Tooth color and whitening - digital technologies

The influence of the addition of titanium oxide nanotubes on the properties of 3D printed denture base materials

INTRODUCTION

In this study, the effects of adding titanium dioxide nanotubes (TiO2) to 3D-printed denture base resin on the mechanical and physical properties of denture bases were examined for the first time.

METHODS

The specimens were digitally created using 3D builder software from Microsoft Corporation through computer-aided design. In accordance with the test specifications for transverse strength, impact strength, hardness, surface roughness, and color stability, specimens were designed and printed with certain dimensions following relevant standards. TiO2 nanotubes (diameter: 15-30 nm and length: 2-3 μm) were added to the 3D-printed denture base resin (DentaBase, Asiga, Australia) at 1.0% and 1.5% by weight. Flexural strength, impact strength (Charpy impact), hardness, surface roughness, and color stability were evaluated, and the collected data were analyzed with ANOVA followed by Tukey's post hoc test (α = 0.05). Field emission scanning electron microscopy (FESEM) and energy dispersive x-ray spectroscopy (EDX) mapping were used to evaluate the dispersion of the nanotubes.

RESULTS

Compared with those of the control group (0.0 wt.% TiO2 nanotubes), the average flexural, impact, and hardness values of the 1.0 and 1.5 wt.% TiO2 nanotube reinforcement groups increased significantly. Both nanocomposite groups showed significant color changes compared to that of the pure resin, and there was a considerable reduction in the surface roughness of the nanocomposites compared to that of the control group.

CONCLUSION

Adding TiO2 nanotubes to 3D-printed denture base materials at 1.0 and 1.5 wt.% could enhance the mechanical and physical properties of the material, leading to better clinical performance.

CLINICAL SIGNIFICANCE

In terms of clinical applications, 3D-printed denture base material has been shown to be a viable substitute for traditional heat-cured materials. By combining this with nanotechnology, existing dentures could be significantly enhanced, promoting extended service life and patient satisfaction while addressing the shortcomings of the current standard materials.

Evaluation of the effects of different photosensitizers used in antimicrobial photodynamic therapy on tooth discoloration: spectrophotometric analysis

BACKGROUND

Tooth discoloration is a common concern in antimicrobial photodynamic therapy (aPDT) using various photosensitizers (PS). Toluidine Blue (TB), Methylene Blue (MB), Phthalocyanine (Pc), and 2-mercaptopyridine-substituted zinc phthalocyanine (TM-ZnPc) are among those studied, but their relative impacts on tooth discoloration remain unclear.

AIM

This study aimed to compare the effects of TB, MB, Pc, and TM-ZnPc in aPDT on tooth discoloration, utilizing a controlled experimental setup.

MATERIALS AND METHODS

The study comprised seventy-five single-rooted incisors with root canals. Following meticulous preparation, a standardized area on the crown surface was designated for examination, and precise measurements of the initial tooth colors were recorded. Samples were randomly divided into five groups: Negative control, MB, TM, Pc, and TM-ZnPc. Photoactivation was performed using LED light, and color measurements were taken at multiple time points up to 90 days. Data were converted to Lab* color values of the CIE Lab* color system (International Commission on Illumination, Vienna, Austria), and ΔE values were calculated. Statistical analysis was performed using Two-way ANOVA and Post-Hoc Tukey tests (p < 0.05).

RESULTS

At day 7 and 30, TM-ZnPc and Pc caused less discoloration compared to MB and TB. TM-ZnPc caused more tooth discoloration compared to Pc (p < 0.05). Compared to baseline, MB and TM-ZnPc caused more tooth discoloration at 30 days and TB caused more tooth discoloration at 90 days (p < 0.05). No significant difference was observed in terms of tooth discoloration at all periods evaluated after Pc application (p > 0.05). All photosensitizers tested in the study caused tooth coloration.

CONCLUSION

All PS induced clinically detectable tooth discoloration, with TB and MB causing more significant discoloration compared to Pc and TM-ZnPc at certain time points. TM-ZnPc and Pc demonstrated more stable coloration levels over time, suggesting their potential reliability in aPDT applications. This study highlights the importance of selecting appropriate PS to minimize tooth discoloration in aPDT, with Pc showing promise in this regard.

Ex vivo study of molecular changes of stained teeth following hydrogen peroxide and peroxymonosulfate treatments

White teeth can give confidence and tend to be associated with a healthier lifestyle in modern society. Therefore, tooth-bleaching strategies have been developed, including the use of hydrogen peroxide. Recently, peroxymonosulfate has been introduced as an alternative bleaching method to hydrogen peroxide. Although both chemicals are oxidizing agents, their effects on the molecular composition of the stained teeth are yet unknown. In this study, the molecular profiles of teeth bleached with hydrogen peroxide and peroxymonosulfate were compared using Liquid Chromatography-Tandem Mass Spectrometry. Statistical analyses were used to assess the samples. In addition, reference spectral libraries and in silico tools were used to perform metabolite annotation. Overall, principal component analysis showed a strong separation between control and hydrogen peroxide and peroxymonosulfate samples (p < 0.001). The analysis of molecular changes revealed amino acids and dipeptides in stained teeth samples after hydrogen peroxide and peroxymonosulfate treatments. Noteworthy, the two bleaching methods led to distinct molecular profiles. For example, diterpenoids were more prevalent after peroxymonosulfate treatment, while a greater abundance of alkaloids was detected after hydrogen peroxide treatment. Whereas non-bleached samples (controls) showed mainly lipids. Therefore, this study shows how two different tooth-whitening peroxides could affect the molecular profiles of human teeth.

Clinical Tooth Color Matching: In Vivo Comparisons of Digital Photocolorimetric and Spectrophotometric Analyses

OBJECTIVE

This study aimed to compare the tooth color matching of two dental colorimetric methods: the spectrophotometric analysis (SPM) and the standardized digital photocolorimetric analysis (DPC).

METHODS

The color of 60 maxillary central incisors of 30 volunteers (22.5 ± 7.6 years) was analyzed. In the DPC method, tooth photographs were standardized with the eLABor_aid protocol, processed with Adobe Photoshop Lightroom software, and the values of L*, a*, and b* were obtained with a Digital Color Meter software. For the SPM, L*, a*, and b* were measured directly with a handheld spectrophotometer. Data were submitted to paired t-test and Pearson correlation test (α=0.05). Mean color difference between the two methods was calculated with CIELAB formula.

RESULTS

All color coordinates revealed different values when comparing DPC to SPM in the same tooth (p<0.0001). Mean color difference (ΔEab) between SPM and DPC was 11.5 ±3.1. A positive correlation was observed for L* (R2=0.73,p<0.0001), a* (R2=0.31, p=0.017), and b* (R2=0.83, p<0.0001).

CONCLUSIONS

Even though the color coordinate values were different in both methods, they were correlated, revealing that the DPC is a viable alternative to determine the tooth color matching.

Different Methods for Assessing Tooth Colour-In Vitro Study

Colour assessment using digital methods can yield varying results, and it is important for clinicians to recognize the potential variability intra and inter-device. This study aimed to compare the L*a*b* values of VITA Classical (VC) and VITA Toothguide 3D-MASTER (VM) guides using two methods, SpectroShade (SS) and eLAB. Thirty-four measurements per tab were performed by a single operator across three batches of each guide. Intraclass correlation coefficients (ICC) between batches were calculated. Values <0.5, 0.5-0.75, 0.75-0.9, and >0.90 were classified as poor, moderate, good, and excellent reliability, respectively. Results were reported as mean and standard deviation of the L*a*b* values and respective colour differences (ΔE00) for each tab and method. Statistical analyses were performed with an independent t-test, α = 0.05. ICC values between batches were excellent for all L*a*b*, except for a* component in eLAB. There were statistically significant differences between methods in most L*a*b* values. The intra-device mean ΔE00 was 0.5 ± 0.6 for VC, 0.5 ± 0.8 for VM in SS, 1.1 ± 0.8 for VC, 1.1 ± 0.9 for VM in eLAB. The mean ΔE00 inter-device was 4.9 ± 1.7 for VC, 5.0 ± 1.7 for VM. Both methods demonstrated good internal consistency, with high ICC values and low intra-device colour differences, but exhibited high variability between methods, higher for a* the component.

Influence of image file and white balance on photographic color assessment

STATEMENT OF PROBLEM

How the color parameters obtained from digital photographs may be influenced by illumination, file format, and subject color is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate color differences (ΔE₀₀) and CIELab color coordinates among different types of file formats of dental shade tab images with and without white balance.

MATERIAL AND METHODS

Different shade tab colors (n=10) were photographed with a digital camera under standard conditions. The photographs were stored in RAW, JPEG, and TIFF file formats and evaluated with and without white balance (WB) adjustment by using an image software program and a gray reference card with known color coordinates. CIEDE2000 color differences between each image file format and the control group (RAW WB) were calculated, and interpreted by the visual perceptibility (PT₀₀=0.8) and acceptability (AT₀₀=1.8) thresholds. The ΔE₀₀ color shift was defined according to CIEDE2000 lightness, chroma, and hue and interpreted by the following respective visual acceptability thresholds: 2.92, 2.52, and 1.90. The differences among the color coordinates were analyzed by Kruskal-Wallis and Bonferroni post hoc tests (α=.05).

RESULTS

The color coordinates presented statistically significant differences between the file formats and control group (P<.001). Excellent matches (ΔE₀₀ ≤0.8) were observed on TIFF and JPEG saved from RAW-WB. Images without WB presented unacceptable mismatches (ΔE₀₀ >5.4). ΔE₀₀ color shift of images without WB were predominantly influenced by ΔH₀₀, while JPEG, WB, and TIFF WB were mostly influenced by ΔC₀₀.

CONCLUSIONS

Only compressed JPEG or TIFF files of dental shade tabs derived from original RAW WB photographs were able to achieve color differences within the limits of the 50:50% perceptibility threshold, providing excellent color matches with the RAW WB files.

Digital Light Processing of Zirconia Suspensions Containing Photocurable Monomer/Camphor Vehicle for Dental Applications

This study reports the utility of solid camphor as a novel diluent in photocurable hexanediol diacrylate (HDDA) monomer to manufacture 4 mol% yttria partially stabilized zirconia (4Y-PSZ) components for dental applications by digital light processing (DLP). The use of a 65 wt% HDDA-35 wt% camphor solution allowed 4Y-PSZ suspensions to have reasonably low viscosities (1399 ± 55.8 mPa·s at a shear rate of 75 s^-1), measured by a cone/plate viscometer, at a high solid loading of 48 vol%, where 4Y-PSZ particles prepared by calcination of as-received 4Y-PSZ granules, followed by a ball-milling process, were used with assistance of a dispersant. These 4Y-PSZ suspensions could be successfully applied to our custom-made DLP machine for manufacturing 4Y-PSZ components. To this end, several processing parameters, including layer thickness of 4Y-PSZ suspension, UV illumination time for layer-by-layer photocuring process, and initial dimensions of 4Y-PSZ objects, were tightly controlled. As sintering temperature increased from 1300 °C to 1500 °C, relative density and grain size of 4Y-PSZ objects increased, and cubic phase content also increased. Thus, after sintering at the highest temperature of 1500 °C for 3 h, high mechanical properties (biaxial flexural strength = 911 ± 40.7 MPa, hardness = 1371 ± 14.4 H_v) and reasonably high optical transmittance (translucency parameter = 7.77 ± 0.32, contrast ratio = 0.809 ± 0.007), evaluated by a spectrophotometer, were obtained due to a high relative density (97.2 ± 1.38%), which would be useful for dental applications.

Whitening Optical Effect of New Chewing Gums

Background:

Today, many treatments are available to enhance the color of teeth, but they require a few days to weeks to deliver this effect.

Objective:

To evaluate the instantaneous optical whitening effect of two new sugar-free chewing gums and one dentifrice of proven efficacy versus one placebo chewing gum.

Methods:

This was a single-blind, parallel trial. 424 participants entered the study and were randomly allocated to four groups. They received a personal silicone mask with a calibrated hole at one upper incisor to apply a dental colorimeter. The tools tested were chewing-gum containing indigotine (E132-FD&C Blue 2) and spirulina, chewing-gum containing only spirulina, chewing-gum placebo, and dentifrice containing Blue Covarine. Vita® Easyshade scored the tooth color, and the WIO and WID whiteness indexes were calculated. For chewing gums, the color of the teeth was scored before the assumption and after 2’30” of mastication. For dentifrice, participants brushed for 1’30”, then rinsed, and the color was scored before brushing and after 2’30”. Statistical analysis was performed by ANOVA and Tukey post-hoc.

Results:

The two experimental whitening chewing gums and the dentifrice significantly increased the WIO and the WID indexes from the baselines (p<0.001). Moreover, their effects were statistically greater than those reported for the placebo chewing gum (p<0.05) but not significatively different among them (p=NS).

Conclusion:

All the tested whitening tools showed an instant optical whitening perception. Further studies are required to assess the intensity of the effect over a prolonged time to meet the people's request for fast whitening tools.

The clinical trial registration no. is PVM-2020-01.

[Modern aspects of determining dental color in aesthetic dentistry]

One of the important factors for creating a beautiful smile is the color of the teeth, which for most people has a more important role than anatomical characteristics. The exact reproduction of the color of the tooth affects the appearance and psycho-emotional state of the patient. The purpose of this work is to review domestic and foreign literature on methods for determining the color of teeth. Methods for determining color are divided into visual, spectrophotometric, colorimetric, digital photo analysis and computer method. The most common in the practice of a dentist is visual, which is based on comparing the examined tooth with color templates. Determination of the color of teeth using scales does not give a reliable result, which is due to the small number of shades in the colors, the phenomenon of metamerism, the impossibility of converting the obtained data into digital values, etc. The hardware method for determining the color of teeth compensates for the disadvantages of the visual and has a high adaptability, which requires many interrelated factors. Due to the complexity and high cost, the devices are used mainly for research purposes. Currently, innovative methods for determining the color of teeth, based on digital and computer analysis, are being actively developed. Thus, hardware methods for determining the color of teeth significantly increase the accuracy of choosing the shade of a future aesthetic restoration or orthopedic construction, excluding subjective factors, however, they require mandatory certification. Correct color assessment and identification helps to reduce costly re-treatments and reduce warranty costs. Despite this, visual methods using scales remain in demand among practicing doctors, due to their low cost and ease of use. The accuracy of determining the color of teeth in this case depends on the professionalism of the dentist, as well as on the correctness of the photo protocol.

Surface Morphological Changes and Predisposition to Staining in Dental Enamel Bleached with Different Hydrogen Peroxide Concentrations

Background:

The tooth bleaching treatment can cause structural changes in the surfaces of the teeth; these changes can increase the absorption of staining agents.

Purpose:

This study assessed surface morphological changes and predisposition to staining in dental enamel bleached with different hydrogen peroxide (HP) concentrations, with or without the use of a light source (LS).

Methods:

25 bovine incisor specimens were divided into five groups (n = 5): Control- no treatment; HP35 - hydrogen peroxide 35%; HP35+LED - hydrogen peroxide 35% + light emission; HP20 - hydrogen peroxide 20%; and HP7 - hydrogen peroxide 7,5%. Twenty days after bleaching, the specimens were immersed in staining solutions four hours a day for 28 days. The morphological alterations of the bovine enamel surface were evaluated by means of scanning electron microscopy, X-ray dispersive energy spectroscopy and predisposition to the staining of the brightened enamel by means of colorimetry.

Results:

ANOVA with Tukey's test (p<0.05) showed that HP7 had the highest ΔL values (p=0.176) (brightest), with a better lightening effect. The bleached groups exhibited morphological changes in the enamel. The groups did not exhibit significant changes in oxygen, calcium, and phosphorus values (p=0.020). The presence or absence of light was not significant (p=0.007) for the predisposition to staining in bleached teeth.

Conclusion:

The time of exposure to the staining solution was significant for staining bovine dental enamel. High concentrations of HP were not necessary for achieving effective bleaching. HP caused an increase in enamel porosity and depressions. The light source did not influence bleaching.

Impact of Bleaching before or after Veneer Preparation on Color Masking Ability of Laminate Veneers: An In Vitro Study

Purpose

This study evaluates the effect of bleaching before or after veneer preparation and the depth of preparation on color masking ability of laminate veneers. Methods. Sixty extracted premolars were artificially stained to vita shade A4, verified by digital spectrophotometer (Vita Easy Shade V), and then divided into three groups: NB = nonbleached, BBP = bleaching before preparation, and BAP = bleaching after preparation. Based on the preparation depths, each group was further divided into two subgroups: S1 = 0.5 mm and S2 = 1.0 mm. BBP and BAP were subjected to one session of in-office bleaching using 35% hydrogen peroxide. IPS e-max CAD veneers of 0.5 and 1.0 mm thickness (corresponding to the preparation depths) of the same shade and translucency (HT A1) were cemented immediately to the bleached surfaces. Immediately after cementation, the color change ΔE between the baseline (after staining) and the resulted shades was measured using the Vita Easy Shade V digital spectrophotometer and CIELab color system.

Results

Bleached groups exhibited a significant ΔE value compared to the nonbleached group (p < 0.05). BAP showed the highest ΔE value. No significant difference was found between BBP and BAP. S2 revealed a significant ΔE value than S1 (p < 0.05). No significant difference was found between S1of BAP and S2 of NB, BBP, and BAP (p > 0.05). Regarding the color coordinates, the difference between the tested groups was highly significant in lightness (ΔL∗) (p < 0.001), while no significant differences were found in green/red value (Δa∗) and yellow/blue value (Δb∗) (p > 0.05).

Conclusions

In cases of severe tooth discoloration, one session of in-office bleaching before or after veneer preparation and the preparation depth do not influence the color masking ability of laminate veneers.

Color matching ability of resin composites incorporating supra-nano spherical filler producing structural color

OBJECTIVE

The aim of this study was to evaluate the optical properties of supra-nano spherical fillers with different diameters and the color matching ability of resin composites (RC) incorporating these fillers.

METHODS

Two types of SiO₂-ZrO₂ nano fillers with different diameters (150nm and 260nm) were used. The size distribution of each filler was measured and filler morphology was observed. The colors and spectral reflection spectra were measured by a spectral reflectometer. Experimental RCs incorporating ϕ150-nm/ϕ260-nm filler (D150RC/D260RC) were prepared. For the base dentin part, disc specimens (Estelite Astelia: A1B, A2B, A3B, A3.5B, or A4B) were prepared with a cylindrical cavity. Estelite Astelia with NE shade was layered on top as the enamel layer. Disk specimens with different cavity depths were prepared using A3B shade. Experimental RC was used to fill the cavity, and spectral reflection spectrums were obtained and analyzed. Filtek Supreme Ultra (FSU) with A3B shade was used (n=10) as a control.

RESULTS

Both ϕ150-nm and ϕ260-nm nano fillers showed uniform spherical shape and exhibited no aggregation. The maximum peaks of the spectral reflection spectra of the ϕ150-nm and ϕ260-nm nano fillers were 380nm and 580nm, producing structural colors close to blue and yellow, respectively. The spectral reflection spectrum of FSU had a broad peak at 540nm, and D150RC had a significant peak at 420nm. The D260RC specimen had a broad peak at 680nm. The peaks of D150RC and D260RC significantly decreased in accordance with the shift in base RC shade from A1B to A4B. There was no significant difference in the peak of the reflection spectral spectra among different cavity depths of D260RC. These results suggest that the experimental RC could reflect base RC colors via the matrix resin, and the amount of transmitted light from the base RC was not much different with cavity depth.

SIGNIFICANCE

D260RC producing structural color demonstrated a broad spectrum and reduction in brightness and chromatic value by adapting to surrounding restorative materials, suggesting its ability to enhance the chameleon (blending) effects to improve color matching. D260RC showed better color matching ability than resin composite containing uniformly sized ϕ150-nm SiO₂-ZrO₂ supra-nano spherical filler.

Application of macro photography in dental materials science

OBJECTIVES

The goal of this study was to show the potential of the inexpensive macro photography technique for application in various fields of contemporary dental materials science. The method was used for studying surface characteristics for fractographic evaluation, topography analysis, and for the measurement of optical properties such as translucency and opalescence.

MATERIALS AND METHODS

The variable test setup consisted of a digital camera with macro or microscopic objectives (combined with a lens tube and an objective adapter). The distance between object surface and objectives was controlled by an automatic stacking unit with a software-controlled mobile object slide. The exposure was carried out by LED light sources and a standard illuminant (D55).

RESULTS

Highly resolved pictures with fine details, high focal depth, flexible imaging by adjusting the illuminates in different angles, and the possibility of 3D topography imaging are the main reasons why macro photography proved to be a suitable imaging method for fractographic analyses. The automatic focal stacking technique was a powerful tool for imaging distinct topographies in high-resolution with nearly unlimited focal depth and 3D surface visualisation. Translucency as well as opalescence, measured with the macro photography produced differed from the measurements performed with a conventional spectrophotometer.

CONCLUSIONS

The modular structure of the cost-effective macro photography setup enables diverse applications such as identification of material groups, fractography analysis, and 3D surface visualisation. Quantification of colour, translucency, as well as opalescence under condition of the microscopic scale requires further research.