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The minimum thickness of a multilayer porcelain restoration required for

masking severe tooth discoloration

Article  in  Dental research journal · November 2015

DOI: 10.4103/1735-3327.170576

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Dental Research Journal

1 1
2 2
3 3
4 Original Article 4
5 5
6 The minimum thickness of a multilayer porcelain restoration required 6
7 7
8
for masking severe tooth discoloration 8
9 9
Niloofar Shadman1, Saeideh Gorji Kandi2, Shahram Farzin Ebrahimi1, Maryam Azizi Shoul3
10 10
11 1
Department of Operative Dentistry, Faculty of Dentistry, Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, 11
Kerman, 2Department of Polymer Engineering and Color Technology, Faculty of Color Technology, Amirkabir University of Technology, Tehran,
12 12
3
Department of Operative Dentistry, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
13 13
14 14
15 ABSTRACT 15
16 16
17 Background: Although studies have shown that porcelain veneers are very efficient for treating 17
18 discolored teeth, they did not address in particular the minimum thickness of a multilayer IPS e.max 18
19 Press (IvoclarVivadent, Schaan, Liechtenstein) restoration required to mask discolored tooth. The 19
20 aim of this study was to determine the minimum thickness of a multilayer porcelain restoration 20
21 required for masking severe tooth discoloration. 21
22 Materials and Methods: A total of 24 disk-shaped multilayer specimens were prepared from IPS 22
23 e.max Press with the diameter of 13 mm and four different thicknesses (core/veneer: 0.4/0.4 mm, 23
24 0.5/0.5 mm, 0.6/0.6 mm and 0.8/0.7 mm).Two backgrounds, C4-shade body porcelain and an opaque 24
25 background from the selected IPS e.max ceramic itself were fabricated to mimic a discolored or 25
26 stained natural tooth structure and to determine the masking ability.After applying the resin cement 26
27 layer (Panavia F2.0) with 0.01 mm thickness on each background, all specimens were measured 27
28 on both background using a spectrophotometer and values of L*, a* and b* were calculated to 28
29 determine the color differences (∆E ab* ). One-way ANOVA and post-hoc tests of specimen average 29
30 one-to-one comparison (Tukey HSD) were conducted and P ≤ 0.05 was set as the level of significance. 30
31 Results: ∆E ab* of all groups were within the range of the clinically acceptable color difference 31
32 (∆E ≤3.3), thus all the groups could mask the C4 background even group 1 with only 0.8 mm 32
Received: May 2014
33 Accepted: September 2014 thickness. A trend was shown in the results as by increasing the thickness, ∆Eab* is was decreased. 33
34 The mean ∆E 1*a*b
*
between different thicknesses were statistically significant (P < 0.05) only between 34
Address for correspondence: groups 1 and 4 and between 2 and 4.
35 DR. Maryam Azizi Shoul, 35
36 Shafa St., Jomhori Eslami
Conclusion: All groups could mask the C4 background; hence, the minimum thickness of a multilayer 36
37 Boulvard, Kerman, Iran. porcelain restoration (IPS e.max Press) required for masking severe tooth discoloration was 0.8 mm. 37
38 E-mail: maryam_azizishoul@ 38
yahoo.com Key Words: Masking, minimum thickness, multilayer porcelain, severe discoloration
39 39
40 40
41 41
42 42
43 INTRODUCTION importance in aesthetic dentistry. Depending on the 43
44 severity of discoloration, there are several treatment 44
45 With the increase in the demand for possessing options including vital and nonvital bleaching, 45
46 a beautiful smile and white teeth in recent micro abrasion, composite and porcelain veneers, 46
47 years, management of discolored teeth has high porcelain crowns and sometimes a combination of 47
48 48
49
them.[1] 49
Access this article online
50 All-ceramic restorations are more translucent and 50
51 thus have more aesthetic properties than restorations 51
52 52
53 with metal substrates and can be used in aesthetic 53
Website: http//:drj.mui.ac.ir
54 areas properly.[2] It has been proven that porcelain 54
55 veneers are very efficient for treating discolored 55
56 teeth, and they last for a long time if they bond 56

Dental Research Journal / September 2015 / Vol 12 / Issue 5 1

 Shadman, et al.: Minimum porcelain thickness to mask discoloration

1 properly to the tooth structure. Although limiting the According to the results of a study by Zhou et al., 1
2 preparation in enamel leads to more efficient bonding, high opaque (HO) series of IPS e.max press disks 2
3 the porcelain restoration should also be thick enough with 0.6 mm, 0.8 mm and 1 mm thicknesses could 3
4 to mask the discoloration. However, in treating a mask the metal substrate (∆E *ab <1.5) [8] Shono and Al 4
5 5
deeply discolored tooth, a full coverage crown might Nahedh demonstrated that 1.5 mm thickness of IPS
6 6
7 be the ultimate option.[1] Therefore, determining the e.max (A2-shade) was not able to completely mask 7
8 minimum thickness of a porcelain restoration required the black background.[9] 8
9 for masking heavily discolored teeth can be very However, the influence of severe discolored tooth on 9
10 useful in clinical treatments. a multilayer (core and veneer) IPS e.max restoration 10
11 11
There are several factors that determine the final has not been established previously. Therefore, we
12 12
13 aesthetic properties of an all-ceramic restoration investigated this aspect of influence on IPS e.max 13
14 in vivo: Color of the ceramic, thickness and the press by measuring its L*, a* and b* values. 14
15 combination of ceramic layers (such as core and The purpose of this in vitro study was to determine 15
16 veneer with different shade and opacity), the the minimum thickness of a multilayer all-ceramic 16
17 thickness and the color of the luting agent and the 17
restoration (IPS e.max press) required for masking
18 18
color of underlying tooth structure.[3] The ability of an severe tooth discoloration (C4-shade) including a
19 19
20 all-ceramic restoration for masking a tooth with severe HO core for masking the underlying discoloration 20
21 discoloration can be determined by measuring the and an A1 shade veneering layer to provide some 21
22 color difference (∆Eab* ) when the restoration is placed translucency simulating tooth enamel. In addition, 22
23 over two different backgrounds: A dark background Panavia F 2.0 light (Kurrary, Kurashiki, Okayama, 23
24 and a background fabricated from the same material Japan) resin cement was used to enhance the masking 24
25 as the tested restoration but with enough thickness ability.[10] The null hypothesis was that all of the 25
26 to be completely opaque. The masking ability can be selected thicknesses for the ceramic restoration in 26
27 27
determined using the following formula [Eq. 1].[4,5] corporation with the selected resin cement would
28 28
29 mask the C4-shade background. 29
30  (1) 30
31 MATERIALS AND METHODS 31
32 32
33
Spectrophotometer is used to determine International Fabrication of ceramic specimens 33
34 Commission on Illumination (French Commission In this in vitro study, a total of 24 disk-shaped 34
35 internationale de l’éclairage, hence its CIE multilayer specimens were prepared from IPS e.max 35
36 initialism) L*a*b* (CIELAB) color coordinates by Press (Ivoclar Vivadent, Schaan, Liechtenstein), 36
37 spectral reflectance measurements. L*, a* and b* are which is a lithium disilicate glass ceramic in form 37
38 representatives of lightness, greenness-redness and of ingots for the heat-press technique. Different 38
39 yellowness-blueness respectively.[2] When there is no 39
thicknesses of disks were fabricated as recommended
40 40
color difference (∆Eab* = 0), the masking ability of the by the manufacturer using lost wax and heat pressed
41 41
42 system is perfect. However, it has been shown that techniques. For IPS e.max press ceramic, the baseline 42
43 the visually acceptable color difference, for dental disk thickness was 0.4 mm of core and of 0.4 mm 43
44 applications, is when ∆Eab* is ≤3.3.[4] of veneer (group 1). Additional specimens were 44
45
Heat-pressed glass-ceramic lithium disilicate- made with increasing core/veneer thickness (mm) 45
46 of 0.5/0.5 (group 2), 0.6/0.6 (group 3) and 0.8/0.7 46
47 reinforced ceramics (IPS e.max press, IvoclarVivadent, 47
(group 4) according to the manufacture’s instruction.
48 Schaan, Liechtenstein) is a lithium silicate glass 48
According to a similar study of color analysis on
49 ceramic with proper aesthetic features and strength 49
IPS e.max ceramic,[6] sample size was considered six
50 which can be used as extremely thin anterior 50
51 specimens for each group. HO1 shade was selected 51
veneers.[6]
52 to fabricate the ceramic core layer according to the 52
53 Dozic et al. concluded that thin porcelain veneers manufacture’s recommendation for masking severe 53
54 (IPS e.max press, A1, 0.6 mm thick, IvoclarVivadent) tooth discoloration.To obtain the desired thicknesses, 54
55 cannot mask the underlying tooth color even when cores’ wax patterns were fabricated by PixCera 55
56 different shades of resin cements are used.[7] machine (Perfactory, Gladbeck, Germany). Sets 56

2 Dental Research Journal / September 2015 / Vol 12 / Issue 5

 Shadman, et al.: Minimum porcelain thickness to mask discoloration

1 containing three wax patterns were invested in an NeyTech, CA, USA) for 10 min and then cleaned with 1
2 investment ring with a phosphate-bonded investment airborne-particle abrasion using 100 µ Al2O3 powder 2
3 (Ivoclar Vivadent, Schaan, Liechtenstein) after at 2 bar pressure (BEGO, ZiroDent Dentalhandel 3
4 attachment of a 3 mm-diameter sprue to each of the GbR,. Cologne, Germany). Finally, etching of the 4
5 5
patterns. The rings were bench set for 60 min and disks was done using IPS ceramic etching gel (4.5%
6 6
7
placed into a burn out furnace (Ivoclar Vivadent, hydrofluoric acid) for 20 s. Afterwards, all specimens 7
8 Schaan, Liechtenstein) for 120 min. The specimens were cleaned in an ultrasonic bath (Ultrasound Vita- 8
9 were then heat-pressed in an EP600 furnace (Ivoclar Sonic II, Vita Zahnfabrik, Germany) for 5 min and 9
10 Vivadent, Schaan, Liechtenstein), air-cooled, divested dried. 10
11 by blasting with 80 µ glass beads at 4 bar pressure, Fabrication of backgrounds 11
12 and ultrasonically treated in an acidic cleaning liquid Two backgrounds (C4-shade body porcelain [C4]
12
13 (Invex, Ivoclar Vivadent, Schaan, Liechtenstein). 13
14 and an opaque background from the selected IPS 14
15 The manufacturer’s instructions were followed during e.max ceramic itself, Opaque Ceramic, [OC]) were 15
16 all procedures. The thickness were measured using used to mimic a discolored or stained natural tooth 16
17 a digital caliper with 0.01 mm resolution (Mitutoyo structure and to determine the masking ability. For 17
18 Digimatic, Kawasaki, Japan) and were adjusted if OC background, a 4 mm-thick specimen (core and 18
19 needed with 350, 600 and 1500 grit silicon carbide veneer = 2.2 and 1.8) was fabricated using the waxing 19
20 paper (Matador Wasserfast, Germany) under running machine mentioned before for the core (HO1) and a 20
21 21
water. split brass ring mold (with 4.2 mm thickness) for the
22 22
veneerig layer (mixture of 50% T and 50% TI shades).
23 According to the manufacture’s instruction a thin 23
24 Deep dentin (A1: 0.2 mm) was applied between 24
layer of IPS e.max deep dentin should be applied on
25 the core and veneering layer. Finally measured for 25
HO cores before appling a more translucent veneering
26 inherent CIELAB values. The C4 plate (Vita VMK68, 26
layer. We applied a 0.2 mm thickness of deep dentin
27 Vita Zahnfabrik, BadSackingen, Germany) was 27
(A1 shade) using a digital caliper. In the next step,
28 fabricated with a 4.2 mm-thick mold and its inherent 28
29
the core disks were veneered with A1 shade of IPS 29
CIELAB values were measured. The two backgrounds
30 e.max ceram layering material (mixture of 50% 30
had the same diameter as the specimens.
31 T and 50% TI shades, Ivoclar Vivadent, Schaan, 31
32 Liechtenstein). To obtain an uniform thickness, the The thickness sufficient to mask a discolored tooth 32
33 core disks were inserted into custom made brass structure (critical thickness) was determined by 33
34 molds with 13 mm internal diameter and 1, 1.2, calculating the ∆E1*a*b of specimens between the C4 34
35 1.4 and 1.7 mm thicknesses to the desired depth. and OC backings. 35
36 These molds were fabricated 0.2 mm thicker than 36
37 We selected the Panavia F 2.0 (Kurrary, Kurashiki, 37
the desired final thicknesses to compensate for the
38 Okayama, Japan) light cure resin cement to benefit 38
veneering layers shrinkage. The veneering porcelain
39 from its partial masking ability.[10] Since the luting 39
40 was mixed with build-up liquids and introduced to the 40
cement was the same for all ceramic specimen in
41 molds with hand vibration and condensation. Excess 41
our study, we placed the cement layer on the two
42 moisture was removed with a tissue. After firing, the 42
backgrounds instead of applying it to the 24 ceramic
43 thickness was adjusted if needed with silicone carbide 43
specimen.
44 paper under running water. 44
45 For applying the cement layer on each background, 45
46 Firing was performed according to the manufacturer’s 46
a disc with 13 mm in diameter was obtained from
47 recommended procedure. After firing, the disks were 47
a plastic sheet which had 0.1 mm thickness, placed
48 ground on the veneer side using the same polishing 48
on the background and silicone mold was prepared.
49 apparatus with 350, 600 and 1500 grit silicon carbide 49
Four gaps were made in the silicon mold for the
50 paper under running water to adjust to the designated 50
51 cement excess. Inside the space, cement was placed. 51
total thicknesses and an auto-glazing process was
52 First, a plastic sheet and the glass slab were put on 52
performed at 730°C.
53 the uncured resin cement and pressured with finger 53
54 Later, the disks were immersed in IPS e.max Press and cured by Quartz-Tungsten-Halogen light curing 54
55 Invex liquid for 20 min (<1% hydrofluoric acid) device for 40 s (Optilux 501, Demetron Kerr, Orange, 55
56 and cleaned in an ultrasonic cleaner (DENTSPLY CA, USA)[11] [Figure 1]. 56

Dental Research Journal / September 2015 / Vol 12 / Issue 5 3

 Shadman, et al.: Minimum porcelain thickness to mask discoloration

1 Spectrophotometric analysis A smaller ∆E indicates that the specimen is less 1

2 The color measurements were performed using a sensitive to (as better able to mask) the C4-shade 2
3 Gretag Macbeth ColorEye 7000A spectrophotometer background color. Critical thickness is the minimum 3
4 (Color Eye 7000 A, Model C6; Gretag Macbeth, New ceramic thickness sufficient for masking the C4- 4
5 5
Windsor, NY, USA). This spectrophotometer with an background that is determined through the clinically
6 6
7 integrating sphere d/8 geometry has two measuring acceptable ∆E range (∆Eab* ≤ 3.3). 7
8 modes; specular component included and specular 8
Determining the minimum thickness of ceramic for
9 components excluded (SCE). In the present study the 9
masking C4-shade background (critical thickness) is
10 specular excluded (SCE) configuration was applied 10
11
a cut-off point, which does not need any statistical 11
to compensate for errors caused by surface glaze.
12 analysis. For the four different thicknesses specimen 12
Before each measurement, the spectrophotometer
13 groups, one-way ANOVA and post-hoc tests of 13
was calibrated using the calibration tile supplied
14 specimen (Tukey HSD) were conducted, and P ≤ 0.05 14
by the manufacturer. The ceramic specimens were
15 was set as the level of significance. 15
16 placed individually over each of the backgrounds. In 16
17 Commission Internationale de l’Eclairage colorimetry Mean ΔE values were statistically evaluated. 17
18 color is quantified using the parameters of lightness Differences between means at P ≤ 0.05 was considered 18
19 (L*) and chromaticity along the red-green (a*) and statistically significant. To make a statistical analysis, 19
20 yellow-blue (b*) axes. The difference between two SPSS 21 computer program (SPSS Inc., Chicago, Il, 20
21 colors (ΔE) is determined by measuring CIELAB USA) was used. 21
22 22
23
values by a spectrophotometer. CIELAB coordinates 23
provide a numerical description of the color’s RESULTS
24 24
25 position in a three-dimensional color space. The L* 25
color coordinate ranges from 0 to 100 and represents According to the spectrophotometric measurements,
26 26
27 lightness. The a* color usually coordinate ranges L*, a* and b* values of the backgrounds are presented 27
28 from 90 to 70 and represents the greenness on the in Table 1. The mean CIELAB color values and ΔE 28
29 negative axis and redness on the positive. The b* values of IPS e.max ceramic specimens placed on 29
30
color coordinate ranges almost from 80 to 100 and both backgrounds are shown in Tables 2 and 3. 30
31 31
32 represents yellowness (positive b*) and blueness ∆Eab* of all groups were within the range of the 32
33 (negative b*). ∆Eab* represents the numerical distance clinically acceptable color difference (∆E ≤3.3), 33
34 between L*a*b* coordinates of 2 colors using the thus all the groups could mask the C4 background. 34
35 Eq. 1.[12] The ∆Eab* value (difference between C4 [1] A trend was showing the results as by increasing the 35
36 and OC [2]) was evaluated for each thickness. The thickness, ∆Eab* was decreased. 36
37 total color difference ∆Eab* was calculated using the 37
38 38
Eq. 1. Table 1: Chromatic values of ceramic backgrounds
39 39
40 Background L* a* b* 40
41 OC 70.59  −0.81 7.17 41
42 C4 61.36 3.35 16.61 42
43 OC: Opaque ceramic. 43
44 44
45 Table 2: Chromatic values of ceramic specimen 45
46 under different backgrounds (mean ± SD) 46
47 Group Background L* a* b* 47
48 1 OC 75.97±0.85 −1.35±0.09 10.23±0.52 48
49 C4 74.57±0.87 −0.61±0.10 9.53±0.40 49
50 2 OC 75.89±0.55 −1.36±0.08 10.31±0.68 50
51 C4 74.61±0.62 −0.81±0.07 9.48±0.56 51
52 3 OC 75.15±0.46 −1.44±0.02 9.81±0.49 52
53 C4 74.18±0.49 −1.03±0.05 9.04±0.48 53
54 4 OC 75.69±0.67 −1.30±0.10 10.62±0.94 54
55 Figure 1: Schematic figure for the method to prepare constant C4 74.97±0.86 −1.09±0.09 9.93±0.73 55
56 cement layer thickness. SD: Standard deviation; OC: Opaque ceramic. 56

4 Dental Research Journal / September 2015 / Vol 12 / Issue 5

 Shadman, et al.: Minimum porcelain thickness to mask discoloration

1 Table 3: ∆Eab
*
of ceramic specimen over different achieved when the tooth preparation is limited to 1
2 backgrounds (mean ± SD) the enamel. In addition, increasing the opacity of 2
3 Group Thickness ΔL* Δa* Δb* ΔE the ceramic restoration adversely affects its aesthetic 3
4 1 0.8 −1.42±0.22 0.74±0.02 −0.70±0.18 1.75±0.25 properties. Therefore, using a multilayer ceramic 4
5 5
2 1 −1.28±0.37 0.55±0.07 −0.82±0.16 1.62±0.36 restoration including an opaque core for masking the
6 3 1.2 −0.96±0.21 0.40±0.04 −0.77±0.11 1.31±0.19 6
7 underlying discoloration and also a veneering layer 7
4 1.5 −0.72±0.25 0.21±0.02 −0.69±0.26 1.03±0.32
8 to give some translucency in combination with an 8
SD: Standard deviation.
9 opaque luting cement would be beneficial.[10] 9
10 10
The mean ∆Eab* between different thicknesses was In the present study, we used a C4-shade dental
11 11
12 statistically significant (P < 0.05) only between porcelain to simulate a severely discolored tooth 12
13 groups 1 and 4 (mean difference of 0.71) and between and evaluated the ability of different thicknesses 13
14 2 and 4 (mean difference of 0.59). of IPS e.max ceramic specimens for masking this 14
15 discoloration by measuring their CIELAB values. 15
16 DISCUSSION Besides color differences, the masking ability
16
17 17
18 of ceramic materials can be evaluated with a 18
According to the results of our study, the minimum
19 spectrophotometric instrument in terms of the opacity 19
thickness of a multilayer porcelain restoration (IPS
20 or contrast ratio (CR). The (CR = Yb/Yw) is defined 20
e.max Press) required for masking severe tooth
21 as the ratio of illuminance (Y) of the test material 21
22 discoloration was 0.8 mm. Thus, our null hypothesis 22
when it is placed over a black background (Yb) to the
23 that all the specimen groups would mask the C4-shade 23
illuminance of the same material when it is placed
24 background was supported. 24
over a white background (Yw).[5]
25 25
Management of tooth discoloration caused from
26 According to some studies, when the numerical 26
intrinsic or extrinsic factors is one of the major
27 distance between L*a*b* coordinates of 2 colors 27
28 challenges any dentist may face. Depending on the 28
(ΔE) is <1 unit, it means that the colors are match
29 etiology and severity of the tooth discoloration, 29
and when it is between 1 and 2, the difference is
30 treatment options can range from a simple scaling 30
frequently detected by observers and ΔE of higher
31 and polishing of the teeth and different bleaching 31
32 than 2 is detectable by all observers. However, ΔE 32
procedures to restorative treatments such as veneers
33 of below 3.7 in oral environment is unnoticeable 33
or even crowns.[1]
34 because of the uncontrolled clinical condition.[14-16] ΔE 34
35 In treating sever tooth discolorations, restoring an anterior values of <1 unit were regarded as not appreciable 35
36 tooth by an all-ceramic restoration with the advantages by the human eye; ΔE values >1 and <3.3 units 36
37 such as excellent aesthetic properties, biocompatibility were considered appreciable by skilled operators, but 37
38 and wear resistance can be an appropriate option. But, clinically acceptable; ΔE values >3.3 were considered 38
39 39
there is a question that how much tooth reduction is perceivable by untrained observers (e.g., patients), and
40 40
41
necessary to mask the severe discoloration? Our study for that reason were regarded as not acceptable.[17] In 41
42 was conducted to answer this question. this study, all groups had ∆E*ab of between 1 and 2. 42
43 Although a thin porcelain veneer of an opaque According to some other studies, differences in ∆Eab* 43
44 44
ceramic can mask the underlying discolored tooth, lower than 1.1 cannot be detected by the human eye,
45 45
46
it leads to a nonvital appearance. Therefore, in our a ∆Eab* between 1.1 and 3.3 can be detected but is still 46
47 study we tried to find the minimum thickness of a considered clinically acceptable, while a ∆Eab* higher 47
48 multilayer ceramic restoration with an opaque core than 3.3 can be detected and is by an aesthetic point of 48
49 and a translucent veneer to not only mask the tooth view considered as clinically not acceptable.[18-20] We 49
50 discoloration, but also to have a vital appearance. also considered ∆Eab* < 3.3 as a clinically acceptable 50
51 color difference in our study. 51
52 Although increasing the thickness of a ceramic 52
53 restoration improves its masking ability, the increased The overall optical behavior and aesthetic properties 53
54 amount of tooth reduction thereby necessary can of an all-ceramic restoration are determined by the 54
55 jeopardize pulpal health.[13] On the other hand, an underlying tooth structure color, the thickness of the 55
56 efficient bonding of a ceramic restoration can be ceramic layers, and the color of the cement.[11,12,21-23] 56

Dental Research Journal / September 2015 / Vol 12 / Issue 5 5

 Shadman, et al.: Minimum porcelain thickness to mask discoloration

1 Vichi et al. investigated the masking ability of ceramic Zhou et al. concluded that IPS e.max Press HO 1
2 restorations of various thicknesses (1.0, 1.5, and series ceramic specimen thickness of 0.4 mm 2
3 2.0 mm) of a leucite-reinforced ceramic material (IPS could not guarantee completely masking the metal 3
4 Empress; Ivoclar Vivadent, Schaan, Liechtenstein) substrate background and produced clinically 4
5 5
over different opaque posts and reported that full unacceptable color match. While the thicknesses
6 6
masking or acceptable ΔE was achieved only with the of 0.6 mm, 0.8 mm and 1.0 mm could significantly
7 7
8 2 mm-thick ceramic material.[11] mask the color of metal substrate disks (ΔE <1.5).[8] 8
9 In our study, groups 3 (1.2 mm) and 4 (1.5 mm) 9
Results of a study by Shimada et al. revealed that
10 had ∆Eab* of <1.5. 10
there were no significant differences in ∆Eab* value at
11 11
2.0 mm thickness of IPS Empress2 Ingot-100 under Studies in this field, however, did not address in
12 12
different backgrounds (a composite build-up material, particular the minimum thickness of multilayer IPS
13 13
14 a gold alloy and a silver palladium alloy).[24] e.max Press required masking a discolored tooth. 14
15 The purpose of this in vitro study was to determine 15
Chu et al. suggested that Procera and Empress 2 had
16 the minimum thickness of all-ceramic restoration 16
significantly higher CR and masking abilities when
17 required to mask a C4-shade background while 17
compared to Vitadur Alpha. However, when the
18 using Panavia F2 resin cement to enhance the 18
19 discoloration is too intense, the application of these 19
masking ability. To achieve the best aesthetic results
20 two materials may still be limited.[13] 20
in masking a severe discoloration, our ceramic
21 In this study, we investigated the masking ability of specimen included two ceramic layers with different 21
22 IPS e.max Press. By the tremendous advances in the 22
properties; a HO core layer to mask the underlying
23 23
mechanical and optical properties and fabrication discoloration and a translucent veneering layer
24 24
25 methods of ceramic materials, heat-pressed glass- to replicate the natural tooth vitality appearance. 25
26 ceramic lithium disilicate-reinforced ceramics (IPS Our results showed that the minimum thickness 26
27 e.max Press) have become popular due to the material’s of the porcelain required for masking severe tooth 27
28 favorable mechanical and aesthetic properties. IPS discoloration was 0.8 mm. By limiting the tooth 28
29 e.max Press with the compressive strength of 350-450 preparation to only 0.8 mm (in the enamel), we 29
30 MPa and fracture toughness of approximately 3 times can get a more predictable bonding of the ceramic 30
31 that of the Lucite glass ceramic also has the ability restoration to the tooth structure.[1] 31
32 of bonding to tooth structure. Its fabrication technique 32
33 In our study, ∆Eab* of all groups were lower than 3.3 or 33
(lost wax) is more practical than layering technique
34 3.7 which are clinically acceptable color difference. 34
and leads to an excellent adaption of the restoration. It
35 Even considering the perceptible difference 35
36 is the optical compatibility between the glassy matrix 36
(ΔE >2),[12] still all groups had the ability of masking
37 and the crystalline phase which makes the glass- 37
the discolored background.
38 ceramic lithium disilicate-reinforced ceramics high 38
39 translucent aesthetic ceramics. Including various shades CONCLUSION 39
40 with different chroma and opacities gives the dentist 40
41 the opportunity of achieving the desired color even in 41
42
The minimum thickness of a multilayer porcelain 42
treating severe discolored teeth.[12,25] restoration (IPS e.max Press) required for masking
43 43
44 An investigation on masking ability of IPS e.max severe tooth discoloration was 0.8 mm including a 44
45 computer-aided design/computer-aided manufacturing 0.4 mm core and 0.4 mm veneer. 45
46 low translucent in a group with a dark-colored 46
47 abutment tooth revealed that 1.0 mm of this restorative ACKNOWLEDGMENTS 47
48 material cemented using either translucent cement or 48
49 The authors thank Kerman University of Medical Sciences 49
opaque cement and 1.5 mm cemented with translucent
50 for financial support, Dr. Jahani for statistical analysis and 50
51 cement had ΔE values higher than the clinically Toos Dental laboratory for specimens’ fabrication. 51
52 unacceptable range (ΔE >3.7).[12] But we concluded 52
53 that by using a restoration from IPS e.max Press with REFERENCES 53
54 only 0.8 mm thickness in combination with Panavia 54
55 resin cement on C4 shade abutment, ∆E*ab would be 1. Setien VJ, Roshan S, Nelson PW. Clinical management of 55
56 in clinically acceptable range. discolored teeth. Gen Dent 2008;56:294-300. 56

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