Color and masking properties of translucent monolithic zirconia before and after glazing

Shade match comparison of CAD-CAM single crowns to a lithium disilicate crown

PURPOSE

To assess the shade match ability of four varieties of all-ceramic crowns to a neighboring bilayered lithium disilicate crown.

MATERIAL AND METHODS

A dentiform was used to fabricate a bilayered lithium disilicate crown on the maxillary right central incisor, following the anatomy and shade of a selected natural tooth. Two crowns (one full-contour, one cutback) were then designed on a prepared maxillary left central incisor, following the contour of the neighboring crown. The designed crowns were used to manufacture monolithic lithium disilicate, bilayered lithium disilicate, bilayered zirconia, and monolithic zirconia crowns, 10 each. An intraoral scanner and a spectrophotometer were used to assess the frequency of matched shades and to calculate the color difference (ΔE) between the two central incisors at the incisal, middle, and cervical thirds. Kruskal-Wallis and two-way ANOVA were used to compare the frequency of matched shades and ΔE values, respectively (α = 0.05).

RESULTS

There was no significant (p > 0.05) difference in frequencies of matched shades for each group at the three sites; except bilayered lithium disilicate crowns. Bilayered lithium disilicate crowns had significantly (p < 0.05) higher match frequency than monolithic zirconia at the middle third. The ΔE value was not significantly (p > 0.05) different among the groups at the cervical third. However, monolithic zirconia had significantly (p < 0.05) higher ΔE values than bilayered lithium disilicate and zirconia at the incisal and middle thirds.

CONCLUSIONS

Bilayered lithium disilicate and zirconia appeared to most closely match the shade of an existing bilayered lithium disilicate crown.

Borosilicate glass as a surface finishing alternative for improving the mechanical properties of third-generation zirconia

OBJECTIVE

This study evaluated the effect of an experimental borosilicate glass on the mechanical and optical behavior of 5Y-PSZ zirconia and comparing it to commercial glaze and as-sintered.

METHODS

Disc-shaped specimens of a 5Y-PSZ (Zpex Smile) were prepared and sintered (1550 °C, 2 h). The zirconia discs were randomly divided according to the surface treatment: as-sintered (C), commercial glaze (G), and experimental borosilicate glass (SL). Glaze and experimental glass powders were mixed with building liquids and applied to zirconia with a brush. G specimens were fired at 950 °C and SL at 1200 °C. An extended dwell time of 20 min was applied to both groups. Biaxial flexural strength, roughness (Ra and Rz), translucency (TP00), color alteration (ΔE00), Vickers hardness, fracture toughness, residual stresses, and x-ray diffraction analyses were conducted. Statistical analyses were performed with Weibull statistics, Kruskal-Wallis, or ANOVA tests (α = 5%).

RESULTS

SL yielded the highest flexural strength (799.35 MPa), followed by G (662.34 MPa), and C (485.38 MPa). The fracture origin of SL specimens was in the bulk zirconia, while G and C showed fractures starting at the surface. As-sintered reached the highest fracture toughness and hardness. Glaze and borosilicate glass provided surface compressive stresses. Borosilicate glass application led to phase transformation (t→m). SL and G showed the lowest roughness. TP00 and ΔE00 were similar among groups.

SIGNIFICANCE

Borosilicate glass improved strength without harming the optical properties of third-generation zirconia. Toughness and roughness provided by the experimental glass were similar to those from commercial glaze.

Translucency of chairside monolithic zirconias using different sintering ovens: An in vitro investigation

OBJECTIVE

To evaluate the translucency of several monolithic zirconias (MZ) processed in various sintering ovens designed for single-visit, chairside use.

METHODS

Discs (n = 40) from zirconia blocks were fabricated for each MZ at manufacturer-recommended minimal thicknesses, as provided in each material's instructions for use: IPS e.max ZirCAD LT (ZLT); CEREC Zirconia+ (CZ+); 3M Chairside (3M); KATANA Zirconia (KT). Groups (n = 10) were sintered following manufacturer instructions for each oven: CEREC SpeedFire, Ivoclar CS4, Ivoclar CS6, and Ivoclar S2 (laboratory furnace control). Specimens were highly polished on one side and glazed on the other. Each side was measured with a spectrophotometer against white and black backgrounds to determine translucency parameter (TP) and contrast ratio (CR) values. Results for TP and CR for each material and oven combination were compared with a linear mixed model. Oven precision was evaluated using the Kruskall-Wallis test.

RESULTS

Glazed specimens were more translucent than polished ones (p < 0.001). ZLT and CZ+ were more translucent than 3M and KT regardless of the sintering oven (p < 0.01). Several oven/material combinations reached or exceeded the S2 oven TP: CS4 with CZ+ and 3M; CS6 with ZLT and KT (p < 0.01). SpeedFire was significantly less precise (p < 0.05) and produced lower TP values for ZLT, CZ+, and KT (p < 0.01). Results for TP and CR were highly correlated.

CONCLUSIONS

MZ surface finish, material thickness, and oven used all had a significant effect on translucency. Some chairside-oriented solutions produced results with translucency equal to conventionally processed zirconia.

CLINICAL SIGNIFICANCE

The translucency of a ceramic restoration is an important factor in determining its esthetics. Clinicians desiring the most esthetic outcomes with monolithic zirconia should be aware of the significant effects that surface finishing, material thickness, and the sintering oven used can have on restoration translucency.

A step-by-step technique to create an ideal color match, form, and surface texture to all-ceramic restorations

OBJECTIVES

Although the presence of a chairside CAD/CAM system in the dental office saves time and cost, it deprives the dentist from the dental technologist' skills and experience. The dentist now has to gain and acquire knowledge and skills about how to finish, characterize, stain, and glaze ceramic restorations. The main objectives of this article is to teach novel and reproducible techniques for surface color, texture, glaze and polish for either the chairside or laboratory fabricated indirect ceramic restoration.

CLINICAL CONSIDERATIONS

A protocol for intraoral characterization of monolithic ceramics; the "Triple R" protocol for tooth color mimicking was followed. It consist of three steps: (1) "Recognize" tooth color shapes, (2) "Record" the present color shapes in the patient dentition by drawing a color map for the color shapes extension and determine which luster paste stain to be used for replicating them, and (3) "Replicate" intraorally the recorded color shapes guided by the adjacent natural teeth using low fusing ceramic pastes (shades and stains) for color shape replication. Also, the final touch technique was followed to shape, texture and final surface finish of dental restorations. It is composed of 5 basic levels which we call dental "micro-esthetics that define shape, texture, and surface luster.

CONCLUSIONS

Following the steps of both; the "Triple R" protocol and the "FINAL TOUCH" technique will help to reproduce the final shade of the restoration to create the illusion of a natural tooth to the observer.

CLINICAL SIGNIFICANCE

This article shows how combining two practical methodologies to record and replicate both color shapes and surface texture of natural teeth may extend mimicking, that is, step by step natural tooth shade beyond the limitations of the available commercial shade guides.

Comparing the color match of monolithic CAD-CAM dental ceramics with the VITA Classical shade guide

STATEMENT OF PROBLEM

Matching the shade selected and the final color of a ceramic restoration is challenging, and studies on matching monolithic ceramics to the shade selected are lacking.

PURPOSE

The purpose of this in vitro study was to compare the color match of monolithic lithium disilicate (LDS), zirconia-reinforced lithium silicate (ZLS), presintered zirconia-reinforced lithium silicate (PS-ZLS), polymer-infiltrated ceramic network (PICN), and multilayer zirconia with the 3 modes of the VITA Classical shade guide.

MATERIAL AND METHODS

This study was performed on 50 rectangular plates (14×12×1 mm) of 5 types of ceramics with A2 shade (n=10). Zirconia specimens were evaluated in 3 locations: incisal, medial, and cervical thirds. The color coordinates of the specimens of all 7 groups were measured on #3 and #8 Ivoclar Natural Die Color material by using a reflective spectrophotometer. The color coordinates of A2 VITA shade were measured in 5 modes: without backing placed in specimen holder, shade tab on the backgrounds #3 and #8, and 1-mm-thick shade tab on the backgrounds #3 and #8. The color difference of each specimen with 3 modes of A2 shade (without backing and on similar backgrounds) was calculated by using the ΔE00 formula, and comparison among groups was performed by using 2-way ANOVA and Tamhane post hoc tests. The comparison of ΔE00 between the values obtained from backgrounds #3 and #8 was performed by using the independent t test (α=.05).

RESULTS

In both backgrounds, statistically significant differences were found between the studied groups and VITA shade (P<.001). In most situations, the amount of color difference was lowest for the "shade tab on the backgrounds" mode. On background #3, the highest color difference was related to ZLS (6.48 ±0.23), and the lowest values were observed in the PICN group (1.02 ±0.31). On background #8, the highest color difference was related to ZLS compared with the "without backing" mode (8.62 ±0.27), and the lowest values were reported for ZLS compared with the "shade tab on the backgrounds" mode (1.27 ±0.44). The independent t test showed a statistically significant color difference on the 2 different backgrounds for all situations (P<.001).

CONCLUSIONS

Color selection of monolithic ceramics with the VITA Classical shade guide is improved by placing the VITA tabs on a similar background. Background color has a significant effect on the final shade of the monolithic ceramics. Choosing the correct color for LDS, ZLS, and PS-ZLS requires more care than for PICN and zirconia.

Masking Ability of Monolithic and Layered Zirconia Crowns on Discolored Substrates

There is scarce information on the colorimetric behavior of monolithic and layered zirconia crowns in combination with various abutment colors. This study evaluated the masking ability on discolored substrates of monolithic and layered zirconia crowns. Anterior crowns were fabricated using 3Y-TZP zirconia and layering ceramic and divided into three groups: monolithic (ML), bi-layer (BL), and tri-layer (TL). The crowns were placed over eleven substrates (ND1-ND9, zirconia, metal), and CIE L*, a*, b*, C*, and h° color coordinates were measured in the cervical, middle, and incisal areas with a spectrophotometer. Masking ability was calculated using the color difference formula, and values were interpreted according to the perceptibility and acceptability thresholds. Data were analyzed statistically (α = 0.001). The L* coordinate was not significantly different between BL and TL crowns, regardless of the measurement area or substrate (p ≥ 0.001). In the middle area, the L* coordinate of the ML group was statistically different from the BL and TL groups only for zirconia and metal substrates, while in the incisal area, only for ND7 and metal substrates. The a* coordinate was significantly different between the ML and layered crowns for all measurement areas and substrates (except zirconia). The b* and C* coordinates differed significantly between the groups only in the cervical area (p < 0.001). The ML crown had better masking ability than the BL and TL crowns. However, the color differences for ML crowns were below the acceptability threshold for ND2, ND3, and ND7 substrates in the cervical and middle areas and below perceptibility threshold only for the incisal area. The lowest masking ability of the crowns was found for ND9 and metal substrates in all measurement areas.

Influence of manufacturing technique on the color of zirconia restorations: Monolithic versus layered crowns

OBJECTIVES

The study aimed to compare the color of monolithic and layered zirconia crowns fabricated using different brands in the cervical, middle, and incisal areas.

MATERIALS AND METHODS

A total of 45 crowns were fabricated from three brands (Katana, Nacera, Cercon) using three methods (monolithic = ML (n=5), cut-back + enamel = BL (n=5), cut-back + dentin + enamel = TL (n=5)). CIE L*, a* b*, C*, h° color coordinates were recorded with a dental spectrophotometer in cervical, middle, and incisal areas. Color differences between manufacturing techniques, tooth areas, and brands were calculated using the CIEDE2000(1:1:1) formula, and the values were compared to the perceptibility (PT₀₀ ) and acceptability thresholds (AT₀₀ ). Comparisons between color coordinates were analyzed statistically (Kruskal-Wallis and Mann-Whitney U tests, p < 0.001).

RESULTS

Significant differences were found between CIE L*, a*, b*, C*, h° coordinates of the zirconia crowns (p < 0.001), generally. The lowest color differences were obtained between BL and TL crowns in cervical and middle areas. Color differences between cervical and middle areas were mostly below PT₀₀ . An acceptable color difference was found between Katana and Cercon crowns.

CONCLUSIONS

The manufacturing technique and the brand influenced the color of zirconia crowns. Also, the color of the crowns varied from cervical to incisal.

CLINICAL SIGNIFICANCE

Reproducing the optical properties of teeth with ceramic crowns might be challenging, given the differences in the internal configuration of the enamel and dentine, as well as their complex behavior when interacting with light. When deciding whether to fabricate a monolithic crown in translucent zirconia or improve its appearance by layering with more translucent glass-ceramic, the clinicians and dental technicians must be aware of these procedures' effect on the final color of the restorations.

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.