Staining Beverages and Cigarette Smoke on Composite Resin and Human Tooth Fluorescence by Direct Spectrometry

Impact of smoking on resin bonded restorations: A narrative review

INTRODUCTION

Smoking is a common risk factor for multiple diseases, including diabetes mellitus, cardiovascular diseases, pulmonary diseases, and different cancers. It is an established cause of multiple oral health conditions, in addition to adversely impairing the appearance of oral tissues. Smoking has also been identified to impact dental restorations' functional and esthetic aspects. This narrative review is focused on the significance of the esthetic consequences of smoking on resin-based dental restoration. It provides an understanding of the challenges dental professionals and patients face.

METHODS

A literature search was conducted to identify studies on the impact of smoking exposure on the esthetic appearance of composite restorations. The inclusion criteria were met by five studies selected for analysis.

RESULTS

The studies revealed that conventional cigarettes cause more noticeable color changes than electronic cigarettes. Additionally, the choice of composite material significantly influences the color stability of dental restorations. Exposure to both smoking and staining agents could worsen the color alterations in dental restorations. Smokers may benefit from dental ceramics, which offer better aesthetics. Quantitative insights into these effects can be gained by incorporating delta E (ΔE) values and fluorescence intensity in esthetic evaluations.

CONCLUSIONS

The studies provide valuable insights into the multiple factors that can impact the aesthetics of dental restorations. Dental professionals should take into account the smoking type, composite material, and patient habits when planning treatments. Utilizing ΔE values and fluorescence intensity in esthetic evaluations can provide a more comprehensive understanding. Future research should focus on longitudinal studies, alternative materials, and individual patient profiles.

Effect of Commercial Mouth Rinses on Physical Properties of Conventional and Bulk-fill Resin Composites

OBJECTIVE

To evaluate the effects of commercial mouth rinses on color, roughness, sorption (SR), and solubility (SL) of resin composites.

METHODS AND MATERIALS

Disc-shaped specimens (stage I: 6 mm × 2 mm; stage II: 10 mm × 1.5 mm) were made from the following resin composites (n=10): conventional nanofilled (Filtek Z350XT, 3M Oral Care), conventional nanohybrid (Luna, SDI), bulk-fill nanofilled (Filtek One Bulk-Fill, 3M Oral Care), and bulk-fill nanohybrid (Aura Bulk-Fill, SDI) exposed to distilled water (control), blue mouth rinse without alcohol (Colgate Total 12 Clean Mint, Colgate-Palmolive), or blue mouth rinse with alcohol and essential oil (Listerine Tartar Control, Johnson & Johnson). In stage I, tests were performed at the baseline, and after the immersion in solution time points to evaluate coordinates of the CIEL*a*b* system (ΔL*, Δa*, Δb*), general color change (ΔEab, ΔE00, and ΔSGU), and surface roughness (Ra). In stage II, SR and SL were evaluated (ISO 4049:2019) after immersion in the solutions for 7 days. The results were evaluated by generalized linear models (Ra, SR), Kruskal-Wallis, and Dunn tests (color, SL), with α = 0.05.

RESULTS

There were no significative differences for Ra between the solutions. Both mouth rinses promoted significantly negative ΔL* (Luna), Δa* (Filtek One Bulk-fill), and Δb* (all materials except conventional nanofilled resin composite). Mouth rinse without alcohol promoted significantly negative Δa* on all resin composites tested. Both mouth rinses promoted higher ΔEab and ΔE00 for bulk-fill resin composites compared to control. Mouth rinse with alcohol caused higher ΔSGU for bulk-fill nanofilled resin composite. It also promoted greater SR in all the resin composites compared with mouth rinse without alcohol and higher SR in nanohybrid resin composites compared with control. Both mouth rinses promoted higher SL values in Luna and differed significantly from control.

CONCLUSIONS

The physical properties were manufacturer dependent and mediated by mouth rinses. The mouth rinses promoted color changes in the resin composites, pointing out that bulk-fill resin composites were more affected by these effects, especially when the mouth rinse contained essential oil and alcohol.

Effect of Activated Charcoal Toothpaste on Color Stability of Bleached Teeth Immersed in Different Drinks

OBJECTIVE

This study aimed to evaluate the effect of activated charcoal toothpaste on the color stability of teeth subjected to tooth bleaching and pigmenting agents.

METHODS

A total of 120 bovine crowns were randomly divided into 12 groups (n=10) according to two study factors: staining solutions (three levels): saliva (control), coffee, and red wine; and toothpaste (four levels): BPC, Bianco Pro Clinical (Bianco Oral Care) (Control); BIW, Black is White (Curaprox); BCA, Bianco Carbon (Bianco Oral Care); and NAT, Natural Suavetex (Suavetex). The samples were subjected to office bleaching with a 35% hydrogen peroxide-based gel (Whiteness HP Blue, FGM), followed by immersion in the solution for 45 minutes per day and daily toothbrushing for 7 days. The color (ΔE) and luminosity changes (ΔL*) were measured using reflectance spectroscopy (Vita EasyShade). The CIE values (L*, a*, b*) were measured at baseline after bleaching (T0) and immediately after immersion in solution each day (Ti1-Ti7) and after all toothbrushing cycles (Tb1-Tb7). ΔE and ΔL were analyzed using a two-way analysis of variance and Tukey's test (α=0.05). The clinically unacceptable level of ΔE > 3.3 was used to evaluate the color change.

RESULTS

The color change was significantly influenced by the staining solutions and toothpastes (p<0.001). The color change (ΔE) was significantly higher when immersed in wine than in coffee, and lower ΔE values were observed for artificial saliva (control), irrespective of the toothpaste used. In artificial saliva, BPC, BIW, and BCA resulted in significantly lower ΔE values than NAT, which presented a clinically unacceptable level of dental color change (ΔE>3.3). Coffee resulted in a lower (L*) reduction than wine, irrespective of the toothpaste used.

CONCLUSION

Charcoal toothpastes resulted in a color change on the surface of the tooth enamel (ΔE). The bleaching effect of the charcoal toothpastes and control evaluated in this study partially reduced the color changes on the surface of the tooth enamel caused by staining solutions but was unable to reestablish the measured values to the baseline. For teeth immersed in artificial saliva, the color change was not noticeable in BCA, BIW, and control-BPC (ΔE≥3.3), except for NAT, which showed a significant color change.

Effects of conventional and heated tobacco product smoking on discoloration of artificial denture teeth

STATEMENT OF PROBLEM

Cigarette smoke can cause discoloration of artificial denture teeth. However, studies on the effects of heated tobacco product smoke on artificial denture teeth are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effects of conventional cigarette and heated tobacco product smoke on the color stability of artificial denture teeth.

MATERIAL AND METHODS

Ninety maxillary central incisor denture teeth (Endura Anterior HC5 A3; Shofu) were randomly divided into 3 groups (n=30). Teeth in the control group were exposed to air; those in group CC were exposed to conventional cigarette (Marlboro Medium; Philip Morris) smoke, and those in group HT were exposed to heated tobacco product (IQOS 2.4 plus holder, Marlboro Heets Silver; Philip Morris) smoke. Before the experiment, the shade of the artificial denture teeth was evaluated in accordance with the Commission International de I'Eclairage (CIELab) color system by using a spectrophotometer (Shadepilot; DeguDent GmbH). The average CIELab value was estimated by scanning the entire labial surface of each specimen. To simulate smoking, standard conditions described by the Coresta Recommended Method N°22 were used-the puff duration was 2 seconds, with a 60-second interval between puffs. For each cigarette, 6 puffs and 6 intervals were simulated across 372 seconds. A total of 105 cigarettes were used based on a smoking simulation of 15 cigarettes each day for 7 days. The teeth in the control group were stored in fresh air in the smoke chamber for the same period as those in the experimental groups. After the experiment, L∗, a∗, and b∗ values were measured, and ΔE was calculated to evaluate the color change. All statistical analyses were performed with a statistical software program using a paired t test to determine discoloration after exposure to cigarette smoke. One-way ANOVA and the Tukey test were used to evaluate the significant differences between groups (α=.05).

RESULTS

Lightness was significantly lower in the CC and HT groups (P<.001). All CIELab values showed statistically significant differences in the CC group. The greatest color change was observed in the CC group (ΔE=6.93 ±0.59), whereas the HT group showed a clinically imperceptible color change (ΔE=0.79 ±0.21). Discoloration was minimal in the CC group (ΔE=0.34 ±0.13).

CONCLUSIONS

Conventional cigarette and heated tobacco product smoke can change the color of denture teeth. Heated tobacco product smoke causes less discoloration of denture teeth.

Optical Property Stability of Light-Cured versus Precured CAD-CAM Composites

Objective. The aim of this study was to evaluate the optical property changes after staining of precured (PC) and light-cured (LC) composites. Materials and Methods. Specimens were prepared using different LC composites (GrandioSO—Voco, Filtek Z350-3M/ESPE, Opallis—FGM, and Kalore—GC) and four PC blocks (Grandio Blocs—Voco, Lava Ultimate—3M ESPE, Brava Block—FGM, and Cerasmart—GC) from the same manufacturers (n = 20). Baseline color, gloss, translucency, and fluorescence were evaluated. The staining protocol was performed for 15 days, and the final optical properties were reevaluated. Results. The changes in each property were calculated (ΔGloss, ΔTranslucency, ΔFluorescency, ΔE  $\ast$  00). Data were analyzed by ANOVA and Tukey’s test (α = 5%). Changes in all properties were observed after staining for all materials, with darkening and reduction of gloss, fluorescence, and translucency. Nonsignificant differences were observed between the light-cured and precured materials of the same manufacturer for ΔG and ΔT, but significant differences existed for ΔF and ΔE  $\ast$  00. For ΔF, the only significant differences were observed between Brava Block and Opallis (smaller). For ΔE  $\ast$  00, only the light-cured composites GrandioSO and Z350 showed significantly less change than the corresponding blocks. Precured composites were affected the same way as light-cured ones by the staining in relation to the reduction of gloss and translucency. Conclusion. A higher reduction in fluorescence was observed for only one brand of block and was similar for the others. The two brands of light-cured materials showed less staining, while for the others, the staining was similar. The effects of staining vary according to the composite formulation.

Analysis of chemical deposits on tooth enamel exposed to total particulate matter from cigarette smoke and tobacco heating system 2.2 aerosol by novel GC-MS deconvolution procedures

Tobacco smoking contributes to tooth discoloration. Pigmented compounds in the smoke generated by combustion of tobacco can cause discoloration of dental hard tissues. However, aerosols from heated tobacco products cause less discoloration than cigarette smoke (CS) in vitro. The objective of the present study was to optimize a method for extracting the colored chemical compounds deposited on tooth enamel following exposure to total particulate matter (TPM) from CS or a heated tobacco product (Tobacco Heating System [THS] 2.2), analyze the extracts by gas chromatography coupled to time-of-flight mass spectrometry, and identify the key chemicals associated with tooth discoloration. Sixty bovine enamel blocks were exposed for 2 weeks to TPM from CS or THS 2.2 aerosol or to artificial saliva as a control. Brushing without toothpaste and color measurements were performed each week. Noticeable discoloration of enamel was observed following exposure to CS TPM. The discoloration following exposure to THS 2.2 aerosol TPM or artificial saliva was not distinguishable to the eye (ΔE < 3.3). Carbon disulfide was used to extract surface-deposited chemicals. Untargeted analyses were followed by partial least squares correlation against discoloration scores (R2 = 0.96). Eleven compounds had variable importance in projection scores greater than 2. Discriminant autocorrelation matrix calculation of their mass spectral information identified eight of the eleven compounds as terpenoids. None of the compounds were related to nicotine. Several of these compounds were also detected in THS 2.2 aerosol TPM-exposed enamel, but at lower levels, in line with our findings showing less discoloration. Compared with CS TPM exposure, THS 2.2 aerosol TPM exposure resulted in lower deposition of color-related compounds on enamel surface, consistent with minimal discoloration of dental enamel.

Color stability, Roughness, and Microhardness of Enamel and Composites Submitted to Staining/Bleaching Cycles

Objective

To compare the effect of two bleaching systems (bleaching gel and whitening strips) on the color change, roughness, and microhardness of enamel and two resin composites.

Material and methods

Two cavities were prepared on bovine enamel specimens (n = 16) and restored with two composites: a nano-hybrid [Herculite Ultra (HU)] and a micro-hybrid composite [TPH Spectra (TS)]. Baseline color (CIE L*a*b*), roughness (μm), and microhardness (kgf/mm²) were measured using a spectrophotometer, optical profilometer, and Vickers microhardness (VHN) tester, respectively. The specimens were stained with coffee for 14 days, and randomized into two bleaching groups: gel and strips (n = 8), then submitted to a 10-day bleaching/staining test. Color, roughness, and microhardness were re-measured. The outcomes were analyzed using two-way ANOVA and Fisher’s-PLSD test (α = 0.05).

Results

Gel significantly improved the color (ΔE 4.9–8.3) and increased the roughness (Ra 0.04–0.08 μm) of all substrates (p < 0.0001) compared to strips. Enamel color was significantly improved (ΔE 5.4–8.3) compared to that of HU (ΔE 2.6–4.9) and TS (ΔE 2.0–4.9) with either gels or strips. TS roughness (0.03–0.08 μm) was significantly higher than that of enamel (0.01–0.05 μm) and HU (0.02–0.04 μm). Enamel had significantly reduced microhardness compared to HU (p = 0.0144).

Conclusion

Gels produced the greatest color improvement and roughness compared to strips. Enamel had significant color improvement but had the greatest decrease in microhardness.

Clinical significance

There was unacceptable color change between enamel and the composites after the combined cyclic effects of staining and bleaching.

Effects of Exposure to Cola-Based Soft Drink on Bleaching Effectiveness and Tooth Sensitivity of In-Office Bleaching: A Blind Clinical Trial

OBJECTIVE

The purpose of this single-blind (evaluators) and parallel design study was to evaluate whether exposure to a cola-based soft drink during bleaching treatment with 35% hydrogen peroxide (HP) affects color change and bleaching-induced tooth sensitivity.

MATERIAL AND METHODS

Forty-four patients with central incisors darker than A2 were selected. Participants who did not drink cola-based soft drinks were assigned to the control group (CG), while participants who drank a cola-based soft drink at least twice a day were assigned to the experimental group (EG). For the CG, foods with staining dyes were restricted. For the EG, there was no restriction on food and patients were asked to rinse their mouths with a cola-based soft drink for 30 s, 4 times daily. For both groups, 2 sessions with three 15 min applications of 35% HP were performed. Shade evaluation was assessed via subjective (VITA classical and VITA bleacheguide shade guides) and objective methods (Easyshade spectrophotometer) at baseline, during bleaching (first, second, and third weeks), and post bleaching (1 week and 1 month). Patients recorded their sensitivity perceptions using a numerical rating scale and 0-10 visual analog scales. Variation in shade guide units and the 2 colors (DE) were evaluated with a Student's t-test (α = 0.05) and Mann-Whitney test (α = 0.05). Absolute risk of tooth sensitivity and intensity of tooth sensitivity were evaluated by a Chi-square test (α=0.05).

RESULTS

Effective bleaching was observed for both groups after 30 days, without statistical difference (p > 0.08). There was no significant difference in absolute risk of bleaching-induced tooth sensitivity between the 2 groups (p = 0.74). Higher and significant scores in pain scales were detected for the EG in comparison to the CG (p < 0.05).

CONCLUSION

Even that the cola-based soft drink exposure during in-office bleaching treatments did not affect the bleaching's effectiveness; patients reported a higher intensity in bleaching-induced tooth sensitivity.

Influence of surface treatment on the fluorescence of composite resins subjected to in situ bleaching

OBJECTIVE

Use fluorescence analysis to evaluate the effect of polishing and surface sealant on the color of composite resin bleached with carbamide peroxide and subjected to staining.

MATERIALS AND METHODS

Forty-eight composite resin specimens (Z250/Z350XT) were fabricated. After 24 hours stored in distilled water, all specimens were submitted to in situ bleaching with 16% home peroxide for 8 hours daily for a period of 14 days. Subsequently specimens were separated in three groups according to surface treatment proposed (group 1-polishing Sof-Lex; group 2-BisCover; group 3-control). After this, all the specimens were stained with red wine. A spectrofluorometer was used to evaluate the fluorescence in two readouts (L0-after surface treatment and L1-after staining).Data were analyzed by applying ANOVA using a statistical software program.

RESULTS

No differences were shown for the factor treatment and other interactions. The lowest mean fluorescence value was found for Z350XT resin (1759.18 ± 0.13) when compared with Z250 (6863.92 ± 0.13). There was significant difference in the mean fluorescence values for all surface treatments between the two different readouts L0 (4820.93 ± 0.05) and L1 (3802.17 ± 0.05).

CONCLUSION

The results suggested that all surface treatments proposed did not influenced the results of wine staining of bleached resins when compared with the control evaluated by the fluorescence method.

CLINICAL SIGNIFICANCE

The purposes of this research was to find solutions, by means of surfaces treatment, to achieve restorations with a satisfactory and similar final aspect in relation to the teeth, and avoid discrepancies related to the esthetics and longevity of the restoration.

Color stability of Lucirin-photo-activated resin composite after immersion in different staining solutions: a spectrophotometric study

INTRODUCTION

Exceptional optical properties characterize teeth. As such, an esthetic restorative material should enable the dental professional to imitate the optical properties of natural teeth accurately. IPS Empress Direct was introduced to the market with the claim that it can mimic optically dental tissues with superior clinical performance.

AIM

To evaluate the ability of IPS Empress Direct to mimic tooth appearance and color and resist staining.

MATERIALS AND METHODS

Three disc specimens were prepared for each shade of enamel and dentin of Lucirin-based composite, IPS Empress Direct (Ivoclar Vivadent) (A1, A2, A3, B1, and B2) (total of 60). The specimens were submitted to colorimetric evaluation in comparison after immersion in 10 different solutions (coffee, coffee with sugar, coffee with milk, red tea, red tea with sugar, red tea with milk, tomato juice, pomegranate juice, coke, and distilled water as a control group) for 4 weeks using spectrophotometric analysis.

RESULTS

After plotting the data and conducting linear regression analyses, IPS Empress showed high potential in mimicking the optical properties of natural tooth color according to the CIE color space. Three solutions showed a change in color higher than 3, coffee, coffee with sugar, and red tea. All other solution showed changes in color that are acceptable clinically.

CONCLUSION

IPS Empress Direct can satisfactory mimic teeth appearance and color while manifesting high stability of color resisting staining upon clinical aging.