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Introduction
Of all artificial teeth, those made from either methacrylate resin based or porcelain have the best esthetics.1
However, the colour stability of methacrylate resin and
porcelain is crucial for maintaining their dental
esthetics.2 The degree of discolouration of artificial teeth
can be affected by a number of intrinsic and extrinsic
factors that include incomplete polymerisation, water
sorption, diet, oral hygiene and photo-oxidation.3,4 The
intrinsic factors are related to the chemical stability and
oxidation of polymer matrices of the material, and causes
of discolouration include accelerated aging, water effects,
ultraviolet irradiation from sunlight, temperature and
environmental humidity.46
The extrinsic factors include diet, oral hygiene and the
adsorption of colourants in beverages.3,7 Beverages,
such as coffee, tea and cola, coloured dental irrigants,
such as chlorhexidine, and nicotine are known to cause
discolouration of oral tissues and dental materials, and
among these, coffee, tea and cola cause the greatest
degree of discolouration.711 Additionally, the degree
of discolouration of artificial teeth that is caused by
coloured dental irrigants is reported to be substantially
greater than that caused by ultraviolet radiation alone.6
Acrylic resin teeth have several advantages over porcelain teeth: they weigh less, are less likely to fracture,
and the quality of the bond between the tooth and the
base is better.12 However, they are inferior to porcelain
teeth in maintaining an acceptable esthetic appearance
because they become discoloured more rapidly, and do
not wear well. As a result, their durability and service life
is shorter than those of porcelain teeth.2 Although
porcelain teeth are superior to resin based teeth because
of their better wear resistance properties and esthetic
appearance, porcelain teeth can become discoloured
because of progressive adsorption of colourants on the
porcelain surface and infrequent cleaning.1,2,13
The reflective colours of surfaces can be measured by
tristimulus colour analysers, such as a spectrophotometer
or a colourimeter14,15 using the CIELAB Colour CIE
L*a*b* system which was developed by the Commission
Internationale de lEclairage (CIE).16,17 In this system,
colour perception is designed to approximate human
vision, and changes in colour are reported in three spatial
coordinates, L*, a* and b*, where L* represents the
brightness (value) of a shade, a* represents the amount of
red-green colour and b* represents the amount of yellowblue colour. Using this information, colour differences
for each spatial coordinate can be measured in order to
calculate the overall colour difference DE.
When a material is completely colour stabile, no
colour difference will be detected after exposure of a test
material to the test environment (DE50). Although
different thresholds values of colour difference above
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Table 1 Types of porcelain and acrylic teeth that were used in this study
Type of
material
Porcelain
Acrylic
Trade name
Manufacturer
Shade and
form
Code
Real
Porcelain Teeth
Vacuum
Natura Vacuum
Major Dent
Midway
Acry Rock
A1, 113
2, 341
R
PT
Zahnfabrik Bad Nauheim, GmbH & Co. Luxor KG, Frankfurt, Germany
Major Prodotti Dentari S.p.A., Moncalieri, Italy
Zahnfabrik Bad Nauheim, GmbH & Co. Luxor KG, Frankfurt, Germany
Dental Manufacturing S.p.A., Via Ca` Mignola Nuova (Ro), Italy
36, 275
1F, 33/A
A1, P2
A1, K10
N
MD
M
AR
Colour measurements
The colour of each tooth was measured before immersion
in each solution by the CIE L*a*b* system using
a colourimeter (Shade Eye NCC; Shofu Dental
Corporation, Kyoto, Japan).25 Before each measurement,
the colourimeter was calibrated according to the manufacturers recommendations. Each measurement session
comprised three colour measurements that were taken
from the central region of the cervical area of each tooth
(24 mm from the gingival region). The mean values of
the L*, a* and b* measurements were then calculated, and
were used as the baseline measurements. After completing
the baseline colour measurements, the teeth were then
immersed in 300 mL of various immersion solutions (see
later for their preparation) in capped flasks that were
maintained in a temperature controlled water bath (type:
SB1X; Grant Instruments Ltd, Cambridge, England) at
371uC.
The colour measurements for each tooth were repeated
after 1 day, 1 week, 2 weeks and 4 weeks of immersion in
the coloured and control solutions. For these repeated
colour measurements, each tooth was rinsed in distilled
water for 5 min, and then blotted dry with tissue paper
before the colour measurement. Colour was then measured
three times in each tooth in the identical manner that was
described for the baseline colour measurement.
The mean values of the L*, a* and b* measurements
were calculated, and were then used as to calculate the
colour difference DE* from the baseline measurement
for each tooth at each of the four different immersion
times using the formula
1=2
DE ~ (DL )2 z(Da )2 z(Db )2
where DE is the colour change in all dimensions (L*a*b*),
and DL*, Da* and Db* are the colour changes in each
spatial coordinate.17 In order to relate DE* to the clinical
environment, the data were converted to National Bureau
of Standards (NBS) units1,2 using the equation
NBS units~DE |0:92
where the specific colour differences are expressed in
terms of NBS units (Table 2).
Statistical analysis
Repeated measures analyses of variance (ANOVA), with
two between unit factors (material and solution) and one
within unit factor (immersion time) in order to identify
Table 2 Critical remarks of colour differences using NBC
grading system
Critical remarks of colour differences
NBS unit
Trace
Slight
Noticeable
Appreciable
Much
Very much
00.5
0.51.5
1.53.0
3.06.0
6.012.0
12.0z
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1 day
1 week
Tooth
code DE
R
PT
N
MD
M
AR
R
PT
N
MD
M
AR
R
PT
2 weeks N
MD
M
AR
R
PT
4 weeks N
MD
M
AR
DL*
Da*
Db*
0.633
0.350
0.000 20.125
1.573
0.950 20.025 21.100
0.891
0.850
0.050
0.150
0.907
0.200
0.050 20.625
1.187
0.900 20.200
0.000
0.641
0.450
0.000 20.325
1.025 20.050
0.375
1.408
2.435
0.150
0.275 20.550
0.679
0.350
0.150
0.125
0.966 20.075
0.250 20.800
0.776
0.400 20.100 20.600
0.675
0.025
0.175 20.625
.
.
1 719
1 350
0.150
0.150
3.028
0.325
0.000
0.000
0.275
0.100
0.100
1.062
3.237
1.075 20.200 20.200
0.955
0.250
0.150
0.150
1.102
0.675
0.325
0.325
1.289
1.175
0.025 20.350
2.482
0.875
0.050 22.425
0.615
0.275
0.150
0.250
3.505
1.200 20.425 22.625
2.250 20.400 21.925
3.163
3.252
1.125
0.000 23.075
NBC
units
0.582
1.447
0.819
0.834
1.092
0.589
1.295
2.240
0.625
0.889
0.714
0.621
1.295
2.240
0.625
0.889
0.714
0.621
1.186
2.283
0.566
3.225
2.910
2.991
1 day
1 week
Tooth
code DE
R
PT
N
MD
M
AR
R
PT
N
MD
M
AR
R
PT
2 weeks N
MD
M
AR
R
PT
4 weeks N
MD
M
AR
DL*
Da*
NBC
units
Db*
0.984
0.775 20.050
0.300
0.847
0.575 20.150
0.025
0.581
0.350 20.100 20.050
1.439
1.000
0.000 20.150
0.915
0.750
0.000 20.225
1.281
1.075
0.175 20.500
1.299
1.225 20.125
0.100
0.776
0.675 20.025
0.125
0.568 20.025
0.075
0.025
1.100
0.050
0.200 20.900
1.234
1.125
0.000 20.150
1.842
0.775
0.025 21.075
1.238
1.125
0.175
0.350
0.998
0.825
0.100 20.250
0.573
0.025
0.150
0.125
1.426
0.475
0.250 21.250
1.453
0.825
0.175 21.025
2.661
1.375
0.175 22.225
1.792
1.650
0.075
0.450
1.135
0.850 20.075 20.525
0.805 20.250
0.000
0.025
1.964
0.950
0.075 21.700
2.256
1.225 20.200 21.850
2.489
1.350
0.250 21.925
0.905
0.780
0.534
1.324
0.842
1.179
1.195
0.714
0.523
1.012
1.135
1.695
1.139
0.918
0.527
1.312
1.337
2.448
1.648
1.045
0.740
1.807
2.075
2.290
1 day
Results
The colour differences of porcelain and acrylic teeth
after their immersion in the four solutions for 1 day,
1 week, 2 weeks and 4 weeks are summarised in
Tables 36. There were statistically significant interactions (P,0?001) between tooth type, solution type and
the duration of the immersion. Of the three coloured
solutions, tea was found to be more chromogenic than
either filtered coffee or cola whose chromogenic effects
were not significantly different from each other.
Immersion in distilled water for 4 weeks did not cause
any discolouration to the porcelain and acrylic teeth.
When the NBS grading system was used to assess
colour change, it was found that tea caused a perceivable colour difference in the Porcelain Teeth
Vacuum porcelain teeth and the Midway and Acry
Rock acrylic teeth, and a marked colour difference in
the Major Dent acrylic teeth after immersion for
4 weeks (Table 4). Filtered coffee caused perceivable
1 week
Tooth
code DE
R
PT
N
MD
M
AR
R
PT
N
MD
M
AR
R
PT
2 weeks N
MD
M
AR
R
PT
4 weeks N
MD
M
AR
1.066
1.805
0.683
0.645
1.117
0.593
1.291
0.754
1.517
1.213
1.424
0.717
2.174
0.770
1.162
1.019
1.132
0.882
0.789
1.024
1.315
1.266
1.190
0.746
DL*
Da*
NBC
units
Db*
0.850
0.125
0.500
1.475 20.075 20.525
0.225
0.075
0.000
0.300
0.275
0.100
0.475 20.100 20.100
20.150
0.150 20.350
.
0 750
0.075
0.950
0.325
0.000 20.175
20.675
0.125
0.350
20.725
0.250 20.200
0.750
0.400
0.825
20.150
0.200
0.250
1.350
0.100
1.500
0.350
0.175
0.075
0.350
0.475
20.700
20.675
0.400
0.125
0.100
0.325
0.625
20.175
0.100
0.075
20.050
0.325
0.650
0.600
0.275
0.300
0.400
0.325
0.625
0.225
0.475
0.400
20.175
0.225
0.250
20.150
0.325
0.175
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0.980
1.661
0.628
0.593
1.028
0.545
1.188
0.693
1.395
1.116
1.310
0.660
2.000
0.708
1.069
0.937
1.041
0.812
0.726
0.942
1.210
1.165
1.095
0.686
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1 day
1 week
Tooth
code DE
R
PT
N
MD
M
AR
R
PT
N
MD
M
AR
R
PT
2 weeks N
MD
M
AR
R
PT
4 weeks N
MD
M
AR
0.265
0.192
0.162
0.159
0.187
0.157
0.305
0.222
0.258
0.182
0.194
0.211
0.575
0.251
0.275
0.210
0.234
0.226
0.315
0.257
0.287
0.237
0.249
0.236
DL*
Da*
Db*
0.925
0.125
0.425
20.275
0.175 20.175
0.275 20.025
0.050
20.300
0.125 20.025
20.675 20.050
0.050
20.050
0.125
0.075
1.175
0.300
0.950
0.350
0.250
0.725
0.750
0.150
0.775
20.425
0.500
0.550
0.125
0.100
0.875
20.075
0.250
0.575
0.825
0.550
1.250
20.500
0.475
0.600
20.075
0.550
0.700
20.675
0.650
0.750
21.375
0.475
0.900
20.500
0.500
0.775
0.675
0.500
1.550
20.475
0.475
0.750
20.575
0.400
0.650
20.600
0.725
0.825
21.100
0.275
0.575
20.700
0.400
0.600
NBC
units
0.243
0.176
0.149
0.146
0.172
0.145
0.281
0.204
0.237
0.168
0.178
0.195
0.529
0.231
0.253
0.193
0.215
0.208
0.290
0.237
0.264
0.218
0.229
0.217
Discussion
In the present study, it was found that the tea caused
more discolouration to artificial teeth than either filtered
coffee or cola, and the degree of discolouration increased with immersion time. In addition, it was found
that porcelain teeth were more resistant to discolouration than acrylic teeth.
Although instruments, such as spectrophotometers
and colourimeters, and visual assessments can be used to
PT
D* S
DW a
Cola a,
b
Tea a,
b
FC b
N
D* S
MD
D* S
DW a
Cola a
DW
Tea
a
a,
b
b
FC
FC
Tea
Cola c
M
D* S
AR
D* S
D*
DW a
Cola a,
b
FC b
DW a
Cola a
DW a
Cola a
FC
FC
Tea
Tea
Tea
measure the extent of discolouration of dental materials,2 instrumental measurements are preferred because
the measurements are not compromised by the subjective interpretation of visual assessments.7,26 When
these instruments use the CIELAB Colour CIE L*a*b*
system to measure colour, they report colour changes in
three spatial coordinates in order to calculate DE.16 The
authors used such a system to measure the colour
difference DE after immersing artificial teeth in filtered
coffee, tea and cola. Additionally, the NBS developed a
clinical classification system for comparing colour
differences in dental materials using NBS units.24 In
this measuring system, an observer can report on his/her
perception of the colour change.27
In this study, the authors used the CIELAB Colour
CIE L*a*b* and NBS systems to assess colour
differences of artificial teeth after their immersion in
tea, filtered coffee and cola. It was found that the highest
NBS unit value was 3?2, a value which describes the
colour change as a marked change according to the
NBS system. Using the CIELAB Colour CIE L*a*b*
system, it was found that the highest DE value was 3?5,
and this value is lower than the acceptable upper DE
limit of 3?7 when using this system.14,19,20,23
Mutlu-Sagesen et al.1 commented that it is difficult to
create an in vitro experimental environment in order to
mimic the in vivo oral environment. The aim of our
study was to assess the effect of three different staining
solutions on the degree of discolouration of artificial
teeth for 4 weeks in a simulated in vivo oral environment.
For this purpose, the immersion solutions were maintained at a constant temperature of 37uC and these
experimental conditions have been used by other
investigators.13,9,10,2830 The duration of the immersion
Table 7 Comparison of colour change in each type of articial teeth after 4 week immersion in each solution
Tea
Filtered coffee
Cola
Distilled water
Tooth code
D*
Tooth code
D*
Tooth code
D*
Tooth code
D*
N
R
PT
M
AR
MD
a
a, b
a, b, c
b, c
c
c
N
PT
R
MD
M
AR
a
a, b
a, b, c
b, c
b, c
c
AR
R
PT
M
MD
N
a
a
a
a
a
a
AR
MD
M
PT
N
R
a
a
a
a
a
a
D: differences according to the results of the Tukey honestly significant difference (HSD) multiple comparison test.
*Different letters indicate dissimilarity of the groups (P,0?05).
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Conclusions
Within the limitations of the authors in vitro study, the
authors concluded that:
Acknowledgement
This research is supported financially by the Department
of Scientific Research Projects of Ataturk University
(Project No. 2003/158).
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