| Abstract|| |
Aim: The aim of this study was to compare the effect of chlorhexidine mouthrinse on the color stability between three different types of composites.
Materials and Methods: A total of 30 samples of size 10-mm length, 1-mm width, and 1-mm thickness were prepared on a customized microglass slide from each of the composite materials and immersed in 20 ml of distilled water followed by incubation at 37°C for 24 h. The samples were divided into three groups (n = 10) – Group I: A nanofilled composite, Filtek Z350XT (3M ESPE, St. Paul, USA); Group II: A microhybrid composite, Polofil Supra (Voco GmbH, Germany); and Group III: A nanoceramic composite, Ceram.x Sphere TEC (Dentsply, Konstanz, Germany). Baseline color values were recorded using a spectrophotometer (V-770 UV-Visible/NIR Spectrophotometer, Easton, Maryland, USA) according to the laboratory scale. After baseline color measurements, ten randomly selected specimens from each group were immersed in 20 ml of 0.2% chlorhexidine mouthrinse (Rexidin Plus, Aurangabad, India) for 24 h. The postimmersion color values of the samples were then recorded, respectively, using the same spectrophotometer.
Statistical Analysis Used: The statistical analysis was done using one-way ANOVA followed by Tukey's post hoc test.
Results: Statistically significant difference was observed between the mean color change values in the three groups (P < 0.05) with the highest color change (delta E [ΔE]) in Group III (Nanoceramic composite). The ΔE for Group I (Nanofilled composite) was 3.16, Group II (Microhybrid composite) was 3.32, and Group III (Nanoceramic composite) was 3.51.
Conclusion: All the three types of composites displayed color changes after immersion in mouthrinse, but the color shift depended on the material used, and the nanofilled composites (Filtek Z350XT, 3M ESPE, St. Paul, MN, USA) had higher color stability.
Keywords: Chlorhexidine mouthrinse; color stability; composite resin; spectrophotometer
|How to cite this article:|
Shree Roja R J, Sriman N, Prabhakar V, Minu K, Subha A, Ambalavanan P. Comparative evaluation of color stability of three composite resins in mouthrinse: An in vitro study. J Conserv Dent 2019;22:175-80
|How to cite this URL:|
Shree Roja R J, Sriman N, Prabhakar V, Minu K, Subha A, Ambalavanan P. Comparative evaluation of color stability of three composite resins in mouthrinse: An in vitro study. J Conserv Dent [serial online] 2019 [cited 2019 Jul 17];22:175-80. Available from: http://www.jcd.org.in/text.asp?2019/22/2/175/257570
| Introduction|| |
Resin-based restorative materials have evolved over the past decades and are widely used to meet esthetic demands in dental practice. The color stability of these restorative materials in a dynamic oral environment is an important criterion influencing its clinical longevity which still continues as an inherent challenge to the material. Although the quality of composite resin restorations has improved with the advent of new technologies in material science in recent years, discoloration of the composite resin materials remains to be the major long-term clinical problem. Furthermore, the assessment of color stability and discoloration is one of the commonly used outcome measurement tools that rate the success and failure of composite resin restorations in the clinical practice.
Discoloration of composite resin may occur due to several extrinsic and intrinsic factors. Extrinsic factors include adsorption and absorption of colorants from exogenous sources. The degree of color change due to exogenous sources can vary based on the presence of surface roughness, oral hygiene status, nutritional habits, smoking habits, and consumed beverages. Intrinsic discoloration may occur due to change in color of resin material itself such as change in resin matrix or at the matrix/filler interface, whereas chemical discoloration associated with alteration/oxidation of amine catalyst, polymeric matrix structure, or unreacted methacrylate group may occur due to incomplete polymerization.
A recent study suggested that the effects of intrinsic discoloration were less in completely polymerized composite resin materials as there were no perceptible color changes observed after water storage. Hence, the extrinsic discoloration is the most significant factor affecting the color stability and long-term success of composite resin restorations, which focuses the need for dental researchers and material scientists to improve the resistance to discoloration of new resin-based materials for esthetic restorations.
The etiology for discoloration of composites is multifactorial, of which proprietary mouthrinse is one of the causative factors. The low pH of the mouthrinse may influence the hardness, wear, and color stability of composites. Furthermore, the alcoholic ingredients are not the only factor causing softening of resin composites, but studies have revealed that color stability can be reduced by both alcohol-containing and alcohol-free mouthrinses. The emulsifiers and organic acids present in the mouthrinse may lead to surface degradation of the resin composite materials. Since color stability of composites is of major concern that could even be affected by nonalcohol-containing mouthrinse, this study was carried out to compare the effect of a nonalcohol-containing mouthrinse on the color stability of three different types of composites.
| Materials and Methods|| |
Materials used in this study are listed in [Table 1] and [Figure 1].
|Figure 1: Materials used in this study. (1) A nanofilled composite; Filtek K Z350XT (3M ESPE, St. Paul, MN, USA). (2) A microhybrid composite; Polofil Supra (Voco, GmbH, Germany). (3) A nanoceramic composite; Ceram.x Sphere TEC (Dentsply, Konstaz, Germany). (4) Chlorhexidine mouthrinse (Rexidin Plus, Aurangabad, India). (5) LEDition Polymerization Unit (Ivoclar Vivadent AG, Liechtenstein). (6) Composite filling instrument (GDC Composite Filling Instrument). (7) Blaze Aesthetic Polishing Kit (Medicept UK LTD). (8) Microglass slides and specimen preparation|
Click here to view
Thirty specimens of size 10-mm length, 1-mm width, and 1-mm thickness were prepared on a customized microglass slide (12 mm × 1 mm) from each of the composite material using composite filling instrument (GDC Composite Filling Instrument). Wax index of 1-mm thickness and 1-mm width was made on either side of the microglass slide for standardization. The thickness was confirmed using a vernier caliper. Another glass slide was placed on the top and gently pressed for 30 s to extrude the excess material and for achieving a smooth surface [Figure 1]. Each specimen was cured using LED light-curing unit (LEDition Polymerization Unit, Ivoclar Vivadent AG, Liechtenstein) for 20 s for two cycles with a light intensity of 600 mW/cm2 from the upper and lower surfaces of the specimens and then polished with Blaze Aesthetic Polishing Kit (Medicept UK Ltd) in three sequences from prepolishers to high-gloss polishers following the manufacturer's instruction.
The specimens were divided into three groups (n = 10).
- Group I – A nanofilled composite; Filtek Z350XT (3M ESPE, St. Paul, MN, USA)
- Group II – A microhybrid composite; Polofil Supra (Voco, GmbH, Germany)
- Group III – A nanoceramic composite; Ceram.x Sphere TEC (Dentsply, Konstaz, Germany).
All the prepared samples were immersed in 20 ml of distilled water in separate containers according to the group, respectively, followed by incubation at 37°C for 24 h. After 24 h, baseline color values of each sample were recorded using a spectrophotometer (V-770 UV-Visible/NIR Spectrophotometer, Easton, Maryland, USA) [Figure 2]. Colorimetric values of the specimens were determined using the L*a*b* system of the Commission Internationale de l'Eclairage (CIE L*a*b* Color Scale) [Table 2].
After baseline color measurements, ten randomly selected specimens from each group were immersed in 20 ml of 0.2% chlorhexidine mouthrinse (Rexidin Plus, Aurangabad, India) for 24 h. After 24 h, the specimens were washed with distilled water and then blot-dried before subjecting to spectrophotometric analysis. The postimmersion values were recorded for each sample using the same UV spectrophotometer. The measurement of the discoloration of composite was analyzed by the UV spectrophotometer. The formula used for calculating color differences in this system is as follows:
△E*ab = ([△L*]2+ [△a*]2+ [△b*]2)1/2
The data were collected, tabulated, and subjected to statistical analysis.
The main principle of spectrophotometry is that every substance absorbs or transmits certain wavelengths of radiant energy, but not other wavelengths. It measures the light absorption peak of the material subjected to the analysis. The wavelength of measurement spectrum used in this study was between 400 and 720 nm.
Color change between the groups was compared by performing one-way ANOVA. Multiple comparisons were made by Tukey's post hoc test [Table 3]. The data were analyzed using statistical software SPSS Version 16 (IBM Corp, Chicago, IL, USA).
| Results|| |
All samples displayed color changes after immersion, and there was a statistically significant difference observed between the mean color change values in three groups. Clinically acceptable value for color change in dental materials was presumed to be ΔE ≤3.3. Group III (Nanoceramic composite) had the highest color change (ΔE: 3.51 – clinically unacceptable) than the Group I (Nanofilled composite, ΔE: 3.16 – clinically acceptable) and Group II (Microhybrid composite, ΔE: 3.32 – clinically acceptable).
| Discussion|| |
The frequent reasons for replacement of tooth-colored restorative materials are staining and discoloration. Discoloration can occur due to intrinsic factors or extrinsic factors. Intrinsic discoloration may occur due to aging of material itself, such as alteration of the resin matrix and changes in the interface of matrix and fillers. Extrinsic discoloration may occur due to adsorption or absorption of colorants from exogenous sources such as coffee, tea, nicotine, beverages, and mouthrinses. This study evaluated the effect of mouthrinse on the color stability of three different types of composites as it is one of the most important factors, which threatens the color stability of esthetic restorations.
The color changes can be assessed using various instruments including spectrophotometer and colorimeter. In this study, spectrophotometers are used because they are considered to be more accurate in measuring color change than colorimeter. Spectrophotometers contain monochromators and photodiodes that measure the reflectance curve every 10 nm or less. The spectrophotometer used in this study (V-770 UV-Visible/NIR Spectrophotometer, Easton, Maryland, USA) has wavelength ranged from UV to NIR (190–2700 – option 3200 nm). The gratings and detectors' switchover can be set to change automatically between 800 and 900 nm. An advantage of the UV spectrophotometer is the fact that it can identify the exact levels of compounds within a particular spectrum sample. Each color and the saturation of the color are identifiable.
In this study, the color stabilities of three different composites immersed in chlorhexidine mouthrinse for 24 h were evaluated which are equivalent to 2 min of use daily for 2 years. Studies have revealed that chlorhexidine-containing mouthrinse having 0.2% of chlorhexidine gluconate could cause perceptible color change in composites (clinically acceptable value assumed to be ≤3.3).
The ability of chlorhexidine-containing mouthrinse solutions to change the color of restorative materials depends on the type of restorative materials, capability of resin matrix to absorb water, and type of filler and filler content in resin composites. The staining potential of composites can also be attributed to its surface structure. The rougher the surface, the higher the susceptibility of the material to extrinsic staining.
Resin composites absorb fluids that may cause discoloration. The amount of water absorption is related to the resin ingredient of composites and the quality of interaction between the resin and the filler. Excessive water absorption plasticizes the resin ingredients by hydrolyzation and by microcrack formation. Consequently, the interface between the matrix and fillers allows discoloration.
In the present study, Group I (Nanofilled composites) had the least color change (mean value: 3.16) than the other two groups. Nanofilled composites contain nanoparticles that can fill the gaps between large particles which result in lesser and smaller voids in resin composites. Due to small particle size of the filler, the surface area of the fillers has increased dramatically, and the interaction between the matrix and filler surface is also increased. Nanofilled composites also have higher resistance to water absorption and lesser filler matrix debonding. This could partly explain higher color stability nanofilled composites than other two types of composites tested in this study.
When the samples of Group II (Microhybrid composite) were immersed in chlorhexidine mouthrinse, the mean color change value was 3.32. Microhybrid composites contain filler particles with an average size of 0.01–0.04 μm which are larger than nanofillers (20 nm). Large filler particles are more susceptible to discoloration and water absorption than smaller filler particle, and the effect of coloring agents on the quality of the bond between the matrix and filler can cause discoloration. Water absorption may cause microcracks by expanding and laminating the resin component and hydrolyzing the silane and decrease the functional life of composite resins; thus, microcrack formation and interfacial gaps between the filler and matrix allow soluble coloring agents of mouthrinses to penetrate and cause discoloration. This reason could be attributed to the lesser color stability of microhybrid composites than nanofilled composites. These results were in accordance with those of Gürdal et al.
In the present study, of the three types of composites, Nanoceramic composite (Group III) had the highest color change (mean value: 3.51). The nanoceramic composites comprise organically modified ceramic nanoparticles and glass fillers and these nanoceramic particles and nanofillers have methacrylate group available for polymerization. The highest color change of nanoceramic composites can be related to structural difference. A study demonstrated that Ceram.x did not yield better surface quality than other nanofilled composites. This was explained by low volumetric filler content of material and porosities detected on Ceram.x specimens. Rough surface has been shown to mechanically retain stains more than smooth surface. Our findings are in accordance with those of Celik et al. and Jung et al.
However, in clinical conditions, saliva, salivary pellicle, foods, and beverages consumed may have additive/mitigating effects on the physical and esthetic properties of these groups of restorative materials. Further studies are, therefore, necessary to evaluate these parameters in vivo conditions, but routine in vitro testing of esthetic restoratives is recommended for new products. Instead of premature replacement of the restorations, routine use of whitening tooth paste, repolishing techniques, and bleaching procedures are viable ways to remove superficial stains of composite resin., Despite the findings about the role of various extrinsic and intrinsic substances on the discoloration of composite resins, studies on methods of stain removal have been limited.
| Conclusion|| |
With the limitations of the present experimental study and the parameters used, it can be concluded that:
- All the three types of composites tested in this in vitro study displayed color changes after immersion in mouthrinse, but the color shift depended on the material used
- Nanofilled composites had higher color stability than other two types of composites
- Resin formulation of composites including the filler has a direct impact on its susceptibility to stain by external agents, and the chlorhexidine mouthrinse can be considered as stainable solutions.
- Use of mouthrinse by patients should be subjected to dental supervision to control their adverse effects on the esthetic quality of restoration
- Patients should be warned to expect composite restorations to discolor if they regularly use mouthrinses which contain high concentration of chlorhexidine gluconate
- Knowing the composition of restorative material is important to select appropriate material for each clinical application and to use it in an effective way to promote its best properties.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Demirci M, Yildiz E, Uysal O. Comparative clinical evaluation of different treatment approaches using a microfilled resin composite and a compomer in class III cavities: Two-year results. Oper Dent 2008;33:7-14.
Al-Dharrab A. Effect of energy drinks on the color stability of nanofilled composite resin. J Contemp Dent Pract 2013;14:704-11.
Ren YF, Feng L, Serban D, Malmstrom HS. Effects of common beverage colorants on color stability of dental composite resins: The utility of a thermocycling stain challenge model in vitro
. J Dent 2012;40 Suppl 1:e48-56.
Baig AR, Shori DD, Shenoi PR, Ali SN, Shetti S, Godhane A, et al.
Mouthrinses affect color stability of composite. J Conserv Dent 2016;19:355-9.
] [Full text]
Gurgan S, Onen A, Koprulu H.In vitro
effects of alcoholcontaining and alcohol-free mouthrinses on microhardness of some restorative materials. J Oral Rehabil 1997;24:244-6.
El Embaby AS. The effects of mouth rinses on the color stability of resin-based restorative materials. J Esthet Restor Dent 2014;26:264-71.
Mjör IA, Moorhead JE, Dahl JE. Reasons for replacement of restorations in permanent teeth in general dental practice. Int Dent J 2000;50:361-6.
Abu-Bakr N, Han L, Okamoto A, Iwaku M. Color stability of compomer after immersion in various media. J Esthet Dent 2000;12:258-63.
Asmussen E. Softening of BISGMA-based polymers by ethanol and by organic acids of plaque. Scand J Dent Res 1984;92:257-61.
Chittem J, Sajjan GS, Varma Kanumuri M. Spectrophotometric evaluation of colour stability of nano hybrid composite resin in commonly used food colourants in Asian countries. J Clin Diagn Res 2017;11:ZC61-5.
Gupta G, Gupta T. Evaluation of the effect of various beverages and food material on the color stability of provisional materials – An in vitro
study. J Conserv Dent 2011;14:287-92.
] [Full text]
Al-Samadani KH. The effect of preventive agents (Mouthwashes/Gels) on the color stability of dental resin-based composite materials. Dent J (Basel) 2017;5. pii: E18.
Poggio P, Dagna A, Lombardini M, Chiesa M, Bianchi S. Staining of dental composite resins with chlorhexidine mouthwashes. Ann Stomatol 2009;58:62-7.
Bagheri R, Burrow MF, Tyas M. Influence of food-simulating solutions and surface finish on susceptibility to staining of aesthetic restorative materials. J Dent 2005;33:389-98.
Yua B, Lim HN, Lee YK. Influence of nano- and micro-filler proportions on the optical property stability of experimental dental resin composites. Mater Des 2010;31:4719-24.
Malekipour MR, Sharafi A, Kazemi S, Khazaei S, Shirani F. Comparison of color stability of a composite resin in different color media. Dent Res J (Isfahan) 2012;9:441-6.
Gürdal P, Akdeniz BG, Hakan Sen B. The effects of mouthrinses on microhardness and colour stability of aesthetic restorative materials. J Oral Rehabil 2002;29:895-901.
Celik C, Yuzugullu B, Erkut S, Yamanel K. Effects of mouth rinses on color stability of resin composites. Eur J Dent 2008;2:247-53.
Jung M, Sehr K, Klimek J. Surface texture of four nanofilled and one hybrid composite after finishing. Oper Dent 2007;32:45-52.
Hafez R, Ahmed D, Yousry M, El-Badrawy W, El-Mowafy O. Effect of in-office bleaching on color and surface roughness of composite restoratives. Eur J Dent 2010;4:118-27.
Anfe TE, Agra CM, Vieira GF. Evaluation of the possibility of removing staining by repolishing composite resins submitted to artificial aging. J Esthet Restor Dent 2011;23:260-7.
Dr. Narayanan Sriman
Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, SNR College Road, Nava India Bus Stop, Peelamedu, Coimbatore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]