Agreement of Try-In Pastes and the Corresponding Luting Composites on the Final Color of Ceramic Veneers

Fracture resistance of partial and complete coverage veneers and ceramic crowns for maxillary central incisors

STATEMENT OF PROBLEM

Minimally invasive treatments have gained popularity in recent years. However, research comparing the fracture resistance of lithium disilicate partial coverage veneer restorations with that of ceramic crowns is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate and compare the fracture resistance of lithium disilicate restorations fabricated for preparations of various designs. The designs included veneer preparations with finish lines in the upper, middle, and lower third of the facial surface and ceramic crown preparations with margins in the lower third of the facial surface. All restorations were designed and fabricated using a chairside digital workflow.

MATERIAL AND METHODS

Four maxillary right central incisor typodont teeth were prepared for partial coverage veneer preparation with the margin in the upper middle third of the facial surface (PU1/3); partial coverage veneer preparation with margin in lower middle third of the facial surface (PL1/3); complete coverage veneer preparation (CV) with margin in the cervical region; and ceramic crown (CC) preparation. Each preparation was scanned, and 15 casts were 3D printed from each scan. A total of 60 lithium disilicate restorations were fabricated (n=15 per group) using a chairside computer-aided design and computer-aided manufacturing (CAD-CAM) system (Primescan and MCXL). The different restorations were cemented to the 3D printed testing dies with a photopolymerizable resin cement. The specimens were artificially aged with 10 000 thermal cycles between 5 and 55 °C with a dwell time of 30 seconds and were loaded to failure using a universal testing machine. The maximum load to fracture was analyzed using a 1-way ANOVA and post hoc Tukey honestly significant difference (HSD) test (α=.05). Additionally, the fracture patterns of the specimens were evaluated with a stereomicroscope for descriptive purposes.

RESULTS

The mean fracture resistance of the chairside CAD-CAM lithium disilicate veneers and ceramic crowns was statistically different depending on the design of the restoration (P<.05). Group CC demonstrated the highest fracture resistance values (1440.66 N), followed by CV (929.8 N) and PU1/3 (756.13 N). The lowest value was for PL1/3 (532.4 N).

CONCLUSIONS

The fracture resistance measured for the maxillary central incisor partial coverage veneers with margins in the middle third of the facial surface appear capable of resisting average occlusal forces. However, these veneers demonstrated lower fracture resistance values when compared with complete coverage veneers. Further, lithium disilicate crowns demonstrated higher fracture resistance than veneers, irrespective of their design.

Masking capacity of minimally invasive lithium disilicate restorations on discolored teeth-The impact of ceramic thickness, the material's translucency, and the cement color

OBJECTIVES

To evaluate minimally invasive restorations' capacity to mask discolored teeth and explore the impact of ceramic thickness, translucency, and cement color.

MATERIALS AND METHODS

Twenty-four assessment pairs of naturally colored and discolored bovine dentin samples were formed, using lithium disilicate specimens in six different thicknesses (0.3-0.8 mm), two different translucencies (high, low), and two cements (transparent, tooth-colored). Evaluators assessed the color differences in each assessment pair, and the threshold for detecting a color difference was determined using sequential testing and the Bonferroni-Holm method.

RESULTS

A thickness of 0.6 mm effectively masked color differences using high translucent ceramic with transparent cement, detectable differences were still observed at 0.7/0.8 mm. A threshold thickness of 0.4 mm was seen using high translucent ceramic and tooth-colored cement, with color differences still discernible at 0.5 and 0.8 mm. A threshold thickness of 0.4 mm was detected using low translucent ceramic and transparent cement, while detectable differences persisted at 0.5, 0.7, and 0.8 mm. A 0.5 mm threshold thickness was observed when using low translucent ceramic and tooth-colored cement, and no detectable color differences were detected beyond this thickness.

CONCLUSIONS

Masking can be achieved with a thickness of 0.4-0.5 mm using a low translucent material and tooth-colored cement.

CLINICAL SIGNIFICANCE

Understanding the impact of ceramic thickness, translucency, and cement color can aid clinicians in making informed decisions for achieving the best esthetic outcomes while preserving tooth structure. Effective masking can be accomplished with ceramic thicknesses starting at 0.4 mm, especially when employing a low translucent material and tooth-colored cement. However, clinicians should be aware that discolorations may still be detectable in certain scenarios when using minimally invasive lithium disilicate restorations.

Antibacterial and fluorescent clear aligner attachment resin modified with chlorhexidine loaded mesoporous silica nanoparticles and zinc oxide quantum dots

OBJECTIVES

To develop an antibacterial and fluorescent clear aligner attachment resin via the incorporation of chlorhexidine loaded pore-expanded mesoporous silica nanoparticles (CHX@pMSN) and amino-silane functionalized zinc oxide quantum dots (aZnO_QDs), and to evaluate its antibacterial activity, fluorescence capability, esthetic properties, mechanical performance and biocompatibility.

METHODS

CHX@pMSN and aZnO_QDs were incorporated into the commercial resin composites (Filtek Z350 XT, 3M) at different mass fractions, control group: Filtek; fluorescent attachment resin (FAR): Filtek + 3 wt% aZnO_QDs; antibacterial and fluorescent attachment resin (AFAR)-1: Filtek + 3 wt% aZnO_QDs + 1 wt% CHX@pMSN; AFAR-2: Filtek + 3 wt% aZnO_QDs + 3 wt% CHX@pMSN; AFAR-3: Filtek + 3 wt% aZnO_QDs + 5 wt% CHX@pMSN. CHX release, antibacterial activity, fluorescence capability, color change, stain resistance, degree of conversion, depth of cure, polymerization shrinkage, water sorption and solubility, softening in solvent, flexural strength, flexural modulus, shear bond strength, and cytotoxicity were evaluated comprehensively.

RESULTS

CHX could be continuously released from the AFAR groups for up to 30 days. CFU, MTT, lactic acid production, SEM and CLSM evaluation showed AFAR-2 and AFAR-3 could effectively inhibit S. mutans biofilms even after 1-month aging. Only AFAR-3 showed clinically perceptible color change and all the experimental groups were not more susceptible to staining. AFAR-1 and AFAR-2 could suppress polymerization shrinkage and enhance the resistance to degradation without compromising other properties, including degree of conversion, water sorption and solubility, flexural strength, flexural modulus, and shear bond strength. Depth of cure of all the four experimental groups was significantly decreased (p < 0.05) but still within the ISO standard. CCK-8 assay and live/dead cell staining denied the cytotoxicity of experimental resins. Fluorescence intensity tests showed that FAR and AFAR-2 could emit strong yellowish fluorescence under the excitation of ultraviolet for up to six months.

CONCLUSIONS

AFRA-2 possessed long-term antibiofilm activity, strong fluorescence capability and satisfying biocompatibility without compromising esthetic and mechanical properties. This study proposed a new strategy for reducing bacteria accumulation around the attachment, which is also promising in helping orthodontists to remove the attachment thoroughly and precisely.

Masking Abilities of Dental Cad/Cam Resin Composite Materials Related to Substrate and Luting Material

An outstanding treatment challenge related to aesthetic monolithic materials is to mask discolored substrates in aesthetic areas. The purpose of the study is to evaluate the substrate masking ability of different resin composite materials and the influence of their association with luting agents and substrates. Five types of 2M2 HT (high translucency) resin composite materials were selected: Vita Enamic [E] and four types of nanoparticle-filled composites Lava Ultimate [L], Cerasmart [C], Shofu HC [S], and Hyramic [H]. Resin composite Vita VM LC with different shades was used for the substrates: 2M2, 3M2, and CP2. Variolink Esthetic Try-inpastes neutral, light+, and warm+ colors were chosen to simulate the luting agent color. Optical parameters (TP (translucency), CR (contrast ratio), and OP (opalesce)) and color differences ΔE (chromatic difference) were calculated. Statistical analyses were performed to evaluate the comparisons between the groups and establish correlations. TP average values for all materials were in the range of 21.49–24.53. OP average values were in the rage of 6.31–7.85. OP is moderate positive correlated to TP and CR is negative and strong correlated to TP. Related to materials, average color changes decrease as following: E > H > C > L > S. Referring to the tryin material, warm colors induce marked color changes of the restoration. The differences of the color changes determined by all studied substrates are significant. For the final aesthetic aspect of the restoration, it is essential to consider the underlying dental structure, luting agent, and restoration material as a whole unit. The masking ability of the investigated resin matrix ceramic materials materials shows differences, the best behavior demonstrated Shofu HC and Lava Ultimate. Marked color changes are related to high chroma substrates. For substrates with a darker color, the association with warm try-in pastes lead to marked color changes, but with neutral and light try-in pastes at most perceivable.

Effect of CAD/CAM Ceramic Thickness on Shade Masking Ability of Discolored Teeth: In Vitro Study

Shade matching is a common challenge that dentists face during fabrication of esthetic dental restoration. Thus, the aim of the current study was to assess the masking ability of two types of CAD/CAM ceramics for gaining high esthetic prosthesis. This in vitro study used a total sample size of 66 lithium disilicate (LD) and leucite reinforced (LR) CAD/CAM ceramics sub-grouped into three thicknesses: 0.5, 1, and 1.5 mm. Nine shades of natural dentin die materials were prepared as a replica of the underlying tooth structure. The difference in color (ΔE) and translucency parameter (TP) were assessed for both tested ceramics at the three thicknesses. One-way ANOVA was performed to compare the three thicknesses of each ceramic, followed by multiple pairwise comparisons between both ceramics. LR had significantly higher ΔE than LD at all thicknesses used unlike the case in TP. Thickness of 0.5 mm exhibited the highest ΔE and TP, while 1.5 mm thickness showed the lowest ΔE and TP in both ceramics. Increase in ceramic thickness had a great impact on both color masking ability of the underlying tooth structure and its translucency. The higher the ceramic thickness, the better the masking ability and the lower the translucency was reported.

Effects of abutment tooth and luting agent colors on final color of high-translucent zirconia crowns

PURPOSE

This study aimed to evaluate the effects of the tooth portion evaluated and the colors of the abutment tooth and resin luting agent on the final color of monolithic zirconia crowns.

METHODS

Monolithic zirconia crowns were fabricated for left maxillary central incisors using two shades (A2 and A3) of highly translucent monolithic zirconia disks. A model of the abutment tooth was fabricated using resin core materials (white: W; dentin: D). The color of the crowns was measured with try-in pastes (clear: C; brown: B) as a resin-luting agent substitute. The measurement was performed after placing the crown on the model with the attached abutment tooth with try-in paste. The color of three labial portions (cervical, body, and incisal) was evaluated using a dental spectrophotometer. The color difference (ΔE) between the CIELab values of the zirconia disks and the final me asurement of zirconia crowns was calculated.

RESULTS

The ΔE between the crown of the A2 shade and the zirconia disk of the A2 shade had the highest ΔE value in the body portion with W-B (ΔE=3.92). Similarly, the A3 shade had the highest ΔE value in the cervical portion, with W-B (ΔE=4.27). The results of three-way ANOVA showed that the ΔE values were influenced by the tooth portion evaluated and the color of the abutment tooth.

CONCLUSIONS

The final color of the monolithic zirconia crowns was significantly in fluenced by the tooth portion evaluated and the color of the abutment tooth.

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.

The effect of resin cement shade and restorative material type and thickness on the final color of resin-matrix ceramics

PURPOSE

This study aims to evaluate the effects of cement shade, restorative material type, and thickness on the final color of resin-matrix ceramics.

METHODS

Ninety A2 shade resin-matrix ceramic specimens were prepared from Vita Enamic, GC Cerasmart, and Lava Ultimate at 0.5 and 1.0 mm thicknesses. Sixty resin cement disks were fabricated from different shades (A1, A3O, B05, and TR) of RelyX Ultimate at 0.1 mm thickness. CIE color coordinates were measured using a spectrophotometer, and color differences (∆ E 00 ) were calculated. Data were statistically analyzed (P =0.05).

RESULTS

The ΔE 00 values were influenced by the cement shade, restorative material type, thickness, and their interactions ( P < 0.05). A3O cement caused clinically unacceptable values for all groups at 0.5 mm thickness and GC at 1.0 mm thickness. A1 and TR cement shades demonstrated visually perceptible but clinically acceptable values, except for VE-A1 and LU-A1 at 0.5 mm thickness. The ∆E 00 values of the B05 cement shade were lower than the visually perceptible threshold for both thicknesses except for GC at 0.5 mm thickness.

CONCLUSIONS

The shade of the resin cement and the type and thickness of the resin-matrix ceramic material significantly affected the resulting final color. To provide a shade matching with natural dentition and to obtain esthetic restorations, especially for the anterior teeth, the resin cement shade and resin-matrix ceramic material should be carefully selected.

Experimental methodologies to evaluate the masking ability of dental materials: A systematic review

OBJECTIVE

To conduct a systematic review on the masking ability of discolored substrates, analyzing the capacity and quality of the response produced by the different methodologies and techniques applied to overcome this clinical challenge.

MATERIALS AND METHODS

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The electronic search was conducted in MEDLINE/PubMed, Scopus and Web of Science databases, without date restriction. In vitro studies, written in English, applying different methodologies to evaluate masking ability were included. The variables of interest were: type, color and thickness of the restorative and/or cement material; use of pigments in the restorative material and/or cement; color of the substrate; and background color used for the evaluations.

RESULTS

Database search retrieved 307 eligible papers with a final inclusion of 47 published papers. Approximately 98% of the studies used ΔE, 36% used TP, and only 6% used CR to evaluate the masking ability of restorative materials.

CONCLUSIONS

The most appropriate methodology to evaluate the masking ability is using color difference equations (ΔE) associated with the perceptibility and acceptability thresholds.

CLINICAL SIGNIFICANCE

As different methodologies have been used to evaluate the masking ability of esthetic restorative materials on colored substrates, there is an urgent need to reach a consensus and propose a method, which is suggested by the present systematic review.

Spectrophotometric evaluation of color errors generated in the visual color duplication procedure for current ceramic veneers

Background/purpose

Color errors associated with the visual color duplication approach for ceramic laminate veneers are still challenging in esthetic dentistry. The aim of this study is to evaluate color errors generated during traditional visual shade matching approach.

Materials and methods

Eighteen stooth-shaped veneer discs (shade A2 and 0.7 mm in thickness) were fabricated using six veneer materials. The veneer specimens placed on five extracted teeth with nominal shade A2 formed veneer-tooth combinations. Color coordinates of the A2 shade tab, the extracted teeth, and the veneer-tooth combinations were measured using a spectrophotometer. Then, the veneers were reduced to 0.5 mm, and 0.3 mm in thickness consecutively. Color measurements were performed repeatedly. Color differences of the extracted teeth to veneer-tooth combinations (ΔEt-v), veneer-tooth combinations to shade tab (ΔEv-s), and translucency parameter (TP) values were calculated and analyzed using Two-way ANOVA.

Results

ΔEt-v ranged from 2.0937 to 5.0603 (mean of 3.1833±1.5485). Mean of ΔEv-s was 4.0103±1.8508. ΔEt-v and ΔEv-s values were significantly influenced by veneer material and thickness (P<0.05). TP values decreased gradually with the lessening of veneers thickness.

Conclusion

Acceptable color duplication of ceramic veneers cannot be achieved by routine visual shade replica protocols, when the thickness of veneers is less than 0.7 mm. Specified color matching standards for the ceramic veneers are needed.

Advances in materials and concepts in fixed prosthodontics: a selection of possible treatment modalities

The introduction of adhesive techniques in combination with translucent restorative materials has greatly influenced treatment concepts in fixed prosthodontics. Modern production technologies offer access to new polymer materials that provide innovative pre-treatment options for complex prosthetic rehabilitations. Additionally, computer-aided design and manufacturing (CAD/CAM) provides access to new ceramic types and thus extends the range of indications for metal-free restorative options. With these developments, important changes of treatment concepts in fixed prosthodontics have occurred which affect the professional life of dental practitioners with a focus on prosthetic dentistry. This article gives an overview of the advances in selected fields of fixed prosthodontics and provides support in material selection for different kinds of indications, from single-tooth restorations to fixed dental prostheses.

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.

The effect of ceramic thickness and resin cement shades on the color matching of ceramic veneers in discolored teeth

The objective of this study was to analyze the effects of ceramic material thickness and resin cement shade on the color matching of ceramic veneers at the gray tooth structures. Seventy-two artificial maxillary right central incisor teeth (C2 shade) were prepared according to veneer tooth preparation in practice. Ceramic materials (LT, A2 shade, IPS e.max Press) were selected to fabricate the 0.50- and 0.75-mm thick veneers at the body region. The ceramic veneer specimens were bonded to the artificial teeth by the 6 shades of resin cements (Variolink Veneer: shades of HV+3, LV-2, LV-3; and RelyX^TM Veneer: shades of WO, TR, A3). A clinical spectrophotometer (Crystaleye, Olympus) was used to measure the color parameters. The color differences (ΔE values) of ceramic veneers and A2 shade tab (Vitapan Classical, Vita) and C* _ab values were calculated. The results of three-way ANOVA indicated that the ΔE values of ceramic veneer and A2 shade tab were significantly different in the thickness of ceramic materials, shades of resin cements, and measuring regions (p < 0.001). There were significant differences in 0.50-mm-thick ceramic veneers that exhibited higher ΔE values compared with veneers that were 0.75-mm thick. Tukey's HSD test showed that the average ΔE values in body region were significantly smaller than that in cervical and incisal regions. The color matching of ceramic veneers was significantly influenced not only by the ceramic thickness and the resin cement shades but also the tooth regions.