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Patricia Villalta, DDS, MS,a Huan Lu, DDS, PhD,b Zeynep Okte, DDS, PhD,c
Franklin Garcia-Godoy, DDS, MS,d and John M. Powers, PhDe
College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, Fla; Department of
Restorative Dentistry and Biomaterials, University of Texas Dental Branch at Houston, Tex;
University of Ankara, Faculty of Dentistry, Ankara, Turkey
Statement of problem. Discoloration of resin-based composites by colored solutions is a common problem.
The use of bleaching agents for discolored natural teeth is becoming increasingly popular. It is not clear if
bleaching agents can remove the stain from composite resins.
Purpose. The purpose of this study was to investigate the effects of 2 staining solutions and 3 bleaching systems
on the color changes of 2 dental composite resins.
Material and methods. Forty-five disk-shaped specimens (9 3 2.5 mm) of each of 2 composite resins, Filtek
Supreme (FS) and Esthet X (EX), were prepared. The specimens were then divided into 3 groups of 15 specimens each and immersed in 2 staining solutions (coffee or red wine) or distilled water (control) for 3 hours
daily over a 40-day test period. The 3 groups were then divided into 3 subgroups (n=5), and 3 bleaching agents
(Crest Night Effects, Colgate Simply White Night, or Opalescence Quick) were applied to the surface of the
specimens over a 14-day period. Color of the specimens was measured with a spectrophotometer using CIELAB
color space relative to CIE standard illuminant D55 at baseline, after staining, and after bleaching. The color
differences (DEab*) between the 3 measurements were calculated. The value DEab*=3.3 was used as an acceptable value in subjective visual evaluations. Analysis of variance and nonparametric analysis (Kruskal-Wallis test
and Mann-Whitney test) were used to analyze the data.
Results. After staining, FS had more color change than EX and was more affected by the wine solution. After
bleaching, the color of both EX and FS specimens returned to the baseline. The color differences between
bleaching and baseline were less than value DEab*=3.3 for all groups.
Conclusion. The nanocomposite (FS) changed color more than the microhybrid composite (EX) as a result of
staining in coffee or red wine solutions. After bleaching, discoloration was removed completely from the
composite resins tested. (J Prosthet Dent 2006;95:137-42.)
CLINICAL IMPLICATIONS
Red wine and coffee caused discoloration of the composite resins tested. Different concentrations
of carbamide peroxide appear to have clinically similar effects in removing stain on the surface of
shade A2 composite resins.
FEBRUARY 2006
Composite resin restorative materials undergo a series of physical changes as a result of the polymerization
reaction and the subsequent interaction with the wet
oral environment.3 Following polymerization, the inward movement of water molecules causes mobilization
of ions within the matrix and outward movement of
unreacted monomers and ions leached from fillers and
activators.4-6 Elution of leachable components contributes to further shrinkage and loss of weight, whereas
hygroscopic absorption of water results in a swelling of
material and an increase in weight.7 This process may
cause softening of the resin matrix and reduction of stain
resistance.8,9
Discoloration of tooth-colored resin-based materials
may be caused by intrinsic and extrinsic factors. Intrinsic
factors involve the discoloration of the resin material
itself, such as the alteration of the resin matrix and the
interface of matrix and fillers.2 The intrinsic color of
THE JOURNAL OF PROSTHETIC DENTISTRY 137
VILLALTA ET AL
Composite resins
Filtek Supreme
Esthet-X
Bleaching agents
Crest Night Effects
Colgate Simply White Night
Opalescence Quick
Code
Composition/type
Lot No.
FS
EX
Nanocomposite
Microhybrid composite
20040330
0410055
CNE
CSWN
OPAL
30435614J0
P9809176
5J69
Manufacturer
VILLALTA ET AL
Esthet X
Filtek Supreme
STBL
BBL
BST
STBL
BBL
BST
3.6
0.7
4.0
6.3
1.4
5.1
(0.3)*
(0.5)
(0.7)*
(2.2)*
(0.9)
(1.5)*
CNE
3.9
1.1
3.2
6.2
2.4
3.8
(0.4)*
(0.5)
(0.4)
(0.5)*
(0.4)
(0.4)*
Wine
OPAL
4.1
1.4
5.2
6.5
1.0
5.7
(0.5)*
(0.3)
(0.8)*
(0.9)*
(0.5)
(0.6)*
CSWN
3.5
2.0
5.3
9.2
0.7
8.9
(0.5)*
(0.7)
(0.9)*
(1.2)*
(0.2)
(1.2)*
CNE
3.9
0.9
3.3
15.5
3.1
12.4
(0.8)*
(0.6)
(0.4)*
(5.0)*
(1.0)
(5.0)*
Water
OPAL
4.3
2.3
6.4
11.5
2.1
10.1
(0.6)*
(0.9)
(1.4)*
(5.2)*
(1.8)
(5.3)*
CSWN
0.7
0.8
0.4
1.0
0.9
0.4
(0.3)
(0.1)
(0.2)
(0.3)
(0.3)
(0.2)
CNE
0.6
1.1
0.8
0.6
0.9
0.9
(0.2)
(0.2)
(0.5)
(0.3)
(0.6)
(0.6)
OPAL
1.0
1.3
0.6
1.1
0.6
0.8
(0.8)
(1.0)
(0.3)
(0.3)
(0.2)
(0.2)
STBL, Interval between staining and baseline; BBL, interval between bleaching and baseline; BST, interval between bleaching and staining; CSWN, Colgate Simply
White Night; CNE, Crest Night Effects; OPAL, Opalescence Quick.
*
Indicates clincially unacceptable value (DEab*$3.3).
Color testing
Color of the specimens was measured with a spectrophotometer (Color Eye 7000; GretagMacbeth LLC,
New Windsor, NY) against a white background using
CIELAB color space relative to CIE standard illuminant
D55 at baseline, after staining, and after bleaching. The
color differences (DEab*) between the 3 measurements
were calculated as follows45:
DEab DL 2 1 Da 2 1 Db 2 1=2
Staining process
Forty-five specimens of each composite resin were
separated into 3 groups (n=15). All specimens in each
group were immersed in 1 of the 2 staining solutions
(coffee or red wine) or distilled water (control) for 3
hours per day at room temperature over a 40-day test
period. Solutions were changed daily. Coffee group
specimens were immersed in vials containing 50 mL
of freshly brewed regular coffee per vial (Auroma
Paramount Coffee, Lansing, Mich); wine group specimens were immersed in vials containing 50 mL of red
wine (Concha y Toro Frontera Cabernet Sauvignon
2002; Merlon, Chile); and control group specimens
were immersed in distilled water. The vials were
sealed with parafilm (Pechiney Plastic Packaging Inc,
FEBRUARY 2006
Bleaching process
Three bleaching agents were used in this study
(Table I). The 15 specimens in each staining group
were further divided into 3 subgroups. Specimens in
each subgroup (n=5) were bleached by one of the
bleaching agents. The bleaching agents were painted
on the top surface of the specimen according to the
manufacturers instructions. All bleaching agents were
applied at room temperature for 8 hours per day for
14 days to simulate the bleaching process. To be consistent with the other 2 paint-on products, Opalescence
Quick was applied for a time period that far exceeded
the manufacturers recommended time of no more
than 2 hours per session. After bleaching, the specimens
were rinsed with tap water for 1 minute to remove the
bleaching agents, blotted dry, and stored in distilled
water at 37C.
A limit of DEab*#3.3 was interpreted as a clinically
acceptable difference in this study.46 One-way and 2way analysis of variance (ANOVA) tests were used to
analyze the data if the normality and equal variance
assumptions were met. Statistical software (SPSS 11.5
for Windows; SPSS Inc, Chicago, Ill) was used to perform the analysis. Fishers protected least significant
difference (PLSD) intervals were calculated (a=.05) to
compare the group mean values. If the data did not
meet the assumptions for ANOVA, a nonparametric
analysis (Kruskal-Wallis test and Mann-Whitney test)
was used to analyze the data.
RESULTS
Mean values and SDs of DEab*s for intervals of staining and baseline, bleaching and baseline, and bleaching
and staining are listed in Table II. After staining, FS
and EX both had clinically significant discoloration
(DEab*.3.3) for the coffee and wine groups, and FS
139
VILLALTA ET AL
Table III. One-way ANOVA of color change from baseline after staining for EX (control group included)
Source
Corrected model
Intercept
Stain
Error
Total
Corrected total
df
Mean square
98.083(a)
362.895
98.083
12.501
473.480
110.585
2
1
2
42
45
44
49.042
362.895
49.042
.298
64.761
1219.186
164.761
,.001
,.001
,.001
Table IV. Two-way ANOVA of color change from baseline after bleaching for EX
Source
Corrected model
Intercept
Stain
Bleach
Stain 3 Bleach
Error
Total
Corrected total
df
Mean square
11.713(a)
74.061
4.379
3.262
4.072
12.987
98.761
24.700
8
1
2
2
4
36
45
44
1.464
74.061
2.189
1.631
1.018
.361
4.058
205.292
6.069
4.520
2.822
.002
,.001
.005
.018
.039
ANOVA, the data relating to color change after bleaching was not analyzed by a statistical method. The data
showed that all 3 bleaching products had a clinically significant effect on the removal of stain from discolored
FS specimens. The color differences between bleaching and baseline for all the groups were less than 3.3
(the clincially acceptable color change), even for the significantly discolored specimens in coffee or wine groups
(Table II).
DISCUSSION
After staining, both composite resins tested had perceptible color changes (DEab* between 3.5 and 15.5).
Low pH and alcohol may affect the surface integrity of
composite resins and cause staining. These results are
similar to those reported by Stober et al.22 The effect
of staining solutions on color changes of composite
resins was material dependent. This result is consistent
with another study.11 The staining susceptibility of a
material may be attributed to its resin or filler type. As
purported by the manufacturer, Filtek Supreme (FS) is
a nanocomposite with a primary 20-nm silica filler and
loosely bonded cluster zirconia/silica particle size ranging from 0.6 to 1.4 mm. Its resin matrix is composed of
Bis-GMA, UDMA, Bis-EMA, and TEGDMA. As purported by the manufacturer, Esthet X (EX) is a microhybrid composite containing BisGMA, BisEMA, and
TEGDMA, and 0.6- to 0.8-mm-sized fillers. FS demonstrated more discoloration than EX for the 2 staining
solutions, especially for the wine group. As FS and EX
had different compositions, FS might absorb a staining
VOLUME 95 NUMBER 2
VILLALTA ET AL
CONCLUSIONS
Different composite resins reacted differently in the 2
staining solutions. FS and EX specimens had clinically
significant discoloration (DEab*.3.3) in both the coffee
and wine solutions, and FS was more affected by the
wine. After bleaching with 3 types of bleaching agents,
discoloration was removed from the composite resins.
The authors thank Dr Jay Kim, professor, Loma Linda University,
School of Dentistry for his help with the statistical analysis.
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Reprint requests to:
DR PATRICIA VILLALTA
BIOSCIENCE RESEARCH CENTER, COLLEGE
NOVA SOUTHEASTERN UNIVERSITY
3200 SOUTH UNIVERSITY DRIVE
FT LAUDERDALE, FL 33329
FAX: 945-262-1782
E-MAIL: pvillalt@nova.edu
OF
DENTAL MEDICINE
0022-3913/$32.00
Copyright 2006 by The Editorial Council of The Journal of Prosthetic
Dentistry.
doi:10.1016/j.prosdent.2005.11.019
VOLUME 95 NUMBER 2