Color stability of resin-based composites exposed to smoke. A systematic review

Effects of different beverages on the color stability and fluorescence of resin composites: in situ study

OBJECTIVE

To evaluate the color change (ΔE) and fluorescence (FL) of resin composites after the consumption of beverages.

MATERIALS AND METHODS

One hundred and sixty disc-shaped specimens (6 × 2 mm) of Filtek Z350 XT (FZX) and Forma (FOR) resin composites were randomized for use in devices by five volunteers who ingested 100 ml daily of red wine (RW), beer (BE), energy drink (ED) and water (WT) over 15 days. The data were collected from digital photographs and analyzed using the CIE-Lab and RGB scales to obtain ΔE and FL and statistics via two-way ANOVA (for ΔE) and ANOVA for repeated measures (for FL), α = 0.05.

RESULTS

The highest ΔE values were obtained for FZX and FOR in the RW (ΔE = 10.5 for FZX and ΔE = 9.90 for FOR) and BE (ΔE = 6.3 for FZX and ΔE = 6.1 for FOR) drinks. For FL, there were different levels of change between the composites, with a much more significant reduction in FL intensity with RW.

CONCLUSION

Beverages have the potential to stain the composites evaluated, especially alcoholic beverages.

CLINICAL SIGNIFICANCE

Before carrying out an esthetic treatment with resin composites, it is ideal to investigate the types of drinks consumed by patients, for greater predictability of treatment.

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.

The color stability of artificial white spot lesions treated with resin infiltration after exposure to staining beverages

BACKGROUND

To evaluate the effect of staining beverages on the color-changing of resin-infiltrated artificial white spot lesions (WSLs).

METHODS

Thirty-five artificial WSLs were created by pH cycling on flat bovine teeth specimens. The WSLs were treated with resin infiltration and were divided into five groups based on staining beverages: artificial saliva, coffee, wine, green tea, and Coca-Cola. These specimens were subjected to a 28-day exposure to the respective beverages. Color stability was assessed using a spectrophotometer at different time points: baseline, after 7, 14, 21, and 28 days of exposure, and repolishing. The color difference (∆E) between each time point and the baseline was calculated. Statistical analysis was performed using two-way measures ANOVA with a significance level of p = 0.05.

RESULTS

All resin-infiltrated specimens exposed to staining beverages for 7 days exhibited more significant color changes than those exposed to artificial saliva. The color change patterns varied based on the type of beverage. The color alterations intensified with extended immersion in the wine and Coca-Cola groups, while there were no significant differences in the color of specimens after 28 days of immersion in the coffee and green tea groups. However, after cleaning with pumice powder, all specimens showed significantly reduced color changes compared to those observed after 28 days of immersion, except those immersed in coffee.

CONCLUSIONS

Exposure of resin-infiltrated bovine tooth specimens to staining beverages resulted in a significant color alteration as the immersion time increased. However, the staining effect could be minimized by cleaning with pumice powder, except for the coffee group.

CLINICAL RELEVANCE

After resin infiltration treatment, patients should be advised to minimize the consumption of colored beverages to prevent staining that could impact esthetic appearance.

Surface roughness of different types of resin composites after artificial aging procedures: an in vitro study

BACKGROUND

The temperature changes, chemical agents, and brushing activity that resin composite restorations are exposed to in the oral environment can cause changes in surface roughness. In this study, the aim was to investigate in vitro the clinical one-year surface roughness changes of different types of composites (flowable or conventional) from the same companies by subjecting them to immersion in solutions, brushing, and thermal cycling procedures to simulate intraoral conditions.

METHODS

Four different resin composite brands were included in the study using both their conventional (Charisma Smart, 3M Filtek Ultimate Universal, Omnichroma, Beautifil II) and flowable resin composites (Charisma Flow, 3M Filtek Ultimate Flowable, Omnichroma Flow, Beautifil Flow Plus F00), giving 4 groups with 2 types of resin composite in each. 40 samples were prepared for each group/resin type, for a total of 320 samples. After initial surface roughness measurements by a mechanical profilometer, the samples were divided into 4 subgroups (n = 10) and immersed in solutions (distilled water, tea, coffee, or wine) for 12 days. The samples were then subjected to 10,000 cycles of brushing simulation and 10,000 cycles of thermal aging. Surface roughness measurements were repeated after the procedures. For statistical analysis, the 3-way analysis of variance and the Tukey test were used (p < 0.05).

RESULTS

It was concluded that composite groups and types had an effect on surface roughness at time t0 (p < 0.001). At time t1, the highest surface roughness value was obtained in the Beautifil-conventional interaction. When the surface roughness values between time t0 and t1 were compared, an increase was observed in the Beautifil II and Beautifil Flow Plus F00, while a decrease was observed in the other composite groups.

CONCLUSION

Composite groups, types, and solutions had an effect on the surface roughness of resin composites. After aging procedures, it was concluded that the Beautifil group could not maintain the surface structure as it exceeded the threshold value of 0.2 μm for bacterial adhesion.

Evaluating the Effects of Cigarette Smoking and Heated Tobacco Products on Hard Dental Tissues: A Comparative Histological and Colorimetric Analysis

OBJECTIVES

This study aimed to evaluate and compare the impact of cigarette smoking (CS) and heated tobacco (HT) on the alteration of color and ultrastructural characteristics of human enamel and cementum.

BACKGROUND

According to tobacco companies, a less harmful substitute for CS is HT products. Nevertheless, comprehensive research on the effects of HT on tooth structures has been lacking. This study aimed to evaluate and compare the impact of CS and HT on the alteration of color and ultrastructural characteristics of human enamel and cementum.

MATERIALS AND METHODS

Thirty intact and noncarious human maxillary premolars extracted for orthodontic treatment purposes, previously disinfected, were used in the study. The specimens were randomly separated into six groups (n = 10), as follows: Group 1: enamel without smoking exposure; Group 2: enamel exposed to CS; Group 3: enamel exposed to HT; Group 4: cementum without smoking exposure; Group 5: cementum exposed to CS; and Group 6: cementum exposed to HT. The measurement of color change was conducted using a spectrophotometer. The surface alterations and mineral composition of enamel and cementum were evaluated using scanning electron microscopy and energy-dispersive X-ray spectroscopy. ANOVA test followed by Tukey's post hoc test was used to determine significant differences between groups.

RESULTS

Results showed that CS had a more pronounced effect on enamel and cementum color changes than HT. The impact of CS and HT on color changes was more evident in cementum than in enamel. Surface morphology of enamel and cementum showed alterations in histology following exposure to both smoking types. Moreover, the mineral content experienced a significant reduction after using CS and HT. The reduction in calcium content after CS and HT exposure was similar. However, HT led to a significant decrease in the phosphorus content of enamel when compared with CS. At the same time, CS exposure in cementum resulted in a more significant reduction in Ca/P ratio than HT.

CONCLUSIONS

Although HT may appear to present a lower danger to hard dental tissues than CS, it is not entirely harmless. CS results in more color changes on the enamel and cementum of teeth. Both smoking methods affected the mineral content of teeth, with CS having a significant effect on the roots, while HT significantly affected the crowns' mineral composition.

The effect of whitening toothpastes on the color stability and surface roughness of stained resin composite

BACKGROUND

This study aimed to investigate the effect of whitening toothpastes on the color stability and surface roughness of resin composites stained with coffee and cigarette smoke.

METHODS

Seventy-two disk-shaped specimens (6 × 2 mm) of suprananohybrid resin composite were randomly divided into two groups and exposed to coffee and cigarette smoke (n = 36). After staining, the samples randomly divided into four groups according to whitening toothpastes and were brushed for 4 min: Opalescence Whitening (OW); Colgate Optic White (COW); Curaprox Black is White (CPX) and, distilled water (control) (n = 9). Color was measured with spectrophotometer at the initial, after staining, and after brushing, and surface roughness was measured with profilometer at the initial and after brushing. A surface morphology analysis was examined using scanning electron microscopy and atomic force microscopy. The obtained data were statistically analyzed. (p < 0.05).

RESULTS

Cigarette smoke caused a significantly higher color change than coffee in the resin composite (p < 0.05). Brushing with hydrogen peroxide and silica-containing whitening toothpaste showed significant differences in color change (p < 0.05). The lowest whitening effect was found in activated charcoal-containing toothpaste. While all toothpastes increased the degree of surface roughness of resin composites, the highest roughness was caused by whitening toothpastes containing activated charcoal. (p < 0.05).

CONCLUSIONS

The color stability and surface properties of resin composites can be affected by brushing them with whitening toothpaste. The utilization of whitening toothpaste containing hydrogen peroxide can be considered a safe method for increasing the whiteness of discolored resin composites.

Impact of smoking on resin bonded restorations: A narrative review

INTRODUCTION

Smoking is a common risk factor for multiple diseases, including diabetes mellitus, cardiovascular diseases, pulmonary diseases, and different cancers. It is an established cause of multiple oral health conditions, in addition to adversely impairing the appearance of oral tissues. Smoking has also been identified to impact dental restorations' functional and esthetic aspects. This narrative review is focused on the significance of the esthetic consequences of smoking on resin-based dental restoration. It provides an understanding of the challenges dental professionals and patients face.

METHODS

A literature search was conducted to identify studies on the impact of smoking exposure on the esthetic appearance of composite restorations. The inclusion criteria were met by five studies selected for analysis.

RESULTS

The studies revealed that conventional cigarettes cause more noticeable color changes than electronic cigarettes. Additionally, the choice of composite material significantly influences the color stability of dental restorations. Exposure to both smoking and staining agents could worsen the color alterations in dental restorations. Smokers may benefit from dental ceramics, which offer better aesthetics. Quantitative insights into these effects can be gained by incorporating delta E (ΔE) values and fluorescence intensity in esthetic evaluations.

CONCLUSIONS

The studies provide valuable insights into the multiple factors that can impact the aesthetics of dental restorations. Dental professionals should take into account the smoking type, composite material, and patient habits when planning treatments. Utilizing ΔE values and fluorescence intensity in esthetic evaluations can provide a more comprehensive understanding. Future research should focus on longitudinal studies, alternative materials, and individual patient profiles.

The Product Science of Electrically Heated Tobacco Products: An Updated Narrative Review of the Scientific Literature

Heated tobacco products represent a novel category of tobacco products in which a tobacco consumable is heated to a temperature that releases nicotine from the tobacco leaf but not to a temperature sufficient to cause combustion. Heated tobacco products may therefore have the potential to be a less harmful alternative for adult smokers who would otherwise continue to smoke cigarettes, as their use should result in exposure to substantially fewer and lower levels of toxicants. This update represents a two-year extension to our previous narrative review, which covered peer-reviewed journal articles published up to August 31, 2021. The scientific evidence published between 2021 and 2023 continues to indicate that aerosols produced from heated tobacco products contain fewer and substantially lower levels of harmful and potentially harmful constituents and that these observed reductions consistently translate to reduced biological effects in both in vitro and in vivo toxicological studies. Biomarker and clinical data from studies in which product use is controlled within a clinical setting continue to suggest changes in levels of biomarkers of exposure, biomarkers of potential harm, and clinical endpoints indicating the potential for reduced harm with switching to exclusive use of heated tobacco products in adult smokers. Overall, the available peer-reviewed scientific evidence continues to indicate that heated tobacco products offer promise as a potentially less harmful alternative to cigarettes, and as such, the conclusions of our original narrative review remain valid.

Color and Chemical Stability of 3D-Printed and Thermoformed Polyurethane-Based Aligners

The significant rise in the use of clear aligners for orthodontic treatment is attributed to their aesthetic appeal, enhancing patient appearance and self-confidence. The aim of this study is to evaluate the aligners' response to common staining agents (coffee, black tea, Coca-Cola, and Red Bull) in color and chemical stability. Polyurethane-based thermoformed and 3D-printed aligners from four brands were exposed to common beverages to assess color change using a VITA Easyshade compact colorimeter after 24 h, 48 h, 72 h, and 7 days, as well as chemical stability using ATR-FTIR spectroscopy. The brand, beverage, and manufacturing method significantly influence color stability. ATR-FTIR analysis revealed compositional differences, with variations in response to beverage exposure affecting the integrity of polymer bonds. Color change analysis showed coffee as the most potent staining agent, particularly affecting Tera Harz TC85 aligners, while ClearCorrect aligners exhibited the least susceptibility. 3D-printed aligners showed a greater color change compared to thermoformed ones. Aligners with a PETG outer layer are more resistant to stains and chemical alterations than those made of polyurethane. Additionally, 3D-printed polyurethane aligners stain more than thermoformed ones. Therefore, PETG-layered aligners are a more reliable choice for maintaining the aesthetic integrity of aligners.

Effect of different finishing and polishing systems on surface properties of universal single shade resin-based composites

BACKGROUND

Recently, universal single-shade resin composites have become increasingly available in the dental market. The modification of their composition can have an inadvertent effect on their physical and surface properties, and subsequently determinantal effect on their clinical function and longevity. Therefore, this study aimed to evaluate the effect of different finishing and polishing (F/P) systems on surface roughness (Ra), surface gloss (GU), and Vickers microhardness (VMH) of universal single-shade RBCs.

MATERIALS AND METHODS

Four commercial RBCs were used; the universal single-shade RBCs were Omnichroma, Charisma® Diamond ONE, and Vittra APS Unique, and a conventional nanocomposite Filtek™ Z250 XT was used as a control. The 3 F/P systems were Sof-Lex™ XT, Enhance®/PoGo®, and Diacomp® Plus Twist. A total of 160 discs were used for the 3 F/P system groups for all RBCs (n = 10). After F/P, the Ra, GU, and VMH were assessed. The data were analyzed using 2-way ANOVA at p-value < 0.05.

RESULTS

Significant differences were found among the four RBCs and the 3 F/P systems (p < .000). Omnichroma showed the lowest Ra and acceptable GU, but the lowest VMH. Charisma showed the highest Ra, acceptable GU, and VMH. Vittra showed acceptable Ra, GU, and VMH and Filtek showed the highest GU, VMH, and acceptable Ra.

CONCLUSION

Although conventional nanohybrid RBC (Filtek Z250 XT) showed better GU and VMH values, the universal single-shade RBCs demonstrated comparable surface properties. The highest GU & VMH and lowest Ra were achieved by Diacomp followed by Enhance and Soflex.

Assessing color stability of orthodontic esthetic wires in different staining solutions

BACKGROUND

Esthetic orthodontic wires are preferred for their ease to fit in with natural tooth color, but their susceptibility to staining in the oral environment poses a concern. Various Coatings such as Teflon and Epoxy aim to enhance appearance and biocompatibility but may still result in discoloration. Understanding the color stability of these wires under different staining conditions is crucial for a better and enhanced treatment plan.

OBJECTIVE

This study intended to assess the color stability of esthetic orthodontic wires under various staining solutions that are often used in daily life.

METHOD

Color changes of Teflon and Epoxy-coated esthetic orthodontic wires were meticulously measured at baseline, 7, 14, and 21-day intervals utilizing the precise CIE Lab* color measurement system. A total of thirty-two samples of wires from each brand were prepared (n= 8/group) and immersed in staining solutions (coffee, tea, cola, and saffron). The color change within and between the groups was statistically evaluated (p< 0.05).

RESULTS

Significant variations in color stability were observed across different staining solutions. Saffron emerged as the most potent agent, inducing the most pronounced color changes, whereas cola demonstrated the least impact. Furthermore, Epoxy-coated wires consistently exhibited superior color stability compared to their Teflon-coated counterparts across all staining solutions and time intervals.

CONCLUSION

This study underlines the significance for orthodontists to consider staining agents' possible effects on orthodontic wires into account when selecting the orthodontic wires. The findings suggest that Epoxy-coated wires hold promise in mitigating discoloration issues during orthodontic therapy.

Clinical longevity of direct and indirect posterior resin composite restorations: An updated systematic review and meta-analysis

OBJECTIVES

To answer the PICO(S) question: Is there a difference in clinical longevity between direct and indirect resin composite restorations placed on permanent posterior teeth?

DATA

Randomized controlled clinical trials (RCTs) investigating direct and indirect resin composite restorations in posterior permanent teeth were considered.

SOURCES

Several electronic databases were searched, with no language or date restrictions. The revised Cochrane Collaboration's tool for assessing risk of bias (RoB-2) was used to analyze the studies; meta-analyses were run and the certainty of evidence was assessed by the GRADE tool. A subgroup meta-analysis was performed for resin composite restorations placed on posterior worn dentition.

STUDY SELECTION

Twenty-three articles were included in qualitative synthesis, while 8 studies were used for meta-analyses. According to the RoB-2 tool, 5 studies were ranked as "low risk", 7 had "some concerns", while 11 papers were rated as "high risk" of bias. There were no statistically significant differences in short-term (p = 0.27; RR=1.54, 95% CI [0.72, 3.33]), medium-term (p = 0.27; RR=1.87, 95% CI [0.61, 5.72]) and long-term longevity (p = 0.86; RR=0.95, 95% CI [0.57, 1.59]). The choice of restorative technique had no influence on short-term survival of resin composite restorations placed on worn dentition (p = 0.13; RR=0.46, 95% CI [0.17, 1.25]). The certainty of evidence was rated as "very low".

CONCLUSIONS

Direct and indirect resin composite restorations may show similar clinical longevity in posterior region, regardless of the observation period or substrate (wear-affected and non-affected dentition). The very low quality of evidence suggests that more long-term RCTs are needed to confirm our results.

Smoke and mirrors - does smoking cause discolouration of composite restorations?

DATA SOURCES

Searches were carried out across PubMed, Embase, Scopus and Web of Science for studies published until 28th March 2022.

STUDY SELECTION

In vitro studies assessing colour stability of resin-based composites (RBCs) exposed to conventional cigarette smoke (CS), tobacco heating systems (THS) or electronic nicotine delivery systems (ENDS) were considered. Included studies used a spectrophotometer or colorimeter for assessment of discolouration and measured discolouration using CIELAB or CIEDE2000 colour difference formulas. Literature not published in English was excluded.

DATA EXTRACTION AND SYNTHESIS

Data was extracted from thirteen studies which met the inclusion criteria. A data collection form was used to collate the extracted information on sample shape, sample diameter, sample thickness, time elapsed before smoke exposure, smoke exposure protocol, colour measurement device, sample finishing method, brushing simulation and whether exposure was to CS, THS or ENDS.

RESULTS

All 13 included studies analysed CS, four studies analysed ENDS and two studies analysed THS. A high level of variability was identified between the studies in relation to smoke exposure protocol. CS caused the highest level of discolouration of RBCs.

CONCLUSIONS

This systematic review of in vitro studies found CS caused irreversible RBC discolouration. ENDS and THS caused less colour change, which could be reversed with repolishing or bleaching procedures, although evidence was limited. Further research is required to consider the long-term effect of CS, ENDS and THS on discolouration of RBCs.

Effect of Laser and Conventional Office Bleaching and Polishing on the Color Change of Stained Nanohybrid and Microhybrid Composite Resin

Aim

The present study investigated the effects of laser and conventional in-office bleaching, and polishing on the color of stained composite resin.

Materials and Methods

A microhybrid composite (Clearfil AP-X) and a nanohybrid composite (Grandio) were selected. Twenty-four discs (2 × 10 mm) for each composite were prepared. The samples were immersed in coffee solution (25 g of coffee in 250 mL water) for seven days. Then the samples were divided into three groups (n = 8) and the stains were removed using bleaching (with Opalescence Xtra Boost), diode laser irradiation with Heydent material and a Sof-Lex polishing kit. The L ∗a ∗b ∗ color parameters were determined using a spectrophotometer before and after immersion and after stain removal procedures, and the overall color changes (ΔE) were calculated. The data were analyzed with two-way analysis of variance.

Results

In the Clearfil composite resin group, the mean ΔE compared to the baseline using in-office bleaching, laser irradiation, and Sof-Lex polishing kit were 3.31, 3.35, and 4.93, respectively. These values with the Grandio composite resin were 3.31, 6.35, and 4.57, respectively. The highest capacity to remove stains was related to the conventional in-office bleaching method. Grandio composite resin underwent more color changes than Clearfil composite resin significantly (P-value < 0.05).

Conclusion

Both composite resins exhibited color changes after immersion in the discoloring solution. However, after staining-removing procedures, the ΔE values decreased. Decreases in the ΔE values were not sufficient to restore the color to that before immersion in the discoloring solution with any stain-removing methods.

Dental Restorations

Fulfilling a patient's request for a healthy, functional and esthetic smile represents a daily challenge for dental practitioners [...].

Effect of immersion and thermocycling in different beverages on the surface roughness of single- and multi-shade resin composites

BACKGROUND

Resin composite restorations are highly esthetic restorations, which should have and maintain high surface polish. However, esthetic restorations are subjected to different beverages at variable temperatures, which may affect their surface roughness. This study aimed to evaluate the surface roughness of single-shade (Omnichroma) and multi-shade (Filtek Z350XT) composite materials, following aging by immersion and thermocycling in different beverages, simulating one year of clinical service.

METHODS

Thirty specimens of each material were prepared and divided into 6 subgroups (n = 5). In each material, the grouping of the specimens was as follows: the first subgroup was the as-prepared specimens stored dry without immersion or thermocycling. The second, third, and fourth subgroups were immersed in saliva, tea, and red wine, respectively, for 12 days at 37 °C. The fifth and sixth subgroups were thermocycled for 10,000 cycles, in tea (the fifth between 37 and 57 °C) and in red wine (the sixth between 37 °C and12°C). The resultant surface roughness was measured by two different methods, stylus profilometer and atomic force microscopy (AFM). Intergroup comparison was performed using independent t test, while intragroup comparison was performed using one-way analysis of variance (ANOVA) followed by Tukey's post-hoc test.

RESULTS

Intergroup comparison between both composites showed no statistically significant differences in all groups using the stylus profilometer roughness measurements (P>0.05), while the AFM measurements showed significant difference (P ≤ 0.05) within all storage media except the as-prepared control (P = 0.0645), where nanofilled Filtek Z350 XT showed lower nano-roughness. Intragroup comparison data were variable, depending on the material, aging conditions, and roughness assessment tool. However, the resultant average surface roughness (R_a) values in all groups did not exceed the threshold value of R_a 0.2 μm.

CONCLUSIONS

Both resin composites attained and retained a clinically acceptable surface finish after immersion and thermocycling in different beverages.

Evaluation of the Effect of Electronic Cigarette Devices/Vape on the Color of Dental Ceramics: An In Vitro Investigation

The use of vaping or electronic cigarette devices (ECDs) has recently increased as an alternative to conventional tobacco smoking products. By recording the CIELAB coordinates (L*a*b*) and computing the total color difference (ΔE) values using a spectrophotometer, the effect of ECDs on contemporary aesthetic dental ceramics was investigated in this in-vitro study. A total of seventy-five (N = 75) specimens from five different (n = 15) dental ceramic materials (Pressable ceramics (PEmax); Pressed and layered ceramics (LEmax); Layered zirconia (LZr); Monolithic zirconia (MZr) and Porcelain fused to metal (PFM)) were prepared and exposed to aerosols produced by the ECDs. The color assessment was performed using a spectrophotometer at six time intervals (0 = baseline; 250-puff exposures; 500-puff exposures; 750-puff exposures; 1000-puff exposures; 1250-puff exposures; and 1500-puff exposures). By recording L*a*b* and computing total color difference (ΔE) values, the data were processed. A one-way ANOVA and Tukey procedure for pairwise comparisons were used to assess color differences between tested ceramics (p < 0.05). All test materials demonstrated significant color differences (ΔE) after exposure to vaping (p < 0.05). The LZr group displayed noticeably high ΔE values at all the distinct puff exposure intervals, with the highest ΔE value of (13.67) after 1500 puffs. The lowest (ΔE) values were observed in the PFM group after 250 and 500 puffs (0.85 and 0.97, respectively). With the exception of the group PEmax (p = 0.999), all groups produced readings of "ΔE" that indicated significant differences (p < 0.05) at various degrees of puff exposures. ECDs can noticeably alter the color of the dental ceramics affecting the esthetics of the patients. All the materials tested demonstrated significant color changes (ΔE > 3.33) above the clinically acceptable threshold, except for the PFM and PEmax group (ΔE < 3.33) which showed color stability after exposure to the ECDs.

Effect of Different Artificial Staining Procedures on the Color Stability and Translucency of a Nano-Hybrid Resin-Based Composite

BACKGROUND

To evaluate the effect of different experimental staining procedures on color stability and translucency of a nano-hybrid resin-based composite (RBC).

METHODS

Forty-eight cylindrical-shaped specimens (10 × 2 mm) were prepared with a nano-hybrid RBC (Clearfil Majesty ES-2) and randomly divided in four groups according to the experimental staining procedure: G1) static immersion in a staining solution (coffee) (44 ± 1 °C); G2) staining cycling between coffee (44 ± 1°C) and distilled water (37 ± 1°C) with an experimental staining machine based on Arduino, an Open Source hardware development platform; G3) staining cycles as in G2 + brushing with a low abrasive toothpaste (Relative Dentin Abrasion RDA = 30) (Elmex Sensitive Professional); G4) staining cycles as in G3, with brushing performed with a very strong abrasive toothpaste (RDA = 90) (Lacult Active). Color parameters were recorded at the baseline (T0) after staining procedures (T1) and repolishing (T2) using a spectrophotometer. Color change (∆E00) and translucency (TP, CR) were evaluated. Data were statistically analyzed (p < 0.05).

RESULTS

For ∆E00 after staining, Group 1 showed the highest color change and Group 3 the lowest. All groups were significantly different (p < 0.001) except for Group 2 vs. Group 4; after repolishing, Group 1 was significantly higher than Group 3 (p < 0.001), Group 2 (p < 0.001), and Group 4 (p = 0.003); Group 2 was higher than Group 3 (p < 0.001). For TP variable, after staining procedures, Group 2 was significantly higher than all other groups (p < 0.001), and Group 1 was significantly higher than Group 3 (p < 0.001) and Group 4 (p = 0.007). After repolishing, Group 4 was significantly lower than Group 3 (p = 0.008) and Group 2 (p = 0.027). Repolishing procedure significantly reduced color parameters.

CONCLUSIONS

The investigated staining procedure induced significant differences in color stability and translucency. The use of a very strong abrasive toothpaste (RDA = 90) induced higher color change than a low abrasive one (RDA = 30). Repolishing procedures are able to partially reduce color change induced by artificial staining procedures.

Color Stability of Polymer-Based Composite CAD/CAM Blocks: A Systematic Review

BACKGROUND

This systematic review aims to evaluate the color stability of resin composite CAD/CAM blocks (CCB) when submitted to staining solutions.

METHODS

A systematic search was performed on different databases (Embase, Medline, Scopus, Web of Science). Search terms were: 'polymer infiltrated', 'polymer-based', 'resin nanoceramic', 'resin ceramic', 'hybrid composite', 'hybrid ceramic', 'composite ceramic', 'resin infiltrated', 'CAD-CAM', 'CAD/CAM', 'color stability', 'staining', 'staining susceptibility', 'color change', 'color difference'.

INCLUSION CRITERIA

in vitro articles published in the English language until 18 September 2022 without initial time restriction evaluating the color stability of CCB when submitted to staining solutions.

EXCLUSION CRITERIA

studies investigating color change induced by smoke or whitening treatments; studies not including a clinical evaluation of the results using the thresholds for color perceptibility and acceptability. Risk of bias assessment using the QUIN tool.

FINDINGS

Out of the 378 initially retrieved articles, 19 were included in this review. They investigated 17 different CCBs and different artificial staining by liquid protocols, including coffee, red wine, tea, and cola. CCBs exceeded clinical acceptability thresholds for color shift in 18 out of 19 studies, with a significantly higher color stability than conventional hybrid resin-based composites (RBCs), and a significantly lower color stability than ceramic materials. The identified differences in CCBs in color stability can be attributed to the material's composition, but also to the heterogeneity of staining procedures. Interpretation and clinical implication: Clinicians should be aware that, although to a lower degree when compared to RBCs used in direct or indirect procedures, CCBs undergo color changes to a higher degree in comparison to ceramic materials.