A comparative evaluation of the variations on the shades of pressable ceramic system with the layering technique after different number of firing cycles: An in vitro study.

AIM: The main aim of the present study was to compare and evaluate the effect of repetitive firings on different shades of a pressable all ceramic system layered with veneering porcelain. SETTING AND DESIGN: In-vitro comparative study. MATERIALS AND METHODS: An in vitro comparative study was conducted, and a total of 60 disc shaped specimens (15 mm in diameter and 0.8 mm in thickness) were made of heat pressed ceramic of shades A2, A3, and B2 (20 discs of each shade) grouped as Group I, II, and III, respectively, using the lost wax technique. The discs were subsequently layered with veneering porcelain followed by glazing and overglazing and underwent a firing cycle at each step until six times combined. CIE L*a*b* measurements were noted on each sample after the third, fourth, fifth, and sixth firing using VITA Easyshade Advance 4.0 spectrophotometer. STATISTICAL ANALYSIS USED: Statistical Analysis was done by SPSS 17.0 software. One way analysis of variance, multiple comparisons using the Tukey test, and descriptive statistical analysis were done for all the groups in the study. P <0.05 was statistically significant. RESULTS: The mean color differences for the repeated firings were imperceptible (ΔE <1.67) to the human eye for all ceramic samples tested except between the fourth and fifth firing of Group II (shade A3). CONCLUSION: The analysis revealed that although repeated firings lead to changes in L*, a*, and b* values, the mean color difference was below the clinically acceptable color change (ΔE <3.7).

Exploring Digital Gingival Shade Matching in Students.

PURPOSE: To study the degree of accuracy in gingival shade matching of undergraduate students using a computer application. MATERIALS AND METHODS: In total, 76 undergraduate dental students' gingival shade selection abilities were evaluated using an in-house developed computer application. A total of 15 intraoral gingival photographs and 21 pink gingival color porcelain samples were used. The environmental conditions were standardized, and no time limit was set for answering in the computer application. RESULTS: Fourteen gingival color samples (66.6%) were not useful for representing the studied gingival shades. Not all natural gingival colors studied were represented within the 50.50% acceptability limits of the pink samples. There were no statistically significant differences between men and women in terms of "hit" percentages. The highest correlation coefficient (in absolute value) was for the L* coordinate (the darker the gingiva in the picture, the higher the hit rate for choosing the "ideal" shade tab); however, none of the linear correlation coefficients were statistically significant. CONCLUSIONS: Not all colors provided in the pink ceramic system were useful for subjective gingival selection. There were no statistically significant differences between male and female dental students in gingival color perception. The L* coordinate was the only one that influenced the correct perception of gingival color by dental students, and it did so more in women than in men.

Microwave disinfection of facial silicone prostheses, Part 1: Color stability.

STATEMENT OF PROBLEM: The choice of cleaning method is an important consideration for lengthening the serviceable time of facial prostheses as microbial organisms and biofilms could degrade facial prostheses and cause skin irritation. Whether microwave disinfection is a suitable cleaning method without degradation of the properties of a prosthesis is unclear. PURPOSE: The purpose of this in vitro study was to measure the color stability of 6 commonly used facial silicone elastomers after microwave disinfection over a simulated 1.5-year period. MATERIAL AND METHODS: Six different facial silicone elastomers: MDX4-4210, MDX4-4210/Type A, M511, A-2186, VST-50, and A-2000 were mixed with intrinsic silicone white opacifier (except for the control group) and subsequently combined with 4 silicone intrinsic pigment color groups: red (R), yellow (Y), burnt sienna (B), and a mixture of R+Y+B (M). The control group was a silicone elastomer without opacifier or pigment. Each of the 30 experimental groups consisted of 5 specimens (N=150). Five specimens were placed in a 250-mL Erlenmeyer flask filled with 160 mL of tap water. Seven flasks were then placed in a 660-W microwave oven. An exposure of 6 minutes was used according to the antimicrobial efficacy of microwave disinfection protocol on facial silicone prostheses with a final water temperature of 60 °C for 18 times (simulating 1.5 years of microwave disinfection with one 6-minute exposure monthly). A spectrophotometer was used to measure reflectance color change values (∆E). Color differences were calculated following CIELab (∆E*ab) and CIEDE2000 (∆E00) formulae. ∆E*ab and ∆E00 were statistically analyzed by a linear mixed effects model with 3 factors (silicone type, color shade, and time) using the R Statistical software program (α=.05). RESULTS: Both ∆E*ab and ∆E00 of all silicone elastomers studied were less than the visual perceptibility thresholds (∆E*ab<1.1 and E00<0.7) and were considered clinically acceptable (∆E*ab<3.0 and E00<2.1) after the 1.5-year simulation of microwave disinfection. Yellow and blue pigments had more effect on MDX4-4210 and M511, while red pigment had more effect on MDX4-4210, MDX4-4210/Type A, and M511 (P<.05). Nevertheless, the values were still below the perceptibility threshold (∆E*ab≤1.0 and E00<0.6). CONCLUSIONS: All 6 facial silicone elastomers maintained clinically acceptable color after 18 months of exposure to microwave disinfection.

Influence of crown shade, translucency, and scan powder application on the trueness of intraoral scanners.

OBJECTIVES: Natural teeth and dental restorations present with various shades and levels of translucency. This study aimed to determine whether these variations in ceramic crowns and scan powder application affect the trueness of intraoral scanners. METHODS: Eight identical premade resin typodonts, each prepared for a crown on the maxillary right second molar, were used. Eight lithium disilicate crowns, distinguished by two levels of translucency (high and low) and four shades (BL1, A2, A3, and A4), were fabricated to an identical design and cemented onto each typodont, providing eight distinct experimental groups (2 levels of translucency × 4 shades). Reference scans were acquired using a desktop scanner. Test scans were performed ten times for each experimental group using two different intraoral scanners (Medit i700 and CEREC Primescan AC), with and without the application of scan powder (n = 10). Three-dimensional metrology software was used to assess the trueness of the intraoral scan datasets. Statistical analysis involved the Kruskal-Wallis H test, Mann-Whitney U test, and independent t-test (α=0.05). RESULTS: For powder-free intraoral scan datasets, the crown shade did not significantly affect trueness within each translucency group (P = 1.000). For both intraoral scanners, compared with low translucency groups, higher marked deviations were exhibited by high translucency groups (P<.001). Scan powder use largely mitigated these differences (P>.05) and enhanced the trueness of the intraoral scan (P<.01). CONCLUSIONS: Shade did not significantly influence the trueness of intraoral scans. High-translucency crowns were scanned with less accuracy than were low-translucency crowns. CLINICAL SIGNIFICANCE: Unlike tooth shade, translucency significantly affected the accuracy of intraoral scans. Therefore, considering the use of scan powder when scanning objects with high translucency may be beneficial.

Assessment of the color stability of two silicone elastomers for maxillofacial prostheses upon exposure to cold beverages.

PURPOSE: This study investigated the color stability of different commercially available silicone materials for facial prostheses upon exposure to everyday beverages. It was hypothesized that the beverages would not alter the color of the silicone under conditions simulating daily exposure. METHODS: Sixty specimens were fabricated using two materials - VST-50 and Silfy - and exposed to commercially available cold mineral water, tea, or coffee. Specimen color was evaluated on days 1 and 15. The color was measured with a spectrophotometer based on CIELab system and color differences were calculated as ΔE. Statistical analysis was performed using the Kruskal-Wallis test and Mann-Whitney U test. RESULTS: The mean ΔE values after 15 days of exposure to mineral water, cold green tea, and coffee were 1.016, 3.480, and 3.636 for VST-50 and 0.440, 0.798, and 1.425 for Silfy, respectively. Both materials showed significant differences in color, and VST-50 showed a greater color change than Silfy, especially for coffee. CONCLUSION: Pigmented silicone elastomers have low color stability, leading to an overall color change in silicone prostheses when exposed to pigmented beverages. Color changes in such prostheses can be mitigated by selecting materials with better color stability to extend their longevity.

A Systematic Review on Maxillofacial Prosthesis with Respect to Their Color Stability.

The aim of this systematic review was to identify and analyze the findings of various studies that analyzed the changes in the color stability of maxillofacial prosthetic materials after the addition of various colorants and nanoparticles and assess the change in color after being subjected to either natural or artificial accelerated aging as well as outdoor aging. This systematic review was conducted in accordance with the guidelines of transparent reporting of systematic reviews and meta-analysis (PRISMA Statement). The primary objective of this systematic review was to evaluate the color stability of maxillofacial prosthesis. The secondary objective was to assess the effect of various colorants; pigments; opacifiers; UV absorbers-such as inorganic colorants (dry earth pigments); metal oxides; and organic colorants. The time period of the included studies extended from 2013 to 2023. Electronic database search identified a total of 217 studies. Ten studies were included to meet the research question. All 10 included studies analyzed the effect of various colorants and their exposure to various aging and weathering conditions. It was found that various pigments and nanoparticles had an effect on the color stability. Also weathering and aging conditions had a direct effect on the color stability as well. In terms of disinfection, although there was not much color difference observed, highest change in color stability was observed when rubbing or brushing of the prosthesis was carried out. In conclusion, the color stability of maxillofacial prosthetics is a critical factor that influences both patient satisfaction and the overall cosmetic look. The potential of pigments and nanoparticles to enhance the color stability of silicone-based maxillofacial prosthesis has received much research. By avoiding color fading and discoloration brought on by environmental variables including UV radiation, aging, and chemical exposure, the inclusion of various pigments and nanoparticles has been demonstrated to improve the color stability of silicone maxillofacial prostheses.

Effect of group and individual education on shade matching competency of dental students.

PURPOSE: To evaluate the influence of group and individual education on shade matching quality using a visual color competency test to match shade tab pairs from two Vita classical A1-D4 shade guides. METHODS: 60 dental students, 21-25 years old (39 females, 21 males) participated in the study. All participants passed a color deficiency test before the experiment. The examination was voluntary and approved by the corresponding Ethics Committee. Students were randomly divided into three groups (n=20): one control group, NE (no education) and two experimental groups - GE (group education) and IE (individual education). The study was performed in three phases. In the "before" (B - Phase 1) and "after" (A - Phase 3) phase, all groups had to match 16 pairs of tabs from two Vita classical A1-D4 shade guides, with the shade designations hidden by custom letter markings. All tabs were mixed on a gray surface illuminated by color-correcting light. In Phase 2 (between B and A), GE had only group education, while IE received additional individual education and training. The control group did not participate in Phase 2. Means and standard deviations were calculated, and differences were compared using the one-way ANOVA, ANCOVA test, and Student t-test for dependent samples (α= 0.05). RESULTS: The NE group matched 10.3 (3.2) and 10.4 (2.9) tab pairs in the before and after phases, respectively. Corresponding results for GE were 11.1 (2.2) and 14.4 (1.9) and 9.5 (3.6) and 15.0 (1.5) for IE, respectively. In Phase 1 (B), no statistically significant difference was recorded among the groups (P= 0.260). The experimental groups achieved a statistically significant improvement compared with the control group in Phase 3 (A) (P< 0.001). Both experimental groups achieved statistically significant improvement within the group after education, GE (P< 0.001) and IE (P< 0.001). Within the limitations of this study, it was concluded that both experimental groups had statistically significant progress in shade matching. The group that received individual education (IE) made statistically significant progress compared with the group that received group education (GE). No statistically significant difference was found in the results of the control group between Phase 1 and Phase 3 of the study. CLINICAL SIGNIFICANCE: Improving the shade matching ability facilitates the work of dentists and dental technicians and enhances the esthetics of dental restorations.

Analysis of shade-matching ability in dental students: a comparative study under clinical and correcting light conditions.

BACKGROUND: Selecting the ideal tooth shade is essential to the success of aesthetic dental restorations. Students' cognitive abilities are involved in the multifaceted and intricate process of shade matching. Hence, the present study aimed to assess and compare the shade-matching ability of undergraduate dental students in various years of dental education under clinical and correcting light. METHODS: This comparative cross-sectional study was instigated amongst male 4th, 5th, and 6th-year students of the dental complex of King Faisal University, Kingdom of Saudi Arabia. A total of 72 male dental students assessed the shade under clinical (fluorescent light) and correcting light (handheld Dental Base Light) by using VITA Classical shade guides. Statistical analysis was done using SPSS version 23 (Armonk, NY, USA). The Chi-square test was used to evaluate the association between correct and incorrect shade matching under correcting and clinical light. RESULTS: Out of 72 male students, 22(30.6%) were from the 4th year, 26(36.1%) were from the 5th year, and 24(33.3%) were from the 6th year, with a mean age of 22.92 ± 1.01 years. The majority of the 6th-year students selected shade of anterior tooth # 11 correctly under clinical and correcting light, and 3(12.5%) students selected incorrectly under clinical and correcting light, with a statistically significant association among them (p = 0.004). As far as the shade selection of the posterior tooth is concerned, a statistically significant difference was observed under clinical light among all clinical students (p = 0.008). CONCLUSION: The clinical performance of dental students in shade matching improved with advancing years of dental education. Additionally, the shade matching ability of all groups of dental students was superior under correcting light compared to conditions under clinical light.

Comparison between direct and indirect "digital image" dental visual shade matching considering the effect of clinical experience and gender.

INTRODUCTION: Shade matching is an essential procedure to obtain an esthetic prosthesis. The Direct Visual Shade Matching (DSM) method using shade guides is the most used method by dentists. However, The Indirect Visual Digital Shade Matching (ISM) method based on digital imaging is concerned to be reliable and useful in determining shade matching in dental practice. Several factors such as method, clinical experience, and gender can affect the success of shade matching. AIM OF THE STUDY: This study aimed to compare these two methods and evaluate the effect of experience and gender on the results. MATERIALS AND METHODS: Three volunteers' maxillary central incisor teeth were evaluated using (DSM) and (ISM) methods by 87 examiners (42 males, 45 females). These examiners were further divided into three groups based on their clinical experience: Undergraduate Preclinical Dental Students (UPDS) with 31 examiners, Undergraduate Clinical Dental Students (UCDS) with 34 examiners, and Postgraduate Dental Students from the Department of Prosthodontics (PDS) with 22 examiners. The spectrophotometer device results of three teeth were considered as a reference for shade matching. Statistical analyses of the data were performed using Kruskal-Wallis, Mann-Whitney U, and Chi-square tests. RESULTS: No significant difference was found between indirect and direct methods according to Perfect Matches (p > 0.05). However, according to Shade Matching Deviation Score (SMDS) values a statistically significant difference was found between the two methods where the best result was obtained with the ISM method (p < 0.05). There was a significant difference between the PDS group and the other two groups in terms of clinical experience (p < 0.05). There was no significant difference between gender groups (p > 0.05). CONCLUSION: Digital images, captured under standardized lighting conditions, may serve as a reliable alternative method for direct shade matching. The (ISM) method requires a camera, related accessories, and computer skills. However, as these tools are commonly available nowadays, the focus for practitioners should be on effectively learning and applying these tools to achieve the best results. While clinical experience plays a significant role in the shade matching process, gender does not appear to have a substantial influence. CLINICAL SIGNIFICANCE: This study found no significant differences between the (DSM) and (ISM) methods, leaving the clinical relevance of this method open to debate. However, the ISM method yielded superior responses. Despite requiring specialized tools, conditions, and training, the widespread use of cameras and computers in modern clinics makes the necessary equipment and software readily available. This method enhances clinician-technician communication, potentially improving prosthesis esthetics and patient satisfaction, especially for less experienced clinicians or those with color deficiencies. Further research is crucial to determine its clinical significance.

In-vivo repeatability of three intra-oral spectrophotometers.

OBJECTIVE: The objective was to assess the repeatability of three spectrophotometers, based on the CIELCh factors and shadeguide reference measurements. MATERIALS AND METHODS: Color analysis was performed using three devices: Rayplicker, Easyshade 4, and Easyshade V. Five repeated measures were performed by the same operator, on the right central maxillary incisor of 30 patients. The CIELCh factors were retrieved and the intra-class correlation was calculated. The Vita Classical and Vita 3D Master shadeguides were used to evaluate the respective Fleiss' Kappa factors. RESULTS: Rayplicker and Easyshade V demonstrated strong intra-class correlation based on the CIELCh factors: 0.98, 0.99, and 0.91 for Rayplicker, and 0.95, 0.99, and 0.93 for Easyshade V, for the L*, C*, and h* parameters, respectively. Regarding the repeatability of the shadeguide data, while Easyshade 4 had the best repeatability when using the Vita Classical as a reference, Rayplicker and Easyshade V showed better repeatability when using the Vita 3D Master. CONCLUSION: These findings suggest that both Rayplicker and Easyshade V are reliable devices for measuring CIELCh parameters. In terms of shadeguide references, the reliability of spectrophotometers is generally lower compared to the CIELCh measurements. CLINICAL SIGNIFICANCE: Given their good repeatability, both the Rayplicker and the Easyshade V spectrophotometers are reliable tools for prosthetic dental practices.

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.

Three-dimensional representation of the Vita Toothguide 3D-Master: An in vivo clinical study.

STATEMENT OF PROBLEM: The Vita Toothguide 3D-Master (Vita Zahnfabrik) is considered the dental shade guide in which the three dimensions of color - lightness, hue, and chroma - are most well-ordered in the CIELAB color space. No research has yet explored how well the Vita Toothguide 3D-Master is ordered in the 3D color space by recording color coordinates in vivo. PURPOSE: To evaluate the spatial color distribution of the Vita Toothguide 3D-Master's lightness, chroma, and hue groups and its 26 physical shade tabs. MATERIALS AND METHODS: The dental color (L*, C*, h°, a*, and b* color coordinates) of a healthy maxillary central incisor was recorded for 1361 participants (aged between 18 and 89 years) using a Vita Easyshade Compact spectrophotometer (Vita Zahnfabrik). The R 2.7.2. statistics program was used to create the visual representations. RESULTS: The five lightness levels are those that are best distributed in the color space, in relation to the L* coordinates, followed by the chroma group and, finally, the hue group. The 5M1, 5M2, and 5M3 physical shade tabs are situated at a greater distance apart from the other tabs in the color space. CONCLUSIONS: The Vita Toothguide 3D-Master's 26 physical shade tabs are satisfactorily distributed in three-dimensional space, although strict mathematical criteria are not followed. The natural dental shades that fall lower on the lightness scale are the most poorly represented by the physical shade tabs. CLINICAL IMPLICATIONS: Darker teeth are poorly represented by the Vita Toothguide 3D-Master's physical shade tabs. The spatial distribution of dental shade guides needs to be improved to ensure they provide homogeneous coverage of the entire chromatic spectrum corresponding to natural teeth. This would help reduce the errors inherent to the subjective visual color selection process.

Chroma-dependence of CIEDE2000 acceptability thresholds for dentistry.

OBJECTIVES: Determine visual 50:50% color difference acceptability thresholds (AT) for regions of the dental color space with varying chromaticity. METHODS: A 40-observer panel belonging to two different groups (dentists and laypersons) evaluated 144 dental resin composites pairs (divided in three different sets of 48 pairs according to chroma value: Low Chroma (LC), Medium Chroma (MC) and High Chroma (HC) placed 40 cm away and inside of a viewing cabinet (D65 Standard light source; diffuse/0° geometry). A Takagi-Sugeno-Kang (TSK) fuzzy approximation was used for fitting the data points and calculate the 50:50% acceptability thresholds in CIEDE2000. A paired t-test was used to evaluate the statistical significance between thresholds differences and Bonferroni correction was applied. RESULTS: The CIEDE2000 50:50% AT were ∆E00 = 2.84, ∆E00 = 2.31 and ∆E00 = 1.80 for LC, MC and HC sets of sample pairs, respectively. The 50:50% AT values were statistically significant between the different sets of sample pairs, as well as the 50:50% AT values obtained for different observer groups. CONCLUSIONS: 50:50% CIEDE2000 acceptability thresholds for dentistry are significantly different depending on the chromaticity of the samples. Observers show higher acceptability for more achromatic samples (low chroma value) than for more chromatic samples. CLINICAL SIGNIFICANCE: The difference in the AT for distinct regions of the dental color space can assist professionals as a quality control tool to assess clinical performance and interpret visual and instrumental findings in clinical dentistry, dental research, and subsequent standardization processes.

Cie L*A*B* Values in VITA Classical and VITA 3D Master by Two Dental Spectrophotometers.

PURPOSE: To compare the CIE L*a*b* values of two different dental shade guides using two shade-matching spectrophotometers. MATERIALS AND METHODS: SpectroShade Micro (SS) and Easyshade (ES) (VITA Zahnfabrik) were tested. One calibrated operator performed 30 measurements of each tab from three batches of the two guides, VITA Classical (VC) and VITA 3D Shade Master (VM). Receiver operating characteristic (ROC) curves and intraclass coefficients (ICC) between the different batches were calculated. Results were given as mean and SD of the L*a*b* values and the respective color differences according to the CIEDE 2000 formula (ΔE00) for each of the shade tabs in the two spectrophotometers and then analyzed with independent student t test (α = .05). RESULTS: A total of 1,440 and 2,610 measurements for VC and VM, respectively, were performed per spectrophotometer. There were statistically significant differences between the two devices for all L*a*b* values, with the exception of: L* for 3R1.5; a* for 2R1.5, 3L1.5, 2L2.5, 3M2, 3L2.5, 4L1.5, and 4L2.5; and b* for D3, 1M2, and 3M2. When assessing the same shade guide, differences in ΔE00 were detected between devices above the acceptability threshold (AT) (ΔE00 ≥ 1.8) for all shade tabs except for VC (C1, C2, D3, A3.5, C3, and A4) and VM (4M1, 3R2.5, 4L2.5, and 4M3). The overall mean of the interdevice ΔE00 was 2.2 ± 1.0 for VC and 2.5 ± 1.0 for VM. CONCLUSIONS: The two dental spectrophotometers presented high ICC and ROC values, which validates their indication as auxiliary tools. However, there are discrepancies in the hues D (VC) and R (VM) with interdevice variability when evaluated for the L*a*b* component. Int J Prosthodont 2023;36:e38-e52.

The impact of zirconium dioxide nanoparticles on the color stability of artificially aged heat-polymerized maxillofacial silicone elastomer.

The limited service life of craniofacial prostheses due to degradation and color instability is a significant challenge. This in vitro study aimed to determine how zirconium dioxide (ZrO2) nanoparticles affect the color stability of M511 heat temperature vulcanizing (HTV) maxillofacial silicone elastomers after artificial aging. ZrO2 nanoparticles were added at concentrations of 1, 2, and 3 wt% to M511 HTV silicone elastomer. Two intrinsic silicone pigments were used (red and mocha). Silicone with pigment and without ZrO2 nanoparticles were used as the control. Eighty disk-shaped specimens were fabricated and divided into eight experimental groups, each containing ten specimens (n = 10). All specimens were subjected to artificial aging, and color changes were recorded at 252, 504, and 1008 h intervals. The L*a *b * values were measured using a colorimeter and the CIE-Lab system. To interpret the recorded color differences, a 50:50 percent perceptibility threshold (ΔE* = 1.1) and acceptability threshold (ΔE* = 3.0) were implemented. A one-way analysis of variance and Tukey's post hoc test at a significance level of 0.05 were used for the statistical analysis. We found that every evaluated specimen group exhibited a chromatic change (ΔE* > 0). The ΔE* values for the mocha pigments with and without ZrO2 nanoparticles were below the perceptible threshold (1.1 units). The ΔE* values of the red pigment with and without ZrO2 nanoparticles were significantly higher than the acceptable threshold (P < 0.000). According to the findings of this in vitro study, all the specimens underwent color changes (ΔE* > 0). The red pigment exhibited highly significant chromatic alterations. In contrast, mocha pigments with and without ZrO2 nanoparticles exhibited the least color change and were below the perceptible threshold. ZrO2 nanoparticles provided important protection and showed a reduction in color change.

Fifteen ceramic gingival samples: A proposed gingival shade guide.

OBJECTIVE: (1) To put forward a set of valid pink ceramic samples for subjective gingival colour selection in the Caucasian population, and (2) to assess the quality of the shade matches provided by the selected pink samples. METHODS: The ceramic gingival shade samples (n = 133) were obtained by mixing pairs of basic colours from a single system. In each mixture, the proportions of the colours were altered in 10% increments, following the numerical order used by the manufacturers of the three colour systems under study (Heraceram, Vita VM9 and IPS Style). The CIELAB colour coordinates were recorded using spectrophotometry in three zones of healthy anterior gingiva (n = 360). The sample was randomly divided into two subsamples, each of which contained 180 participants. Subsample 1 was used to select the ceramic gingival samples that provided the best shade matches, using the k-means clustering method. Subsample 2 was used to assess the chromatic validity of the selected gingival samples, according to the coverage error. RESULTS: To identify the ceramic gingival samples that best represented participants' gingival colour, the minimum colour differences (ΔEab∗, ΔE00) between the cluster centroids and the 133 gingival samples were calculated. Fifteen gingival samples were selected: 8 from the Heraceram system, 4 from the VM9 system, and 3 from the IPS Style system. Coverage errors for the 15 gingival samples fell below the gingival clinical acceptability thresholds in the three gingival zones examined. CONCLUSIONS: The 15 ceramic gingival colour samples provide satisfactory coverage of the gingival colour space, with coverage errors below the ΔE00 clinical acceptability threshold of 2.9 units. These pink colour samples have the potential to provide good gingival shade matches in subjective colour selection. CLINICAL SIGNIFICANCE: Mixing basic ceramic colours is a viable method for generating a series of pink shades that can be used as a physical gingival shade guide. The resulting guide provides valid results (under the acceptability thresholds) for subjective selection gingival colour selection in clinical practice.

A system for reliable composite shade matching: Custom shade tabs and an intra-oral mockup.

OBJECTIVE: This article introduced a systematic approach to matching composite and tooth shades to create esthetic restorations that visually integrate seamlessly with the patient's tooth and surrounding dentition. A basic explanation of color science was presented to aid the clinician in adopting this systematic approach to color matching. To demonstrate the need for custom shade guides, an objective analysis of composites from different companies was performed by recording the color coordinate values of multiple composites and then calculating CIEDE2000 color differences. Different locations on the tooth were analyzed using the same identified shade from different companies, as well as using the same composite shade applied in different thicknesses. A case report documented the clinical application of these shade matching techniques. CLINICAL CONSIDERATIONS: Shade matching, particularly in the anterior esthetic region, can be challenging, which can result in patient dissatisfaction with the esthetic result. Stock shade tabs are not a reliable indicator of actual composite shades. CONCLUSIONS: The most predictable esthetic results were achieved by using custom shade guides as an entry point, followed by a direct composite color mockup intraorally. CLINICAL SIGNIFICANCE: To consistently meet the esthetic demands of today's patients, dentists need reliable tools when selecting a composite shade for restorations. Composites with the same shade designation vary in color and shade designation cannot be relied upon for accurate shade selection. The use of custom shade guides and an intra-oral mockup can enhance the esthetic outcome.

Color difference for shade determination with visual and instrumental methods: a systematic review and meta-analysis.

BACKGROUND: Shade determination is a critical step for the fabrication of a satisfactory restoration. Visual shade selection with conventional shade guides is subjective and influenced by variables related to light, observer, and object. Shade selection devices have been introduced to provide subjective and quantitative shade values. This systematic review and meta-analysis aimed to compare the color difference for shade selection with visual and instrumental methods. METHODS: An initial search was conducted on databases (MEDLINE via PubMed, Scopus, and Web of Science) in addition to a manual search through references of identified articles. Studies comparing the accuracy of visual and instrumental shade selection based on ΔΕ were included in data synthesis. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated to estimate the effect size for global and subgroup meta-analysis using the inverse variance weighted method and random-effects model (P ˂ 0.05). Results were presented as forest plots. RESULTS: The authors identified 1776 articles from the initial search. Seven in vivo studies were included in the qualitative analysis of which six studies were included in the meta-analysis. For the global meta-analysis, the pooled mean (95% CI) was - 1.10 (- 1.92, - 0.27). Test for overall effect showed that instrumental methods were significantly more accurate than visual methods with significantly less ΔΕ (P = 0.009). Test for subgroup difference showed that the type of instrumental shade selection method used had a significant effect on accuracy (P ˂ 0.001). Instrumental methods including spectrophotometer, digital camera, and smartphone showed significantly better accuracy compared with visual shade selection (P ˂ 0.05). The greatest mean difference was found between the smartphone and visual method with a mean (95% CI) of - 2.98 (- 3.37, - 2.59) with P ˂ 0.001 followed by digital camera and spectrophotometer. There was no significant difference in accuracy between IOS and visual shade selection (P = 1.00). CONCLUSIONS: Instrumental shade selection with a spectrophotometer, digital camera, and smartphone showed significantly better shade matching compared with a conventional shade guide, whereas IOS did not improve the shade matching significantly compared with shade guides. REVIEW REGISTRATION: PROSPERO CRD42022356545.

Effect of cross-polarization filters on the trueness of colors obtained with a single-lens reflex camera, macro lens, and a ring flash.

OBJECTIVE: To investigate the effect of cross-polarization filters on the colors of shade tabs obtained with a digital single-lens reflex (DSLR) camera, macrolens, and a ring flash. MATERIALS AND METHODS: Digital images of four shade tables (1M1, 3L2.5, 3R2.5, and 5M3) from the VITA Toothguide 3D-Master shade guide were taken using a DSLR camera, 100 mm macrolens, and ring flash with two different cross-polarizing filters (Polar_eyes and Filtropolar), and without (Nonpolarizer; n = 7). The CIE L*a*b* color coordinates of digital images were calculated and remeasured with a spectroradiometer (SR). The color differences (ΔE00 ) between the SR and digital images were calculated and analyzed with the two-way analysis of variance (ANOVA) and Tukey HSD test (α = 0.05). RESULTS: ΔE00 values of all test groups were higher than the clinically acceptable threshold (∆E00 > 1.80). While the ∆E00 values of Filtropolar (6.19 ± 0.44) and Polar_eyes (7.82 ± 0.23) groups were significantly higher than the Nonpolarizer (4.69 ± 0.32) for the 1M1 shade tab, ∆E00 value of Polar_eyes (6.23 ± 0.34) was significantly lower than Nonpolarizer (10.71 ± 0.48) group for 5M3 shade tab (p < 0.05). CONCLUSION: The color-matching results of tested digital photography techniques with and without cross-polarization were unacceptable, compared to a spectroradiometer. While digital photography with Polar_eyes cross-polarizing filter has closer results to the reference device for the low-in-value shade table (5M3), for the high-in-value shade table (1M1), improved results were obtained without a cross-polarizing filter. CLINICAL SIGNIFICANCE: The cross-polarization filters are increasingly used in dentistry for tooth color communication with digital photography techniques. However, the digital photography techniques with-without cross-polarization filterers should be improved to obtain clinically acceptable color-matching results.

The effect of color vision resolution on intra-oral shade-selection accuracy.

BACKGROUND: Dentists must be able to identify subtle color changes as shade-matching is crucial in aesthetic dentistry. OBJECTIVE: To determine whether color discrimination ability is related to shade-matching accuracy among dentists. METHODS: The sensitivity of the normal-color vision population to different colors was investigated using Farnsworth Munsell 100 Hue (FM-100) test results. The FM-100 test was administered to 37 dentists at the Hospital of Stomatology, Jilin University. Sensitivity of dentists with normal-color vision to different colors was investigated using the FM-100 test. Participants were instructed to arrange color caps of various colors according to the gradual change in colors and the results were scored. Visual shade matching test using Vita 3D-MASTER shade guide was performed to determine shade-matching accuracy. The relationship between color discrimination ability and shade-matching accuracy was analyzed. The number of misplaced color caps in the FM-100 test was also calculated. RESULTS: The FM-100 test revealed that 16 and 21 participants had excellent and average color discrimination ability, respectively, and their shade-matching accuracies were 68.75% and 66.67%, respectively. No significant difference was observed in the shade-matching accuracy between the two groups. No significant correlation was observed between the color discrimination ability and shade-matching accuracy. In addition, the number of wrong color caps on the 43-63 color tray with the transition from blue-green to blue-purple was the highest according to Friedman's test. CONCLUSION: Color discrimination ability of dentists does not affect their visual shade-matching accuracy. Additionally, people with normal color vision are not sensitive to the transition from blue-green to blue-purple.