Shigemi Ishikawa-Nagai

Clinical performance of a newly developed spectrophotometric system on tooth color reproduction

STATEMENT OF PROBLEM Matching a natural maxillary central incisor to a metal ceramic crown is one of the most difficult challenges in clinical dentistry due to the limitations of dental shade guides and the subjectivity of perceptual evaluation. PURPOSE The purpose of this study was to assess the clinical effectiveness of a spectrophotometric shade-matching system on tooth color reproduction. MATERIAL AND METHODS Two metal ceramic crowns were fabricated for a maxillary central incisor for 36 patients using 2 shade-matching techniques. The first technique was conventional visual matching using 3 shade guide systems, and the second was an instrument-based color-matching technique using a new spectrophotometric system. Color difference (DeltaE) values between the contralateral natural tooth and each of the 2 crowns were calculated in the cervical, middle, and incisal regions. The DeltaE values were compared using a Students t test (alpha=.05). Three calibrated examiners evaluated the color match by ranking it from 1 to 10 (10 = perfect match; 1 = no match; < or =8, accepted; > or =7, rejected). McNemars test was used to calculate the odds ratio of accepting restorations fabricated using a spectrophotometric system to conventional methods. RESULTS Results revealed that the mean DeltaE values of crowns matched with the spectrophotometer were significantly lower than those using a conventional technique (P<.001). The odds ratio of 12.5 was calculated, indicating that conventionally matched crowns were more likely to be rejected than those matched using the spectrophotometer (P<.001). CONCLUSIONS In this clinical study, crowns fabricated using a dedicated spectrophotometer had a significantly better color match and a lower rate of rejection due to shade mismatch compared to crowns fabricated with a conventional shade-matching method.

The optical effect of composite luting cement on all ceramic crowns.

PURPOSE To investigate the optical properties of resin-based composite cements and assess their effects on the color of all ceramic crowns. MATERIAL AND METHODS Optical properties of three cements (Variolink II, Esthetic, Nexus II) were analyzed using disk samples (100 microm and 1.0 mm diameter) based on CIELAB color coordinates L*a*b*C* and opacity index. Empress (Ivoclar) and Katana (Noritake) crowns were filled with four different shades of die material (IPS die material ST3, ST5, ST9 and Tetric Evo Ceram Bleach XL). The shade of the crowns was measured with each of three shades of composite cement (Chroma, Bleach and Opaque, Esthetic cement). ST3 and glycerin served as the control. Color differences were calculated in incisal, body and cervical regions. RESULTS In the cervical and body regions, the color change caused by the bleach abutment could not be altered by using different colored cements for the Empress and Katana crowns. In the cervical region, the color changes effected by the dark brown abutment could be reversed with the bleach luting cement; in the body region this was true only for the Empress crown. Neither different abutment colors nor different luting cement shades resulted in perceptible color changes in the incisal regions. Mean DeltaE* values in the three areas (incisal, body, cervical) were significantly different (p-value<0.01); in the cervical and body regions Empress mean DeltaE* was significantly larger (p<0.01). CONCLUSION The composite cements evaluated in this study created perceptible color differences with particular combinations of die material, cement and ceramic crown.

Spectrophotometric Analysis of Tooth Color Reproduction on Anterior All‐Ceramic Crowns: Part 2: Color Reproduction and Its Transfer from In Vitro to In Vivo

Color reproduction of an anterior tooth requires advanced laboratory techniques, talent, and artistic skills. Color matching in a laboratory requires the successful transfer from in vivo with careful considerations. The purpose of this study was to monitor and verify the color reproduction process for an anterior all-ceramic crown in a laboratory through spectrophotometric measurements. Furthermore, a crown insertion process using composite luting cements was assessed, and the final color match was measured and confirmed. An all-ceramic crown with a zirconia ceramic coping for the maxillary right central incisor was fabricated. There was a significant color difference between the prepared tooth and the die material. The die material selected was the closest match available. The ceramic coping filled with die material indicated a large color difference from the target tooth in both lightness and chromaticity. During the first bake, three different approaches were intentionally used corresponding with three different tooth regions (cervical, body, and incisal). The first bake created the fundamental color of the crown that allowed some color shifts in the enamel layer, which was added later. The color of the completed crown demonstrated an excellent color match, with Delta E 1.27 in the incisal and 1.71 in the body. In the cervical area, color match with Delta E 2.37 was fabricated with the expectation of a color effect from the underlying prepared tooth. The optimal use of composite luting cement adjusted the effect from the underlying prepared tooth color, and the color match fabricated at a laboratory was successfully transferred to the clinical setting. The precise color measurement system leads to an accurate verification of color reproduction and its transfer. CLINICAL SIGNIFICANCE The use of a dedicated dental spectrophotometer during the fabrication of an all-ceramic crown allows the dentist and the laboratory technician to accurately communicate important information to one another about the shade of the tooth preparation, the shade of the contralateral target tooth, and the influence of luting cement on the final restoration, thereby allowing the technician better control over the outcome of their tooth color matching efforts and the final color match of an all-ceramic restoration.

Assessment of a prototype computer colour matching system to reproduce natural tooth colour on ceramic restorations

OBJECTIVES The aim of this study was to assess the accuracy of a prototype computer colour matching (CCM) system for dental ceramics targeting the colour of natural maxillary central incisors employing a dental spectrophotometer and the Kubelka-Munk theory. METHODS Seventeen human volunteers with natural intact maxillary central incisors were selected to participate in this study. One central incisor from each subject was measured in the body region by a spectrophotometer and the reflectance values were used by the CCM system in order to generate a prescription for a ceramic mixture to reproduce the target tooths colour. Ceramic discs were fabricated based on these prescriptions and layered on a zirconia ceramic core material of a specified colour. The colour match of each two-layered specimen to the target natural tooth was assessed by CIELAB colour coordinates (ΔE(*), ΔL(*), Δa(*) and Δb(*)). RESULTS The average colour difference ΔE(*) value was 2.58±84 for the ceramic specimen-natural tooth (CS-NT) pairs. ΔL(*) values ranged from 0.17 to 2.71, Δa(*) values ranged from -1.70 to 0.61, and Δb(*) values ranged from -1.48 to 3.81. There was a moderate inverse correlation (R=-0.44, p-value=0.0721) between L(*) values for natural target teeth and ΔE(*) values; no such correlation was found for a(*) and b(*) values. CONCLUSION The newly developed prototype CCM system has the potential to be used as an efficient tool in the reproduction of natural tooth colour.

Assessing the accuracy of computer color matching with a new dental porcelain shade system

STATEMENT OF PROBLEM In a previous study, a novel computer color matching system for dental ceramic restoration was developed, and 21 new shades were established. Theoretically, a natural tooth color can be accurately reproduced by combining 2 or 3 ceramic mixtures from the database of 21 new shades. PURPOSE The purpose of this study was to test the use of these shades in conjunction with the computer color matching system to determine their ability to accurately reproduce the body color of 29 shade tabs from a shade guide (VITAPAN 3D-Master). MATERIAL AND METHODS Disks of 21 reference shades were prepared with porcelain (Cerabien CZR) and polished to 1.0 mm thickness. A spectrophotometer was used to measure the reflectance values from 380 to 780 nm for each disk; the scattering coefficient and absorption coefficient were determined. By using the reflectance values and the scattering and absorption coefficients, the computer color matching program generated porcelain prescriptions incorporating proportions from the 21 reference shades to reproduce the shade tabs. Disks were fabricated from the prescriptions, polished to 1.0 mm thickness, then placed over a zirconia core plate and measured with the spectrophotometer. The color differences (ΔE*) between the shade tabs and the corresponding ceramic disks were calculated. Statistical analysis was performed with the 1-sample t test. RESULTS The ΔE* values between computer color matching specimens and the target shade tabs varied from 0.5 to 1.9, with an average ΔE* of 1.3, which was significantly less than the clinically detectable ΔE* threshold of 1.6 (P<.001). CONCLUSIONS The computer color matching system with the established 21 new shades is accurate and effective for reproducing tooth shades.

Optical effects of different colors of artificial gingiva on ceramic crowns

OBJECTIVES The interaction between gingival color and the shade of ceramic restorations has never been fully studied. The purpose of this study is to investigate the optical effects of altering artificial gingival color on the ceramic crown shade in the cervical area. METHODS Thirty-one all-ceramic crowns of different shades were used in this study with six different artificial gingival colors. Using a spectrophotometer (Crystaleye(®) Olympus, Japan), we measured the shade of crowns in cervical areas with each of six different artificial gingiva. The crown color measured in the presence of pink artificial gingiva (control) was compared with the crown color with five other artificial gingiva. color difference values ΔE* were calculated and compared between the control group and test groups and the correlation of the artificial gingival color with the crown color was also assessed. RESULTS Significant differences were found in the mean L* and a* values of all-ceramic crowns at the cervical regions in all six gingival color groups (p<0.001) and significant Pearson correlations were also found for the mean L* (r=0.987, p<0.001) and a* (r=0.856, p=0.03) values between the artificial gingiva and the ceramic crowns. The mean ΔE* values between the control group and each of the five other gingival groups were all significantly larger than the clinical perceptual threshold of ΔE* 1.6 (p<0.001). CONCLUSIONS Different colors of artificial gingiva generated clinically detectable shade differences in the cervical region of ceramic crowns.

Identification of putative bone anabolic peptides targeting adherent plasma membrane

Bone matrix provides unknown essential cues for osteoblast lineage cells to develop, grow, repair and remodel bones via adherent plasma membrane. Because of its tight sealing with bone matrix in vivo and culture surface in vitro as well, the adherent plasma membrane has been unveiled target of investigation to date. Herein, we report a new approach to explore the adherence plasma membrane of osteoblasts with biofunctional peptide candidates in a bacterial peptide library. To accomplish this, human osteoblast like hFOB 1.19 cells were cultured on porous filter with 8 μm pore through which bacterial peptides were allowed to meet the membrane for affinity selection. The affinity-selected peptides were coated on culture plate to further evaluate their influence on osteoblastic cell adhesion, as well as expressions of osteoblast differentiation markers, alkaline phosphatase and osteocalcin. Finally, the serial screenings identified two prominent active peptides that enhanced the differentiation markers nearly to the same level as a control peptide of bone morphogenetic protein-2. Osteogenic activity is expected for the peptides when immobilized on bone implant surface.

Knowledge and Practice of Oral Cancer Screening in Teaching Faculty—Comparison of Specialty and Year of Clinical Experience

The purpose of this study was to assess the knowledge, practice, confidence, and perceived barriers to oral cancer screening among teaching faculty in Japan. Results were compared by specialist as well as years of clinical experience. A 25-question survey was used to assess the oral cancer screening practices of faculty dentists at Iwate Medical University, School of Dental Medicine, the only dental school located in the northeast (Tohoku) region of Japan. The study was approved by the Institutional Review Board of Iwate Medical University. The response rate was 83% (n = 110, 71.8% were male). This survey revealed that only 43.6% of the dentists performed oral cancer screening frequently (always or usually) at the initial appointment, and there was no significant differences between specialists and clinical experience. Visual inspection of the oral cavity was the primary screening method, but the frequency and content of the examination (TMJ and tonsil) was significantly different between specialties. A history of cancer and tobacco use motivated providers to perform an examination and was significantly different between various specialists and clinically experienced providers. In contrast, HPV and alcohol consumption were a weak motivator. The confidence level of providers on their examination knowledge/skills was poor, especially among junior faculty. More than 80% of junior faculty indicated a lack of knowledge/skills as a major barrier.

A prospective clinical trial to assess the optical efficacy of pink neck implants and pink abutments on soft tissue esthetics

OBJECTIVE The purpose of this prospective, randomized, controlled, multicenter clinical study was to analyze the optical effects of an anodized pink colored implant shoulder/abutment system in the peri-implant mucosa of immediately placed dental implants. MATERIALS AND METHOD Forty subjects with a restoratively hopeless tooth in the maxillary esthetic zone, were recruited and randomized to receive either a pink-neck implant, or a conventional gray implant. All patients received an immediate implant and immediate provisional and two identical CAD/CAM titanium abutments with different surface colors: pink and gray, and one zirconia all-ceramic crown. The color of the peri-implant mucosa was measured using a dental spectrophotometer and analyzed using CIELAB color system. RESULTS The overall color difference between the peri-implant mucosa with a pink abutment and a gray abutment was ΔE = 4.22. Patients with gray implants presented a color change of ΔE = 3.86-4.17 with this abutment change, while patients with pink implants had a color change of ΔE = 3.84-4.69. The peri-implant mucosa with a pink abutment was significantly more red when compared with a gray abutment (P ≤ .01). CONCLUSIONS When a pink abutment was used, there is a significant color change of the peri-implant mucosa that is above the detectable color threshold. CLINICAL SIGNIFICANCE Esthetic outcomes are important for the success of implant treatment of maxillary anterior implants. The phenomenon of the gray color of a dental implant and abutment shining through the peri-implant mucosa has been documented in the literature. The objective of this study was to assess the optical effect of an anodized pink-neck implant and a pink abutment on the color of peri-implant mucosa. This study demonstrates that using pink-neck implant and a pink abutment would contribute positively to the overall esthetic outcome for an anterior implant.

Clinical Application of the Computer Color Matching (CCM) System on Metal Ceramic Restorations. Part 1. Color Reproducibility of CCM Samples.

Studies related to the Computer Color Matching (CCM) system were carried out from a clinical standpoint. The concept involved making a 3-layered porcelain sample by the CCM program and comparing its color to that of an objective porcelain sample which resembled the structure of the upper anterior tooth.Points A and B dealt with measurements of the reflection rate of the enamel layer and the enamel+dentin stratified layer, respectively. Point C consisted of the enamel+dentin+opaque stratified layer, and points D and E consisted of the dentin+opaque layer.Trial porcelain samples were baked according to these standards, and their color was analyzed and compared to the objective samples.The results showed that the color of the CCM porcelain samples was almost identical to that of the target samples, and the color difference dE was within the range of 1.0-3.0 (CMC), indicating a high level of color reproducibility.