Color stability of CAD/CAM Zirconia ceramics following exposure to acidic and staining drinks

Comparison of the Degree of Staining of Computer-Aided Design-Computer-Aided Manufacture (CAD-CAM) Ceramic Veneers by Green Tea, Coffee, and Coca-Cola Using a Digital Spectrophotometer

BACKGROUND The majority of dental professionals currently recognize lithium disilicate E-max ceramic veneers as a the most widely used, conservative, and effective cosmetic materials in dentistry. This study aimed to compare the degree of surface changes - roughness (Ra), depth (Rz), and mean color changes (ΔE₀₀) - of computer-aided design-computer-aided manufactured (CAD/CAM) ceramic veneers materials of varying thicknesses caused by staining by green tea, coffee, and Coca-Cola using digital spectrophotometer. MATERIAL AND METHODS This study was conducted at King Khalid University, College of Dentistry. Lithium disilicate glass ceramic (LDGC) material was used to create 60 rectangular slices using the CAD/CAM system. The material thickness and the type of beverage were measured. The specimens were immersed in beverages according to the manufacturer's instructions. Specimen description and tomography were completed with a 3D noncontact surface metrology using interferometry. The "VITA Easy-Shade" spectrophotometer was used to measure ΔE₀₀. It was recorded after 2 weeks for different material thicknesses after immersing samples in green tea, coffee, and Coca-Cola staining materials.f RESULTS Significant changes in ceramic thickness were found in Ra and Rz of 0.07 and 1.00 mm after 14 days of staining. Coca-Cola showed a significant difference in Ra and Rz with 1.00 mm thickness measurement compared to the 0.07 mm group with ≤ of 0.05, which was considered statistically significant. Highest ΔE₀₀ were recorded among samples stained by Coca-Cola, followed by coffee, for both thicknesses. CONCLUSIONS Those findings support previous studies using spectrophotometric analysis of staining of CAD-CAM ceramic veneers that Coca-Cola followed by coffee resulted in the greatest color ΔE₀₀ change.

Influence of Acidic Environment on the Hardness, Surface Roughness and Wear Ability of CAD/CAM Resin-Matrix Ceramics

This study aimed to measure the effect of storage environment on the hardness, surface roughness and wear ability of CAD/CAM resin-matrix ceramics. A total of 200 rectangular-shaped specimens were obtained by sectioning 5 CAD/CAM blocks; Crystal Ultra (CU), Vita Enamic (VE), Lava Ultimate (LU), Cerasmart (CS) and Vita blocks Mark II (MII). Microhardness and surface roughness were measured at baseline and after 7 days of immersion either in saliva or cola (n = 10). The wear ability of the CAD/CAM materials against steatite-ceramics antagonist was determined using a chewing simulator. The data were statistically analyzed using factorial ANOVA followed by post hoc Bonferroni multiple comparison tests (p < 0.05). The independent factors significantly influenced the microhardness and surface roughness (p < 0.05). The highest VHN was observed in MII at baseline (586.97 ± 13.95), while CU showed the lowest VHN after 7 days of immersion in cola (68.3 ± 1.89). On the contrary, the highest Ra was observed after 120,000 chewing cycles for the VE specimens (1.09 ± 0.43 µm) immersed in cola, while LU showed the lowest Ra at baseline (0.07 ± 0.01 µm). The highest % mass loss of the antagonist was observed with MII immersed in cola (1.801%), while CS demonstrated the lowest % mass loss of 0.004% and 0.007% in AS and cola, respectively. This study confirms that the surface properties of tested CAD/CAM materials are susceptible to degradation in an acidic environment except for hardness and wear of CS material.

Effect of Different Shading Techniques on the Color of Zirconia Ceramic Restoration (An In vivo Study)

BACKGROUND: The color of all ceramic restorations has a significant effect on the final appearance of the restoration. AIM: This study aimed to evaluate the effect of different shading techniques on the color stability of monolithic zirconia crowns cemented on the upper anterior teeth. METHODS: In this study, there were nine patients. Each patient has undergone a reduction for the upper six anterior teeth. Fifty-four zirconia jacket crowns were constructed using CAD/CAM technique. According to the shading technique, the crowns were categorized into two groups (pre-shaded and liquid shaded), where the upper right reduced teeth received pre-shaded zirconia crowns while the upper left reduced teeth received liquid-shaded zirconia crowns according to the selected shade. The color was assessed using easy shade after cementation and 1 year follow-up period. Data were collected, tabulated, and statistically analyzed. RESULTS: Color change (ΔE) of the cemented pre-shaded zirconia crowns on the upper right central incisors, lateral incisors, and canines was 2.37, 2.84, and 1.92, respectively, while color change (ΔE) of the cemented liquid-shaded zirconia crowns on the upper left central incisors, lateral incisors, and canines was 2.52, 2.88, and 2.77, respectively. Color change of both pre-shaded and liquid-shaded zirconia crowns after 1 year follow-up was within the clinically acceptable range 1>E>3.7, and there was no significant difference between them. CONCLUSIONS: The aging and technique of shading had no significant effect on the color of zirconia ceramic.

Color changes of dental zirconia immersed in food and beverage containing water-soluble/lipid-soluble pigments

The present study examined color changes in the tooth-colored restorative materials, zirconia (3Y-TZP), resin composite, and porcelain. The colors (CIELab) of these materials were measured using a spectrophotometer. Specimens were immersed in black tea or curry for 1 and 7 days, after which colors were re-assessed. Color differences (∆E^*ab) before and after immersion were calculated. Specimens after the 7-day immersion were ultrasonically cleaned, and colors were measured again to assess the color recovery rate. The surface free energy, roughness, and water sorption/solubility of each material were also evaluated. Specimens were observed under a scanning electron microscope. The ∆E^*ab of 3Y-TZP was the smallest with both immersions. Resin composite had the smallest recovery rate. The surface free energy and roughness of 3Y-TZP were smaller than those of porcelain. 3Y-TZP and porcelain showed almost no sorption during the 7-day period. The present results revealed that 3Y-TZP exhibited the strongest resistance to discoloration.

Physical Properties and Color Stainability by Coffee and Red Wine of Opaque and High Translucency Zirconia Dental Ceramics after Hydrothermal Degradation

The objective was to evaluate the bending strength, phase transformation, roughness, and color stainability by coffee and red wine of opaque and high translucency yttria-stabilized zirconia before and after hydrothermal degradation in saline solution or oral mouthwash. Presintered zirconia blocks with medium opacity (ZrO₂-3 mol. % of Y₂O₃) designed as ZrOp and high translucency zirconia (5.2 mol. % of Y₂O₃) designed as ZrTrans were used. Specimens (n = 80/group) were cut and sintered at 1500°C for 2 h. The specimens were hydrothermally degraded in an autoclave (134°C–1.8 kg/cm²) for 20 h in saline solution (0.5 g/L) and oral mouthwash solution (0.02% sodium fluoride, without alcohol and with 21.6% alcohol). After hydrothermal degradation, the samples were immersed in containers with coffee or red wine for 14 days to determine their color stainability. The results showed that the ZrOp had a higher bending strength than the ZrTrans before and after hydrothermal aging. In ZrOp and ZrTrans, the roughness increased after hydrothermal degradation. ZrOp samples had a higher Ra roughness than the ZrTrans samples. Roughness did not change after immersion in coffee or red wine. The X-ray diffraction (XRD) results showed that ZrOp samples underwent a tetragonal to monoclinic phase transformation, while ZrTrans samples were unchanged. Both ZrOp and ZrTrans samples changed color after immersion in coffee and red wine.

Assessment of Color Stainability of Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) Ceramic Materials After Hot and Cold Coffee Immersion at Different Time Intervals

BACKGROUND This spectrophotometric study assessed the color stability of CAD/CAM restorative materials with different exposed surfaces following staining by hot Arabic Qahwa and cold coffee. MATERIAL AND METHODS Ninety-six specimens were fabricated from 3 different CAD/CAM ceramic materials: Vita Suprinity (Vita-S), Vita Enamic (Vita-E), and Vitablocs Mark II (Vitablocs-MII). We divided 32 specimens for each group into glazed or polished surfaces, with 16 specimens in each group, then subdivided them according to staining materials: Arabic Qahwa and Frappuccino Cold Coffee. Color of specimens was measured during immersion in staining materials (BEFORE) as baseline with (Vita classic) and (L, a, b), for average color changes (ΔE₀₀), then remeasured after 2, 4, and 12 weeks, and described as 1st, 2nd, and 3rd measurements for VITAPAN Classic shade and T1, T2, and T3 for ΔE00 values using the CIE L*a*b* equation. We performed ANOVA and then post hoc testing. RESULTS We found significant differences in ΔE₀₀ values during immersing in hot Arabic Qahwa and cold coffee for tested materials in glazed or polished specimens. Polished specimens of Vita-S and Vita-E had the highest color changing and staining compared to glazed surfaces. Vitablocs-MII had the best color stability through immersion periods. Moreover, there were changes in relation to VITAPAN Classic shade guide for both Vita-S and Vita-E specimens during different immersion periods. CONCLUSIONS Coffee caused staining and contamination of ceramic material. Values of ΔE₀₀ for tested ceramic materials were significantly different but were within the clinically acceptable range. Polished specimens showed higher staining; therefore, we highly recommend re-glazing of ceramic restorations to maintain color stability.

Surface roughness and color measurements of glazed or polished hybrid, feldspathic, and Zirconia CAD/CAM restorative materials after hot and cold coffee immersion

Background

The purpose of this study evaluates and compares the effect of surface roughness (Ra) and color stability on computer-aided design/computer-aided manufacturing (CAD/CAM) hybrid resin (Vita Enamic), feldspathic (Vitablocs® Mark II), and lithium disilicate Zirconia (Vita Suprinity) glazed or polished ceramics immersed in hot Arabic Qahwa and cold coffee.

Methods

A total of 96 standardized samples were prepared from CAD/CAM restorative materials. Half of the samples were polished as per the manufacturer’s instructions using a porcelain polishing kit, and the other half were glazed. Samples were distributed and immersed in hot Arabian Qahwa and cold coffee followed by thermocycling. Ra measurements and color changes were conducted before and after immersion. SEM images were captured from each type of glazed or polished ceramic. One-way ANOVA paired Student’s t-test, and Bonferroni test were conducted to detect significant difference between the groups. P > 0.05 was a significant level.

Results

Of all the tested samples, Ra increased without any significant difference; however, mean color changes (ΔE*) showed significant differences. An increase in Ra was noted for all the glazed and polished samples after immersion and thermocycling. However, differences were significant only in VM II. In addition, ΔE* was significant only in Vita Suprinity (VS) samples. For immersion groups, significant Ra changes were noticed in glazed samples, only in Vita Enamic (VE) with no ΔE*. In polished samples, mean Ra changes were observed in VM II and VS samples. Significant differences were also noticed in polished VE and VS subgroups of ΔE*.

Conclusions

Ra affects all the tested samples, providing higher values on the polished specimens. The ΔE* caused by hot Arabic Qahwa and cold coffee on glazed or polished CAD/CAM restorative materials were clinically acceptable.

Effects of Khat on Surface Roughness and Color of Feldspathic and Zirconia Porcelain Materials under Simulated Oral Cavity Conditions

Background and Objectives: Khat chewing is considered as a daily habit that is practiced by more than five million people globally. The effect of khat chewing on the surface roughness and the color stability of natural teeth and the material used in the fabrication of dental prosthesis remains unknown. This study was conducted to explore and compare the effect of khat homogenate (KH) on the surface roughness (Ra) and the average color changes (ΔE*) amongst natural teeth and selected shades from different porcelain types, namely, feldspathic metal ceramic (MC) VM13, computer-aided design/computer assisted manufacture (CAD/CAM) feldspathic (Vitablocs Mark II), and multilayer zirconia (Ceramill Zolid PS) porcelains. Materials and Methods: Seventy samples were prepared from natural teeth, feldspathic MC, CAD/CAM Vitablocs Mark II, and zirconia porcelain. The Ra values were measured using a profilometer and expressed in micrometers, whereas the ΔE* values were measured using VITA Easyshade® V spectrophotometer for all samples before and after frequent immersion and thermocycling in KH for 30 days. The surface topography was used to assess the materials surfaces (glazed or polished) after KH immersion by using a white light interferometry machine. Results: Results revealed that the Ra and the ΔE* values of the different types of tested porcelain were influenced by KH. The order of surface roughness values was glazed or polished MC > polished Zircon > polished Vitablocs Mark II > natural teeth. The lowest ΔE* values were recorded for glazed Vitablocs Mark II and MC, and the values could be arranged as polished zircon > natural teeth > glazed zircon > polished MC > polished Vitablocs Mark II. P values were significantly varied (< 0.001) among all the tested groups, except the zircon group (>0.05) for both Ra and ΔE*. Conclusion: KH significantly affected both surface parameter and color of glazed or polished porcelain materials and natural teeth.

Effect of Grit-blasting on the Color Stability of Zirconia Ceramics Following Exposure to Beverages

Aim

The aim of this study was to evaluate the effect of grit-blasting on the color stability of zirconia ceramics following exposure to beverages.

Method

A total of 80 planar zirconia specimens were prepared from dense sintered zirconium blocks and were randomly allocated into four groups (n=20). Ten specimens from each group were grit-blasted (GB) using aluminum trioxide powder from a distance of 10 mm. The remaining 10 specimens were used as such without grit-blasting (NGB). The grit-blasted and non-grit-blasted specimens were immersed in artificial saliva, Coffee, Red Bull, and Coca-Cola at room temperature over a 28-day test period. Color measurement (ΔE) of the zirconia specimens was performed at baseline (T0) and after seven (T1), 14 (T2), and 28 (T3) days of immersion in the beverages using the Color Eye 7000A Spectrophotometer (Gretag Macbeth, New Windsor, NY). The data were analyzed using analysis of variance (ANOVA) and the post-hoc Bonferroni test. A p-value of less than 0.05 was considered statistically significant.

Result

The GB specimens immersed in coffee showed the highest color changes as compared to other groups (4.47± 0.04) and the NGB specimens stored in saliva showed the lowest ΔE values (0.83± 0.03). Energy drinks and soft drinks showed similar ΔE values at the end of the 28-day study period in both the NGB and GB groups. All the specimens, irrespective of the beverages, in both groups showed increased ΔE values at different immersion periods except for NGB specimens immersed in saliva, which showed decreased ΔE values from T2 to T3.

Conclusion

GB specimens showed increased ΔEs compared to NGB Zirconia ceramics. Among the beverages, the coffee immersion of GB specimens showed marked color changes. The specimens immersed in the energy and acidic drinks from both groups showed perceivable color changes at the end of the 28-day study period.

Colorimetric and spectrophotometric measurements of orthodontic thermoplastic aligners exposed to various staining sources and cleaning methods

Background

Manufacturers of orthodontic aligners suggest that users remove appliances every time they consume solid foods or any drink (except water). This is to avoid a color change within the clear thermoplastic material of which they are made. However, limited quantitative evidence exists to guide users and practitioners in this regard. Herein, we evaluated the color stability of the polymer forming three different American brands of aligners and the stain-removal potential of two cleansers to provide such guidelines.

Methods

The removable appliances (300 specimens, 100 per brand) were exposed to different staining agents common in a regular diet (coffee, black tea, red wine, cola) or to a control solution in vitro over 12 h or 7 days. The three brands evaluated were Invisalign®, ClearCorrect® and Minor Tooth Movement®. These were then cleaned by using either Invisalign® cleaning crystals or the Cordless Sonic Cleaner combined with a Retainer Brite® tablet. The CIELAB color space approach was used to compare color changes (ΔE) in aligners before immersion (T0), after a 12-h exposure (T1), after a 7-day exposure (T2) and after cleaning (T3). Statistical methods (Levene’s test, ANOVA, Brunner-Langer model, Tukey’s range test and t-test) were used to identify interactions between the brands themselves or between the brands and the cleaning methods. Statistical analyses were performed at the .05 significance level.

Results

A 12-h or 7-day exposure to instant coffee or red wine significantly colored the Invisalign® aligners compared to the two other brands. Black tea created an important extrinsic color change for all three brands after 7 days. Clinically, both cleaning methods showed a better efficacy in removing stains from black tea compared to other staining agents.

Conclusions

The Invisalign® aligners were more prone to pigmentation than the ClearCorrect® or the Minor Tooth Movement® devices after an exposure to coffee or red wine. Black tea caused important stains on the surface of the three tested brands. Both cleansing methods performed similarly.