RESEARCH AND EDUCATION

Stainability of acrylic resin materials used in CAD-CAM and

conventional complete dentures
Faisal D. al-Qarni, BDS, MS, PhD,a Charles J. Goodacre, DDS, MSD,b Mathew T. Kattadiyil, BDS, MDS, MS,c
Nadim Z. Baba, DMD, MSD,d and Rade D. Paravina, DDS, MS, PhDe

ABSTRACT
Statement of problem. The effect of staining beverages on the color of dentures made with computer-aided design and computer-aided
manufacturing (CAD-CAM) is unknown.
Purpose. The purpose of this in vitro study was to evaluate the stainability of acrylic resins used in CAD-CAMefabricated complete dentures
compared with conventional materials.
Material and methods. Acrylic resin denture teeth from 3 different manufacturers (2 conventional and 1 milled) were obtained (N=45).
Denture base acrylic resin specimens were made with 3 different techniques (compression molding, injection molding, and milling)
(N=45). Conventional and/or milled acrylic resins were used to make specimens comprising both denture teeth and denture base acrylic
resins (4 conventional, 2 milled denture bases with bonded teeth, and 1 all-milled) (N=105). All specimens were then immersed in coffee,
red wine, or distilled water as control. The CIELab color differences between before and after immersion were determined by using a
VITA Easyshade spectrophotometer. The tooth-denture base interface of the denture blocks was evaluated visually for the presence of
stain. The CIELab data were analyzed by using ANOVA, and chi-square test was used for visual assessment (a=.05).
Results. Significant interactions were found between each acrylic resin material and each staining solution immersion when compared with
distilled water immersion (P<.001). Denture teeth had similar color change after immersion in coffee (P=.149), while the most pronounced
color change was observed with Portrait teeth upon immersion in wine (P<.001). Injection-molded denture base specimens exhibited less
color change upon staining in wine than compression-molded or milled specimens (P<.001). Upon staining in coffee, milled specimens
were not significantly different from injection- (P=.053) and compression-molded specimens (P=.180). The chi-square test showed a
significant association between processing technique and stain accumulation at the tooth-denture base interface when evaluated visually
(P<.001). Stain accumulation was greatest with compression-molded specimens (58%), followed by injection-molded (43%) and milled
specimens with bonded teeth (8%). Monolithic teeth with milled denture base had no stain deposits at the tooth-denture base interface.
Conclusions. The stainability of milled acrylic resins was no better than that of conventional materials. However, CAD-CAM milled denture
blocks with teeth and base acrylic resins had greater resistance to stain accumulation at the tooth-denture base interface than those of
conventional processing methods. (J Prosthet Dent 2019;-:---)

A new technique for complete denture fabrication has
emerged using the CAD-CAM technology.1,2 Advanced
5-axis milling is used to fabricate denture bases from
prepolymerized acrylic resin blocks that are less porous
than conventional denture acrylic resin.1,3 The clinical
advantages of CAD-CAM dentures over conventionally
fabricated ones include the reduced number of appoint-
ments and electronic archiving.3-5 From a material
standpoint, CAD-CAM denture bases are milled from
highly condensed acrylic resin, leading to better flexural

a
Assistant Professor, Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
b
Distinguished Professor, Loma Linda University School of Dentistry, Loma Linda, California.
c
Professor and Director, Advanced Specialty Education Program in Prosthodontics, Loma Linda University School of Dentistry, Loma Linda, Calif.
d
Professor, Loma Linda University School of Dentistry, Loma Linda, Calif.
e
Professor, Department of Restorative Dentistry and Prosthodontics, The University of Texas School of Dentistry at Houston, Houston, Texas; and Director, Houston Center
for Biomaterials and Biomimetics, The University of Texas School of Dentistry at Houston, Houston, Texas.

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Table 1. Materials used

Clinical Implications Group Material Manufacturer
Shade/
Mold
Milled acrylic resins are expected to undergo similar Denture SR Vivodent DCL Ivoclar Vivadent AG A1/A24B
color change compared with conventional denture Teeth Portrait IPN Dentsply Sirona A1/55F
materials after exposure to colored beverages. Monolithic AvaDent, Global Dental A1
Science LLC
When denture teeth are coupled with denture base
Denture base Lucitone 199 Dentsply Sirona Original
acrylic resin, the use of monolithic teeth with a resin (Compression-molded)
milled denture base seems to provide a tooth-resin IvoBase Hybrid Ivoclar Vivadent AG Preference
interface that is more resistant to stain (Injection-molded)

accumulation. Lucitone 199 (Milled) AvaDent, Global Dental Original

Science LLC

was to evaluate the stainability of acrylic resin denture

strength and hardness.3 In addition, milled bases un-
dergo no polymerization shrinkage, which improves
adaptation to supporting tissues.3,4 Commercially avail-
able CAD-CAM dentures were first reported in 2013,2,3
and since then, they have increased in popularity.5
CAD-CAM dentures have been reported to be equally
effective and more time-efficient6 and to have better
adaptation7 and improved clinical retention8 than
conventionally fabricated dentures.
Synthetic denture teeth are generally made of acrylic
resin as they bond chemically and micromechanically
through the interlocking of denture base polymers to the
polymer network of the denture tooth.9 Newer designs
consist of various polymer structures, including inter-
penetrating polymer network (IPN) and double cross-
linking (DCL).10 Denture teeth in CAD-CAM dentures
are typically bonded to recesses milled into the cameo
surface of the denture base.1,2 More recently, complete
dentures fabricated entirely by a milling process where
monolithic teeth are milled as part of the denture base
have been introduced.11
Color stability, the property of a material to retain its
color over time and in a specified environment, is an
important clinical property for all dental materials.12 As
the whiteness and color of their teeth has been reported
as important to an aging population,13,14 color changes
may lead to patient dissatisfaction and the need for
denture replacement.15 A change in color is also an
indicator of aging or material damage.16,17 Contributing
factors include stain accumulation, water sorption,
dissolution of ingredients, degradation of intrinsic pig-
ments, and surface roughness.17,18 The color stability and
stainability of acrylic resin denture base and teeth by
different beverages and food colorants has been inves-
tigated,19-24 with coffee and red wine being the most
commonly used beverages because of their greater
staining potential than other staining solutions such as
tea or cola.10,12,25-29
The authors are unaware of studies on the color
stability and stainability of materials used for CAD-CAM
dentures. Therefore, the purpose of this in vitro study
base and teeth used in CAD-CAMefabricated complete
dentures and to investigate the influence of CAD-CAM
processing on stain accumulation at the tooth-denture
base interface. The null hypotheses were that immer-
sion in different staining solutions would produce no
difference in color change for different acrylic resin
denture teeth and bases and that stain accumulation
would be similar in CAD-CAM and conventionally
processed dentures.
MATERIAL AND METHODS
Three brands of acrylic denture teeth were used: 2 con-
ventional brands and 1 milled. For the conventional
denture teeth, a maxillary right central incisor (shade A1)
was selected from 2 manufacturers: SR Vivodent
DCL (Ivoclar Vivadent AG) and Portrait IPN (Dentsply
Sirona). The milled monolithic denture teeth were
virtually designed and fabricated by AvaDent (Global
Dental Science LLC). This yielded 3 test groups:
Vivodent, Portrait, and Monolithic denture teeth. The
materials used in the study are listed in Table 1.
Similarly, 3 denture base materials were evaluated: 2
conventional and 1 milled resin systems. Conventional
materials were processed by either compression molding
(Lucitone 199; Dentsply Sirona) or injection molding
(IvoBase; Ivoclar Vivadent AG) following the manufac-
turers’ instructions. Lucitone 199 milled specimens were
custom made by AvaDent. All specimens were sectioned
by using a rotating saw (IsoMet 1000 Precision saw;
Buehler) to make square specimens of 10 mm in length
and 2 mm in thickness. Dimensions were confirmed
by using digital calipers with 0.01-mm accuracy (Absolute
Digimatic Caliper 500-172-20; Mitutoyo Corp). Speci-
mens were polished following a conventional denture
polishing protocol.30
Additionally, a central incisor, a lateral incisor, and a
canine denture tooth were positioned in baseplate wax
(HYGENIC; Coltène), festooned, and smoothened. The
margins between wax and denture teeth were visually
inspected to ensure a smooth transition. A polyvinyl

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- 2019
siloxane duplication material (Capsil; Great Lakes
Dental Technologies) was used to make the molds used
to produce duplicated specimens. Heat processing of
specimens was performed by either the compression- or
injection-molding technique to make denture block
specimens. Information regarding mold size and tooth
position was sent to AvaDent, where similar specimens
were designed with recesses to accommodate acrylic
resin denture teeth. SR Vivodent DCL or Portrait IPN
anterior teeth were bonded by the proprietary bonding
mechanism used by AvaDent. In addition, the laser
scanning and milling of denture base resin, along with
the denture teeth, was performed by AvaDent to
fabricate similar specimens with monolithic denture
teeth. This yielded 7 groups: SR Vivodent DCL with
compression-molded base (Vivodent/Compression),
Portrait IPN with compression-molded base (Portrait/
Compression), SR Vivodent DCL with injection-molded
base (Vivodent/Injection), Portrait IPN with injection-
molded base (Portrait/Injection), SR Vivodent DCL
bonded to milled denture base (Vivodent/Bonded),
Portrait IPN bonded to milled denture base (Portrait/
Bonded), and Milled monolithic denture teeth and milled
denture base (Monolithic/Milled). Polishing was per-
formed following the protocol mentioned earlier.
The staining solutions used were coffee and red wine.
Coffee (Instant Coffee; Folgers) was added to boiling
water and stirred at room temperature until cooled to
37
C before immersion. A coffee to water ratio of
10 g/350 mL was used according to the manufacturer’s
suggested concentration. Red wine was used as supplied
(Avalon California Cabernet Sauvignon 2013). Distilled
water was used as a control.
All specimens were stored in a humid incubator at
37
C for 24 hours before baseline color measurements.
Specimens were then assigned to 1 of the 3 immersion
solutions. Denture teeth (n=5) and denture base resin
specimens (n=5) were placed in 24-well plates, with 2 mL
of each immersion solution dispensed into each well.
While each denture block (n=5) was placed in a 50-mL
conical centrifuge tube, 10 mL of each solution was
sufficient to completely immerse a specimen. Immersed
specimens were incubated at 37
C and 100% relative
humidity. All solutions were replaced every 24 hours over
7 days. This period may correspond to 34 to 67 months of
clinical service, based on an average daily exposure of 5 to
10 minutes to coffee or wine.10 After 7 days, the speci-
mens were removed, rinsed with distilled water, and
dried with absorbent paper.
Color measurements of denture teeth were stan-
dardized with the aid of a positioning device used in a
previous study,10 with new inserts made with light-
polymerized urethane dimethacrylate (Triad; Dentsply
Sirona) to ensure reproducible positioning of the
al-Qarni et al
3
spectrophotometer probe over the middle third of each
denture tooth. Similarly, a positioning device was made
for the denture blocks, where the color change was
measured at the denture tooth-denture base resin
interface of each anterior tooth. Each color measure-
ment was repeated 3 times, and the average value was
used for analysis. All color measurements were per-
formed by a single investigator (F.D.a.Q.). Color co-
ordinates were determined by using an intraoral
spectrophotometer (VITA Easyshade; VITA North
America), and results were expressed by using the
CIELab (DEab) formula:
rffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
h i
DEab = ðL2 −L1 Þ2 +ða2 −a1 Þ2 +ðb2 −b1 Þ2 :
Clinical interpretation of results through visual
thresholds was performed; 50%:50% perceptibility
threshold (PT) was set at DEab=1.2, while the 50%:50%
acceptability threshold (AT) was at DEab=2.7.31,32
After the 7-day immersion and the color measure-
ments, the denture block specimens were brushed by
using a denture brush under running distilled water for
10 seconds to remove superficial stain and then visually
assessed to determine whether the tooth-denture base
interface had any dark stains. An investigator (F.D.a.Q.)
with normal color vision, determined by the Ishihara
test,33 performed visual evaluations under D65 illuminant
with the color rendering index (CRI)  90.32 Only the
presence or absence of stains was recorded, regardless of
the extent or amount of stain. Each tooth-denture base
junction was measured as an individual specimen, which
yielded the number of specimens of n=15.
One-way and 2-way analyses of variance (ANOVA)
tests were performed to determine statistically significant
differences among materials and staining solutions. The
differences in color change values were evaluated with
the Tukey multiple comparison test. Visual test results
were analyzed by using the chi-square test. All analyses
were computed by using a statistical software program
(IBM SPSS Statistics, v22; IBM Corp) (a=.05).
RESULTS
Color difference values (DEab) for denture teeth, denture
base resins, and denture block specimens are listed in
Table 2. The ANOVA results are presented in Tables 3-5.
All denture teeth immersed in coffee and red wine
showed an increase in DE values (Fig. 1), which was
statistically significant compared with distilled water
immersion, regardless of the denture tooth brand
(P<.001). Generally, teeth immersed in coffee showed the
most apparent discoloration, with no statistical signifi-
cance among the different materials (P=.149). Portrait
teeth were the most affected by red wine (P=.001), while
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Table 2. CIELab (DEab) color differences for test groups (mean ±standard Table 3. Two-way ANOVA for color difference of denture tooth
deviation) specimens
DEab Source Sum of Squares df Mean Square F P
Group Water Coffee Wine Corrected model 91.201 8 11.400 42.304 <.001
Denture teeth Intercept 304.096 1 304.096 1128.459 <.001
Portrait 1.3 ±0.3 4.5 ±1.0 3.2 ±0.3 Material 4.055 2 2.027 7.523 .002
Vivodent 1.4 ±0.4 3.8 ±0.7 2.2 ±0.4 Solution 80.019 2 40.010 148.470 <.001
Monolithic 0.6 ±0.2 4.8 ±0.7 1.6 ±0.3 Material×solution 7.127 4 1.782 6.611 <.001
Denture base resin Error 9.701 36 0.269 d d
Compression 1.4 ±0.2 2.3 ±0.3 3.2 ±0.3 Total 404.998 45 d d d
Injection 0.4 ±0.1 1.8 ±0.2 2.1 ±0.5 Corrected total 100.902 44 d d d
Milled 0.3 ±0.1 2.1 ±0.1 3.0 ±0.6
Denture blocks
Vivodent/Compression 1.6 ±0.4 3.2 ±1.7 3.4 ±1.5
Portrait/Compression 1.6 ±0.4 3.2 ±1.1 3.8 ±0.7
Table 5. Two-way ANOVA for color difference of denture block
Vivodent/Injection 1.7 ±0.9 2.7 ±1.1 1.8 ±0.9
specimens
Portrait/Injection 1.9 ±0.5 4.0 ±1.3 1.9 ±0.8
Source Sum of Squares df Mean Square F P
Vivodent/Bonded 1.1 ±0.4 2.5 ±1.1 1.3 ±0.7
Corrected model 95.081 20 4.754 4.947 <.001
Portrait/Bonded 1.4 ±0.8 3.0 ±1.2 1.6 ±0.6
Intercept 527.431 1 527.431 548.828 <.001
Monolithic/Milled 1.1 ±0.4 2.6 ±0.5 1.9 ±0.3
Materials 24.107 6 4.018 4.181 .001
Solutions 43.964 2 21.982 22.874 <.001
Materials×solutions 27.010 12 2.251 2.342 .012
Table 4. Two-way ANOVA for color difference of denture base resin Error 80.725 84 0.961 d d
specimens Total 703.236 105 d d d
Source Sum of Squares df Mean Square F P Corrected total 175.806 104 d d d
Corrected model 42.955 8 5.369 59.067 <.001
Intercept 151.801 1 151.801 1669.911 <.001
Material 7.907 2 3.954 43.493 <.001 (P=.041). When immersed in red wine, compression-
Solution 32.695 2 16.348 197.836 <.001 molded specimens (with both Vivodent and Portrait
Material×solution 2.352 4 0.588 6.469 <.001 denture teeth) had significantly more color change than
Error 3.273 36 0.091 d d
all other groups (all P<.05), while differences among
Total 198.028 45 d d d
those groups were not statistically significant (all P>.05).
Corrected total 46.227 44 d d d
Color difference values for denture block specimens are
presented in Figure 3.
Visual evaluation of the tooth-denture base interfaces
no significant difference was found between Monolithic
of the denture blocks showed that the presence of stain
and Vivodent teeth immersed in red wine (P=.063).
was significantly dependent on the processing technique
After 7-day immersion, denture base specimens
(P<.001). A total of 58% of the compression-molded
immersed in coffee and red wine had significantly more
interfaces were stained with coffee or wine, while 43%
color change than those immersed in distilled water
of the injection-molded interfaces accumulated stains.
(P<.001). Specimens processed with the injection-
Milled denture bases with bonded teeth had 8% stained
molding technique were less affected by coffee and red
interfaces regardless of the staining solution, whereas the
wine than compression-molded specimens (P=.001).
entirely milled specimens had 0% of the interfaces
Milled specimens immersed in coffee had color difference
affected by stains (Fig. 4). Most tooth-denture base in-
that fell between the injection- and compression-molded
terfaces (61%) were stained by coffee, while 39% were
specimens (Fig. 2) and were not statistically significant
stained by wine. The numbers and percentages by group
(all P>.05). However, milled specimens immersed in red
and processing technique are listed in Table 6. Examples
wine behaved similarly to compression-molded speci-
of varying degrees of stain accumulation are shown in
mens and had a significantly higher color difference than
Figure 5.
injection-molded specimens (P=.003). Generally, red
wine produced more pronounced color changes (higher
DISCUSSION
DE) than coffee.
All denture block specimens had a similar color Immersion in staining solutions produced significant
change when immersed in coffee, with the exception of color change in all the acrylic resins used in the study.
Portrait/Injection specimens, which had DE values The extent of color change was dependent on the staining
greater than those of Vivodent/Bonded specimens solution and the type of material being immersed. When

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7.0 7.0
Water Coffee Red wine
6.0 6.0 Water Coffee Red wine
Color Change (ΔE)

Color Change (ΔE)

5.0 5.0
4.0 4.0
3.0 3.0
2.0 2.0
1.0 1.0
0.0 0.0
Potrait IPN Vivodent DCL Monolithic Compression Injection Milled
Denture Teeth Denture Base
Figure 1. Mean color change of denture teeth after immersion in Figure 2. Mean color change of denture base acrylic resins after
different staining solutions. immersion in different staining solutions.

Stained Tooth-resin Interfaces (%)

7.0 100
Water Coffee Red wine 90 Coffee Wine
6.0
80
Color Change (ΔE)

5.0 70
60
4.0
50
3.0 40
30
2.0
20
1.0 10
0
0.0 V/C P/C V/I P/I V/B P/B M/M
V/C P/C V/I P/I V/B P/B M/M
Denture Blocks
Denture Blocks
Figure 4. Results of visual evaluation showing percentage of stained
Figure 3. Mean color change of denture block specimens after
tooth-resin interfaces after immersion in coffee or wine. M/M,
immersion in different staining solutions. M/M, Monolithic/Milled; P/B,
Monolithic/Milled; P/B, Portrait/Bonded; P/C, Portrait/Compression; P/I,
Portrait/Bonded; P/C, Portrait/Compression; P/I, Portrait/Injection; V/B,
Portrait/Injection; V/B, Vivodent/Bonded; V/C, Vivodent/Compression; V/I,
Vivodent/Bonded; V/C, Vivodent/Compression; V/I, Vivodent/Injection.
Vivodent/Injection.

evaluated individually, acrylic resin used with CAD-CAM Table 6. Number (percentage) of stained tooth-denture base interface
dentures underwent a color change comparable with that Immersion Solution
Total (by Processing
of the conventionally fabricated materials. However, the Group Coffee Wine Total Technique)

interface between the denture teeth and denture base Vivodent/Compression 9 (60) 9 (60) 18 (60) 35 (58)
Portrait/Compression 8 (53) 9 (60) 17 (57)
was more susceptible to discoloration in conventional
Vivodent/Injection 10 (67) 5 (33) 15 (50) 26 (43)
dentures than in CAD-CAM milled dentures.
Portrait/Injection 8 (53) 3 (20) 11 (37)
Susceptibility of acrylic resins to staining is mainly asso-
Vivodent/Bonded 4 (27) 0 4 (13) 5 (8)
ciated with the inherent water sorption property.19 A ten- Portrait/Bonded 1 (7) 0 1 (3)
dency to absorb water is likely to cause absorption of other Monolithic/Milled 0 0 0 0
colored liquids. Absorbed water molecules soften the resin
by acting as a plasticizer and cause the polymer matrix to
expand and separate polymer chains, leading to penetration
of staining solutions and discoloration of the resin.19,20 concentration prepared by Koksal and Dikbas25 and
All the acrylic resin teeth used in this study had the Mutlu-Sagesen et al.12 In this study, the manufacturer’s
greatest color change when immersed in coffee. This suggested coffee concentration was higher than that in
finding was consistent with that of other studies inves- those 3 studies. The addition of sugar and/or creamer to
tigating the color change of denture teeth.10,12,25 How- coffee has also been reported to influence stainability.23
ever, some studies reported that red wine induced more The discoloration from coffee results from both surface
color change in denture teeth than coffee.15,22 The con- adsorption and absorption, possibly because of the
flicting results may be attributed to differences in coffee different polarities of the yellow colorants.21 The polar
brands and the concentrations at which they were pre- colorants attach to the surface of the acrylic resin, while
pared. For instance, in the study by Arana-Correa et al,15 the less polar colorants are more compatible with
they prepared coffee at a concentration 60% less than the the resin matrix and can therefore be absorbed into the

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Figure 5. Representative staining specimens. A, Slight coffee stain accumulation of Vivodent/Compression specimen. B, Vivodent/Injection specimen
stained by wine. C, Vivodent/Bonded specimen stained by coffee. D, Portrait/Compression specimen stained by wine.

material. Tannic acid, in particular, has been reported to
be a primary staining ingredient of coffee.19
Unlike denture teeth, the color of denture base resin
was most affected by red wine, regardless of the pro-
cessing method used. Other studies evaluating the
stainability of denture base resins have also reported that
red wine causes the most apparent discoloration
compared with coffee, tea, or cola.24,28 Red wine has also
been reported to cause the greatest color changes in
composite resin interim restorative materials.23 Antho-
cyanidins, specifically cyanidin-3-glucoside, is a natural,
water-soluble compound that provides the color of
grapes and berries. Red wines also contain similar con-
centration of anthocyanidin pigment, which can cause
discoloration.19 The acidic pH of red wines may affect the
resin structure and soften the polymer matrix, leading to
surface roughening and facilitating discoloration. The pH
of the red wine used in this study was 3.8 (Accumet
XL25; Fisher Scientific). Exposure to alcoholic liquids has
also been found to act as a plasticizer but cannot be
considered a significant cause of color change in denture
bases. Regis et al18 reported that a color difference of
DE>1.0 was only observed with an alcohol concentration
greater than 42%, while the alcohol content in red wine
used in the present study was 13.8% by volume. In
addition, Hollis et al19 reported the greatest color change
with grape juice, which has a pigment concentration and
pH value comparable with those of red wine but is
nonalcoholic.
An analysis of the CIELab data revealed that all the
color differences were associated with a decrease in
lightness (L*). All denture base resin decreased in a*
(more green color), and coffee produced an increase in b*
(more yellow) in contrast to wine, which resulted in a
decrease in b* value (more blue). Denture teeth increased
in a* and b* (more red and yellow color).
Spectrophotometers and colorimeters have been used
to overcome the shortcomings and subjectivity of visual
color evaluation. Spectrophotometers offer a 33% in-
crease in accuracy when compared with human eye ob-
servations.34 The VITA Easyshade spectrophotometer has
been reported to have a 96.4% reliability and an accuracy
of 92.6%35 and was therefore used in the present study.
These instruments are designed to measure flat sur-
faces,34 so the dark stain accumulation at the tooth-
denture base interface can only be assessed visually. To

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Figure 5. (continued). E, Portrait/Injection specimen stained by coffee. F, Vivodent/Bonded specimen stained by coffee. G, Vivodent/Compression
specimen stained by coffee. H, Portrait/Compression specimen stained by coffee.
reduce the inaccuracy of the visual evaluation in this
study, only the presence or absence of stain was noted.
Color acceptability thresholds have been assessed
with DEab values ranging between 1.1 and 6.8.31,36 This
high variability may be because of different study designs,
viewing conditions, and materials. The International
Organization for Standardization32 has recently recom-
mended a DEab value of 1.2 as 50%:50% perceptibility
threshold and 2.7 as 50%:50% acceptability threshold.
When immersed in coffee, Portrait, Vivodent, and Ava-
Dent Monolithic teeth had a color difference greater than
the AT. Portrait teeth had the same result when immersed
in wine, while Vivodent and Monolithic teeth had
perceivable and acceptable color change. Denture base
specimens immersed in wine had an unacceptable color
difference for milled and compression-molded specimens,
while the color change of injection-molded specimens
was below the AT. Coffee immersion caused less promi-
nent color difference, and DE values were below the
acceptability threshold.
Visual evaluation of denture block specimens showed
that CAD-CAM dentures may offer better resistance
to discoloration at the tooth-denture base resin
interface. Conventional dentures undergo polymerization
al-Qarni et al
7
shrinkage that could damage the junction between
the denture base and the tooth by creating a space
through which stains and microorganisms can penetrate.
Variable degrees of pigmentation were observed. Im-
mersion in coffee produced light to dark brown discol-
oration (Fig. 5A, 5C, 5E-H), while discoloration caused by
red wine was blue to purple (Fig. 5B, 5D). The extent and
size of the pigmented area seems to be associated with
the size of the void at the interface. Bonding denture
teeth to milled acrylic resin base can also cause discol-
oration, although to a lesser extent, probably due to the
roughness sometimes created by the bonding agent.
The in vitro use of standardized specimens to mea-
sure color is essential to evaluate the material’s internal
and surface characteristics and its effect on color stability.
This does not, however, represent staining patterns that
are frequently observed on dentures. It is the experience
of the authors that denture staining after clinical use is
typically seen at the junction between the denture tooth
and denture base acrylic resin. This study aimed to
evaluate this phenomenon by testing denture blocks.
Saliva, microbial biofilm, and cleaning solutions were
not used in this study, which limits its clinical application.
The results of this study, however, can be used to
THE JOURNAL OF PROSTHETIC DENTISTRY
8 Volume
emphasize the importance of following good denture
hygiene practice and instructions to minimize denture
staining. Future research can focus on different CAD-
CAM denture systems and different shades of teeth
and denture bases. The influence of accelerated aging on
the color stability of milled acrylic resins should also be
investigated.
CONCLUSIONS
Within the limitations of this in vitro study, the following
conclusions were drawn:
1. All evaluated acrylic resin specimens had significant
color change when immersed in coffee or red wine.
Coffee produced the most color difference.
2. Monolithic teeth and base acrylic resin materials
used in CAD-CAM dentures had similar color
change to conventionally processed acrylic resin.
3. At the tooth-denture base interface, CAD-CAM
milled specimens were less likely to harbor stains
than compression- or injection-molded specimens.
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Corresponding author:
Dr Faisal al-Qarni
2835 King Faisal Road, Dammam 34212
SAUDI ARABIA
Email: fdalqarni@gmail.com
Acknowledgments
The authors thank Dr Wendy Gregorius for providing the positioning device used
with denture teeth, Dr Mary Anne Melo for providing VITA Easyshade device, Dr
Maria Ibrahim for statistical consultation, and AvaDent, Dentsply Sirona, and
Ivoclar Vivadent AG for donating the materials used for the study.
Copyright © 2019 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2019.07.004
al-Qarni et al