Effect of resin composite shade on digital fiber-optic transillumination imaging in vitro

Digital imaging fiber-optic transillumination (DIFOTI) devices have been used to detect caries, a technique without using X-rays. However, the effects of resin composites (RCs) shades on the images acquired with DIFOTI devices have not been investigated. Thus, this study aimed to elucidate the influence of RC shade on the images obtained with DIFOTI technique. Three shades (A1, A3, and Opaque) for each of four flowable RCs were filled on a cavity prepared in a left mandibular first premolar obtained from a donated body. Then, transmission images with a DIFOTI device (DIAGNOcam; KaVo, Biberach, Germany) were acquired, and the average lightness values of the images in the RC and enamel were used to calculate differences between those areas. To clarify the influence of the optical translucency and color on DIFOTI images, the color parameters (L*, a* and b*) of each RC were obtained with black and white backgrounds. The color differences between the backgrounds were calculated as transparency parameter (TP) values. The number of repetitions was set to 10. Differences in the lightness value of the shades varied in each RC. The difference in lightness was significantly associated with the TP value and color parameters of L* (p < 0.01), with negative (R = - 0.81) and positive (R = 0.84) correlations, respectively. In conclusion, DIFOTI images of RCs with high optical translucency resembled those of the natural tooth structure.

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.

Influence of resin cement on color stability of ceramic veneers: in vitro study

Statement of the problem

Long-term success of ceramic veneers depends on the color stability of resin cement used for their cementation. Color change of cement may be seen through the ceramic and compromise esthetics.

Purpose

This study aimed to compare the color change of two resin cements and their visibility through the ceramic veneers after accelerated artificial aging.

Materials and methods

In this in vitro study, color change (ΔE) was measured in the following groups (n = 10) before and after accelerated artificial aging: group 1, IPS e.max press high translucent ceramic discs; groups 2, Variolink NLC resin cement discs; group 3, Choice 2 resin cement discs; groups 4, Variolink NLC discs bonded to e.max ceramic discs; group 5, Choice 2 disc bonded to e.max ceramic discs. Color change was measured using a spectrophotometer according to International Commission on Illumination Lab (CIELab). Data were analyzed using one-way ANOVA and Tukey’s post-hoc test.

Results

Group 2 showed the highest (ΔE = 10.4 ± 0.9) and group 1 the lowest (ΔE = 0.9 ± 0.4) color change. The color change of Variolink was significantly greater than Choice 2 either alone (p < .001) or through the ceramic discs (p < .004). The color change of both cements was lower through the ceramic veneer and this reduction was statistically significant (p < .001).

Conclusion

Noticeable color change may be expected in areas of cement exposure for both cements studied. Also, in case of using Variolink cement, the color change may be seen through the ceramic veneers.

Cement opacity and color as influencing factors on the final shade of metal-free ceramic restorations

OBJECTIVE

To investigate the influence of opacity and color of luting cements on the final shade of metal-free restorations.

MATERIALS AND METHODS

Five resin cement colors in combination with four different thicknesses of CAD/CAM ceramic materials were tested, and a composite substrate was used as dentin color reference (n = 3). Specimen color was measured with a spectrophotometer equipped with an integrating sphere before and after cementation (CIELAB). Cement and ceramic color and opacity (TP) were assessed by measuring the tested ceramic thickness as a 1-mm thick disk for each of the cement shades. The differences in color were evaluated (ΔE₀₀ ). Data were statistically analyzed by a Two-Way ANOVA followed by the Tukey Test for post-hoc comparison (P < .05) and multiple comparison Pearson's test (P < .05); the acceptability and perceptibility threshold were evaluated.

RESULTS

Statistically significant influence was found for factors ceramic thickness and cement shade (P < .001). Perceptible and unacceptable color changes were induced on the final restoration by resin cements (ranging from ΔE₀₀  = 0.69 ± 0.54 to ΔE₀₀  = 5.53 ± 0.46), the correlation between factors became strong (r²  > 0.6) in case of mismatch between color and translucency of cement and ceramic. Only the clear shade in combination with the thickest ceramic, resulted in an imperceptible color change (ΔE₀₀  = 0.69 ± 0.54).

CONCLUSIONS

The final shade of ceramic restorations can be influenced by resin cements; the magnitude of influence is related to the cement optical properties.

CLINICAL SIGNIFICANCE

In order to influence the final shade of a ceramic restoration, a cement more opaque than the restorative material should be used. Conversely, in the case of a fitting shade of the restoration, a cement more translucent than the restoration should be used to avoid undesired changes.

Color Stability of Ceramic Veneers Cemented with Self-Adhesive Cements after Accelerated Aging

OBJECTIVES

Color change of cements over time can be detected through translucent ceramic veneers, compromising the aesthetic appearance of restorations in the long-term. This study aimed to assess the color stability of ceramic laminate veneers cemented with self-adhesive resin cements after accelerated aging.

MATERIALS AND METHODS

In this study, 21 IPS e.max ceramic discs, measuring 8mm in diameter and 0.7 mm in thickness, were fabricated and divided into three groups (n=7) for the application of Choice 2 total-etch light-cure resin cement, RelyX U200 dual-cure self-adhesive resin cement, and SpeedCEM self-cure self-adhesive resin cement. The ceramic discs in each group were cemented on the prepared facial surface of bovine teeth. The color parameters were assessed using a spectrophotometer. Subsequently, the samples were subjected to accelerated aging for 100 hours, and the color parameters were measured again. The data were analyzed using two-way repeated-measures analysis of variance (ANOVA) and Tamhane's post-hoc test (P<0.05).

RESULTS

Aging significantly affected the ceramic laminate color parameters in all three groups (P<0.05). SpeedCEM cement showed the lowest color stability (ΔE=4.2) after aging, and its color change was clinically unacceptable (ΔE>3.5). The color change of the other two groups was clinically acceptable (1<ΔE<3.5).

CONCLUSION

The self-adhesive dual-cure cement showed color stability comparable to that of the total-etch light-cure cement for cementation of IPS e.max ceramic laminates. The color stability of both cements was superior to that of the self-adhesive self-cure cement.

Evaluation of the Final Color of Ceramic Veneers with Different Self-Adhesive Resin Cements

Background:

Proper selection of cement plays an effective role in the success of ceramic laminate veneers. The cement can affect the final color by changing the optical properties of the ceramic.

Objective:

Due to the ease of clinical use of the seventh generation of cement (Self-Adhesive Cement), this study aimed to evaluate the effect of this type of cement on the final color of Ceramic Veneers (CV).

Methods:

In this study, 21 IPS e.max ceramic disks (8mm× 0.7 mm) were used. They were divided into 3 groups of 7, depending on the type of cement. (Choice 2, RelyX U200, Speed Cem). In the first stage, ceramic disks were set on the facial surface of bovine’s teeth by bonding agents and the color properties were analyzed by spectrophotometer. In the next stage, specimens were cemented on the prepared surfaces according to the manufacturer’s instructions and their color was evaluated subsequently.

Results:

Results were analyzed by repeated measures two-way ANOVA and TAMHANE post hoc methods (P < 0.05). Results showed that cement influences the color of the ceramic laminate. ∆E values were reported to be higher than the critical point after cementation (∆E > 2.69).

Conclusion:

There was no significant difference between the effects of three cement types on the final color of the ceramic veneers.

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.

Optical properties of translucent zirconia: A review of the literature

Translucent monolithic zirconia is the newest option of zirconia-based ceramics, which aimed to substitute the opaque classic yttria-stabilized tetragonal zirconia polycrystal (Y-TZPs) in more demanding esthetic cases.

The aim of this review was to assess the available literature regarding the optical, chemical and mechanical properties of translucent zirconia ceramics.

This systematic review was developed according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines. An electronic literature search was undertaken through Medline (National Library of Medicine) via PubMed to identify relevant articles, published in the interval 2010-2018. The search was limited to the English language publications, in vitro studies of color and microstructure of translucent zirconia material.

Yttria-stabilized tetragonal zirconia polycrystals (Y-TZPs) has excellent mechanical properties, but its intense white color and high opacity represent an esthetic limit. Cubic zirconia represents a new generation of dental ceramics with molecular structure and physical properties different from the conventional zirconia. Dental manufacturers created new formulations of this restorative material, introducing new cubic varieties of zirconia with improved optical properties. Translucent monolithic zirconia provides a new restorative option that combines strength with improved esthetics, due to its increased translucency. Translucent zirconia is indicated for anterior and posterior restorations but should be used carefully for discolored teeth, because the background color can affect the final esthetic appearance of the restoration.

Influence of implant abutment material and ceramic thickness on optical properties

STATEMENT OF PROBLEM

Anterior shade matching is an essential factor influencing the esthetics of a ceramic restoration. Dentists face a challenge when the color of an implant abutment creates an unsatisfactory match with the ceramic restoration or neighboring teeth.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of abutment material and ceramic thickness on the final color of different ceramic systems.

MATERIAL AND METHODS

Four experimental and control ceramic specimens in shade A3 were cut from IPS e.max CAD, IPS Empress CAD, and VITA Suprinity PC blocks. These specimens had thicknesses of 1.0 mm, 1.5 mm, 2.0 mm, and 2.5 mm, respectively, for the experimental groups, and 4 mm for the controls. Background abutment specimens were fabricated to yield 3 different shades: white zirconia, yellow zirconia, and titanium at a 3-mm thickness. All 3 ceramic specimens in each thickness were placed in succession on different abutment backgrounds with glycerin optical fluid in between, and the color was measured. A digital spectrophotometer was used to record the specimen color value in the Commission Internationale De L'éclairage (CIELab) color coordinates system and to calculate the color difference (ΔE) between the control and experimental groups. The Kruskal-Wallis test was used to analyze the effect of ceramic thickness on different abutments, and the pair-wise test was used to evaluate within the group (α=.05).

RESULTS

The color differences between the test groups and the control decreased with increasing ceramic thickness for every background material. In every case, significant differences were found between 1.0- and 2.5-mm ceramic thicknesses. Only certain 2.5-mm e.max CAD, VITA Suprinity PC, and Empress CAD specimens on yellow-shade zirconia or VITA Suprinity PC on titanium were identified as clinically acceptable (ΔE<3).

CONCLUSIONS

Increasing ceramic restoration thickness over the abutment background decreased the color mismatch. Increasing the thickness of ceramic on a yellow-shaded zirconia abutment rather than on titanium or white zirconia yielded a more esthetic color for the whole restoration.

Spectrophotometric analysis of clinical factors related to the color of ceramic restorations: A pilot study

STATEMENT OF PROBLEM

Shade matching natural teeth with ceramic restorations is still an esthetic, clinical challenge.

PURPOSE

The purpose of this prospective clinical study was to evaluate the influence of color-related factors on the color variation of ceramic restorations based on spectrophotometric analysis.

MATERIAL AND METHODS

Color records were obtained from 11 participants who received 38 lithium disilicate restorations. CIELab color coordinates were measured with a spectrophotometer on the ceramic restoration, tooth (baseline), prepared tooth, and luted ceramics. Color variation (ΔE₀₀) was calculated for each variable (luting agent and restoration type, tooth substrate shade, ceramic thickness, and translucency parameters) measured at baseline on the prepared tooth and after cementation of the restorations. Confidence intervals (CI) for the means (95% CI) were calculated, and the ΔE₀₀ values and CIELab individual color coordinates were compared for each pair of variable by using the Student t test or Welch test (α=.05).

RESULTS

Greater color variation values were observed between measurements obtained on the prepared tooth and luted restoration. The lower ΔE₀₀ values were observed over darker tooth substrate measured at baseline and after luting (P=.007).

CONCLUSIONS

The 3 conditions evaluated presented clinically visible color differences, highlighting the importance of clinical evaluations on the visual color acceptability limits for restorations, which are usually defined in laboratory studies. The lithium disilicate ceramic showed lower masking ability over darker tooth substrate, whereas the coordinates L*, a*, and b* were cementation-dependent.

Effects of Luting Composites on the Resultant Colors of Ceramic Veneers to Intended Shade Tab

PURPOSE

To investigate the color differences of ceramic veneers and the intended shade tab, and evaluate the effects of luting composites on the resultant colors of ceramic veneers.

MATERIALS AND METHODS

Pressable leucite-reinforced feldspathic ceramic discs (IPS e.max), with nominal shade A3, were fabricated with thicknesses of 1.0 mm, 0.7 mm, and 0.5 mm (n = 10/ thickness). The ceramic specimens were cemented onto a composite background (shade Dentin) using a veneer adhesive system with five colors of luting composites (RelyX). The colors of the veneer (veneer/luting/background complexes) and corresponding shade tab (A3, Vitapan) were measured using a spectrophotometer, and subsequently converted to CIE L*a*b* values. Color differences (△E) between each complex and the shade tab were calculated and analyzed with two-way ANOVA. Tukey's multiple comparisons were used to evaluate the effects of luting composites on the △E values.

RESULTS

The means of color differences between ceramic veneers and intended shade tab were 2.50 ± 0.38, 3.17 ± 0.48, and 3.84 ± 0.63 for the 1.0 mm, 0.7 mm, and 0.5 mm thicknesses, respectively. △E values were significantly affected by the veneer thickness and the luting composite color (p < 0.001). Tukey's multiple comparison results revealed no significant differences among the luting composites in the thickness of 1.0 mm and 0.7 mm.

CONCLUSIONS

The color matching of ceramic veneers to the intended shade tab was not achieved in the 0.7 mm and 0.5 mm veneer thicknesses, whichever colors of the luting composites were used.

Influence of resin cement shade on the color and translucency of ceramic veneers

Objective

This in vitro study evaluated the effect of two different shades of resin cement (RC- A1 and A3) layer on color change, translucency parameter (TP), and chroma of low (LT) and high (HT) translucent reinforced lithium disilicate ceramic laminates.

Material and Methods

One dual-cured RC (Variolink II, A1- and A3-shade, Ivoclar Vivadent) was applied to 1-mm thick ceramic discs to create thin RC films (100 µm thick) under the ceramics. The RC was exposed to light from a LED curing unit. Color change (ΔE) of ceramic discs was measured according to CIEL*a*b* system with a standard illuminant D65 in reflectance mode in a spectrophotometer, operating in the light range of 360-740 nm, equipped with an integrating sphere. The color difference between black (B) and white (W) background readings was used for TP analysis, while chroma was calculated by the formula C^*_ab=(a^*2+b^*2)^½. ΔE of 3.3 was set as the threshold of clinically unacceptable. The results were evaluated by two-way ANOVA followed by Tukey's post hoc test.

Results

HT ceramics showed higher ΔE and higher TP than LT ceramics. A3-shade RC promoted higher ΔE than A1-shade cement, regardless of the ceramic translucency. No significant difference in TP was noted between ceramic discs with A1- and those with A3-shade cement. Ceramic with underlying RC showed lower TP than discs without RC. HT ceramics showed lower chroma than LT ceramics, regardless of the resin cement shade. The presence of A3-shade RC resulted in higher chroma than the presence of A1-shade RC.

Conclusions

Darker underlying RC layer promoted more pronounced changes in ceramic translucency, chroma, and shade of high translucent ceramic veneers. These differences may not be clinically differentiable.

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.

Influence of type of cement on the color and translucency of monolithic zirconia

STATEMENT OF PROBLEM

With the development of translucent zirconia, questions regarding the influence of cements on the final color of monolithic zirconia restorations have arisen.

PURPOSE

The purpose of this in vitro study was to evaluate color changes in terms of the perceptibility and acceptability of monolithic zirconia-and-cement combinations with 2 monolithic zirconia thicknesses and 3 types of cement. The translucency parameters of these combinations were also compared.

MATERIAL AND METHODS

Sixty monolithic zirconia ceramic disks were milled with 2 different thicknesses (0.6 mm and 1 mm). A conventional glass ionomer cement, a resin-modified glass ionomer cement, and a resin cement from the same manufacturer were applied to the ceramic surfaces of both thickness disks (n=10). Translucencies and color changes of the monolithic zirconia specimens after cement application were examined by using a spectrophotometer, and translucency parameters (TPs) and color changes (ΔEs) were calculated and statistically analyzed.

RESULTS

Colors and TPs of the zirconia disks changed significantly after being cemented to 0.6- and 1-mm-thick disks (P<.05). The lowest ΔE values (3.53 for the 0.6-mm and 2.23 for the 1-mm thick disks) were observed for the zirconia-resin modified glass ionomer combination, whereas the highest ΔE values (5.64 for the 0.6-mm and 5.06 for the 1-mm thick disks) were observed for the zirconia-resin cement combination. The glass ionomer cement most strongly affected the TP values of both of the thicknesses.

CONCLUSIONS

Cement types and zirconia thickness affected the colors and translucencies of the monolithic zirconia specimens.

Color changes in resin cement polymerized with different curing lights under indirect restorations

Aim:

The aim of the study was to investigate the effects of different interface materials and curing units on color changes in a resin cement material.

Materials and Methods:

Three interface materials and different curing systems, quartz-tungsten-halogen and polywave and monowave light-emitting diode (LED) light curing units, were studied at two-time intervals. Polystyrene strip was used as a control group. All measurements were made on a white background for standard color measurement. According to the CIE L*a*b* color space, the baseline color values of each specimen were measured. Differences between the measurements were calculated as ΔE, ΔL, Δa, and Δb. Data were analyzed using analysis of variance (ANOVA) and Duncan's tests (α = 0.05) with SPSS 20.0 software (SPSS Inc., Chicago, IL, USA). ANOVA revealed significance for interface materials and curing units and time for ΔE (P < 0.05).

Results:

Interaction between polymerizing units, material and time was not significant (P > 0.05). Monowave LED exhibited significantly higher color changes than the other units ([P < 0.05] [ΔE 2.94 ± 0.44]). QTH promoted composite specimens significantly less color change ([P < 0.05] [ΔE 0.87 ± 0.41]).

Conclusion:

This study concluded that color of resin cement used in the adhesion of indirect restorations was affected by curing device light and indirect restoration material type.

Digital Smile Design for Computer-assisted Esthetic Rehabilitation: Two-year Follow-up

OBJECTIVE

The esthetics of the smile are related to the color, shape, texture, dental alignment, gingival contour, and the relationship of these with the face.

PURPOSE

To present a two-year follow-up for an esthetic rehabilitation clinical case in which the method of digital smile design (DSD) was used to assist and improve diagnosis, communication, and predictability of treatment through an esthetic analysis of the assembly: face, smile, periodontal tissue, and teeth.

CLINICAL PROCEDURE

The smile's esthetics were improved through gingival recontouring, dental home bleaching, and a restorative procedure with thin porcelain laminate veneers using lithium disilicate glass-ceramic (e.max Ceram, Ivoclar-Vivadent) laminates on teeth 4 through 13.

DISCUSSION

The proposed technique had an acceptable clinical performance at the end of a two-year follow-up.

SIGNIFICANCE

DSD can be used to increase professional/patient communication and to provide greater predictability for the smile's esthetic rehabilitation.

The influence of resin cements on the final color of ceramic veneers

PURPOSE

To evaluate the effect of three brands of resin cement on the final color of ceramic veneers.

METHODS

50 disk-shaped ceramic specimens (IPS e.Max, 0.6mm×8.0mm diameter) and disk-shaped composite resin background specimens (4.0mm×8.0mm diameter) were prepared and divided into 10 groups (n=5). These paired specimens were bonded using ten shades of resin cement (Variolink Veneer, shades LV-3, LV-2, MV, HV+2, HV+3; Panavia F, shades light and brown; and RelyX™ Veneer, shades WO, TR, A3). A spectrophotometer (VITA Easyshade) was used to measure the color parameters (CIE L*a*b* values) of the paired disks before and after cementation. The color differences (ΔE values) after cementation were calculated and statistically analyzed by the One-way ANOVA (at the significant level p<0.05).

RESULTS

The color parameters of the ceramic disks were measured in terms of the increase in L* value, and the decrease in Cab(*) value after bonding with the resin cement. The ΔE values of ceramic disks after cementation ranged from 1.38 to 7.16. The ΔE values were more than 3.3 when the ceramic disks were cemented with resin cements in shade HV+3 (4.90) and shade WO (7.16). One-way ANOVA of ΔE values revealed significant differences in the resin cement shades.

CONCLUSIONS

Resin cements can affect the final color of ceramic veneer restorations, and the extent of this effect varies according to the resin cement shades.

Management of the single discoloured tooth. Part 2: Restorative options

This is the second article of a two part series covering the aetiology, prevention and broad range of management options for the single discoloured tooth. The article covers situations where masking and simulation techniques with direct composite are required. Direct composite, indirect composite and ceramic veneers are then considered, as well as full coverage crowns. The option of extraction of the affected tooth and its prosthodontic replacement will also be considered. Clinical cases are used to illustrate various scenarios.

CLINICAL RELEVANCE

The single discoloured tooth is a commonly encountered clinical problem in general dental practice. A wide variety of management options exist and it is recommended that general dental practitioners consider adopting minimally invasive techniques in the first instance before moving on to more invasive therapies.

Achieving the desired colour in discoloured teeth, using leucite-based CAD-CAM laminate systems

OBJECTIVES

To evaluate the cumulative effect of the abutment tooth and resin cement colour on the resultant optical properties of porcelain laminate veneers (PLVs) fabricated with leucite-based CAD/CAM blocks with different shades and thicknesses.

METHODS

A total of 224 ceramic specimens were prepared from the IPS Empress CAD with four different shades of HT-A1, LT-A1, MT-A1 and Bl-1. Resin composite discs were prepared with shade A3.5. For the cementation, 4 different shades of light-cure resin cements were chosen. L*, a*, and b* values, as well as the chroma (C) and hue (h) values of each cemented ceramic and the A1 shade table, were recorded.

RESULTS

L*, Cab* and hab* values of the cemented ceramics were influenced by ceramic shade, ceramic thickness, cement shade, and interaction terms of the three variables. There were significant differences between the 1-mm-thick ceramic veneers that exhibited higher L* and lower Cab* values compared with veneers that were 0.5mm in thickness. Using the Tr shade cement resulted in lower L* and higher Cab* values for all thicknesses and ceramic shades, whereas the WO shade cement resulted in higher values.

CONCLUSIONS

The selected colour of a laminate restoration is significantly affected by the ceramic shade, ceramic thickness and resin cement shade. Using the WO shade resin cement seems to be more effective in masking the discoloured abutment tooth. Clinicians should also select the translucency level of the ceramic block with the shade when a leucite-based CAD/CAM system is chosen to treat a discoloured tooth.

Effect of resin cement and ceramic thickness on final color of laminate veneers: an in vitro study

STATEMENT OF PROBLEM

Different shades of resin cements may adversely affect the final color of translucent restorations, especially thin laminates.

PURPOSE

The purpose of this study was to determine the effect of different types and shades of resin cement and different thicknesses and shades of IPS Empress Esthetic ceramics on the final color of laminate restorations.

MATERIAL AND METHODS

A total of 392 disks were made with A1, A3, EO, and ET shades of IPS Empress Esthetic with 0.5-mm and 1-mm thicknesses. Two dual-polymerizable and 2 light-polymerizable resin cement systems from different manufacturers (a total of 13 shades) were selected for cementation (n=7). Similarly, with porcelain ingot shades A1 and A3, opaque and translucent shades were selected from the Rely X Veneer and Maxcem Elite cement systems. For the opaque and translucent shades of the Variolink II resin cement system, the highest and lowest (+3 and -3) and medium (0) shades of Variolink Veneer cement were included in the study. Color changes in the porcelain substructures after cementation were examined with a colorimeter, and color differences (ΔE) were calculated. The results were analyzed with Wilcoxon signed-ranks and Kruskal-Wallis tests (α=.05).

RESULTS

The results indicated that the color of porcelain disks changed significantly after cementation (P<.001). Most of the color changes appeared after cementation with Variolink-3 Veneer in all porcelain shades. The smallest color change was obtained from Variolink II Tr in the EO shade of porcelain. The colors of the same shades of different resin cement systems were found at different coordinates in the CIE L*a*b* system. The final color difference (ΔE) of cemented veneers decreased when ceramic thickness increased.

CONCLUSIONS

The type and shade of resin cement and the thickness and shade of the ceramic all influenced the resulting optical color of laminate restorations.

Effect of substrate shades on the color of ceramic laminate veneers

STATEMENT OF PROBLEM

Ceramic laminate veneers are generally fabricated with varying thicknesses ranging from 0.3 to 1 mm, depending on the need to mask discolored teeth or slightly correct the contour of malpositioned teeth. Clinical color reproduction poses a challenge because of color interaction with the underlying substrate, whether tooth structure or esthetic restorative material.

PURPOSE

The purpose of this in vitro investigation was to measure the effect of color change resulting from applying 2 shades of ceramic material, translucent (T1) and opaque (O2), to 2 shades of composite resin substrate material, light (A3) and dark (C4), on the overall color of ceramic laminates.

MATERIAL AND METHODS

Forty disks were fabricated. Twenty disks (15 × 0.5 mm) were cut from pressed ceramic, 10 disks for each shade (translucent and opaque). Additionally, 20 disks (15 × 4.0 mm) were fabricated from light-polymerized composite resin material, 10 disks for each shade (light and dark). The ceramic disks were bonded to the composite resin disks with clear resin cement. The specimen combinations were divided into 4 groups (n=5). Color measurements were done with a colorimeter (Minolta Chroma Meter CR-200b) configured with diffuse illumination/0-degree viewing geometry. Mean CIE lightness (L*), chroma (C*(ab)), and hue angle (h(ab)) values were obtained. A 2-way analysis of variance (ANOVA) was used to compare the means and standard deviations between the different color combinations (α=.05), followed by Tukey's HSD post hoc test for significant interactions.

RESULTS

The 2-way ANOVA showed significant differences (P<.001) in L*, C*(ab), and h(ab) for a change in the composite resin substrate, regardless of the ceramic material shade. There was significant color change from dark to light substrate (P=.044). The mean h(ab) (SD) of dark substrate/opaque veneer was 89.62 (1.5), while the mean h(ab) of light substrate/translucent veneer was 81.23 (1.7).

CONCLUSIONS

Within the limitations of this study, the selected color of a 0.5 mm ceramic laminate veneer was significantly affected by the change in color of the supporting substrate.

The effect of dentin desensitizer on shear bond strength of conventional and self-adhesive resin luting cements after aging

This study tested the impact of Gluma Desensitizer on the shear bond strength (SBS) of two conventional (RelyX ARC, Panavia 21) and two self-adhesive (RelyX Unicem, G-Cem) resin luting cements after water storage and thermocycling. Human third molars (N=880) were embedded in acrylic resin. The buccal dentin was exposed. Teeth were randomly divided into four main groups, and the following cements were adhered: 1) RelyX ARC, 2) Panavia 21, 3) RelyX Unicem, and 4) G-Cem. In half of the teeth in each group, dentin was treated with Gluma Desensitizer. In the conventional cement groups, the corresponding etchant and adhesive systems were applied. SBS of the cements was tested after 1 hour (initial); at 1, 4, 9, 16, and 25 days of water storage; and at 1, 4, 9, 16, and 25 days of thermocycling. SBS data were analyzed by one-way analysis of variance (ANOVA); this was followed by the post hoc Scheffé test and a t-test. Overall, the highest mean SBS (MPa) was obtained by RelyX ARC (ranging from 14.6 ± 3.9 to 17.6 ± 5.2) and the lowest by Panavia 21 in combination with Gluma Desensitizer (ranging from 0.0 to 2.9 ± 1.0). All tested groups with and without desensitizer showed no significant decrease after aging conditions compared with baseline values (p>0.05). Only the Panavia 21/Gluma Desensitizer combination showed a significant decrease after 4 days of thermocyling compared with initial values and 1 day thermocycling. Self-adhesive cements with Gluma Desensitizer showed increased SBS after aging conditions (ranging from 7.4 ± 1.4 to 15.2 ± 3) compared with groups without desensitizer (ranging from 2.6 ± 1.2 to 8.8 ± 2.9). No cohesive failures in dentin were observed in any of the test groups. Although self-adhesive cements with and without desensitizer presented mainly adhesive failures after water storage (95.8%) and thermocyling (100%), conventional cement (RelyX ARC) showed mainly mixed failures (90.8% and 89.2%, after water storage and thermocyling, respectively). Application of the Gluma Desensitizer to dentin before cementation had a positive effect on the SBS of self-adhesive cements.