Resin composite thickness' influence on L*a*b* coordinates and translucency
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(2) Resin composite thickness’ influence on L*a*b* coordinates and translucency. S. Ardu, I. Rossier, E. di Bella, I. Krejci & D. Dietschi. Clinical Oral Investigations ISSN 1432-6981 Clin Oral Invest DOI 10.1007/s00784-018-2585-9. 1 23.
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(4) Author's personal copy Clinical Oral Investigations https://doi.org/10.1007/s00784-018-2585-9. ORIGINAL ARTICLE. Resin composite thickness’ influence on L*a*b* coordinates and translucency S. Ardu 1 & I. Rossier 2 & E. di Bella 3 & I. Krejci 4 & D. Dietschi 4,5 Received: 3 August 2017 / Accepted: 17 August 2018 # Springer-Verlag GmbH Germany, part of Springer Nature 2018. Abstract Objectives To evaluate if material thickness can influence the L*a*b* coordinates and translucency of different composite shades. Materials and methods Twelve composite disc specimens made of three different resin composite materials (dentin A2, Essentia, GC; body shade A2, Brillant Everglow, Coltene-Whaledent; enamel skin neutral, Inspiro, Edelweiss DR) and of three different thicknesses 0.5, 1.0, and 1.5 mm were readied. L*a*b* coordinates of the 118 specimens were assessed by a calibrated reflectance spectrophotometer over a black as well as a white background. Results Over the black background, median ΔE00 values varied from 0.7 (Brilliant Everglow) to 1.5 (Inspiro SN) for 0.5-mm composite thickness (intrinsic color variation) and from 3.2 (Essentia) to 7.5 (Inspiro SN) for 1.0 mm, respectively 6.1 (Essentia) to 11.1 (Inspiro SN) for 1.5-mm composite thickness (color variation related to thickness). Over the white background, median ΔE00 values varied from 0.6 (Essentia) to 1.6 (Inspiro SN) for 0.5-mm composite thickness and from 2.9 (Inspiro SN) to 4.3 (Essentia) for 1.0 mm, respectively 4.9 (Inspiro SN) to 7.0 (Essentia) for 1.5-mm composite thickness. Transparency varied from 25.2% (Essentia) to 34.6% (Inspiro SN) for 0.5-mm composite thickness, from 20.3% (Essentia) to 27.5% (Inspiro SN) for 1.0-mm thickness and from 14.8% (Essentia) to 22.9% (Inspiro SN) for 1.5-mm thickness. Conclusions Material thickness can influence the L*a*b* coordinates and translucency of different composite shades. Clinical relevance L* a* b* coordinates are influenced by composite thickness. Keywords Resin composite thickness . L*a*b* coordinates . Translucency. Introduction Resin composite materials are widely used today in general practice and a large number of dentists worldwide trust them. * S. Ardu stefano.ardu@unige.ch 1. Treatment Plan Unit and Division of Cariology and Endodontology, Clinique Universitaire de Médecine Dentaire (CUMD), University of Geneva, Geneva, Switzerland. 2. Laboratory Technician, Division of Cariology and Endodontology, Clinique Universitaire de Médecine Dentaire (CUMD), University of Geneva, Geneva, Switzerland. 3. Department of Economics and Business Studies, University of Genoa, Genoa, Italy. 4. Division of Cariology and Endodontology, Clinique Universitaire de Médecine Dentaire (CUMD), University of Geneva, Geneva, Switzerland. 5. Division of Cariology, UCLA, Los Angeles, CA, USA. for numerous restorative applications in the smile frame. The esthetic results which can be achieved in routine are, in fact, largely satisfying both for dentists and patients. They also allow a substantial economy in terms of tooth substance if compared to amalgams and they are much cheaper than a conventional prosthetic based approach which require longer chair time sessions and, sometimes, expensive dental technicians intervention. Specifically, in the front area and especially for small class IV or conventional class III cavities, the utilization of free-hand bonded restorations has become the Bgolden standard^. However, the use of composite can still present difficulties such as unsatisfactory esthetic outcomes mainly due to an insufficient color match with neighboring teeth or with the tooth structure surrounding the restoration. This is why proper color selection and layering technique are key points to success. Numerous layering concepts have actually been developed which make use of different opacity and color gradients, resulting in various number of layers used tentatively to match the tooth shade [1–4]. In consideration of the variability in the.
(5) Author's personal copy Clin Oral Invest. specific optical properties of these many composite shades, no study so far investigated the possible influence of resin composite’s thickness on the color of each layer or the final restoration as a whole. Particularly there is a lack in information concerning a possible impact on the restoration esthetic outcome when different thicknesses of dentin, body, and enamel composite shades are employed. The aim of this Bin vitro^ study is therefore to test if thickness of resin composite samples made of different shades (dentin, body, and achromatic enamel shades) can influence their L*a*b* coordinates and translucency. The working hypothesis is that thickness of resin composite materials do not influence L*a*b* coordinates and translucency of different composite materials.. Materials and methods A total of 118 samples were readied for this in vitro study. Specifically, twelve 10-mm diameter disc were shaped with one enamel (SN Inspiro Edelweiss DR), one body shade (A2B2 Brillant Everglow Coltene-Whaledent), and one dentin shade (MD Essentia GC). Each resin composite material was readied in three different thickness 0.5, 1.0, and 1.5 mm (± 0.05 mm) (Table 1) and maintained in an incubator (INP-500, Memmert GmbH) at 37 °C for 1 week. All specimens were obtained by pressing a small quantity of resin composite between two glass slides to the thickness of 0.5, 1.0, and 1.5 mm for each one of the tested materials. Composite resin samples were light cured for 20 s at a distance of 1 mm with a LED curing device (Valo, Ultradent, South Jordan, USA) used in Bstandard mode^ with a power density of > 1000 mW/cm2 (checked by LED Demetron radiometer 910726, Kerr Corporation Middleton, USA). L*a*b* coordinates of the 108 specimens were assessed by a calibrated reflectance spectrophotometer (SpectroShade, MHT Handy Dental Type 713000, Serial No. HDL0090, MHT, Arbizzano di Negar, Verona, Italy) over a black as well as a white background. Color differences were expressed according to the following, classical CIEDE 2000 (ΔE00) formula:. Table 1 Resin composite specifications. ΔE*00. sffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi 0 0 0 2 0 2 0 2 ΔL ΔC ΔH ΔC ΔH : ¼ þ þ þ RT kLSL kC SC kH SH kC SC k H SH. Transparency (TP) was calculated according to the following formula:. TP ¼. h. LB * −LW *. 2. 2 2 i1=2 þ aB * −aW * þ bB * −bW *. where the subscript B refers to the color coordinates of specimens over the black background and the subscript W refers to those measurements over the white background. ΔE00 values were calculated as color difference between the median of each resin composite material at 0.5-mm thickness and individual L*a*b* values at the same thickness (color variation within the same material) and also individual L*a*b* values at 1.0- and 1.5-mm thickness (color variations in-between differences thicknesses of the same material). These calculations were repeated for all measurements made over a black as well as a white background. A statistical analysis of the results was carried out by means of repeated measures ANOVA (normality assumptions tested by the Kolmogorov-Smirnov test checked), followed by Fisher LSD post hoc test.. Results When analyzed over a black background, median ΔE00 values varied from 0.7 (Brilliant Everglow) to 1.5 (Inspiro SN) for 0.5-mm composite thickness, from 3.2 (Essentia) to 7.5 (Inspiro SN) for 1.0-mm composite thickness and from 6.1 (Essentia) to 11.1 (Inspiro SN) for 1.5 composite thickness. When analyzed over a white background, median ΔE00 values varied from 0.6 (Essentia) to 1.6 (Inspiro SN) for 0.5mm composite thickness, from 2.9 (Inspiro SN) to 4.3 (Essentia) for 1.0-mm composite thickness and from 4.9 (Inspiro SN) to 7.0 (Essentia) for 1.5 composite thickness. Transparency varied from 25.2% (Essentia) to 34.6% (Inspiro SN) for 0.5-mm composite thickness, from 20.3%. Composite. Composition. Manufacturer. Essentia (dentin). MD dentin. GC. Lot 1511201. Brillant Everglow (body). (Univesal restorative radiopaque) A2/B2 body. Coltene-Whaledent. 2018–2011 Lot G27377. Inspiro SN (enamel). (Submicron hydrid universal) Enamel Skin Neutral (Nano-hybrid). Edelweiss-Whaledent DR. Lot and expiring date. 2017–2006 Lot 750602 2018–2011.
(6) Author's personal copy Clin Oral Invest Table 2 ΔE00 values of color difference between the median and all values for each resin composite material at 0.5 mm thickness over black and white background (left column). ΔE00 values of color difference between the median of each resin composite material at 0.5 mm Composite. Essentia Brilliant Everglow Inspiro SN. Black background. White background. 0.5 mm. 1.0 mm. 1.5 mm. 0.5 mm. 1.0 mm. 1.5 mm. 0.8A. 3.2B 5.1B 7.5C. 6.1C 7.2C 11.1D. 0.6A 0.8A 1.6A. 4.3C 4.0C 2.9B. 7.0D 6.6D 4.9C. A. 0.7 1.5A. (Essentia) to 27.5% (Inspiro SN) for 1.0-mm thickness and from 14.8% (Essentia) to 22.9% (Inspiro SN) for 1.5 thickness. L*a*b* values and transparency were significantly different for the three thicknesses of each composite investigated (ANOVA, p < 0.05). A Fisher’s LSD post hoc test after allowed a grouping of the samples analyzed. All results with statistical analysis and groupings are illustrated in details in Tables 2 and 3.. Discussion This in vitro study was carried out in order to test the possible effect of resin composite thickness on color coordinates. The choice of using a spectrophotometer to measure colors was done to avoid all bias due to human eyes evaluation and in accordance with precedent studies [5–7] and the utilization of a black and a white background was aimed to mimic specific clinical situations. Black background better simulates clinical situation of anterior partial crown fracture or class IV restorations, where no tooth substance remain, while white background better simulates clinical situation of veneers and class III or V where a residual tooth substance is still present [8].. Table 3 Median % of translucency values of composites for the three thicknesses (0.5, 1.0, 1.5 mm) Composite. Essentia Brilliant Everglow Inspiro SN. thickness and values of the same material at 1.0- and 1.5-mm thickness over black and white background (central and right columns). Superscript letters (A = best, D = worst) refer to the ranking by mean of Fisher’s LSD test (significant differences of group mean for p value < 0.01). Thickness 0.5 mm. 1.0 mm. 1.5 mm. 25.2D. 20.3B 23.9C 27.5E. 14.8A 20.5B 22.9C. F. 29.6 34.6G. Superscript letters (A = best, D = worst) refer to the ranking by mean of Fisher’s LSD test (significant differences of group mean for p value < 0.01). The choice of three different composite materials resulted from the need to use and test specific opacity and color gradients which could not be found in one single restorative system; then, one dentin shade, one body shade, and one achromatic enamel from three brands and companies were selected for this study [1]. We wanted, in fact, to investigate if color variation and transparency varied independently of the composite’s transparency. Furthermore, adhesive restorations can be performed only by means of dentin (class V), body (class I or II), or enamel (chipping or small class III). Concerning the color differences calculation, several methods can be used: our choice fell on the CIEDE 2000 (ΔE00) which was considered in literature to be the most adequate in respect to human eyes color perception [9]. Moreover, its cutoff color limit of 1.8 for not acceptable differences and its detection level set at 0.8 (ΔE00) [10] are smaller than the ones proposed by the classical ΔE [11, 12]. These values represent where 50% of observers think that color differences are, respectively, disturbing or detectable [9]. Concerning data interpretation, ΔE00 at 0.5 mm represent the composite variability within the same thickness while ΔE00 at 1.0 and 1.5 mm represent the color variation due to thickness increase. This kind of analysis was carried out in order to check if thickness of resin composite samples can influence their L*a*b* coordinates and their translucency. Essentia® and Brillant Everglow® had the smallest ΔE00 increment if faced to Inspiro® when compared with the 0.5 mm median L*a*b* centroid values of each resin composite material backed by black background. On the other hand, when the white background is considered, Inspiro® had the smallest statistical increment. This behavior is easily explainable by his higher transparency, that is why L*a*b* values are highly influenced by the background employed. A similar trend was found elsewhere [13, 14] with composite of different transparency. The higher ΔE00 values recorded by Inspiro® at 0.5 mm, witnessed a higher dispersion, maybe due to some micro-.
(7) Author's personal copy Clin Oral Invest. defects within the samples related to the molding of a high viscosity material. They could be due to some imperfections in material maybe due to the fact that the batch number employed was at the beginning of the material production. The same trend was find even in a precedent study [13] with a batch number close to the one used in this in vitro investigation. It is interesting to notice that at each increment the ΔE00 changes are all classified as disturbing color differences for human eyes, independently of the background considered. This fact has to be considered as highly clinical relevant and highlights the importance of resin composite thickness on color. Moreover, even the variance at 0.5 mm of Essentia® and Inspiro® (when considered over a black background) and Brillant Everglow (when considered over a white background) are clinically detectable, even if not disturbing. This means that independently of the stratification technique employed, esthetic results can be not predictive. Inspiro® was, statistically, the most transparent composite followed by Brillant Everglow® and Essentia® independently of the thickness considered. This characteristic can be clinical relevant and, especially in front teeth, have to be considered in case of free hand bonded restoration. The difference in transparence can, in fact, highly affect the final outcome. Specifically, in class IV, a thicker than due layer of a too translucent enamel can give the restoration an unpleasant grayish aspect. On the other hand, it allows the creation of nice transparency whenever necessary. A wise balance of enamel transparency and dentin opacity can be one of the clinical keys for esthetic success [15–17]. In this paper, a double discussion based on statistic and ΔE00 differences have been proposed. Statistics represent, so far, the Bstate of the art^ based discussion but ΔE00 values tell us if these differences are perceivable by human eyes or are just merely mathematics thus without any clinical influence. This last aspect is, thus, the most relevant in clinics, due to his esthetic implications. Some general limitation must be considered due to the nature of the study: a higher number of resin composite materials and different thickness should be analyzed. Further in vivo studies are thus recommended in order to confirm or reject the here obtained results.. Conclusions Within the limitations of this study, the thickness of composite samples significantly influenced their L*a*b* and translucency. The working hypothesis stating that thickness of resin composite materials do not influence L*a*b* coordinates and translucency of the material itself has, therefore, to be rejected.. Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest. Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent For this type of study, formal consent is not required.. References 1.. 2.. 3. 4. 5.. 6.. 7.. 8.. 9.. 10.. 11. 12. 13. 14.. 15.. 16.. 17.. Dietschi D, Fahl N Jr (2016) Shading concepts and layering techniques to master direct anterior composite restorations: an update. Br Dent J 221:765–771 Ardu S, Krejci I (2006) Biomimetic direct composite stratification technique for the restoration of anterior teeth. Quintessence Int 37: 167–174 Dietschi D (2001) Layering concepts in anterior composite restorations. J Adhes Dent 3:71–80 Vanini L (1996) Light and color in anterior composite restorations. Pract Periodontics Aesthet Dent 8:673–682 Ardu S, Braut V, Gutemberg D, Krejci I, Dietschi D, Feilzer AJ (2010) A long-term laboratory test on staining susceptibility of esthetic composite resin materials. Quintessence Int 41:695–702 Ardu S, Gutemberg D, Krejci I, Feilzer AJ, Di Bella E, Dietschi D (2011) Influence of water sorption on resin composite color and color variation amongst various composite brands with identical shade code: an in vitro evaluation. J Dent 39(Suppl 1):e37–e44 Nasu T, Minesaki Y, Ito S, Kajihara H, Muraguchi K, Kadokawa A (2004) Color stability of new composite denture tooth containing reactive organic composite filler. Jap Prosthodont Soc 48:242–250 Ardu S, Braut V, Di Bella E, Lefever D (2014) Influence of background on natural tooth colour coordinates: an in vivo evaluation. Odontology 102:267–271 Luo MR, Cui G, Rigg B (2001) The development of the CIE 2000 colour difference formula: CIEDE2000. Color Res Appl 26:340– 350 Paravina RD, Ghinea R, Herrera LJ, Bona AD, Igiel C, Linninger M, Sakai M, Takahashi H, Tashkandi E, Perez Mdel M (2015) Color difference thresholds in dentistry. J Esthet Restor Dent 27(Suppl 1):S1–S9 Um CM, Ruyter IE (1991) Staining of resin-based veneering materials with coffee and tea. Quintessence Int 22:377–286 Hunter RS (1975) The measurement of appearance. Wiley, New York, pp 77–80 151-2,225,234 Ardu S, Duc O, Di Bella E, Krejci I (2017 Jan) Color stability of recent composite resins. Odontology 105(1):29–35 Gregor L, Krejci I, Di Bella E, Feilzer AJ, Ardu S (2016) Silorane, ormocer, methacrylate and compomer long-term staining susceptibility using ΔE and ΔE 00 colour-difference formulas. Odontology 104(3):305–309 Villarroel M, Fahl N, De Sousa AM, De Oliveira OB Jr (2011) Direct esthetic restorations based on translucency and opacity of composite resins. J Esthet Restor Dent 23(2):73–87 Ardu S, Krejci I (2006) Biomimetic direct composite stratification technique for the restoration of anterior teeth. Quintessence Int 37(3):167–174 Erratum in: Quintessence Int. 2006 May; 37(5):408 Betrisey E, Krejci I, Di Bella E, Ardu S (2016) The influence of stratification on color and appearance of resin composites. Odontology 104(2):176–183.
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