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.

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

OBJECTIVE: To evaluate the optical properties and the relative translucency parameter of Ceramill ZI White (3Y-TZP) and Ceramill Zolid FX White (5Y-PSZ) zirconia ceramic systems and compare them with those of the bovine dentin and enamel/dentin structures. MATERIALS AND METHODS: 3Y-TZP and 5Y-PSZ zirconia ceramic systems were evaluated. A 0.5-mm-thick 3Y-TZP (3Y-NC.5), 0.5-mm-thick (5Y-NC.5), and 1.4-mm-thick (5Y-C.14) were used. A 0.5-mm-thick dentin specimens and 1.4-mm-thick enamel/dentin specimens (n = 5) were obtained from anterior bovine maxillary teeth. Scattering, absorption, transmittance, and albedo coefficient were calculated using Kubelka-Munk's model. Data were statistically analyzed using Kruskal-Wallis and Mann-Whitney tests (p < 0.001), and goodness-of-fit coefficient (GFC). Relative translucency parameter differences were evaluated using translucency thresholds. RESULTS: Reflectance, scattering, absorption, and transmittance properties were wavelength dependent. Good matches (GFC ≥ 0.999) in spectral reflectance were observed between 0.5-mm-thick dentin and 1.4-mm-thick enamel/dentin, and 3Y-NC.5 and 5Y-NC.5. Scattering was the main optical extinction process during light interaction with zirconia and dental structures, as indicated by albedo coefficient. Translucency differences were acceptable only for 3Y-NC.5 and the dentin structure, and 5Y-C.14 and the enamel/dentin structure. CONCLUSIONS: Optical properties of 3Y-TZP and 5Y-PSZ dental zirconia differed from each other and from bovine dental structures. Nevertheless, 3Y-TZP showed similar relative translucency parameter to bovine dentin. CLINICAL SIGNIFICANCE: To achieve the best esthetic results in restorative dentistry, it is crucial for clinicians to know about the optical properties of 3Y-TZP and 5Y-PSZ and to be able to compare these properties with those of dental structures.

Effectiveness and one-year whiteness stability of different in-office bleaching agents and alternative protocols.

STATEMENT OF PROBLEM: In-office bleaching has been widely researched. However, few studies have evaluated alternative protocols for this procedure. Moreover, information on the long-term stability of in-office whitening is limited. PURPOSE: The purpose of this in vitro study was to evaluate the effectiveness and 1-year stability of in-office bleaching with 35% hydrogen peroxide (35%HP) and 37% carbamide peroxide (37%CP) using traditional and alternative protocols. MATERIAL AND METHODS: Forty human third molars were stained with tea and allocated to groups (n=10). Traditional protocols consisted of 3 applications of 35%HP for 15 minutes and 1 application of 37%CP for 45 minutes. Alternative protocols consisted of 1 application of 35%HP for 45 minutes and 3 applications of 37%CP for 45 minutes. Protocols were applied for 3 weeks. CIELab color coordinates were measured at baseline and weekly during treatment and at 1-week, 6-month, and 1-year follow-ups. Effectiveness and stability of the bleaching treatments were interpreted using 50:50% perceptibility and acceptability thresholds. CIELab, chroma, hue angle, and whiteness index were analyzed using the Wilcoxon signed-rank test (α=.05). RESULTS: All protocols showed improvement in bleaching after the first week (P≤.005). All bleaching procedures presented excellent whitening outcomes. Alternative protocols showed a larger rebound effect after 1 year, indicating less stability. For the whiteness index, no differences between the completion of the treatments and 1-year follow-up was found for the bleaching treatments and protocols (P>.05), except for the 37%CP alternative protocol (P=.005). CONCLUSIONS: All tested protocols presented excellent effectiveness in bleaching. Traditional protocols exhibited a greater whiteness stability, while the alternative protocols showed a greater rebound effect after 1 year.

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

OBJECTIVES: To evaluate the effect of thickness on color and translucency of a multi-color polymer-infiltrated ceramic-network (PICN) material. METHODS: Specimens of 0.5, 1.0, 1.5 mm thicknesses were obtained by sectioning VITA ENAMIC® multiColor (E-MC) High Translucent CAD-CAM blocks (1M1-HT, 1M2-HT, 2M2-HT, 3M2-HT, and 4M2-HT). Spectral reflectance and color coordinates were measured on white and black backgrounds using a spectroradiometer, CIE D65 illuminant and CIE 45°/0° geometry. CIEDE2000 color and translucency differences (ΔE00 and ΔTP00 ) between thicknesses and adjacent layers were evaluated using their respective 50:50% perceptibility and acceptability thresholds (PT00 and AT00 ). RESULTS: In general, ΔE00 between thicknesses for all shades and layers were above AT00 in general. Chroma decreased from cervical to incisal layers with statistically significant differences (p < 0.05), and ΔE00 between sequential layers were above PT00 , for all shades and thicknesses. TP00 decreased from 0.5 to 1.5 mm and increased from cervical to incisal layers for all shades with statically significant translucency differences (p < 0.05). In general, for all thicknesses, TPT00 < ΔTP00 < TAT00 for sequential layers. CONCLUSIONS: The gradient in color and translucency of E-MC PICN material was influenced by the thickness of the CAD-CAM block. In addition, color and TP transition values between the layers depends on the thickness and shade. CLINICAL SIGNIFICANCE: The effect of thickness must be taken into account by dental technicians and dentists when CAD-CAM multicolor PICN materials are used.

Color stability and degree of conversion of gingiva-colored resin-based composites.

OBJECTIVES: To evaluate gingiva-colored resin-based composites' (GCRBC) color stability and degree of conversion (DC%). METHODS: Eight discs (8 × 1 mm) of 20 shades of GCRBC were prepared. Color coordinates were measured against a gray background with a calibrated spectroradiometer, CIE D65 illuminant and the CIE 45°/0° geometry at baseline and after 30 days of storage in distilled water, coffee, and red wine. Color differences ( ∆ E 00 ) between final and baseline conditions were calculated. An ATR-FTIR spectrometer with a diamond tip was used to calculate DC%. The results were analyzed statistically using ANOVA and Tukey post-hoc test. The level of significance was p < 0.05. RESULTS: DC% and color stability correlated with each other and with the GCRBC brand. DC% ranged between 43% and 96%, highest values correspond to flowable composites. All composites have experienced color changes after immersion in water, wine and coffee. However, the magnitude of the color change has varied widely depending on the immersion medium and the GCRBC. Color changes generated by the wine were, globally, greater than those induced by coffee (p < 0.001) and above the acceptability thresholds. CONCLUSIONS: The DC% of GCRBCs is sufficient to achieve adequate biocompatibility and physicomechanical properties, but the high susceptibility to staining could compromise aesthetic long-term results. CLINICAL SIGNIFICANCE: The degree of conversion and the color stability of gingiva-colored resin-based composites correlated with each other. All composites have experienced color changes after immersion in water, wine and coffee. Color changes generated by wine were, globally, greater than those induced by coffee and above the acceptability thresholds that could compromise aesthetic long-term results.

Effect of layering strategy and prolonged water aging on masking ability of composite resins.

STATEMENT OF PROBLEM: Layered composite resins may adequately mask discolored substrates. However, whether color changes that occur over time affect masking ability is unclear. PURPOSE: The purpose of this in vitro study was to investigate the effect of layering and water aging on the masking ability of 2 composite resins. MATERIAL AND METHODS: Disk specimens (1.5 mm-thick and shade A1) from Charisma Diamond (CD) and Filtek Z350XT (Z350) were made according to the composite resin shade combination used in the layering strategies: bilayer for CD (enamel/dentin) and for Z350 (enamel/body and enamel/dentin) and trilayer for Z350 (enamel/body/dentin) (n=5). Color measurements were obtained with a spectrophotometer over an A3.5 ceramic substrate, and the whiteness index for dentistry (WID) was calculated. The specimens were aged in water at 37 °C and evaluated at different times: 24 hours, 1 week, 1 month, 2 months, 6 months, 12 months, 18 months, and 24 months. CIEDE2000 color differences (ΔE00) and WID differences (ΔWID) were calculated and interpreted by 50:50% color and whiteness perceptibility and acceptability thresholds. Changes among strategies and aging times were analyzed using the Kruskal-Wallis test (α=.05). Contrasts were made using the Mann-Whitney U test with Bonferroni correction (α=.001). RESULTS: ΔE00 decreased from 24 hours to 2 months of aging. From 2 months onwards, ΔE00 increased for all layering strategies and times, without significant changes in lightness for CD (P>.004). Overall, for the CD restorative system, an increase in ΔWID was observed after 1 month of aging (P<.001), while for the Z350 restorative system, ΔWID decreased after aging (P<.001), except for the Z350 bilayer strategy (enamel + dentin) at 1 week and 2 months (P>.004). For all layering strategies and aging times, color differences were higher than the 50:50% perceptibility threshold for ΔE00 and, after 6 months, higher than the 50:50% acceptability threshold for ΔE00 and the 50:50% whiteness acceptability threshold. CONCLUSIONS: The ability of the tested composite resins to mask a discolored substrate was affected by the layering approach applied and by prolonged water aging.

Visual and instrumental coverage error of two dental shade guides: an in vivo study.

OBJECTIVES: This study aims to evaluate in vivo the color agreement between natural teeth and dental shade guides by means of visual and instrumental coverage error ([Formula: see text]) index. MATERIALS AND METHODS: The color of the middle third of 735 incisors was visually determined by two evaluators using the Vita Classical (VC) and Vita 3D Master (V3DM) shade guides. The color match between the natural tooth and the shade tab was rated as poor (P), good (G), or optimum (O) by each observer. CIE color coordinates of the target teeth and shade tabs of VC and V3DM were instrumentally measured using a clinical spectrophotometer. Visual ([Formula: see text]) and instrumental ([Formula: see text]) coverage error indexes were computed using CIELAB and CIEDE2000 metrics for both shade guides. For [Formula: see text] calculation, only the concordant inter-observer determination on tooth shade rated as O-O or O-G was used. The results were evaluated using perceptibility (PT, [Formula: see text]= 1.2, [Formula: see text]= 0.8) and acceptability (AT, [Formula: see text]= 2.7, [Formula: see text]= 1.8) color thresholds for dentistry. RESULTS: VC and V3DM exhibited [Formula: see text] (2.5, 3.2, and 3.2, 2.7 CIELAB units; 1.9, 2.3, and 2.8, 2.4 CIEDE2000 units, respectively, for O-O and O-G match) and [Formula: see text] (4.7, 4.8, and 4.1, 4.6 CIELAB units; 3.3, 3.4, and 3.4, 3.6 CIEDE2000 units, respectively, for O-O and O-G match) values greater than 50:50% AT for both color difference formulas. [Formula: see text] contributes more than 50% (53.2-82.4% range) to the [Formula: see text] value. This contribution depends on the shade guide used and the quality of the visual rating. CONCLUSIONS: The evaluated shade guides exhibited visual coverage errors above acceptability thresholds, largely due to the contribution of the instrumental coverage error to the visual coverage error. CLINICAL RELEVANCE: It necessary to further improve commercially available dental shade guides to facilitate achievement of satisfactory esthetics results in clinical practice.

Color and optical properties of 3D printing restorative polymer-based materials: A scoping review.

OBJECTIVE: Color and optical properties are particularly crucial to mimic natural tooth. This scoping review aimed to present an overview of the literature published on color and optical properties of 3D printing restorative polymer-based materials. The literature search was performed in MED-LINE/Pubmed, Scopus and Web of Science. MATERIALS AND METHODS: The literature search was conducted in the three databases based on the question: "Are the optical properties and color adequately reported on polymer-based 3D printing dental restorative materials studies?" with no restriction on year of publication. Data were reported and synthesized following PRISMA-ScR statement. RESULTS: Nine studies fit the inclusion criteria. Five studies focused on evaluating only color stability; three articles assessed the color stability along with mechanical and morphological properties and only one study compared color parameters of 3D printed to conventional polymers. Two studies evaluated translucency parameter and no study was found evaluating scattering, absorption, and transmittance. CONCLUSIONS: Color and optical properties of 3D printed polymers that can be used in restorative dentistry are not adequately evaluated and characterized. Future studies on the influence of experimental printing conditions should include these physical properties to assist on improving esthetics. CLINICAL SIGNIFICANCE: This review shows the scarce literature existing on color and optical properties of 3D printing restorative polymer-based materials. These properties and their study are of outmost importance to create materials that mimic natural tooth to allow clinicians to obtain esthetically pleasant restorations.

Effectiveness and color stability of bleaching techniques on blood-stained teeth: An in vitro study.

OBJECTIVE: Evaluate the effectiveness and color stability of bleaching techniques on blood-stained teeth. MATERIAL AND METHODS: The teeth were stained by blood and allocated to groups: walking bleach, inside/outside, and in-office bleaching. L*, a*, b*, C*, h° color coordinates were measured using a clinical spectrophotometer at baseline, weekly (T1-T2-T3), and at 1-week (T4), 6-months (T5), and 1-year (T6) follow-up evaluations. ΔEab* , ΔE00 , and ΔWID were calculated between sequential evaluation timepoints and between baseline and each evaluation timepoint. Color coordinates and WID differences in each timepoint and technique were analyzed by Wilcoxon Signed Rank, Kruskal-Wallis and Mann-Whitney U test, respectively. ΔEab* , ΔE00 , and ΔWID were interpreted by color visual thresholds. RESULTS: The techniques presented a significant increase in L* and WID and, a significant decrease in a* and b* until the completion of treatments. Statistical differences between the techniques for a*, b* and WID were observed from T1 until T3. All techniques demonstrated excellent effectiveness for ΔEab* , ΔE00 , and ΔWID between baseline and each evaluation and follow-up timepoints. However, at T6, it was possible to identify a rebound effect for all techniques. CONCLUSIONS: All bleaching techniques presented excellent effectiveness. The stability of the whitening produced was maintained for 6 months. CLINICAL SIGNIFICANCE: Effective whitening of blood-stained teeth was achieved using walking bleach (sodium perborate), inside/outside (hydrogen peroxide - 7.5%) and in-office techniques (hydrogen peroxide - 35%). The bleaching techniques were effective after the completion of the treatments. A slight rebound was observed at 1 year follow-up.

Masking ability of resin composites: Effect of the layering strategy and substrate color.

OBJECTIVE: To evaluate the effect of layering strategy and substrate color on the masking ability of resin composites. MATERIALS AND METHODS: A1-shaded specimens from Charisma Diamond and Filtek Z350XT were produced using different layering strategies. Color measurements were made by a reflectance spectrophotometer over A2, C2, A3.5, C3, C4 substrates. Color differences were calculated and interpreted by the 50%:50% perceptibility and acceptability visual thresholds. Data was analyzed by Kruskal-Wallis and Dunn post hoc test. Chi-square test was used to determine the association between masking ability, and independent variables. RESULTS: Color differences were significantly lower on A2 and C2 in comparison with C4 for the majority of the layering strategies. Acceptable matches were observed on most of the combinations over A2. Moderately unacceptable mismatches were observed in most of the combinations over C2 and A3.5. Clearly unacceptable mismatches were observed on the C3 and C4. The ΔE00 color shifts were predominantly influenced by ΔL00 for all layering strategies and substrate colors. CONCLUSION: Masking ability was affected by the layering strategy and substrate color. Acceptable masking was associated with A2 and C2, and with layering strategy composed of 0.5 mm enamel opacity and 1.0 mm dentin opacity thicknesses, using the Filtek Z350XT. CLINICAL SIGNIFICANCE: Resin composites-shade A1-applied by different layering strategies with a final thickness of 1.5 mm were able to mask mild and moderately discolored substrates. Severely discolored substrates were not masked effectively.

The effects of thickness and shade on translucency parameters of contemporary, esthetic dental ceramics.

OBJECTIVE: To analyze translucency variations among four different contemporary esthetic ceramic systems having different shades and thicknesses. MATERIAL AND METHODS: Ceramic specimens having different shades and translucencies were tested: leucite reinforced glass-ceramic (ECAD), conventional feldspathic ceramic (Noritake), zirconia reinforced lithium silicate glass-ceramic (Suprinity) and hybrid ceramic (Enamic). Specimens of 0.6, 0.9, 1.2, 1.5 and 2.0-mm thickness (n = 3/group, 615 total) were prepared. Translucency (TP) and Relative Translucency (RTP) Parameters were calculated from spectroradiometric color readings. Effects of shade and thickness for a given system were statistically analyzed using MANOVA and Tukey post-hoc multiple comparisons tests. Translucency variations were assessed comparatively with literature-based perceptibility and acceptability thresholds. RESULTS: TP/RTP values of all ceramic materials decreased with increasing thickness. The most translucent specimens were 0.6-mm thick ECAD HT-A3.5 (TP = 31.99) and ECAD HT-C2 (RTP = 23.75), while the least translucent was 2-mm thick Enamic T-3 M2 (TP = 7.27; RTP = 4.79). Thickness and material type significantly influenced translucency (p < 0.001). Noritake and ECAD LT showed similar translucency values, as well as Suprinity HT and ECAD LT. CONCLUSIONS: For ceramic restorations thicker than 0.9-mm, any thickness increase of 0.3-0.5 mm produces a perceptible but clinically acceptable translucency variation. Increases in thickness larger than 0.6-mm will result in an unacceptable translucency shift. Dental practitioners need to recognize key factors that influence translucency of ceramic restorations in order to choose the optimal material, shade, translucency, and thickness suitable for different clinical scenarios. While shade plays a minor role in translucency variation, ceramic type and restoration thickness significantly affect overall translucency.

Masking ability of bleach-shade resin composites using the multilayering technique.

OBJECTIVE: Evaluate the masking ability of bleach-shade resin composites applied by multilayering techniques over colored substrates. MATERIALS AND METHODS: Disc-shaped specimens were fabricated from bleach-shade resin composites using different multilayering techniques. Substrates were produced in opaque ceramic discs simulating colored substrates (A2, A3, A3.5, C2, C3, C4) and a bleached tooth (0M1). Color coordinates were obtained using a reflectance spectrophotometer. Color difference was calculated by CIEDE2000 using coordinates of 0 M1 ceramic as standard reference. Data were analyzed by one-way ANOVA and Tukey's post-hoc test (p ≤ 0.05). Masking ability interpretation was based on perceptibility and acceptability thresholds. RESULTS: All combinations presented ΔE00 above the acceptable threshold (ΔE00 >1.8), ranging from 2.49 to 7.42, regardless of the restorative system, multilayering strategy or substrate color. Multilayering combinations placed over A2, A3 and A3.5 were moderately (1.8<ΔE00 ≤3.6) and clearly unacceptable (3.6<ΔE00 ≤5.4), combinations associated with C2, C3 and C4 were clearly unacceptable and, extremely unacceptable (ΔE00 >5.4). Lower ΔE00 was observed for combinations with 0.5 mm extra white enamel layer (2.49), or 1.0 mm white dentin layer (2.69), over A2 and A3.5 substrates. Lightness difference showed the greatest contribution to ΔE00 . CONCLUSIONS: Bleach-shade resin composite systems applied by the multilayering technique were not able to ensure effective masking ability. CLINICAL SIGNIFICANCE: Bleach-shade resin composites applied with different combinations of the multilayering technique were not effective in masking colored substrates. Alternative strategies, techniques and dental materials should be explored to obtain acceptable masking.

Color, lightness, chroma, hue, and translucency adjustment potential of resin composites using CIEDE2000 color difference formula.

OBJECTIVE: To evaluate color, lightness, chroma, hue, and translucency adjustment potential of resin composites using CIEDE2000 color difference formula. METHODS: Three resin composites (Filtek Universal, Harmonize, and Omnichroma) were tested. Two types of specimens were prepared: an outer base shade with an inner hole filled with test shades and single-composite specimens of all shades. Spectrorradiometric reflectances measurements and subsequent CIELAB color coordinates and translucency parameter (TP) were performed. Color (CAP00 ), lightness, chroma, hue, and translucency (TAP00 ) adjustment potential using CIEDE2000 color difference were computed. Color and transparency differences among composite materials and shades were statistically tested (P < 0.05). RESULTS: Positive CAP00 and TAP00 values were found for majority of tested materials. CAP00 values ranged from -0.14 to 0.89, with the highest values found for Omnichroma (>0.75 in all cases). TAP00 values ranged from -0.06 to 0.86 with significant translucency differences among dual and single specimens. Omnichroma exhibited the highest adjustment potential for all color dimensions studied. CONCLUSIONS: Lightness, hue, chroma, and translucency adjustment potential have been introduced using CIEDE2000 color difference formula, and have shown their usefulness to evaluate blending effect in dentistry. Color coordinates and translucency adjustment potential were dependent on dental material. Omnichroma exhibited the most pronounced blending effect. CLINICAL SIGNIFICANCE: Resin composites with increased color and translucency adjustment may simplify shade selection, making this process easier and less time consuming. Furthermore, these materials might facilitate challenging and complex color matching situations.

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.

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.

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.

Influence of Gender on Visual Shade Matching in Dentistry.

OBJECTIVE: Accuracy on visual shade matching (VSM) is one of the most difficult procedures in esthetic dentistry. Some variables can influence on this process and gender is one of the most controversial. This observational study evaluated the influence of gender on accuracy of VSM. MATERIALS AND METHODS: One-hundred observers (65 females and 35 males) shade matched four human upper central incisors (UCI) to shade tabs from Vita Classical (VC) shade guide. In addition, the spectral reflectance values from the four UCI and from the 16 VC shade tabs were measured using a spectroradiometer (SP). Measurements were performed over a gray background, inside a viewing booth and under D65 illuminant (diffuse/0º geometry). CIELAB coordinates (L*, a*, and b*) were calculated according to CIE D65 illuminant and CIE 2º Standard Observer. Instrumental shade matching for each UCI, based on minimum color difference, was performed using two color difference metrics (CIELAB and CIEDE2000(2:1:1)). Data was analyzed using descriptive statistics and McNemar test (α = 0.05). RESULTS: Irrespective of the color difference metric, the most prevalent shade performed by females showed greater success (50% for CIELAB and 100% for CIEDE2000(2:1:1)) than males (25% for CIELAB and 50% for CIEDE2000(2:1:1)). However, such difference on gender was statistically significant only when using CIEDE2000(2:1:1) color difference metric (p ≤ 0.05). CONCLUSIONS: The most prevalent shade option resultant from VSM performed by females using VC shade guide perfectly agreed (100% success rate) with measurements from SP and CIEDE2000(2:1:1) color difference metric. CLINICAL SIGNIFICANCE: The ability to understand and distinguish color differences in VSM is critical in clinical dentistry. Variation in shade perception due to observer gender can be minimized using additional observers and/or improving shade matching ability. (J Esthet Restor Dent 29:E15-E23, 2017).

Influence of printing orientation on mechanical properties of aged 3D-printed restorative resins.

OBJECTIVE: To evaluate the influence of printing orientation on flexural strength (σf) and elastic modulus (E) of different 3D printing dental restorative resins. METHODS: Bar-shaped specimens (n = 20) were fabricated from two SLA-printed resins (FT- Formlabs Temporary, and FP- Formlabs Permanent) and two DLP-printed resins (DFT- Detax Freeprint Temp, and GCT- GC Temporary) using two building orientations (0º and 90º). The 3D-printed structures were aged (14 d) before submitted to three-point bending in 37ºC distilled water at a crosshead speed of 1.0 ± 0.3 mm/min until fracture to calculate the σf and the E values. The fractured surfaces were evaluated using stereomicroscopy and scanning electron microscopy (SEM) following fractography principles. Data were statistically analyzed using two-way ANOVA and Tukey post-hoc (α = 0.001). RESULTS: FP and FT showed significantly higher E values than DFT and GCT, irrespectively of printing orientation (p < 0.001). There was no statistical difference between the building orientations (0º and 90º) for the mean σf and E values for the resin materials evaluated. Fractographic characteristics were similar for the surface fracture from all the materials evaluated, showing typical brittle fracture behavior. SIGNIFICANCE: Printing orientation did not influence of flexural strength and elastic modulus values for the 3D-printed resin structures evaluated. Surface topography was mostly governed by the 3D printer type.

Exploring the optical behavior and relative translucency parameter of CAD-CAM resin-based composites, polymer-infiltrated ceramic network, and feldspar porcelain.

OBJECTIVES: To evaluate and compare the optical properties and relative translucency parameter of CAD-CAM restorative materials. METHODS: Four CAD-CAM materials were evaluated: Lava Ultimate (LU), Grandio Blocs (GB), VITA Enamic (VE), and VITA Mark II (VM). Disk-shaped samples in shade A2-HT were prepared (n = 10) and polished to 1.00 ± 0.01 mm of thickness. Scattering (S), absorption (K), albedo (a) coefficient, transmittance (T%), light reflectivity (RI), infinite optical thickness (X∞), and radiative transfer coefficients (µa, and µ'S) were calculated using Kubelka-Munk method and Thennadil's semi-empirical approach. Root Mean Square Error (RMSE) and Goodness of Fit (GFC) were used as performance optical behavior. Translucency differences were evaluated using the relative translucency parameter (RTP00) and 50:50 % translucency perceptibility and acceptability thresholds (TPT00 and TAT00). RESULTS: The spectral distribution of S, K, T%, RI, and X∞ was wavelength-dependent. GFC and RMSE values indicated good spectral behavior matches and good comparative spectral values for RI in LU-GB, LU-VE, and GB-VE, and for K in VE-VM. VM displayed the highest scattering values across the wavelengths, while VE and VM showed lower absorption at shorter wavelengths. LU and GB had the highest transmittance. The X∞ values indicated that all 1.0 mm thick materials could be influenced by the background. No good spectral match and no good comparative spectral values were found between CAD-CAM materials and anterior bovine maxillary specimens. VM had the lowest RTP00 values with perceptible and unacceptable differences compared to CAD-CAM materials evaluated. SIGNIFICANCE: Understanding the optical behavior of different CAD-CAM materials was essential for guiding clinicians in material selection and optimizing their clinical performance. The findings confirm that the different compositions and microstructure impact the optical properties and translucency of CAD-CAM restorative materials.