Two‐year retrospective evaluation of monoshade universal composites in direct veneer and diastema closure restorations

The color-matching ability of single-shade universal composites in extracted human teeth

OBJECTIVES

To evaluate the color-match with extracted natural teeth of three single-shade universal composites, a group-shade universal composite, and a highly translucent-shade conventional composite.

METHODS

Twenty extracted human teeth were divided into light- and dark-shade groups (n = 10, LSG and DSG). A preparation was restored with the 3 single-shade universal composites, OMNICHROMA (OMC), Admira Fusion x-tra U (AFU), and Essentia U (ESU); a highly translucent-shade conventional composite, Tetric EvoCeram T (TEC-T); and two shades of a group-shade universal composite-Filtek Universal Restorative (FUR A1 and A4). Composites were photopolymerized, polished, and stored in water for 24 h. The ΔE00 value between the unprepared and restored surfaces was obtained using a spectrophotometer. Composite placement and measurements were repeated three times per tooth. Color differences were statistically analyzed with the within-between-subjects t-test and repeated-measures analysis of variance (ANOVA), followed by post hoc pairwise comparisons with a Bonferroni adjustment (α = 0.05).

RESULTS

There were no statistically significant differences between OMC and FUR (A1 and A4). AFU and ESU showed significantly higher ΔE00 values than OMC and TEC-T (p < 0.05). Single-shade composites exhibited significantly higher ΔE00 values in the DSG than in the LSG except ESU (p < 0.05). None of the composites satisfied the criteria for an acceptable match (ΔE00 >1.8).

CONCLUSION

OMC showed the same color matching ability as a group-shade universal composite. A highly translucent-shade conventional composite and OMC exhibited better color matching ability than other single-shade composites. Overall, single-shade universal composites performed better in lighter-shaded teeth.

CLINICAL SIGNIFICANCE

Single-shade universal composites have the potential to reduce chair time by eliminating shade selection in cavities with lighter-shade teeth. Highly translucent incisal conventional composites also may be used if the appropriate shade of composite is not available.

Color Stability of Single-Shade Resin Composites in Direct Restorations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The objective was to compare the color match and color stability behavior of single- and multi-shade resin-based composites (RBCs) used for direct restorations. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized clinical trials evaluating the shade performance of single-shade RBCs in direct restorations were included. A search of the scientific literature was performed in five databases (April 2024). The meta-analysis was performed using RevMan 5.4, calculating the risk difference (RD) and 95% confidence interval (CI) of the dichotomous outcome using a random effects model. Bias was assessed using the RoB 2.0 tool, and certainty of evidence was assessed using the GRADEpro tool. Four studies were selected, with 263 restorations analyzed. The results showed comparable performance between single-shade RBCs and multi-shade RBCs in terms of color match and color stability over 12 months. Three studies had a low risk of bias with all expected results, and one study had some concerns. The certainty of evidence for color stability was considered low for all follow-up periods due to the small number of events and sample size. According to the United States Public Health Service Evaluation (USPHS) and the World Dental Federation (FDI), there is comparable clinical color performance between single-shade and multi-shade RBCs over 12 months.

Surrounding and background shades effect on color adjustment of single-shade composites

This study evaluated the effects of surrounding and background shades on the color adjustment potential (CAP) and visual color match of two single-shade composites, Vittra APS Unique and Charisma Diamond One. Cylinder-shaped specimens were constructed, consisting of either single-shade composites alone (simple) or composites surrounded by the Forma material at shades A1 or A3 (dual). Simple specimens using only the Forma at the specified shades were also prepared. Color measurements of simple specimens were taken against a gray background using a spectrophotometer. For dual specimens, the color of the inner composite was measured against a gray or chromatic (the same shade as the outer composite) background. Color differences (ΔE00) between the single-shade composites and the A1/A3 composite were calculated. CAP was determined by comparing data from simple and dual specimens. Four experienced dentists scored the color match (perfect to unacceptable) for each specimen using a viewing booth illuminated by an illuminant D65. Data were analyzed with repeated-measures ANOVA and the Kruskal-Wallis test. The results showed that both single-shade composites showed the lowest color discrepancies when they were compared to A1 and A3. Using a chromatic background only significantly affected the CAP when the outer composite was A3. The visual analysis showed poor color matches between the single-shade and control chromatic composites, except for Charisma Diamond One surrounded by A1. In conclusion, the CAP values of the evaluated single-shade composites were impacted by both surrounding shade and background color, and the color match of these materials tended to be poor.

Effect of aging and fiber-reinforcement on color stability, translucency, and microhardness of single-shade resin composites versus multi-shade resin composite

OBJECTIVE

The purpose of this study was to evaluate the effect of aging and fiber-reinforcement on the color stability, translucency, and microhardness of single-shade resin composites versus multi-shade resin composite.

MATERIALS AND METHODS

Four resin composites (Filtek Z250, Omnichroma, Vittra APS Unique, Zenchroma) were tested. Three subgroups of specimens were prepared for each of the composites: control, polyethylene fiber-reinforcement, and glass fiber-reinforcement- groups (n = 10/per group). The samples were subjected to aging for 10,000 thermal cycles. Color differences (ΔE00 ) were calculated after aging. Relative translucency parameter (RTP00 ) and microhardness values were calculated before and after aging. A two-way analysis of variance and the generalized linear model was used (p < 0.05).

RESULTS

The lowest and highest ΔE00 values were found for Filtek Z250 (0.6 ± 0.2) and Omnichroma resin composites (1.6 ± 0.4), respectively. The ΔE00 value of the polyethylene fiber-reinforcement group (1.2 ± 0.6) was significantly higher than the ΔE00 value of the glass fiber-reinforcement group (1.0 ± 0.4, p < 0.001). The RTP00 value of the glass fiber-reinforcement group (1.92 ± 0.78) was significantly higher than the RTP00 value of the polyethylene fiber-reinforcement group (1.72 ± 0.77, p < 0.001). The highest microhardness values were found in glass fiber-reinforcement group (76.48 ± 17.07, p < 0.001).

CONCLUSION

Single-shade resin composites were more translucent, had higher color change, and lower hardness than multi-shade resin composite. For relative translucency and microhardness, statistical significance was found in the material and fiber type interaction. The glass fiber-reinforcement provided higher translucency, lower color change and higher microhardness values than polyethylene fiber-reinforcement group after aging. Thermocycling had a significant impact on the color stability, translucency parameter, and microhardness of the tested resin composite materials.

CLINICAL SIGNIFICANCE

Single-shade resin composite materials have greater color-changing potential. The glass fiber-reinforcement optimize resin material mechanical properties and color stability more than polyethylene fiber-reinforcement.

Color discrepancy of single-shade composites at different distances from the interface measured using cell phone images

Objectives

This study aimed to evaluate the impact of substrate color and interface distance on the color adjustment of 2 single-shade composites, Vittra APS Unique and Charisma Diamond One.

Materials and Methods

Dual disc-shaped specimens were created using Vittra APS Unique or Charisma Diamond One as the center composite, surrounded by shaded composites (A1 or A3). Color measurements were taken with a spectrophotometer against a gray background, recording the color coordinates in the CIELAB color space. Illumination with a light-correcting device and image acquisition using a polarizing filter-equipped cell phone were performed on specimens over the same background. Image processing software was used to measure the color coordinates in the center and periphery of the inner composite and in the outer composite. The color data were then converted to CIELAB coordinates and adjusted using data from the spectrophotometer. Color differences (ΔE00) between the center/periphery of single-shade and outer composites were calculated, along with color changes in single-shade composites caused by different outer composites. Color differences for the inner composites surrounded by A1 and A3 were also calculated. Data were analyzed using repeated-measures analysis of variance (α = 0.05).

Results

The results showed that color discrepancies were lowest near the interface and when the outer composite was whiter (A1). Additionally, Charisma Diamond One exhibited better color adjustment ability than Vittra APS Unique.

Conclusions

Color discrepancies between the investigated single-shade composites diminished towards the interface with the surrounding composite, particularly when the latter exhibited a lighter shade.

Color Match of a Universal-shade Composite Resin for Restoration of Non-carious Cervical Lesions: An Equivalence Randomized Clinical Trial

PURPOSE

The objective of this double-blind, split-mouth, randomized clinical trial was to evaluate the color match of a single-shade composite resin Admira Fusion X-tra in comparison with a multi-shade composite resin Admira Fusion in non-carious cervical lesion restorations (NCCLs).

METHODS AND MATERIALS

One hundred and twenty restorations were performed on NCCLs with two restorative materials (n=60). After prophylaxis, the teeth were isolated with a rubber dam, and one universal adhesive was applied in the selective enamel etching strategy. For both groups, the restorations were inserted incrementally and light-cured. The values of the coordinates L*, a*, and b* in the cervical third before vs after the restorations and cervical vs middle third after the restorations were evaluated using a digital spectrophotometer after the coordinate values were used to calculate the CIEDE (ΔE00). The restorations were evaluated at baseline and after 7 days of clinical performance according to the FDI criteria. Statistical analysis was performed using the Chi-square test for all parameters. Color change was analyzed by Student t-test for paired samples (α=0.05).

RESULTS

All restorations were evaluated after 7 days. Regarding the color measurement, no significant difference was observed when Admira Fusion was compared to Admira Fusion X-tra for any of the comparisons performed (p>0.05). However, the values of ΔE00 in the cervical third before vs after the restorations were higher when compared with ΔE00 observed when the cervical vs middle third after restorations were compared. All restorations received the score "clinically very good" after 7 days for all outcomes, including the subjective color match, when evaluated for FDI criterion.

CONCLUSIONS

The single-shade composite resin used achieves the same color match when compared to a multi-shade composite resin after 7 days in NCCLs.

The role of interface distance and underlying substrate on the color adjustment potential of single-shade composites

OBJECTIVE

This study assessed how the distance from the composite interface and the underlying chromatic substrate affect the color adjustment potential (CAP) of two single-shade composites.

MATERIALS AND METHODS

Cylinder-shaped specimens were created using Vittra APS Unique (VU), Charisma Diamond One (DO), and a shaded (A3) composite. Some single-shade specimens were surrounded by the A3 composite, forming dual specimens. Color measurements of simple specimens were taken against a gray background using a spectrophotometer. All specimens were positioned at a 45° angle in a viewing booth under illuminant D65, and images were captured with a DSLR camera against gray or A3 backgrounds. Image colors were measured using image processing software and converted to CIELAB coordinates. Color differences (ΔE00 ) between the single-shade composites and the A3 composite were calculated. CAP was determined by comparing data from simple and dual specimens.

RESULTS

No clinically significant differences were observed between color measurements obtained from images and the spectrophotometer. CAP was higher for DO compared to VU and increased as the distance from the composite interface decreased and when specimens were positioned against an A3 background.

CONCLUSION

The color adjustment potential increased with decreased distance from the composite interface and against a chromatic background.

CLINICAL SIGNIFICANCE

Achieving satisfactory color match in restorations using single-shade composites is crucial, and selecting an appropriate underlying substrate is essential. The color adjustment gradually decreases from the restoration margins towards its center.

Accelerated versus Slow In Vitro Aging Methods and Their Impact on Universal Chromatic, Urethane-Based Composites

Structural coloring of dental resin-based composites (RBC) is used to create universal chromatic materials designed to meet any aesthetic need, replacing the mixing and matching of multiple shades. The microstructural adjustments to create this desideratum involve nanoscale organic-inorganic core-shell structures with a particular arrangement. The generally higher polymer content associated with these structures compared to universal chromatic RBCs colored by pigments, which in their microstructure come close to regularly shaded RBCs, can influence the way the material ages. Accelerated and slow aging up to 1.2 years of immersion in artificial saliva at 37 °C were therefore compared in relation to their effects on the materials described above and in relation to the immersion conditions prescribed by standards. Quasi-static and viscoelastic parameters were assessed to quantify these effects by a depth-sensing indentation test equipped with a DMA module. The microstructure of the materials was characterized by scanning electron microscopy. The results convincingly show a differentiated influence of the aging protocol on the measured properties, which was more sensitively reflected in the viscoelastic behavior. Accelerated aging, previously associated with the clinical behavior of RBCs, shows a 2- to 10-fold greater effect compared to slow aging in artificial saliva of up to 1.2 years, highly dependent on the microstructure of the material.