Dental

Materials

Journal

24 (3) : 382 390, 2005

Color

Stability

of a Dental

Composite

after

Immersion

in Various

Media

Lamia MUTLU-SAOESENI, Gulfem ERGUN2, Yalcin OZKAN3 and Mustafa SEMIZ4 Ankara Education and Research Hospital of Health Ministry, Ankara , Turkey 2 1 Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara , Turkey 3 Division of Pharmaceutical Sciences, Giilhane Military Medical Academy, Ankara , Turkey 4 Department of Statistics, Faculty of Art and Sciences, Gazi University, Ankara , Turkey Corresponding author, E-mail : sagesene@isbank.net.tr
Received May 6, 2005/Accepted July 7, 2005

The purpose of this study was to determine the effects of staining solutions on the different shades of a dental composite, and to compare these effects with that of distilled water. Two shades of effect (ET1 and ET2) , two shades of enamel (EL and EM) , and two shades of dentin (DA1 and DA2) were used. Specimens were immersed in three staining solutions (chlorhexidine gluconate, filtered coffee, and orange juice) and distilled water. Color changes were characterized using the CIELAB color space. Since significant interactions occurred, the staining effect of each solution on each shade was determined using one-way ANOVA and the levels of factor in one-way ANOVA were compared using Tukey's method (p<0.05) The staining solutions were found to be more chromogenic than distilled water, and EM and DA2 shades were found to be more color-stable. Based on the color change results in this study, chlorhexidine gluconate (1 .45) , filtered coffee (1.43) , and orange juice (1.02) were determined as having "slight" staining effects on the tested shades. As for the tested shades in this study, they revealed acceptable color change results. Key words : Color stability, Dental composite, Staining solutions

be evaluated. Color change value indicates the color stability property of a material. It was stated that In fixed prostheses, esthetics is a common problem the color change of a resin composite was influenced and inescapable challenge to all dentists. If it is by many factors: shade of resin composite, curing achieved, the dentist is considered to be successful by condition, composite thickness, background color for his/her patients. To this end, many new materials color measurement, storage method of specimen durhave been introduced to serve as more useful ing observation, length of observation period, color measurement method, and color measuring instruprosthodontic applications. However, when considering the costs, resin-based materials are preferred to ment23) . Spectrophotometers and colorimeters, apdental ceramics. Resin-based restorative materials plied to both in vitro and in vivo environments, make not only function properly but also fulfill the esit possible to study the numerous parameters related thetic demands that is, restorations must impercepto color stability13,17,24) In particular, tristimulus coltibly harmonize in shape and shade with natural orimeters are capable of detecting color differences teeth1). Ideally, dental composites should not change below visual perception threshold25) . Human percepcolor or appearance after fabrication. A restoration tion of color is a very complex process which encomthat undergoes significant discoloration may be a passes both subjective and objective phenomena. The source of embarrassment for both the patient and perceptual factor of color match may be as subjective dentist2). Indeed, discoloration is considered a major as "hot" or "cold" to a particular individual in a paresthetic failure in tooth-colored restorations. Howticular setting. Therefore, color evaluation by visual ever, dental resin-based composites have been recomparisons may not be a reliable method due to inconsistencies inherent in color perception and specifiported to change color because of intrinsic and extrinsic factors. Intrinsic factors involve chemical cation among observers26) . Hence, preceding any changes of the material. The cause for such chemical practical application of technology that quantifies discoloration has been attributed to oxidation of the color differences, parameters that have visual signifiamine accelator3,4), exposure to various energy cance must first be established25,26) sources5-9), and immersion in water for a long peFor any crown and bridge veneering material, riod3,10) Extrinsic factors include staining by adhecolor stability is a very important physical property sion or penetration of colorants, a result of contamithat is critical to its success color stability deternation from exogenous sources such as coffee2'11-17) , mines a material's ability to retain its color over a teall-13,16) , other stain-producing beverages15,16,18-20) period of time and in a specified environment27) and colored solutions17,21,22). Haselton et al.2) stated that it became apparent To study discoloration, color change values must through a review of literature that color change is

INTRODUCTION

MUTLU-SAGESEN

et al.

383

not categorical, but rather material-specific. Resin composite materials designed for permanent fixed prosthodontic applications must possess color stability comparable to that of dental porcelain25) . Artglass, a dental composite material, is used in the fabrication of crown and bridge restorations, implant-supported restorations, inlays, and onlays. However, only a few in vitro studies have been conducted to investigate the potential staining effects on this dental composite material due to filtered coffee, tea, mouth rinses, red wine, turmeric solution, UV radiation22), and accelerated aging after exposure to a xenon arc light source25) . Though this material was reported to be the most color-stable material when subjected to accelerated aging25) , it has shown relatively diverse color stability results against various staining solutions22) . Against this background, the color stability outcomes of its different shades in various staining solutions were of particular interest to the authors. The purpose of this in vitro study, therefore, was to test the color stability of six shades of Artglass when immersed in three staining solutions and distilled water for one day, one week, two weeks, and four weeks. MATERIALS AND METHODS

mm, height: 2 0.1 mm) were prepared in accordance with the manufacturer's instructions for the polymerization procedure given in Table 1. After being removed from the mold and stored in distilled water at 37 1 C for 24 hours to complete the postirradiation/post-setting polymerization21) , all specimens were finished and polished with special rotating instruments to have a uniform surface. Specimen surfaces were polished by one operator with the Artglass finishing and polishing tool kit (Artglass tool kit, Heraeus-Kulzer, Germany) . The method for finishing Artglass restorations differs completely than that of conventional crown and bridge restoration materials. Low working speeds help to achieve an optimum cut by the cross-cut carbide burs and prolong the life of the polishers. According to the manufacturer's instructions, Piccolo (special tungsten carbide bur operated at 15.000 rpm) , Silico (silicone polisher operated at 5-10.000 rpm) , Prepol (Kevlar polisher for gentle prepolishing operated at 3-5.000 rpm) , Mepol (natural bristle polisher with integrated polishing paste operated at 3-5.000 rpm) , and Hipol (high gloss polisher with integrated polishing paste operated at 3-5.000 rpm) with HP-Paste (polycrystalline paste for polishing Artglass surface) were used for finishing and polishing. After removal from the distilled water, specimens were tested by the XL20 Tristimulus Colorimeter (Gardner Lab. Inc., Maryland, USA) for their initial colors in the L *a * b * color system. Testing procedure was done by evaluating the light directed to and reflected from the specimen surface at a constant angle. Using a tungsten-halogen illumination source of 2,854K color temperature, all measurements were done according to the CIE standards28) . Before each measurement session, the colorimeter was calibrated with the standard white card for ET1, EL, DA1, and DA2, standard blue card for ET2, and standard yellow card for EM. Color change of each specimen was measured relative to its initial color, and initial shade differences among products were
used

To investigate the color stability of a dental composite material, six different shades of Artglass system (two shades of effect: ET1 and ET2; two shades of enamel: EL and EM; two shades of dentin: DA1 and DA2) were chosen. The effect shades consisted of translucent colors to characterize the incisal and occlusal areas of crown and bridge prostheses. Artglass enamel is applied to the upper third of the veneer on top of Artglass dentin. Specification of the dental composite material used in this study is given in Table 1. Twenty-four specimens were prepared for each shade of this composite material, such that a total of 144 discs were prepared for the four treatment solutions. Test specimens (diameter: 15
Table 1 Specification of the dental composite material

384

COLOR

STABILITY

OF A DENTAL

COMPOSITE

Table

Treatments

used

in this

study

not group able by after urements

evaluated. was to serve then as

The calculated. their and , the 36 from of

mean

measurement As controls be data solution shade solutions distilled of were (Table of in by water four were these (i.e., measured included group. specimens not

for

each were

Table

NBS

rating

system

own could control each each

damaged before 144 and meas-

measurement treatment) with specimens the three

Six each mens of

immersed and six as weeks specicontrol in that Solutions week. solution, spatula. at weeks Before by an baseline, (2W) every ultra-

in

staining in a

were

immersed up to

specimens dark are were reduce solutions Color then and one four room. used or

maximum solutions daily beginning

a treatment color To all were change multiplied solution values by National (Table 3) . analysis the with among significant, shade variance, compared All SPSS variance for was and by of interactions respect the the determined the levels Tukey's to the variance (ANOVA) between immersion were found of one-way factor in the was shades period. to solution analyone-way be a were in factor Bureau a calculated. clinical of 0.92 of To setting, to obtain relate the the the data cor-

Staining consumed at the of stirred each (1D)

substances 2) . every each a

refreshed precipitation were of day weeks

particles everyday was week after were Cleaner, in (HS a

responding units9,29) Two-way , used and As to

Standards

(NBS)

plastic

specimen , one (4W)

measured (1W) , two

compare

treatment. cleaned HS

solutions interactions

measurement, sonic Corp., ultrasonic Livermore, paper move towel. stains cleaner Livermore,

specimens (Ultrasonic CA)

factors

Health-Sonics multipurpose Corp., dried was done surfaces (E*) the whole surwith to reof a

statistically on sis each of

effectiveness using of

non-ionic Health-Sonics

solution CA) This that After which and was was adsorption measured. CIELAB for five

minutes procedure strongly the of color color color on

and

ANOVA test. using

multiple (p<0.05) were software

comparisons performed package.

cleaning adhered which, a result of

analyses Windows

to

the change

(7.5.1)

specimens. value matrix face Mean three period tioned measurements a*, ter, Hunter's and b* different in after each

loss the

in

specimen

RESULTS Table 4 b* ) ) gives of values, the the initial specimens. their NBS are different 1-4. the induced 1.45) water. also caused shades . four the Least In treatment highest level of solutions, discolorawas coffee of discoloramaterial. found and units shown shades in standard for each Table of color measurements The mean deviations, of 5. the The are four color and (L*, a*,

values

were before specimens

determined each

after immersion

and (E*

change their immer-

measurements group, each were values where measurement. made were values as by obtained were follows:

were All

reposi-

corresponding sion periods of

colorimetric examiner. the colorimefrom the L*,

mean E* presented

the

same from calculated

values in Figs.

Artglass

and E* equation28)

Among chlorhexidine tion with (E* distilled juice on

discoloration addition, varying of this filtered degrees composite

For dard

each

immersion of E*

period, values of

the each

mean shade

and in

staneach

orange tion

deviation

different

MUTLU-SAOESEN

et al.

385

Table

Color

of different

shades

of Artglass

material

before

immersion

Table

Color

changes

of different

shades

of Artglass

On the overall, discoloration by the three staining solutions (CH, FC, and OJ) was significant when compared to the control specimens stored in distilled water. Results of two-way ANOVA showed that there was an interaction between the shades (ET1, ET2, EL, EM, DA1, and DA2) and the solutions (CH, FC, OJ, and DW) after every immersion period: F=3.766,

p<0.001 after one day; F=36.209, p<0.001 after one week; F=13.571, p<0.001 after two weeks; and F=17.042, p<0.001 after four weeks. As an interaction was found in every immersion period (1D, 1W, 2W, and 4W), the influence of solution on each shade in every period was examined by one-way ANOVA and Tukey's pairwise comparison test.

386

COLOR

STABILITY

OF A DENTAL

COMPOSITE

Fig. 1

Color after

changes one day.

of

Artglass

shades

in

solutions

Fig. 2

Color changes after one week.

of

Artglass

shades

in

solutions

Fig. 3

Color after

changes two weeks.

of

Artglass

shades

in

solutions

Fig. 4

Color after

changes four weeks.

of

Artglass

shades

in

solutions

Table

Results

of color

change

among

shades

for each

solution

As were shade as after E* CH

seen (E*

in

Table = 1.45) first was week

6, and day DW

the FC of for of

most

staining = 1.43) and (E* OJ 1.02.

solutions for the DA1 least = 0.05) showed

(A E*

DISCUSSION The increasing demand for esthetic dentistry has been met with rapid development of new restorative materials. However, failure or success of any esthetic restoration depends on the color match and color stability of the restorative material among its other properties19) . Discoloration can be evaluated

after expected the results

the

immersion, EM shade

second ranging

immersion. 0.11 to

from

MUTLU-SAGESEN

et al.

387

visually color an

and determination

by

instrumental is based on

techniques. visual This comparison method However, subjective instruments system between and showed is tool for has great human that developing the and is

Visual of most since inconsisare has measured observer instrumental, into analysis application reprebeen

object

with applied evaluation

color in gives color

standards. dentistry30,31) rise measuring colorimetric relationship values to

frequently visual tent ferred. used color sponses. "objective" important colored tential CIELAB metrics visual idly for tal carried to change

results, The study

CIELAB the ( E*) Such color

studies evaluation

an of po-

technological objects, in the system has and field been that of andits designed of into assessment color out by both a

it

dentistry. associated specifically

The color

use

of difference

the

to data and

improve is technique rap-

interpretation developing precise industry,

colorimetric useful of E* standardized values31) and

In

the

denare and

monitoring tristimulus

evaluation colorimeters

spectrophotometers It discoloration is made pound hand, mechanism sary3,5,10,34). have meet materials dling lasting polishability, color tive tions ral of teeth. been esthetic possess properties, adhesion and In make are used probably to is known than because polymerize an aromatic, that

1,11,26,30 - 33) light-cured chemically chemically by means tertiary materials which Tooth-colored, as requirements. many high to a desirable strength, enamel natural other it words, possible indistinguishable and color dental aromatic are amines resin-based restorative This is qualities: short dentin, that resin-based to produce from of cured cured a amine. materials materials. materials show less This are comthe other by not necesa

chromogenic On

light-cured in

polymerized are

composites materials because good curing these hantime, excellent mimics restorarestoranatuthe to

materials that teeth30). Studies have an

virtually

shown

that choice

Artglass, with patient of abrasion to be very respect as the

dental to as dentist. the the

comesesIts and to et that al.17) polish-

posite, thetic thetic strength, esthetic of stated ing the Artglass color was the

is

excellent of

expectations and clinical elasticity properties natural that a effective

the

well

experiences modulus, are tooth said

resistance, similar Dietschi

structure. gloss reducing tested. favorably resistance an ability In the to to present (CH, (to lightness week, FC, white) (to lightness after discoloration

satisfactory in materials

surface in

most

of

composite surfaces stability,

Indeed, shown staining maintain study, and

well-polished high-quality and plaque brilliance although OJ) one after in DW caused day, one de-

have high and

accumulation, for the more they week. a three increase caused Then long

time35) staining in decrease at

solutions lightness in second

after black)

creased (to black) an absolute contrast to the results observed at first week. After four weeks, lightness decreased (to black) in all treatment solutions. After first day, a* values of specimens in CH, OJ, and DW increased (to red) , and b* values of the specimens in the staining solutions (CH, FC, and OJ) also increased (to yellow) . After one week, a* values of almost all the specimens in all solutions decreased (to green) . After two weeks, a* of specimens immersed in CH, FC, and OJ decreased (to green) while b* values increased (to yellow) . After four weeks, though a* values of specimens immersed in CH, FC, and OJ increased (to red) , the color of specimens immersed in DW turned to green (in a* axis) and yellow (in b* axis) . The color stability of a resin composite material is affected by many chemical factors of its resin components such as purity of the oligomers and monomers, concentration/type of activators, initiators and inhibitors, oxidation of unreacted carbon-carbon double bonds, filler loading, and color of the inorganic pigments3,4,7,8,19,23,34) Artglass contains methyl acrylic acid ester, silicate glass filler, and inorganic pigments. Glass filler does not absorb water, but methyl acrylic acid ester does. Thus, depending on the quality of the bond between methyl acrylic acid ester and glass fillers, and depending on the amount of water absorbed, discoloration could occur. As for internal discoloration in the polymer matrix of more color-intensive materials, it is partly concealed and thereby less noticeable because of the high proportion of inorganic color pigments. However, to date, because of lack of information from the manufacturers, a correlation is yet to be established between color stability and type and level of pigmentation present in a restorative material7) . In an in vitro study, three different restorative materials (compomer, resin-modified glass ionomer, and composite resin) were immersed in various media (whiskey, coca cola, orange juice, and deionized water) . It was found that composite resin (Clearfil) exhibited minimal perceivable color changes in whiskey, orange juice, and coca cola19). It was also pointed that there was a correlation between color (pigments) and discoloration in provisional restorative materials, and was confirmed that lighter materials discolor more markedly than darker ones4,5,7,32,33)Similarly in the current study, color changes for all shades of the dental composite material were generally "extremely slight", but lighter shades (ET1, ET2, EL, and DA1) showed "slight change" in color . Uchida et al.33) reported that the higher discoloration associated with lighter shades may result from one of these two factors: (a) discoloration through environmental breakdown of the polymer, leading to release of monomers and shift of color from a cured resin to that of the monomers; and (b) environmental effect on the retention and/or stability of pigments and other addi-

388

COLOR

STABILITY

OF

A DENTAL

COMPOSITE

tives shade lected intraoral In

in of

the a

polymer dental with

formulation. composite respect material to the

Therefore, should conditions be of

the sethe

other

hand,

noted and

that water of

color were this study not

changes perceivable were where immersion in CH

caused

by ( E*

chlorhexidine < 1.0) with . those for reach E* Khokhar four tea. composite They The of all

carefully

results previous shades = 3.3. et al.40) resins determined and could To study,

agreement treatment periods did

environment. dentistry, ( E* of E* of a discoloration will be rated is that as is more than up the visual above In this soat each the E*

studies, in all

results not

perceivable to upper evaluations. this study, lutions time color values ered of none the of as level a value limit

< 1.0)

acceptable considered

= 3.3 acceptability

which in with E*

evaluated by that be

the chlorhexidine, most of with

color

stability coffee,

of and was oral

subjective values . in staining value Though their were study

Discoloration will be rated that an for were from changes. showed shades color greater samples. effect ingredients. extent with of one's also (acidic was chosen shown resins coffee plays an of varies as to discoloration dietary used soft in of a of change for the These staining as were

the a

staining regular oral method

unacceptable13) immersed in the E* solutions. perceivable, 1.45 which this up material Changes solutions showed varied to E*

superficial hygiene routine employed. The solution In the

removed the

specimens showed interval changes ranged minor specimens the

routine. in this

imitate ultrasonic

regular cleaning

hygiene was

increase all staining visually 0.05 to All a Artglass

immersion also present one As than day, such, the affects study,

duration its degree the week, changes

of

a of

material color

in

test

considnone so an

change20,40) periods were four or canstudy. with the degree re-

through value

immersion two in weeks, periods of

= 3.3, revealed in E* than that according

namely weeks. shorter

one color evaluation with be

and longer study this

unacceptable value the staining to its The associated ange low-pH effect on Coffee cause fect tures staining the color it on has juice were DW

result. staining results solution

periods the results to durations, time.

this of

for the

not

be

speculated it would

Likewise, sults of of color Apart responding a can evaluate Artglass be

erroneous

compare as

different change from NBS regarded the shades. between . The change" exhibited color

immersion varies the units as a with

in and a drink)

an

oral

cavity

is Oras

colorimetric E* obtained visual in the

values, present

the

corstudy

hygiene previous , and

habits. study its

was

assessment of to the NBS regarded EL, and the change" in general, exhibit than and helps glass to exhibit 1-4, six rating,

means different a as DA1 EM and in

to

medium compomers was been

staining

changes According

investigated19). a treatment have and strong natural solution staining tooth present role in strucin affecting The varithe beef-

color "slight

change change" "slight shades Many phobic stain

0.5 shades in

and

1.5

is

composite

ET 1, ET2, color , whereas slight that resin) stability

showed DA2 color. hydroa greater

11-14,36).Filtered solution

compound important dental according storage

"extremely concluded (composite and glass This of color

authors materials

characteristics of coffee

composites. to time, of species, temperature, instant acid ) 37) . of

chemistry ety, and consists browning Ruyter13) tea that face ity coffee tration gation clinically, tary longevity oral cavity. and of on growing humidity. of

resistance

hydrophilic ionomer) explain high all limit meant shade, color. resin veneers after changes study, the staining immersion obtained. only staining different to determine In clinical solutions dependin vitro. As six a in b E* why color val(for that the

environment, General caffeine products studied (2-5% and the

(resin-modified coffee materials16'39). ), and and the change ues shade with final of peneIn showed long a* values solutions, where the Although were six shades results. below DA1, the color vivo a treatment and of L* all ongoing might

ionomer observation

composition ) , chlorogenic others staining (20-35% effects materials. and coffee

(3-9% Um

Artglass As the shown clinically CH =1.45< color result

did in

not Figs.

coffee They

unacceptable 3.3) . in This each

resin-based

veneering by and tea

stated by sur-

E*

discoloration adsorption the polymer to colorants.

occurred

changes in an

absorption, phase with this Results that a similar of the

whereby yellow

compatibilcolorants and present may a patient's either material in

"acceptable" that in b*

studies significant period, values24,33).In the six

concluded increase but no the shades after color change was material should staining product pattern may can be be of

served of

facilitate

adsorption the

values

investioccur diethe the

significant present in day values limited and of were to three

suggested and hygiene or brevity

process that determine

further habits of

indicated would a restorative

increased first

the

especially highest this one future of material a more the

study

Chlorhexidine of when vestigated esthetic nearly acceptable" all oral tissues combined the restorative the limit color

is and with

reported dental dietary

to

cause

discoloration especially Lee mouth concluded et al.38) rinse inon that the , on the "

shades solutions, types whether conditions, on ing

of

composite studies and suitable effective materials factors

restorations, factors7) effect of and values . Fay .

consider solution exists. staining different

discoloration materials, change ( E* < 3.3)

were et

within al.39)

restorative on many

replicated

MUTLU-SAGESEN

et al.

389

well as with the factor of immersion period, saliva, salivary pellicle, foods and beverages consumed may have more additive/mitigating effects on the physical and esthetic properties of this group of restorative materials than which can be realized in an in vitro study. Therefore, further studies are necessary to evaluate these parameters in vivo, but routine in vitro testing of esthetic restoratives is recommended for newer products. CONCLUSIONS Within the limitations of this in vitro study, the following conclusions were drawn. 1 . Discoloration occurred in all the six shades of the dental composite material after immersion in the various test solutions. Changes in lightness and chromacity coordinates resulted in overall discoloration. 2 . In general, nearly all the shades of this dental composite material tended to become more yellow (b*), darker (L*), and slightly greener (a*) in DW, but redder (a* ) in staining solutions (CH, FC, and OJ) . 3. Lighter or less chromatic shades tended to show larger colorimetric changes than the more chromatic or darker shades. 4 . Chlorhexidine, filtered coffee, and orange juice induced almost the same staining effects, but all color changes were rated as "slight" changes. 5. Shades of this dental composite material tested revealed acceptable color change results. ACKNOWLEDGEMENTS We wish to thank the manufacturer the generous supply of materials appreciated cooperation. REFERENCES 1) Knispel G. Factors affecting the process of color matching restorative materials to natural teeth. Quintessence Int 1991; 22: 525-531. 2) Haselton DR, Diaz-Arnold AM, Dawson DV. Color stability of provisional crown and fixed partial denture resins. J Prosthet Dent 2005; 93: 70-75. 3) Asmussen E. Factors affecting the color stability of restorative resins. Acta Odontol Scand 1983; 41: 11-18. 4) Eldiwany M, Friedl KH, Powers JM. Color stability of light-cured and post-cured composites. Am J Dent 1995; 8: 179-181. 5) Brauer GM. Color changes of composites on exposure to various energy sources. Dent Mater 1988; 4: 55-59. 6) Burrow MF, Makinson OF. Color change in lightcured resins exposed to daylight. Quintessence Int 1991; 22: 447-452. 7) Lang R, Rosentritt M, Leibrock A, Behr M, Handel G. and suppliers for and their much-

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390

COLOR

STABILITY

OF

A DENTAL

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