zirconia.
lized tetragonal zirconia Purpose. The purpose of this in vitro study was to characterize the effect of thickness on the color
polycrystal (Y-TZP) has been accuracy of high-translucency monolithic multilayer precolored zirconia.
widely applied to restore teeth
Material and methods. Plate-shaped (20×20 mm) Vita A2 shade high-translucency monolithic
with a gray substrate (such as multilayer precolored zirconia specimens of 3 types (SHT Multilayer, AT Multilayer, and 3D
an implant abutment or teeth Multilayer) in 4 thicknesses (0.5, 1.0, 1.5, and 2.0 mm) were fabricated (N=120, n=10). A
with a metal foundation resto- spectrophotometer was used to measure the color attributes (CIELab) against gray or A2
ration),1-4 providing a combi- substrates to evaluate the color accuracy based on differences in color (DE) (versus the Vita
nation of acceptable shade guide) and chroma. Statistical analysis was performed by using the Pearson correlation, 2-
translucency and high me- way ANOVA, and post hoc Scheffé test (a=.05).
chanical properties.2,4 Zirconia Results. Against gray substrates, thickness was significantly positively correlated with all color
and metal can be veneered attributes. Against A2 substrates, L* values increased with an increase in thickness; however, a*, b*,
with feldspathic porcelain,5-7 and chroma values remained stable. Zirconia with a thickness of 1.0 mm exhibited the lowest DE,
although veneered restora- regardless of the type, except for AT Multilayer against A2 substrates, where the lowest DE was
achieved at 0.5 mm. At thicknesses 1.0 mm, the DE between the 2 substrates was imperceivable.
tions are at risk of debonding
8-11
and/or chipping. Monolithic Conclusions. Thickness affected the color accuracy of different high-translucency monolithic
multilayer precolored zirconia multilayer precolored zirconia types. It appears that the optimal thickness in terms of color
needs no veneering porce- accuracy is 1.0 mm. These results could be used as a reference for the selection and preparation
9,10,12,13 of abutments in clinical applications. (J Prosthet Dent 2021;-:---)
lain because of its
multilayer shade and trans-
lucency gradient,14-19 with good long-term survival.20-23 technical difficulties with artificial coloring,27,28 but the
Therefore, monolithic multilayer precolored zirconia has final color can only be modified via external color-
been considered an excellent restorative dental mate- ing,12,29,30 allowing minimal alteration in color.4,31 Thus,
2,9,24-26
rial. The use of precolored zirconia eliminates the the initial color of the monolithic multilayer precolored

C.-M. K. and T.-Y. P. contributed equally to this work.

a
Graduate student, Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
b
Postdoctoral Researcher, School of Dentistry, College of Dentistry, China Medical University, Taichung, Taiwan, ROC.
c
Assistant Professor, School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
d
Professor, Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
e
Joint Professor, Institute of Oral Biology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
f
Consultant, Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC.
g
Adjunct Professor, Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, ROC.
h
Adjunct Researcher, Department of Education and Research, Taipei City Hospital, Taipei, Taiwan, ROC.
i
Special Researcher, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

THE JOURNAL OF PROSTHETIC DENTISTRY 1

2 Volume
Clinical Implications
It is necessary to assess restoration thickness when
using high-translucency monolithic multilayer
precolored zirconia. A restoration with a 1.0-mm
thickness should achieve the best color accuracy.
zirconia is important. However, the color of the precolored
zirconia blocks is not always consistent with the standard
Vita shade guide, and the brightness and color saturation
have been reported to vary with the thickness of the
monolayer zirconia.32 The relationship between thickness
and the final color in monolithic monolayer zirconia has
been investigated30,33,34; however, studies of this issue for
monolithic multilayer precolored zirconia are lacking. The
purpose of this in vitro study was to assess the color ac-
curacy of different high-translucency precolored zirconia
types as a function of thickness and to identify the
thickness that most closely matches the standard Vita
shade guide. The null hypothesis was that the color ac-
curacy of high-translucency monolithic multilayer precol-
ored zirconia of different types would not vary with
thickness.
MATERIAL AND METHODS
Table 1 lists the 3 types of high-translucency monolithic
multilayer precolored zirconia (Super High Translucency
Multilayer [SHTM], Anterior Multilayer [ATM], and 3D
Multilayer [3DM]; Aidite Technology Co, Ltd) used in
this study. Plate-shaped (20×20 mm) specimens with 4
thicknesses (0.5, 1.0, 1.5, and 2.0 mm)35-37 were designed
with a 3-dimensional design software program (exocad
DentalCAD; exocad GmbH) (Fig. 1A), and a total of 120
specimens (3 types of zirconia, each with 4 thicknesses,
n=10 per group) were made with a computer-aided
design and computer-aided manufacturing system
(Cameo 250i; Aidite Technology Co, Ltd). The specimens
were located upright in the center of A2-shade mono-
lithic multilayer precolored zirconia disks so that each
specimen included all layers (Fig. 1A). All the specimens
were sintered in a high-temperature furnace: SHTM
specimens (1530  C for 11.5 hours) and ATM and 3DM
specimens (1450  C for 12 hours). Before analysis, the
thickness of the specimens was verified with calipers
(Laboratory Calipers; YDM Corp). The specimens were
ultrasonically cleaned in distilled water for 5 minutes and
then air-dried.
A2 substrate fabrication involved cutting paraffin wax
into test pieces of equal length and width (40×40 mm) to
act as a cast in forming a plate of nickel-chromium (Ni-
Cr) alloy (KeraN Ni-Cr alloy; Eisenbacher Dentalwaren
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
Table 1. Materials used
Materials
Chemical Composition
(Yttria Content)
Lot
Translucency Number Code
Super high 3Y-TZP 40% Z160730 SHTM
translucency
multilayer
Anterior multilayer 5Y-PSZ 49% Z160312 ATM
3D multilayer 4Y-PSZ+5Y-PSZ 3 43-57% W160807 3DM
3Y-TZP, 3 mol% yttria-stabilized tetragonal zirconia polycrystal; 5Y-PSZ, 5 mol% yttria-
partially stabilized zirconia; 4Y-PSZ+5Y-PSZ, mixture of 4Y-PSZ (4 mol% yttria-partially
stabilized zirconia) and 5Y-PSZ. All data compiled from manufacturers.
ED GmbH). The method for preparation of the A2 sub-
strate was based on the existing clinical methods. After
casting, the surface of the Ni-Cr alloy plate was ground
and airborne-particle abraded with alumina (Al2O3). The
substrates were then coated with a shade A2 opaque
layer (GC Initial Paste Opaque; GC Corp) and fired at
930  C (DEKEMA 624; Jensen Dental). This procedure
was performed 3 times. A standard professional
photography card (QP Card 101; QPcard AB) was used
for a gray substrate.
The monolithic multilayer precolored zirconia speci-
mens were chosen and placed upon 2 different substrates
(A2 and gray) (Fig. 1A), and the color attributes L*
(lightness), a* (red-green), and b* (yellow-blue) were
measured with a dental spectrophotometer (Shade Pilot;
DeguDent GmbH) (Fig. 1B).38 The entire specimen was
placed in the dental spectrophotometer to ensure that
the color analyzing area covered whole specimen. Vita
A2 shade guide (L*=73.7, a*=1.3, and b*=18.0) was set
as the standard, and then the color difference (DE) be-
tween each specimen and the standard was calculated.
The spectrophotometer was calibrated by using the white
balance plate provided by the manufacturer before the
measurements. The color measurement process is shown
in Figure 1B. During processing, the spectrophotometer
was recalibrated every 10 measurements.
The color difference formula was based on the
CIEDE2000 system by using the following formula39:
DE=[(DLʹ/kL SL)2 + (DCʹ/kC SC2 + (DHʹ/kH SH)2 + RT
(DCʹ/kC SC) (DHʹ/kH SH)]2, where DLʹ, DCʹ, and DHʹ are
the differences in lightness, chroma (C), and hue,
respectively; kL, kC and kH are weighting factors for
lightness, C, and hue, respectively; SL, SC, and SH are
averaging factors for lightness, C, and hue, respectively;
and RT is an overall correction factor based on differences
in hue and chroma. The color attributes of the A2 sub-
strate were L*=74.4, a*=1.1, and b*=23.3, and those of
the gray substrate were L*=39.5, a*=-0.8, and b*=0.6.
C values were calculated from the following formula40:
C=[(a*)2 + (b*)2]1/2, where a higher C value indicates a
higher ratio of a given solid color in the material.
The Shapiro-Wilk test and Levene test confirmed that
all the data were normally distributed and homogeneous;
therefore, parametric tests were used. The correlations
Kang et al
- 2021
Figure 1. A, Zirconia specimens (SHTM, ATM, and 3DM) on 2 different substrates (gray and A2). B, Dental spectrophotometer for measuring CIEDE2000
color attributes (right); specimens placed in center of frame of spectrophotometer, and light path of sensor perpendicular to upper surface of specimen
(left). ATM, Anterior Multilayer; SHTM, Super High Translucency Multilayer; 3DM, 3D Multilayer.
between zirconia thickness and color attributes (L*, a*,
b*, and DE) were analyzed by using the Pearson corre-
lation. The mean and standard deviations in the color
attributes of each substrate were calculated. Two-way
ANOVA was used to analyze the effects of the type
and thickness of the zirconia on the color attributes and
C value. Multiple comparisons were performed by using
the post hoc Scheffé test (a=.05). All statistical analysis
was performed with a statistical software program (IBM
SPSS Statistics, v19; IBM Corp).
RESULTS
Figures 2 and 3 present the mean and standard deviation
of each color attribute (CIE L*, a*, b*, and DE) against
the gray and A2 substrates. Table 2 lists the results of the
Pearson correlation. Against the gray substrate, zirconia
thickness was significantly positively correlated with L*
(r>0.8, P<.001), a* (r>0.8, P<.001), and b* (r>0.9, P<.001)
in all specimens. Against the A2 substrate, specimen
thickness was significantly positively correlated with L*
(r>0.6, P<.001) in all specimens; however, no correlation
was found between zirconia thickness and a* and b* in
any of the specimens. The a* and b* values of ATM
(irrespective of thickness) were those that most closely
approximated the Vita A2 shade guide. Regardless of
thickness and backing substrate, SHTM presented the
Kang et al
3
lowest L* values, 3DM presented the lowest a* values,
and ATM presented the lowest b* values (P<.001).
The results of 2-way ANOVA on the effects of zir-
conia type and thickness on the color attributes and C
values against 2 substrates are shown in Table 3. Table 4
lists the DE results. Figure 4 presents the C results.
Against the gray substrate, the 1.0-mm specimens (all
types of zirconia) had the smallest DE, and zirconia
thickness was shown to have a significant influence on C
(P=.017). Against the A2 substrate, the 1.0-mm speci-
mens of SHTM and 3DM had the smallest DE, whereas
the 0.5-mm specimens of ATM had the smallest DE.
Increasing the thickness of the zirconia led to a decrease
in DE but had no effect on C values. The post hoc Scheffé
analysis revealed a statistically significant difference in
the DE of 3DM against the 2 backing substrates (P<.001);
however, no significant differences were observed in the
DE of SHTM or ATM. For a given zirconia thickness,
the C values of SHTM were higher than those of ATM
and 3DM.
DISCUSSION
The results indicated that the color accuracy of different
high-translucency monolithic multilayer precolored zir-
conia types varied with material thickness; hence, the
null hypothesis was rejected. Figures 2-4 show that
THE JOURNAL OF PROSTHETIC DENTISTRY
4 Volume - Issue -

90 3 ** ** ** **
** ** ** * ** ** ** **
** ** ** **
80
1

a*
70
L*

–1
60

50 –3
0.5 1.0 1.5 2.0 0.5 1.0 1.5 2.0
Thickness (mm) Thickness (mm)
SHTM ATM 3DM SHTM ATM 3DM
A B

30 6 ** **
** * ** **
** ** ** ** ** * *
** **
20 4

ΔE
b*

10 2

0 0
0.5 1.0 1.5 2.0 0.5 1.0 1.5 2.0
Thickness (mm) Thickness (mm)
SHTM ATM 3DM SHTM ATM 3DM
C D
Figure 2. Means and standard deviations of color attributes against gray substrate. A, Lightness (L*). B, Red to green (a*). C, Yellow to blue (b*). D, Color
difference (DE). * P<.05, **P<.01. ATM, Anterior Multilayer; SHTM, Super High Translucency Multilayer; 3DM, 3D Multilayer.
90 ** ** ** 4
** ** * *
80 ** ** ** **
** * *
** ** ** **
70
L*

2
a*

60

50 0
0.5 1.0 1.5 2.0 0.5 1.0 1.5 2.0
Thickness (mm) Thickness (mm)
SHTM ATM 3DM SHTM ATM 3DM
A B

30 6 * * * *
** ** ** **
** ** ** ** * * *

20 4
ΔE
b*

10 2

0 0
0.5 1.0 1.5 2.0 0.5 1.0 1.5 2.0
Thickness (mm) Thickness (mm)
SHTM ATM 3DM SHTM ATM 3DM
C D
Figure 3. Mean and standard deviations of color attributes against A2 substrate. A, Lightness (L*). B, Red to green (a*). C, Yellow to blue (b*). D, Color
difference (DE). * P<.05, **P<.01. ATM, Anterior Multilayer; SHTM, Super High Translucency Multilayer; 3DM, 3D Multilayer.

THE JOURNAL OF PROSTHETIC DENTISTRY Kang et al

- 2021 5

Table 2. Pearson correlation coefficient indicating effects of thickness on color of zirconia against 2 substrates
Gray Substrate A2 Substrate
Color Attributes SHTM ATM 3DM SHTM ATM 3DM
L* 0.92* (<.001) 0.91* (<.001) 0.81* (<.001) 0.82* (<.001) 0.66* (<.001) 0.63* (<.001)
a* 0.92* (<.001) 0.94* (<.001) 0.95* (<.001) -0.62* (<.001) 0.36 (.024) 0.155 (.347)
b* 0.88* (<.001) 0.89* (<.001) 0.88* (<.001) -0.67* (<.001) -0.47* (<.001) -0.52* (<.001)
DE 0.05 (.759) 0.24 (.138) 0.43* (.006) 0.53* (<.001) 0.67* (<.001) 0.55* (<.001)

ATM, Anterior Multilayer; SHTM, Super High Translucency Multilayer; 3DM, 3D Multilayer. *Correlation significant at 0.01 level (2-tailed). P value listed in parentheses.

Table 3. Results of 2-way ANOVA on effects of zirconia type and thickness on color attributes (L*, a*, b*, and DE) and chroma (C) values against gray and
A2 substrates
Color Attribute Source Type III Sum of Squares df Mean Square F P
Gray substrate
L* Type 125.26 2.00 62.63 48.43 <.001
Thickness 758.16 3.00 252.72 195.41 <.001
Type×Thickness 29.73 6.00 4.96 3.83 .002
Error 139.68 108.00 1.29 d d
a* Type 15.14 2.00 7.57 163.36 <.001
Thickness 73.04 3.00 24.35 525.35 <.001
Type×Thickness 0.97 6.00 0.16 3.49 .013
Error 5.02 108.00 0.05 d d
b* Type 558.05 2.00 279.03 703.05 <.001
Thickness 302.25 3.00 100.75 253.85 <.001
Type×Thickness 5.92 6.00 0.99 2.49 .027
Error 42.86 108.00 0.40 d d
DE Type 5.28 2.00 2.64 9.43 <.001
Thickness 34.00 3.00 11.34 40.46 <.001
Type×Thickness 10.66 6.00 1.78 6.34 <.001
Error 30.26 108.00 0.28 d d
C Type 560.34 2.00 280.17 709.78 <.001
Thickness 299.53 3.00 99.84 252.94 <.001
Type×Thickness 6.79 6.00 1.13 2.87 .012
Error 42.63 108.00 0.34 d d
A2 substrate
L* Type 156.32 2.00 78.16 54.05 <.001
Thickness 192.80 3.00 64.27 44.44 <.001
Type×Thickness 20.81 6.00 3.47 2.40 .033
Error 156.19 108.00 1.45 d d
a* Type 26.67 2.00 13.33 259.55 <.001
Thickness 0.41 3.00 0.14 2.68 .049
Type×Thickness 2.95 6.00 0.49 9.56 <.001
Error 5.55 108.00 0.051 d d
b* Type 437.32 2.00 218.66 502.29 <.001
Thickness 41.61 3.00 13.87 31.86 <.001
Type×Thickness 6.98 6.00 1.16 2.67 .019
Error 47.02 108.00 0.44 d d
DE Type 24.37 2.00 12.18 24.22 <.001
Thickness 38.967 3.00 13.00 25.82 <.001
Type×Thickness 7.524 6.00 1.25 2.49 .027
Error 54.324 108.00 0.50 d d
C Type 431.48 2.00 215.74 486.55 <.001
Thickness 41.58 3.00 13.86 31.26 <.001
Type×Thickness 7.39 6.00 1.23 2.78 .015
Error 47.89 108.00 0.44 d d

SHTM exhibited the lowest brightness (L*) and highest C manufacturer, SHTM has the lowest translucency (40%).
values, whereas ATM exhibited the highest L* and This may explain why the translucency of SHTM was not
lowest C. Based on the translucency data provided by the correlated to the value of L*. The L* values of 3DM were

Kang et al THE JOURNAL OF PROSTHETIC DENTISTRY

6 Volume - Issue -

Table 4. Pairwise comparison of color difference (DE) between Vita A2 shade guide and monolithic multilayer precolored zirconia specimens against
different backing substrates
Gry Substrate A2 Substrate
Thickness SHTM ATM 3DM SHTM ATM 3DM
0.5 mm 3.82 ±0.14a 3.78 ±0.31a 3.29 ±0.29a 2.86 ±0.16a 2.60 ±0.58a 3.74 ±0.37a
1.0 mm 1.83 ±0.36b 2.60 ±0.47b 2.91 ±0.32b 2.26 ±0.28a 3.33 ±1.08b 3.45 ±0.40a
1.5 mm 2.72 ±0.68c 3.39 ±0.63c 3.97 ±0.66c 3.03 ±0.84a 3.72 ±0.90b,c 4.58 ±0.72b
2.0 mm 3.67 ±0.80a 4.03 ±0.58a 3.75 ±0.69c 3.86 ±0.78b 4.66 ±0.79c 4.67 ±0.92b
ATM, Anterior Multilayer; SHTM, Super High Translucency Multilayer; 3DM, 3D Multilayer. Values mean ±standard deviation; different letters within same column indicate groups statistically
different from each other based on Scheffé post hoc test (P<.05).

2.0 mm

1.5 mm

*
Gray

*
*
1.0 mm

*
*
0.5 mm

2.0 mm

1.5 mm
A2

*
1.0 mm

*
*
0.5 mm

0 5 10 15 20 25
Chroma
SHTM ATM 3DM

Figure 4. Chroma (C) of each monolithic multilayer precolored zirconia type as function of thickness. * P<.05. ATM, Anterior Multilayer; SHTM, Super
High Translucency Multilayer; 3DM, 3D Multilayer.

similar to those of ATM, whereas the C values of 3DM
were similar to those of SHTM. Note that the pigments
used in precolored zirconia blocks are metal oxides. Thus,
any increase in the quantity of pigments will lead to a
corresponding increase in C values and a decrease in
brightness. Therefore, brightness was affected more by
chroma than by translucency.15,27 In the selection of
high-translucency monolithic multilayer precolored zir-
conia, the C values of different types of zirconia blocks
(even those of the same nominal shade) should be
considered. A zirconia block with too high a C value
should not be chosen because the final color after firing
will produce lower brightness than expected, preventing
an acceptable color match of the definitive zirconia
restoration.14
The minimum recommended thickness for zirconia
molar crowns and veneer restorations is 1.0 mm35 and
1.5 mm, respectively.36 Nonetheless, in clinical practice,
the actual thickness of the restorations can vary
considerably because of occlusion, tooth morphology, or
esthetics. The present study therefore analyzed a range
of thicknesses from 0.5 to 2.0 mm.37 Kim et al33 reported
that the thickness of monolithic zirconia is inversely
proportional to the lightness. Tabatabaian et al34 also
reported that the thickness of monolithic zirconia
affected its final color. In the present study, increasing
the thickness of high-translucency monolithic multilayer
precolored zirconia tended to enhance the red and yel-
low hues and brightness (Table 2). The zirconia speci-
mens used in the present study were indicated to
replicate the Vita A2 shades. While the color of speci-
mens overlaying the A2 substrate were accurate, the
color of specimens overlaying the gray substrate were
skewed, consistent with previous studies16,17 that re-
ported that the color of high-translucency zirconia was
affected by the color of the underlying substrate because

THE JOURNAL OF PROSTHETIC DENTISTRY Kang et al

- 2021
of light transmission. When the thickness is 1.0 mm,
the underlying substrate will have a large effect on the
final color of zirconia restorations but less so when the
thickness is 1.5 mm.
Two substrates were evaluated: a gray substrate (18%
gray QP card 101 used to calibrate measurements of
color38) and an A2 substrate (to replicate underlying
tooth and abutment color). As shown in Table 4, zirconia
coatings of 1.0 mm most closely matched the Vita A2
shade guide in terms of DE in all the specimens except for
0.5-mm ATM against the A2 substrate. The increased
influence of the underlying substrate was because ATM
had the highest translucency and 0.5 mm was the thin-
nest specimen.25,34 This finding was consistent with
previous studies reporting the effects of translucency on
the optical properties of monolithic zirconia.7,10,33,34 It
has been reported that a DE1.6 color difference is un-
detectable by the human eye.41 Thus, the color difference
observed in thick specimens in the present study
(exceeding 1.5 mm) should be undetectable.
The optimal thickness for monolithic multilayer pre-
colored zirconia was also assessed in terms of color. In
the 1.0-mm specimens, the DE of SHTM (2.69), ATM
(2.74), and 3DM (1.95) should provide sufficient masking
ability for most clinical applications. A previous study
reported that the flexural strength of monolithic zirconia
between 0.8 mm and 1.3 mm in thickness can exceed
typical masticatory forces,42 suggesting that 1.0 mm is the
optimal thickness for monolithic zirconia.
Limitations of the present study included that only
the Vita A2 shade was used to assess color accuracy.
Different results may have been found with other shades.
In addition, the in vitro experimental design did not
replicate factors such as the saliva, gingiva, cement, and
postprocessing (polishing or glazing), which might have
affected the surface properties of the zirconia and its final
color accuracy. Thus, future studies should consider such
factors to evaluate color accuracy more precisely.
CONCLUSIONS
Based on the findings of this in vitro study, the following
conclusions were drawn:
1. The thickness of different high-translucency
monolithic multilayer precolored zirconia types
affected the color accuracy.
2. Regardless of the type of zirconia block or substrate
used, at a thickness of 1.5 mm, low light trans-
mission resulted in high DE and C values.
3. At a thickness of 1.0 mm, the transmission of light
from the underlying substrate affected the final color
and decreased the brightness and C values.
Kang et al
7
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Corresponding author:
Dr Her-Hsiung Huang
Department of Dentistry
National Yang Ming Chiao Tung University
No. 155, Sec. 2, Li-Nong St
Taipei 112
TAIWAN, ROC
Email: beer.huang@nycu.edu.tw
Acknowledgments
The authors thank Aidite Technology Co, Ltd, Qin Huang Dao, China, for free
materials and technical assistance in the manufacturing of specimens.
CRediT authorship contribution statement
Chien-Ming Kang: Conceptualization, Methodology, Investigation, Validation.
Tzu-Yu Peng: Formal analysis, Visualization, Writing e original draft.
Her-Hsiung Huang: Supervision, Project administration, Writing e review &
editing.
Copyright © 2021 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2021.07.011
Kang et al