Optical effect of resin cement, abutment material, and ceramic thickness on the final shade of CAD-CAM ceramic restorations

Abstract

Statement of problem: High-translucency ceramics can be influenced by the underlying structure, altering the restoration shade. How this affects color matching is unclear.

Purpose: The purpose of this in vitro study was to investigate the optical effects of cement shade, ceramic type, ceramic thickness, and abutment material on the final color of computer-aided design and computer-aided manufacturing (CAD-CAM) ceramic restorations.

Material and methods: Two shades of resin cement (yellow, translucent), 3 types of background (titanium, white zirconia, yellow zirconia), and 3 types of high-translucent ceramic (each type shade A1 and A3) were used in this study. For the experimental groups, a total of 72 ceramic specimens were produced across 4 groups based on ceramic thickness (1.0 mm, 1.5 mm, and 2.0 mm). For the control groups, each ceramic type and shade was prepared at a thickness of 4 mm. A total of 8 resin cement specimens were produced in 4 groups based on shade by using a plastic mold (12×12×0.2 mm). To demonstrate the effect of implant abutment materials, 3 types of background were fabricated with a thickness of 2 mm. For the experimental groups, 3 specimens (ceramic, cement, and background) were sequentially placed with glycerin in the center of each background specimen. Color measurements of the experimental groups were made with a spectrophotometer and recorded in the Commission Internationale de l'Eclairage Lab coordinate system. The color differences (ΔE) between experimental and control groups were then calculated. The Kruskal-Wallis test (α=.05) was used to analyze the multiple comparisons of ceramic thickness, ceramic type, and abutment material. The Mann-Whitney U test (α=.05) was used to analyze cement shade.

Results: Significant differences were found for different ceramic thicknesses, ceramics types, and abutment materials (P≤.001). A clinically acceptable shade (ΔE≤3) was found in 1.5- and 2.0-mm ceramics with the titanium and 2.0-mm ceramics with the yellow zirconia background. However, the color between the experimental group and the control group was similar when using the 2 cement shades (P>.05).

Conclusions: An increase in ceramic thickness could minimize alteration of the final shade. High-translucency ceramics, together with a resin cement, were able to successfully mask titanium with a ceramic thickness of at least 1.5 mm. However, only a ceramic with a thickness of 2.0 mm was able to mask the yellow zirconia background.