Acceptability of shade differences in metal ceramic crowns

Analysis of Aesthetic Preferences Regarding Gingival-Dental Color Combinations

STATEMENT OF PROBLEM

It is our view that the color of teeth and gingiva needs to be analyzed conjointly, given their close anatomical interrelation and the lack of research on perceptions of this chromatic combination.

OBJECTIVE

To determine aesthetic preferences concerning the chromatic combination of ceramic gingival specimens and acrylic teeth and analyze the influence of age and sex.

MATERIAL AND METHODS

A sample of 120 participants responded to a survey, in which each participant first selected the three "ad hoc" ceramic gingival specimens whose color they considered the most attractive from seven Vita Lumex AC Gingiva colors (231-237). Each participant then allocated a score from 1 to 10 for the chromatic combination of each of the three ceramic gingival specimens chosen in combination with each of the three acrylic teeth (maxillary central incisor, maxillary lateral incisor, and maxillary canine) in the three most frequent colors in the reference population (1M1, 3M1, and 2L1.5). The questionnaire also collected data on age and sex. Statistical analysis of the results was conducted using SPSS (v.28) software.

RESULTS

Participants most frequently chose gingival shade 232 as their first preference (80.8%), shade 233 was most frequently placed in second position (75%), and most participants selected shade 235 as their third preference (58.3%). The highest rated gingiva-tooth shade combination was 232-1M1 (mean score 7.9), followed by 232-3M1 (mean score 7.3). The only significant difference (p < 0.05) between men and women was between the mean scores allocated for the 232-3M1 combination, which was rated higher by women than men. Statistically significant differences were found between the mean scores allocated by different age groups for the 233-3M1, 233-2L1.5, and 235-1M1 combinations. Younger participants scored the first two shade combinations lower, while the opposite was true for the last combination.

CONCLUSIONS

When establishing aesthetic preferences, gingival color takes priority over dental color when both structures are visible in combination. Preferences regarding the most attractive gingival shades are focused on only two colors (232 and 233). A substantial majority of participants rated the 232-1M1 gingival-dental shade combination most highly. Practically no significant differences were identified between the mean scores allocated for gingival-dental color combinations according to sex. Age made a greater difference to results, although both variables had only a modest impact.

CLINICAL SIGNIFICANCE

Producing a combined gingival-dental shade guide would be useful, enabling the patient to provide their complete aesthetic vision, particularly in clinical situations where gingival tissue needs to be restored in patients with high smile lines. Manufacturers need to improve their gingival shade ranges, due to the limited number available, their disparity with natural gingival color, and the fact that patients do not like most shades on offer. A large percentage of aesthetic preferences focused on a limited number of gingival-dental color combinations, with lighter dental shades combined with the gingival shades that best approximate natural gingival color considered the most aesthetic. Age has more influence on gingival-dental color preferences than sex, although both factors have only a modest impact. For high smile lines, patients prioritize gingival color within the gingival-dental chromatic combination, since the preference for a certain shade of gingival specimen is maintained, irrespective of tooth color, indicating a stable chromatic hierarchy.

Validity and reliability of a proposed anterior implant esthetic index (AIEI)

STATEMENT OF PROBLEM

Patient satisfaction and esthetic acceptance are important factors in predicting the success of implant therapy in the anterior maxilla. A standardized esthetic index to evaluate implant esthetic outcomes is still lacking.

PURPOSE

The purposes of this study were to describe the newly developed images that correlate to the pink esthetic score and white esthetic score (PES/WES) for improved standardized documentation and to evaluate the validity and reliability of the proposed anterior implant esthetic index (AIEI) with patient satisfaction scores.

MATERIAL AND METHODS

A photograph deemed ideal (perfect score of 2) using the PES/WES criteria was acquired and digitally altered to represent scores of 1 (minor discrepancy) and 0 (major discrepancy) according to the PES/WES guidelines. A pilot study enrolled prosthodontists and periodontists to review and verify the representations. A 29-question survey was developed and distributed to 33 participants on a tablet computer to evaluate the photographs. The participants were asked about their satisfaction level with the photographs on a visual analog scale from 0 to 100. Data were extracted, and ANOVA was used to compare mean satisfaction scores. Post hoc Tukey tests were used to analyze the differences within each variable (α=.05).

RESULTS

Standardized sets of 14 altered PES and 14 altered WES photographs were generated. The interrater reliability (n=5) of the pilot study showed moderate agreement with κ=0.453 (95% CI: 0.431-0.476) for all and individual scores. Based on the patient survey, 5 of the 14 factors of the PES/WES showed no significant difference and were eliminated when constructing the index. Using scores and percentages, the anterior implant esthetic index was developed for scores of 0, 1, and 2 for each of the remaining 9 criteria. The maximum score for the index was 20 points.

CONCLUSIONS

Photographic representation of each criterion within the PES/WES standardized the patient's ability to evaluate anterior implant esthetics. An anterior implant esthetic index was developed, and a moderate interrater reliability agreement and good validation with patient satisfaction scores were obtained.

Evaluating the Effect of High-Translucent Zirconia Thickness and Substrate Shade on the Final Color of the Restoration

OBJECTIVES

The purpose of this study was to evaluate the effect of high-translucent zirconia thickness and substrate shade on the final color of the restoration.

MATERIAL AND METHODS

A total of 60 high-translucent monolithic zirconia disks were prepared using a CAD/CAM system. They were placed on composite substrates with A2, A3.5, and C3 colors (n = 10). The color differences (ΔE) of the ceramic disks on the A3.5 and C3 substrate compared to the control group (A2) were calculated and compared with acceptable thresholds (ΔE = 5.5) and perceptible thresholds (ΔE = 2/6). A one-sample t-test and repeated measures ANOVA were used to analyze the data statistically.

RESULTS

The highest ΔE values were observed when comparing two zirconia disk thicknesses on the A3.2 substrate without cement (ΔE = 5/65). The lowest value of ΔE compared to the control group (A2) was related to the disk with 1 mm thickness on the A3.5 substrate (ΔE = 2/54), and the highest value was for the disk with 0.6 mm thickness on the C3 substrate (ΔE = 4/88).

CONCLUSIONS

Using the zirconia disk with a 1 mm thickness on the C3 structure and a disk with a 0.6 mm thickness on the A3.5 structure with the presence of F2 cement can achieve an acceptable color difference (value of 5.5).

Comparative Analysis of Fluorescent Characteristics of Different Provisional Restorative Materials for Improved Dental Esthetics

At present, provisional restorative materials are widely used for both short- and long-term treatment purposes. In esthetic dentistry, for the simulation of natural teeth, fluorescence plays a crucial role in enhancing the elegant, vibrant, and life-like appearance of restorative teeth, making them more closely resemble natural teeth. To achieve ideal esthetic outcomes, restorative materials must replicate the characteristics of natural teeth to provide the most realistic appearance possible. Thus, this study aims to compare the color difference in fluorescence (∆E00) between a normal bovine tooth and eight provisional restorative materials under ultraviolet radiation. Eight provisional restorative materials were fabricated, for a total of 80 specimens (size 13.0 mm × 8.0 mm × 1.0 mm). A sound bovine tooth incisor was collected and used as a control for both enamel and dentine conditions. The color difference in fluorescence (∆E00) was assessed using a spectrophotometer. A one-way ANOVA and Tukey's test (p < 0.05) were used to analyze the resulting data. The results revealed that the color difference in fluorescence (∆E00) between the normal bovine tooth and eight provisional restorative materials used in this study was higher than the 50% acceptability threshold, indicating a clear mismatch between the fluorescence of the materials and that of the normal bovine tooth. Unifast Trad had the lowest ∆E00 among the provisional restorative materials, while Luxatemp Fluorescence had the highest color difference in fluorescence (∆E00). The color difference in fluorescence (∆E00) between Unifast Trad and Luxatemp Fluorescence is statistically significant. However, no significant difference was observed between Temporary CB, Vipi Block Trilux, and Protemp 4, or between Luxatemp Star and Luxatemp Fluorescence. It can thus be concluded that the ∆E00 mostly differs among the different materials. Luxatemp Star and Luxatemp Fluorescence exhibited the highest ∆E00 by a significant margin compared to the other groups.

Perception and Acceptance of Shade Variances in the Smile

(1) This study aimed to evaluate the influences of differences in denture teeth shade on harmony ratings and esthetic quality. Particular attention was paid to the question of how the overall variance of shade differences in the dental arch influences the perception of shade differences between adjacent teeth. (2) A total of 51 pictures of upper front teeth with standardized different colors of the left central incisor and different color variance of the dental arch were created. Eighty participants without dental knowledge and of different age, sex and educational level rated the pictures on a visual analogue scale from 0 (strongly disagree) to 100 (strongly agree) with regards to esthetic and color equality. (3) Results: The color differences between two teeth were judged in a negative linear correlation to the evaluation of color and esthetic quality. There was a sex- and education-specific difference in color and harmony ratings. In relation to the age of the participants, there was a significant difference in the color rating (p = 0.01) but not in the harmony rating (p = 0.27). Lower rating of color difference and harmony was found for a color difference in the dental arch up to ΔE = 3.1. In contrast, higher color differences resulted in higher ratings. (4) There is an influence of personal parameters on color perception. Color inhomogeneity in a dental arch leads to significant differences in color and harmony rating in a non-linear relation.

Perceptibility and acceptability of lightness difference of a single maxillary central incisor

OBJECTIVES

The aim of this study was to assess the lightness difference perceptibility and acceptability thresholds, for a single maxillary central incisor, and to investigate possible differences in these thresholds regarding the direction (+ΔL* vs. -ΔL*), the observer group (dentists vs. laypersons), and the gender and age of the observers.

MATERIALS AND METHODS

A series of images with varying lightness (L*), were created by altering the right maxillary central incisor of a male Caucasian, on a frontal view full-portrait image. Digital modification of one central incisor by 1 ΔL* unit resulted in 15 different images: one control, seven with increased and seven with decreased lightness. The images were presented in random order, on a digitally calibrated monitor, to 158 observers, grouped into 79 dentists, and 79 laypersons, who were asked to evaluate every image and answer whether they perceive a difference and if yes, whether they accept this difference. A multifactorial analysis of covariance was performed to analyze the perception and acceptance of any difference in the central incisors and to estimate the thresholds. The statistical significance level was α = 0.05.

RESULTS

Overall, the magnitude of ΔL*, direction of ΔL*, observer group and age were each significant (p < 0.001), as was gender (p = 0.03). The effect of the magnitude of ΔL* interacted with its direction and the observer group (p = 0.045), and the effect of age interacted with the direction of ΔL*, and the gender and the group of the observers. Estimated 50%:50% perceptibility thresholds ranged from 0.1 to 2.7, and 50%:50% acceptability thresholds ranged from 2.3 to 4.5. Overall, dentists perceived lightness differences at lower magnitudes than laypersons; difference in lightness was perceived and accepted at lower magnitudes when the tooth become lighter instead of darker; and female observers perceived and accepted lightness differences at lower magnitudes compared to males. As age increased overall, differences of lightness were perceived and accepted at higher magnitudes.

CONCLUSIONS

Perceptibility and acceptability of lightness differences of a single maxillary central incisor are affected by the magnitude and the direction of lightness change, as well as the gender, the age, and the type of the observers.

CLINICAL SIGNIFICANCE

Even small changes in lightness are perceivable; however, thresholds of perception and acceptance are dependent on the magnitude and the direction of change and are also dependent on the observer, with women, dentists and younger people perceiving and accepting changes at lower magnitudes of ΔL*.

Visual Versus Digital Color Determination of 3D-Printed Teeth as an Exercise in Dental Students' Education

Visual color determination is part of the daily routine in dental practice. However, it is not a part of dental education so far. The aim of this study was to evaluate whether visual or digital tooth color determination of 3D-printed teeth is a reliable tool for inexperienced dentistry students. Preclinical dental students evaluated eleven 3D-printed, tooth-shaped samples (VarseoSmile Crown plus, BEGO, Bremen, Germany) of different color shades. Visual shade determination using a reference scale (3D-Master Toothguide (3DM_TG), VITA Zahnfabrik, Bad Säckingen, Germany), followed by a digital color determination using a spectrophotometer (VITA Easyshade V, (ES_V), VITA Zahnfabrik), was performed. Color deviation was calculated in the Lab* color space (ΔE00) and converted into CIELAB 2000. The results were evaluated using the Mann-Whitney U test and the Wilcoxon Rank Sum test (α = 0.05). Significant differences between visual and digital color determination were proven (p < 0.001). Visual color determination (3DM_TG) showed a mean deviation (ΔE00 ± 95%CI) of 6.49 ± 0.47. Digital color determination (ES_V) showed significantly lower mean deviations of ΔE00 of 1.44 ± 0.58. Digital tooth color measurement using a spectrophotometer was a more reliable tool for the color determination of 3D-printed teeth for inexperienced dentistry students.

Effect of Ceramic Thickness and Technician Variability on the Shade Duplication of Dental Ceramo-Metallic Restorations

Ceramic thickness and technicians' manipulative variables are critical factors affecting the resultant shade of dental ceramo-metallic restorations. This study investigated the effect of the following variables on shade duplication of ceramo-metallic specimens: (a) ceramic thickness; (b) differences between several technicians (inter-technician variability); and (c) the ability of each technician to repeat the resultant shade (intra-technician variability). Ninety ceramo-metallic specimens were prepared and divided into three main groups (n = 30/gp) according to the different technicians who built up the veneering ceramic of the specimens. Each group was further subdivided into three subgroups (n = 10/subgroup) according to the thickness of the ceramic (1, 1.5, and 2 mm built over a 0.5 mm-thick metal substructure). Three different technicians were asked to follow the same protocol as regards the same ceramic batch (Shade 3M2, Vita VM13, Zahnfabrik, Germany), firing temperature, and number of firing cycles. Meanwhile, each technician followed his own protocol with regard to other ceramic manipulative variables. The duplicated shades of the specimens were investigated using the Vita Easyshade spectrophotometer by using the verify shade mode. Color difference (∆E) values were calculated between the target shade (3M2) and the duplicated shades of the specimens automatically by the Vita Easyshade spectrophotometer (Vita, Zahnfabrik, Germany). The effect of ceramic thickness and inter- and intra-technician variability on the duplication of the target shade was investigated. The results showed that the effect of ceramic thickness on the duplicated shades depended on inter-technician variability. High inter-technician variability (∆E = 2-6.4) was noticed in contrast to low intra-technician variability (∆E = 0.2-1.5). It could be concluded that proper shade-duplication of ceramo-metallic restoration was a cumulative technique intimately related to manipulative variables and ceramic thickness.

Perceptual and quantitative analysis of discoloration of orthodontic elastomeric chains by food

BACKGROUND

The objectives of this study were to use a digital camera to measure the discoloration of orthodontic elastomeric chains in various immersion solutions over different time periods and to determine the valid acceptability tolerances for color changes in orthodontic elastomeric chains by surveying digital photographs.

METHODS

Orthodontic elastomeric chains were applied to the maxillary anterior teeth of nine typodont models. The models were divided into three groups and immersed in the curry, coffee, and wine solutions. The digital images of the elastomeric modules were captured and processed using commercial software after 30 min of immersion, thrice a day, for 28 days. The differences in color changes ([Formula: see text]), depending on the type of immersion solution and period, were analyzed using a repeated-measures analysis of variance (ANOVA) test. A web-based survey questionnaire was randomly distributed to 50 respondents for a visual analysis of the elastomeric chain discoloration. The relationship between the surveying score and [Formula: see text] value was analyzed using Spearman's correlation coefficient. The perceptibility and acceptability of elastomeric chain discoloration ([Formula: see text]) based on the type of immersion solutions and periods were analyzed using a regression model.

RESULTS

Significant differences were observed in the discoloration of the elastomeric power chain depending on the immersion solution and period. The amount of discoloration was highest in curry, followed by coffee and wine (P < 0.05). The mean discoloration ([Formula: see text]) continued to increase over the entire immersion period. There was a significant correlation between visual scoring and discoloration ([Formula: see text]) over the entire period, especially in the early stages compared to the later stages (r = 0.918, P < 0.05). In 50% of the respondents, the predicted clinically unacceptable discoloration was between 4.46 and 9.98 and in 90% of the respondents, it was between 16.52 and 19.85.

CONCLUSIONS

The amount of discoloration was the highest for curry, followed by coffee and wine, and continued to gradually increase during the observation period. Significant differences were found between the color measurements obtained and the visual assessment by observers. The observers varied in their tolerance for perceptibility and acceptability for elastomeric chain discoloration based on the type of dietary media.

Using artificial intelligence to predict the final color of leucite-reinforced ceramic restorations

OBJECTIVES

The aim of this study was to evaluate the accuracy of machine learning regression models in predicting the final color of leucite-reinforced glass CAD/CAM ceramic veneer restorations based on substrate shade, ceramic shade, thickness and translucency.

METHODS

Leucite-reinforced glass ceramics in four different shades were sectioned in thicknesses of 0.3, 0.5, 0.7, and 1.2 mm. The CIELab coordinates of each specimen were obtained over four different backgrounds (black, white, A1, and A3) interposed with an experimental translucent resin cement using a calibrated spectrophotometer. The color change (CIEDE2000) values, as well as all the CIELab values for each one of the experimental groups, were submitted to 28 different regression models. Each regression model was adjusted according to the weights of each dependent variable to achieve the best-fitting model.

RESULTS

Different substrates, ceramic shades, and thicknesses influenced the L, a, and b of the final restoration. Of all variables, the substrate influenced the final ceramic shade most, followed by the ceramic thickness and the L, a, and b of the ceramic. The decision tree regression model had the lowest mean absolute error and highest accuracy to predict the shade of the ceramic restoration according to the substrate shade, ceramic shade and thickness.

CLINICAL SIGNIFICANCE

The machine learning regression model developed in the study can help clinicians predict the final color of the ceramic veneers made with leucite-reinforced glass CAD/CAM ceramic HT and LT when cemented with translucent cements, based on the color of the substrate and ceramic thicknesses.

The Effect of Sintering Procedures on Fit and Color in Zirconia Crowns

Purpose:

The aim of this study was to examine the effects of various sintering procedures on the color parameters, marginal, and internal fit of zirconia crowns.

Materials and Methods:

Overall, 60 zirconia crowns were produced using 3 distinct zirconia blocks (Wieland Zenostar, Zirkonzahn Ice Translucent, and Zirkonzahn Prettau). For the sintering procedure of the crowns, six groups were created as follows: Wieland-Standard, Wieland-Speed, Ice-Standard, Ice-Speed, Prettau-Slow, and Prettau-Standard programs. The crowns were assigned into groups ( n = 10 in each group). The color parameters, marginal fit, and internal fit of the crowns were evaluated. The normality of data distribution was evaluated with the Kolmogrov–Smirnov test. Two independent samples t-test and Mann–Whitney U test were used to compare the sintering groups.

Results:

Acceleration of sintering caused a significant change in the color parameters of the Wieland and Ice groups but not in the Prettau group. In the Wieland group, marginal ( p = .047) and internal ( p = .004) gap values of speed sintering were found to be significantly lower than those in standard sintering. In the Ice group, the marginal gap values of speed sintering were found to be significantly lower than those in standard sintering ( p = .019). In the Prettau group, the marginal gap values of standard sintering were found to be significantly higher ( p = .035) than those in slow sintering.

Conclusions:

It was concluded that the effects of sintering procedures on color parameters, and internal and marginal fit of zirconia crowns were clinically insignificant. Speed sintering can be recommended for zirconia restorations.

The accuracies of three intraoral scanners with regards to shade determination: An in vitro study

PURPOSE

To compare the accuracy of three intraoral scanners for shade determination function in vitro, and to preliminarily investigate the shade-matching characteristics of the three intraoral scanners.

MATERIALS & METHODS

The shade of the middle third region of each shade tab on the Vita Classical A1-D4 shade guide (VC) was measured by a spectrophotometer (Vita Easyshade V, VE) and three intraoral scanners, including CEREC Omnicam (OM), 3Shape TRIOS 3 (T3), and TRIOS 4 (T4). A conversion table between VC values and CIELAB values was established from the database of VE to analyze the trueness. The reproducibility of the instruments was then compared by repeating the measurements five times.

RESULTS

The mean color difference for each instrument was highest in the OM, followed by the T4, and lowest in the T3 and VE, repectively. The L^* and a^* value for OM, and the b^* value for T4, were significantly different from those for VE (p <0.05). The reproducibility of the instrument was highest in the VE (Fleiss' kappa: 0.95), followed by the T3 (Fleiss' kappa: 0.89), T4 (Fleiss' kappa: 0.87), and OM (Fleiss' kappa: 0.78).

CONCLUSIONS

Of the three intraoral scanners, the trueness was best on the T3. The reproducibility of all the instruments was excellent. This article is protected by copyright. All rights reserved.

Effects of Substrate and Cement Shade on the Translucency and Color of CAD/CAM Lithium-Disilicate and Zirconia Ceramic Materials

The aim of this in vitro study was to evaluate the effects of substrate and cement shades on the translucency and color of lithium-disilicate and zirconia CAD/CAM materials. Two light-cured resin cements (RelyX Veneer Cement; 3M; Choice 2 Veneer Cement; Bisco Dental) with a standardized thickness (0.1 mm) were tested in combination with two different monolithic CAD/CAM materials (E-Max CAD (LI2SI2O5); Ivoclar Vivadent; Katana (ZrO2); Kuraray-Noritake Dental) on two different colored composite substrates used as a dentin (Filtek Supreme XTE; 3M); for a total of 12 combinations (n = 10). The specimens’ color was measured with a spectrophotometer (Spectroshade; MHT). Measurements were taken using the CIELAB color coordinate system (L*a*b*) against black and white backgrounds. L*a*b* values were statistically analyzed for the variables Substrate, Ceramic, and Cement by applying a Three-Way ANOVA followed by the Tukey Test for post-hoc comparison (p < 0.05). Translucency Parameter (TP) and Constant Ratio (CR) were assessed to evaluate translucency; acceptability and perceptibility thresholds (ΔE00 1.8 and 0.8) were used. Statistically significant influence was found for factors ceramic material, cement shade, and substrate color (p < 0.05). Unacceptable color differences were reported for Li2Si2O5. Opacity was significantly higher when white opaque cement shade was employed. Ceramic type and cement shade significantly influenced L*a*b* color coordinates. The final translucency and color of ceramic restorations can, therefore, be influenced by ceramic material, cement shade, and substrate color.

Color Change of Resin-based Composites After In Vitro Bleaching Protocols: A Systematic Review and Meta-analysis

OBJECTIVES

To systematically review the literature on color stability of resin-based composites (RBC) after in vitro bleaching protocols and to assess the influence of bleaching protocols by meta-regression analysis on RBC color stability, and the association with clinical and experimental characteristics.

METHODS

The electronic search was conducted in MEDLINE/PubMed, Scopus, and Web of Science databases and included English language studies that evaluated and reported color differences (CIELAB values) of RBC after in vitro bleaching procedures using hydrogen peroxide and/or carbamide peroxide.

RESULTS

Database search for color change of RBC after bleaching retrieved 1335 eligible papers after removing duplicates. After initial screening, 66 articles were assessed for full-text reading with final inclusion of 23 published papers. A meta-regression analysis showed that storage time (p≤0.01), color measuring device (p≤0.01), and background color (p≤0.01) had influenced on color changes of RBC. The bleaching protocol (bleaching agent and time of application) did not influence on color changes of RBC (p>0.01).

CONCLUSIONS

There is evidence that RBC change color after bleaching, but the change is not clinically significant.

Effects of CAD/CAM ceramics and thicknesses on translucency and color masking of substrates

OBJECTIVE

To compare the translucency and masking of zirconia-reinforced lithium silicate with lithium disilicate glass-ceramic and hybrid composite.

MATERIALS AND METHODS

One hundred and twenty disc-shaped specimens were fabricated using Enamic, Celtra Duo, IPS E.max CAD, and Suprinity. Twelve groups were prepared according to material type and thickness (0.5, 1.0, and 1.5 mm). The specimens were tested over five substrates: composite resin-A3.5 shade (A3.5 control group), zirconia-A1 shade (ZR), nickel-chromium alloy (NC), black (B), and white (W). A spectrophotometer operating at wavelengths from 360 to 750 nm and a view-area size of 9.53 mm was used for color measurement.

RESULTS

Mean color difference values (ΔΕ) were found to be lowest in Suprinity and highest in IPS E.max. CAD. Color difference values were significantly related to substrate shade. The A3.5 substrate revealed the significantly lowest ΔΕ values of all the substrates (P = 0.05). Regarding the translucency parameters for ceramics of different thicknesses, a significant difference was observed among all groups except in Suprinity.

CONCLUSIONS

Different ceramic types with different thicknesses and substrate strongly affect translucency and masking.

CLINICAL SIGNIFICANCE

Fabricating durable aesthetic restorations that also meets patients' expectations is among the most significant challenges in dentistry. With high demand for more natural restorations, ceramics based on computer-aided design (CAD) and computer-aided manufacture (CAM) became popular and exhibited excellent results. However, various factors such as abutment shade, luting cement color, and ceramic type, thickness, and translucency may affect the prosthesis shade. The objective of this study was to evaluate the effects of these factors on the final shades of CAD/CAM-based ceramic restorations.

Surface Treatment of Industrial-Grade Magnetite Particles for Enhanced Thermal Stability and Mitigating Paint Contaminants

Pigments can retain their color for many centuries and can withstand the effects of light and weather. The paint industry suffers from issues like aggressive moisture, corrosion, and further environmental contamination of the pigment materials. Low-cost, long-lasting, and large-scale pigments are highly desirable to protect against the challenges of contamination that exist in the paint industry. This exploratory study reinforces the color and thermal stability of industrial-grade (IG) magnetite (Fe3O4). IG Fe3O4 pigments were further considered for surface treatment with sodium hexametaphosphate (SHMP). This metaphosphate hexamer sequestrant provides good dispersion ability and a high surface energy giving thermal and dust protection to the pigment. Various physicochemical characterizations were employed to understand the effectiveness of this treatment across various temperatures (180-300 °C). The X-ray diffraction, Raman, and X-ray photoelectron spectroscopy techniques signify that the SHMP-treated Fe3O4 acquired magnetite phase stability up to 300 °C. In addition, the delta-E color difference method was also adopted to measure the effective pigment properties, where the delta-E value significantly decreased from 8.77 to 0.84 once treated with SHMP at 300 °C. The distinct color retention at 300 °C and the improved dispersion properties of surface-treated Fe3O4 positions this pigment as a robust candidate for high-temperature paint and coating applications. This study further encompasses an effort to design low-cost, large-scale, and thermally stable pigments that can protect against UV-rays, dust, corrosion, and other color contaminants that are endured by building paints.

Effect of thickness, cement shade, and coffee thermocycling on the optical properties of zirconia reinforced lithium silicate ceramic

OBJECTIVE

To investigate the effect of thickness, cement shade, and coffee thermocycling (CTC) on the optical properties of zirconia reinforced lithium silicate (ZLS) paired with different shades of a resin cement.

MATERIALS AND METHODS

Thirty ZLS specimens were prepared in two different thicknesses (0.8 and 1.5 mm) and three different resin cement shades (Tr, A2, and A3) were applied (n = 5). Color determinations were done before and after 5000 CTC by using a noncontact spectroradiometer. Color change due to CTC and relative translucency parameter (RTP) before and after CTC were calculated by using CIEDE2000. Data were analyzed using ANOVA and Bonferroni-corrected t-tests(α = 0.05).

RESULTS

Material thickness and resin cement shade (P < 0.001) affected baseline color. Material thickness affected color difference (P = 0.025). Thickness, resin cement shade, and CTC (P ≤ 0.0001) affected RTP. The difference between the color changes of the 0.8- and 1.5-mm specimens combined with A2 shade cement after CTC was significant (P = 0.01). RTPs of all pairs decreased after CTC (P < 0.001).

CONCLUSIONS

Cement shade and material thickness affected the baseline color. The thickness of ZLS affected the color change after CTC only with A2 resin cement and the color change was less when the ZLS was thicker. CTC reduced the translucency of all pairs.

CLINICAL SIGNIFICANCE

Clinicians and patients should be aware of a potential color change after long-term coffee consumption when zirconia reinforced lithium silicate is used particularly for laminate veneers with A2 shade of the tested resin cement.

Colour agreement between try-in paste and resin cement: effect of background on zirconia-reinforced lithium silicate

PURPOSE

To investigate colour agreement between different shades of Panavia V5 resin cement and their try-in pastes under zirconia-reinforced lithium silicate ceramics.

METHODS

Forty-four zirconia-reinforced lithium silicate ceramic specimens were prepared at 0.8 ± 0.01 mm thickness. Composite resin tooth-shaded background specimens were obtained in two shades. Resin cement specimens were fabricated at 0.1-mm thickness. Colour difference values (ΔE) between Aquagel and both the try-in paste and resin cement were calculated using the CIE-Lab system. The CIEDE2000 (ΔE00) colour formula was used to determine colour differences. The three-way ANOVA test and a multiple comparisons test were used for statistical analysis (α = 0.05).

RESULTS

A statistically significant difference was found between the ΔE00 values obtained from the cement shade colour measurements for all specimens (P < 0.05). According to the three-way ANOVA test, lower ΔE00 values were observed in the try-in paste group compared to the resin cement group. The ΔE00 values were significantly affected by the cement shade and tooth-shaded background (P < 0.05).

CONCLUSIONS

The colour agreement between the try-in pastes and the corresponding resin cement differed, and the try-in pastes could not mask the dark dental background as much as the corresponding resin cement.

An evaluation of factors affecting dental shade matching in first-year dental students

STATEMENT OF PROBLEM

Shade selection has become more important and challenging as it becomes more emphasized in esthetic dentistry. It would be beneficial to screen dental students early in their predoctoral education for any deficiencies in color discrimination. Specific tests that reliably predict dental shade-matching ability have not been fully established.

PURPOSE

The purpose of this study was to determine whether the Farnsworth-Munsell 100 Hue Test (FM-100), Perceptual Ability Test (PAT), ethnicity, age, sex, and time to complete the tests affect dental shade-matching ability and value discernment in first-year dental students. Secondary aims were to determine whether correlations exist between performance on the PAT and FM-100 and between FM-100 and dental shade matching.

MATERIAL AND METHODS

The FM-100 test was administered to 98 first-year dental students in a Judge II booth (color temperature=6500 K, color rendering index=90). The Vita Toothguide 3D-Master shade guide was used in this study. For the Value Test, students arranged 3 sets of 5 masked shade tabs from lightest to darkest. In all 3 sets, the value ranged from 1 to 5. In set #1, each shade tab had the same hue and chroma. In set #2, the hues were constant, but the chroma varied. In set #3, the hue and chroma varied. For the Matching Test, students matched together 11 pairs of masked shade tabs from 2 shade guides. Ethnicity (white, African American, Hispanic, Middle Eastern, and Asian), PAT scores, age, sex, and time to complete tests were recorded. Data were analyzed by using least square means, Wilcoxon Rank Sum, Kruskal-Wallis, and Spearman correlation tests (α=.05).

RESULTS

FM-100 total error scores (TES) ranged from 0 to 188. Forty-three students had superior color discrimination (TES 0 to16), 51 had average (TES 20 to 100), and 4 had poor color discrimination (TES>100). Ethnicity, age, and sex did not significantly affect performance on any tests. Longer completion time resulted in better performance on FM-100 (P=.002) and Matching Tests (P=.032). However, increased time resulted in fewer correct answers on the Value Test (P=.016). There was a significant effect of PAT on FM-100 results (P<.001). As PAT scores increased, TES scores decreased, indicating better color discrimination. Similarly, lower TES scores resulted in higher Matching Test results (P<.001). However, this was not observed on the Value Test (P=.302). Correlation between the PAT and FM-100 was weak (r=-0.217), as well as between the FM-100 and Matching Test (r=-0.364).

CONCLUSIONS

Ethnicity, age, and sex did not affect dental shade-matching ability. Participants with higher PAT scores demonstrated higher color discrimination on the FM-100 and were better at matching dental shade tabs. Time had different effects on the Matching and Value tests.

Influence of coloring liquid immersion on flexural strength, Vickers hardness, and color of zirconia

STATEMENT OF PROBLEM

Zirconia is a widely used restorative material, yet its white color does not meet esthetic requirements and coloring is needed. However, the effects of different durations of coloring have not been thoroughly investigated.

PURPOSE

The purpose of this in vitro study was to evaluate the effects of coloring liquid immersion of different durations on the flexural strength, Vickers hardness, and color of zirconia.

MATERIAL AND METHODS

Fifty bar-shaped and 60 disk-shaped zirconia specimens were milled from nonshaded (Copran Zri) and preshaded (Copran Zri Precoloured Medium) disks by using a computer-aided design and computer-aided manufacturing (CAD-CAM) system. Preshaded specimens were assigned to the group PS and received no further immersion. Nonshaded specimens were divided into 4 subgroups as per immersion time in coloring liquid (Copran Color A2 Shade): control (C; no immersion), G45 (45 seconds of immersion), G90 (90 seconds of immersion), and G135 (135 seconds of immersion). Bar-shaped specimens were subjected to a 3-point flexural strength test by using a universal testing machine (Lloyd LRX), following the International Organization for Standardization (ISO) 6872:2015 specification. Color coordinates of disk-shaped specimens were measured with a spectrophotometer (VITA Easyshade Advance 4.0) over a gray background. Color differences were calculated by using both CIE76 and CIEDE2000 formulas, followed by a comparison of obtained values with perceptibility (CIE76: 3.7, CIEDE2000: 0.8) and acceptability (CIE76: 6.8, CIEDE2000: 1.8) thresholds of each formula. Subsequently, Vickers hardness measurements were conducted. The data were statistically analyzed by using the Shapiro-Wilk test, 1-way ANOVA, and the Tukey HSD test (α=.05).

RESULTS

Immersing zirconia specimens in coloring liquid decreased the flexural strength and hardness values, as group C presented the highest values for both parameters. In addition, prolonged duration had a negative effect on mechanical properties. The flexural strength of groups PS and G45 (P=.993) and groups G90 and G135 (P=.999) was statistically similar. For Vickers hardness, group G135 presented the lowest values with the difference between groups G90 and G135 being statistically similar (P=.061). Color differences among groups varied from 2.49 to 27.33 for ΔE∗, whereas ΔE₀₀ values ranged from 0.58 to 8.26. Compared with group C, ΔE∗ values of all shaded specimens exceeded the acceptability threshold of 6.8. The color difference between each group was higher than the acceptability threshold values of both ΔE∗ and ΔE₀₀ except for groups G45 and PS.

CONCLUSIONS

Colored zirconia specimens had lower flexural strength and Vickers hardness values than nonshaded specimens, regardless of the immersion time or coloring technique.

The whitening effect of single brushing with blue-covarine containing toothpaste-A randomized controlled trial

OBJECTIVE

To evaluate whether a blue covarine containing silica-based toothpaste promotes a whitening effect immediately after tooth brushing.

METHODS

A triple-blind, parallel group, randomized design was used to compare the tooth color before and after brushing. Two silica-based toothpastes were chosen, one of them containing blue covarine (BCT) and the other one without pigment to serve as control (CT). Tooth color was measured using a spectrophotometer and expressed as CIEDE 2000 ΔE, CIELAB values, WIO index, WI_D index and VITA scale tooth shade. In addition, the participants' satisfaction with and perception of their own tooth color were registered using an aesthetic numeric analogue scale.

RESULTS

No significant changes in color components or dimensions measured using CIEDE 2000 ΔE (CT: mean = 1.3, 95% CI 0.8, 1.7; BCT: mean = 1.6, 95% CI 1.2, 2.1), WIO, WI_D, VITA scale or CIELAB values were detected for the CT and BCT groups, comparing the results before and after brushing. Likewise, the participants' satisfaction with the treatment results (P = 0.31) and the participants' evaluation of tooth color (P = 0.71) did not differ significantly between groups.

CONCLUSION

After a single application, no significant improvement in tooth whiteness by the presence of blue covarine in a silica-based toothpaste was detected in color dimensions or by assessing the participants' satisfaction and perception.

CLINICAL SIGNIFICANCE

The present study does not show a clinically relevant increase in tooth whiteness after a single brushing with a blue covarine containing toothpaste, nor could the study participants observe a difference between treatment with blue covarine containing toothpaste and control treatment.

Colour thresholds of the gingival chromatic space

OBJECTIVE

To establish the thresholds of chromatic perception and clinical acceptability of gingival colour according to professional category and in accordance with the perceptibility/acceptability threshold of 50:50 (colour differences that can be perceived/accepted by 50 % of the observers).

METHODS

A total of 21 different coloured samples made of pink gingiva Heraceram porcelain were used. Dentists (n = 54), dental assistants (n = 56), dental students (n = 126) and participants unrelated to dentistry (n = 116) were asked to identify pairs of samples that appeared identical. In addition, they were asked to indicate the pairs of samples whose colour they considered to be acceptable for use in a dental rehabilitation. A least squares regression was adjusted using an S-shaped curve of the equation y = exp (B0 + B1/x). The adjusted model was used to predict a colour difference value for an acceptability percentage of 50 %.

RESULTS

The threshold value for the perception of colour changes in human gingiva varies from ΔEab* 2.3 ± 0.38 units and CIEDE2000 (ΔE00) 1.5 ± 0.28units (dental students) to ΔEab* 2.7 ± 0.43 units and ΔE00 1.8 ± 0.30 units (participants unrelated to dentistry). The threshold of gingival acceptability varies from ΔEab* 2.9 ± 0.43 units and ΔE00 2.0 ± 0.31 units (dental assistants) to ΔEab* 3.6 ± 0.54 units and ΔE00 2.5 ± 0.41 units (dental students).

CONCLUSION

From the total number of samples, the average threshold of perception for the gingival chromatic space is 3.1 units for ΔEab* and 2.1 units for ΔE00. Moreover, the mean gingival acceptance threshold is 4.1 units for ΔEab* and 2.9 units for ΔE00. These thresholds are similar for all professional categories studied.

CLINICAL SIGNIFICANCE

The determination of the perception and acceptability thresholds in the gingival chromatic space are of special relevance for designing the physical shade tabs used in gingival colour guides. The results from this work will aid in selecting optimal gingival colour for patients.

Effect of substrate and cement on the final color of zirconia-based all-ceramic crowns

OBJECTIVE

To evaluate the influence of the substrate and the cement on the final color of ceramic crowns.

METHODS

Prosthetic crowns (framework + porcelain) were fabricated using two all-ceramic systems (YZ, 3 mol% yttria-stabilized tetragonal zirconia; IZ, alumina-based zirconia-reinforced glass-infiltrated ceramic) and a metal-ceramic system (MC; n = 8). Metal (M) and resin (R) were used as substrate abutments. For R substrate, crowns were evaluated as seated (R) and after cementation (R-C). CIELAB color coordinates were obtained using a dental spectrophotometer with D65 light illumination. CIELAB, CIEDE2000 (1:1:1) and CIEDE2000 (2:1:1) color difference metrics were used. Data were analyzed using 95% confidence intervals and compared to perceptibility (PT) and acceptability (AT) thresholds.

RESULTS

The ∆ E ab * , ∆E₀₀ (1 : 1 : 1), and ∆E₀₀ (2 : 1 : 1) values of the restorative systems evaluated using different substrates (M.R) were similar to the AT values of each metric. When non-cemented and cemented crowns were evaluated (R.R-C), MC had color difference values at PT and below AT; while YZ and IZ showed similar values to AT, for ∆ E ab * and ∆E₀₀ (1 : 1 : 1) metrics.

CONCLUSION

The substrate and cement affected the final color of zirconia-based all-ceramic crowns, but the color differences corresponded to an acceptable match.

CLINICAL SIGNIFICANCE

As both substrate and cement influence the final color of multi-layered ceramic prosthesis, dentists and dental technicians should understand the optical properties of dental ceramics to reproduce the natural appearance of dental structures and maximize the chance for excellent color matches.

Influence of electronic nicotine delivery systems (ENDS) in comparison to conventional cigarette on color stability of dental restorative materials

Objective:

The use of Electronic Nicotine Delivery Systems (ENDS) is increasing rapidly. However, its discoloring effect on dental restorations is not known. This study aimed to evaluate the effect of ENDS aerosol when compared to conventional cigarette smoke (CS) on the color stability of dental ceramic (DC) and resin composite (RC).

Methods:

This research project was conducted from November 2018 to May 2019. In this study 30 discs each for DC and RC materials were fabricated to be equally divided into groups of exposure to CS, ENDS aerosol and storage in distilled water (No smoke; NS) respectively (n=10). Specimens were exposed for a total of 7 days, with a rate of 10 cycles per day, each cycle represented 10 puffs. The color change was assessed using the CIELAB color space, by calculating ΔE. Data was analysed using ANOVA and multiple comparisons test.

Results:

Ceramic specimens in CS (2.422 ± 0.771) and ENDS (2.396 ± 0.396) groups showed comparable ΔE (color change) (p=0.992). Similarly, composite specimens in CS (42.871 ± 2.442) and ENDS (46.866 ± 3.64) groups showed comparable ΔE (p>0.05). NS specimens in both composite and ceramic samples showed lower ΔE than CS and ENDS specimens respectively.

Conclusions:

Aerosol from Electronic nicotine delivery systems (ENDS) showed similar discoloration levels as cigarette smoking (CS). The level of discoloration for ceramic samples for both ENDS and CS was below clinically perceptible levels (Mean ΔE < 2.5). Discoloration of composite resin due to CS and ENDS was visually perceptible (Mean ΔE > 4.0).

Intra- and inter-brand color differences of denture teeth under different illuminations

Debonding, staining and wear are usually the reasons for denture teeth replacement by new ones from same or different brands.

Influence of abutment material on the shade of dental implant restorations in the esthetic zone: a single case report

High esthetic demand and expectation challenges the rehabilitation of the esthetic zone with dental implants. Most implant system manufacturers offer customized and prefabricated ceramic, specifically zirconia or alumina abutments, as an alternative to titanium or gold alloy abutments, with the aid of computer-aided designing/computer aided manufacturing (CAD/CAM) technology. A 45-year-old male patient was referred to the prosthodontics clinic for the restoration of maxillary central incisors with all ceramic dental implants. After healing, both implants were restored with all-ceramic crowns but different customized abutment materials for the purpose of comparison. The all-ceramic crown was cemented on a customized zirconia abutment at the implant site # 11 and on a customized gold alloy abutment at implant site # 21. The treating dentist as well as two prosthodontists performed a meticulous clinical examination to compare the ceramic crowns side by side and agreed that the outcome was esthetically satisfactory. The patient was satisfied with the esthetics and functional outcome of the final restorations, as was the prosthodontist.

Color agreement between try-in paste and resin cement: Effect of thickness and regions of ultra-translucent multilayered zirconia veneers

Background. The current study aimed at identifying the color agreement between try-in pastes and the respective resin cements and investigated the effect of thickness and regions of Ultra-Translucent Multilayered Zirconia Veneers.

Methods. A total of 90 cubic zirconia discs were prepared at two different thicknesses (0.5 mm and 0.7 mm) (n=45) in five groups in terms of the shade of the try-in paste and resin cement as follows: Universal, Clear, Brown, White and Opaque. Try-in paste and the respective resin cement were applied between the specimens and composite substrate, respectively, and colorimetric evaluation was carried out using CIE-Lab system. For each specimen, ΔE between the try-in paste and cement was calculated. Data were analyzed with SPSS 17 using Multifactor ANOVA (P<0.05).

Results. Multifactor ANOVA results showed that ΔE values were significantly affected by the resin cement shade and the thickness of ceramic veneer (P<0.05). The results showed better shade agreement between the try-in paste and the respective resin cement with thicker ceramic veneers. The results of Tukey HSD revealed that ΔE values for the Clear, Universal and Brown shades were less than those of the White and Opaque shades. Lighter shades exhibited better agreement between the try-in paste and the respective resin cement.

Conclusion. Perceptible color difference was found between the try-in pastes and the respective resin cement in most colors investigated. Although, the agreement of the try-in pastes and the respective resin cement was affected by the thickness of zirconia veneers, the different regions of multilayered ultra-translucent zirconia ceramic showed no significant effect.

Acceptability and perceptibility thresholds in dentistry: A comprehensive review of clinical and research applications

OBJECTIVE

The objective was to provide a literature review on perceptibility and acceptability thresholds in dentistry and corresponding recommendations.

OVERVIEW

A literature review on visual thresholds included findings on the judgments of the color and appearance of tooth-, gingiva- and skin-colored restorative dental materials. Discrepancies in study design contributed to inconsistencies in the research findings of some studies. These differences are related to (a) number of observers and inclusion criteria, (b) specimen number and size, (c) color measurement instrument and the setup and formulas used, (d) psychophysical experiment, (e) data processing (fitting method), and (f) % perceptibility or % acceptability values. A straightforward, consistent and practical model for the clinical and research application and interpretation of visual thresholds and recommended protocols for threshold research were provided.

CONCLUSIONS

Visual thresholds are of paramount importance as a quality control tool and guide the evaluation and selection of dental materials and their clinical performance. Although clinical shade matching conditions and method are rarely controlled, research on visual thresholds, especially when aiming to set standards for the profession, must be carefully planned and executed.

CLINICAL SIGNIFICANCE

Perceptibility and acceptability thresholds define visual match or mismatch of color, translucency, and whiteness in dentistry. Clinical and research findings cannot be fully interpreted in terms of real-life relevance without comparison with perceptibility and acceptability tolerances.

The influence of different shades and brands of resin-based luting agents on the final color of leucite-reinforced veneering ceramic

Objectives

This study aimed to evaluate the influence of different shades and brands of resin-based luting agents on the final color of a leucite-reinforced veneering ceramic.

Methods

This in-vitro study was done on 36 ceramic discs (IPS Empress I, 11 × 0.5 mm, A2 shade) and 36 cement disks (11 × 0.2 mm) made of Panavia SA Cement Plus (Kuraray Medical Inc.) and Choice2 (Bisco Inc., Schumburg) brands in translucent, universal A2, and opaque shades (n = 6 per each color in each resin cement brand). Color parameters (CIEL^*a^*b^*) of ceramic specimens were calculated without and with each brand/shade of resin-based luting agents by using a spectrophotometer, and put into CIELab formula. The color differences (ΔE) between the two sets of measurements were calculated and analyzed with two-way ANOVA and Tukey’s post hoc test (α = 0.05).

Results

Both the resin-based luting agent shade (P < 0.001) and brand (P = 0.023) significantly affected the color differences. ΔE values were significantly different between Panavia-opaque and Choice2-opaque (P < 0.001). No significant difference existed between ΔE of the two brands in A2 (P = 0.178) and translucent shades (P = 0.079). The ΔE values of Panavia-A2 was significantly different from the translucent and opaque shades of the same brand. Moreover, the ΔE of Choice2-translucent shade was significantly lower than that of A2 and opaque shades. The ΔE values were higher than the clinically-acceptable threshold in all groups (ΔE > 3.7) except for Choice2-translucent (ΔE = 3.37).

Conclusions

The final color of leucite-reinforced veneering ceramic can be affected by the same shades of resin-based luting agents from different brands and different shades of resin-based luting agents from the same brand.

In vitro evaluation of color and translucency reproduction of maxillofacial prostheses using a computerized system

PURPOSE

Accurate color matching of maxillofacial prostheses to skin is important for esthetics. A computerized color matching system specific to human skin has recently been developed. The purpose of this study was to evaluate the accuracy in color and translucency matching of the computerized color matching system across different skin colors.

MATERIALS AND METHODS

The silicone was colored to simulate 28 different skin colors (n=5) to serve as “target skin colors”. Using a spectrocolorometer (e-skin), color codes were determined for “replicate skin color” fabrication. CIELAB Delta-E between target skin color-replicate skin color pairs and translucency parameter were calculated. CIELAB Delta-E values were compared with one-way ANOVA and Tukey multiple-comparison. The agreement between L*, a*, b* and translucency parameter of target skin colors and replicate skin color were calculated by a two-way mixed average measures intraclass correlation coefficient. Translucency parameter of target skin color-replicate skin color pairs were compared with Paired t-test (α=.05).

RESULTS

The mean CIELAB Delta-E value was 3.83 and significant differences were found among colors. The intraclass correlation coefficient showed excellent reliability for L*, a*, b* and good reliability for translucency parameter (P<.001). The mean translucency parameter of replicate skin colors was significantly higher than that of translucency parameter.

CONCLUSION

The computerized color matching system specific to human skin was found to be reliable in terms of color and translucency between target skin colors and replicate skin color.

Effects of staining and polishing on different types of enamel surface sealants

OBJECTIVE

To assess surface discoloration of four enamel sealants based on different chemical compositions after exposure to artificial aging and staining solutions. Furthermore, their cleanability after polishing will be evaluated.

MATERIALS AND METHODS

Selected sealants were a composite resin-based sealant with fillers (Pro Seal), a composite resin-based sealant without fillers (Light BondSealant), a resin-modified glass ionomer-based sealant (ClinproXT Varnish) and a silicon-based sealant (Protecto). Natural teeth served as medium. Immersion solutions were water, juice, tea, and turmeric. In a standardized setting, all samples were measured seven times with a spectroradiometer (Photoresearch PR670) at baseline, after thermocycling; 7 days; 2 and 4 weeks of immersion; and after finally polishing.

RESULTS

Thermocycling had no significant effect on color stability. After exposure to staining solutions, all sealed surfaces showed significant color changes. Color change predominately occurred for all sealants in the first week of staining (P ≤ .01). Best resistance to staining decreased as follows: Protecto > Light Bond Sealant > ProSeal > Clinpro XT Varnish. Surface cleaning by polishing significantly reduced the color change.

CONCLUSION

Sealed enamel surfaces are prone to discoloration, which is most prominent in filled composite and glass-ionomer-based sealants. Staining can be reduced by polishing; however, in this in vitro setting the original color could not be restored.

CLINICAL SIGNIFICANCE

Enamel sealants might exert adverse effects in terms of discoloration. This should be taken into consideration by clinicians and patients, particularly when sealants are applied in esthetically critical areas.

Effect of surface finishing on the colour stability and translucency of dental ceramics

BACKGROUND

The purpose of this study was to investigate the effects of staining solutions and surface finishing on the colour stability and translucency of hybrid ceramic (HC) and resin nanoceramic (RNC) materials.

METHODS

Twenty four groups consisting of 10 specimens (240 specimens in total) were created out of HC and RNC, including six groups to be stored in distilled water served as the controls groups. The Vita Enamic technical set, Shofu polishers, medium and fine rubber wheels and Sof-Lex polishing discs were used as polishing instruments. Cola, tea, and coffee were used as staining solutions. The colour differences (∆E*) and translucency parameter (TP) were evaluated by a spectrophotometer. Data were analysed by a One-way Analysis of Variance (ANOVA) and Mann-Whitney U test.

RESULTS

There was a statistically significant difference between the ∆E* values of the HC specimens in the coffee groups and the ∆E* values of the other HC groups (p < 0.05). The ∆E* values of the RNC specimens in the coffee and tea groups were not different from the specimens in the cola groups (p > 0.05). The TP values of the polished groups were higher than the Sof-Lex groups and the Shofu groups on both HC and RNC materials (p < 0.05).

CONCLUSIONS

Increased ∆E* values were observed in HC specimens stored in a coffee solution compared to the specimens stored in a tea or cola solution. Both of the RNC specimens stored in coffee and tea had higher ∆E* values than the RNC specimens stored in the cola. The TP values of both HC and RNC specimens stored in the coffee solution decreased.

Dentinal tubule sealing effects of 532-nm diode-pumped solid-state laser, gallic acid/Fe3+ complex, and three commercial dentin desensitizers

The purpose of this study was to compare dentinal tubule sealing effects of a 532-nm diode-pumped solid-state (DPSS) laser, gallic acid/Fe³⁺ complex, and three commercially available dentin desensitizers. Human premolars (n = 44) extracted for orthodontics had standardized cervical cavities prepared, etched (37% phosphoric acid) and randomly assigned to either a control (n = 4), or one of five treatment groups (n = 8/group). Desensitizing treatments were either a 532-nm DPSS laser, gallic acid/Fe³⁺ complex, oxalate-based Super Seal™ (SS), DIO™ Enamel Coating Pen Pro Tooth (Dio), or adhesive-type Hybrid Coat™ (HC). Dentinal fluid flow (DFF) was monitored continuously in real time during the application of each desensitizing agent, by using a nanoliter-scaled fluid flow-measuring device. Following treatment, morphological changes on dentinal surfaces and within tubules were observed by scanning electron microscopy (SEM). DFF rates were significantly reduced after treatment in all experimental groups (P < 0.05), except SS (P > 0.05). The gallic acid/Fe³⁺ complex reduced DFF rates the most, and significantly (P < 0.05) more than the three commercial dentin desensitizers. There were no significant differences in DFF reduction rates between the gallic acid/Fe³⁺ complex and the DPSS laser groups (P > 0.05). There were no significant differences in DFF reduction rates among the three commercial dentin desensitizers (P > 0.05). SEM examination of treated dentin showed that the degree of occlusion of dentinal tubules correlated closely with the corresponding reduction in DFF rates. The gallic acid/Fe³⁺ complex and 532-nm DPSS laser were superior to other desensitizing methods in occluding dentinal tubules and reducing DFF rates.

Alignment efficiency and esthetic performance of 4 coated nickel-titanium archwires in orthodontic patients over 8 weeks: A multicenter randomized clinical trial

INTRODUCTION

The objective of this 4-arm parallel study was to evaluate the alignment efficiency and esthetic performance of 4 coated nickel-titanium archwires over an 8-week period.

METHODS

Patients in the permanent dentition requiring maxillary and mandibular fixed orthodontic treatment with a preadjusted edgewise appliance were eligible for inclusion. Patients attending 4 hospital departments (United Kingdom and Italy) were randomly allocated to 1 of 4 treatment interventions: (1) BioCosmetic (Forestadent, Pforzheim, Germany), 0.017 in; (2) Titanol (Forestadent), 0.016 in; (3) TP Aesthetic (TP Orthodontics, La Porte, Ind), 0.014 in; and (4) Tooth Tone (Ortho Organizers, Calsbad, Calif) 0.016 in. Block randomization with block sizes of 4 and 8 was used to ensure an allocation ratio of 1:1:1:1. The primary outcome was alignment efficiency determined by the reduction in Little's irregularity index (mm). Secondary outcomes were color change using the Commission Internationale de L'Eclairage L*a*b* system and percentage of coating loss. Blinding was only applicable to outcome assessment of alignment efficiency. Regression models with Sidak's multiple comparison of means were used to analyze the data.

RESULTS

One hundred fifty patients (300 dental arches) were allocated to the treatment interventions, including 61 male and 89 female subjects with a mean age of 16.60 years. The average duration of follow-up was 63.65 days. Baseline characteristics for the archwire groups were similar. One patient was lost to follow-up. Five percent (n = 15) of the archwires fractured: BioCosmetic, 5.3% (n = 4); Titanol, 6.8% (n = 5); TP Aesthetic, 5.3% (n = 4); and Tooth Tone, 2.7% (n = 2). We analyzed 283 dental arches for alignment efficiency. There was no statistically significant difference for mean reduction in irregularity between the archwire groups (P = 0.627): BioCosmetic (n = 71), 3.86 mm (95% CI, 3.31-4.41); Titanol (n = 69), 4.51 mm (95% CI, 4.00-5.02); TP Aesthetic (n = 71), 4.13 mm (95% CI, 3.49-4.78); and Tooth Tone (n = 72), 4.21 mm (95% CI, 3.89-4.46). There was a statistically significant difference between archwire groups for color change (P = 0.001) and percentage of coating loss (P = 0.001), with BioCosmetic performing best in both parameters.

CONCLUSIONS

There was no difference between the archwires for alignment efficiency. BioCosmetic performed statistically significantly better than did the other groups for both color change and coating loss.

REGISTRATION

This trial was registered with the East Midlands NHS Research Ethics Committee (12/EM/0190).

PROTOCOL

The protocol was not published before trial commencement.

Effect of mouthrinses on color stability of monolithic zirconia and feldspathic ceramic: an in vitro study

BACKGROUND

Patients susceptible to periodontal disease and dental caries, including those who undergo fixed prosthodontic treatments use chemical plaque control agents. However, these mouthrinses may result in adverse effects such as discoloration of the restorative materials. The aim of this study was to compare the color stability of monolithic zirconia and feldspathic porcelain after immersion in two different mouthrinses: 0.2% Chlorhexidine digluconate (CHX), or Listerine®. Color change was evaluated by color spectrophotometer and according to the Commission Internationale de l'Eclairage (CIELab) system.

METHODS

We prepared 72 disc-shaped porcelains (n = 36) as follows: Group A consisted of dental direkt cube X2 discs (49% translucency) as the monolithic zirconia and group B consisted of VITA VMK 95 as a feldspathic porcelain. Groups A and B were divided into three subgroups (n = 12 per group). Each subgroup was immersed in one of the following three solutions: distilled water (control), CHX, or Listerine® for 2 min, once per day. We recorded the samples' baseline color values according to the CIELab system by using a color spectrophotometer operated by an experienced operator. Color measurements were subsequently obtained following 7 days of immersion, and after the samples were rinsed with distilled water and allowed to dry. We measured CIE L*, a*, and b*and calculated the color difference (ΔE*ab). All data were analyzed by the Mann-Whitney and Kruskal-Wallis tests.

RESULTS

Color changes occurred in the experimental groups. The ΔE*ab values were significantly greater in VMK 95 porcelain compared to cube X2 (both p < 0.001) following immersion in CHX and Listerine® mouthrinses. However no significant difference was founded when distilled water was used (p = 0.630). For the two materials, the ΔE values were highest in CHX, followed by the Listerine® and distilled water.

CONCLUSION

Both monolithic zirconia and feldspathic porcelain were susceptible to color changes following immersion in CHX and Listerine® mouthrinses.

Effect of brushing and thermocycling on the shade and surface roughness of CAD-CAM ceramic restorations

STATEMENT OF PROBLEM

The effects of toothbrushing (B) and thermocycling (TC) on the surface texture of different materials with various fabrication processes have been investigated. However, studies of computer-aided design and computer-aided manufacturing (CAD-CAM) ceramic restorations are limited.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of B and TC on the color stability and surface roughness of extrinsically characterized and glazed CAD-CAM ceramic restorations.

MATERIAL AND METHODS

Lithium disilicate CAD ceramic (n=90) and zirconia ceramic (n=90) were studied. All specimens were crystallized/sintered, characterized, and glazed following the manufacturer's recommendation. The specimens were divided into 9 different groups: B, TC, and a combination of B plus TC (B+TC). Brushing was performed at 50 000, 100 000, and 150 000 cycles, simulating an oral environment of 5, 10, and 15 years. Thermocycling was performed at 6000, 12 000, and 18 000 cycles, simulating an oral environment of 5, 10, and 15 years. Brushing plus TC was performed with the combination of the 50 000 cycles of B, then 6000 cycles of TC, and 10 000 cycles of B, then 12 000 cycles of TC, and 15 000 cycles of B, then 18 000 cycles of TC. The color and surface roughness of each specimen were measured before and after all interventions with simulated cycles. Color differences (ΔE) and surface roughness (ΔR_a) data were analyzed using 2-way ANOVA, followed by the least significant difference test (α=.05). The correlation between ΔE and ΔR_a was statistically analyzed using the Pearson correlation analysis.

RESULTS

Within the lithium disilicate CAD groups, intervention did not result in any significant differences in color change (P>.05). Within the zirconia groups, a 15-year clinical simulation revealed significantly higher ΔE values than a simulated 5-year exposure (P=.017). Increased simulated cycles showed significantly higher R_a values for all groups. Within the zirconia groups, B revealed significantly smoother surfaces than TC (P<.001) and B+TC interventions (P<.001). For the zirconia, simulating B+TC for15 years revealed significantly higher R_a values than the groups of B+TC for 5 years (P<.001) and B+TC for 10 years (P=.003). No correlation (lithium disilicate CAD, r=.079; P=.462; zirconia, r=.001; P=.989) was found between the color change and surface roughness.

CONCLUSIONS

For both lithium disilicate CAD and zirconia, color changes were below the selected clinical perceptible threshold (ΔE=2.6) after all intervention and simulated cycles. All mean surface roughness measurements were below 0.2 μm. Generally, the surface of both lithium disilicate CAD and zirconia became rougher. No correlation was found between color difference and surface roughness for either material.

Comparison between Color Spaces of Vita Lumin Shade Guide with Natural Teeth in Bengaluru Population using Spectrocolorimeter: An in vivo Study

AIM

The aim of this study is to compare the color space of Vita Lumin shade guide (SG) with the natural teeth of the local population.

MATERIALS AND METHODS

A total of 100 maxillary central incisors (100 patients) were subjected to color measurement with a spectrocolorimeter. For each tooth, L*, a*, b* values were recorded. All the shade tabs of Vita Lumin SG were analyzed with a spectrocolorimeter to define the color space covered by the Vita Lumin SG. The L*a*b* values of natural teeth were plotted on separate scattered diagrams and compared.

RESULTS

About two out of three attributes (luminance and blue spectrum) of the local population of Bengaluru displayed a broader range than those available in Vita Lumin SG.

CONCLUSION

The local population requires an SG with an extended range, covering a higher luminance spectrum and broader blue spectrum.

CLINICAL SIGNIFICANCE

Esthetic restorations require accurate shade matching with the adjacent natural teeth, SGs being the mean of shade selection and communication should be comparable to the natural teeth.

Aesthetically improved and efficient tannin–metal chelates for the treatment of dentinal hypersensitivity

Tannin–metal chelates for the efficient nucleation of hydroxyapatite and an aesthetically improved solution for the dentinal hypersensitivity treatment.

Effect of cement type on the color attributes of a zirconia ceramic

PURPOSE

This in vitro study evaluated the effects of four different cements on the color attributes of a zirconia ceramic.

MATERIALS AND METHODS

40 zirconia ceramic disk specimens (0.5 mm thickness, 10 mm diameter, 0.1 mm cement space) were fabricated by a computer-aided design and computer-aided manufacturing system. The specimens were divided into 4 groups of 10 specimens and cemented to composite substrates using four different cements including: Glass Ionomer, Panavia F2.0, Zinc Phosphate, and TempBond. The L^*, a^*, and b^* color attributes of the specimens were measured before and after cementation by a spectrophotometer. Additionally, ΔE values were measured to determine color changes for the groups and then compared with the perceptional threshold of ΔE = 3.3. Repeated Measures ANOVA, Tukey Post Hoc, Bonferroni, One-way ANOVA, and One-sample t-test tests were used to analyze the data. All tests were carried out at the 0.05 level of significance.

RESULTS

Statistically significant differences were detected in the ΔE values for Zinc Phosphate (P<.0001) and TempBond (P<.0001) groups. However, there were no statistically significant differences in this respect for Glass Ionomer (P=.99) and Panavia F2.0 (P=1) groups. The means and standard deviations of the ΔE values for Glass Ionomer, Panavia F2.0, Zinc Phosphate, and Tempbond groups were 2.11±0.66, 0.94±0.39, 5.77±0.83, and 7.50±1.16 Unit, respectively.

CONCLUSION

Within the limitations of this study, it was concluded that Zinc Phosphate and Tempbond cements affected the color attributes of the tested zirconia ceramic beyond the perceptional threshold. However, Glass Ionomer and Panavia F2.0 cements created acceptable color changes.

Influence of the color of composite resin foundation and luting cement on the final color of lithium disilicate ceramic systems

STATEMENT OF PROBLEM

Lithium disilicate restorations are commonly used, particularly in the anterior region. The color of the underlying composite resin foundation (CRF) and luting cement may negatively affect the color of lithium disilicate ceramic restorations.

PURPOSE

The purpose of this in vitro study was to investigate the effect of CRF and resin cement materials on the color of lithium disilicate ceramics in 2 different translucencies.

MATERIAL AND METHODS

Twenty disks (11×1.5 mm, shade A2) were fabricated from medium-opacity (mo) (n=10) and high-translucency (ht) (n=10) lithium disilicate (Lds) blocks (IPS e.max Press). Five CRF disks (11×3 mm) were fabricated in 5 different shades (A1, A2, A3, B2, C2) and 30 resin cement disks (11×0.2 mm) in the shades of translucent (Tr), universal (Un=A2), and white-opaque (Wo). Ceramic specimens were placed on each CRF, and the resin cement combination and color was measured with a spectrophotometer. CIELAB color coordinates were recorded, and the color coordinates of both ceramics on the shades of the A2 CRF and resin cement were saved as the control. Color differences (ΔE₀₀) between the control and test groups were calculated. Data were analyzed with 3-way analysis ANOVA and compared with the Tukey HSD test (α=.05).

RESULTS

The ΔE₀₀ values were influenced by the shades of the CRF, resin cement materials, and also their interactions (P<.05). The ΔE₀₀ values were not affected by the ceramic type. The ΔE₀₀ values of the Wo cement groups (1.73 to 2.96) were significantly higher than those of the other cement shades (0.88 to 1.29) for each ceramic type and CRF shade (P<.05).

CONCLUSIONS

Lithium disilicate ceramics in 2 different translucencies were similarly influenced by the color of the underlying cement and CRF. When translucent and universal cement shades were used, the core shade did not affect the final color of the ceramics. White opaque cement caused clinically unacceptable color changes in both ceramics on all shades of CRFs except the C2 CRF and when high translucency ceramic was used on the A2 CRF. These changes were clinically acceptable, but perceptible.

A Preliminary Research into Clinical Semi-permeability Tolerance in the Field of Dental Rehabilitation

Objective

To study clinical semi-permeability tolerance level in the field of dental restoration.

Method

Vita 95 enamel porcelain powder was adopted and 6.0% used as the control transmissivity. Discoid porcelain plates with different transmissivity, namely increasing transmissivity (0.25%, 0.5%, 1.0%, 1.5%, 2%, 2.5%, 3%, 3.5%, 4% and 4.5%) and decreasing transmissivity (-0.25%, -0.5%, -1.0%, -1.5%, -2%, -2.5%, -3% and -3.5%) were made. Forty observers judged these according to six grades: same, similar, slightly different, visibly different, recognizable and significantly different, and under the observation conditions of a neutral grey background and 45^°/0^° lighting. The judgment results were analysed statistically.

Results

When the transmissivity of the control porcelain plates was 6.032%, and the transmissivity of test porcelain plates decreased by 1% or increased by 3%, observers could find slight differences between the test samples and the control samples. When transmissivity of test samples decreased by 2.5% or increased by 4.5%, observers thought that the two porcelain plates belonged to different orders of magnitude.

Conclusions

Under the experimental conditions, the upper and lower limits of clinical semi-permeability tolerance were 3% and 1%, respectively.

A novel regression model from RGB image data to spectroradiometric correlates optimized for tooth colored shades

OBJECTIVES

Objectives of this study were to correlate RGB data from the VITA Linearguide 3D Master and VITA Bleached Guide 3D Master shade guides with their spectroradiometric correlates through a regression model while indicating a methodology for validation of accuracy of digital imaging systems. Additional objectives were to provide summary RGB data and to determine a relationship between lightness and RGB values for these shade guides.

METHODS

Radiant energy measurements and images were taken with a Canon Rebel T3i and Macro Ring Lite MR-14EX for each shade tab. RGB data was extracted using Image J and compared with spectroradiometric measurements. Regression models relating the RGB data to spectroradiometric counterparts in CIE XYZ and absolute reflectance were developed using SAS 9.3. Image data was statistically analyzed to determine a relationship between RGB values and lightness.

RESULTS

Regression models with R(2) values greater than 0.99 for RGB to XYZ and greater than 0.95 for RGB to absolute reflectance were developed. Summary RGB data for the shade guides including Pearson correlation coefficients ranging between -0.92 and -0.97 for RGB related to lightness was determined.

CONCLUSIONS

A relationship between RGB and lightness for the shade guides was found. Regression models were developed that allow tooth color information to be translated from digital images to accurate shade tab correlates for color matching purposes in dentistry. This allows for optimal color accuracy when using digital imaging to translate color information and provides a method of validating digital imaging systems for color accuracy.