Effect of the amount of thickness reduction on color and translucency of dental monolithic zirconia ceramics

Comparative Analysis of Translucency in Different Thicknesses of Monolithic Zirconia Crowns

OBJECTIVES

Achieving optimal esthetics in dental restorations remains challenging, particularly with zirconia crowns, which, despite their durability, often exhibit less translucency than natural teeth. This study aimed to evaluate how varying thicknesses of monolithic zirconia crowns affect their translucency.

MATERIALS AND METHODS

In this experimental laboratory study, an initial model (a brass die) was scanned, and two dies, one black (9005 RAL), and one white (9010 RAL), were created from Resin according to the scanned file. Next, 30 zirconia crowns (ZrO2, Arum, High Translucent) were fabricated in three thicknesses: 0.5, 0.8, and 1.5 mm. The color and translucency of the samples were assessed under standard lighting conditions (D65) using a spectroradiometer, and the color parameters L*, b*, and a* were recorded. The translucency of each sample was measured using the CIEDE2000 and CIE-Lab formulae. Data were analyzed using one-way ANOVA and the Tamhane test.

RESULTS

Statistically significant changes in the color and translucency of the samples were observed with varying thicknesses (p < 0.001). Specifically, the translucency parameter (TP), L*, and b* values decreased as the thickness increased, whereas a* values remained relatively stable. The average TP values for CIE-Lab ranged from 11.51 at 0.5 mm to 6.54 at 1.5 mm, and for CIEDE2000, they ranged from 8.19 at 0.5 mm to 4.82 at 1.5 mm.

CONCLUSION

Within the limitations of this in vitro study, it can be concluded that reducing the thickness of monolithic zirconia restorations increases their translucency. Thinner zirconia restorations demonstrate a higher TP, which may offer improved esthetic integration in clinical applications.

Factors Affecting the Color Change of Monolithic Zirconia Ceramics: A Narrative Review

Zirconia restorations are widely used in dentistry due to their high esthetic expectations and physical durability. However, zirconia's opaque white color can compromise esthetics. Therefore, zirconia is often veneered with porcelain, but fractures may occur in the veneer layer. Monolithic zirconia restorations, which do not require porcelain veneering and offer higher translucency, have been developed to address this issue. Zirconia exists in three main crystal phases: monoclinic, tetragonal, and cubic. Metal oxides such as yttrium are added to stabilize the tetragonal phase at room temperature. 3Y-TZP contains 3 mol% yttrium and provides high mechanical strength but has poor optical properties. Recently, 4Y-PSZ and 5Y-PSZ ceramics, which offer better optical properties but lower mechanical strength, have been introduced. This review examines the factors affecting the color change in monolithic zirconia ceramics. These factors are categorized into six main groups: cement type and color, restoration thickness, substrate color, sintering, aging, and zirconia type. Cement type and color are crucial in determining the final shade, especially in thin restorations. Increased restoration thickness reduces the influence of the substrate color while the sintering temperature and process improve optical properties. These findings emphasize the importance of material selection and application processes in ensuring esthetic harmony in zirconia restorations. This review aims to bridge gaps in the literature by providing valuable insights that guide clinicians in selecting and applying zirconia materials to meet both esthetic and functional requirements in restorative dentistry.

Impact of Substrate Material, Esthetic Material Thickness, and Cement on Color Reproduction in Implant-Supported Fixed Restorations

Purpose  This study aimed to evaluate the impact of substrate material, esthetic material type and thickness, and cement shade on the final color reproduction of implant-supported fixed restorations. The goal was to identify optimal combinations for achieving clinically acceptable esthetic outcomes. Material and methods  An in vitro study was conducted using four substrate materials, hybrid polyetherketoneketone (PEEK)-based ceramic-reinforced polymer (BioHPP), chromium-cobalt alloy (CrCo), grade 5 titanium (Ti), and white zirconium oxide ceramic (WZirCAD), and three esthetic materials, lithium disilicate ceramic (e.max CAD), polymethyl methacrylate (PMMA), and zirconia oxide ceramic (e.max ZirCAD), at five different thicknesses (0.5, 1, 1.5, 2, and 2.5 mm). Color differences (ΔE*) were measured using a spectrophotometer, both with and without cement application. Statistical analysis was performed using the Kruskal-Wallis test and Bonferroni correction to assess the effects of material combinations on color reproduction. Results  The study found that a 1 mm thickness of e.max CAD on BioHPP and CrCo substrates provided the best color matching, with ΔE* values closest to clinical acceptability. PMMA showed higher ΔE* values, indicating lower color stability compared to e.max CAD and e.max ZirCAD. Cement shade had a near-significant influence on final color perception, particularly with e.max ZirCAD on CrCo substrates. Conclusions  The study suggests that using e.max CAD at 1 mm thickness on BioHPP or CrCo substrates provides superior esthetic results, underscoring the need for careful material selection in clinical practice. Further in vivo research is recommended to validate these findings and explore long-term outcomes.

Comparative analysis of optical and numerical models for reflectance and color prediction of monolithic dental resin composites with varying thicknesses

OBJECTIVE

To assess the prediction accuracy of recent optical and numerical models for the spectral reflectance and color of monolithic samples of dental materials with different thicknesses.

METHODS

Samples of dental resin composites of Aura Easy Flow (Ae1, Ae3 and Ae4 shades) and Estelite Universal Flow Super Low (A1, A2, A3, A3.5, A4 and A5 shades) with thicknesses between 0.3 and 1.8 mm, as well as Estelite Universal Flow Medium (A2, A3, OA2 and OA3 shades) with thicknesses between 0.4 and 2.0 mm, were used. Spectral reflectance and transmittance factors of all samples were measured using a X-Rite Color i7 spectrophotometer. Four analytical optical models (2 two-flux models and 2 four-flux models) and two numerical models (PCA-based and L*a*b*-based) were implemented to predict spectral reflectance of all samples and then convert them into CIE-L*a*b* color coordinates (D65 illuminant, 2°Observer). The CIEDE2000 total color difference formula (ΔE00) between predicted and measured colors, and the corresponding 50:50% acceptability and perceptibility thresholds (AT00 and PT00) were used for performance assessment.

RESULTS

The best performing optical model was the four-flux model RTE-4F-RT, with an average ΔE00 = 0.72 over all samples, 94.87% of the differences below AT00 and 65.38% below PT00. The best performing numerical model was L*a*b*-PCHIP (interpolation mode), with an average ΔE00 = 0.48, and 100% and 79.69% of the differences below AT00 and PT00, respectively.

SIGNIFICANCE

Both optical and numerical models offer comparable color prediction accuracy, offering flexibility in model choice. These results help guide decision-making on prediction methods by clarifying their strengths and limitations.

Randomized clinical trial of zirconia laminate veneers sintered by using conventional versus speed process: 1-year follow-up

STATEMENT OF PROBLEM

The application of highly translucent multilayered zirconia ceramic in minimally invasive esthetic dentistry allows the achievement of both esthetics and strength with minimal thickness. Clinical studies that have assessed the performance of zirconia ultrathin veneers sintered with the conventional and speed procedure are lacking.

PURPOSE

The purpose of this clinical study was to evaluate the effect of speed sintering processes on the translucency and clinical performance of zirconia laminate veneers.

MATERIAL AND METHODS

Four participants had their teeth restored with 32 ultratranslucent zirconia laminate veneers. Based on the zirconia sintering procedure, the participants were randomly allocated into 2 groups. The teeth were prepared by selective reduction over trial restorations. Zirconia veneers were milled from multilayer zirconia blanks and sintered either by speed sintering or conventional sintering as specified by the manufacturer's recommendations. The intaglio surface of the veneers were airborne-particle abraded with 50-μm aluminum-oxide, and the veneers were then adhesively bonded to the teeth with translucent light-polymerizing resin cement. The modified California Dental Association (CDA)/Ryge criteria were used to assess participants at baseline and every 3 months for 12 months. The translucency and the color difference of the tooth before and after veneer restoration were evaluated. For statistical analysis, the Pearson chi squared test, independent t test, and paired t test were used (α=.05).

RESULTS

Translucency and color differences were significantly higher in the conventionally sintered group (P<.05). No restorations were lost. No significant differences were found between the 2 groups in the CDA/Ryge criteria or color parameter after follow-up intervals (P>.05). The primary qualitative changes observed at the final recall were marginal integrity and marginal discoloration. The color match and zirconia surface were rated Alfa.

CONCLUSIONS

After 1 year of follow-up, both conventional and speed sintered ultrathin zirconia laminates showed satisfactory functional, esthetic, and color stability outcomes.

Effects of Coloring Liquid Dipping Time and Surface Finishing Procedures on the Optical Properties of Monolithic Zirconia

BACKGROUND

Monolithic zirconia restorations can be produced from self-colored or uncolored blocks. The coloring procedure of uncolored blocks and surface treatments may affect the appearance of the restoration.

AIM

The purpose of this study is to evaluate the effect of liquid coloring and surface treatments on optical properties of translucent monolithic zirconia.

METHODS

All specimens were cut from zirconia blocks with a thickness of 1 mm. Specimens were dipped in the coloring liquids for 3 min, 5 min, and 7 min and then divided into groups of 10 specimens for surface treatments. Glaze and mechanical polishing were applied, and the color of the specimens was measured under the D65 lighting condition with a spectrophotometer device. Color values obtained from the CIE Lab formula and the translucency parameter (TP), opalescence parameter (OP), and contrast ratio (CR) were calculated. The normality of the data was confirmed with the Shapiro-Wilk test. A three-way analysis of variance (ANOVA) was used to assess the effect of dipping time, liquid shade, and surface treatments.

RESULTS

The effect of liquid shade and dipping time on the TP, OP, and CR parameters were statistically significant, and the TP values were reduced with the application of coloring liquid. Mechanical polishing groups had higher OP values and lower TP values than glazed groups.

CONCLUSION

In cases where high translucency is required, it may be advisable to use self-colored blocks and apply glaze as a surface treatment to achieve the desired optical properties.

Translucency of recent zirconia materials and material-related variables affecting their translucency: a systematic review and meta-analysis

BACKGROUND

Recent forms of translucent zirconia material have been developed, offering a wide range of options and varieties for enhancing aesthetics, making it a preferred choice in the field of prosthetic dentistry. However, there is insufficient understanding regarding the recent types of zirconia materials and their optical behavior. Understanding the variables that influence the translucency of zirconia and identifying strategies to enhance its esthetics are crucial.

PURPOSE

The current systemic review highlights a comprehensive understanding of different zirconia generations in relation to their optical characteristics and evaluates material-related variables affecting their translucency.

METHODS

The present review studied in-vitro studies that evaluated the optical characteristics of different yttria content of yttria stabilized materials. The topics explored were: (1) the different zirconia material generations and their optical behavior; (2) material-related factors that affect their translucency. The research was restricted to online publication in the English language from July 1, 2010, to July 31, 2023, using PubMed, Scopus, and Science Direct resources. The search key terms and their combinations were "zirconia," "translucent zirconia," "cubic zirconia," "highly translucent zirconia," "yttria partially stabilized zirconia," "monolithic zirconia," "translucency," "optical properties," and "light transmission."

RESULTS

The data obtained from fifty-three studies addressed the optical characteristics of various zirconia generations. They reported that changing yttria content had a significant impact on translucency. Different kinds of zirconia ceramics of the same generation have varying translucencies. Achieving optimum aesthetics with monolithic zirconia is challenging due to factors related to material aspects such as the presence of additives, point defects, microstructure, thickness, phase distribution, and sintering conditions.

CONCLUSIONS

Newly developed monolithic dental zirconia ceramics have improved aesthetics and translucency. However, additional research is necessary to evaluate their performance and long-term durability.

TRIAL REGISTRATION

This systematic review was registered in PROSPERO, under number CRD42023474482.

Optical properties of dental zirconia, bovine dentin, and enamel-dentin structures

OBJECTIVE

To evaluate the optical properties and the relative translucency parameter of Ceramill ZI White (3Y-TZP) and Ceramill Zolid FX White (5Y-PSZ) zirconia ceramic systems and compare them with those of the bovine dentin and enamel/dentin structures.

MATERIALS AND METHODS

3Y-TZP and 5Y-PSZ zirconia ceramic systems were evaluated. A 0.5-mm-thick 3Y-TZP (3Y-NC.5), 0.5-mm-thick (5Y-NC.5), and 1.4-mm-thick (5Y-C.14) were used. A 0.5-mm-thick dentin specimens and 1.4-mm-thick enamel/dentin specimens (n = 5) were obtained from anterior bovine maxillary teeth. Scattering, absorption, transmittance, and albedo coefficient were calculated using Kubelka-Munk's model. Data were statistically analyzed using Kruskal-Wallis and Mann-Whitney tests (p < 0.001), and goodness-of-fit coefficient (GFC). Relative translucency parameter differences were evaluated using translucency thresholds.

RESULTS

Reflectance, scattering, absorption, and transmittance properties were wavelength dependent. Good matches (GFC ≥ 0.999) in spectral reflectance were observed between 0.5-mm-thick dentin and 1.4-mm-thick enamel/dentin, and 3Y-NC.5 and 5Y-NC.5. Scattering was the main optical extinction process during light interaction with zirconia and dental structures, as indicated by albedo coefficient. Translucency differences were acceptable only for 3Y-NC.5 and the dentin structure, and 5Y-C.14 and the enamel/dentin structure.

CONCLUSIONS

Optical properties of 3Y-TZP and 5Y-PSZ dental zirconia differed from each other and from bovine dental structures. Nevertheless, 3Y-TZP showed similar relative translucency parameter to bovine dentin.

CLINICAL SIGNIFICANCE

To achieve the best esthetic results in restorative dentistry, it is crucial for clinicians to know about the optical properties of 3Y-TZP and 5Y-PSZ and to be able to compare these properties with those of dental structures.

A comparative study of translucency and color perception in monolithic zirconia and lithium disilicate veneers

Ceramic laminate veneers which are a conservative approach to restoring anterior teeth, combining minimal preparation and esthetics. This study aims to evaluate the impact of the thickness of monolithic zirconia laminate veneers on their optical properties and color perception, comparing them to lithium disilicate. A total of 60 laminate veneers were prepared using two ceramic materials, divided into three groups for each material (n = 10) with thicknesses of 0.5, 0.7, and 1.0 mm. CIELab color parameters of the veneers were measured using a spectrophotometer and translucency parameters were calculated. The veneers were cemented onto uniform dies and final L, a, b values of the restorations were measured. The color difference between the different thicknesses was calculated using the CIEDE2000 formula. Two-way ANOVA and Bonferroni HSD post hoc tests were conducted to compare the color parameters (α = 0.05). The results showed that both material type (p < 0.001) and thickness (p < 0.001) influenced translucency values. The translucency values of zirconia veneers were significantly lower than those of lithium disilicate. The color differences (ΔE00) resulting from thickness changes (0.5-1.0 mm) were near or below the perception threshold for lithium disilicate, but distinct for zirconia restorations. In conclusion, monolithic zirconia veneers demonstrated lower translucency compared to lithium disilicate. Changing the material thickness affected the translucency of both materials, but not the color perception only for zirconia.

Effect of partially stabilized zirconia thickness on the translucency and microhardness of resin cement

STATEMENT OF PROBLEM

Partially stabilized zirconia has been introduced as a more translucent iteration. However, knowledge of the effect of the thickness of partially stabilized zirconia on the microhardness of resin cement is sparse.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of thickness and material type on the translucency of partially stabilized zirconia and the microhardness of the resin cement polymerized beneath.

MATERIAL AND METHODS

Specimens were prepared from 2 translucent zirconias with different yttrium content (Ceramil Zolid HT+ [HT] and Ceramil Zolid FX [SHT]) and a lithium disilicate glass-ceramic (e.max CAD [EX]) of different thicknesses (0.5, 1, 1.5, and 2 mm) (n=10). Color coordinates were recorded by using a spectrophotometer, and the relative translucency parameter (RTP) was calculated by using the CIEDE2000 formula. The microhardness of the resin cement polymerized under ceramic specimens was measured. Two-way analysis of variance, the Tukey honestly significant difference, and independent samples t tests were used to analyze the data (α=.05).

RESULTS

Material type (P<.001), thickness (P<.001), and their interaction significantly affected the RTP (P=.001) and hardness values (P<.001). Regardless of the thickness, EX had the highest RTP (P≤.027), and the resin cements polymerized under EX showed the highest microhardness (P≤.002). However, the difference between HT and SHT for RTP (P≥.082) and resin cement hardness (P≥.984) was not significant. Specimens of 0.5 mm resulted in higher RTP (P≤.001) and resin cement hardness (P≤.006) than the 1.5- and 2-mm specimens of each ceramic.

CONCLUSIONS

Increasing material thickness reduced the translucency of the partially stabilized zirconia and the hardness of the resin cements polymerized beneath.

Effect of CAD/CAM Position and Thickness of Ultra-Translucent Multilayered Zirconia on Color Aspects

Background

Ultra-translucent multilayered zirconia restorations fabricated using computer-aided design and computer-aided manufacturing (CAD/CAM) technology have recently gained popularity. Their esthetic appeal is crucially dependent on the color accuracy, influenced by prosthesis thickness and multilayer composition due to CAD/CAM milling positions. This study comprehensively investigated how these two factors impacted color accuracy, thereby enhancing our understanding of color outcomes.

Materials and Methods

One hundred monolithic multilayer zirconia specimens with 10 × 10 mm square shape were milled in four different positions and five different thicknesses (1.0, 1.5, 2.0, 2.5, and 3.0 mm). The specimens were placed on an A3 shade resin composite substrate, and CIELAB values (L ∗, a ∗, and b ∗) were measured using a spectrophotometer. Delta E (ΔE) values were calculated to quantify the color differences between the specimens and the A3 VITA classical shade tab and compared with the perceptibility and acceptability thresholds of ΔE = 1.2 and 2.7, respectively. Pearson correlation, two-way ANOVA, and Tukey multiple comparisons (α = 0.05) were performed.

Results

The proportion of the dentin layer was positively correlated with the a ∗ and b ∗ values, while specimen thickness was positively correlated with the a ∗ value and negatively correlated with the L ∗ and b ∗ values. Significant difference in ΔE value due to different CAD/CAM positions was not observed within the same specimen thickness. Perceptible color differences were observed in specimens with thicknesses greater than 1 mm, while specimens with 1 mm thickness fell within the clinically acceptable range. Highest ΔE value was found in the specimen with 1 mm thickness.

Conclusions

Different compositions of multilayers in the final restoration due to different CAD/CAM positions do not significantly affect the color appearance of ultra-translucent multilayer zirconia, with color only influenced by specimen thickness.

Effects of thickness and polishing treatment on the translucency and opalescence of six dental CAD-CAM monolithic restorative materials: an in vitro study

BACKGROUND

Computer-aided design and computer-aided manufacturing (CAD-CAM) materials for prosthetic is gaining popularity in dentistry. However, limited information exists regarding the impact of thickness and roughening treatment on the optical properties of contemporary CAD-CAM restorative materials. This study aimed to quantitatively evaluate the translucency and opalescence of six dental CAD-CAM materials in response to different thicknesses and roughening treatments.

METHODS

Six dental CAD-CAM materials, lithium disilicate glass-ceramic (IPS e.max CAD, LS), polymer-infiltrated ceramic (VITA Enamic, VE), resin-nano ceramic glass-ceramic (LAVA Ultimate, LU), polymethyl methacrylate (Telio CAD, TE), and two zirconia reinforced lithium silicate (VITA Suprinity, VS, and Celtra Duo, CD), in shade A2 were prepared as 12 × 12mm2 specimens of four thicknesses (0.5mm, 1.0mm, 1.5mm, and 2.0mm) (N = 240, n = 10). After three different treatments (polished, roughened by SiC P800-grit, and SiC P300-grit), the translucency parameter (TP00) and opalescence parameter (OP) were measured with a spectrophotometer (VITA Easyshade V). The surface roughness was analyzed with a shape measurement laser microscope. The data were analyzed using a MANOVA, post hoc Tukey-Kramer test, the t test, and regression analysis (α = .05).

RESULTS

The TP00 and OP were significantly influenced by material type, thickness and roughening treatment (P < .05). TP00 showed a continues decline with increasing thicknesses, while the variations of OP were material-dependent. TP00 ranged from 37.80 (LS in 0.5mm) to 5.66 (VS in 2.0mm), and OP ranged from 5.66 (LU in 0.5mm) to 9.55 (VS in 0.5mm). The variations in TP00 of all materials between adjacent thicknesses ranged from 2.10 to 15.29, exceeding the acceptable translucency threshold except for LU. Quadratic and logarithmic regression curves exhibited the best fit for TP00 among the materials. Compared to polished specimens, rougher specimens exhibited lower TP00 and higher OP in all materials except for LS (P < 0.05). Roughening with P300-grit decreased TP00 and OP by an average of 2.59 and 0.43 for 0.5mm specimens, and 1.26 and 0.25 for 2.0mm specimens, respectively.

CONCLUSIONS

Variations in translucency caused by thickness and roughening treatment were perceptible and may be clinically unacceptable. Careful consideration should be given to the selection of CAD-CAM materials based on their distinct optical properties.

Effect of thickness on color and translucency of a multi-color polymer-infiltrated ceramic-network material

OBJECTIVES

To evaluate the effect of thickness on color and translucency of a multi-color polymer-infiltrated ceramic-network (PICN) material.

METHODS

Specimens of 0.5, 1.0, 1.5 mm thicknesses were obtained by sectioning VITA ENAMIC® multiColor (E-MC) High Translucent CAD-CAM blocks (1M1-HT, 1M2-HT, 2M2-HT, 3M2-HT, and 4M2-HT). Spectral reflectance and color coordinates were measured on white and black backgrounds using a spectroradiometer, CIE D65 illuminant and CIE 45°/0° geometry. CIEDE2000 color and translucency differences (ΔE₀₀ and ΔTP₀₀ ) between thicknesses and adjacent layers were evaluated using their respective 50:50% perceptibility and acceptability thresholds (PT₀₀ and AT₀₀ ).

RESULTS

In general, ΔE₀₀ between thicknesses for all shades and layers were above AT₀₀ in general. Chroma decreased from cervical to incisal layers with statistically significant differences (p < 0.05), and ΔE₀₀ between sequential layers were above PT₀₀ , for all shades and thicknesses. TP₀₀ decreased from 0.5 to 1.5 mm and increased from cervical to incisal layers for all shades with statically significant translucency differences (p < 0.05). In general, for all thicknesses, TPT₀₀  < ΔTP₀₀  < TAT₀₀ for sequential layers.

CONCLUSIONS

The gradient in color and translucency of E-MC PICN material was influenced by the thickness of the CAD-CAM block. In addition, color and TP transition values between the layers depends on the thickness and shade.

CLINICAL SIGNIFICANCE

The effect of thickness must be taken into account by dental technicians and dentists when CAD-CAM multicolor PICN materials are used.

A Scoping Review on the Polymerization of Resin-Matrix Cements Used in Restorative Dentistry

In dentistry, clinicians mainly use dual-cured or light-cured resin-matrix cements to achieve a proper polymerization of the organic matrix leading to enhanced physical properties of the cement. However, several parameters can affect the polymerization of resin-matrix cements. The main aim of the present study was to perform a scoping review on the degree of conversion (DC) of the organic matrix, the polymerization, and the light transmittance of different resin-matrix cements used in dentistry. A search was performed on PubMed using a combination of the following key terms: degree of conversion, resin cements, light transmittance, polymerization, light curing, and thickness. Articles in the English language published up to November 2022 were selected. The selected studies' results demonstrated that restorative structures with a thickness higher than 1.5 mm decrease the light irradiance towards the resin-matrix cement. A decrease in light transmission provides a low energy absorption through the resin cement leading to a low DC percentage. On the other hand, the highest DC percentages, ranging between 55 and 75%, have been reported for dual-cured resin-matrix cements, although the polymerization mode and exposure time also influence the DC of monomers. Thus, the polymerization of resin-matrix cements can be optimized taking into account different parameters of light-curing, such as adequate light distance, irradiance, exposure time, equipment, and wavelength. Then, optimum physical properties are achieved that provide a long-term clinical performance of the cemented restorative materials.

Effect of thickness of externally characterized stains on optical properties of high-translucency zirconia

OBJECTIVES

There is insufficient information about the effects of the thickness of externally characterized stains or glazes on CIELAB color parameters and the translucency parameter (TP) of 5 mol% yttria partially stabilized zirconia (5Y-PSZ). The present study evaluated the effect of a thickness reduction of the externally characterized or glazed layer on its CIE2000 color parameters and TP₀₀ of 5Y-PSZ.

MATERIALS AND METHODS

Twenty-eight specimens were sectioned from 5Y-PSZ blanks. Three brands of powdered stains (namely VI, SH, and IV) and a glaze (GL) were used to extrinsically stain the specimen surfaces (n = 7 per group). After measuring the final thickness and color, specimens of each group were carefully ground and finally polished. The reduced thickness was carefully controlled in decrements of 0.02 mm on the characterized stains or glazed layers at each reduction cycle until the surface of the un-stained zirconia was exposed. The CIELAB color parameters of specimens were measured using a spectrophotometer. Subsequently, differences in lightness (∆L'), chroma (∆C'), and hue (∆H'), and TP₀₀ values and color differences (ΔE₀₀) were calculated using the CIEDE2000 formula to determine differences between the specimen and the un-stained zirconia at each reduction cycle. A paired-samples t-test, two-way mixed-design analysis of variance, and Pearson correlation coefficient were used to analyze the data (α = 0.05).

RESULTS

There were no significant differences in lightness, chroma, hue, or TP₀₀ values before or after glazing or after each reduction cycle of the glazed layer. Mean ΔE₀₀ values ranged between 20.94 and 33.55 after applying the externally characterized stains. With a decreased thickness of the characterized stain layer, there were observed that significant decreases in ∆L', ∆H', ∆C', and ΔE₀₀, and significant increases in TP₀₀.

CONCLUSIONS

Increasing the thickness of externally characterized stains decreased the lightness and caused the alternation of chroma and hue, whereas these phenomena were not observed in the glazed group. There was a slight change of CIE2000 color parameters and TP₀₀ when the thickness of the characterized layer exceeded 0.06 mm.

CLINICAL RELEVANCE

The application and thickness of externally characterized stains can sensitively affect CIE2000 color parameters and translucency of 5Y-PSZ.

Effect of speed sintering of monolithic zirconia with different yttria contents on color and crystal phase

This study evaluated the color and microstructure of monolithic zirconia crowns with different yttrium oxide (Y₂ O₃ ) contents treated by conventional or speed sintering. Four types of zirconia ceramics were assessed: two monolayer zirconia, and two multilayer zirconia. The monolithic zirconia crowns were fabricated using a dental computer-aided design/computer-aided manufacturing (CAD/CAM) system and in two shades (A2 and BL). After milling, the zirconia crowns were sintered using either speed sintering or conventional sintering. For each combination of zirconia (4), shade (2), and sintering condition (2), the color parameters were determined at three positions of each of nine crowns using a non-contact dental spectrophotometer. In addition, the zirconia phases in the specimens were quantified using X-ray diffractometry. Significant differences in the ΔE₀₀ values at different measurement positions were observed for the Multi2 crown of the BL shade group. The color difference resulting from conventional and speed sintering programs was not affected by the difference in yttria content of Mono1, Mono2, and Multi1. However, in Multi2, containing 3Y-TZP and 5Y-PSZ, a color change was caused by the use of speed sintering. Therefore, when performing speed sintering with Multi2, it is necessary to select the color in consideration of these results or take measures for staining.

Effect of glazing and polishing on opalescence and fluorescence of dental ceramics

OBJECTIVE

Tooth enamel has opalescence and fluorescence, which should be mimicked by esthetic dental restorations. The purpose of this study was to compare the effects of glazing and polishing on the opalescence and fluorescence of dental ceramics.

MATERIALS AND METHODS

Twenty-four discs were fabricated of feldspathic, IPS e.max, zirconia, and Enamic ceramics with 10 mm diameter and 0.5 and 1 mm thicknesses (n = 12). Of the discs fabricated with 0.5 and 1 mm thicknesses, half of them were glazed and the remaining half were polished (n = 6). Opalescence was calculated as the difference in yellow-blue (CIE ∆b*) and red-green (CIE ∆a*) color axes between the transmitted and reflected colors. The fluorescence of specimens was measured by a novel technique. Data were analyzed using two-way analysis of variance at a 0.05 level of significance.

RESULTS

In all groups (except for the Enamic ceramic), the mean opalescence of polished specimens (e.max = 2.704, feldspathic = 1.67, zirconia = 3.143) was higher than that of glazed specimens (e.max = 2.163, feldspathic = 1.016, zirconia = 2.690). The mean opalescence of glazed Enamic specimens (2.140) was higher than that of polished specimens (1.308). The fluorescence of glazed and polished specimens was not significantly different.

CONCLUSION

Surface treatment (glazing/polishing) affects the opalescence, but not the fluorescence of dental ceramics evaluated in this study.

Color prediction of layered dental resin composites with varying thickness

OBJECTIVE

The aim of this study was to assess the accuracy of a Principal Components Analysis (PCA)-based method for reflectance reconstruction and color estimation of layered dental resin-based composites with different thicknesses.

METHOD

Bi-layered samples of different clinically relevant thicknesses were created using shades of VITAPAN Excell (VE), VITAPAN Dentine (VD) and VITA Physiodens (VP), combined with their corresponding enamel shades. Spectral reflectance of all samples was measured over a black background using a non-contact spectroradiometer with CIE 45^∘∕0^∘ geometry. Two different PCA-based models, built from two different configurations of known samples, were proposed to reconstruct the spectral data and color of unknown layered samples. Root Mean Square Error (RMSE), Goodness of Fit (GFC), as well as ΔE₀₀ with corresponding 50:50% acceptability and perceptibly thresholds (AT and PT) were used as performance assessment.

RESULTS

The 5-samples training set approach provided an average RMSE < 0.015 and GFC > 0.999 when measured and predicted spectral reflectances were compared, while for the 9-samples training set, RMSE < 0.0098 and GFC > 0.9999 were obtained. The overall mean color differences obtained with the 5-samples training set approach were ΔE₀₀ = 0.99 (AT% = 96.25% and PT% = 32.50%), while using the 9-samples training set resulted in lower overall mean color differences: ΔE₀₀ = 0.50 (AT% = 99.22% and PT% = 83.87%).

SIGNIFICANCE

Within the framework of this study, the two proposed PCA-based configurations allow the prediction of the spectral reflectance of layered dental resin-based composites of different shades and thicknesses, with a high degree of accuracy.

Evaluating the Effect of Different Polymer and Composite Abutments on the Color Accuracy of Multilayer Pre-Colored Zirconia Polycrystal Dental Prosthesis

With increasing aesthetic awareness and emphasis on time costs in today’s society, monolithic multilayer precolored zirconia ceramics (M-Zr) facilitate aesthetic restorations in a convenient and straightforward manner without the need for veneering porcelain to modify the color. However, the effect of abutment materials on the final color of M-Zr remains unclear. Herein, we placed Vita A1 Shade M-Zr on six different abutment materials, zirconia (Y-TZP), 3D printed composite resin (CR), dental model resin (MR), polyetheretherketone (PEEK), polyetherketoneketone (PEKK), and cobalt−chromium alloy (Co−Cr), to evaluate their effect on the color accuracy of M-Zr. The color attributes (L*, a*, and b*) were measured using a dental spectrophotometer. The translucency parameter (TP), contrast ratio, color difference (ΔE) between each background substrate and the Vita A1 Shade Guide, and chroma values (C) were calculated to evaluate the color accuracy of M-Zr. A statistical analysis was performed using one-way analysis of variance and post hoc Tukey’s HSD tests (α = 0.05). The experimental results indicate that the TP values and contrast ratio of the M-Zr samples were 14.85 and 0.83, respectively. Co−Cr had the highest ΔE (6.08) and lowest C value (7.52); PEKK had the lowest ΔE (2.60), and PEEK had the highest C value (12.23) (p < 0.05). Notably, the ΔE values of CR (3.13), PEEK (2.86), and PEKK were within clinical indicators (ΔE < 3.7). Based on these results, it can be concluded that the abutment material has a significant effect on the final color of the M-Zr, and PEEK or PEKK resulted in good color accuracy. When choosing the dental MR, traditional zirconia, or metals as abutment materials, colored or opaque cement might be required to eliminate color distortion and achieve desirable optical properties.

Retention strength of monolithic zirconia crowns cemented with different primer-cement systems

BACKGROUND

The purpose of this in vitro study was to assess the influence of different cement systems with different ceramic primers on the retention strength of zirconia crowns.

METHODS

Thirty extracted molars were prepared with flat occlusal surfaces, 20 degrees taper, and 3 mm axial wall height. A zirconia crown with an occlusal bar was fabricated for each tooth. All specimens were divided (n = 10) into; Group M: Multilink Speed/Monobond N, Group P: Panavia V5/Clearfil Ceramic Primer Plus, Group D: Duo-Link universal/Z-Prime Plus. The intaglio surfaces of crowns were air-abraded using 50 µm alumina at 2.5 bar for 10 s. Then each crown was cemented onto its corresponding tooth. All specimens were thermocycled for 10,000 cycles between 5 and 55 °C. Each crown was subjected to gradually increasing vertical load along the path of insertion through hooks engaging the occlusal bar using a universal testing machine until failure. The force at dislodgment was recorded and retention strength was calculated for each specimen. The failure modes were recorded for each specimen. The data were statistically analyzed using one way ANOVA test followed by Tukey HSD test (α = .05).

RESULTS

Group D showed lowest strength (1.42 ± 0.23 MPa) and differed significantly (P < .001) from Group M (2.71 ± 0.45 MPa) and Group P (2.47 ± 0.41 MPa). There was no significant difference (P = .34) between Group M and Group P. The failure modes for Groups M and Group P were mainly cohesive, while Group D showed adhesive failure.

CONCLUSIONS

The retention strength of zirconia crowns was improved with Multilink Speed and Panavia V5 cement systems, while the use of the Duo-Link Universal cement system only showed half of those retention strength values.

Digital Tools for Translucence Evaluation of Prosthodontic Materials: Application of Kubelka-Munk Theory

Translucency is one of the most important parameters to be considered by digital systems when predicting the matching appearance and hence the quality of prosthodontic restoration work. Our objective has been to improve the effectiveness of the algorithmic decision systems employed by these devices by (a) determining whether Kubelka-Munk theory can be used as an algorithm for predicting restoration suitability, and (b) evaluating the correlation between the visual evaluation of prosthodontic materials and the predicted translucency based on the use of the ΔE*, OP, CR, and K/S algorithms. In this regard, three zirconia systems and one lithium disilicate have been spectrophotometrically and visually characterized. Based on the results of this study, it has been proven that zirconia systems and lithium disilicate systems exhibit different optical behaviors. The psychophysical experience suggests that none of the existing mathematical methods can adequately estimate translucency, spectrophotometric, and colorimetric techniques, and that which is perceived by an experienced observer. However, translucency evaluation through the K/S algorithmic decision system should not be disregarded. New methods to measure translucency should be developed to improve digital systems for prosthodontic applications.

Effect of grinding on the optical properties of monolithic zirconia

OBJECTIVES

The purpose of this study was to analyze the color infiltration in monolithic zirconia after grinding, which plays an essential role in the color stability of restorations after occlusal adjustment.

METHODS

One hundred and eight white zirconia plates (36 Dentsply Sirona-Cercon high translucency [C], 36 Zirkonzahn-Prettau [P], 36 Zirkonzahn-Prettau anterior [Pa]) were stained by infiltration with target colors Vita A2, A3.5, and A4. In a standardized experimental setup, all plates were grinded in nine successive steps (from baseline to 500 μm), and color was measured with a spectroradiometer at each grinding step. Color differences ΔE₀₀ between initial color and after each grinding step were calculated. The data was analyzed using regression, Kruskal-Wallis test, inverse prediction, and simultaneous 95%-confidence intervals.

RESULTS

Grinding had a significant effect on color stability across all zirconia types and target colors (p < 0.001). At each cut level and target color, ΔE₀₀ means for groups C, P, and Pa were statistically different (p < 0.05). Among the three zirconia types, Pa had the lowest ΔE₀₀ mean score for cut levels 20-100 μm for A2 and between 50 and 300 μm for A3.5 and A4. For all other cut levels, differences between Pa and P were not significant (α = 0.05). C had the largest mean ΔE₀₀ except for A4 until 100 μm, where it was second best.

CONCLUSION

Zirconia type had a significant effect on the color infiltration depth across all target colors. Pa showed the best color stability until 150 μm material reduction, whereas C presented significantly less color stability than the other two zirconia materials.

CLINICAL SIGNIFICANCE

Color stability is important for minimizing the risk of restoration failure due to unacceptable color changes after grinding. Pa is less susceptible to color change and has an additional buffer of 60 μm until exceeding the color acceptability threshold. When higher flexural strength is needed, P is to be preferred.

Optical properties evaluation of rapid sintered translucent zirconia with two dental colorimeters

Background/purpose

The efficient rapid sintering technique has employed to dental zirconia ceramics for shortening the fabrication time of zirconia restorations. The purpose was to compare the optical properties of two generations of rapid sintered translucent zirconia using two dental colorimeters.

Materials and methods

Two generations of translucent zirconia ceramics, 3 mol% yttria-tetragonal zirconia polycrystal (3Y-TZP): Copran Zr-i Ultra-T (UT) and Cercon HT (HT), and 5 mol% yttria-tetragonal zirconia polycrystal (5Y-TZP): Cercon xt (XT), of different thicknesses (0.5, 0.8, and 1.2 mm; n = 5) underwent rapid sintering (RS) or conventional sintering (CS). The CIELAB values were measured on the white and black backgrounds, respectively, by digital colorimeters, shadepilot, DeguDent (DD) and Easyshade V, Vita (Vita). Translucency parameter (TP), color difference (ΔE), surface morphology, and surface roughness were evaluated.

Results

RS resulted in reduced lightness, except in the XT group. The chromaticity increased slightly after RS. Translucency decreased with increasing material thickness. ΔE values differed between both sintering processes but were clinically acceptable (ΔE < 5). Grain size of XT decreased after RS. RS did not affect the surface roughness.

Conclusion

RS is a feasible method for shortening the manufacturing time of zirconia restorations. A significant difference in TP value was only in the XT group between both sintering methods as measured on DD. Color differences in rapid sintered translucent zirconia materials are imperceptible and acceptable. The specimen thickness affected more in the TP values of Vita than DD. DD has higher sensitivity to translucency and color compared with Vita.

Influence of zirconia/glass veneer thickness and implant abutment material on the final shade of implant restorations

Aim

The aim of this study was to investigate the combined effect of ceramic material, ceramic thickness, and implant abutment background to the final color of restorations.

Settings and Design

This was a comparative in vitro study.

Materials and Methods

Three different types of monolithic and porcelain-veneered zirconia disc-shaped specimens (Prettau Anterior, VITA YZ ST, and VITA YZ HT) were prepared in A3 shade with two different thicknesses (1 mm and 1.5 mm) (n = 10). Each zirconia material was made of 4-mm thickness as a control specimen of each monolithic zirconia type, and 4-mm thick veneering ceramic (VITA VM9 Base Dentine) was made as a control for veneered zirconia groups. Three simulated implant abutments were fabricated from titanium, white-shaded and yellow-shaded zirconia. The zirconia specimens were placed on different abutment backgrounds, and the color difference (ΔE) between experimental and control specimens was measured.

Statistical Analysis Used

The three-way ANOVA and the Scheffé test were used for data analysis (α = 0.05).

Results

The mean ΔE values between two thicknesses were significantly different in every background for all zirconia materials. The ΔE values of zirconia specimens on yellow zirconia were lower than those of other abutments. The clinically acceptable ΔE value (ΔE <3) was found in some monolithic zirconia specimens on white-shaded and yellow-shaded abutments, while the ΔE value is approximately 3 or less in all 1.5-mm thick porcelain-veneered zirconia groups.

Conclusions

Different zirconia materials on implant abutments affected the final color of restorations. To achieve satisfactory color, the minimum thickness of zirconia restorations should be at least 1.5 mm on yellow zirconia abutment.

Effects of milling method and artificial ageing on optical properties of high translucent zirconia for chairside restorations

OBJECTIVES

This study aimed to evaluate the optical properties of highly translucent 5 mol% yttria, partially stabilised monolithic zirconia, and 3 mol% yttria-stabilised tetragonal zirconia after their subjection to different milling methods and artificial ageing.

METHODS

Two types of pre-shaded zirconia materials were used: inCoris TZI C and Katana STML. A total of 120 specimens were categorised according to the milling method (dry or wet-milling) and the solution used for milling (fresh distilled water or impregnated water with residues of CAD/CAM ceramic materials). The translucency and contrast ratios of all specimens were calculated after they were subjected to sintering and accelerated ageing. The material phase composition was tested before and after ageing, using X-ray diffraction analysis to evaluate T-M phase transformation. Data were statistically analysed via a three-way analysis of variance between the subject factors, the material and milling method, and the within-subject factor, ageing. The analysis of covariance model was used to analyse the changes in translucency and contrast ratio between baseline and ageing, with statistical significance set at p < 0.05.

RESULTS

Katana STML and inCoris TZI C showed the highest translucency when dry-milled (21.9 ± 1.4, and 11.8 ± 0.7, respectively), and the lowest when milled with used impregnated water (5.4 ± 1.2 and 10.7 ± 1.3, respectively). Wet-milling using impregnated water, should be avoided owing to the saturation of alumina particles. Accelerated ageing resulted in the same pattern for both materials. Significance Dry milling of highly translucent zirconia can result in higher translucency and lower contrast ratio values.

Effect of Veneering and Hydrothermal Aging on the Translucency of Newly Introduced Extra Translucent and High Translucent Zirconia with Different Thicknesses

Purpose

The purpose of this study was to evaluate the effect of veneering and aging on the translucency of newly introduced extra and high translucent zirconia with different thickness.

Materials and Methods

One hundred forty disk-shaped specimens were fabricated from two translucent zirconia blocks (VITA YZ XT and VITA YZ HT), and they are milled with CAD/CAM system. Then, specimens were divided into nonveneered (XT, HT) and veneered groups (XTV, HTV). Nonveneered groups were prepared with four different thicknesses (0.5-1-1.5-2 mm). Veneered groups were divided into three subgroups (n = 10) for veneering with base dentin ceramic with thicknesses of 0.5 + 0.5, 0.5 + 1, and 0.5 + 1.5 mm. A spectrophotometer was used to calculate the translucency parameter (TP) and contrast ratio (CR) of all specimens before and after aging. Statistical analysis was performed using 3-way ANOVA and Tukey HSD tests (p < 0.05).

Results

TP values were significantly affected by thickness of specimens (p < 0.001). VITA YZ XT was significantly found more translucent than VITA YZ HT. The highest translucency was observed in the XT-0.5 mm group. There is no significant difference between translucency of the veneered and nonveneered groups in the same thickness for XT. On the contrary, veneering significantly affected translucency of HT. TP values significantly decreased after aging for all groups. After aging, translucency value difference before and after aging was the highest in the XT-0.5 mm group whereas the HTV-2 mm group showed the lowest difference after aging. TP decreased significantly as thickness of specimen increases regardless of the material type. Extra translucent and nonveneered zirconia groups are more prone to hydrothermal aging.

Conclusions

The translucency parameter of zirconia ceramics was significantly influenced by both material type and veneering. Also, extra translucent and nonveneered zirconia groups are more susceptible to hydrothermal aging.

Effects of surface treatments and abutment shades on the final color of high-translucency self-glazed zirconia crowns

STATEMENT OF PROBLEM

Achieving excellent esthetics with monolithic self-glazed zirconia crowns in anterior teeth is challenging, and the impact of different surface treatments and abutment shades on the final color is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effects of different external surface treatments (self-glazed, milled, polished, and glazed), different intaglio surface treatments (milled and airborne-particle abraded), and different abutment shades on the color difference of high-translucency self-glazed zirconia crowns.

MATERIAL AND METHODS

Sixty shade A1 and 60 shade A3 crowns were fabricated with a thickness of 0.80 ±0.02 mm and randomly divided into 12 groups (n=10). Different external and intaglio surface treatments were applied. Shade A1 and A3 abutments were made with composite resin. Color was measured with a spectrophotometer and expressed in CIELab coordinates, and color differences (ΔE₀₀) between specimens and references were calculated. The data were analyzed with ANOVA and the Tukey post hoc test. The impact of different surface treatments and abutment shades on the color difference were compared by using multiple linear regression (α=.05).

RESULTS

The effects of external surface treatments, intaglio airborne-particle abrasion, and abutment shades on the L∗, a∗, b∗ and ΔE₀₀ values of the final color of the crowns were significantly different (P<.001). Polishing resulted in the greatest ΔE₀₀ value among all external surface treatments (P<.001). The average ΔE₀₀ values of all crowns on the A3 abutment were higher than those of all crowns on the A1 abutment (P<.001). The influence on the color difference was abutment>external surface treatment>intaglio surface treatment.

CONCLUSIONS

Different surface treatments affected the final color of zirconia crowns, and a greater impact was seen with external surface treatments than with intaglio surface treatments. External polishing resulted in the greatest color difference. The abutment shade had the most effect on the color difference, as the darker the abutment color, the greater the color difference.

Effect of external staining on the optical properties and surface roughness of monolithic zirconia of different thicknesses

STATEMENT OF PROBLEM

The effect of the number of external staining applications on the color, translucency, and surface roughness of monolithic zirconia is not known.

PURPOSE

The purpose of this in vitro study was to investigate the effect of glazing and repeated external staining on the color, translucency, and surface roughness of 2 types of monolithic zirconia with 2 different thicknesses.

MATERIAL AND METHODS

Thirty-two 10×10-mm monolithic zirconia blocks, of which 16 were super high translucent and 16 were high translucent, were milled. The thickness of half the blocks was 0.7 mm, and the others were 1.2-mm thick. Four specimens in each subgroup were colored with value stain, and the other half with yellow stain. Staining was repeated twice for each specimen. The color and translucency of each specimen were measured before overglazing as the baseline, after overglazing, and after each staining process by using a spectrophotometer. The surface roughness (Ra) was measured after overglazing, the first staining, and the second staining. Data were analyzed by using repeated measures ANOVA and the independent t test (α=.05).

RESULTS

The number of coloring, type of coloring, and thickness changed the optical properties of monolithic zirconia. a∗, b∗, L∗ Value and ΔE were affected by the stage of firing (glazing, first staining, and second staining) (P<.001). ΔE Increased after the first and second staining in each type and thickness of monolithic zirconia and each type of stain. The amount of ΔE change was more for the first staining stage. The color difference (ΔE) after overglazing ranged from 3.08 to 3.75. The highest changes in color were related to the first staining with yellow colorant of super-high-translucent monolithic zirconia (cubeX²) with 0.7-mm thickness (ΔE=17.62). The surface roughness of the specimens was affected by the number of colorings (P<.001). In all groups, the first staining increased the surface roughness, and the second staining decreased the surface roughness. The type of monolithic zirconia (P=.756), thickness (P=.735), and type of stain (P=.239) had no significant effect on the surface roughness.

CONCLUSIONS

The first stage of staining with both stains caused more color change in all types and thicknesses of monolithic zirconia. Translucency increased after glazing and decreased after the first and second staining. The first staining increased the surface roughness, and the second decreased the surface roughness.

Effects of thickness of different types of high-translucency monolithic multilayer precolored zirconia on color accuracy: An in vitro study

STATEMENT OF PROBLEM

High-translucency monolithic multilayer precolored zirconia provides acceptable esthetics and eliminates chipping of the veneering porcelain. However, the color is not always consistent with the standard Vita shade guide, and the color saturation may vary with the thickness of the zirconia.

PURPOSE

The purpose of this in vitro study was to characterize the effect of thickness on the color accuracy of high-translucency monolithic multilayer precolored zirconia.

MATERIAL AND METHODS

Plate-shaped (20×20 mm) Vita A2 shade high-translucency monolithic multilayer precolored zirconia specimens of 3 types (SHT Multilayer, AT Multilayer, and 3D Multilayer) in 4 thicknesses (0.5, 1.0, 1.5, and 2.0 mm) were fabricated (N=120, n=10). A spectrophotometer was used to measure the color attributes (CIELab) against gray or A2 substrates to evaluate the color accuracy based on differences in color (ΔE) (versus the Vita shade guide) and chroma. Statistical analysis was performed by using the Pearson correlation, 2-way ANOVA, and post hoc Scheffé test (α=.05).

RESULTS

Against gray substrates, thickness was significantly positively correlated with all color attributes. Against A2 substrates, L∗ values increased with an increase in thickness; however, a∗, b∗, and chroma values remained stable. Zirconia with a thickness of 1.0 mm exhibited the lowest ΔE, regardless of the type, except for AT Multilayer against A2 substrates, where the lowest ΔE was achieved at 0.5 mm. At thicknesses ≥1.0 mm, the ΔE between the 2 substrates was imperceivable.

CONCLUSIONS

Thickness affected the color accuracy of different high-translucency monolithic multilayer precolored zirconia types. It appears that the optimal thickness in terms of color accuracy is 1.0 mm. These results could be used as a reference for the selection and preparation of abutments in clinical applications.

Optical properties of a novel glass-ceramic restorative material

OBJECTIVE

To examine the optical properties of a dental restorative material manufactured from lithium aluminosilicate ceramic and reinforced with lithium disilicate. Translucency and the optical effects of various supporting materials on color were the primary focus.

METHODS

Five 10 × 10 mm samples were prepared in thicknesses of 0.5, 1.0, 1.5, and 2.0 mm of both high translucency (HT) and low translucency (LT) versions of the material in shade A3. A spectrophotometer was used to measure the illuminance of the samples with black and white backings in order to calculate contrast ratio (CR) and relative translucency parameter (RTP). A baseline relationship between translucency and material thickness was examined and the effects of composite, titanium, and zirconia abutments on color change were studied.

RESULTS

No significant findings were identified for RTP or CR between the HT and LT material, regardless of the material thickness (p = 0.39, p = 0.14, respectively). Regardless of material thickness (HT vs. LT), translucencies (RTP and CR) were significantly different with composite, titanium, and zirconia backings compared to baseline values (p < 0.0001). Titanium had the most significant decrease in translucency compared to composite and zirconia. There was no difference in ΔE00 between the HT and LT materials (p > 0.05) regardless of the backing. Titanium had the most significant effect on color of both materials followed by composite then zirconia (p < 0.0001).

CONCLUSIONS

There is not a clinically significant difference in translucency between the high translucency and low translucency materials. Only zirconia supporting structures produced changes in color that are clinically acceptable.

CLINICAL SIGNIFICANCE

Understanding the optical properties of glass-ceramic restorative materials aids providers in selecting appropriate materials for optimum esthetic outcomes. The lithium-aluminosilicate reinforced with lithium disilicate material does a poor job masking supporting structures and resisting color change.

Effects of abutment tooth and luting agent colors on final color of high-translucent zirconia crowns

PURPOSE

This study aimed to evaluate the effects of the tooth portion evaluated and the colors of the abutment tooth and resin luting agent on the final color of monolithic zirconia crowns.

METHODS

Monolithic zirconia crowns were fabricated for left maxillary central incisors using two shades (A2 and A3) of highly translucent monolithic zirconia disks. A model of the abutment tooth was fabricated using resin core materials (white: W; dentin: D). The color of the crowns was measured with try-in pastes (clear: C; brown: B) as a resin-luting agent substitute. The measurement was performed after placing the crown on the model with the attached abutment tooth with try-in paste. The color of three labial portions (cervical, body, and incisal) was evaluated using a dental spectrophotometer. The color difference (ΔE) between the CIELab values of the zirconia disks and the final me asurement of zirconia crowns was calculated.

RESULTS

The ΔE between the crown of the A2 shade and the zirconia disk of the A2 shade had the highest ΔE value in the body portion with W-B (ΔE=3.92). Similarly, the A3 shade had the highest ΔE value in the cervical portion, with W-B (ΔE=4.27). The results of three-way ANOVA showed that the ΔE values were influenced by the tooth portion evaluated and the color of the abutment tooth.

CONCLUSIONS

The final color of the monolithic zirconia crowns was significantly in fluenced by the tooth portion evaluated and the color of the abutment tooth.

Effects of sintering time on translucency and color of translucent zirconia ceramics

OBJECTIVE

To investigate the effect of sintering time on translucency and color of translucent zirconia ceramics.

MATERIALS AND METHODS

Sixty translucent zirconia (5Y-TZP) specimens (12 × 1.6 mm, Katana (KAT) and NexxZr (NEX)) were divided into six groups (n = 10) according to sintering time; 1, 2 (specified by manufacturer-control), and 3 hs. Color differences (ΔEab) within same material when sintered using different times and between materials when same sintering time was used were calculated, as well as translucency parameters (TP) after the use of each sintering time. Data for ΔEab and TP were analyzed with two-way ANOVAs, pairwise comparisons, and Fisher's LSD Test (Post-hoc).

RESULTS

When 1 or 3 h were used, color difference from the color of specimens when manufacturer-specified time (2 h) was used was similar for both KAT and NEX. ΔEab values of NEX were significantly higher than KAT when sintered for 1 or 3 h (P < 0.001). TP increased for KAT when sintered for 1 h, and was higher than NEX. TP for NEX increased when sintered for 3 h (P < 0.001), but was not significantly different than that of KAT.

CONCLUSIONS

Effect of 1 or 3-h sintering on color was similar for both zirconias. For NEX, this effect resulted in greater differences from the color of specimens when manufacturer-specified time was used. Sintering for 1 h increased the translucency of KAT.

CLINICAL SIGNIFICANCE

When high translucency is desired, clinicians may prefer 1-h sintering for KAT zirconia. When lower translucency is desired, 3-h sintering for NEX can be used. However, for NEX, the color after 1- or 3-h sintering was different than the color obtained with manufacturer-specified time, and this difference may affect the final color of restoration compared to the final color when manufacturer-specified time is used.

Color compatibility between dental structures and three different types of ceramic systems

BACKGROUND

To assess color compatibility between dental structures (human enamel and dentine) and three different types of ceramic systems.

METHODS

Samples (1 and 2 mm-thick) of extracted tooth (containing dentine and enamel areas) and three ceramic systems with different shades and opacities (HT-High Translucent, T-Translucent) were prepared for this study: Vita Suprinity-VS (HT, T; A1, A2, A3, A3.5, B2, C2, D2) (Vita Zahnfabrik); Vita Enamic-VE (HT, T; 1M1, 1M2, 2M2, 3M2) (Vita Zahnfabrik) and Noritake Super Porcelain EX-3-NKT (A1, A2, A3, A3.5, B2, C2, D2) (Kuraray Noritake Dental). Reflectance measurements of all samples were performed over black backgrounds using a non-contact spectroradiometer (SpectraScan PR-670, Photo Research) under a CIE 45°/0° geometry. CIE L*a*b* color parameters were measured and CIELAB/CIEDE2000 color differences (ΔE₀₀/ΔE^*_ab) and corresponding Coverage Error (CE) of ceramic system for dentine or enamel samples were calculated. Color data was analyzed using one-way ANOVA and post-hoc multiple comparisons tests. CE values were interpreted by comparisons with available 50:50% acceptability color threshold (AT) for dentistry.

RESULTS

Statistically significant differences in lightness were found among all ceramic systems and human dentine (p < 0.001), while no significant differences were registered between enamel and VSHT, T and VEHT. 1 mm dentine showed no statistical differences with VST and VSHT for a* coordinate, while 2 mm dentine showed no significant differences (p > 0.05) with VEHT. Thin samples (1 mm) of dentine and enamel showed significant statistical differences (p < 0.05) for b* coordinate with less translucent materials (NKT, VET and VST). For dentine samples, none of the ceramic materials provided a CE lower than AT. VSHT provided the best CE for 1 mm-thick (CE₀₀ = 1.7, CE_ab = 1.9) and for 2 mm-thick (CE₀₀ = 2.3; CE_ab = 2.5) enamel samples.

CONCLUSIONS

Color coordinates of evaluated esthetic ceramic systems were statistically different from those of human dentine in almost all cases. The evaluated ZrO₂ lithium silicate glass-ceramic (VS), with its two levels of translucency, provided lower CE values with human enamel samples while conventional feldspathic ceramic (NKT) and hybrid ceramic systems (VE) demonstrated a better color compatibility with dentin samples.

Effect of mouth rinses on optical properties of CAD-CAM materials used for laminate veneers and crowns

OBJECTIVE

The purpose of this study was to investigate the effect of mouth rinses on the color and translucency of three computer-aided design and computer-aided manufacturing (CAD-CAM) restorative materials in laminate veneer and crown thicknesses.

METHODS

Specimens from two different 5Y-TZP zirconia (InCoris TZI (IT), and Zirkonzahn (ZH)) and lithium disilicate (IPS e.max CAD [IC]) in two different thicknesses (0.7 mm for laminate veneer, and 1.5 mm for crown) were sectioned. All specimens were colored with an A2-shade liquid, and the baseline color values were recorded according to the CIELab system with a spectrophotometer. Each group was divided into two subgroups (n = 15) according to the immersion solution: two different mouth rinses, KL (Klorhex), and LI (Listerine, cool mint) for 180 hours. The color coordinates (L*, a*, b*) of the specimens were measured before and after immersion in a mouth rinse, and TP and ΔE₀₀ color differences were calculated by using the CIEDE2000 color difference formula. A 3-way ANOVA, Bonferroni test, and 1-sample t tests were used to analyze the data (α = 0.05).

RESULTS

The 3-way ANOVA revealed a significant interaction of material, thickness, and mouth rinse for translucency parameter and color difference (ΔE₀₀ ) data (p < 0.001). TP decreased for both zirconia materials in laminate veneer thickness when immersed in LI mouth rinse (p < 0.05). No difference was found among the TP mean values of three materials in crown thickness after immersed in mouth rinses (p > 0.826). Both zirconia materials immersed in LI showed greater discoloration than after immersed in KL (p < 0.05). A significant difference was found in color change values among three materials for the laminate veneer thickness after immersed in LI (p < 0.001). However, all color difference values were within the clinical acceptability threshold, except for when ZH in laminate veneer thickness was immersed in LI.

CONCLUSIONS

The color change of ZH zirconia with LI mouth rinse in laminate veneer thickness was high. For both zirconia ceramics, translucency decreased and the color was less stable in laminate veneer thickness after immersed in LI compared to the crown thickness.

CLINICAL SIGNIFICANCE

The results of this in vitro study suggest that long-term use of alcohol-containing mouth rinse may alter the optical properties of tested CAD-CAM materials in tested laminate veneer thickness. For color stability with the long term use of tested mouth rinses, lithium disilicate may be preferred for both types of restorations.

Effect of in vitro aging and acidic storage on color, translucency, and contrast ratio of monolithic zirconia and lithium disilicate ceramics

STATEMENT OF PROBLEM

How the translucency and color of ceramic restorations are affected by surface changes from the corrosive environment in the oral cavity and aging of materials is unclear.

PURPOSE

The purpose of this in vitro study was to compare the impact of acidic exposure and aging on the color and translucency of monolithic zirconia and lithium disilicate ceramics.

MATERIAL AND METHODS

Twenty computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic zirconia specimens and 20 pressed lithium disilicate specimens were fabricated. Half of the specimens of each group were aged in an autoclave (7.5 hours, 134 °C, 0.2 MPa), and the rest were immersed in hydrochloric acid to simulate the acidic conditions in the oral cavity from gastric reflux. The color coordinates L∗, a∗, and b∗ were measured with an ultraviolet spectrophotometer before and after aging or acidic storage. The translucency parameters and contrast ratios were calculated, and the CIEDE2000 color difference formula was used to determine color differences before and after each treatment. ANOVA and ANCOVA test models were used for data analysis (α=.05), while differences of color parameters in respect to acceptability and perceptibility thresholds were evaluated with the 1-sample t test (α=.05).

RESULTS

Lithium disilicate presented a significantly higher translucency parameter and lower contrast ratio at baseline compared with monolithic zirconia specimens (P<.001). Acidic storage significantly impacted all parameters compared with aging, especially for the lithium disilicate group. Color differences were above the acceptability ΔΕ₀₀ threshold for lithium disilicate after acidic storage (P=.001) and below for monolithic zirconia after acidic storage (P=.003).

CONCLUSIONS

The performance of lithium disilicate was slightly inferior compared with that of monolithic zirconia specimens, as they presented significant and clinically observable differences for the translucency parameter and ΔΕ₀₀ after acidic storage and aging.

Effect of surface finishing and polishing procedures on color properties and translucency of monolithic zirconia restorations at varying thickness

OBJECTIVE

This study aimed to assess the impact of monolithic zirconia thickness on its color properties after different surface finishing and polishing procedures, and following aging in coffee solution.

MATERIALS AND METHODS

Two types of monolithic zirconia brands [Prettau Anterior (PA) and DD Cubex2 (DDC)] with three different thicknesses: 0.5, 1, and 1.5, and 10 mm diameter were tested. The color properties were evaluated after various surface finishing procedures (glazing, adjusting with burs + glaze, polishing, adjusting with burs + polishing) and after 5,000 cycles in a coffee solution were evaluated. The differences in color (ΔE) and translucency, were calculated and statistically analyzed by three-way ANOVA and pairwise comparison (α = 0.05).

RESULTS

The brand, material thickness, and surface finishing protocol before and after coffee thermocycling had significant effect on color variations (p < 0.001). For translucency, 3-way ANOVA revealed a significant interaction between the material thickness and surface finishing protocol following aging in coffee solution (p < 0.001), however no significant interaction was observed following the surface finishing protocols (p = 0.247).

CONCLUSIONS

The optical properties of monolithic zirconia ceramics can be influenced by the material brand, material thickness and the procedure of surface finishing and polishing.

CLINICAL SIGNIFICANCE

Clinicians should take into consideration the potential change of the color properties of monolithic zirconia restorations following both contouring and occlusal adjustment procedures and coffee intake.

Evaluation of shade correspondence between current monolithic CAD/CAM blocks and target shade tab by considering the influence of cement shade and restorative material thickness

It was aimed to evaluate shade matching between novel CAD/CAM blocks and the A2 target shade tab by considering the influence of cement shade and restorative material thickness on the chromatic background. A total number of 120 rectangular-shaped specimens were subtracted from four different prefabricated CAD/CAM blocks [Vita Enamic (VE), Lava Ultimate (LU), GC Cerasmart (GC), and Vita Mark II (VMII)]. These specimens had thicknesses of 0.5 mm and 1.0 mm. Three different shades (A2, opaque, and translucent) of dual-polymerized resin cement were chosen. The dentin shade (A3.5) restorative composite foundation was incrementally fabricated in a silicon mold. For control group, the A2 shade tab of the Vitapan classical shade guide was used. Different restorative material-cement-foundation assemblies were generated with optic gel. Color readings were performed by using a clinical spectrophotometer, and CIEDE2000 (ΔE₀₀) formula was used to assess color differences. Data were statistically analyzed (α = 0.05). With increasing thickness, color difference values decreased. Higher mean ΔE₀₀ units were observed in all restorative material sub-groups for 0.5 mm thickness. In TR shade, no statistically significant difference was detected among the mean ΔE₀₀ values of 0.5 mm-thick restorative materials. Color differences in groups 1.0 mm-opaque-LU and 1.0 mm-opaque-GC indicated perceptible but clinically acceptable values (0.8˂ΔE₀₀ ≤ 1.8). The highest and lowest ΔE₀₀ units were observed in the 0.5 mm-A2-VE group (ΔE₀₀ = 7.07) and 1 mm-opaque-GC group (ΔE₀₀ = 1.46), respectively. Luting cement shade, restorative material type, and thickness significantly influenced the resultant color of restoration. Opaque cement on dentin foundation exhibited lower color differences.

Color accuracy of different types of monolithic multilayer precolored zirconia ceramics

STATEMENT OF PROBLEM

The use of monolithic multilayer precolored zirconia facilitates the production of esthetic restorations in a convenient and straightforward manner. However, the accuracy of the final color is not clear.

PURPOSE

The purpose of this in vitro study was to determine the color accuracy of different types of monolithic multilayer precolored zirconia ceramics of varying thicknesses.

MATERIAL AND METHODS

Eighty cubical A2-shade monolithic multilayer precolored zirconia ceramic specimens (15×15 mm) of 2 different thicknesses (1.0 mm and 1.5 mm) and 4 zirconia brands (UPCERA EXPLORE [UPEX], KATANA Zirconia STML [STML], Enamel ZR Multi-5 [EZM5], and Aidite 3D Pro Zir [A3DM]) were fabricated and divided into 8 groups (n=10). The Commission Internationale de l'Eclairage (CIELab) values were measured against 3 different backing substrates (gray, transparent, and A2) by using a spectrophotometer. The color difference (ΔE) between the backing substrates of each group and the Vita A2 Shade Guide, translucency parameter (TP), and chroma (C) values were calculated to evaluate the accuracy of the final color. Statistical analysis was performed by using ANOVA and the post hoc Tukey HSD tests (α=.05).

RESULTS

The ΔE values for UPEX and STML exceeded the clinically acceptable thresholds for gray and transparent backing substrates (ΔE>3.7) and were higher than those for the A2 backing substrate. A3DM showed less ΔE from the shade guide for all the backing substrates (P<.05), and the corresponding ΔE values were within the clinically acceptable threshold (ΔE<3.7). The TP value was inversely proportional, and the C value was proportional to thickness. For the zirconia ceramics with identical thicknesses, UPEX and STML exhibited the highest TP values, and A3DM showed the lowest C value (P<.05).

CONCLUSIONS

At a specific thickness, color accuracy was mainly affected by the type of monolithic multilayer precolored zirconia ceramic, and the high transparency of ceramics will cause color differences.

Color stability of individually stained monolithic zirconia following occlusal adjustment

OBJECTIVE

To meet esthetic requirements, monolithic zirconia can be stained by color-infiltration. However, adjustments of occlusal surfaces are often necessary, leading to demasking effects if too much of the color-infiltrated layer is removed. The effect of subsequent material removal on color stability of individually stained zirconia is analyzed here.

MATERIALS AND METHODS

Thirty-six white zirconia disks were divided into three groups. Standardized staining strategies for tooth colors VITA A2, A3.5, and A4 were developed and applied to the disks. Samples were grinded in nine successive steps from 20 to 500 μm. A spectroradiometer was used to measure the color differences after each step. Regression analyses were performed for color differences from baseline as a function of depth of material removal. Depth of material removal resulting in color changes surpassing the acceptability threshold of ΔE₀₀ = 1.8 was estimated using inverse prediction.

RESULTS

Up to 500 μm material removal, color difference ΔE₀₀ changes linearly with the depth of material removal (P < 0.05). Regression analyses showed coefficients of determination (R² ) of 0.97 (VITA A2), 0.87 (VITA A3.5), and 0.96 (VITA A4). Acceptability threshold was surpassed at 62, 87, and 92 μm, respectively.

CONCLUSIONS

Discolorations occur within clinically relevant occlusal adjustments of <100 μm. The effect is more severe with lighter, less saturated tooth colors.

CLINICAL SIGNIFICANCE

Staining that is resistant to occlusal adjustments and abrasion is only possible if the staining solution infiltrates sufficiently deep into the ceramic structure. This study provides for the first time in the literature numerical values that describe the thresholds of acceptability of color differences in zirconia ceramics. These values are essential because they determine the extent of possible occlusal adjustments, and thus the color stability. Further research is necessary to improve the infiltration depth of staining solutions.

Impact of high-speed sintering, layer thickness and artificial aging on the fracture load and two-body wear of zirconia crowns

OBJECTIVE

To investigate the impact of high-speed sintering, layer thickness and artificial aging in a chewing simulator on the fracture load (FL) and two-body wear (2BW) of 4Y-TZP crowns.

METHODS

4Y-TZP crowns (Ceramill Zolid HT+, Amann Girrbach AG) in three different layer thicknesses (0.5, 1.0, 1.5; N=192, n=64/group) were manufactured using CAD/CAM technology and sintered at 1580°C (high-speed sintering) or 1450°C (control group). Specimens were polished in two-steps and bonded to standardized CoCr abutments with Multilink Automix (Ivoclar Vivadent). 2BW after 6000 thermo- and 1,200,000 chewing-cycles employing enamel antagonists was determined using best fit machining. FL was tested before and after artificial aging. Univariate ANOVAs, post hoc Scheffé, unpaired t-, Kruskal-Wallis- and Mann-Whitney-U-test were computed (p<0.05).

RESULTS

High-speed sintering resulted in less 2BW of the zirconia than the control group (p=0.013). High-speed sintering (p=0.001-0.006) and an increase in layer thickness (p<0.001-0.012) resulted in higher FL values, while artificial aging led to a reduction of FL (p<0.001).

SIGNIFICANCE

As high-speed sintering resulted in less two-body wear of the zirconia and comparable or even higher fracture load results than the control group, this cost- and time efficient alternative presents promising mechanical results.

Choice of resin cement shades for a high-translucency zirconia product to mask dark, discolored or metal substrates

PURPOSE

The aim was to study the masking ability of high-translucency monolithic zirconia and provide guidance in selecting resin luting cements in order to mask discolored substrates.

MATERIALS AND METHODS

160 high-translucency zirconia specimens were divided into 32 groups depending on their thickness and shades. Using five shades of try-in paste, the specimens were luted onto the sub strates (Co-Cr, precious-metal, opaque porcelain-sintered Co-Cr, opaque porcelain-sintered precious-metal, and 5M3-shade zirconia). All CIELAB color parameters were measured and statistically analyzed.

RESULTS

Zirconia shade and thickness and try-in paste shade affected CIELAB color parameters (P=.000) in different substrates groups, and there were interactions among these factors (P=.000). All five try-in paste shades can be chosen to achieve ΔE values of zirconia with 1.2 - 1.5 mm for masking dark-tooth-like 5M3-shade and zirconia with 1.5 mm for masking precious-metal groups < 2.6. Only suitable try-in paste shades were used, can ΔE values that less than 2.6 be achieved when applied translucent monolithic zirconia with 0.7-1.0 mm for masking dark-tooth-like 5M3-shade and zirconia with 0.7 - 1.2 mm for masking precious-metal groups.

CONCLUSION

Choosing suitable resin cement shades is necessary for high-translucency monolithic zirconia to achieve ideal masking ability (ΔE < 2.6) on the dark-tooth.

Optical properties of currently used zirconia-based esthetic restorations fabricated with different techniques

OBJECTIVE

The aim was to evaluate the effects of different types of monolithic zirconia (MZ) and fabrication techniques on the optical properties of newly generated zirconia-based materials after aging.

MATERIAL AND METHODS

Sixty specimens (n = 10) were prepared. For the groups layering-veneering (LV), overpressing (OP), porcelain fused to zirconia (PFZ), and cutback (CB), 3Y-TZP, IPS e.max ZirCAD was prepared as the core material (0.5 ± 0.01 mm). For full-contour (FC) technique, 3Y-TZP was used for MZ-LT (low translucency) and 4Y-TZP was used for MZ-MT (medium translucency). L*, a*, b*, chroma (C), and relative translucency (RTP) were measured before (L₁ *, a₁ *, b₁ *, C₁ , RTP₁ ) and after (L₂ *, a₂ *, b₂ *, C₂ , RTP₂ ) UV aging. Statistical analyses were performed by one-way ANOVA with Tukey's test and paired sample t tests (P = .05).

RESULTS

Fabrication techniques significantly affected the L*, a*, b*, C, RTP, and ΔE₀₀ values (P ˂ .01). The highest L₁ * value was found in MZ-LT; followed, in order, by OP, PFZ, LV, CB, and MZ-MT. The highest b₁ * and C₁ values were found in OP, while MZ-MT had the lowest values (P ˂ .05). FC had the highest RTP values for MZ-MT (13 ± 0.9 RTP_1; 11.2 ± 0.9 RTP₂ ), and the lowest RTP values were found for MZ-LT (8.5 ± 0.9 RTP_1; 8.3 ± 1.2 RTP₂ ) (P ˂ .01). Aging caused significant differences in the L*, a*, b*, C, and RTP values (P < .05). The color changes were between 0.9 and 2.1 ΔE₀₀ .

CONCLUSIONS

The fabrication technique significantly affected the optical properties. UV aging caused zirconia-based restorations to become darker and more yellow, red, saturated, and opaque.

CLINICAL IMPLICATIONS

Fabrication techniques with different zirconia structures affected the optical properties of the restoration, even when the same shades were chosen. If more translucent restorations are needed, choosing 4-YTZP with the FC technique is better than veneering with 3-YTZP. Choosing 3-YTZP with the FC technique produces more esthetic results if brighter and more opaque restorations are needed.

Monolithic Zirconia: An Update to Current Knowledge. Optical Properties, Wear, and Clinical Performance

The purpose of this paper was to update the knowledge concerning the wear, translucency, as well as clinical performance of monolithic zirconia ceramics, aiming at highlighting their advantages and weaknesses through data presented in recent literature. New ultra-translucent and multicolor monolithic zirconia ceramics present considerably improved aesthetics and translucency, which, according to the literature reviewed, is similar to those of the more translucent lithium disilicate ceramics. A profound advantage is their high strength at thin geometries preserving their mechanical integrity. Based on the reviewed articles, monolithic zirconia ceramics cause minimal wear of antagonists, especially if appropriately polished, although no evidence still exists regarding the ultra-translucent compositions. Concerning the survival of monolithic zirconia restorations, the present review demonstrates the findings of the existing short-term studies, which reveal promising results after evaluating their performance for up to 5 or 7 years. Although a significant increase in translucency has been achieved, new translucent monolithic zirconia ceramics have to be further evaluated both in vitro and in vivo for their long-term potential to preserve their outstanding properties. Due to limited studies evaluating the wear properties of ultra-translucent material, no sound conclusions can be made, whereas well-designed clinical studies are urgently needed to enlighten issues of prognosis and long-term survival.