High Strength Crowns
Experience the precision and durability of our 3D Milled Crowns, crafted in our in house dental laboratory. We meticulously select high-quality materials sourced from Europe and Japan to ensure results.

What Are Dental Crowns?
Dental crowns are tooth-shaped caps placed on damaged, weakened or decayed teeth. Custom-designed crowns ensure comfortable bite force and fit, and function as good as natural teeth. Made of either ceramic or metal materials, dental crowns are long lasting and durable.
Dental bridges work similarly to crowns except it covers a gap between two teeth. It is made up of two crowns on the supporting teeth adjacent to the gap with a prosthetic tooth suspended in between. They are used as an alternative for patients who want to avoid surgery or dental implant treatment.

Why Do Teeth Need Crowns?
The most common reason why you would need a crown or veneer is because your tooth is weakened, either from dental cavities or have been fractured. Crowns are also used in worn out or discoloured teeth to achieve a more beautiful shape and to hide any discolouration.
Teeth that would benefit from crowns:
- Teeth with Large Fillings or Cavities
- Teeth with Cracks or Chipped
- Teeth that had Root Canal Treatment
- Teeth that have a odd shape or colour different to the neighbouring teeth
Crowns can protect your teeth from further wear and cracks, which may lead to extraction of the tooth.
Benefits Of a Dental Crown

Enamel, once destroyed will not grow back – if you have a weakened, cracked or damaged tooth, a crown may be your best answer to help restore the tooth’s function and avoid extraction.
Crowns act as helmets to weak teeth, helping to protect damaged and sensitive teeth.
Apart from restoring the function of your teeth, dental crowns can also be shaped and coloured to match your natural teeth.
Dental crowns mimic your natural teeth, do not shift around, and look and feel like your own teeth.
When well taken care of, crowns can last as long as 15 years.
Why Are Crowns Different At Dental Designs Clinic?
%201.png?width=1304&height=1009&name=Untitled%20design%20(21)%201.png)
-
Experienced Dentists
-
High quality, genuine materials used
-
CAD/CAM Equipment with Fully digital workflow
-
100% metal-free
-
Accessible by car or MRTs
-
5-year warranty
%201.png?width=1304&height=1044&name=Untitled%20design%20(22)%201.png)
Same Day/ Next Day Crowns
At Dental Designs Clinic, we use a fully digitalised CAD/CAM system for the entire crown procress from start to finish. This allows us to prepare and fabricate your crowns in the same day or the day after.
Compared to traditional crowns, this system eliminates the need for long waiting times, dental moulds, temporary restorations, and multiple dental visits.
This technology ensures exceptional precision and accuracy, resulting in strong restorations that seamlessly blend in with your natural teeth.
Process Of Getting Dental Crowns
At Dental Designs
%201.png?width=549&height=600&name=Untitled%20design%20(14)%201.png)
1. Consultation
During your consultation, we will assess the tooth's condition, evaluating the extent of the damage, checking the nerve's health, and assessing the suitability of your tooth for a dental crown.
3D scans, professional photographs and x-rays may be taken to assess for any underlying dental issues and better understand your concerns.
If any anomalies are found, our dentists will discuss alternative treatment options with you.
%201.png?width=550&height=600&name=Untitled%20design%20(16)%201.png)
2. Preparing Your Teeth
A crown preparation is a procedure whereby a dentist readies a tooth to receive a dental crown.
Your dentist meticulously removes any decay and reshapes the underlying tooth to create space for the crown.
The goal is to ensure a snug fit for the crown, which will ultimately protect and strengthen the tooth.
%201.png?width=549&height=600&name=Untitled%20design%20(23)%201.png)
3. Designing Your Crown
CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) technology has revolutionized the design and fabrication of dental crowns.
A specialized software allows the dental technician to create a virtual model of the tooth on a computer, where the design will be adjusted for shape, size, and bite alignment, ensuring an optimal fit.
Once the virtual design is complete, the CAD software communicates with a milling machine (CAM) to make the crown.

4. Milling And Hand Finishing The Crown
In our in-house laboratory, each crown is precisely milled from a single block of material with diamond drills to ensure an accurate fit.
Our experienced dental technicians then hand finished the crowns by adding final touches with glazes to create a realistic look.
Once ready, the crown is strengthened and the stains made permanent in a furnace at 1550℃.

5. Crown Cementation
You'll be back in the dentist's chair for this step. The dentist will try on the crown to confirm that it's fitting well on your tooth, and to check the that it blends in well with the rest of your teeth.
If all is well, the crown will be cleaned and conditioned, and modern dental adhesives are used to permanently secure your crown in place.
%201.png?width=550&height=600&name=Untitled%20design%20(15)%201.png)
6. Review Check
A follow-up review will be scheduled about a week after the treatment.
During our follow-up review, we will carefully assess your bite force, examine the stability of the crown, and evaluate the overall comfort and fit.
Our goal is to ensure that you feel completely at ease with the crown in your mouth. Since everyone's bite is unique and can be influenced by muscle structure, a small number of patients may require further adjustments to improve the feeling of their bite.
%201.png?width=549&height=600&name=Untitled%20design%20(14)%201.png)
1. Consultation
During your consultation, we will assess the tooth's condition, evaluating the extent of the damage, checking the nerve's health, and assessing the suitability of your tooth for a dental crown.
3D scans, professional photographs and x-rays may be taken to assess for any underlying dental issues and better understand your concerns.
If any anomalies are found, our dentists will discuss alternative treatment options with you.
%201.png?width=550&height=600&name=Untitled%20design%20(16)%201.png)
2. Preparing Your Teeth
A crown preparation is a procedure whereby a dentist readies a tooth to receive a dental crown.
Your dentist meticulously removes any decay and reshapes the underlying tooth to create space for the crown.
The goal is to ensure a snug fit for the crown, which will ultimately protect and strengthen the tooth.
%201.png?width=549&height=600&name=Untitled%20design%20(23)%201.png)
3. Designing Your Crown
CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) technology has revolutionized the design and fabrication of dental crowns.
A specialized software allows the dental technician to create a virtual model of the tooth on a computer, where the design will be adjusted for shape, size, and bite alignment, ensuring an optimal fit.
Once the virtual design is complete, the CAD software communicates with a milling machine (CAM) to make the crown.

4. Milling And Hand Finishing The Crown
In our in-house laboratory, each crown is precisely milled from a single block of material with diamond drills to ensure an accurate fit.
Our experienced dental technicians then hand finished the crowns by adding final touches with glazes to create a realistic look.
Once ready, the crown is strengthened and the stains made permanent in a furnace at 1550℃.

5. Crown Cementation
You'll be back in the dentist's chair for this step. The dentist will try on the crown to confirm that it's fitting well on your tooth, and to check the that it blends in well with the rest of your teeth.
If all is well, the crown will be cleaned and conditioned, and modern dental adhesives are used to permanently secure your crown in place.
%201.png?width=550&height=600&name=Untitled%20design%20(15)%201.png)
6. Review Check
A follow-up review will be scheduled about a week after the treatment.
During our follow-up review, we will carefully assess your bite force, examine the stability of the crown, and evaluate the overall comfort and fit.
Our goal is to ensure that you feel completely at ease with the crown in your mouth. Since everyone's bite is unique and can be influenced by muscle structure, a small number of patients may require further adjustments to improve the feeling of their bite.

Bridge/Ceramic Filling/Crown Warranty
Well established for more than 30 years, with >250 scientific studies confirming the clinical safety of tried and tested CEREC tooth restorations. Worldwide, more than 30 million tooth restorations have been produced with CEREC.
Creating Smiles, Changing Lives
28 Overall reviews
The service and doctor is the best in town! The customer service and receptionists are very friendly! Dr Phillip Miller and Dr Noah Teo is very nice and very professional on their skill! They also very patient to explain to me about the treatment!
Will come back again!
Thank you very much!
李岳侨
Beautiful and friendly dental clinic, was recommended by my colleague. Been coming here for dental cleaning and fillings. Always a good visit!
J. Kho
This dental clinic has very good staff who are well trained and friendly. The dentists are also very good and will explain the treatment in detail before starting treatment. The equipment is very high tech and I believe they are able to do high quality work as I did my crown here and it looks much better than my colleague who also recently did his at another place. The waiting room is also very comfortable. good job!
C. Zheng De
This clinic is one of the best I have ever seen. I saw dr Justin for my implant which I did many years ago, the tooth was loose, and other drs told me to remove it as they could not find out what brand it was but dr Justin was able to take 3d xrays and locate the brand and specially ordered the part in. he saved me from having to do a surgery to remove and put a new implant which would have cost me a bomb. the tooth looks even better than the original thanks to the experieced dental technician Katsuya from Japan.
Very happy and will keep coming back for my regular dental.
G. Hock An
my workplace is close by and I had a problem with my tooth for a few days, so I made an appointment to come down. The receptionist who booked my appointment was very helpful and friendly to explain the way to the clinic from my office. I saw Dr Nicholas who was able to do a root canal treatment on the same visit so that I didn't need to come back. I felt safe and comfortable to do my dental treatment here as the dental picks are all wrapped up and sterilized and only opened before each treatment when im inside.
P. Wendy
I had an amazing experience at this dental clinic. Dr. Justin Giam is a skilled dentist who explained everything thoroughly. The staff was friendly, and the clinic is conveniently located near my workplace. Highly recommended!
S. Goh
I am so glad I found Dental Designs, it was recommended to me by an expat friend. Dr Rares is the best dentist I have ever encountered. He is extremely conscientious and empathic in his work, with a great attention to detail. His work is stellar, and he is always tuned in to the patient's needs. I have had multiple dentists in Oslo, Norway and in London, and although some of them have been excellent, I can truly say that not one of them has been of his caliber.
h. hjertenes
Great dental clinic! Dr Giam is very friend and his treatments are very gentle. He is good at explaining his treatment to his patients and a lot of great cafes nearby as well. Excellent customer service and helpful receptionist. Decent location too!
C. MichaelJr
My dental implant procedure here was top-notch. Dr Justin did the surgery for me and he was skillful.The team was patient and made sure I felt relaxed throughout. They even sent me a message to check up on me for post-surgery care. Thank you!
J. Florentyna
Dr. Tiffany Tan did an excellent job with my Invisalign treatment. My teeth are now perfectly aligned, and it was a comfortable process from start to finish. The clinic's hygienist, Kelly, is fantastic as well!
W Y
I can’t recommend this clinic enough, was so glad to have found it. Great facility, really enjoyed the ambience with radio music. But thats beside the point, Dr Tiffany is so terrific, they are so kind and really care about doing a good and meticulous job, and are so professional to share with me all x-rays of my teeth and explaining the issues and the process. I’ve never had any dentists that are so genuine and pro-active to help the patients be informed and understand the situations thoroughly. I feel very assured to be in such good hands. Thank you greatly!
T. Pham
I had a dental veneer procedure to fix my chipped front tooth, and the results exceeded my expectations. The clinic is conveniently close to my workplace, and the entire team was friendly and skilled. A great experience overall!
L. Chia Heng
Dr. Justin Giam and his team are exceptional. I had a replacement for my dental crown, and they made sure I felt comfortable and relaxed throughout. The clinic is just a short walk from the MRT station.
A. H.
I fell down and chipped my front teeth on holiday and came to doc Justin who is my usual dentist. he was able to fix it same day and by now I dont even remember which teeth was chipped. best doc in town!
l. pienkowski
I appreciate the professionalism and patience of the staff here. They did a fantastic job with my ceramic filling, which was much better shape and bite than the other one i had done previously at another clinic, and the clinic's location in the CBD is perfect for me.
R. Phua
The hygienist, Kelly, provided me with the best scaling and polishing I've ever had. The clinic is not only convenient but has friendly receptionists and great staff. I highly recommend it!
L. Josephine
I have been coming to this dental clinic for years and I bring all my family and recommend to my colleagues to come as well, because they are just so good. Especially Dr Justin Giam, he is very skilled in crowns and veneers for me. My father's implant denture was able to be done smoothly, which was important because we have to fly in to Singapore to come for the dental treatment, so it saves us so much time here. The assistant doctors are also good to do the usual fillings and cleanings without any pain. The receptionists are friendly and helpful for making the appointment a pleasant one. Very good job dental design!
L. Winnie
I needed replacement retainers, and I found that dental designs provide clear retainers with same day pickup. its convienent as its close to my office and I could go out for a coffee while waiting.
E. Michael
My tooth has been hurting on and off for the past months and I ignored it as I was busy. i went to the dentist near my house and was told to extract it and do an implant as it was decayed and the cavity was too big. I didnt want to extract my tooth so i looked for other options and found Dental Designs where I was able to be seen and my tooth could have a root canal treatment and crown done instead of extraction. the tooth is functioning well and I can bite normally, there was no downtime. i strongly recommend Dental Designs as the dentist here is much more skillful and knowledgeable and the receptiontists are also very friendly.
J J
I did a whitening procedure here in the clinic and had good results, my friends commented it was much whiter and I'm happy with the results. there is a little sensitivity but it goes away after one day. highly recommend this clinic if you are looking for a dentist to do teeth whitening. the cleaning was also very comfortable and i didnt feel any pain or bleeding.
L. Kathleen
I read about Dental Designs as I wanted to do Invisalign treatment for a long time, and I chose Dr Tiffany Tan as she has good reviews. During the first consultation, she took time to listen to my concerns and also explained various options for me to suit my needs. There was also no hard selling even though I could not decide to do the treatment on the same day, the staff was also all smiles and very helpful. I came back again with my wife and Dr Tiffany was very patient in explaining my condition and the treatment options again, thus I decided to go with them. I completed my Invisalign treatment after about 18 months and the results are just as what Dr Tiffany promised. All my colleagues and friends are able to see the difference, I had an underbite which is completely resolved. The whole process was very smooth and the whole team was just so helpful and responsive throughout. Kudos to Dental Designs and Dr Tiffany Tan!
L. Ian Jun Jie
The dentists here are very skillful and do a good job, the staff is also very friendly and its easy to book appointments over whatsapp. I recently had to do a root canal and dental crowning for my tooth and the process was easy.
M. Hui Tan
Best experience I ever had at a dental clinic or medical clinic for that matter. I've been to many clinics in UK and Sydney and none of them are as good as Dr Tiffany. I have been using a specially prescribed mouthguard at night which cost me close to 3000 AUD from a specialist in Melbourne as otherwise I would have jaw pain when I woke up in the mornings. I went to a consultation with Dr Tiffany Tan as I wanted to straighten my front teeth which had shifted a little over the years. Dr Tiffany was able to assess not only that my teeth could be straightened but that the bite was all wrong. I started on Invisalign treatment with her and 2 years later I am able to chew steak and peanuts without wincing, and I do not need the special mouthguard at all. Thanks to Dr Tiffany, I now have a normal life without pain and trust me it is unbelievable how much my bite affected my life prior to my Invisalign treatment. Thank you Dr Tiffany and the Dental Designs clinic team, you guys are amazing!
L. Mallory Alice
I saw Dr Justin to fix my teeth veneers which I had (stupidly) done at a dentist in Thailand as my friend brought me there during a holiday. He was able to check it and advise that my gums were badly infected due to the poor veneers which they did, which was causing a bad smell in my mouth. Dr Justin had to remove all the veneers and the hygienist Ms Kelly is also really gentle and I had the best clean in my life here with the air cleaning. Dr Justin was then able to give me new veneers which are properly fitted and which looked so natural compared to the other ones that were done and I feel like they are my real teeth. There is no more bad smell and my teeth and gums are healthy now!
S. Matthew Lucian
Firstly, I want to commend the dentist here Dr Justin as he is skilled in his work and delivers what he promises.
Additionally, I am seen within 15 minutes each time I come for my appointment, which is not the case when I attend other medical appointments in Singapore.
The staff are also excellent.
Z. Nael
Visited this clinic for the first time today after reading all the reviews. Indeed a dental clinic with very good service. The receptionist was very friendly. My appointment was at 12pm and I saw Dr Justin at 12pm without any delay. He was very professional with his work and casual when talking. Made me feel comfortable. Took pics of my teeth to tell me what is wrong and what needs to be done. Not pushy at all asking me to do this and that. Price is pretty reasonable for where they are located. Thanks for the great service!
M. Yousuff
Popped into Dental Designs on Cecil street for the first time a couple of weeks ago and then a filling just yesterday. Staff are highly professional, from the front desk to the doctor and dental assistant.
Dr Peter Tang is fantastic at what he does. Really good bedside manners, explains the procedure in great detail to make sure I know what is going to be done and also removed my fear of having my teeth cleaned. Will definitely make this place my regular go-to for all dental matters!
O. Xu (Olive)
Cara kerja Sangat bagus dan terjamin
Yessi sania sibarani
Frequently Asked Questions on Dental Crown in Singapore
A dental crown is a tooth-shaped “cap” that is placed over a tooth — covering the tooth to restore its shape and size, strength, and/or to improve its appearance. It is normally made of a stronger material such as ceramic or metal. The crowns, when cemented into place, fully enclose the entire visible portion of a tooth that lies at and above the gum line.
The primary purpose of a crown is to cover or protect a damaged tooth. So, if you have had a root canal or a very big cavity, your dentist may suggest a dental crown to protect the remaining tooth structure. You may also need a crown as a part of a dental bridge or with dental implants
Same-Day Dental Crown Procedure: Quick and Convenient
With our same-day dental crown procedure, you'll experience a streamlined process:
Morning Appointment:
-
Initial Examination: Evaluation of your tooth's condition, potentially including x-rays. Additional treatments may be considered for extensive issues or insufficient natural tooth structure.
-
CAD/CAM CEREC Procedure:
- Local anesthesia for comfort.
- Removal of decay and old fillings.
- Tooth reinforcement with a core and space reduction for the crown.
- 3D digital scan taken using advanced technology.
In Between Appointments:
- You have time for lunch or can return to work.
Afternoon Appointment: 3. Crown Design: Our in-house lab technicians design a virtual crown using computer technology.
-
On-Site Milling: The crown is milled from porcelain, typically within a day. It's then glazed and fired in our in-house lab.
-
Final Fitting:
- The crown is tried in and checked for fit.
- Adjustments are made if necessary.
- The crown is permanently cemented in place.
In contrast to traditional crown procedures with multiple appointments and interim care, our same-day process offers efficiency and convenience for a quicker solution to your dental needs.
Metal Free Crowns
All-ceramic or all-porcelain dental crowns are made from high strength ceramic, typically in a single layer. They provide a natural color match and are hypoallergenic. These crowns require less tooth structure trimming as they can be permanently bonded. They are a good choice for front and back teeth.
Zirconia dental crowns are made from strong white silicate material called zirconium oxide. They come in two types - solid zirconia and high translucent zirconia. Solid zirconia is suitable for back teeth that undergo high stresses, while high translucent zirconia is used for a more natural tooth aesthetic.
At our Clinic, we generally use Metal-free crowns, as they offer natural aesthetics, minimal tooth alteration, hypoallergenic properties, exceptional strength, and versatility for a beautiful, long-lasting smile.
Metal Containing Crowns
Metal crowns can be made from gold alloy, other alloys like palladium, or a base-metal alloy such as nickel or chromium. Crowns with higher gold content require less tooth trimming and are resistant to chipping and breaking. However, they have a metallic color. Porcelain-fused-to-metal crowns have a metal interior and a porcelain layer for a more natural appearance, but they can chip or wear off over time. These crowns can be used for front or back teeth and are typically cheaper.
On average, dental crowns last between 5 and 10 years. The life span of a crown depends on the amount of “wear and tear” the crown is exposed to, how well you follow good oral hygiene practices, and your personal mouth-related habits (you should avoid such habits as grinding or clenching your teeth, chewing ice, biting your fingernails and using your teeth to open objects such as beer caps, or packaging).
While a crowned tooth does not require any special care, remember that the underlying tooth is still your natural tooth and is still subject to decay or gum disease. Therefore, continue to follow good oral hygiene practices, including brushing your teeth at least twice a day and flossing once a day and make sure there is no food stuck between the teeth.
- Discomfort or sensitivity.
You may experience some heat and cold sensitivity on your newly crowned tooth immediately after the procedure as the anaesthesia begins to wear off if the tooth that has been crowned still has a nerve in it. Your dentist may recommend that you brush teeth with toothpaste designed for sensitive teeth. This sensitivity is usually temporary and will go away in a few day. Persistent soreness or sensitivity that occurs when you bite down could mean that the crown is slightly too thick and is hitting the opposing tooth in some positions, and this needs to be highlighted to your dentist who can fix it. - Chipped crown. Crowns made of all porcelain or porcelain fused to metal can sometimes chip. If the chip is small, a composite resin can be used to repair the chip with the crown remaining in your mouth. This is usually just a temporary fix. If the chipping is extensive, the crown may need to be replaced.
- Loose crown. Sometimes the cement washes out from under the crown. Not only does this allow the crown to become loose, it allows bacteria to leak in and cause decay to the tooth internally. If a crown feels loose, contact your dentist’s office.
- Crown falls off. Sometimes crowns fall off. Reasons include decaying of the underlying tooth and loosening of the cementing material used to place the crown. If your crown comes off, clean the crown and the front of the tooth. You can replace the crown temporarily using dental adhesive or temporary tooth cement that is sold in stores for this purpose. Contact your dentist’s office immediately. He or she will give you specific instructions on how to care for the tooth and crown for the day or so until you can be seen for an evaluation. Your dentist may be able to re-cement the crown in place; if not, a new crown will need to be made.
- Allergic reaction. Because the metals used to make crowns are usually a mixture of metals, an allergic reaction to the metals or porcelain used in crowns can occur, but this is extremely rare.
- Dark line on crowned tooth next to the gum line. A dark line next to the gum line of your crowned tooth could be present if you have a porcelain-fused-to-metal crown. This dark line is simply the metal of the crown showing through. While not a problem in itself, the dark line may be cosmetically unacceptable and you can request to replace the crown with an all porcelain or ceramic one.
The dental crown will never stain or change color unlike natural teeth. Crowns containing metal usually appear different or unnaturally opaque compared to your other teeth. However, ceramic crowns can be made indistinguishable from your existing teeth.
Onlays and 3/4 crowns are variations on the technique of dental crowns. The difference between these crowns and the crowns discussed previously is their coverage of the underlying tooth. The “traditional” crown covers the entire tooth; onlays and 3/4 crowns cover the underlying tooth to a lesser extent.
Inlays are only possible when the cavity is less than 1/3 the size of the tooth and are an alternative to large fillings. They tend to have a better shape for cleaning and to prevent food getting stuck between the teeth, and last much longer than conventional fillings.
The advantage of onlays, “3/4 crowns” or inlays are that they involve much less removal of the tooth structure, while still protecting the weak areas of the tooth. Also, if the restoration fails in future, there is more tooth remaining which makes it more likely to survive rather than requiring an extraction.
For tooth decay or fractures that are not as large, we recommend ceramic onlays and inlays as explained above.
However, if the tooth is badly damaged, we will need to place a dental crown.
The purpose of the crown is to protect the tooth by covering it, and it has to be made of strong enough materials to serve its purpose. Some people may think about using a normal filling material to directly place a large filling over the surface of the tooth. This may work in the short term, but as the normal filling material is not rigid enough to hold the tooth together, cracks will continue to progress and the filling will break. The tooth will still need to be prepared or drilled again to fit a dental crown, causing more issues.
Porcelain veneers or a combination of braces and teeth whitening for the front teeth can help you achieve a purely cosmetic treatment by changing the shape of the teeth.
A dental bridge or implant can replace missing tooth if you choose to extract the tooth rather than to do a crown.
References:
- The Evolution Of the Cerec System
Werner Moörmann – https://www.sciencedirect.com/science/article/abs/pii/S0002817714652995
- Influence Of Different Convergence Angles and Tooth Preparation Heights on the Internal Adaptation Of Cerec Crowns
Shu-Hui Mou-Tsongi Chai-Juo-Song Wang-Yuh-Yuan Shiau – https://www.sciencedirect.com/science/article/abs/pii/S0022391302727376
- Marginal Adaptation Of Cerec 3 Cad/cam Composite Crowns Using Two Different Finish Line Preparation Designs
aber Akbar-Cynthia Petrie-Mary Walker-Karen Williams-J. Eick – https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-849X.2006.00095.x
- Cerec Cad/cam Chairside System
G Sannino-F Germano-L Arcuri-E Bigelli-C Arcuri-A Barlattani – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402686/
- An Up To 5-year Clinical Evaluation Of Posterior In-ceram Cad/cam Core Crowns
Andreas Bindl-Werner Mörmann – https://www.ncbi.nlm.nih.gov/pubmed/12375459
- Full-ceramic CAD/CIM anterior crowns and copings https://europepmc.org/article/med/11351494