journal of dentistry 40s (2012) e47e54

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Effects of ageing and staining on color of acrylic resin

denture teeth
Wendy C. Gregorius a,*, Mathew T. Kattadiyil b, Charles J. Goodacre a,1,
Clyde L. Roggenkamp a, John M. Powers c, Rade D. Paravina d
a

Department of Restorative Dentistry, Loma Linda University School of Dentistry, 11092 Anderson Street, Loma Linda, California 92350,
United States
b
Advanced Specialty Education Program in Prosthodontics, Department of Restorative Dentistry, Loma Linda University School of Dentistry,
11092 Anderson Street, Loma Linda, California 92350, United States
c
Oral Biomaterials, Department of Restorative Dentistry and Prosthodontics, The University of Texas School of Dentistry at Houston,
7500 Cambridge Street, Houston, Texas 77054, United States
d
Houston Center for Biomaterials and Biomimetics, Department of Restorative Dentistry and Prosthodontics, The University of Texas School of
Dentistry at Houston, 7500 Cambridge Drive, Houston, Texas 77054, United States

article info

abstract

Article history:

Objectives: To assess the color stability of high-strength acrylic resin denture teeth after

Received 25 June 2012

exposure to red wine, coffee and artificial ageing.

Received in revised form

Methods: Four different shades of acrylic resin denture teeth were selected from three

9 September 2012

manufacturers. The teeth were evaluated in two phases: Phase I, upon staining for 7 days

Accepted 11 September 2012

in distilled water (control Group A), red wine (experimental Group B) and coffee (experimental Group C), and Phase II, upon artificial ageing in a Weather-Ometer for a total
exposure of 150 kJ/m2 (control Group A; Phase I). Denture tooth positioning jigs were

Keywords:

fabricated and color data recorded by means of an intra-oral spectrophotometer and

Staining

expressed using the Commission Internationale dEclairage (CIE) L*a*b* color notation

Ageing

system. Means and standard deviations were determined. The staining data were analysed

Color

by three-way ANOVA, while the artificial ageing data were analysed by two-way ANOVA.

Denture

Fishers PLSD intervals were calculated at a significance level of P  0.05.

Teeth

Results: In the staining experiment, the main effects of stains and denture teeth and the

Acrylic

two-way and three-way interactions among stains, denture teeth and shades were signifi-

Coffee

cant (P  0.05). The same was true for the main effects of denture teeth and shades and their

Red wine

interactions in the ageing experiment.

The smallest overall color change upon staining in red wine was recorded for Vita
Physiodens denture teeth (DE* = 0.9  0.4), followed by SR Vivodent PE 1.2 (0.6) and Portrait
IPN 2.4 (0.6). Corresponding values for staining in coffee were 2.0 (0.6), 1.7 (1.0) and 1.8 (0.8),
while ageing-dependent changes in color were 1.7 (0.4), 2.4 (0.8) and 1.1 (0.4) for Portrait IPN,
SR Vivodent PE and Vita Physiodens teeth, respectively.
Conclusion: Although the null hypothesis has been partially rejected, because some statistically significant changes in color and color coordinates occurred upon staining and ageing,

* Corresponding author. Tel.: +1 909 558 4640; fax: +1 909 558 0253.
E-mail address: wgregorius@llu.edu (W.C. Gregorius).
1

Office of the Dean, Department of Restorative Dentistry, Loma Linda University School of Dentistry, 11092 Anderson Street, Loma
Linda, California, 92350, United States.
0300-5712/$ see front matter # 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jdent.2012.09.009

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journal of dentistry 40s (2012) e47e54

all evaluated denture teeth exhibited good color stability compared to the 50:50% acceptability
threshold used in data interpretation.
Clinical significance: Selection of a color stable and stain-resistant denture tooth can contribute
to denture longevity and overall patient satisfaction.
# 2012 Elsevier Ltd. All rights reserved.

1.

Introduction

Manufacturers have been striving to improve the stain

resistance and mechanical properties of denture teeth for
decades. Dentsply Trubyte (York, PA) introduced denture teeth
to reduce the potential for discolorations and delamination
between layers caused by tooth wear or laboratory alterations in
the 1970s.1 The material reportedly was made of poly(methyl
methacrylate), or PMMA, with an inter-penetrating polymer
network (IPN) and a double cross-linked material layering. Ten
years later, denture teeth made of sustained life material (SLM)
that combined IPN technology with ultra-high molecular
weight polyethylene, which reportedly increased wear resistance by 25%, were introduced.1 Ivoclar Vivadent (Amherst, NY)
introduced denture teeth made of a synthetic polymer based on
PMMA with a double cross-linked (DCL) polymer and matrix,
which reportedly is solvent resistant (SR) and provides shade
stability and resistance to mechanical wear.2 Anterior teeth
with a pearly effect (PE) have a blue iridescence and reportedly
give a denture the vital appearance of healthy teeth.2 Vident, A
VITA Company (Brea, CA) distributes Vita Physiodens denture
teeth. Vita MRP (microfiller reinforced polyacrylic) material,
developed and used in the fabrication of Vita Physiodens, is
comprised of a triple cross-linked PMMA, a cross-linked
monomer, and inorganic microparticle filler that are polymerised into a polymer network. The manufacturer claims that
this tooth is a hard, homogenous structure that is abrasion and
craze resistant with a lifelike surface anatomy.3
In the United States, the population of 65 year olds and
older is increasing in number as the average life expectancy
increases. Currently, the annual estimate of resident population for both sexes over the age of 65 years is 38.8 million,
which is approaching 13% of the total population.4 In 2050, the
number of Americans aged 65 and older is projected to be 88.5
million, more than double its projected population of 40.2
million in 2010.4
The importance of stain and wear resistant denture teeth
becomes clear when considering the number of patients who
will need prosthodontic treatment. While there will be a
decrease in the percentage of the population that is completely edentulous, there will be a steady to increasing need for
complete dentures until 2020 due to patients living longer.5 A
surveillance study conducted by the National Health and
Nutrition Examination Survey, authorised by the Centres for
Disease Control, during the periods of 19881994 and 1999
2002, showed that edentulism was <1% among adults aged 20
39 years, 4.9% among those aged 4059 years, and 24.9%
among those aged >60 years. The mean number of teeth
present in the individuals surveyed was shown to correlate
inversely with age. Approximately 8% of adults >20 years were
completely edentulous.6

Many studies draw attention to the notion that the

psychological impact of aesthetic dentistry to patients is
positive.711 Studies also suggest that the ageing population
tend to focus on the whiteness and color of their teeth.12,13
Studies evaluating patient satisfaction with their dental
appearance and tooth color show different outcomes in terms
of age-related perceptions, but invariably agree with the
conclusion that aesthetics and tooth color remain important
to patients in all age groups. In a study to evaluate a range of
aesthetic factors, fifty-three percent of patients placed priority
on shade selection and teeth whitening.14 The results of
another study showed no difference in patient satisfaction
with tooth color based on age, moreover, tooth color was
found to be independent of age suggesting a broad-based
application of aesthetic dentistry.15
The importance of aesthetics in restorative dentistry is
linked to the selection of durable and color stable biomaterials.
With the introduction of a newer generation of denture teeth,
evaluation of the long-term effects of ageing and staining are
needed. Few reports in the literature have tested the color
stability and staining of acrylic resin denture teeth. They
maintain that high-strength acrylic resin denture teeth
remain susceptible to staining by pigments.1618 With an
increase in aesthetic demands and patient expectations of
removable prostheses, the resistance of denture teeth to color
changes plays a significant role in the selection of denture
teeth.
The ability of denture teeth to remain color stable through
wear and time is critical and a measure by which the longevity
and patient acceptance of a removable prosthesis may be
evaluated. The aetiology of artificial tooth discoloration is
multifactorial. Wear, lack of patient maintenance, the effect of
compositional characteristics, exposure to stains, and time
are factors that contribute to intrinsic and extrinsic staining.
While denture teeth have been modified to address some
of these factors, there is a need for research relating to the
various brands of artificial teeth and their color stability
compared to other restorative materials. Many studies have
investigated the effects of staining pigments on ceramics,
composite resins, provisional acrylic resins and denture
base materials. However, few studies have assessed the
extent to which reinforced acrylic resin denture teeth resist
color changes when aged and exposed to staining pigments.1618
The purpose of this study was to assess the color stability of
high-strength acrylic resin denture teeth from three manufacturers when compared to the control by evaluating in vitro
staining after exposure to red wine and coffee and artificial
ageing-dependent color changes. The null hypothesis was that
no significant color changes would occur upon staining and
ageing.

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journal of dentistry 40s (2012) e47e54

2.

Materials and methods

Maxillary right central incisor denture teeth in Vita shades

B1, A2, A3, and A4 were selected from three different
manufacturers: Portrait IPN (DENTSPLY Trubyte, York, PA),
SR Vivodent PE (Ivoclar Vivadent, Amherst, NY), and Vita
Physiodens (Vident, A VITA Company, Brea, CA) (Fig. 2). Using
manufacturer mould comparison charts, tooth moulds of
similar size and shape having a near-flat facial surface were
selected: 21J Portrait IPN, A17 SR Vivodent PE, and T9L VITA
Physiodens.
Five maxillary central incisor denture teeth in four shades
(n = 20) from each of the three manufacturers (n = 3  20 = 60)
were tested in a control group (Group A) and equal numbers
of teeth in two experimental groups (Groups B and C). Groups
AC represented Phase I. Group A teeth, serving as the
control, were tested in distilled water for 7 days. The teeth in
Group B were tested in red wine for 7 days separately from
Group C teeth, which were tested in coffee for 7 days. The red
wine and coffee solutions were replaced every 12 h during
the 7-day testing period. The total sample size of teeth for
Groups AC for Phase I were 180 denture teeth. Phase II
included only the teeth from the control Group A
(n = 3  20 = 60) and were subjected to artificial ageing in a
Weather-Ometer.
A positioning jig (Fig. 1) was made for each of the three
tooth moulds to consistently direct the placement of the 5 mm
diameter probe of the intra-oral spectrophotometer (VITA
Easyshade, Vident, A VITA Company, Brea, CA) against the
facial surface of each denture tooth for measurements. The
three jigs were made from acrylic blocks, which were milled so
that a concavity on one surface was larger in depth and
diameter than each acrylic resin denture tooth being measured. Four cylindrical indices were placed on the toothpositioning surface of the block and at the midpoint between
the four sides of the block and the central tooth concavity, for
repositioning of the top portion of the jig. Poly(vinyl siloxane)
(PVS) material was expressed into the concavity in the acrylic
block and one denture tooth was placed into the PVS material
during polymerisation, so that the near-flat facial surface of

the tooth was horizontal and facing upward with the ridge lap
portion of the tooth stabilised in PVS material within the
concavity. The facial portion of the tooth was elevated above
the block. An acrylic rod, measuring the same diameter as the
Easyshade measuring probe and 5 mm in height, was attached
to the central portion of the tooth surface, and PVS material
was expressed surrounding the acrylic rod, over exposed
portions of the tooth, along the surface of the block and into
the indices for a stable repositioning jig for the tooth and
Easyshade measuring probe. The two larger components of
the jig, PVS repositioning portion and acrylic block, were
detachable and replaceable, due to the repositioning indices,
which allowed each denture tooth from the same manufacturer to be placed within the jig and measured with
repeatability.
The color data were recorded by one operator. Color was
measured at baseline and after 7 days of total immersion in red
wine (2009 Robert Mondavi Cabernet Sauvignon) and coffee
(ground, drip brewed, caffeinated, dark roast, Starbucks Caffe`
Verona Bold) for Groups B and C (experimental groups, n = 10).
The color of teeth in Group A (control group, n = 5) also was
measured at baseline and after 7 days of total immersion in the
distilled water. As significant color changes of the control
group were not anticipated, in Phase II, the control group
teeth were used to evaluate color before (baseline) and
after artificial ageing by exposure to 150 kJ/m2 in a WeatherOmeter (Atlas Ci35A Xenon Weather-Ometer, Atlas Material
Testing Technology LLC, Chicago, IL, USA). A Weather-Ometer
is an artificial ageing machine, in which an object may be
exposed to light and darkness and intermittent exposure to
water spray that simulates direct exposure with additional
short wavelength energy.19 The denture teeth were exposed to
a controlled irradiance xenon arc filtered through borate
borosilicate glass. Color coordinates were determined by
one operator using the Easyshade intra-oral spectrophotometer and results expressed using Commission Internationale
dEclairage (CIE) L*a*b* color notation system (CIELAB). Color
differences (DE*) were determined using the following
equation20:
2 1=2

DE DL 2 Da 2 Db 

[(Fig._1)TD$IG]

Fig. 1 Custom positioning Jig: (A) view of the acrylic block with tooth positioned in the central concavity with top portion of
the jig and measuring probe; (B) view of the relationship between the four cylindrical indices of the acrylic block to the top
portion of the jig and probe; (C) assembled jig with measuring probe.

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journal of dentistry 40s (2012) e47e54

[(Fig._2)TD$IG]

intervals for comparison of means were calculated at the 0.05

level of significance.

Fig. 2 Denture teeth and Vita (or Vita equivalent) shades

B1, A2A4 from left to right: (A) Portrait IPN, shades B1, A2
A4; (B) SR Vivodent PE denture teeth shades 110/01, 130/
2A, 210/2B, 340/3E; (C) Vita Physiodens denture teeth
shades 1M1, A2A4.

where L* is lightness, a* is green-red coordinate, and b* is blueyellow coordinate. Chroma, C*, and hue angle, h8, were calculated from a* and b* coordinate values.
Previous visual judgement thresholds were used in the
interpretation of results. A DE* = 1.8 was considered as the
50:50% perceptibility threshold, while a DE* = 3.5 was considered to be a 50:50% acceptability threshold.21
Means and standard deviations for comparisons among
three stains, three denture teeth and four shades were
determined. The staining data were analysed by three-way
analysis of variance (ANOVA) with factors of denture tooth,
shade, and staining solution with interactions. The artificial
ageing data were analysed by two-way ANOVA with factors of
denture tooth and shade with interactions. Fishers PLSD

3.

Results

3.1.

Color difference

Since the mean color difference upon storage in distilled

water was below DE* = 1, it will not be listed by manufacturer
and for individual color coordinates. The mean color
differences upon staining in red wine were 2.4 (0.6), 1.2
(0.6) and 0.9 (0.4) for Portrait IPN, SR Vivodent PE and Vita
Physiodens teeth, respectively. Corresponding values for
staining in coffee were 2.0 (0.6), 1.7 (1.0) and 1.8 (0.8), while
ageing-dependent changes in color were 1.7 (0.4), 2.4 (0.8) and
1.1 (0.4) for Portrait IPN, SR Vivodent PE and Vita Physiodens
teeth, respectively (Table 1).
In the staining experiment, the main effects of stains and
denture teeth and the two-way interactions among teeth and
stain and three-way interactions among stains, denture teeth
and shades were significant at the 0.05 level. With SR Vivodent
PE and Vita Physiodens teeth, coffee caused larger changes in
DE* than distilled water and red wine. With Portrait IPN teeth,
both coffee and red wine caused larger changes in DE* than
distilled water.
In the ageing experiment, the main effects of denture teeth
and shades and their interactions were significant at the 0.05
level. Ageing caused the largest changes in DE* for SR Vivodent
PE teeth. In general, the less chromatic shades had larger
changes in DE*.

3.2.

Lightness difference

The mean lightness differences upon staining in red wine

were 1.8 (0.6), 0.5 (0.6) and 0.3 (0.3) for Portrait IPN, SR
Vivodent PE and Vita Physiodens teeth, respectively. Corresponding values for staining in coffee were 1.5 (0.8), 0.2 (0.6)
and 1.0 (0.6), while ageing-dependent changes in lightness

Table 1 Differences in color (DE*): staining (7 days minus baseline) and ageing (150 kJ/m2 minus baseline).
Denture teeth*

Shade

Portrait IPN (21J)

P11
P2
P3
P4

0.9
0.7
0.6
1.3

(0.3)
(0.3)
(0.2)
(0.8)

2.4
1.9
2.8
2.5

(0.8)
(0.2)
(0.6)
(0.7)

2.9
2.0
1.9
1.3

(0.8)
(0.8)
(0.4)
(0.4)

1.8
1.6
1.3
2.0

(0.4)
(0.1)
(0.3)
(0.7)

SR Vivodent PE (A17)

110
130
210
340

0.5
1.0
1.1
1.0

(0.3)
(0.5)
(1.2)
(0.4)

1.3
1.0
1.4
1.1

(0.9)
(0.2)
(0.5)
(0.7)

1.7
1.3
1.1
2.8

(0.8)
(0.7)
(0.7)
(1.4)

2.7
1.8
3.2
1.9

(0.4)
(0.8)
(1.3)
(0.5)

Vita Physiodens (T9L)

1M1
A2
A3
A4

0.9
0.7
0.5
0.6

(0.5)
(0.3)
(0.1)
(0.5)

0.7
1.1
0.8
0.8

(0.3)
(0.6)
(0.2)
(0.5)

2.0
1.5
1.9
1.8

(0.5)
(0.6)
(0.9)
(1.0)

1.9
1.1
0.6
0.8

(0.2)
(0.3)
(0.2)
(0.7)

Distilled water

Red wine

Coffee

A. ageingy

*
Fishers PLSD intervals at the 0.05 level of significance were 0.2, 0.2 and 0.3 for comparisons of DE* among three stains, three denture teeth
and four shades.
y
Fishers PLSD intervals at the 0.05 level of significance were 0.4 and 0.4 for comparisons of DE* among three denture teeth and four shades.

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journal of dentistry 40s (2012) e47e54

Table 2 Differences in lightness (DL*): staining (7 days minus baseline) and ageing (150 kJ/m2 minus baseline).
Denture teeth*

Shade

Portrait IPN (21J)

P11
P2
P3
P4

0.1
0.4
0.2
0.4

(0.7)
(0.2)
(0.3)
(0.1)

1.8
1.4
2.4
1.7

(0.7)
(0.2)
(0.5)
(0.6)

2.4
1.4
1.0
0.9

(0.6)
(0.6)
(0.6)
(0.5)

1.4
1.3
1.1
1.3

(0.4)
(0.3)
(0.3)
(0.4)

SR Vivodent PE (A17)

110
130
210
340

0.0
0.3
0.2
0.4

(0.5)
(0.3)
(0.2)
(0.2)

0.5
0.1
0.6
0.6

(0.9)
(0.6)
(0.3)
(0.4)

0.0
0.1
0.2
0.5

(0.6)
(0.7)
(0.5)
(0.5)

1.6
0.8
1.4
0.7

(0.3)
(0.8)
(0.4)
(0.2)

Vita Physiodens (T9L)

1M1
A2
A3
A4

0.8
0.2
0.1
0.0

(0.6)
(0.3)
(0.5)
(0.3)

0.3
0.4
0.3
0.2

(0.5)
(0.4)
(0.2)
(0.3)

0.7
1.2
1.2
1.1

(0.7)
(0.5)
(0.7)
(0.5)

1.5
0.5
0.3
0.2

(0.3)
(0.4)
(0.3)
(0.3)

Distilled water

Red wine

Coffee

A. ageingy

Fishers PLSD intervals at the 0.05 level of significance were 0.2, 0.2 and 0.2 for comparisons of DL* among three stains, three denture teeth
and four shades.
y
Fishers PLSD intervals at the 0.05 level of significance were 0.2 and 0.2 for comparisons of DL* among three denture teeth and four shades.

were 1.3 (0.4), 1.1 (0.5) and 0.6 (0.6) for Portrait IPN, SR
Vivodent PE and Vita Physiodens teeth, respectively (Table 2).
In the staining experiment, the main effects of stains and
denture teeth and the two- and three-way interactions among
stains, denture teeth and shades were significant at the 0.05
level. With Portrait IPN teeth, red wine and coffee caused
larger changes in DL* than distilled water. With Vita
Physiodens teeth, coffee caused larger changes in DL* than
distilled water and red wine.
In the ageing experiment, the main effects of denture teeth
and shades and their interactions were significant at the 0.05
level. Ageing caused larger changes in DL for Portrait IPN teeth.
In general, the less chromatic shades had larger changes in DL*.

3.3.

Chroma difference

The mean chroma differences upon staining in red wine were

1.2 (0.6), 0.1 (1.0) and 0.4 (0.7) for Portrait IPN, SR Vivodent PE
and Vita Physiodens teeth, respectively. Corresponding values
for staining in coffee were 1.2 (0.7), 1.0 (1.7) and 1.3 (0.8), while
ageing-dependent changes in chroma were 0.1 (1.0), 1.6

(1.1) and 0.3 (0.8) for Portrait IPN, SR Vivodent PE and Vita
Physiodens teeth, respectively (Table 3).
In the staining experiment, the main effects of stains and
denture teeth and the two- and three-way interactions among
stains, denture teeth and shades were significant at the 0.05
level. With Portrait IPN teeth, red wine caused large negative
changes in DC*, whereas coffee caused large positive increases
in DC*. With SR Vivodent PE and Vita Physiodens teeth, coffee
caused the most significant changes in DC* when compared to
red wine and the control.
In the ageing experiment, the main effects of denture teeth
were significant at the 0.05 level.
Ageing caused larger changes in DC* for Vita Physiodens
teeth. In general, the more chromatic shades had larger
changes in DC*.

3.4.

Hue difference

The mean hue differences upon staining in red wine were 2.1
(1.2), 0.7 (0.5) and 1.2 (1.2) for Portrait IPN, SR Vivodent PE
and Vita Physiodens teeth, respectively. Corresponding values

Table 3 Differences in chroma (DC*): staining (7 days minus baseline) and ageing (150 kJ/m2 minus baseline).
Denture teeth*

Shade

Portrait IPN (21J)

P11
P2
P3
P4

0.6
0.5
0.4
1.1

(0.4)
(0.4)
(0.3)
(0.9)

1.0
0.9
1.3
1.5

(0.5)
(0.6)
(0.4)
(0.9)

1.6
1.2
1.5
0.6

(0.6)
(0.9)
(0.4)
(0.8)

0.6
0.4
0.0
1.3

(0.7)
(0.5)
(0.6)
(0.8)

SR Vivodent PE (A17)

110
130
210
340

0.1
0.3
0.8
0.5

(0.4)
(1.1)
(1.5)
(0.9)

0.4
0.2
0.6
0.7

(1.2)
(0.7)
(1.2)
(0.8)

1.0
1.3
0.8
2.7

(1.6)
(0.6)
(1.0)
(1.4)

1.8
0.9
2.2
1.3

(0.5)
(1.1)
(1.7)
(0.7)

Vita Physiodens (T9L)

1M1
A2
A3
A4

0.2
0.3
0.2
0.4

(0.3)
(0.6)
(0.3)
(0.6)

0.1
0.7
0.6
0.5

(0.3)
(1.0)
(0.3)
(0.7)

2.0
0.8
1.3
1.3

(0.5)
(0.6)
(0.7)
(1.1)

0.9
0.7
0.1
0.3

(0.3)
(0.6)
(0.4)
(0.9)

Distilled water

Red wine

Coffee

A. ageingy

Fishers PLSD intervals at the 0.05 level of significance were 0.3, 0.3 and 0.3 for comparisons of DC* among three stains, three denture teeth
and four shades.
y
Fishers PLSD intervals at the 0.05 level of significance were 0.5 and 0.6 for comparisons of DC* among three denture teeth and four shades.

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journal of dentistry 40s (2012) e47e54

Table 4 Differences in hue (Dh8): staining (7 days minus baseline) and ageing (150 kJ/m2 minus baseline).
Denture teeth*

Shade

Portrait IPN (21J)

P11
P2
P3
P4

0.3
0.3
0.2
0.2

(0.2)
(0.2)
(0.1)
(0.2)

3.8
1.9
1.5
1.3

(1.2)
(0.7)
(0.4)
(0.3)

1.0
0.7
0.6
0.4

(0.5)
(0.3)
(0.1)
(0.2)

2.7
2.1
1.4
1.3

(0.4)
(0.3)
(0.3)
(0.4)

SR Vivodent PE (A17)

110
130
210
340

0.3
0.0
0.0
0.1

(0.3)
(0.3)
(0.3)
(0.3)

0.4
1.0
0.9
0.5

(0.8)
(0.4)
(0.4)
(0.2)

0.5
0.5
0.5
0.5

(0.4)
(0.4)
(0.2)
(0.4)

4.0
2.9
2.9
2.0

(0.4)
(0.5)
(0.7)
(0.2)

Vita Physiodens (T9L)

1M1
A2
A3
A4

0.4
0.3
0.2
0.2

(0.3)
(0.2)
(0.1)
(0.1)

3.1
0.5
0.5
0.5

(0.9)
(0.3)
(0.1)
(0.2)

1.1
0.9
0.9
0.5

(0.4)
(0.2)
(0.4)
(0.2)

2.8
1.0
0.8
0.8

(0.3)
(0.2)
(0.2)
(0.2)

Distilled water

Red wine

Coffee

A. ageingy

Fishers PLSD intervals at the 0.05 level of significance were 0.2, 0.2 and 0.2 for comparisons of Dh8 among three stains, three denture teeth
and four shades.
y
Fishers PLSD intervals at the 0.05 level of significance were 0.2 and 0.3 for comparisons of Dh8 among three denture teeth and four shades.

for staining in coffee were 0.7 (0.3), 0.3 (0.6) and 0.9 (0.4),
while ageing-dependent changes in hue were 1.9 (0.7), 3.0 (0.9)
and 1.3 (0.9) for Portrait IPN, SR Vivodent PE and Vita
Physiodens teeth, respectively (Table 4).
In the staining experiment, the main effects of stains,
denture teeth and shades and the two-way and three-way
interactions among stains, denture teeth and shades were
significant at the 0.05 level. With Portrait IPN teeth, red wine
caused the largest changes in Dh8 with higher changes with
lighter shades (higher values). With Vita Physiodens teeth,
coffee caused larger changes in Dh8 than distilled water and
red wine.
In the ageing experiment, the main effects of denture teeth
and denture teeth and shade interactions were significant at
the 0.05 level. Ageing caused larger changes in Dh8 for SR
Vivodent PE teeth. In general, the less chromatic shades had
larger changes in Dh8.

4.

Discussion

The null hypothesis has been partially rejected, because some

statistically significant changes in color and color coordinates
occurred upon staining and ageing. However, all staining and
ageing dependent differences in color were below the 50:50%
acceptability threshold of DE* = 3.5, thus indicating satisfactory
color stability of evaluated denture teeth.
A method for measuring color differences was employed
using an intra-oral spectrophotometer and custom repositioning jig (Fig. 1) for repeatability of the probe in relationship to
the denture tooth surface. The custom positioning device
fabricated in this study was a modified version based on a jig
that was first introduced in an in vivo study in 2009. This
method addressed the problem of controlling probe angulation and repositioning against a tooth.22
The changes in color and color coordinates likely would
have been greater if the teeth had been immersed in staining
solution for more than 7 days and aged for more than 150 kJ/
m2. However, a 7-day staining period was chosen based on the
assumption that exposure to coffee and red wine is on average
510 min a day. The 7-day exposure to a single solution,

therefore, corresponds to 3467 months of its consumption of

staining.
When it comes to ageing, it has been reported that it is more
appropriate to express ageing in kJ/m2 than in lighting hours.23
However, it is more complex to determine the real-life
equivalent to the artificial ageing exposure utilised in this
study than in the case of staining. Also, one has to be aware of
the potential simultaneous effects of staining, ageing, oral
hygiene, and other habits in the patients lifestyle.
Recent evaluation of visual judgments of dental ceramics,21
used in result interpretation in this study, found that a 50:50%
CIELAB perceptibility threshold (DE* = 1.8) was statistically
different than corresponding 50:50% acceptability threshold
(DE* = 3.5). Another study reported significant differences in
50:50% acceptability thresholds for lightness, chroma and hue
differences for dental ceramics.24 Frequently referenced
earlier findings reported a DE* = 1.0 as the 50:50% perceptibility
threshold,25 whereas DE* = 2.726 and 3.327 were reported as the
50:50% perceptibility thresholds. The only study on visual
judgments performed on denture teeth reported DE* = 2.6 and
as the 50:50% perceptibility and DE* = 5.5 as the 50:50%
acceptability threshold.28 Significantly higher thresholds
compared to previous studies might have occurred due to
difference in areas compared visually and instrumentally,
sub-optimal color matching conditions and a freestyle
shade matching method.29
In this study, all mean color differences by manufacturer
were below the 50:50% acceptability threshold of DE* = 3.5.
Actually, the color differences were above the 50:50%
perceptibility threshold only for Portrait IPN and SR Vivodent
PE denture teeth upon ageing. Color differences for Vita
Physiodens teeth upon staining in red wine and coffee, and
ageing were at or below the 50:50% perceptibility threshold.
Color changes by shade and differences in color coordinates
(Tables 14) can be easily interpreted using the threshold
values. Basically, all evaluated products and shades exhibited
good color stability and can be presented in the following
decreasing order: Vita Physiodens (most stable) > SR Vivodent
PE > Portrait IPN.
High-strength plastic denture teeth maintain resistance to
discoloration by pigments when compared to conventional

journal of dentistry 40s (2012) e47e54

denture teeth. The color stability was evaluated for two types
of high-strength plastic teeth and compared to two types of
conventional plastic teeth and one type of porcelain tooth in a
study that used food dye, coffee, and turmeric as coloring
liquids. High-strength denture teeth were significantly more
susceptible to pigments than porcelain teeth. The turmeric
coloring liquid had the greatest staining potential for all five
denture teeth, and color changes over time were significant.16
The high-strength plastic denture teeth used in this study
were susceptible to time-dependent color changes from coffee
and red wine that were found to be significant and clinically
perceptible.
Another study reported on color changes of three types of
reinforced acrylic denture teeth, and two types of porcelain
teeth after exposure to coffee, tea, and cola with distilled water
as the control. The research concluded that coffee was the
most chromogenic staining solution and discoloration was
time dependent.18 The present study confirms these findings,
as denture teeth became yellower and more chromatic due to
the effects of coffee.
The type of denture tooth, extrinsic staining, oral hygiene,
and diet affect the clinical discoloration of denture teeth. In a
study testing the discoloration of two types of porcelain,
conventional acrylic and reinforced acrylic denture teeth,
color evaluation for each group of teeth was done after
suspension in distilled water and immersion into solutions
of filtered coffee, tea, and cola. The greatest staining effect
for reinforced acrylic and conventional acrylic denture
teeth was seen with filtered coffee. However, cola had the
highest discoloration value for conventional acrylic denture
teeth.17
Microhybrid composite restorative materials exhibited less
pronounced color changes than nanohybrid composites when
exposed to discoloration media. Surface roughness, surface
integrity, and polishing technique affect stainability. The
superficial layer of composite resins adsorbs staining agents
leading to discoloration of composite resin restorations. A
study evaluated the discoloration of two nanohybrids, two
microhybrids, and a posterior composite resin material after
exposure to tea, cola, coffee, red wine, and water. Evaluation of
color was measured before and after immersion in each. A
significant change in color was found, and red wine held the
highest value for color change. The study concluded that all
composite restorations underwent clinically unacceptable
color changes, but that triethyleneglycol-dimethacrylate
(TEGDMA) may be responsible for high discoloration rates
due to its hydrophilic nature.30
A study to assess discoloration of acrylic resin denture
teeth following thermal cycling and polymerisation methods
was done using different denture teeth manufacturers. The
teeth were subjected to simulated microwave polymerisation
and simulated conventional polymerisation in a water bath
followed by thermal cycling in a simulation machine.
Significant color differences were found between Biotone
IPN and SR Vivodent PE teeth irrespective of the method of
polymerisation. However, DE* values were <3.5 overall and,
therefore, no clinically significant color changes were found.
No significant differences were found between color changes
following microwave polymerisation and conventional polymerisation.31

e53

Cross-linking agents and fillers are added to acrylic teeth

to provide discoloration resistance, improve strength and
prevent crazing, and to increase resistance to wear.32 When
four experimental composite resin teeth were fabricated with
three types of fillers, it is interesting to note that color stability
was not influenced by the presence of a polished tooth
surface. Filler exposure and not surface roughness was
considered to be due to the effects of polishing. The study
showed that discoloration occurs in the matrix resin, filler,
and at the interface. Silanisation of the filler prevented gaps
that could form at the interface due to matrix resin swelling
by water uptake. Polishing was not a strong factor in
discoloration, if the surfaces were polished and the fillers
were silanised.33

5.

Conclusions

Although the null hypothesis has been partially rejected,

because some statistically significant changes in color and
color coordinates occurred upon staining and ageing, all
evaluated denture teeth exhibited good color stability compared to the 50:50% acceptability threshold used in data
interpretation.
The smallest overall color shift upon staining and ageing
was recorded for Vita Physiodens (most color stable), followed
by SR Vivodent PE and Portrait IPN denture teeth. The most
pronounced changes in lightness, chroma and hue were
recorded for Portrait IPN, Vita Physiodens and SR Vivodent PE
denture teeth, respectively. In general, the denture teeth
became darker, more chromatic, and redder, due to the effects
of red wine and coffee, but with varied degrees of staining
amongst them.

Conflict of interest statement

Dr. Paravina is a paid consultant for Vita Zahnfabrik. He
participates or has participated in projects funded by
Dentsply, Ivoclar Vivadent and Vita Zahnfabrik; however, no
significant financial contributions or funding to this work were
made by these manufacturers.

Acknowledgments
The authors thank Dr. W. Patrick Naylor, scientific advisor;
Dr. Judith M. Strutz and Dr. Warren S. Yow, critical reviewers;
Dr. Udochukwu E. Oyoyo, assistance with data analysis; Dr. R.
Steven Kurti, Mr. Miroljub Ilich, Mr. Ronald D. Moran, and Mr.
Daryl L. Osborne, technical advisors. Denture teeth for the
study were donated by Ivoclar Vivadent, Amherst, NY, Vident,
A Vita Company, Brea, CA and Dentsply Trubyte, York, PA.

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e54

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