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

Impact of liner treatment on the translucency of CAD/CAM multi-colored lithium disilicate and multi-layered zirconia implant-supported crowns, and evaluation of fracture strength of ceramic crowns

This study aimed to evaluate the optical properties of liner-treated CAD/CAM Multi-colored lithium disilicate (Amber Mill Direct; AMD) and multi-layered zirconia (Omega multi; OM) implant-supported crowns, as well as their effect on the fracture strength of Ti or Zr abutments to which they were applied. After sintering AMD and OM ceramic blocks, they were classified into three groups: untreated, liner-treated, and liner-treated with added color. Optical properties were evaluated by analyzing color differences using background materials to assess translucency and the masking ability of liner-treated ceramics. Subsequently, the fracture strength of implant-supported crowns applied to Ti or Zr abutments was measured, and statistical analysis was conducted using Weibull statistics. Untreated AMD exhibited the highest translucency. Liner treatment reduced translucency in both ceramics, while color-added liner treatment increased translucency. Liner-treated AMD showed greater color difference compared to OM, whereas color-added liner treatment reduced the color difference. Fracture strength was highest in Ti abutment-OM crowns (548.03 N) and lowest in Zr abutment-AMD crowns (283.58 N). Additionally, the Weibull coefficient was over twice as high in Ti abutment-AMD crowns (m = 17.500). Color liners can adjust the high translucency of lithium disilicate ceramics to block discoloration, providing natural tooth-like color and enabling the creation of esthetic restorations. Furthermore, lithium disilicate ceramic crowns applied to Ti abutments exhibited high Weibull coefficients and fracture strengths.

Translucency and colour masking ability of hybrid CAD/CAM materials with different thicknesses: in vitro study

OBJECTIVE

To evaluate effect of material thickness and translucency of two different hybrid CAD/CAM materials on their masking ability.

MATERIALS AND METHODS

40 rectangular-shaped specimens (12 × 14 mm) were obtained from Vita Enamic and Grandio blocks at 0.5 and 1 mm-thick (n = 10/group). Colour parameters of specimens were measured on PMMA tooth-coloured replica backgrounds (A2, C4) and black, white backings using dental spectrophotometer. Translucency parameter (TP) and masking ability (∆E00) values of tested materials with 0.5, and 1 mm thicknesses were calculated. Quantitative variables were compared between groups using student t-test.

RESULTS

TP and ∆E00 significantly decreased as thickness of tested materials increased. Grandio showed significantly higher TP values. There were significantly lower ΔE00 values for Vita Enamic compared to Grandio at 1 mm thickness and inversely insignificant at 0.5 mm. The 0.5 mm-thick ∆E00 of tested materials was above clinical acceptability threshold, whereas, 1 mm-thick did not exceed showing better masking properties.

CONCLUSIONS

Thickness is more effective for colour masking than translucency. In thin thickness, the masking ability is less effective, irrespective of tested materials. Translucency of tested materials was affected by their composition. Both hybrid CAD/CAM materials are promising alternatives for masking dark discolouration at 1 mm-thick.

Assessment of color stability and translucency of various CAD/CAM ceramics of different compositions and Thicknesses: An in vitro study

Background

Translucency and optical characteristics significantly affect the aesthetics of ceramic restorations. The introduction of new virgilite crystals to novel ceramic advanced lithium disilicate through a matrix firing process enhances the material's strength and aesthetic quality according to the manufacturer.

Materials and Methods

Four types of CAD/CAM ceramics; lithium disilicate (LD), leucite reinforced (LR), advanced lithium disilicate (ALD), and zirconia-reinforced lithium silicate (ZLS) exposed to different staining solutions (tea, cola, coffee, and distilled water). Each ceramic type had 120 specimens, divided into subgroups based on thickness (0.5 mm, 1 mm, and 1.5 mm). Color changes (ΔE00) and translucency parameters (TP00) were measured after thermocycling, and spectrophotometry was employed to evaluate ΔE00 and TP00 after 1, 7, and 30 days of exposure to the staining solutions.

Results

ZLS exhibited the lowest color stability, while lithium LD and ALD displayed the highest. Thickness significantly affected color stability, with 0.5 mm thickness showing the least change. The duration of exposure also impacted color changes, with 30 days causing the most significant shift. LD demonstrated the highest translucency. Coffee and tea induced more pronounced reductions in translucency and color stability compared to the control group.

Conclusions

Material structure, thickness, staining solution, and exposure duration significantly influenced the color stability and translucency of CAD/CAM ceramics, with LD and ALD demonstrating superior color stability and LD exhibiting the highest translucency.

Quantitative examination of factors influencing the colour reproduction ability of lithium disilicate glass-ceramics

BACKGROUND

Effects of ceramic translucency, layer thickness, and substrate colour on the shade of lithium disilicate glass-ceramic restorations proved to be significant in several studies, however, quantitative, numerical results on the relationship between the colour difference and these parameters are still lacking. The purpose of this in vitro study was to quantitatively determine how the colour reproduction ability of a lithium disilicate glass-ceramic is affected by its translucency, layer thickness, and substrate colour.

METHODS

Ceramic samples were prepared from A2 shade IPS e.max CAD blocks with high and low translucencies (HT and LT) in a thickness range of 0.5-2.5 mm (+/- 0.05 mm). Layered samples were acquired utilizing composite substrates in 9 shades; transparent try-in paste was used. The spectral reflectance of the specimens was assessed under D65 standard illumination with a Konica Minolta CM-3720d spectrophotometer. The CIEDE2000 colour difference (ΔE00) between two samples was analysed using perceptibility and acceptability thresholds set at 50:50%. Statistical analysis involved linear regression analysis and the Kruskal-Wallis test.

RESULTS

An increase in the thickness of 0.5 mm reduced the ΔE00 of the HT samples to 72.8%, and that of the T samples to 71.1% (p < 0.0001). 7 substrates with HT and LT specimens had significantly different results from the mean (p < 0.05). A thickness of 0.5 mm is not sufficient to achieve an acceptable result at any level of translucency, while the low translucency ceramic at a thickness of 1.5 mm gave acceptable results, except for severely discoloured substrates (ND8 and ND9).

CONCLUSIONS

The colour reproduction ability of lithium disilicate glass-ceramics is significantly affected by their translucency, layer thickness, and 7 substrates out of 9 substrates examined.

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.

Effect of Different Scaling Methods on the Surface Topography of Different CAD/CAM Ceramic Compositions

This study evaluated the effect of ultrasonic and manual scaling using different scaler materials on the surface topography of computer-aided designing and computer-aided manufacturing (CAD/CAM) ceramic compositions. After scaling with manual and ultrasonic scalers, the surface properties of four classes of CAD/CAM ceramic discs: lithium disilicate (IPE), leucite-reinforced (IPS), advanced lithium disilicate (CT), and zirconia-reinforced lithium silicate (CD) of 1.5 mm thickness were evaluated. Surface roughness was measured before and after treatment, and scanning electron microscopy was used to evaluate the surface topography following the performed scaling procedures. Two-way ANOVA was conducted to assess the association of the ceramic material and scaling method with the surface roughness. There was a significant difference in the surface roughness between the ceramic materials subjected to different scaling methods (p < 0.001). Post-hoc analyses revealed significant differences between all groups except for IPE and IPS where no significant differences were detected between them. CD showed the highest surface roughness values, while CT showed the lowest surface roughness values for the control specimens and after exposure to different scaling methods. Moreover, the specimens subjected to ultrasonic scaling displayed the highest roughness values, while the least surface roughness was noted with the plastic scaling method.

Influences of Different CAD/CAM Ceramic Compositions and Thicknesses on the Mechanical Properties of Ceramic Restorations: An In Vitro Study

The aim of this study was to assess the influences of different CAD/CAM ceramic compositions and thicknesses on the surface roughness and hardness of ceramic restorations. Four different ceramics were used in the current study: lithium disilicate (LD), leucite reinforced (LE), advanced lithium disilicate (ALD), and zirconia-reinforced lithium silicate (ZLS). Each group included 30 specimens subdivided into three different ceramic thicknesses (0.5, 1 and 1.5 mm thicknesses). The microhardness was measured for all the specimens using a microhardness testing machine, while the surface roughness was measured using a non-contact optical profilometer at three intervals (before toothbrushing and after toothbrushing, with and without toothpaste). Three-way and two-way ANOVA were used to determine the factors influencing the surface roughness and microhardness. There was a significant difference in the surface roughness between the studied groups for all the thicknesses. The findings showed that ALD had the lowest surface roughness, while ZLS showed the highest surface roughness. Moreover, ALD, followed by ZLS, had the highest hardness, while LD and LE had the lowest hardness values. Regarding the thicknesses, both the 0.5 and 1 mm ceramic thicknesses showed a significantly lower surface roughness than the 1.5 mm thickness, while the 1.5 mm thickness showed a significantly higher microhardness than the 0.5 mm thickness. The surface roughness and hardness were significantly affected by the ceramic composition and type of filler. It is recommended to use 1.5 mm-thick ceramic materials for the fabrication of definitive full-coverage ceramic restorations, while veneers require 0.5 mm-thick materials. ALD is a promising CAD/CAM material that can be used for the fabrication of restorations with a proper strength in both anterior and posterior regions.

Influence of Surface Type with Coffee Immersion on Surface Topography and Optical and Mechanical Properties of Selected Ceramic Materials

BACKGROUND The aim of this study was to assess and compare the effect of surface type (glazed or polished) with coffee immersion and aging on surface topography (Ra), optical properties (TP, OP), and mechanical properties (fracture forces and modes) of zirconia-reinforced lithium silicate (Vita Suprinity), hybrid polymer-infiltrated-feldspathic ceramic network material (Vita Enamic), and leucite-containing feldspathic glass (Vitablocs® Mark II) made by computer-aided design and computer-aided manufactured (CAD/CAM) ceramic materials. MATERIAL AND METHODS Fifty-four specimens were assembled out of the above 3 CAD/CAMs ceramic materials. Each group was divided into glazed or polished surfaces, having 9 specimens of every type and stained in coffee for 15 days. Ra and color of specimens in the form of TP and OP were recorded before and after immersion in staining material. Fracture forces and modes were analyzed after the 90-day aging. Data were analyzed using ANOVA, then post hoc analysis and Bonferroni tests. RESULTS Our study found significant differences in Ra, TP, and Op before and after coffee immersion between glazed and polished specimens, with higher values in the polished surfaces among the 3 ceramic materials. The highest values of fracture resistance were noted in Vita Suprinity, and Vita Enamic had the lowest values, without significant differences among groups. CONCLUSIONS Most of the TP and OP values were in acceptable clinical range, and Vita Suprinity had superior TP than the other groups. Reparable fracture types were observed in Vita Suprinity, whereas semi-reparable and non-reparable were predominant in other groups.

Effects of background color and thickness on the optical properties of CAD-CAM resin-matrix ceramics

STATEMENT OF PROBLEM

Information regarding the masking ability of computer-aided design and computer-aided manufacture (CAD-CAM) resin-matrix ceramic materials with different compositions is scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the effects of background color and thickness on the optical properties (color and translucency) of CAD-CAM resin-matrix ceramics.

MATERIAL AND METHODS

Twelve rectangular specimens were fabricated at a different thickness (1, 1.5, and 2 mm) (n=12) from each of the resin-matrix ceramic materials: Shofu block (SB), Lava Ultimate (LU), CERASMART (CS), VITA ENAMIC (VE), Crystal Ultra (CU), and the VITABLOCS Mark II feldspathic ceramic (VB). The color of the specimens over amalgam, titanium, enamel, and dentin backgrounds was measured with a spectrophotometer, and the color differences (ΔE∗ab) were calculated by using the Commission Internationale de l'Eclairage (CIE) 76 formula. The difference in color of the specimen over the black and white backgrounds was used to calculate the translucency parameter (TP). ANOVA was used to statistically test whether material, background, and thicknesses influenced ΔE∗ab and TP values. Post hoc comparisons were performed to determine the significant difference among the groups (α=.05).

RESULTS

The interaction with 2 between factors demonstrated that the material was a factor that significantly influenced ΔE∗ab (P<.001). The highest mean ±standard deviation of ΔE∗ab was recorded in the combination of VB material and 2-mm thickness (1.84 ±0.37), and the lowest with CS material with 1.5-mm thickness (0.47 ±0.24). The type of material and specimen thickness significantly influenced TP (P<.001). The highest and lowest mean ±standard deviation of TP were recorded for the 1-mm-thick CS (14.20 ±0.90) and 2-mm-thick SB (4.91 ±0.42) specimens, respectively.

CONCLUSIONS

CERASMART resin-matrix ceramic and VITABLOCS Mark II feldspathic ceramic exhibited high and low masking abilities over the investigated background substrates, respectively. However, irrespective of the thickness, all study materials exhibited acceptable masking abilities.

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.