Influence of individual education and training on quality of color matching in dentistry.

OBJECTIVES: To evaluate the influence of the group and individual education of students on shade matching quality. Secondary study objective included a survey-assessment of quality and difficulty level of color matching. MATERIALS AND METHODS: Forty dental student participants in Integrated Academic Studies of Dentistry at the Faculty of Medicine, University of Nis (26 female, 14 male) 21-25 years old, signed consent to voluntarily participate in the research. The Ethics Committee of the Clinic of Dentistry, Faculty of Medicine, University of Nis, approved the study under number 14/11-2019-2EO. They were randomly divided into two groups (n = 20), experimental (IE, individual education) and control (GE, group education). Each group was divided into four subgroups (n = 5). The study was performed in three phases. In Phase I (I) and III (III), students matched the shade of the maxillary central left incisor (#9) using three different shade guides. Each of the students served as a "patient" for shade matching, while the other members of the subgroup, individually (VMI ) and as a team (VMT ), visually matched the tooth shade. In Phase II (between phases I and III), group IE received standard group and individual education and training, while group GE had only group education. Shade matching results in before and after education were compared with results obtained by an intraoral spectrophotometer. CIELAB (∆E*), and CIDE2000 color differences (∆E00 ) were calculated. The color differences between VMI or VMT and ES readings were graded. In addition, the students rated the level of difficulty and quality of shade matching from 1 to 5, signifying the most to least difficult, and the worst to best match, respectively. Means and standard deviations were calculated. Differences were compared using the Student t-test. RESULTS: Means (s.d.) of CIEDE2000 color differences for VMI before and after IE were 4.5 (1.5) and 3.3 (0.9), respectively. Corresponding values for group GE were 4.4 (1.4) and 4.0 (1.0), respectively. As compared with GE, group IE achieved 15% better results for the best matches and 27.5% for one of the three best matches in by-point comparison. Mean (s.d.) results for VMT in the experimental group before and after IE were 3.6 (2.4) and 2.8 (1.6), respectively. Corresponding results for the control group were 4.4 (2.1) and 3.5 (1.7), respectively. Group IE had statistically higher VMI and VMT scores than GE, while, for GE, only VMT scores were statistically higher. Group IE achieved better results in by-point comparison. After education and training, the students rated the shade matching as more precise and less difficult. Results were significantly better for Quality (IE) (sig = 0.010) and Difficulty (GE) (sig = 0.021). CONCLUSIONS: Within the limitations of the study, the experimental group achieved significantly better results in individual color matching after education and training than the control group, while both groups made progress in team color matching. Both groups rated shade matching more accurate and easier after education. CLINICAL SIGNIFICANCE: Improving the quality of shade matching is expected to enhance the esthetics of dental restorations, increase patient satisfaction, and reduce color corrections.

Colour stability of 3D-Printed orthodontic brackets using filled resins.

OBJECTIVE: To determine the effect of common beverages and accelerated aging on the colour stability of filled resins, which could potentially be used for fabrication of 3D-printed orthodontic brackets. MATERIALS AND METHODS: GR-17.1 (shades A1, A2, and A3), and GR-10 Guide resins (pro3dure medical, Eden Prairie, MN) were printed on an Asiga MAX UV printer into discs 2 mm thick, with a diameter of 10 mm, and then post-print processed as per manufacturer's instructions. Discs were immersed in 5 mL of coffee, tea, red wine, or distilled water for 7 days. Another group was subjected to accelerated aging in accordance with ISO Standard 4892-2. Ten samples were produced per resin, per treatment condition. Colour measurements were taken on the discs before and after treatment using a spectrophotometer against white and black reference tiles to assess colour and translucency differences with the CIEDE2000 colour difference formula. RESULTS: While initial colour of the printed resin discs was acceptable, all resin groups underwent significant colour change during the experiment. Red wine and coffee produced the greatest colour and translucency change, followed by tea, with accelerated aging producing the least change in colour and translucency. CONCLUSION: The 3D-printed resins tested underwent significant changes in colour and translucency following exposure to endogenous and exogenous sources of staining, which may affect their acceptability for fabrication of aesthetic orthodontic brackets.

Multicenter study on visual color difference thresholds. A secondary analysis of light, medium, and dark tooth-colored specimens.

PURPOSE: This secondary analysis further analyzed variations in the 50:50% perceptibility and acceptability thresholds (PT and AT, respectively) pertaining to light, medium, and dark tooth-colored specimen sets. METHODS: Primary raw data from the original study was retrieved. Visual thresholds (Perceptibility - PT and Acceptability - AT) were analyzed among the three specimen sets - light, medium, and dark. The Wilcoxon signed-rank test was used for paired specimens, and the Wilcoxon rank-sum nonparametric test was used for independent specimens (α= 0.001). RESULTS: The 50:50% CIEDE2000 PT and AT values were significantly higher for the light-colored specimen set when compared with the medium and dark-colored specimens: 1.2, 0.7, 0.6, respectively (PT) and 2.2, 16, 14 (AT), respectively (P< 0.001). Independent of the observer group, the highest PT and AT values were always found for the light-colored specimen sets (P< 0.001). Dental laboratory technicians had the lowest visual thresholds, but not significantly different from the other observer groups studied (P> 0.001). Similarly, all research sites had statistically higher visual thresholds for the light-colored specimen set than for the medium- or dark-colored sets, except for two sites that showed statistically similar results for medium-colored specimens but were significantly different from the dark-colored set. Among the different research sites, sites 2 and 5 registered significantly higher PT thresholds for the light specimens (1.5 and 1.6, respectively), and site number 1 had a significantly higher AT threshold relative to the other sites. The 50:50% perceptibility and acceptability thresholds were significantly different among light-, medium-, and dark-colored specimens for different research sites and observer groups. CLINICAL SIGNIFICANCE: The visual perception of color difference related to light-, medium-, and dark-colored specimens varied based on observer group and their geographic location. Therefore, a greater understanding of factors that affect visual thresholds, with the observers being "the most forgiving" for color differences among the light shades, will allow diverse clinicians to overcome some of the challenges of clinical color matching.

Staining- and aging-dependent changes in color and translucency of 3D-printed resin-modified ceramics.

PURPOSE: To evaluate staining- and aging-dependent changes in the color and translucency of 3D-printed resin-modified ceramics (RMC). METHODS: Specimens (n= 5 per condition and material) were fabricated from test materials: Permanent Crown Resin (PCR), Crowntec (CT), Vita Enamic (VE) and Tetric CAD (TC). Specimens were stained in wine, coffee, tea, and water (control) and exposed to artificial accelerated aging (AAA). Color measurements were obtained using a spectrophotometer at baseline (T0) and at 3.5 (T1) and 7 (T2) days after immersion. For AAA, measurements were obtained at baseline (T0) and after exposure to controlled irradiance of 150 kJ/m² (T1) and 300 kJ/m² (T2). Mean and standard deviations were calculated on CIEDE2000 color differences (ΔE00), translucency parameter (TP00) and treatment-dependent changes in the translucency parameter (ΔTP0 0). Differences between materials and test conditions were tested by one-way ANOVA (α= 0.05). Results were additionally interpreted using visual color difference thresholds in dentistry ΔE00= 0.8 for the 50:50 perceptibility threshold (PT) and ΔE00= 1.8 for the 50:50 acceptability threshold (AT). ΔTP00 values were interpreted using 5058;50 TPT00= 0.6 and 50:0% TAT00= 2.6. RESULTS: Statistically significant differences were found among the materials when exposed to the different test conditions. At the T0-T1 time interval, the highest color difference was found with wine (0.1-2.2) on all materials except CT, which showed the highest ΔE00 with AAA (2.5). The second highest color differences were obtained upon exposure to AAA (0.2-2.5) and tea (0.5-1.1). The TP00 at baseline ranged from 5.1 to 9.8. Significant differences in ΔTP00 were found among the tested materials and staining/aging conditions, but no significant differences were found among the staining/aging intervals (T0-T1, T0-T2 and T1-T2). CLINICAL SIGNIFICANCE: Staining- and artificial aging-dependent changes of 3D-printed and milled resin modified ceramics used for definitive restorations could represent a challenge in terms of restoration acceptability or dissatisfaction. Staining and aging conditions produced significant color changes, while translucency changes were not significant.

Color adjustment potential of resin composites: Optical illusion or physical reality, a comprehensive overview.

OBJECTIVE: The objective was to provide a comprehensive overview of color interactions between resin composite (RC) and its surroundings, analyze the design and results of respective research studies, and provide clinical and research recommendations. OVERVIEW: Resin composite (RC) materials can adjust their color to that of surrounding enamel and dentin to a different extent. This phenomenon has been referred to as the "chameleon effect" in dental jargon, while color blending/adjustment/shifting/assimilation is more scientific terms. Studies that evaluated the color adjustment potential of RCs have employed different methods. This article discusses the (a) terminology used to describe color adjustment potential, (b) color science theories associated with color adjustment, (c) design of respective studies, including methods, specimens, and calculations, and (d) their outcome and reported results. Clinical implications and future directions related to the color adjustment potential of RCs are also provided. CONCLUSIONS: Factors that influence the color adjustment potential of RCs are classified into three categories: (1) material type, (2) cavity design, and (3) the substrate surrounding the restoration. Each factor can be optimized to enhance color matching and the restorative outcome. CLINICAL SIGNIFICANCE: A material that blends well and exhibits pronounced color adjustment potential would likely improve the color match and therefore the esthetic outcome. These materials "work" for dental professionals by compensating for their suboptimal shade matching and/or lack of an excellent match in the used material. This review aims to further the understanding of the inherent properties of RCs and allow clinicians to fully utilize them to place RC restorations and minimize the time spent on modifying or replacing existing ones. Hence, the outcomes would encompass the increased chairside efficiency, enhanced esthetic outcome, and patient satisfaction.

Applications of artificial intelligence in dentistry: A comprehensive review.

OBJECTIVE: To perform a comprehensive review of the use of artificial intelligence (AI) and machine learning (ML) in dentistry, providing the community with a broad insight on the different advances that these technologies and tools have produced, paying special attention to the area of esthetic dentistry and color research. MATERIALS AND METHODS: The comprehensive review was conducted in MEDLINE/PubMed, Web of Science, and Scopus databases, for papers published in English language in the last 20 years. RESULTS: Out of 3871 eligible papers, 120 were included for final appraisal. Study methodologies included deep learning (DL; n = 76), fuzzy logic (FL; n = 12), and other ML techniques (n = 32), which were mainly applied to disease identification, image segmentation, image correction, and biomimetic color analysis and modeling. CONCLUSIONS: The insight provided by the present work has reported outstanding results in the design of high-performance decision support systems for the aforementioned areas. The future of digital dentistry goes through the design of integrated approaches providing personalized treatments to patients. In addition, esthetic dentistry can benefit from those advances by developing models allowing a complete characterization of tooth color, enhancing the accuracy of dental restorations. CLINICAL SIGNIFICANCE: The use of AI and ML has an increasing impact on the dental profession and is complementing the development of digital technologies and tools, with a wide application in treatment planning and esthetic dentistry procedures.

Staining and aging-dependent changes in color of CAD-CAM materials.

STATEMENT OF PROBLEM: Consumption of some beverages and aging may affect the color of dental materials used in fixed prosthodontics, but their effect on recently introduced materials is not well known. PURPOSE: The purpose of this in vitro study was to evaluate staining, aging, and the exposure interval on color changes of computer-aided design and computer-aided manufacturing (CAD-CAM) resin nanoceramics (RNC), polymer-infiltrated ceramic-network (PICN) materials, and lithium silicate and lithium disilicate ceramics. MATERIAL AND METHODS: A total of 288 square-shaped, 1-mm-thick specimens prepared from Cerasmart, IPS e.max, Lava Ultimate, Shofu HC, Vita Enamic, and Vita Suprinity were polished by using laboratory and chairside methods in accordance with the manufacturers' instructions. Color data were recorded with a benchtop spectrophotometer, and CIEDE2000 color differences (ΔE00) were calculated. After the baseline measurements (T0), the specimens were divided into 3 groups (n=8) and exposed to staining in coffee and wine and to accelerated artificial aging. The specimens were stored in staining solutions at 37 °C for 60 (T1) and 120 hours (T2). Accelerated aging was performed by using a xenon lamp weathering test chamber for a total exposure of 150 (T1) and 300 kJ/m2 (T2). The results were analyzed by using the t test, ANOVA, and the Tukey honestly significant difference test (α=.05). Color differences of ΔE00 ≤0.8 and ≤1.8 corresponding to the 50:50% perceptibility threshold and 50:50% acceptability threshold were used to interpret the results. RESULTS: As color differences (ΔE00) between laboratory and chairside polishing were not statistically significant (T=-0.81, P=.418), only the results for chairside polished specimens were presented. Color differences for the T0-T1 comparisons ranged from 0.2 to 4.2, T0-T2 from 0.3 to 6.5, and T1-T2 from 0.1 to 2.3. ANOVA showed significance of factors and for interactions (P<.05). Lithium silicate-based and lithium disilicate-based ceramic materials were more color stable than RCN and PICN materials on exposure to coffee and red wine. Color changes greater than acceptability threshold after immersion in coffee were recorded for 3 (T0-T1), 4 (T0-T2), and 2 (T1-T2) materials. Corresponding findings after immersion in wine were 1, 3, and 0 and after artificial aging 0, 2, and 0. ΔE00 and ΔEab values were highly correlated (R2=0.97). CONCLUSIONS: No difference was found in color stability among laboratory and chairside polished specimens. Coffee caused the greatest color changes for T0-T2 interval. Staining-dependent color differences increased with increased exposure, except for IPS e.max and Vita Suprinity. For artificial aging, color change appeared to be material dependent.

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, CEab = 1.9) and for 2 mm-thick (CE00 = 2.3; CEab = 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.

Colour stability of 3D-printed resin orthodontic brackets.

OBJECTIVE: To evaluate the colour stability of polymeric resins that could be used to 3D-print orthodontic brackets. DESIGN: In vitro, laboratory study. MATERIALS AND METHODS: Disc-shaped specimens were fabricated via 3D printing using three resins: Dental LT; Dental SG; and Clear. Five conditions were evaluated for each resin (n = 10 per treatment per resin) to assess its corresponding effect on colour and translucency: immersion in (1) red wine, (2) coffee, (3) tea and (4) distilled water (control), and (5) exposure to accelerated aging. Colour and translucency measurements were made before and after exposure using a spectrophotometer. Mean colour differences (ΔE00) and changes in translucency parameter (ΔTP00) were calculated for each sample using the CIEDE2000 colour difference formula. RESULTS: Statistically significant effects of the resin material, the treatment condition and interactions effects of material and condition were observed for ΔE00 and ΔTP00 (P < 0.001). The most pronounced changes in colour (ΔE00) were a result of the staining effects of wine on all three resins, ranging from 14.5 ± 0.6 to 20.8 ± 1.2. Dental LT, Dental SG and Clear resins all showed changes in colour when exposed to certain staining agents. Dental SG and Clear resins exhibited changes in colour with aging, while the colour of Dental LT resin remained stable with aging. CONCLUSIONS: The colour changes of the resins investigated does not support their use in 3D-printed aesthetic bracket applications.

Stainability of acrylic resin materials used in CAD-CAM and conventional complete dentures.

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

Acceptability and perceptibility thresholds in dentistry: A comprehensive review of clinical and research applications.

OBJECTIVE: The objective was to provide a literature review on perceptibility and acceptability thresholds in dentistry and corresponding recommendations. OVERVIEW: A literature review on visual thresholds included findings on the judgments of the color and appearance of tooth-, gingiva- and skin-colored restorative dental materials. Discrepancies in study design contributed to inconsistencies in the research findings of some studies. These differences are related to (a) number of observers and inclusion criteria, (b) specimen number and size, (c) color measurement instrument and the setup and formulas used, (d) psychophysical experiment, (e) data processing (fitting method), and (f) % perceptibility or % acceptability values. A straightforward, consistent and practical model for the clinical and research application and interpretation of visual thresholds and recommended protocols for threshold research were provided. CONCLUSIONS: Visual thresholds are of paramount importance as a quality control tool and guide the evaluation and selection of dental materials and their clinical performance. Although clinical shade matching conditions and method are rarely controlled, research on visual thresholds, especially when aiming to set standards for the profession, must be carefully planned and executed. CLINICAL SIGNIFICANCE: Perceptibility and acceptability thresholds define visual match or mismatch of color, translucency, and whiteness in dentistry. Clinical and research findings cannot be fully interpreted in terms of real-life relevance without comparison with perceptibility and acceptability tolerances.

Instrumental and visual evaluation of the color adjustment potential of resin composites.

OBJECTIVE: To evaluate the instrumental and visual color adjustment potential (CAP-I, CAP-V), of resin composites. METHODS: Resin composites tested were Omnichroma, Filtek Supreme Ultra, TPH Spectra, Herculite Ultra, and Tetric EvoCeram. Two types of specimens, "dual" and "single" were evaluated. For dual specimens, class I preparations (4 mm-diameter, 2 mm-depth), were created in denture teeth and restored with test resin composites. For single specimens, replications of denture teeth were created using the test resin composites (n = 5) and compared with unrestored denture teeth. Reflectance values were obtained using a spectroradiometer. CAP-I and CAP-V were calculated. Fisher PLSD intervals for comparison of means were calculated at the 0.05 level of significance. RESULTS: CAP-I ranged between 0.02 and 0.67. The Fisher PLSD interval for comparisons between single/dual color differences was 0.09 (P < .0001, power 1.0) and for comparisons between materials and shades 0.18 and 0.33, respectively (P < .0001, power 1.0). CAP-V ranged between 0.16 and 0.60. The Fisher PLSD interval for comparisons between single/dual visual color differences was 0.05 (P < .0001, power 1.0) and 0.08 and 0.14 for comparisons between materials and shades, respectively (P < .0001, except Herculite Ultra-Tetric EvoCeram and certain shade pairs). CONCLUSIONS: Instrumental color differences and visual rating of single specimens were the greatest for Omnichroma, indicating the largest mismatch, while the instrumental and visual color differences of dual specimens were the smallest. Omnichroma had the most pronounced CAP-I followed by Tetric EvoCeram>TPH Spectra = Filtek Supreme Ultra >Herculite Ultra. Similarly, Omnichroma exhibited the most pronounced CAP-V followed by Tetric EvoCeram>TPH Spectra = Herculite Ultra = Filtek Supreme Ultra. CLINICAL SIGNIFICANCE: Resin composites with pronounced CAP blends with surrounding enamel and dentin, resulting in reduced color differences and therefore improving the esthetic appearance of the restoration, simplifying the shade matching and compensating for any color mismatch.

Color adjustment potential of resin composites.

OBJECTIVES: The purpose of this study was to evaluate color adjustment potential (CAP) of resin composites. MATERIALS AND METHODS: Two shades of each of eight commercial resin composites and one control shade were evaluated. Visual (color competent observers, controlled conditions) and instrumental color evaluations (spectroradiometer, spectrophotometer) were performed. The data were analyzed by analysis of variance, Fisher's PLSD intervals for comparison of means, and Spearman's rank order correlation. RESULTS: Instrumental color adjustment potential (CAP-I) ranged from - 0.51 to 0.74, and corresponding Fisher's PLSD intervals were 0.1 and 0.05, respectively (p < 0.0001, power 1.0). Visual color adjustment potential (CAP-V) ranged from 0.10 to 0.78, and corresponding Fisher's PLSD intervals were 0.2 and 0.1, respectively (p < 0.0001, power 1.0). The greatest overall color shifting between test shades in isolation and the same shades surrounded by control shade were recorded for HRi ENA enamel, followed by Clearfil Majesty ES2. The highest visual CAP (blending) was recorded for Herculite Ultra, HRi ENA enamel, and Clearfil Majesty ES2. CONCLUSION: Within the limitation of the study, it was found that color adjustment potential (CAP) was composite and shade-dependent. Positive CAP was recorded both instrumentally and visually for majority of composites and shades. Overall, the measured color difference reduction associated with positive CAP was 31%, while the average visual CAP was 43%. CLINICAL RELEVANCE: Resin composites with pronounced color adjustment potential interact with surrounding dental restorations. Introduced CAP-V and CAP-I were indirect measurements of blending (optical illusion).

Gingival shade guides: Colorimetric and spectral modeling.

OBJECTIVE: To design colorimetric and spectral models of gingival shade guides that adequately represent the color of human gingiva. MATERIALS AND METHODS: A previously compiled database on the spectral reflectance of healthy keratinized gingiva was used for optimization. Coverage Error (CE) and Maximal Error (ME) were optimized using CIELAB and CIEDE2000 color difference formulas. A two-phase process included an FCM algorithm and a nonlinear optimization. A t test was used to compare the performance of the different numbers of clusters/tabs in gingival shade guide models (α = .05). RESULTS: CIELAB CE and ME for shade guide models with 3 to 6 clusters ranged from 3.1 to 3.9 (P = .028 for 3 vs. 4; and P = .033 for 5 vs. 6 cluster/tab comparison), while the corresponding CIEDE2000 range was from 2.1 to 2.8 (P < .001 for 3 vs. 4 tabs; P < .025 for 4 vs. 5; and P = 0.029 for 5 vs. 6 tab comparisons). The percentage of data points exhibiting a CIELAB color difference lower than the acceptability threshold ranged from 48.7% to 71.4%, and from 52.9% to 82.4%. for CIEDE2000. CONCLUSIONS: An increase in the number of clusters in the gingival shade guide models was associated with a decrease in coverage error (better match) to human gingiva. Gingival shade guide models with only 4 tabs provided a CIELAB and CIEDE2000 coverage error lower than the acceptability threshold for gingival color. Spectral clustering of human gingiva was determined to be valid. CIEDE2000 color difference formula outperformed the CIELAB formula in the optimization process. CLINICAL SIGNIFICANCE: Providing a shade guide model with a small number of tabs and a coverage error lower than the 50:50% acceptability threshold would be an optimal solution for shade matching in dentistry. However, no actual gingival or tooth shade guide complies with this. The clustering method, with optimization of both Coverage Error and Maximal Error and spectral clustering that enables more reliable color formulation of cluster representatives of shade guide models, represents an advance when it comes to computer modeling in dentistry.

Color difference thresholds for computer-simulated human Gingiva.

OBJECTIVE: To determine 50:50% perceptibility threshold (PT) and 50:50% acceptability threshold (AT) for computer-simulated samples of human gingiva using CIEDE2000 and CIELAB color difference formulas. MATERIALS AND METHODS: Each of the 60 pairs of simulated human gingiva was displayed on a calibrated monitor, together with three pairs of upper central incisors of different lightness. The color of gingiva left and right from the midline was compared. A total of 30 observers (15 dentists, 15 laypersons) participated in the study. CIEDE2000 and CIELAB formulas were used to calculate the thresholds and a Takagi-Sugeno-Kang Fuzzy Approximation model was used as fitting procedure. Paired t-test (α = 0.05) was used in evaluation of statistical significance of differences. RESULTS: The PT and AT for CIEDE2000 and 95% confidence intervals were 1.1 [0.4, 1.7] and 2.8 [1.8, 4.0], respectively. Corresponding CIELAB values were 1.7 [0.2, 2.6] and 3.7 [2.1, 5.7]. Significant differences (P < .01) were recorded between PT and AT, between the corresponding threshold values in CIEDE2000 and CIELAB formulas as well as between dentists and laypersons. CONCLUSIONS: The difference between the perceptibility and acceptability threshold for gingiva was statistically significant in both CIEDE2000 and CIELAB. The same was true for differences between the corresponding thresholds using two color difference formulas, and between dentists and laypersons. Visual thresholds of human gingiva were not dependent upon lightness of adjacent teeth. Overall, CIEDE2000 color difference formula provided better fit than CIELAB formula in the evaluation of color difference thresholds of human gingiva. CLINICAL SIGNIFICANCE: The data on visual thresholds for healthy human gingiva can be used as quality control tool/guide for selection and evaluation of dental materials, interpretation of color-related findings in clinical dentistry and research, and for standardization in dentistry. It is of particular value that this study was designed based on in-vivo color evaluation of healthy keratinized gingiva of subjects of different ethnicities, age groups, and gender.

Whitening-dependent changes of fluorescence of extracted human teeth.

OBJECTIVE: To evaluate in vitro the fluorescence properties of extracted human teeth whitened with 40% hydrogen peroxide. MATERIALS AND METHODS: A total of 28 extracted human teeth were pumiced for 1 minute using a low-speed dental handpiece and a disposable rubber cup. Pre-whitening fluorescence measurements (T0), maximum excitation (Exmax ), maximum emission (Emmax ), and maximum intensity (Imax 108 ), were performed using a spectrofluorometer. After T0 measurements, the teeth were whitened using the in-office method with 40% hydrogen peroxide, three times for 20 minutes. The fluorescence parameters were measured under the same conditions 7 and 14 days after bleaching (T1 and T2, respectively). RESULTS: Exmax exhibited a broader range 7 days after whitening and decreased after 14 days. The Emmax and Imax 108 displayed a narrower range after whitening. The mean Exmax differed significantly between the time points (F = 20.09. P < .001). The corresponding analysis for the mean Emmax differed significantly between the time points (F = 16.69, P < .001). The same was true for the mean Imax 108 (F = 9.69, P < .001). CONCLUSIONS: Within the limitations of this study, whitening provoked statistically significant changes in fluorescence of the intact teeth in vitro. CLINICAL SIGNIFICANCE: The appearance of human teeth and dental materials and their changes upon aging and exposure to different agents (staining, whitening) is a topic of great relevance to esthetic dentistry. While some appearance parameters, such as color, translucency, and gloss, have been thoroughly studied, fluorescence and its influence on overall tooth appearance is still not well understood, yet it has influenced the development of fluorescence emitting restorative materials.

Reliability of visual and instrumental color matching.

OBJECTIVE: The aim of this investigation was to evaluate intra-rater and inter-rater reliability of visual and instrumental shade matching. MATERIALS AND METHODS: Forty individuals with normal color perception participated in this study. The right maxillary central incisor of a teaching model was prepared and restored with 10 feldspathic all-ceramic crowns of different shades. A shade matching session consisted of the observer (rater) visually selecting the best match by using VITA classical A1-D4 (VC) and VITA Toothguide 3D Master (3D) shade guides and the VITA Easyshade Advance intraoral spectrophotometer (ES) to obtain both VC and 3D matches. Three shade matching sessions were held with 4 to 6 weeks between sessions. Intra-rater reliability was assessed based on the percentage of agreement for the three sessions for the same observer, whereas the inter-rater reliability was calculated as mean percentage of agreement between different observers. The Fleiss' Kappa statistical analysis was used to evaluate visual inter-rater reliability. RESULTS: The mean intra-rater reliability for the visual shade selection was 64(11) for VC and 48(10) for 3D. The corresponding ES values were 96(4) for both VC and 3D. The percentages of observers who matched the same shade with VC and 3D were 55(10) and 43(12), respectively, while corresponding ES values were 88(8) for VC and 92(4) for 3D. CONCLUSIONS: The results for visual shade matching exhibited a high to moderate level of inconsistency for both intra-rater and inter-rater comparisons. The VITA Easyshade Advance intraoral spectrophotometer exhibited significantly better reliability compared with visual shade selection. CLINICAL SIGNIFICANCE: This study evaluates the ability of observers to consistently match the same shade visually and with a dental spectrophotometer in different sessions. The intra-rater and inter-rater reliability (agreement of repeated shade matching) of visual and instrumental tooth color matching strongly suggest the use of color matching instruments as a supplementary tool in everyday dental practice to enhance the esthetic outcome.

Influence of background/surrounding area on accuracy of visual color matching.

INTRODUCTION: Visual shade selection is subjective and influenced by factors that might be operator-dependent or not. The objective was to evaluate influence of observer nonrelated factors (background/surrounding area, and light) and observer-related factors (gender and color competence) on shade-matching quality and to identify the most often mismatched shades in correlation with the background. METHODS: Ten observers with average or superior color discrimination competence according to ISO TR 28642:2011 were asked to match 48 shade tabs of three VITA Classical shade guides, in a viewing booth under two light sources: D65 and D50. Gray, white, black, red, and light blue background/surrounding area simulated various clinical situations. The results were statistically analyzed using Kruskal-Wallis test and Mann-Whitney U test. Post hoc power analyses and sample size calculations were also conducted. RESULTS: The matching scores ranged between 72.7 % (using blue background) and 85.9 % (using white and black backgrounds). There was a statistically significant difference between matching scores on the five backgrounds (χ (2)(4) = 12.67, p = 0.01). When neutral gray was used as reference, Mann-Whitney U value was statistically significant only for the blue background (U = 107.00, Z = -2.52, p = 0.01). The influence of gender and lighting condition was also assessed, no statistically significance being found, but in both cases, the effect size and the achieved power were small. However, color discrimination competence did influence the results (p < 0.01). Background influenced shade matching results for tabs A3, B3, B4, and D4. CONCLUSIONS: Within the limitations of this study, it was concluded that 1. When it comes to the influence of the background/surround area on quality of color matching, no difference among achromatic backgrounds was recorded. Significantly worse results were recorded when the blue background was used. 2. Observers with superior color matching competence performed significantly better than the ones with average competence 3. The most frequently mismatched shade tabs were A3.5, B3, B4, and D4.