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Carossa 2001 Influence of Posts and Cores On Light Transmission Through Different All-Ceramic Crowns Spectrophotometric and Clinical Evaluation
Carossa 2001 Influence of Posts and Cores On Light Transmission Through Different All-Ceramic Crowns Spectrophotometric and Clinical Evaluation
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Influence of Posts and Cores Stefano Carossa, MD, DDSa
on Light Transmission Through Stefano Lombardo, DDSb
Different All-Ceramic Crowns: Paolo Pera, MD, DDSc
Massimo Corsalini, MD, DDSd
Spectrophotometric and Maria Luisa Rastello, PhDe
Clinical Evaluation Giulio Preti, MD, DDSf
Purpose: The influence of different types of posts and cores on light transmission through
all-ceramic crowns was assessed by spectrophotometric analysis and clinical evaluation.
Materials and Methods: Three extracted natural teeth were replicated in acrylic resin, with
roots prepared to receive standardized posts and cores. Using a silicone impression material
as a template, various prosthodontic reconstructions were obtained by combining four types
of posts and cores (polished and matte-finished gold alloy, all-ceramic, and ceramized
metal alloy) and three types of all-ceramic crowns (IPS-Empress 2 surface-colored, IPS-
Empress 2 stratified, and In-Ceram). The spectrophotometric analysis was performed in the
dark at 25C. The teeth were backlit with an incandescent lamp at the color temperature of
A illuminant and shielded to avoid spurious light entering the spectrophotometer. The
transmitted light was analyzed in terms of luminance at four points of the sample surface
(cervical, middle, incisal, and proximal). Twelve measurements were performed for the
natural teeth, and 144 were performed for the artificial teeth. Results: Natural teeth had the
highest luminance. Among all-ceramic crowns, surface-colored IPS-Empress 2 had the
highest luminance, and stratified IPS-Empress 2 had the lowest. Regarding posts and cores,
the luminance was highest with the all ceramic, lower with the ceramized and the polished
gold alloy (which had very similar luminance), and lowest with the matte-finished gold
alloy. No significant difference among prosthodontic combinations was detected under
clinical observation. Conclusion: The surface-colored glass ceramic (IPS-Empress 2) was the
most translucent crown. At the standard crown thickness used, there were small, significant
spectrophotometric, but not clinical, differences among the combinations tested. These
findings show no esthetic contraindications for the use of polished gold alloy posts and
cores with all-ceramic crowns. Int J Prosthodont 2001;14:914.
Fig 3a Complete denture under clinical evaluation: polished Fig 3b Stratified IPS-Empress 2 crowns.
gold alloy posts and cores.
Twelve different prosthodontic combinations were with good eyesight. The samples were included in a
analyzed for each artificial tooth, for a total of 36 sam- maxillary complete denture that was placed in the
ples. Each tooth underwent spectrophotometric analy- mouth of an edentulous patient (Fig 3). The observers
sis on four zones of the facial surface: two were directly were invited to compare side by side, in single blind,
influenced by the underlying posts and cores (cervi- the chromatic appearance of each all-ceramic crown
comiddle) and two were indirectly influenced (in- when varying the post and core, using the Vita 3D
cisoproximal) (Fig 2). The same zones were examined Master criteria for tooth color detection. In brief, they
in the three control natural teeth. Thus, 144 measure- stood about 50 cm from the patients oral cavity using
ments were made in the artificial teeth and 12 were either natural or artificial diffuse light.
made in the natural ones. The analysis was performed The data were analyzed using the Students t test
in a dark room at 25C. The samples, positioned on a for paired or unpaired data. The comparisons of lu-
firm base, were shielded with silicone, leaving only the minance values among prosthodontic reconstruc-
clinical crowns exposed to avoid spurious light enter- tions, namely types of posts and cores and types of
ing the instrument. The teeth were backlit with an in- ceramic, were performed with the Bonferroni multi-
candescent lamp and placed in a black box 20 cm ple comparisons test.
away, having a steady and controlled power supply
(500 W, 120 V) to generate the color temperature of Results
A illuminant (2,856 K). An adjustable diaphragm
placed halfway between the lamp and the model At clinical examination, no difference in the chro-
shielded the light produced by the lamp. The analysis matic aspect of each prosthodontic combination was
was performed using the Spectro Pritchard Photometer noticed by all the observers but one, who detected
1980 B/SX (Photo Research) with additional lens OL- just a small difference in the central and lateral incisor
7Q. The spectrophotometer was placed 150 cm away brightness with surface-colored IPS-Empress 2 crowns
from the sample tooth using a visual angle of 2 degrees, placed on gold alloy and on all-ceramic posts and
so that the transmitted light was measured on four cores.
points of the tooth surface, each having an area of Spectrophotometric analysis showed that colori-
about 1 mm2. Each measurement lasted 2 minutes metric data, like clinical evaluation, gave no signifi-
and consisted of scattering the visible spectrum (380 cant difference in the chromatic aspects of the re-
to 780 nm) at 5-nm intervals.11 The instrument gives constructions. The spectral data showed no significant
automatically the following data: radiance (W/sterad difference in the wavelengths of the different samples.
m2), luminance (candles/m2), and color coordinates By contrast, photometric data showed significant dif-
according to the CIE system 1931 (X, Y, Z), the CIE sys- ferences among prosthodontic combinations; thus, lu-
tem 1960 (u, v), and the CIE system 1976 (uv ). Each minance best represents both the quantity of light
value represented the mean of three consecutive mea- crossing the sample and the visual effect on human
sures performed in rapid sequence. observers. The tooth was thus considered as a source
The clinical evaluation was performed by ten experts of transmitted light and characterized in terms of lu-
in fixed prosthodontics and by five dental students, all minance. In other words, the luminance values in the
IPS-Empress 2 IPS-Empress 2
Natural teeth (A) surface colored (B) In-Ceram (C) Stratified (D)
Mean SEM Mean SEM Mean SEM Mean SEM
Table 3 Comparison of Luminance Values by Type of Post and Core and by Zone
(Irrespective of Ceramic and Tooth)
tables represent the photometric measurements ob- The influence of different posts and cores on the
tained considering natural and artificial teeth as opal luminance of the three all-ceramic crowns is re-
glass illuminated by a known level of illuminance and ported in Table 2. With all-ceramic posts and cores,
with a reference lamp of known color temperature.12 the luminance of both surface-colored IPS-Empress
Artificial teeth had a luminance significantly lower 2 and In-Ceram crowns was significantly higher than
than that of the three natural samples. Among all-ce- with the other types of post and core, particularly the
ramic crowns, surface-colored IPS-Empress 2 had matte-finished gold alloy one. The different posts
the highest luminance, and the stratified IPS-Empress and cores had no significant influence on the strati-
2 had the lowest (Table 1). fied IPS-Empress 2.
As shown in Table 3, the different posts and cores At variance with photometric data, no significant dif-
had greater influence on the luminance of the cervi- ference among the four posts and cores was detected
comiddle zone than on that of the incisoproximal by clinical observation. The disagreement between
one. In the cervicomiddle zone, the all-ceramic post objective and subjective evaluation might depend on
and core had significantly greater luminance than the the different conditions of observation because tooth
other three types. In the incisoproximal zone, the appearance is not usually evaluated under intraoral ar-
only significant difference was between the all-ce- tificial transillumination. Moreover, as observed in the
ramic and the matte-finished post and core. literature, a wide range of factors influence tooth es-
thetics, such as hue,5,10,1820 tooth shape,5,19,20 phys-
Discussion iochemical influences of materials,6,7,15,16,1922 strati-
fication and firing technique,19,2325 type of ceramic
The results of this study show that the luminance of and cementation system, and particularly thick-
artificial teeth is significantly influenced by the ma- ness.6,19,26,27 In this regard, a ceramic thickness lower
terial used for crowns and posts and cores. The com- than that used in this study (1.5 to 1.8 mm, as recom-
parison among the three all-ceramic crowns showed mended by the manufacturer), may accentuate the in-
that surface-colored glass ceramic (IPS-Empress 2) fluence of the post and core, making discrimination by
had the highest luminance, whatever the post and the human eye easier.
core (Tables 1 and 2). The lower luminance of the
stratified IPS-Empress 2 and In-Ceram crowns might Conclusions
depend on their composition.8,1317
The all-ceramic post and core had significantly The surface-colored glass ceramic IPS-Empress 2
greater luminance than the other three, with the had the highest luminance because of the greater
matte-finished one being the lowest. The difference translucency of the material.
was significant for surface-colored IPS-Empress 2 Among posts and cores at the standard crown
and In-Ceram, but not for the stratified IPS-Empress thickness used, the matte-finished gold alloy had
2 (Table 2). It can be supposed that the low translu- the lowest luminance, the all-ceramic had the
cency of this ceramic limited the effect of the un- highest, and ceramized metal and polished gold
derlying reconstruction. Unfortunately, because of alloy posts and cores had intermediate values of
their hardness, the all-ceramic posts and cores may luminance that were very similar to each other.
induce biomechanical stress to residual radicular No relevant clinical difference was detected
structures.18 among the different prosthodontic preparations.
No significant difference appeared between ce-
ramized and polished gold alloy posts and cores with Despite the fact that all-ceramic posts and cores
all types of crown and in the zones. The greater lu- showed the luminance most similar to natural teeth,
minance with polished gold alloy posts and cores, as because of their hardness and their high cost, they can-
compared to the matte-finished one, may be because not be recommended for clinical practice. In these re-
of reflection of incident light on the lingual surfaces gards, the polished gold ones seem more suitable for
of posts and cores. The light, reflected in many di- routine use, at least at the thickness used in this study.
rections and transmitted inside the crown, may reach It has to be evaluated if at lower ceramic thickness this
the facial surface, increasing the luminance detected type of post and core assumes a greater influence on
by the spectrophotometer. However, these reflec- both luminance values and clinical observation.
tions have the colorimetric features of the metal alloy
from which they are produced. Thus, it seems advis- Acknowledgment
able to use metal alloy posts and cores cast with a
high-gold fineness, not only for biomechanical ad- The authors gratefully acknowledge the excellent technical sup-
port of Mr Biagio Ciancio.
vantages and biocompatibility, but also for the hue
most similar to the natural teeth. References
As expected, the luminance was significantly in-
fluenced by zone, being highest in the incisoproximal 1. Douglas RD. Precision of in vivo colorimetric assessments of
one and lowest in the cervicomiddle zone, where teeth. J Prosthet Dent 1997;77:464470.
light transmission is interfered with by the presence of 2. ten Bosch JJ, Coops JC. Tooth color and reflectance as related to
posts and cores and by the greater tooth thickness light scattering and enamel hardness. J Dent Res 1995;74:374380.
3. Johnston WM, Kao EC. Assessment of appearance match by visual
(Table 3). Artificial teeth had significantly lower lu- observation and clinical colorimetry. J Dent Res 1989;68:819822.
minance than natural teeth, although the comparison 4. Wasson W, Schuman N. Color vision and dentistry. Quintessence
was done with only three natural samples. Int 1992;23:349353.
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