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. 2025 Dec 19;38(4):733–742. doi: 10.1111/jerd.70079

A Hybrid Approach Using AI‐Assisted Chairside Staining for an Anterior Metal‐Ceramic Crown

Marat Wartanovic Awdaljan 1,✉, Ana Alvarado 2, Elvis Santos 3, João Carlos Roque 4, José Maurício dos Santos Nunes Reis 5, Luis Felipe Rondón 5
PMCID: PMC13069257  PMID: 41417860

ABSTRACT

Objective

To describe a hybrid approach for a metal‐ceramic anterior crown, combining traditional ceramic layering with a chairside staining technique guided by recipes generated using an artificial intelligence‐based software.

Clinical Considerations

The clinical case presented a step‐by‐step protocol from both laboratory and clinical perspectives for the replacement of a single anterior metal‐ceramic crown in a 32‐year‐old male patient dissatisfied with crown color and gingival darkening. Clinical examination revealed a slight color mismatch, shape discrepancy, and inadequate gingival adaptation, with a metal post‐and‐core contributing to the darkened appearance. The final color reproduction was achieved using a chairside staining approach (Vintage Art Universal, Shofu, Kyoto, Japan) guided by Matisse recipes (Labmatisse BV, Wijchen, The Netherlands). This approach reduced treatment time and cost while achieving an optimal esthetic outcome on the first attempt, with a color difference (0.5 units) below the ΔE00 perceptibility threshold, eliminating the need for additional color corrections.

Conclusions

The hybrid approach proved feasible for integrating laboratory procedures with chairside staining protocols. This strategy resulted in an esthetically satisfactory outcome for an anterior metal‐ceramic crown, highlighting the potential of artificial intelligence–driven staining solutions.

Clinical Significance

The artificial intelligence‐assisted chairside staining approach offers clinicians and dental technicians a practical tool for achieving accurate color reproduction in ceramic materials. Applicable to both layered and monolithic restorations, this technique enhances esthetic outcomes while improving treatment efficiency.

1. Introduction

Single anterior restorations remain among the most complex procedures in esthetic dentistry [1]. Accurately replicating the shade, shape, and texture of natural teeth poses significant challenges due to the distinct structure and composition of enamel and dentin, which directly affect their interaction with light and, consequently, their perception by the human eye [2]. Additionally, human teeth exhibit a wide range of color variations, further complicating the reproduction of esthetic results [3, 4, 5].

Historically, metal‐ceramic crowns were considered the gold standard for single‐tooth restorations due to their strength and esthetic properties [6]. However, in recent decades, all‐ceramic restorations have largely replaced them [6, 7]. Despite advancements in restorative materials, metal‐ceramic crowns still have specific indications [8, 9]. They are particularly suitable for situations with significant discoloration and metal post‐and‐core, where oxides can darken the root and surrounding gingiva, requiring a material capable of effectively masking the underlying discoloration [10].

In metal‐ceramic crowns, the ceramic is applied using layering techniques (powder‐and‐liquid) and subsequently fused to a metal framework [11]. These procedures are commonly employed to achieve esthetic outcomes by combining various shades and translucencies of ceramic powders [8]. Additionally, staining techniques can be applied either intrinsically or externally to enhance color reproduction [12], involving the precise application of a thin, smooth layer of metal or ceramic pigments [13].

Recently, chairside staining approaches have been introduced to enhance the color reproduction of all‐ceramic restorations [14, 15, 16]. These techniques employ analog and digital strategies to identify, record, and replicate dental shades, requiring clinicians to develop the knowledge and skills necessary to master procedures traditionally performed by dental technicians [14, 15]. Despite advancements in fabrication techniques, accurately reproducing the color and translucency of natural teeth remains a challenge for both dental technicians and clinicians [17], where multiple factors significantly influence the final outcome [18]. These factors include the shade‐taking process [19], the accuracy of shade guides [4, 5], stump shade [20, 21, 22], available restoration thickness [10], restorative material selection [23], and effective communication with the laboratory [24].

Given the complexity involved in achieving accurate color reproduction in single anterior restorations, artificial intelligence (AI) technologies have been increasingly applied in this field [25, 26]. In vitro studies have explored the use of machine learning regression models [25, 27], neural networks [28], principal component analysis [29, 30] and linear regression models [31] to predict the colorimetric and optical behavior of resin‐based composites, hybrid ceramics and glass ceramics. In clinical settings, a specialized AI‐based software (Matisse) has been developed to assist in color reproduction of ceramic restorations [26, 32, 33]. By integrating clinical color data with an optical understanding of dental materials, this software utilizes machine‐learning algorithms to generate customized ceramic and stain recipes, optimized to achieve an identical color match while accounting for background effects [34, 35].

One of its features, the Staining Studio [26], generates staining recipes to precisely adjust the final color of a restoration. In metal‐ceramic restorations, this function can be utilized chairside during the bisque try‐in to guide the staining process and enhance the restoration's natural appearance. This enables a precise and quantifiable color workflow that aligns with human visual perception [26, 36, 37]. The present article aims to describe a hybrid approach for a metal‐ceramic anterior crown, combining traditional ceramic layering with a chairside staining technique guided by recipes generated using an artificial intelligence‐based software (Matisse). This strategy integrates laboratory and clinical workflows, bridging the gap between conventional techniques and AI technology to achieve an esthetically optimized outcome.

2. Case Report

A 32‐year‐old male patient sought treatment at a private clinic (Santo Domingo, Dominican Republic), for esthetic concerns related to a single metal‐ceramic crown restoration on the right maxillary central incisor. The patient reported dissatisfaction with the crown's color and darkening in the free gingival margin. A comprehensive clinical and radiographic examination revealed a slight color mismatch, shape discrepancy, inadequate gingival adaptation of the existing crown, gingival color alteration, a previous endodontic treatment and the presence of a metal post‐and‐core (Figure 1). The endodontic treatment was evaluated in collaboration with an endodontist. Based on the favorable radiographic and clinical findings, a minimally invasive approach was chosen, replacing only the crown to improve the color, shape, and emergence profile, while avoiding the removal of the post‐and‐core, which could compromise the remaining tooth structure and the prognosis of the future restoration. Shade matching was performed using a dental colorimeter (Optishade, Style Italiano‐Smile Line, Saint‐Imier, Switzerland) to determine the base color to be reproduced. The device identified the closest matching shade 2L1.5 (Vita 3D‐Master, Vita Zahnfabrik, Bad Säckingen, Germany), displayed CIELAB color coordinates (L*: 73.7, a*: 2.5, b*: 15.0) and seamlessly transferred the color data to the Matisse software (Figure 2).

FIGURE 1.

FIGURE 1

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(A) Pre‐operative situation showing a slight color mismatch, shape discrepancy, and inadequate gingival adaptation. (B) Pre‐operative x‐ray displaying the initial condition of the case.

FIGURE 2.

FIGURE 2

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Shade matching of the left maxillary central incisor using a dental colorimeter (Optishade, Style Italiano–Smile Line, Saint‐Imier, Switzerland), which measures the corresponding CIELAB color coordinates. The shade table 2L1.5 (VITA 3D‐Master, VITA Zahnfabrik, Bad Säckingen, Germany) was identified as the closest match.

The presence of a metal post‐and‐core was responsible for the darkened appearance of the remaining tooth structure (Figure 3). After analysis of the underlying remnant, various treatment options were discussed and following the patient's final acceptance, a new metal‐ceramic crown was selected as the preferred restorative material. The tooth preparation and finish line were refined, incorporating a slightly beveled rounded shoulder placed subgingival, to ensure adequate space for the restorative materials and enhance masking in the free gingival margin (Figure 4). Subsequently, a provisional restoration was fabricated to establish a proper emergence profile, promoting biological integration and enhancing the architecture of the free gingiva (Figure 5).

FIGURE 3.

FIGURE 3

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Metal post‐and‐core in the right maxillary central incisor, contributing to the darkened appearance of the remaining tooth structure and adjacent gingival tissues.

FIGURE 4.

FIGURE 4

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Tooth preparation and subgingival finish line after refinement, incorporating a slightly beveled rounded shoulder to ensure adequate space for the restorative materials and enhance masking in the free gingival margin. (A) Frontal view. (B) Occlusal view.

FIGURE 5.

FIGURE 5

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Provisional restoration fabricated to establish an adequate emergence profile, promoting optimal gingival biology and architecture.

A metal framework (Argeloy NP Star, Argen, San Diego, CA) was fabricated by the dental technician with an appropriate thickness, ensuring sufficient space for the ceramic—approximately 1.5 mm in the middle third of the facial side (Figure 6). Additionally, a ceramic layering with feldspathic porcelain (VM13, Vita Zahnfabrik, Bad Säckingen, Germany) was applied at the dentist's request to provide a high‐lightness ceramic base shade for subsequent staining. Following the dental technician's expertise, Opaque 1 and Effect Liner 2 were first applied to mask the metal framework. Margin was built with M4 and M1 in a 40/60 ratio. Dentin shades included 2L2.5 in the cervical third and 1M1 for the remaining structure. To enhance lightness, a 50/50 mixture of Effect Enamel 1 and Effect Opal 1 was used, followed by a thin final layer of Neutral and Window in a 60/40 ratio (Figure 7).

FIGURE 6.

FIGURE 6

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(A) A metal framework (Argeloy NP Star, Argen, CA, USA) with appropriate thickness, ensuring sufficient space for the ceramic. (B) Silicon index showing the available space for the ceramic material, approximately 1.5 mm in the middle third of the facial side.

FIGURE 7.

FIGURE 7

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Ceramic layering using feldspathic porcelain (VM13, Vita Zahnfabrik, Bad Säckingen, Germany) was applied to obtain a bisque bake with appropriate lightness.

For the final color reproduction, the dentist performed a chairside staining procedure during the bisque try‐in (Figure 8). This procedure was executed intraorally using a fine brush under relative isolation. The stains (Vintage Art Universal, Shofu, Kyoto, Japan) were applied according to customized recipes generated by the Matisse software (Labmatisse BV, Wijchen, The Netherlands), using the Staining Studio option. Three individualized recipes were created for the incisal, middle and cervical thirds of the crown, corresponding to regions with distinct optical and colorimetric characteristics. The recipes included for the incisal third (Green/C Shade, 1:2 ratio), middle third (White/C Shade, 2:1 ratio), and cervical third (White/Orange Brown Shade, 3:1 ratio) (Figure 9). Additionally, three staining recipes (Vintage Art Universal, Shofu, Kyoto, Japan) were created for fine incisal characterization: Enamel Effect (Khaki, 1 ratio), Blue Opal (Violet, 1 ratio), and Amber Opal (D Shade, 1 ratio) (Figure 10). The feldspathic porcelains used by the dental technician for ceramic layering and the stains applied by the dentist during the chairside staining procedure guided by the Matisse software are presented in Table 1. A color and morphology check was conducted to assess the finalized metal‐ceramic crown after staining and glazing (Figures 11 and 12). The color coordinates (CIE L*, a*, b*) and CIEDE2000 (∆E00) color difference values of the target crown and the metal‐ceramic restoration are shown in Table 2. The measured ∆E00 values were below the perceptibility threshold (≤ 0.8 units) [36, 37], this outcome was achieved on the first attempt after staining and glazing.

FIGURE 8.

FIGURE 8

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Chairside staining procedure using customized recipes (Vintage Art Universal, Shofu, Kyoto, Japan) generated by the Matisse software (Labmatisse BV, Wijchen, The Netherlands).

FIGURE 9.

FIGURE 9

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Staining recipes (Vintage Art Universal, Shofu, Kyoto, Japan) generated using the Staining Studio feature of the Matisse software (LabMatisse BV, Wijchen, The Netherlands) for the incisal (Green/C shade, 1:2 ratio), middle (White/C shade, 2:1 ratio), and cervical (White/Orange Brown shade, 3:1 ratio) thirds, along with their corresponding target CIELAB values.

FIGURE 10.

FIGURE 10

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Staining recipes (Vintage Art Universal, Shofu, Kyoto, Japan) generated using the Staining Studio feature of the Matisse software (LabMatisse BV, Wijchen, The Netherlands) for the enamel effect (Khaki, 1 ratio), blue opal (Violet, 1 ratio), and amber opal (D shade, 1 ratio), together with their corresponding target CIELAB values.

TABLE 1.

Feldspathic porcelains (VM13, Vita Zahnfabrik, Bad Säckingen, Germany) used by the dental technician for ceramic layering and stains (Vintage Art Universal, Shofu, Kyoto, Japan) applied by the dentist during the chairside staining procedure guided by the Matisse software, along with their respective areas of application.

Ceramic layering Stains (Matisse recipes)
To mask the framework:
  • –

    Opaque 1

  • –

    Effect Liner 2

Cervical:

White and Orange Brown Shade (3:1 ratio)

Margin:

M4 and M1 (40/60 ratio)

Middle third:

White and C Shade (2:1 ratio)

Dentin cervical:

2L2.5

Incisal third:

Green and C Shade (1:2 ratio)

Remaining dentin:

1M1

 Incisal characterization:
  • –

    Enamel Effect (Khaki, 1 ratio)

  • –

    Blue Opal (Violet, 1 ratio)

  • –

    Amber Opal (D Shade, 1 ratio)

Incisal and effects:

Effect Enamel 1 and Effect Opal 1 (50/50 mixture)

Final layer:

Neutral and Window (60/40 ratio)
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FIGURE 11.

FIGURE 11

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Shade assessment of the metal–ceramic crown using a dental colorimeter (Optishade, Style Italiano–Smile Line, Saint‐Imier, Switzerland), which measured the corresponding CIELAB color coordinates and identified shade 2 L1.5 (Vita 3D‐Master, Vita Zahnfabrik, Bad Säckingen, Germany) as the closest match.

FIGURE 12.

FIGURE 12

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(A) The finished metal‐ceramic crown after staining and glazing. (B) Intraoral evaluation of color and morphology.

TABLE 2.

Color coordinates (CIE L*, a*, b*) and CIEDE2000 (∆E00) color difference values of the target crown (TC) and the metal‐ceramic (MC) restoration.

Evaluated structures L* a* b* ∆E00
TC 73.7 2.5 15.0 0.5
MC 72.8 2.7 15.7
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The cementation protocol included modified rubber dam isolation, as absolute isolation of the single tooth was challenging due to the subgingival finish line. A #0 retraction cord (Ultrapack, Ultradent, South Jordan, UT) was placed (Figure 13). The internal surface of the crown was cleaned with 37% phosphoric acid (Etch‐37, Bisco, Schaumburg, IL) and then sandblasted with 50‐μm aluminum oxide (Zeta Sand, Zhermack, Badia Polesine, Italy) along with the metal post‐and‐core, followed by the application of a metal primer (Z‐Prime, Bisco, Schaumburg, IL). The remaining tooth structure was etched for 15 s with 37% phosphoric acid (Etch‐37, Bisco, Schaumburg, IL). A universal adhesive (All‐Bond Universal, Bisco, Schaumburg, IL) was then applied over the remaining tooth structure, internal surface of the crown and the metal post‐and‐core, and light cured. Finally, dual‐cure cement (Duo‐Link Universal, Bisco, Schaumburg, IL) was used for cementation. The final outcome of the case, along with the subsequent one‐month follow‐up are depicted in Figures 14 and 15.

FIGURE 13.

FIGURE 13

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Modified rubber dam isolation and placement of a #0 retraction cord (Ultrapack, Ultradent, South Jordan, UT, USA).

FIGURE 14.

FIGURE 14

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Immediate outcome following the restoration cementation.

FIGURE 15.

FIGURE 15

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One‐month follow‐up after cementation of the restoration.

3. Discussion

Traditionally, achieving accurate color reproduction in ceramics has been a meticulous process performed by dental technicians using hand‐layering techniques. To obtain esthetically acceptable results, various shades and translucencies of ceramic powders are carefully selected [11]. Currently, stained monolithic restorations are more commonly used due to their simplified and efficient fabrication process, whether through pressing or machining techniques, where esthetic characterizations are achieved through the precise selection and application of stains [12]. Regardless of the fabrication technique, the color reproduction workflow typically relies on the reference color of a shade guide, sometimes supplemented by images and largely dependent on the operator's expertise [11, 24]. Advancements in restorative dentistry aim to enhance this workflow by complementing the craftsmanship and expertise of dental professionals with software like Matisse, which utilizes AI to generate precise staining and ceramic recipes, thereby achieving predictable and reliable results [26, 32, 33].

The Matisse software generates customized recipes by considering key clinical factors such as stump shade, available restoration thickness, fabrication technique, and the selected ceramic and staining systems [34, 35], complemented by a dental colorimeter for precise shade‐taking and color check protocol [19, 26]. This approach supports various fabrication techniques, including full layering, micro‐layering, and staining of different dental restorative materials, while integrating currently 24 layering ceramics and staining systems [26, 32, 33]. This flexibility allows dental professionals to utilize their preferred techniques and ceramic brands, bridging the gap between technology and craftmanship [26].

In the presented case, a dental technician fabricated a metal framework as the infrastructure. One of the main concerns during treatment planning was the condition of the metal post‐and‐core that had darkened the surrounding dentin and extended to the root surface, affecting both the esthetics of the restoration and the appearance of the free gingival margin. A ceramic framework could have been an option, particularly polycrystalline ceramics such as zirconia [20, 21, 22]. White and colored zirconia disks (0.4 mm thickness) 3Y‐TZP (3 mol% yttrium tetragonal zirconia polycrystals), layered with liner, dentin, and enamel ceramics to a final thickness of 1.6 mm, demonstrated sufficient masking ability of eight different substrates, including dark and gold‐colored metal alloys, maintaining clinically acceptable ∆Eab values [22, 36, 37]. Likewise, a bilayer ceramic structure composed of a framework ceramic (yttria‐stabilized tetragonal zirconia polycrystal, IPS e.max ZirCAD) with a thickness of 0.7 mm and a veneering ceramic (feldspathic ceramic, IPS e.max Ceram) of 0.8 mm demonstrated effective masking ability when cemented over resin‐based composites simulating severely discolored or non‐vital tooth preparations, as well as metallic substrates, when compared with a simulated standard dentin, showing ∆E00 values below the acceptability threshold [20, 36, 37].

However, ceramics exhibit relative translucency, and due to the significant discoloration of the remaining structure, a metal framework was chosen to effectively block light transmission [10]. In the case described, the tooth had already been prepared for a metal‐ceramic crown. The tooth preparation was retouched, and a slightly beveled rounded shoulder finish line was created to ensure adequate space for ceramic layering and enhance masking at the free gingival margin [9]. A porcelain facial margin was then created by vertically reducing the metal framework [8, 11]. This approach improved the natural appearance, emergence profile, and provided a seamless transition to pink esthetics, while balancing the light‐blocking effect of the metal framework for the post‐and‐core and ensuring sufficient porcelain thickness to mask the darkened dentin.

The fabrication of the crown followed a hybrid workflow, combining laboratory and chairside approaches, and can be described as a semi‐chairside workflow [16]. The dental technician layered the metallic framework with feldspathic porcelain, while the final color adjustment was performed intraorally by the dentist through staining, guided by Matisse‐generated recipes using the Staining Studio option [26]. The color information obtained during shade taking, combined with the expertise of the dental technician, enabled the ceramic layering to achieve a high‐lightness bisque bake, providing a suitable foundation for the subsequent staining process.

The final step was performed chairside [14, 15, 16], following the Matisse‐generated recipes for the different areas of the tooth selected in the software uploaded images. The approach allowed the clinician to actively participate in the color reproduction process, benefiting from direct intraoral application and real‐time comparison with the homologous tooth. Once stained, the ceramic restoration was removed from the mouth and placed in a ceramic furnace for final stain fixation and glazing.

Similar protocols [14, 15] have been described using a chairside staining strategy to customize ceramic restorations by integrating both analog (color mapping) and digital (calibrated photography) analysis. The incorporation of Matisse software into this workflow enhances the predictability of staining recipes, minimizing inconsistencies and mismatches between clinical and laboratory settings, while optimizing time and cost efficiency [26]. From a clinical standpoint, it highlights the synergy between digital technology and artisanal expertise by combining AI‐generated staining protocols with the operator's ability to precisely localize and apply stains. This integration supports a comprehensive color‐matching strategy that merges objective colorimetric validation based on visual thresholds with immediate assessment. The method also facilitates the try‐in process after baking, allowing for instant modifications, if necessary, as well as the verification of accurate morphology, finishing, and surface texture [2, 14, 15, 26].

When the technique is applied intraorally, certain clinical considerations must be observed. Relative isolation should be maintained throughout the staining process, and a thin layer of shade/stain liquid should be applied to the homologous tooth to prevent dehydration [14, 15]. In addition this type of chairside approach encourages clinicians to develop the knowledge and skills traditionally associated with dental technicians, particularly in staining and finishing procedures [14, 15]. From the laboratory perspective, this approach can streamline the workflow and reduce the number of remakes caused by color mismatches, often a frustrating drawback due to the time spent creating and/or correcting imprecise fine color details [26].

Color management in restorative dentistry is a complex process influenced by multiple variables that can affect the final outcome [18]. The shade‐taking device integrated with Matisse, Optishade, is a dental colorimeter that has demonstrated higher accuracy and comparable reliability to a clinical spectrophotometer [19]. It enables the assessment of CIELAB color coordinates under a D65 illuminant, and through the Matisse software's color check protocol, it provides color difference formulas that can be correlated with visual perception [26, 36, 37].

The success of color matching between a dental restoration and the target tooth is largely influenced by both the magnitude and direction of the color difference [37]. The metal‐ceramic crown exhibited a ∆E00 value of 0.5 units, which falls below the established perceptibility threshold (≤ 0.8 units), indicating a clinically excellent match. At this threshold, 50% of observers can detect a color difference, while the remaining 50% perceive no difference between two objects [36, 37]. Color comparisons between homologous maxillary central incisors have previously shown ∆E00 values below the acceptability threshold but above the perceptibility threshold [3]. The result obtained highlights the high level of color reproduction achieved, which is considered one of the most challenging aspects of esthetic dentistry, particularly for maxillary central incisors [1, 3, 17, 26].

Nowadays, the implementation of AI‐based strategies offers new opportunities for objective assessment in dental color science. These data‐driven approaches provide valuable insights for dental technicians and clinicians by enabling more accurate predictions of the optical and colorimetric behavior of restorative materials [25, 26, 27, 28, 29, 30, 31]. Case reports have highlighted the effectiveness of the Matisse software in complex clinical scenarios, demonstrating improved esthetic outcomes and reduced procedural complexity [26, 32, 33]. Future clinical studies should be conducted to objectively evaluate the color‐reproduction reliability and accuracy of AI‐generated protocols across larger patient cohorts, using established color difference thresholds as reference standards. Furthermore, the adoption of AI‐based tools may support dental education by allowing clinicians and dental technicians in training to compare software‐guided strategies with traditional visual techniques, promoting a deeper understanding of color dynamics in esthetic dentistry.

The case report described a technique that integrates traditional laboratory layering methods with chairside staining/glazing procedures, enhanced by AI software, demonstrating how craftsmanship and technology can work synergistically [26]. It also highlights the versatility of the Matisse software, which serves as a valuable tool for dental technicians while also being adaptable for clinical use, particularly with the advancement of CAD‐CAM chairside technologies [16]. This workflow can be seamlessly applied to restorations fabricated from ceramic ingots (pressed) or blocks (machined), with customization achieved through staining techniques, whether in the dental clinic or laboratory. Additionally, the software offers a protocol for metal‐ceramic restorations, allowing the dental technician to implement recipes from the initial stages of ceramic layering.

However, integrating Matisse into daily workflows is not without challenges. Its effectiveness relies on accurate shade‐taking with a colorimeter, which requires proper positioning‐stabilization of the device and a black background [19, 26]. Additionally, for the ceramic layering approach the successful use of the software demands adequate training on different colors assessment and adherence to specific protocols to fully leverage its potential [26]. In contrast, the staining technique requires minimal training and can be seamlessly incorporated into routine clinical practice, as demonstrated in this case. Rather than replacing traditional methods based on visual perception, this approach serves to complement them, allowing for more precise and predictable outcomes.

4. Conclusions

Within the limitations of this case report, the hybrid approach proved feasible for integrating laboratory procedures with chairside staining protocols. This method resulted in an esthetically satisfactory outcome for an anterior metal‐ceramic crown, highlighting the potential of artificial intelligence–driven staining solutions.

Funding

The authors have nothing to report.

Consent

Informed consent was obtained from the patient after providing a detailed explanation of the clinical procedure, including its potential risks, benefits, and alternative treatment options. The patient agreed to participate and authorized the use of clinical data and images for scientific publication, with full protection of their identity.

Conflicts of Interest

M.W. Awdaljan, as the founder and director of Labmatisse BV in The Netherlands, has a financial interest in products showcased in this case report.

Acknowledgments

I want to express my gratitude to Dr. Nithin Govindarajan for his supervision, dedication, and thoughtful contributions to this case report.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Associated Data

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Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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