Esthetics/Cosmetic Dentistry

Radiopacity of different shades of resin-

based restorative materials compared to
human and bovine teeth
Gurel Pekkan, DDS, PhD Mutlu Ozcan, DDS, Dr.med.dent., PhD

This study evaluated the radiopacity of different shades of EQ!L VALUESWEREDETERMINEDFORRADIOPACITYMEASUREMENTSOF

resin-based restorative materials and compared the results to EACHMATERIAL4HEDATAWEREANALYZEDUSINGANON
PARAMETRIC
human and bovine dental hard tissues. Disk specimens 6 mm in ONE
WAY!./6!+RUSKAL
7ALLIS ANDMULTIPLECOMPARISONSWERE
diameter and 1 mm thick ( N = 220, n = 10) were prepared from MADEWITHA3TUDENT
.EWMAN
+EULSpost hoc test ( = 0.05).
the following restorative materials: Different shades of resin-based restorative materials tested did
sEIGHTSHADESOFNANOlLLEDCOMPOSITE!ELITE!ESTHETIC%NAMEL NOTREVEALSTATISTICALLYSIGNIlCANTDIFFERENCESWITHINEACHMATERIAL
sSEVENSHADESOFNANOHYBRIDCOMPOSITE'RANDIO5NIVERSAL group (p > 0.05). Radiopacity values of the resin-based restorative
sSIXSHADESOFPHOTOPOLYMERIZEDPOLYACIDMODIlEDCOMPOMER materials investigated varied depending on their types; however,
'LASIOSITE within different shades of one material type, radiopacity values
sONESHADEOFHYBRIDCOMPOSITE8
TRAlL5 WERECOMPARABLE%VERYSHADEOFNANOCOMPOSITEMATERIALOTHER
Human canine dentin (n = 10), bovine enamel (n = 10), and an THAN!ELITE!ESTHETIC%NAMEL)NCISAL,4'RAYSHOWEDCOMPARABLE
ALUMINUM!L STEPWEDGEWEREUSEDASREFERENCES4HEOPTICAL RADIOPACITYTOHUMANDENTIN/THERMATERIALSTESTEDDEMONSTRATED
density values of each material were measured from radiographic higher radiopacity compared to human dentin and bovine enamel.
IMAGESUSINGATRANSMISSIONDENSITOMETER!LSTEPWEDGETHICKNESS Received: May 23, 2011
ANDOPTICALDENSITYVALUESWEREPLOTTEDANDEQUIVALENT!LTHICKNESS
C
omposite resins are widely
used as esthetic materials
because they are mercury-
free, thermally non-conductive, and
corrosion-resistant.1 With develop-
ments in filler technologies, new
composite resins have progressed
from macrofills to nanofills and
from hybrids to nanohybrids that
are currently available in the dental
marketplace in the form of flow-
able, condensable, ion-releasing
materials or as compomers.2-6
In principle, tooth-colored
restorations are expected to mimic
the translucency of natural teeth.
For this reason, composite resins
are provided in different shades in
order to match the optical proper-
ties of dental tissues. Translucency
and opacity have been viewed as
vital properties of composite resins,
since they indicate the quality and
quantity of light reflection.7 Each
shade of a restorative material has its
own composition. In each composi-
tion, there are different coloring
oxides at different percentages.8,9
Also, matrix composition and filler
types of composite resins vary
between brands that could affect the
radiopacity of different shades of
restorative materials.10-12
The radiopacity of resin-based
restorative materials is an essential
property, in addition to the bio-
logical, physical, and mechanical
requirements. Radiopacity regulates
the reflection degree of the mate-
rial, allowing a proper contrast
between the tooth structure
and the restorative material on a
radiograph.13 Adequate radiopacity
permits assessment of marginal
overhangs, open gingival margins,
and interproximal contours, as well
www.agd.org General Dentistry
!CCEPTED*ULY
as recurrent caries.5,14 The early
commercially available composite
resins and glass ionomer cements
had insufficient radiopacity,
limiting their use as restorative
materials.15 Later, polyacid-modified
compomers became available that
had mechanical properties com-
parable to glass ionomers but with
higher radiopacity.5,16
Radiopacity could be achieved
with the incorporation of biocom-
patible opacifying agents such as
barium, strontium, zirconium,
lanthanum or bismuth oxides,
sulfates, or carbonates that vary
greatly in concentration in com-
posite resins with different com-
positions. Excessive inclusion of
radiopaque fillers results in reduced
translucency of these materials,
but in turn, they can alter the
mechanical properties of restorative
July/August 2012 e237
Esthetics/Cosmetic Dentistry Radiopacity of different shades of resin-based restorative materials

materials.9,17 Resin-based restorative

Table 1. Brands, shades, manufacturers, and chemical compositions of the materials indicated for the restora-
materials investigated in this study. tion of anterior teeth have filler
particles that are smaller in size and
Brand and shade Chemical composition and batch number Manufacturer lower in concentration than those
intended for use in posterior teeth;
!ELITE!ESTHETIC%NAMEL -ATRIXETHOXYLATED"IS '-!"IS '-!4%'$-! "ISCO)NC
! %!! &ILLERTYPEGLASSlLLERAMORPHOUSSILICA this affects their radiopacity.18 In
&ILLERSIZE «M&ILLERCONTENTW fact, moderate radiopaque materi-
"ATCH.O als are preferable to those with a
(%-!WATER high degree of radiopacity, since
!ELITE!ESTHETIC%NAMEL "ATCH.O the latter can obscure caries adja-
! %!! cent to restorations.15,19,20 Ideally,
!ELITE!ESTHETIC%NAMEL "ATCH.O restorative materials should have
! %!! radiopacity values equivalent to
!ELITE!ESTHETIC%NAMEL "ATCH.O or greater than that of enamel.20,21
! %!! On the other hand, radiopacity
!ELITE!ESTHETIC%NAMEL "ATCH.O of dental materials is expressed in
" %!" terms of equivalent aluminium (Al)
!ELITE!ESTHETIC%NAMEL "ATCH.O thickness in millimeters, using a
# %!# reference calibration curve where
!ELITE!ESTHETIC%NAMEL "ATCH.O radiopacity values are compared
$ %!$ to specific thicknesses of Al step
!ELITE!ESTHETIC%NAMEL "ATCH.O wedges under controlled radio-
)NCISAL,4'RAY!),) graphic conditions.22-25
8 TRAlL5685 -ATRIX"IS '-!5$-!4%'$-! 6OCO'MB( The International Organization
&ILLERTYPEIRREGULARSHAPE"A" !L3IGLASS for Standardization (ISO) has
&ILLERSIZE «M
published a radiopacity measure-
&ILLERCONTENTW"ATCH.O
ment protocol and set guidelines
'RANDIOUNIVERSAL -ATRIX"IS '-!5$-!4%'$-!
for polymer-based restorative and
!'! &ILLERTYPESILICANANOlLLERBARIUM ALUMINA
BOROSILICATEMICROlLLER luting materials.23 Accordingly,
&ILLERSIZESILICANANOlLLER NM BARIUM these materials should have radio-
ALUMINABOROSILICATEMICROlLLERn«M pacity values equal to or greater
&ILLERCONTENTW"ATCH.O than that of Al.25,26
'RANDIO5NIVERSAL "ATCH.O The commercially available
!'! resin-based restorative materials
'RANDIO5NIVERSAL "ATCH.O are available in a range of shades.
/!'/! However, there is little information
'RANDIO5NIVERSAL "ATCH.O in the literature regarding whether
!'! or how much radiopacity varies
'RANDIO5NIVERSAL "ATCH.O in different shades.27 Therefore,
!'! the objective of this study was
'RANDIO5NIVERSAL "ATCH.O to compare the radiopacity of
"'" different resin-based restorative
'RANDIO5NIVERSAL "ATCH.O materials in different shades with
"'" human dentin and bovine enamel
'LASIOSITECAPS -ATRIX"IS '-!5$-!4%'$-!"(4 by referring to an Al step wedge
!#! !#!  &ILLERTYPE3I/"A" !L3I&!L3I using a transmission densitometer.
!#! !#!  &ILLERSIZE«M
The null hypothesis tested was
"#" ### &ILLERCONTENTW"ATCH.O
that different shades of resin-based
(%-!HYDROETHYLMETHACRYLATE"(4BUTYLATEDHYDROXYTOLUENE4%'$-!TRIETHYLENEGLYCOLDIMETHACRYLATE
materials would show comparable
"IS '-!BISPHENOL!DIGLYCIDYLMETHACRYLATE5$-!URETHANEDIMETHACRYLATE
radiopacity values.

e238 July/August 2012 General Dentistry www.agd.org

Materials and methods
Specimen preparation Table 2. Means and standard deviations (SDs) of optical density and eq Al
Disk specimens (N = 220, n = 10) values of the tested materials, human dentin (HD), and bovine enamel (BE),
(diameter: 6 mm, thickness: 1 mm) and statistical differences between groups. See Table 1 for material coding.
were prepared from the following
restorative materials: nanofilled Optical density values Eq Al values
composite (Aelite Aesthetic Enamel) Material code (Mean ± SD) (Mean ± SD) Statistical differences*
(eight shades); nanohybrid com- !),) ¢ ¢ !
posite (Grandio Universal) (seven !$ ¢ ¢ "
shades); photopolymerized polyacid
!# ¢ ¢ "
modified compomer (Glasiosite)
(six shades); and hybrid composite !" ¢ ¢ "
(X-tra fil U) (one shade). The mate- !! ¢ ¢ "
rials, their chemical compositions, !! ¢ ¢ "
manufacturers, and batch numbers !! ¢ ¢ "
are listed in Table 1. !! ¢ ¢ "
Materials were compressed
HD ¢ ¢ "
between two glass slides during
photopolymerization (Hilux #! ¢ ¢ C
Ledmax 1040, Darphie Ltd.). All #! ¢ ¢ C, D
materials were polymerized for 40 #! ¢ ¢ #$%
seconds from a constant distance "% ¢ ¢ #$%&
of 2 mm from the surface. Light CC20 ¢ ¢ #$%&'
output was at least 500 mW/cm 2
#" ¢ ¢ #$%&'
as measured with a radiometer
(Hilux Ledmax 1040) after every #! ¢ ¢ #$%&'
10 specimens. '! ¢ ¢ #$%&'
All specimens were ground '/! ¢ ¢ #$%&'
finished to 400-grit silicon carbide '" ¢ ¢ #$%&'
paper (Struers Inc.) under water '! ¢ ¢ $%&'
to create flat surfaces. Thickness of
'" ¢ ¢ %&'
the specimens was measured with a
digital caliper (Youfound Precision
Co., Ltd.) with a critical tolerance
of 1 ± 0.01 mm. All specimens were
ultrasonically cleaned in distilled
4HESAMELETTERSINTHISCOLUMNINDICATENOSIGNIlCANTDIFFERENCESACCORDINGTO+RUSKAL
7ALLISAND
water for five minutes (Eurosonic
.EWMAN
+EULSMULTIPLERANGETESTS = 0.05).
4D, Euronda S.p.A.).
Human canine dentin (n = 10),
bovine enamel (n = 10), and an Al
step wedge were used as references.
Ten enamel disk specimens, 6 mm
in diameter and 1 mm thick, were
prepared from mandibular bovine
incisors by longitudinal sectioning
of the buccal side of the teeth after
separating the roots. Longitudinal
sections of human dentin were pre-
pared to the same thickness using
a micro-slicing device (Accutom,
Struers Inc.).
'! ¢
'! ¢
685 ¢
3TUDENT
Radiopacity analysis
An Al step wedge was machined
from a single Al block (Alu-Keil,
PEHA Medikal Gerate GmbH)
using an electrical discharge
machining technique.28 The
maximum thickness of the step
wedge was 8 mm; each step was 1
mm thick, 4 mm long, and 14 mm
wide. All specimens were kept in
distilled water at 37°C for 24 hours.
www.agd.org
¢ &'
¢ '
¢ H
One specimen of each material—
bovine enamel, human dentin, and
an Al step wedge—were positioned
side by side on occlusal D speed
radiographic film (Kodak Ultra-
speed, Eastman Kodak Company).
A special holder was mounted to
ensure a fixed focus/film distance.
The films were exposed for 0.38
seconds with a dental X-ray system
(Trophy Radiologie) at 70 kV
General Dentistry July/August 2012 e239
Esthetics/Cosmetic Dentistry Radiopacity of different shades of resin-based restorative materials
and 8 mA with an object-to-film
distance of 30 cm. All films were
processed immediately in a stan-
dard automatic processor (Velopex
Extra-X, Medivance Inc.) using
fresh developer and fixer (Velopex
Ready Mixed Developer and Fixer,
Hexagon International Ltd.).
The optical densities of the
radiographic images were measured
with a transmission densitometer
(Pehamed Denso-Dent Densi-
tometer, PEHA Medikal Gerate
GmbH). Means of at least three
readings per specimen were
measured with an aperture size
of 3 mm (DIN 6868/55). Follow-
ing the method of el-Mowafy &
Benmergui, a graph was plotted to
illustrate the relationship between
the step wedge thickness and opti-
cal density values with the follow-
ing equation: y = -0.5296Ln(x) +
2.1971.29 From that graph, optical
density values of the specimens
were used to determine the equiva-
lent Al thickness (eq Al) values.
Statistical analysis
Statistical analysis was performed
using SPSS 13.0 for Windows (SAS
Institute Inc.). Data were analyzed
with ANOVA, Kruskal-Wallis, and
Student-Newman-Keuls multiple
range tests ( = 0.05).
Results
Different shades of resin-based
restorative materials tested did
not reveal statistically significant
differences within each material
group (p > 0.05). The radiopacity
values of the nanofilled composite,
Aelite Aesthetic Enamel, showed
significantly lower radiopacity
(0.788 ± 0.112) than those of other
materials (0.920 ± 0.059 – 2.320 ±
0.114) (p < 0.001) (Table 2). Aelite
Aesthetic Enamel Incisal LT Gray
displayed the lowest radiopacity
(0.788 ± 0.112) among all materials
e240 July/August 2012 General Dentistry
tested (p < 0.001). Other shades of
Aelite Aesthetic Enamel were not
statistically significant compared
to human dentin (1.013 ± 0.125)
(p > 0.05), but they were signifi-
cantly lower than bovine enamel
(1.758 ± 0.170) (p < 0.05).
The hybrid composite, X-tra
fil U, showed significantly higher
radiopacity values (2.320 ± 0.114)
than all other materials (p < 0.05).
The radiopacity of the nanohybrid
composite (1.892 ± 0.169 – 2.061
± 0.194) and the compomer (1.691
± 0.156 – 1.851 ± 0.229) were sta-
tistically higher than that of human
dentin (p < 0.001).
Discussion
The radiopacity of a material can
be simply defined as the inverse of
the optical density of a radiographic
image. Optical density value is a
logarithmic measure of the ratio of
the transmitted-to-incident light
through the film image, measured
by the transmission densitometry.
Optical density values depend not
only on the inherent X-ray absorp-
tion properties of the materials, but
on the characteristics of the film
(fog and base density), its exposure
parameters, and processing condi-
tions.30 Therefore, in this study, the
eq Al values were also calculated in
order to compare the results with a
reference material. The results were
also compared to bovine enamel and
human dentin. Bovine enamel was
used because it has been reported to
present similar morphological and
histological properties compared to
human teeth.31,32 Bovine teeth were
also capable of being made into
disk-shaped enamel specimens mea-
suring 1 mm in thickness and 6 mm
in diameter; this was technically not
possible with the human teeth.
Radiographic density is directly
obtained from digital image analy-
sis. The pixels, already available in
www.agd.org
grey shades, provide the values
straight at a scale of 0–255 through
the software.33 For this reason, direct
or indirect digital image analysis is
considered a fast and easy resource
for interpreting the radiographic
density of restorative materials in
dental practice.34 The advantages of
direct digital systems are immediate
image capture, lack of processing
chemicals, and high sensitivity to
radiation exposure.35 Although
direct or indirect digital dental radi-
ology systems are preferred to study
the radiopacity of a material due to
low irradiation dose, instant image,
and image manipulation, the X-ray
film technique is widely used by
researchers and manufacturers and
is still considered a gold standard
technique.22,34,36 For this reason,
the choice between direct and
indirect digital image analysis and
transmission densitometry requires
further investigation.
According to the results of the
present study, the nanofilled com-
posite, Aelite Aesthetic Enamel,
showed the lowest radiopacity
values; the posterior hybrid compos-
ite, X-tra fil U, showed the highest.
The radiopacity values of all Aelite
shades were lower than 1 mm eq Al.
The radiopacity values of all Aelite
shades were also lower than those
of bovine enamel. The nanofilled
composite tested in this study is
recommended for esthetic anterior
thin veneer restorations or for the
enamel layer of esthetic posterior
restorations. The results indicated
that all shades of this material had
insufficient radiopacity to be used
as a restorative material. Since the
nanofilled composite is particularly
indicated to replace enamel tissues, it
should have a radiopacity value equal
to or higher than that of enamel.15,37
The reason for insufficient radio-
pacity of the nanofilled composite
tested compared to other materials
could be attributed to its composi-
tion. Since it is an esthetic restorative
material indicated especially for the
replacement of enamel, it is expected
to be more translucent and less
opaque.7 Translucency of materials
is achieved with the incorporation
of glass fillers and amorphous silica
particles that are relatively less radio-
paque materials compared to other
inorganic fillers such as barium,
strontium, and zirconium oxides.7
On the other hand, higher
amounts of glass fillers could
adversely affect the translucency
of the resin materials. However,
in nanofilled composite resins,
the nanofillers obtained by sol-gel
technique replace the grinded glass
particles.38 Such nanofillers provide
higher light transmittance of the
material accompanied with lower
viscosity and higher radiopacity. The
nanofilled composite, Aelite Aes-
thetic Enamel, had 73 w% fillers,
which was slightly lower than the
other materials tested. Therefore, it
can be stated that the weight per-
cent of the fillers in the resin matrix,
not the presence of nano-sized fill-
ers, played a major role in radiopac-
ity. In other words, the fewer fillers
in the composite resin, the higher
the radiopacity. The results of the
present study need to be verified in
comparison with other nanofilled
composite resins.
The nanohybrid composite
(Grandio Universal), polyacid
modified compomer (Glasiosite),
and hybrid composite (X-tra fil U)
had inorganic fillers of 87%, 77.5%,
86%, respectively, by weight in
their compositions. In that respect,
the higher filler contents of these
materials could have contributed
to higher radiopacity. Linear cor-
relation between radiopacity values
and the weight percentages of fillers
has been previously reported.22 In
addition, Watts demonstrated that
radiopacity values higher than those
in enamel can be achieved with
composites having filler loading
of approximately 70% by volume
when the mass percentage of radio-
paque oxide in the filler particles
exceeds approximately 20%.39 The
higher the atomic number of the
metallic elements present in the
composition of the materials, the
higher their capacity to absorb
X-rays.30 Nevertheless, this could
not be confirmed in the present
study, since lower radiopacity values
were obtained with the nanofilled
composite, Aelite Aesthetic Enamel,
despite its high filler load.
Other materials tested demon-
strated radiopacity values higher
than 1 mm eq Al. While all shades
of the polyacid modified compomer
(Glasiosite) showed no significant
difference to bovine enamel in terms
of radiopacity, shade GA30 of the
nanohybrid composite (Grandio
Universal) had significantly higher
radiopacity than bovine enamel.
Therefore, the null hypothesis that
different shades of resin-based
materials would show comparable
radiopacity values could be only
partially accepted. In most of the
studies, only one shade of composite
resin was tested and the conclusions
were drawn accordingly.2,5,16,21
To the authors’ knowledge, there
is only one study in the literature
that tested the radiopacity of differ-
ent shades of the same restorative
material. According to that study by
Marouf & Sidhu, the radiopacity of
different shades of resin-modified
glass-ionomer restorative materials
showed no significant differences.27
There were also no differences
found among the radiopacity values
of the shades within each of the
resin-based restorative materials.
Therefore, the results of the present
study partially confirm the results of
Marouf & Sidhu.27
www.agd.org General Dentistry
The radiopacity of composite
resins is a particularly important
property to consider for posterior
restorations.22 For intracoronal resto-
rations, clinicians are advised to use
materials with a high radiopacity.22
It has been previously reported that
the density of a radiopaque compos-
ite resin should be higher than that
of dentin and equal to or slightly
higher than that of enamel.15,37 The
use of materials with a radiopacity
equal to or lower than that of
dentin could result in diagnostic
challenges.13 Conversely, too much
radiopacity (such as with amalgam)
can interfere with the detection
of voids and recurrent caries and
negatively affect diagnostic dis-
crimination in areas covered by the
restoration.34,39 A radiopacity slightly
higher than that of enamel assists in
distinguishing between restorations
and caries-affected or -infected tooth
structures, as well as determining
homogeneity of the restoration.36
A limitation of this study is that
the oral environment was not
simulated. In the oral environment,
factors such as oral fluids, soft tissues,
and the surrounding dental struc-
tures can affect the radiopacity levels
of restorative materials in that low-
density restorative materials become
more visible on a radiograph when
the soft tissue and hard dental struc-
tures are superimposed. Furthermore,
leakage of ions from silicone, barium,
strontium, and sodium filler particles
into the aqueous medium could
result in reduced radiopacity.18,40,41
Future studies are warranted to study
the radiopacity of resin-based restor-
ative materials after aging.
Conclusion
The radiopacities of the resin-based
restorative materials investigated
varied depending on their types,
but within the various shades of
one material type, optical density
July/August 2012 e241
Esthetics/Cosmetic Dentistry Radiopacity of different shades of resin-based restorative materials

values and eq Al values were com-  !ZZOPARDI.-OHARAMZADEH+7OOD$*-AR-  )3/STANDARD$ENTISTRYˆ0OLYMER
BASED
parable. Except for Aelite Aesthetic TIN.VAN.OORT2%FFECTOFRESINMATRIXCOMPO- lLLINGRESTORATIVEANDLUTINGMATERIALSED
SITIONONTHETRANSLUCENCYOFEXPERIMENTAL 'ENEVA)NTERNATIONAL/RGANIZATIONFOR3TAN-
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  7ATTS$#-C#ABE*&!LUMINUMRADIOPACITY
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in the present study, as they could
show similar or lower radiopacity
compared to dentin and enamel.

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relationship with any of the manu- 
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physical properties of contemporary dental lut- HUMANDENTALSTRUCTURES*#ONSERV$ENT
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Author information   .AKAMICHI))WAKU-&USAYAMA4"OVINE
Dr. Pekkan is an associate professor,  3HAH0-3IDHU3+#HONG"3&ORD422ADIO
teeth as possible substitutes in the adhesion
Faculty of Dentistry, Department of PACITYOFRESIN
MODIlEDGLASSIONOMERLINERSAND TEST*$ENT2ES 

BASES*0ROSTHET$ENT 
  &ONSECA2"(AITER
.ETO&&ERNANDES
.ETO!*
Prosthodontics, Dumlupinar Uni-
versity, Kutahya, Turkey. Dr. Ozcan
is a professor, University of Zurich,

 4VEIT!"%SPELID)2ADIOGRAPHICDIAGNOSISOF "ARBOSA'!3OARES#*2ADIODENSITYOFENAMEL
caries and marginal defects in connection with and dentin of human, bovine and swine teeth.
RADIOPAQUECOMPOSITElLLINGS$ENT-ATER !RCH/RAL"IOL 
 
  'U32ASIMICK"*$EUTSCH!3-USIKANT",
and Head of Dental Materials Unit,  "OUSCHLICHER-2#OBB$3"OYER$"2ADIOPAC- Radiopacity of dental materials using a digital
Center for Dental and Oral Medi- ITYOFCOMPOMERSmOWABLEANDCONVENTIONAL 8
RAYSYSTEM$ENT-ATER

cine Clinic for Fixed and Removable RESINCOMPOSITESFORPOSTERIORRESTORATIONS/PER  'àRDAL0!KDENIZ"'#OMPARISONOFTWOMETH-
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