Research Article

The effect of toothbrushing on surface gloss of resin composites

D o r ie n L e f e v e r , m sc , N ik o l a o s P e r a k is , d m d , M ig u e l R o i g , p h d , I v o K r e j c i , d m d , p h d
& STEFANO ARDU, DMD, P h D

A b s t r a c t : Purpose: To determine the changes in surface gloss of different composite materials after laboratory
toothbrushing simulation. Methods: 36 specimens were fabricated for each material and polished with 120-, 220-, 500-,
1200-, 2400- and 4000-grit SiC abrasive paper, respectively. Gloss measurements were made with a glossmeter
(Novocurve) prior to testing procedures and then subjected to simulated toothbrushing for 5, 15, 30 and 60 minutes'by
means of an electric toothbrush with a pressure of 2N while being immersed in a 50 RDA toothpaste slurry. Four
supplementary samples per group were analyzed under SEM immediately after polishing procedures and four samples after
60 minutes simulated toothbrushing in order to evaluate the causes of the gloss decrease. The tested resin composite
materials were Filtek Supreme XTE, Durafill, HRi Enamel Plus, Miris 2, Empress Direct, Venus Diamond, Gradia Direct,
Clearfil Photo Posterior and G-aenial. Natural enamel represented the control group. Statistical analysis was performed
using Kruskal Wallis and Tukey post-hoc test, with a level of significance set at 0.05. Results: Resin composite initial
gloss values ranged from 68.9 to 100.5 at baseline to 10.6 to 62.6 after 1 hour of brushing. Highest gloss values were
obtained by Filtek Supreme XTE, followed by Empress Direct and Durafill. Lowest values were obtained by Clearfil
Photoposterior, Miris 2, Enamel HRi and Venus Diamond. Natural enamel was the only substrate to maintain its gloss
throughout the brushing procedure (110.4 after 60 minutes). SEM analysis revealed different patterns of surface
degradation depending on the composite material. (Am JDent 2012;25:54-58).
C l i n ic a l s ig n if ic a n c e : None of the resin' composites performed as well as natural enamel. Some restorative
materials exhibited a decreased gloss due to toothbrushing, which might result in an esthetic problem. y
0 : Dr. Dorien Lefever, Division of Cariology & Endodontology, Dental School, University of Geneva, Geneva,
Switzerland. E -0 : Dorien.Lefever@unige.ch
Introduction dies5'11 that investigated the influence of toothbrushing on sur
face gloss and surface roughness of resin composites showed a
The esthetic restoration of the anterior dentition represents decrease in gloss and increase in roughness of various resin com
one of the greatest challenges in current daily practice. Continu posites, as well as differences between the observed materials.
ous improvements regarding the esthetic properties of resin This decrease in gloss is the result of degradation due to
composites such as color match, translucency and opalescence mechanical and/or chemical interaction with the oral environ
have led to natural looking restorations. As a consequence, ment, resulting in changes in surface gloss and therefore
these resin composites are increasingly used as an alternative to deteriorated esthetics at long term. This surface degradation
porcelain-fused-to-metal (PFM) crowns and ceramic veneers may be due to several factors: wear of fillers, degradation of the
for the restoration of severely compromised anterior teeth. In resin matrix or weakening of resin-filler bonding. These three
this indication, not only color match, translucency and opales factors lead to a roughening of the surface which is the main
cence,1but also surface gloss is of paramount importance. cause of a gloss decrease. Clinically, this kind of superficial
Surface quality of restorations is in fact one of the important degradation can cause esthetic problems especially in patients
factors that determine their clinical success. A smooth surface who present a high lip line. In this case, the different refraction
can improve longevity and esthetics of restorations by reducing index between natural tooth and resin composite on upper
plaque accumulation and surface staining, allowing successful anterior teeth free of saliva can cause a severe esthetic problem.
mimicking of the tooths natural appearance.2,3 Directly related to Newly developed resin composites have no information
surface quality is also the ability of the material to reflect direct available on their surface gloss. Therefore, the present study
light. This optical phenomenon is defined as gloss or reflective evaluated the gloss behavior of newly developed resin com
capacity. Differences in gloss between a restoration and sur posites with different filler range and mechanical characteristics
rounding enamel are clinically relevant as the human eye can such as Enamel HRi,a Gradia Direct,b Empress Direcf and G-
easily detect differences in gloss even if their colors are matched. aenial,b (Table 1) immediately after polishing and after tooth
On the other hand, high gloss reduces the effect of a color brushing simulation, compared to natural enamel and reference
difference, since the color of reflected light is more predominant materials. The null hypothesis was that surface gloss of resin
than the color of the underlying composite material. composites was not influenced by laboratory toothbrushing
Modem resin composites can achieve a high luster if simulation.
appropiate polishing procedures are used.2 Gloss is an attribute
of visual appearance that originates from the geometrical dis Material and Methods

tribution of light reflected by the surface, and is directly influ Nine resin composites were selected, i.e. eight indicated by
enced by the surface roughness.3 However, the high gloss level the manufacturer as anterior restorative materials and one for
obtained immediately after polishing procedures is not clinical posterior restorations (negative control) (Table 1). Natural
ly stable over time, leading to a matte surface. Previous stu enamel was added as a positive control.
American Journal o f Dentisirv. Vol. 25. No. I, February, 2012
Toothbrushing and composite sutj
Table I. Description of the tested materials. \
Filler mean particle,
Product Composite classification Filler type size and range Matrix composition Abbreviation
Empress Direct inhomogeneous microhybrid Ba-AI-fhiorosilicate glass; Mean 550 nm Dimethacrylate ( EMP
with homologous splinters barium glass filler (0.4 pm), range 150 nm-0.4pm
mixed oxide (ISO nm)
Miris 2d Inhomogeneous microhybrid Silanized barium glass, Mean 0.6 pm Methacrylate MIR
with homologous splinters amorphous silica splinters Range 0.02 pm-2.5 pm
15-20 pm (mean I pm)
G-aenial
Inhomogeneous microhybrid Strontium and lanthanoid Range 16nm -17pm UDMA
with homologous splinters fluoride pre-polymerized Dimethacrylate co-monomer GAE
fillers (16-17 pm)
Filler 8S0 nm silica
16 nm fumed silica
Gradia Direct Inhomogeneous microhybrid Silica 0.85 pm Mean 850 nm UDMA
with heterologous splinters Prepolymerized filler Range 20 nm-20 pm Dimethacrylate co-monomer GRA
Filtek Supreme Inhomogeneous microhybrid Silica filler (20 nm) Mean 0.6 pm bisGMA, UDMA, SUP
XTE' with aggregated particles Zirconia filler 4-11 nm Range 20 nm-10 pm TEGDMA, bis-EMA
Aggregated zirconia/silica
cluster filler (0.6-10 pm)
Enamel HRi Homogeneous microhybrid Glass filler (mean 1.0 pm) Mean 0.9 pm Diurethandimethacrylate HRI
nano zirconium oxide Range 20 nm-2 pm bisGMA
particles 20 nm 1,4-butandioldimethacry late
Durafill' Microfilled inhomogeneous Silicon dioxide (0.02-0.07pm) Mean 0.04 pm UDMA DUR
splinter polymer (2-20 pm) Range 0.02-20 pm
Venus Diamondf Fine hybrid Ba-Al fluoride glass Mean 0.6 pm TCD-DI-HEA, UDMA
nano-particles 5 nm-20 pm Range 5 nm-20 pm 7 '

Clearfil Photo Coarse hybrid Silanated silica Mean 1-2 pm bisGMA CPP
Posterior8 silanated barium glass TEGDMA
silanated colloidal silica urethane tetramethacrylate

Specimen preparation - Thirty-six disc-shaped specimens mea
suring 10 mm in diameter were made of each of nine com
posites (Table 1), resulting in a total of 324 samples, by
covering the resin composite with a transparent matrix strip and
gently pressing it with a glass slide to the thickness of 1 mm.
The resin composites were light cured for 40 seconds from a
distance of 1 mm by using a curing light (L.E.Demetron IIb) at
a light intensity of 1100 mW/cm2 as measured with a radiome
ter (L.E.D.radiometei*). One additional group, made of 36
slices of natural tooth enamel (ENML) obtained from freshly
extracted human anterior teeth, was added to the restorative
material groups as a positive control. This enamel was sub
jected to the same polishing protocol and the same testing
procedures as the composite materials. The surface of all speci
mens was then polished with 120-, 220-, 500-, 1200-, 2400-
and 4000-grit SiC abrasive paper. Polishing was performed for
60 seconds for each grit of abrasive paper under water cooling
at a constant force of 2 N.7 After storage in artificial saliva at
37C for 24 hours, initial surface gloss measurements were
made for each specimen.
Gloss measurements - Surface gloss was measured by means of
a glossmeter (Novo-Curve1) according to Heintze et al.12 This
device measures the amount of light reflected from the surface
of an object, which is then translated into a numerical scale.
The measuring principle of this device is based on a light beam
that strikes the object at a 60 angle. The intensity of the reflect
ed light is measured and compared to the reference value. The
device has a measuring window of 2 mm x 8 mm over which
the specimen is placed and then covered with a black film
container to avoid external light exposure during the measure
ment. Each time before a new measurement was made, the
glossmeter was calibrated by comparing the results with a
calibration plate provided by the manufacturer, which has a
reference value of 94.0 and by checking the zero point to
exclude negative values.
Simulated toothbrushing - After baseline gloss measurements,
each specimen (n=36 per material) was then subjected to
consecutively 5, 15, 30 and 60 minutes of brushing with an
electric toothbrush (Triumph Professional Care*) fixed on a cus
tom made holder, applying a standardized force of 2 N. The
specimens were immersed in a toothpaste slurry consisting of
3g 50 RDA toothpaste (Signalk) mixed with 0.3 mL of distilled
water. After each treatment the slurry was renewed and speci
mens were thoroughly cleaned of any treatment material resi
due both manually and in an ultrasonic bath with distilled water
for 10 minutes in order to remove eventual smear layer created
on their surface. Surface gloss measurements were made
subsequently using the NovoCurve device as described above.
SEM evaluation - Four specimens of each material before and
four samples after 1 hour of simulated toothbrushing were gold
sputtered and then analyzed by scanning electron microscopy
(SEM Phillips XL 201) in order to investigate possible surface
changes.
Statistical analysis - Statistical analysis was performed with
SPSS 17.0 software. As the distribution of data was not normal
(Kolmogorov-Smimov test) non parametric methods were
used. A Wilcoxon signed-rank test was run for each paired
group, i.e. before vs. after treatment (P= 0.05). Furthermore, to
detect whether the results were material dependent, a Kruskal-
Wallis test was run. Tukey post-hoc test was used to detect
differences among group means.
 American Journal o f Dentistry, Vol. 25, No. I, February, 2012
56 Lefeverelal
Table 2. Mean gloss values at baseline and after each brushing cycle of 5 ,15,30 and 60 minutes (GU), AGU and the group of statistical significance of each material.
Baseline After 5 minutes After 15 minutes After 30 minutes After 60 minutes Statistical significance
Material (SD) (SD) (SD) (SD) (SD) AGU (after 60 minutes)
HRI 88.2 (7.1) 29.0 (12.3) 15.9 ( 5.6) 12.8 (2.9) 10.6 (2.2) 77.7 F
DIA 82.5 (4.3) 53.3 (12.8) 17.2 ( 8.7) 12.1 (5.7) 12.5 (5.5) 70.1 FE
GAE 79.5 (4.1) 26.7 ( 7.9) 18.4 ( 7.4) 16.6 (5.1) 13.4 (4.8) 66.1 FE
CPP 68.9 (6.2) 33.1 ( 9.6) 22.1 ( 6.9) 19.0 (8.2) 14.8 (5.7) 54.2 E
MIR 81.1 (4.7) 53.3 (11.7) 42.6 ( 9.0) 29.6 (9.0) 18.9 (5.9) 62.2 D
GRA 78.7 (2.9) 50.0 (12.3) 31.8 (11.1) 21.6 (6.5) 20.8 (7.2) 58.0 D
DUR 84.2 (5.8) 77.5 ( 6.0) 67.9 ( 6.9) 56.8 (7.6) 48.0 (6.5) 36.2 C
EMP 86.7 (3.8) 83.6 ( 53) 73.1 ( 7.9) 65.1 (7.3) 51.1 (7.4) 35.6 c
SUP 100.5 (4.2) 83.2 ( 6.3) 74.0 ( 7.1) 68.2 (8.9) 62.6 (7.5) 37.9 B
ENML 113.2 (4.0) 111.3 ( 6.3) 116.6 ( 2.1) 111.9 (5.8) 110.4 (1.4) 2.8 A
*AGU is the difference in gloss values between the initial and the final values. It is calculated according to the following formula: GUinit - GUfin where init and fin
are the respective values at the baseline and at the end of the experimental phase.

Material

Fig. 2. Boxplot o f GU values of all materials after 1 hour of simulated

Results
Initial gloss values of each composite material and changes
from baseline after each cycle of brushing are shown in Table
2. Resin composite gloss at baseline ranged from 68.9 (CPP) to
100.5 (SUP) GU (gloss units). After 1 hour of toothbrushing
simulation gloss values ranged from to 10.6 to 62.6 (SUP) GU.
The highest AGU was detected for HRi, followed by DIA,
GAE and CPP. EMP showed the lowest AGU.
Natural enamel provided the best baseline and post-
treatment gloss values, resulting in the lowest AGU when
compared to the tested resin composite materials (Figs. 1,2).
SEM images of the tested materials before and after 60
minutes of simulated toothbrushing are shown in Figs. 3A-D.
Discussion
A visual gloss evaluation may include many errors due to
subjectivity. Therefore, a numeric quantitative approach such as
a glossmeter device is mandatory to achieve an objective
evaluation. Furthermore, the glossmeter used in this study
(Novo-Curve) was specifically chosen because it is able to
measure surface gloss of a restricted area.
The composites evaluated in this study were chosen as they
represented a group of resin composites relatively recently
introduced into the market. They were compared to natural
enamel (positive control) and Clearfil PhotoPosterior (nega
tive control). According to the resin composite classification of
toothbrushing.
Ardu et al,'3 the investigated materials represented different
classification categories, in order to investigate the possible
influence of the composition of the resin composite on the
surface gloss. Natural enamel was chosen as positive control
because it is supposed to be the ideal natural substrate. Clearfil
PhotoPosterior on the other hand was considered as negative
control due to its mean filler size which suggests indication for
posterior restorations only.13
The samples were prepared under standardized conditions.
Pre-roughening of the specimens was found necessary to
eliminate voids in the external layer of the composite samples.
In most studies14'18 pre-roughening was performed either with
diamond or tungsten carbide burs to mimic clinical procedures.
However, Heintze et al12 claimed that pre-roughening with dia
mond burs resulted in an inhomogeneous surface texture and
consequently in increased scattering of the results. In order to
obtain a standardized force, a calibration session was initiated
prior to the application of the polishing system, using an elec
tronic laboratory scale to measure the force applied (2 N)
during the polishing steps.19 To overcome the possible influ
ence of the type of illumination and angle of the observer, a
glossmeter with 60 angle of illumination was used for all
measurements.20
As previously reported,7,21 toothbrush abrasion of composite
materials varied according to the type of composite, type of
toothpaste22 and the nature of the toothbrush employed23 There
American Journal o f Dentistry. Vol. 25, No. 1. February, 2012 Toothbrushing and composite sui_

Fig. 3A-D. SEM images of Clearfil PhotoPosterior and Filtek Supreme XTE before and after 60 minutes of simulated
toothbrushing. A. Filtek Supreme XTE before simulated toothbrushing. B. Filtek Supreme XTE after 60 minutes
toothbrushing. C. Clearfil PhotoPosterior before simulated toothbrushing; D. Clearfil PhotoPosterior after 60 minutes
o f toothbrushing. The surface integrity was substantially maintained Only small superficial defects are present, which
might be due to loss of hard zirconium particles. Decrease in surface quality with resin loss and appearance of
macrofillers can be observed.
fore, absolute values of the results of this study cannot be com cantly reduced by simulated toothbrushing. This phenomenon,
pared with other reports. as reported in other studies,911 was material dependent. Gloss
In the present study, the specimens were brushed during 60 decrease is influenced by the resin matrix, filler particles and
minutes, which may correspond to the amount of toothbrushing the silanization between both. Whenever fillers are much harder
that is carried out over a period of 2 years, if it is assumed that the than the surrounding resin, this may result in a rough surface
ideal brushing time is 120 seconds three times a day which is after toothbrushing simulation. The abrasion of the softer resin
equal to a tooth surface brushing of 6 seconds a day. However, might cause a lack of support of the filler, which finally de
various studies showed that the actual mean brushing, even if taches from the matrix, resulting in a concavity in the surface
variable, is about 120 seconds per day, which conesponds to 2 (Photohole effect). This phenomenon may be the cause of the
seconds per day per tooth surface. Therefore, our brushing poor gloss values observed for Clearfil PhotoPosterior (Fig.
simulation may correspond to a clinical simulation of 6 years. 3D) and Venus Diamond. On the other hand, when the material
After polishing procedures at baseline, natural tooth showed con-sists of softer fillers, such as Filtek Supreme XTE, the
the highest gloss. This highlights the fact that, so far, no resin abrasion will occur in a more uniform way, therefore resulting
composite is able to mimic reflectivity of the natural tooth. in a smoother surface and thus a higher gloss (Fig. 3B).
However, Filtek Supreme XTE, a micro-hybrid with aggre Silanization, on the other hand, is another factor of para
gated clusters of Si02 and ZrO nano particles, showed the mount importance.27 A higher quality of silanization might
highest luster among the tested materials (Fig. 3A). This could explain the lower AGU for Empress Direct when compared to
be due to the fact that only microfillers are present in this other materials of the same family (inhomogeneous microhybrid
material. Enamel HRi, Empress Direct and Durafill showed all resin composite with homologous splinters), as claimed by the
a higher reflectivity than the coarse hybrid but lower than Filtek manufacturer.
Supreme XTE. All three restorative materials contained small Within the limitation of this study, natural enamel demon
filler particles (20 nm-0.4 ^m). According to Lee et al26 not strated to be the best substrate in respect to gloss stability and
only the filler size, but the resin matrix system as well as the behavior throughout toothbrushing simulation. In fact, no artifi
shape of the fillers influence initial gloss of materials. Light cial material showed comparable behavior. The null hypothesis
reflectivity seems, therefore, to be related to mean filler size was therefore rejected.
and to the homogeneity of the filler-matrix complex. Higher In future studies, the influence of specific parameters and
filler size and lower homogeneity of the filler-matrix complex parameter combinations should be evaluated in order to
result in less light reflectivity. determine their exact influence on gloss.
The present study clearly showed that, except for the natural a. Micerium. Avegno, Italy.
tooth group, the surface gloss of all the materials was signifi b. GC. Leuven, Belgium

j 8 Lefeveretal
c. lvoclar Vivadent, Schaan, Liechtestein.
d. Coltene Whaledent, Alstatten.
e. 3M Espe, St. Paul, MN, USA.
f. Heraeus Kulzer, South Bend, IN, USA.
g- Kuraray, Tokyo, Japan.
h. Kerr, Orange, CA, USA.
i. Rhopoint Instrumentation Ltd., Bexhill on Sea, UK.
j- Oral B Braun GmbH, Kronberg/Ts., Germany.
k. Unilever, Thyngen, Switzerland.
L Philips, Eindhoven, The Netherlands.
Acknowledgements: To Mrs. Marie Claude Reymond for her help with the
SEM images.
Disclosure statement: The authors declared no conflict of interest. The
manufacturers generously provided the products tested in this study.
Dr. Lefever is Assistant, and Dr. Krejci is Head, Department of Cariology and
Endodontology; Dr. Ardu is Head of Programming and Treatment Planning
Unit, University of Geneva, Geneva, Switzerland. Dr. Perakis is in private
practice, Bologna, Italy. Dr. Roig is Head, Department o f Restorative Dentistry,
International University of Catalunya, Barcelona, Spain.
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