Minimally invasive use of coloured composite resin in aesthetic restoration of periodontially involved teeth: Case report

Color stability and degree of conversion of gingiva-colored resin-based composites

OBJECTIVES

To evaluate gingiva-colored resin-based composites' (GCRBC) color stability and degree of conversion (DC%).

METHODS

Eight discs (8 × 1 mm) of 20 shades of GCRBC were prepared. Color coordinates were measured against a gray background with a calibrated spectroradiometer, CIE D65 illuminant and the CIE 45°/0° geometry at baseline and after 30 days of storage in distilled water, coffee, and red wine. Color differences ( ∆ E 00 ) between final and baseline conditions were calculated. An ATR-FTIR spectrometer with a diamond tip was used to calculate DC%. The results were analyzed statistically using ANOVA and Tukey post-hoc test. The level of significance was p < 0.05.

RESULTS

DC% and color stability correlated with each other and with the GCRBC brand. DC% ranged between 43% and 96%, highest values correspond to flowable composites. All composites have experienced color changes after immersion in water, wine and coffee. However, the magnitude of the color change has varied widely depending on the immersion medium and the GCRBC. Color changes generated by the wine were, globally, greater than those induced by coffee (p < 0.001) and above the acceptability thresholds.

CONCLUSIONS

The DC% of GCRBCs is sufficient to achieve adequate biocompatibility and physicomechanical properties, but the high susceptibility to staining could compromise aesthetic long-term results.

CLINICAL SIGNIFICANCE

The degree of conversion and the color stability of gingiva-colored resin-based composites correlated with each other. All composites have experienced color changes after immersion in water, wine and coffee. Color changes generated by wine were, globally, greater than those induced by coffee and above the acceptability thresholds that could compromise aesthetic long-term results.

Removal of Composite Restoration from the Root Surface in the Cervical Region Using Er: YAG Laser and Drill-In Vitro Study

Background: Recently, the defects of the tooth surface in the cervical region are often restored using composite filling materials. It should meet the needs of the patients regarding esthetics and material stability. The aim of the study was to analyze the tooth root surface at the cervical region after the removal of the composite filling material by means of the Erbium-doped Yttrium Aluminium Garnet (Er: YAG) laser or drill using the scanning electron microscopy (SEM) and fluorescence microscopy. Materials and Methods: For the purposes of this study, 14 premolar teeth (n = 14) were removed due to orthodontic reasons. The rectangular shape cavities with 3 mm in width and 1.5 mm in height were prepared with a 0.8 mm bur on high-speed contra-angle in the tooth surface just below cemento-enamel junction (CEJ) and filled with the composite material. The composite material was removed with the Er: YAG laser at a power of 3.4 W, energy 170 mJ, frequency 20 Hz, pulse duration 300 μs, tip diameter 0.8 mm, air/fluid cooling 3 mL/s, and time of irradiation: 6 sec, at a distance from teeth of 2 mm (G1 group, n = 7) or a high-speed contra-angle bur (G2 group, n = 7). After the removal of composite material, the surfaces of teeth were examined using the scanning electron microscopy (SEM) and fluorescence microscopy. Results: The Er: YAG irradiation allowed to remove completely the composite material from the tooth cavity. The study confirmed, that the ends of collagen fibers were only partially denatured after the Er: YAG laser application. Conclusion: It has been proved that using the Er: YAG laser is an effective and safe method of composite removal for the dentin surface.

An Alternative Prosthodontic Management of Maxillary Dentoalveolar Defect in a Patient With Cleft Palate and Lip: Case Report

Cleft palate/lip is a frequently occurring congenital anomaly; one in every 800 births results in such a problem. Different treatment options are available for replacing missing soft and hard tissues, including removable dental prostheses, fixed dental prostheses (FDPs), and implant prostheses. In the literature, according to different authors, there are different option standard for prosthetic treatment of cleft palate/lip. Some authors report that removable prosthesis is the choice in such cases, some of them regard conventional tooth-supported FDPs as a standard of care. In this case report, the prosthetic treatment of congenital cleft palate/lip was described. Upon the choice of the patient and patient's agreement, the direct construction Fibre-reinforced composite (FRC) adhesive bridge with pink composite gingival epithesis was performed.

Clinical study on natural gingival color

The aims of the study were: to describe the gingival color surrounding the upper incisors in three sites in the keratinized gingiva, analyzing the effect of possible factors which modulate (socio-demographic and behavioral) intersubject variability; to study whether the gingiva color is the same in all three locations and to describe intrasubject color differences in the keratinized gingiva band. Using the CIELAB color system, three reference areas (free gingival margin, keratinized gingival body, and birth or upper part of the keratinized gingiva) were studied in 259 individuals, as well as the related socio-demographic factors, oral habits and the chronic intake of medication. Shadepilot™ spectrophotometer was used. Descriptive and inferential statistical analysis was performed. There are statistically significant differences between males and females for coordinates L* and a* in the middle and free gingival margin. For the b* coordinate, there are differences between males and females in the three locations studied (p < 0.05). The minimum and maximum coordinates in which the CIELAB natural gingival space is delimited are L* minima 28.3, L* maximum 65.4, a* minimum 11.1, a* maximum 37.2, b* minimum 6.9, and b* maximum 25.2*. Age, smoking, and the chronic intake of medication had no significant effect on gum color. There are perceptible color differences within the keratinized gingiva band. These chromatic differences must be taken into account if the prosthetic characterization of gingival tissue is to be considered acceptable. There are significant differences between the color coordinates of the three sites studied in the keratinized gingiva of men and women.

Illuminant effect on the coverage error of a gingiva-colored composite resin shade guide

STATEMENT OF PROBLEM

Dental clinicians face challenges when selecting the proper gingiva-colored composite resin.

PURPOSE

The purpose of this study was to evaluate the coverage error (CE) of a gingiva-colored dental composite resin shade guide with regard to the optical characteristics of the attached gingiva of a selected population under 2 different illuminants: Commission Internationale de l'Eclairage (CIE) illuminants A and D65.

MATERIAL AND METHODS

The spectral reflectance (SR) values of 12 shade tabs of a gingiva-colored composite resin (Amaris gingiva) were measured at 3 different locations without a backing by using a spectroradiometer and an external light source at wavelengths of 380 to 780 nm at 2-nm intervals. All SR measurements were made using 0-degree observer and 45-degree illumination, with target size 1.1 mm in diameter. The attached gingiva (AG) of 120 participants was measured with the same protocol. CIELab values were calculated from the spectral reflectance values. CEs of the attached gingiva for each of the 120 participants for each of the shade tabs and the 2 illuminants and their combination were determined and averaged. The CIEDE2000 color differences were analyzed by a repeated measures ANOVA (using the maximum likelihood estimation method and the Satterthwaite degrees of freedom method) (α=.001).

RESULTS

The CIEDE2000 color difference for each person's gingiva to the closest match in color to the shade guide was determined separately for CIE illuminants A and D65. CE was calculated as the averages of these color differences and was found to be 4.0 for CIE illuminant D65 and 5.8 for CIE illuminant A.

CONCLUSIONS

The tested gingiva-colored shade guide had different CEs under illuminant D65 than under illuminant A and exhibited metamerism. ΔE for both illuminants was greater than the clinically acceptable range reported in the literature.

Exploring the versatility of gingiva-colored composite

Gingival recession has a diverse etiology. The consequences may include gingivitis, periodontitis, and hypersensitivity. Whereas the management can include surgical treatment options, sometimes a more conservative, yet still esthetic approach may be required. The use of gingiva-colored composites provides one such alternative and can be applied to varying presentations of the problem. While surgical treatment can be successful in re-creating favorable esthetic anatomy as well as achieving accurate tissue contour in cases when minor amounts of tissue are reconstructed, long-term results vary because of the vascularity and complexity of the interdental space. Factors such as cost, healing time, discomfort, and variable long-term results make surgery an unpopular choice. If tooth-colored restorative materials are utilized to restore cervical tooth exposure as a result of severe recession, the disproportionate appearance of the visible crown may give a dissatisfying result. Gingiva-colored composite provides dental practitioners with a versatile material that can be used to directly restore cervical defects caused by gingival recession, thus correcting the appearance of the gingival anatomy. It offers a treatment option that may increase patient satisfaction through the provision of a cost-effective, minimally invasive solution with highly esthetic results.