Correlation between patient satisfaction and color changes after tooth bleaching

OBJECTIVE

This study aimed to investigate the relationship between patient satisfaction of outcomes and tooth color changes during and after tooth bleaching.

METHODS

In this clinical trial, 63 volunteers participated in an in-office bleaching procedure using a 40% hydrogen peroxide gel. The treatment consisted of two sessions, each comprising two 30-min applications of the bleaching gel. The L*, a*, and b* values of six maxillary anterior teeth were measured at baseline (T1), after the first bleaching session (T2), after the second bleaching session (T3), 1 week after the second in-office bleaching session (T4), and 3 weeks after the second in-office bleaching session (T5). The color differences (ΔE00 ) were calculated using CIEDE2000. A satisfaction scale with a score ranging from 0 to 3 was used to record participants' level of satisfaction with their tooth color at each time point. The data were statistically analyzed using repeated measures analysis of variance and logistic regression (α = 0.05).

RESULTS

Significant correlations were observed between ΔL*, Δb*, and ΔE00 values at T3 and patient satisfaction (all p < 0.05). The regression model indicated a more pronounced impact of Δb* on patient satisfaction compared to ΔL*. The established regression models were as follows: Logit (PL*b* ) = -4.354 + 0.271ΔL* - 0.585Δb* and Logit (PΔE00 ) = -2.552 + 0.521ΔE00 . The findings suggested a minimum ΔE00 value of 4.90 for satisfactory results. A minimum ΔE00 value of 3.9, 5.0, and 6.8 was necessary for central incisors, lateral incisors, and canines, respectively, to achieve a satisfactory result.

CONCLUSIONS

The ΔL*, Δb*, and ΔE00 values were found to be significantly correlated with patient satisfaction after bleaching. Δb* was identified as having a greater influence on patient satisfaction than ΔL* values in the regression model. Furthermore, attaining a minimum ΔE00 value of 4.90 is necessary to achieve satisfactory outcomes. A greater ΔE00 value is needed for canines than for incisors to achieve equivalent patient satisfaction.

CLINICAL SIGNIFICANCE

This study emphasizes the importance of considering the extent of color change needed to achieve patient satisfaction after tooth bleaching procedures.

Coloring Effects of Disinfectants on Pure or Nano-TiO2-Incorporated Maxillofacial Silicone Prostheses

Silicone elastomers play a crucial role in the field of maxillofacial prosthodontics. To maintain optimal hygiene, various disinfectants have been reported to clean silicone prostheses. Nevertheless, when selecting a disinfectant, it is important to consider not only its antimicrobial efficacy, but also its compatibility with the materials, to minimize any potential impact on the physical properties of the material surfaces. The coloring effect of such disinfectants on different types of silicone is of interest. A total of 144 silicone specimens (72 pure silicones, 72 nano-TiO2-incorporated silicones, from A-2000 and A-2006 silicones) were fabricated in this study. The spectrophotometric analysis was carried out, and the initial CIE L*a*b* color values were measured prior to disinfection. Specimens in each silicone group (with or without nano-TiO2) were subjected to a 30-h disinfection period simulating 1 year of disinfection with the following disinfectants: Control (tap water), 0.2% chlorhexidine gluconate, 4% chlorhexidine gluconate, 1% NaOCl, neutral soap, and effervescent. After the second color values were recorded, the color change (∆E*) was calculated. Significant differences were observed among the disinfectants for both the A-2000 and A-2006 silicone groups. Nano-TiO2 did not show a color protection effect in A-2000 silicone. In contrast, nano-TiO2 incorporation provided color protection against CHG 0.2%, CHG 4%, and NaOCl in A-2006 silicone. Most of the disinfectants did not show acceptable color stability over time. In pure A-2000 silicone, except for 0.2% chlorhexidine, all disinfectant groups demonstrated a color change within the acceptability threshold of 50:50% (∆E* = 3.0). On the other hand, in nano-TiO2-incorporated A-2006 silicone, only 0.2% and 4% chlorhexidine demonstrated an acceptable color change. Overall, chlorhexidine could be used as a suitable disinfectant in maxillofacial silicone prostheses.

Effects of dentin and enamel porcelain layer thickness on the color of various ceramic restorations

OBJECTIVE

To investigate the effects of dentin and enamel porcelain layer thickness on the color of various ceramic restorations.

MATERIALS AND METHODS

Eighty specimens (shade A2 and A3, n = 10) (20 mm in length, 4 mm in width, 1.5 mm in thickness respectively) of casting ceramic (EM); alumina ceramic (AL); zirconia ceramic (ZR); and porcelain-fused-metal (PFM) were prepared. The color distributions of each specimen were measured at 4 places using a spectroradiometer. The dentin/enamel porcelain (D/E) layer thicknesses of the 4 places were 0.8/0.2 mm, 0.6/0.4 mm, 0.4/0.6 mm, and 0.2/0.8 mm. The color differences (ΔE₀₀ ) between the specimens and the corresponding color shade tabs were calculated. Data were analyzed using three-way repeated-measures ANOVA and Holm-Sidak pairwise comparisons (a = 0.05). The acceptability threshold (AT) was used to analyze the results.

RESULTS

The minimum ΔE₀₀ values were 1.31 (0.6/0.4 mm for EM), 1.41 (0.8/0.2 mm for AL), and 1.92 (0.2/0.8 mm for ZR) for shade A2, and 0.93 (0.6/0.4 mm for EM), 0.89 (0.8/0.2 mm for AL), and 1.34 (0.8/0.2 mm for ZR) for shade A3. Most of them were below AT value (1.8). For AL and ZR (shade A2) and ZR (shade A3), the D/E layer thicknesses of 0.8/0.2 mm and 0.6/0.4 mm had lower ΔE₀₀ values than 0.4/0.6 mm and 0.2/0.8 mm (p ≤ 0.001).

CONCLUSIONS

The dentin/enamel porcelain layer thickness that was most color-matched to the shade tab was different for various ceramic restorations. The color of shade A2 AL and ZR and shade A3 ZR was closer to the shade tab when dentin porcelain was thicker than enamel porcelain.

CLINICAL SIGNIFICANCE

Matching the shade of ceramic restoration to the shade tab color is a great challenge in esthetic dentistry. The dentin/enamel porcelain layer thickness is an important factor to influence the improved color matching.

Experimental methodologies to evaluate the masking ability of dental materials: A systematic review

OBJECTIVE

To conduct a systematic review on the masking ability of discolored substrates, analyzing the capacity and quality of the response produced by the different methodologies and techniques applied to overcome this clinical challenge.

MATERIALS AND METHODS

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The electronic search was conducted in MEDLINE/PubMed, Scopus and Web of Science databases, without date restriction. In vitro studies, written in English, applying different methodologies to evaluate masking ability were included. The variables of interest were: type, color and thickness of the restorative and/or cement material; use of pigments in the restorative material and/or cement; color of the substrate; and background color used for the evaluations.

RESULTS

Database search retrieved 307 eligible papers with a final inclusion of 47 published papers. Approximately 98% of the studies used ΔE, 36% used TP, and only 6% used CR to evaluate the masking ability of restorative materials.

CONCLUSIONS

The most appropriate methodology to evaluate the masking ability is using color difference equations (ΔE) associated with the perceptibility and acceptability thresholds.

CLINICAL SIGNIFICANCE

As different methodologies have been used to evaluate the masking ability of esthetic restorative materials on colored substrates, there is an urgent need to reach a consensus and propose a method, which is suggested by the present systematic review.