|Year : 2022 | Volume
| Issue : 3 | Page : 117-124
Translucency and color stability of bleached veneer shades with different resin cement
Mona E Abu Saieda, Gaber I Masoud, Amany M Korsel
Department of Fixed Prosthodontics, Faculty of Dentistry, Tanta University, Tanta, Egypt
|Date of Submission||28-Apr-2022|
|Date of Decision||22-May-2022|
|Date of Acceptance||23-May-2022|
|Date of Web Publication||14-Sep-2022|
Mona E Abu Saieda
(BDS, MSc) Department of Fixed Prosthodontics, Faculty of Dentistry, Tanta University, Egypt Address: Shebin Elkoum, Menufeia
Source of Support: None, Conflict of Interest: None
This in-vitro study aimed to evaluate the translucency and color stability of bleached veneer shades with different resin cement.
Material and Methods
Forty-two IPS E-max CAD discs with bleached shades BL1 and BL3 milled by CAD/CAM, each disc was 0.5 mm in thickness, 10 mm in diameter. Each sample had been formed by cementation of IPS E-max CAD discover a PMMA disc 1 mm in thickness 10 mm in diameter with shade A2 by two different shades of resin cement from Variolink NLC shades clear and +2. This cementation done by using standardized mold 1.6 mm in thickness, with cement layer 0.1 mm. Translucency and color of each sample had been measured by Spectrophotometer. Transparent parameter and color difference △E had been calculated and analyzed by one-way analysis of variance then multiple comparison Tukey's test (α = 0.05).
Using clear shade cement under both shade of IPS E-max showed lower than △E with cement shade +2. P value was highly significant in all samples (ρ> 0.000), while in BL3 disc before cementation and after cementation with clear cement showed nonsignificant result (ρ> 0.227). Transparent parameter was higher before cementation and the lowest value obtained with shade + 2 cement which is opaquer (10.59) with BL3 and (11.69) with BL1.
The final color and translucency of bleached veneers is influenced by the shade of resin cement.
Keywords: bleached veneer shades, color stability, resin cement, translucency
|How to cite this article:|
Abu Saieda ME, Masoud GI, Korsel AM. Translucency and color stability of bleached veneer shades with different resin cement. Tanta Dent J 2022;19:117-24
|How to cite this URL:|
Abu Saieda ME, Masoud GI, Korsel AM. Translucency and color stability of bleached veneer shades with different resin cement. Tanta Dent J [serial online] 2022 [cited 2023 Jan 31];19:117-24. Available from: http://www.tmj.eg.net/text.asp?2022/19/3/117/356079
| Introduction|| |
The goal of esthetic dentistry is to restore natural tooth form, biocompatibility, and appearance . The desire for a beautiful smile has increased, and porcelain veneers have become a valuable treatment for patients seeking better esthetics ,,. The superior optical and mechanical properties of ceramic restorations have promoted them to be one of the most favorable treatments, particularly in anterior teeth  (e.g. IPS E.max). The final color of ceramic restorations is determined by the ceramic thickness, color and thickness of the luting agent, and color of the underlying tooth structure . Ceramic laminate veneers thickness ranges from 0.5 to 1.0 mm, therefore, minimally invasive preparation is required . The significance influence of the thin layer of resin cement on the final esthetic result has led to the development of resin luting agents with different shades to enhance final color match . The null hypothesis is that the shade of resin cement will not affect the final color and translucency of IPS E-max CAD veneer.
| Materials and methods|| |
The experimental study had been carried out at Fixed Prosthodontics Department, Tanta University. The laboratory tests had been carried out at Digital Dental Lab at Cairo and measurement at National Institute of Standard at al Haram.
The design and procedures of the present study had been accomplished according to the research guidelines adopted by the Research Ethics Committee, Faculty of Dentistry, Tanta University.
Groups of the study
According to statistical analysis there are two main groups according to shade of ceramics: '21 samples for each group' [Table 1].
Group 1: IPS E.max CAD discs shade BL1.
Subgroups: 'seven for each.'
- Control group samples without cement.
- Samples with underlying resin cement shade +2.
- Samples with underlying resin cement shade clear.
Group 2: IPS E.max CAD discs shade BL3.
Subgroups: 'seven for each.'
- Control group without resin cement.
- With underlying resin cement shade +2.
- With underlying resin cement shade clear.
Forty-two discs shaped specimens of IPS E-max CAD with BL1 and BL3 shades milled by CAD/CAM (Dental CAM; Vhf Inc., Hauppauge, New York, USA) 0.5 mm thickness 10 mm diameter, using adjustable standardized metallic mold with internal Teflon part with 1.6 mm thickness [Figure 1].
|Figure 1: IPS E-max CAD 0.5 mm in thickness and 10 mm in diameter was checked with caliber.|
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Samples had been finished crystallization and glazing
The partially crystallized ceramic specimens in IPS E-max material groups were subjected to crystallization firing cycle according to the manufacturer's instructions. (Programat P 310; Ivoclar Vivadent AG, Schaan, Liechtenstein) at 850°C for total firing time of 30 min, to improve their mechanical properties, after this specimens were then left to cool to room temperature on a tray ,.
The specimens of the IPS E.max were glazed according to the manufacturers' instructions, by using the suitable glaze porcelain. (IPS Ivoclar, Vivadent, Glaze) was used for IPS E-max glaze group ,,.
In this study two different shades of resin cement (+2, clear). The specimens were cemented on PMMA discs 1 mm thickness 10 mm diameter shade A2 to mimic tooth, with uniform thickness of resin cement (0.1 mm)  using curing led light with light intensity of 650 mW/cm2, polymerization for 20 s/mm of ceramic and segment (Vivadent Bluephase N100-240 V, Ivoclar Vivadent). Separating medium has been used on the Teflon part of the mold befor cementation to faciliate removal of the cemented desk [Figure 2].
The color coordinates and translucency of e-max specimens were measured by using a digital spectrophotometer (Agilent Cary5000 USA). The spectrophotometer recorded the measurements on CIE/Lab color space system. under illuminant D65 and standard observer 10°. The L*, a* and b* color value of each specimen was measured, then the color coordinate was measured again with different color of resin cement and recorded .
| Results|| |
Descriptive statistics was used to describe the data using mean, SD, and range. One-way analysis of variance (ANOVA) was used to compare the color difference throwing all groups of IPS E-max CAD shade BL1 which show highly significant difference. Multiple comparison (Tukey test) was used to compare pairwise materials which showed there is a highly significant difference between IPS E.max discs with shade BL1 without cement and after cementation with clear shade cement and, after cementation using NLC shade +2.
Descriptive statistics was used to describe the data using mean, SD, and range. One-way ANOVA was used to compare the color difference throwing groups of shade BL3 which show highly significant difference. Multiple comparison (Tukey test) was used to compare pairwise materials which showed there is a highly significant difference between IPS E-max Cad discs shade BL3 before cementation and after cemented with NLC shade +2, but there is no significant difference between IPS E-max Cad discs with shade BL3 when cemented with shade clear cement and there is highly significant difference between IPS E-max Cad discs shade BL3 when cemented with clear versus +2 cement [Table 2].
|Table 2: Color difference (ΔE ) Means±SD of IPS E-max Cad shades BL1 and BL3 before and after cementation with two different shades of resin cement (clear) and (+2)|
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Independent t test was used to compare BL1 and BL3 which showed there is a significant difference between without cement and NLC+2 and there is a highly significant difference between clear and NLC+2 but there is no significant difference in without cement + clear [Table 3], [Figure 3].
|Table 3: Color difference (ΔE ) between of IPS E-max Cad in two different bleached shades BL1 and BL3|
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|Figure 3: Diagram showing color difference (ΔE) between of IPS E-max Cad in two different bleached shades BL1 and BL3.|
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Descriptive statistics was used to describe the data using mean, SD, and range. One-way ANOVA was used to compare the translucency parameter measured before and after cementation. Throwing IPS E-max Cad discs shade BL1 which show there is highly significant difference between all sample's groups. Multiple comparison (Tukey test) was used to compare pairwise materials which showed there is a highly significant difference between translucency parameter measured for group IPS E-max Cad discs with shade BL1 without cement and after cemented with cement shade clear and other group of IPS E-max Cad disc shade BL1 without cement and after cementation with cement shade +2, there is a significant difference between BL1 without cement and clear and BL1 without cement and +2.
Descriptive statistics was used to describe the data using mean, SD, and range. One-way ANOVA was used to compare the translucency parameter throwing groups in BL3 which show there is highly significant difference between materials in BL3. Multiple comparison (Tukey test) was used to compare pairwise materials which showed there is a highly significant difference between IPS E-max Cad discs shade BL3 without cement + BL3 with cement shade clear and BL3 with without cement compare with BL3 with +2 cement also between BL3 with cement shade clear versus with cement shade +2 [Table 4].
|Table 4: Transparent parameter mean values of IPS E-max Cad bleached shades BL1 and BL3 before cementation and after cementation with tow different resin cement shades (clear ) and (+2)|
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Independent t test was used to compare BL1 and BL3 in each material which showed there is a significant difference when cemented with NLC+2 and there is a significant difference when cemented with cement shade clear, but between the previous two groups there is no significant difference [Table 5], [Figure 3] and [Figure 4].
|Table 5: (Tukey test) transparent parameter mean values between two different bleached shade of IPS E-max Cad BL1 and BL3 before and after cemented with different shades of resin cement|
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|Figure 4: Diagram showing TP mean values between two different bleached shade of IPS E-max Cad BL1 and BL3 before and after cemented with different shades of resin cement (clear) and (+2). TP, transparent parameter.|
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| Discussion|| |
In this in-vitro study we compared shade and translucency of lithium disilicate ceramic (IPS E-max CAD) LT with bleached shades BL1 and BL3 due to increase demanding of lighter teeth (red carpet white veneers), using CAD/CAM to cut all samples into discs 0.5 in thickness and 10 mm in diameter to mimic veneer , Giti et al. . Found that LT IPS E-max block to be more natural appearance as human teeth transparent parameter (TP) varies from 15 to 19 recorded using 1 mm-thick human teeth, so TP of the acceptable dental materials should be near to the TP of the natural teeth to give them the natural look .
CAD/CAM offer standardized accurate thickness with better smooth surface and improved design ,. PMMA desk 1 mm has been chosen as background resembling tooth shade A2, as used in other study.Tao yu., 2017 .
Resin cement from variolink N L C ((Ivoclar Vivadent, Schaan, Liechtenstein new  which is has been produced to be used under bleached color veneers. in this study two different shades had been chosen Clear and +2.
All samples had been cemented inside standardized metallic mold with Teflon inner part, the mold thickness is 1.6. Mesbah et al. , which give a uniform thickness of resin cement layer 0.1 mm . This also supported by other studies made by Kilinc et al.  and Moreno et al. .
All samples have been measured with spectrophotometer according to CIE Lab. The result had been statically analyzed and scheduled. Each sample has been measured three times, the first time without cement, the second with shade clear resin cement, then the third with +2 shade of resin cement.
In this study, the system CIE Lab was chosen for analysis for TP parameter through 3D coordinates, because it can detect any small color differences . A white and a black background were selected to analyses the samples. Black one represents the clinical situation on the anterior teeth and the white one is used for the posterior teeth .
In this study the null hypothesis that the shade of resin cement will not affect the final color and translucency of IPS E-max CAD veneer, has been rejected.
In general, ΔE less than 1 is not detectable by the human eye, ΔE between 1 and 3.3 can be perceived by the experts and is clinically acceptable, while ΔE more than 3.3 is perceivable by the laypeople and is therefore clinically unacceptable  Another study considered the gold standard for ΔE to be 2  However, most studies believe that ΔE more than or equal to 3.3 is clinically acceptable .
In current study mean of ΔE value for BL1 shade of IPS E-max CAD with clear cement is 1.30 and 2.05 with +2 cement. ΔE with clear vs +2 cement is 0.73 with highly significant P value more than 0.000, more than 0.005, more than 0.000, respectively.
And mean of ΔE value for BL3 shade of IPS E-max CAD with clear cement (1.47) with nonsignificant P value more than 0.227 and (1.70) with +2 cement. ΔE with clear vs +2 cement is 2.28 with highly significant P value more than 0.000, more than 0.001, respectively.
That is there is significant effect of changing shades of resin cement under the bleached color veneers although it is within clinical acceptance range.
There were many studies agree with our results, despite of different material and manufactures. Alqahtani et al.  found that opaque cement increase ΔE value significantly followed by A1, translucent and B0.5 cement show no significant while using with 0.5, 0.7 mm thickness IPS Empress Esthetic, and IPS E-max Press. With cement layer 0.1 in thickness, ΔE threshold of his study was more than 3.3, he found that ceramic material, ceramic thickness and cement shades have significant effect on color of veneers.
Begum et al.  also found that opaque cement resulted in significantly higher ΔE value under IPS E-max with 0.5, 1 mm with cement layer 0.02, the ΔE threshold was more than 3.7. He concluded his result that the color of resin cement has significant influence on color of veneers, opaque cement more able to mask underlying color.
Calgaro et al.  used IPS classic 0.5, 0.7, 1 mm and cement layer 2 mm, found that opaque cement had the lowest ΔE value followed by bleach, transparent and A1, but Turgut et al.  found opaque cement had higher ΔE value than translucent one had a lower ΔE value, with IPS Empress 0.5, 1 mm also more than 3.5.
Turgut and Bagis  they used 392 specimen with 0.5and 1 mm thickness from IPS E-max Empress Esthetic and 13 shades of cement with cement layer 0.1 mm they found that four of shades of cement had significant effect on the color of veneers. For 0.5 mm thickness, the color change was clinically unacceptable, while for 1 mm thickness was clinically acceptable. they concluded their result as ΔE value decreased as ceramic thickness increased. There were differences between the various cement shade. Pires et al.  used IPS E-max 1.5, 0.5 mm in thickness with and without translucent cement with 0.1 mm cement layer thickness, he found thinner specimen with cement had higher ΔE value and vice versa, ΔE value was more than 5.5, so thickness of ceramic and presence of cement significantly influence the final color of veneers.
Jankar et al.  who choose human incisors teeth, and ceramic thickness 0.5 found ΔE more than 3.7, he concluded his results that resin cement has significant effect on the color of ceramic veneers.
Celik et al.  and Dede et al.  used 20 ceramic discs 1.5 mm in thickness with 0.2 mm cement layer ΔE was more than 2.25, they all found that different shades of resin cement affect final color of ceramic veneers.
On the other hand Karaagaclioglu and Yilmaz  and Dozic et al.  have another opinion that their studies came to the conclusion that cement shade had no effect on the final color of ceramic veneers.
Dozic et al. , used prepared porcelain veneers (IPS Empress Esthetic, A1, 0.6 mm thick, Ivoclar Vivadent) were cemented on the resin dies (nine groups of natural dentin colors) using seven shades of resin cement (Variolink Veneers, Ivoclar Vivadent). The L*a*b* values of the cemented veneers were measured, and ΔE values were calculated against the preselected target color (A1). ΔE greater than 3.3 was considered as a significant color mismatch detectable by the human eye. He concluded that the seven shades of resin cement had no significant influence on the final color of the veneers .
Karaagaclioglu and Yilmaz  used 20 human teeth halves, 10 in each group with 0.8 mm cement thickness. The color changes on the veneers after cementation were within a clinical acceptance level. There were no statistically significant color differences on the veneers after cementations between the different cement shades. ΔE threshold more than 3.7 ,.
In current study translucency has been measured three times for each sample without cement and with clear cement then with NLC+2.
The mean ± SD of TP is 15.19 ± 0.61 for shade BL1 IPS E-max desk without cement and 13.25 ± 0.81 with clear cement 11.69 ± 0.67 with NLC+2 cement.
Also there was change in mean ± SD of TP with IPS E-max desk shade BL3 without cement 14.22 ± 0.76 and 12.66 ± 0.84 with clear cement then 10.59 ± 0.52 with + 2 cement witch is more opaque with more masking ability of underlying structure.
It is clear that there was deference between all measures, so that the null hypothesis that the shade of resin cement will not affect the final color and translucency of IPS E-max CAD veneer, has been rejected.
These results has been supported with Hernandes et al.  evaluated two different shades of resin cement effect on TP of A2 LT IPS e-max press 1 mm thick. TP after cementation with Variolink II resin cement 0.1 mm thick was ranged from 15.42 to 15.34 with A1–A3 shades, respectively. The previously mentioned range of TP coincide with range in the current study despite different manufacture and thickness between both studies.
Malkondu et al.  made a study close to the current study but with different materials, using monolithic zirconia with different thickness including 0.6 mm thickness with three types of cements RelyX U200 (resin cement), RelyX Luting (RMGIC) and (GIC). This study resulted in that TP values were ranged from 17.28 to 17.60 before cement application and were 14.89 after using resin cement and 14.05 after using RMGIC. The previous results agreed with the current study as resin cement had more translucent results than RMGIC despite of different materials and manufactures.
Study of Mesbah et al. , support the results of color stability in the current study. He concluded that the color masking ability of a 0.5 mm veneer with an opaque shade of resin cement could be like a 1.0-mm veneer with a translucent shade of resin cement. Thus, being more conservative. Also, that (dual cured) resin cement with high final esthetic results and high degree of color stability as light cured cements.
In agreement with our results, Chen and Wang  observed that resin cements can affect the final color of ceramic veneer restorations (IPS E.Max Press, LT A3) and the extent of this effect varies according to the resin cement shades. However, it should be pointed out that the lithium disilicate glass ceramics evaluated in this study are more translucent than other ceramic types (e.g. polycrystalline and glass-infiltrated composites) , therefore it is expected that the effects of underlying resin cement layer on the restoration shade should be less pronounced in other ceramics. Çömlekoğlu et al.  observed in a multilayered glass-ceramic veneers that color changes for body and cervical regions were not affected by resin color or ceramic thickness, but the incisal area was affected. Abdulaziz Al Ben Ali et al.  found that using LT block of IPS E-max shade BL1 0.5 thickness has TP mean (13.22) which is so close to our result when we use the same shade of ceramic with clear shade cement which is 13.25.
The higher translucency of lithium disilicate ceramics is a consequence of its unique microstructure containing large amount of a glassy phase and a relatively translucent crystal . Hernandes et al.  found that the presence of a resin cement layer under LT ceramics led to an average color change of 1.46 and 2.55 for A1-shade and A3-shade resin cement layers, respectively. Evaluated ceramics with an underlying resin cement layer, significant changes in ceramic TP and chroma were also observed.
She concluded her results as the TP of HT ceramic was significantly higher than that of LT ceramics, regardless of the presence of resin cement. No significant difference in TP was noted between ceramic discs with A1-shade resin cement and those with A3-shade cement. This is against our results in which there is high significant in TP in changing resin cement shades between clear and +2, under two different shades of bleached veneers BL1 and BL3. However, TP was significantly lower in ceramic discs with underlying resin cement layer in comparison to that observed in ceramic discs without resin cement which supports our study.
Moreover, different shades of resin cements produce different levels of translucency and color changes, and these changes were significant when changing the ceramic thickness. Therefore, different shades of resin cements can help changing the color of the overall veneer to achieve an acceptable color match in any ceramic thickness used .
This study could not identically simulate a clinical situation since we tested disc-shaped specimens rather than ceramic veneer restorations. Therefore, complete assessment of ceramic veneer restorations requires a clinical study which thoroughly considers the factors of ceramic thickness and different color of tooth structure. Other types of ceramics with different opacities and colors, and cement shades should also be evaluated.
| Conclusion|| |
With limitation of this in-vitro study it was concluded that:
- The final color of bleached shade of IPS E-max CAD can be affected by the different shades of the same type of resin based luting agent.
- The best result in ΔE was with E.max shade BL1 with underlying resin cement shade +2, then shade BL3 with shade clear followed by BL3 with cement shade +2 and end with BL1 with clear.
- Translucency parameters differ by changing underlying resin cement shade and IPS E-max shade BL1 with clear cement was closer to natural TP value.
- The opaquer cement (+2) has less TP, but more masking ability for underlying structure than clear shade.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]