Journal of Advanced Clinical & Research Insights (2014), 2, 36–41
ORIGINAL ARTICLE
Assessment of the effects of staining solutions, carbamide
peroxide, and mouthwashes on color stability of
composite resin
Érica Crastechini, Paula de Siqueira Barbosa, Heleine Maria Chagas Rêgo, Priscila Holleben, Carlos Rocha Gomes Torres,
Sérgio Eduardo de Paiva Gonçalves, Ana Paula Martins Gomes, Maria Filomena Rocha Lima Huhtala
Department of Restorative Dentistry, Sao Paulo State University - UNESP, Institute of Science and Technology, São José dos Campos, Brazil
Keywords
Composite resin, color stability, carbamide
peroxide, mouthwashes, staining solutions
Correspondence
Maria Filomena Rocha Lima Huhtala, Avenida
Engenheiro Francisco José Longo, 777, Jardim
São Dimas, São José dos Campos, SP, Brazil.
CEP: 12245-000. Tel.: +55 (12) 3947 9382.
Fax: +55 (12) 3947 9010.
Email: huhtala@fosjc.unesp.br
Received 01 June 2014;
Accepted 20 August 2014
doi: 10.15713/ins.jcri.11
Abstract
Objective: The aim of this study was to evaluate the effect of the four staining solutions
(SS) coffee (CF), grape juice (GJ), acai berry, and green tea, on color stability of four
composite resin (CR) A (Amelogen Plus/Ultradent), F (Filtek Z350 XT/3M ESPE),
C (Charisma Opal/Heraeus/Kulser, and G (Grandio SO/Voco GmbH) when submitted
to surface treatments (ST) using the mouthwashes (MW) Listerine Whitening (J and J);
plax whitening tartar control (Colgate) and Oral B Pro-health (Oral B), and bleaching
agent (BA) - 10% carbamide peroxide (CP) (Opalescence PF 10% Regular/Ultradent
Products Inc.).
Materials and Methods: One hundred disks of each CR were made and distributed
into subgroups: Control, MW, and BA. After ST, they were immersed into the SS
(24 h). The specimens were submitted to three color measurements using a reflectance
spectrophotometer (Konica Minolta).
Results: The data were submitted to the statistical analysis using the ANOVA and
Tukey’s tests (P < 0.05). The results showed that after ST, the CR of Group C presented
higher mean color variation (MCV). The ST that showed the highest MCV was 10%
CP after submitting the specimens to the SS. Group F showed the highest MCV. The
ST that showed the highest MCV was Group Oral B and the SS with the highest MCV
were GJ and CF. The CR influences color stability. The MWs increase susceptibility to
staining of CR. All the SS influenced color stability of CR.
Introduction
Direct composite resins (CRs) restorations have innumerable
advantages in restorative treatments, being the best choice to
preserve tooth structure, which corroborates with the recent
concepts of a more conservative approach in restorative
dentistry. The technique enables adequate sealing of cavities
using adhesive systems.[1]
Currently, CRs mimic color, translucency, and texture
of a natural tooth as well as having adequate biomechanical
properties due to the improvement in the matrix composition
and load-matrix bond. Thus, since the beginning of the 1970s,
these restorative materials have become the material of choice
for direct esthetic restorations of anterior teeth and, more
recently, of posterior teeth due to the improvement in the wear
strength properties. The mean longevity of CR in anterior
36
teeth (7 years) is now similar to the one found for amalgam
restorations (10 years).[1,2]
CRs are cross-linked polymeric materials reinforced
with dispersion of glass crystals or inorganic filler particles
composed of glass, quartz, or silica particles bonded to the
organic matrix (bisphenol A-glycidyl methacrylate [Bis-GMA],
triethyleneglycol-dimethacrylate [TEGDMA], ultra direct
memory access) by Silane bonding agents.[2] This composition
and load distribution differ among the different CRs now
available on the market. Recent studies have shown that different
compositions of resins, such as nanohybrid and microhybrid,
undergo changes in color stability when exposed to different
types of beverages such as CF, tea, red wine, and col.[3] Color
change in restorations may be the result of intrinsic or extrinsic
causes. The extrinsic causes include the accumulation of plaque
and stain on the surface or sub-surface resulting in surface
Journal of Advanced Clinical & Research Insights ● Vol. 1:2 ● Sep-Oct 2014
Crastechini, et al.
degradation or slight penetration and reaction of staining agents
within the surface layer of the CR.[4] The intrinsic causes result
in the discoloration of resins such as the alteration of the resin
matrix, matrix interface, and filler particles.[5]
CRs color stability, previously analyzed in other studies,[3,6] is
also affected by factors such as roughness and surface integrity,
which are altered by commonly used chemical agents such as
alcohol, mouthwashes (MW),[7] and by polishing techniques.
At present, due to the search for esthetics and the launching of
new products on the dental market, there has been an exponential
increase for dental bleaching treatments that use bleaching gels
and MW containing bleaching substances in their composition.
In an attempt to have “perfectly white” teeth, individuals have
been using bleaching techniques that may cause modifications
on the surface and shine of composites.[8,9] Teeth restored with
CRs are submitted to the action of these substances. Some recent
studies have tested the relationship between BAs and surface
and color changes of CRs showing that in vitro bleaching did not
increase the susceptibility to staining and surface changes of CR
due to extrinsic factors.[10,11]
Alcohol may be present in the formulae of some MW that,
according to Ardu et al.,[12] may also cause changes in surface and
shine of CR restorations. Similar to fluoride, which is present in the
formula of MW, a substance that, according to Jung et al.[13] promotes
a slight change in color and alteration of the composite surface.
Therefore, understanding the changes in color stability
of CRs caused by chemical agents used in dental procedures
by MW used by patients and by beverages, ingested daily,
containing coloring is of fundamental importance for the dentist,
not only when performing these procedures, but also when
guiding patients who are submitted to esthetic dental bleaching
treatments.
The aim of this study was to evaluate the effect of the four
staining solutions (SS) on color stability of four CR when
submitted to previous surface treatments (ST) using a bleaching
agent (BA) and MW.
The null hypotheses in our study were as follows:
1. The type of CR does not influence color stability of the
material
2. ST with MW and carbamide peroxide (CP) does not
influence susceptibility to color alteration of resins when
immersed in different SS
3. The type of SS does not influence susceptibility to color
change of CR.
Materials and Methods
Fabrication of CR disks
Four hundred disks (3 mm × 2 mm) were made of CR shade
A2 with the aid of a silicone mold with a diameter of 2 mm and
3 mm high. To manufacture the disks, the CR was inserted in
two increments into the silicone mold being one polymerized for
40 s, 36 j/cm², with a high-intensity visible light emitting diodes,
Assessment of color stability of composite resin
Model EMITTER A (Schuster Comércio de Equipamentos
Odontológicos Ltda, Santa Maria – RS – Brazil) at power density
of 600 mW/cm². In the last increment, a polyester matrix was
placed on the resin surface, and the polymerizing tip was in
contact with the matrix during exposure of the material to light.
Distribution of disks into experimental groups
The disks were divided into groups according to the types of CRs
used: A (Amelogen Plus/Ultradent), F (Filtek Z350 XT/3M
ESPE), G (Grandio SO/Voco GmbH), and C (Charisma/Opal/
Heraeus/Kulser) [Chart 1]. Each group of CR (n = 100) was
divided into the following five subgroups according to the MW
solutions (n = 20): L (Listerine Whitening – J and J); P (Plax
whitening tartar control - Colgate); O (Oral B Pro-health - Oral
B); BA (10% CP - Opalescence PF 10% Regular - Ultradent
Products Inc.); and S (control – artificial saliva) [Chart 2]. The
subgroups were placed into the following SS: grape juice (GJ),
green tea (GT), acai berry (AB), and coffee (CF) (n=5) [Chart 3].
Processing of disks in each group
After the disks had been immersed into saliva at 37°C for 24 h,
finishing and polishing was performed. For this procedure, each
disk was placed onto a metal device (with a diameter perforation
slightly larger than the disk and 2 mm deep) and taken to a
circular polishing machine at 300 rpm in order to obtain a
uniform surface. The surface was initially worn using 2400 grit
water abrasive paper coupled to the circular polishing machine
(DP-10, Panambra, São Paulo, SP, Brazil) at 300 rpm and then
polished with 4000 grit water abrasive paper for 10 s.
The three color readings were performed using a reflectance
spectrophotometer (Konica Minolta c, e, p), model CM 2600 d,
to collect the color data according to the system CIE L*a*b*.
The appliance was adjusted to read small samples (SAV) with
an observation angle of 10° and specular reflection. Included the
appliance was adjusted to perform three consecutive readings
on a white standard background to obtain a mean value per
sample. The appliance was coupled to a microcomputer, and the
Chart 1: Characteristics of composite resin used, manufacturers,
compositions, and lot
Composite Manufacturer
Amelogen Ultradent,
plus
Indaiatuba, São
Paulo, BR
Composition
Lot
Bis‑GMA, TEGDMA,
B4LSZ
barium boron‑amine silicate
Filtek
supreme
3M ESPE, Saint
Paul, Minnesota,
USA
Bis‑GMA, Bis‑EMA UDMA, 7018
TEGDMA, zirconion/silicon A2E
Grandio
SO
Voco GmbH,
Bis‑GMA, Bis‑EMA, BHT 1034125
Cuxhaven, Germany and TEGDMA, nanohybrid
Charisma Heraeus Kulzer
Bis‑GMA,
opal
South, Americana, barium‑aluminum and
São Paulo, BR
silicon microparticles
010023
TEGDMA: Triethyleneglycol-dimethacrylate, Bis-GMA: Bisphenol
A-glycidyl methacrylate, Bis-EMA: Ethoxylated bisphenol A-methacrylate,
UDMA: Urethane dimethacrylate
Journal of Advanced Clinical & Research Insights ● Vol. 1:2 ● Sep-Oct 201437
Crastechini, et al.
Assessment of color stability of composite resin
Chart 2: Mouthwashes and bleaching agents used, composition, manufacturer, and lot
Material
Listerine® whitening
Composition
Water, alcohol (8%), hydrogen peroxide, sodium phosphate, poloxamer 407, sodium lauryl
sulfate, sodium citrate, mint flavor, menthol, eucalyptol, sodium saccharin, sucralose
Manufacturer
Jonhson and
Jonhson
Lot
01/2011
Plax® Whitening
tartar control
Active ingredients: sodium fluoride (225 ppm fluoride)
Ingredientes: aqua, glycerin, alcohol, propylele glycol, sorbitol, tetrapotassium
pyrophosphate, polysorbate 20, tetrasodium pyrophosphate, zinc citrate, PVM/MA
copolymer, aroma, sodium benzoate, sodium fluoride, sodium saccharin, Cl 42090.
Contains sodium fluoride
Colgate
BR121AVAL
Oral‑B® Pro‑health
Active ingredients: 0.07% cetylpyridinium chloride. Inactive ingredients: aqua, glycerin,
aroma, polaxamer 407, methylparaben, sodium saccharin, propylparaben, CI 42090
Oral‑B
12709929A0
Opalescence® PF 10%
carbamide peroxide
Carbamide peroxide gel, contains potassium nitrate and 0.11% (1100 ppm) fluoride ions
Ultradent
Products INC
B4PVN
Chart 3: Staining solutions used, compositions, manufacturers and lot
Product
GJ Aurora®
Composition
Concentrated red grape juice, potassium sorbate
and sulfur dioxide as preservatives, no gluten,
unfermented and non‑alcoholic
Manufacturer
Wine cooperative
aurora
Preparation
None
Lot
001/2011
GT
Camellia sinensis
Amor a vida natural
products Inc
100 mL of hot water
and (4 g) of green tea
150
Ouro vermelho®
Açaí D’
Amazônia
Medium acai and guarana syrup (15%), inverted
sugar and guarana extract, contains citric acid.
No coloring, unfermented, no alcohol, no gluten
Eldorado comércio de
gêneros alimentícios
Ltda EPP
None
Product registration:
0733500006‑3
Nescafé®
100% pure CF
Nestlé Brasil Ltda
50 mL of hot water/(2 g)
of CF powder
02711210
CF: Coffee, GT: Green tea, GJ: Grape juice
program Spectromagic N X (Konica Minolta c, e, p) was used.
The first reading was performed immediately after polishing.
Next, 240 specimens were stored in Eppendorfs containing
2 ml of MW solution for 24 h and 80 were stored in Eppendorfs
immersed into CP for 48 h. The other 80 specimens from the
control group were not submitted to this stage and were kept
in artificial saliva. After the ST period, the specimens were
washed with distilled and deionized water, and the second color
reading was performed. The data of general color variation
(ΔE) were calculated comparing the initial data with those
obtained after contact with the MW and BA agent as well as
the initial data after immersion in the SS by using the formula
ΔE*= ([L1*−L0*]2+[a1*−a0*]2+[b1*−b0*]2)1/2. The 400 specimens
were then stored in SS for 24 h. After this time interval, they
were washed with deionized water, and the final color reading
was performed. Throughout this process, all the specimens were
stored at 37°C. The statistical analysis was performed using the
two-way ANOVA and Tukey’s tests for the data after the MW
and three-way ANOVA and Tukey’s tests for the data after the
SS, and a level of significance of 5% was adopted.
Results
The two-way ANOVA test for the ΔE values for the color
variation of CR after contact with the MW and BA, before
38
Table 1: Two‑way ANOVA results for the data after exposure to
mouthwashes and bleaching agent
GL (df)
3
MQ (MS)
8.42
F
3.04
P
0.03*
Surface treatment
3
14.70
5.30
0.00*
Treatment/Resin
9
15.82
5.70
0.00*
Factors
Resin
*Significant differences, df = degree of freedom, MS = mean square,
F = F-statistics, p = p-value
being submitted to the SS, can be seen in Table 1. All factors
analyzed showed statistically significant differences as well as the
interaction among them.
In Table 2, the results of the Tukey’s test for CR are stated.
Groups F and C differ statistically from each other. Group F showed
the lowest mean value for color alteration when submitted to ST,
prior to the SS, but did not statistically differ from Groups G and A.
As to the ST, Table 3 shows the mean values for color
variation, standard deviation (SD), and the results of the Tukey’s
test. It was found that Groups L, P, and O influenced the mean
values for color variation in a statistically similar way. Group CP
showed the highest mean color variation (MCV) and presented
a statistically significant difference in comparison with the other
groups, prior to the exposure to SS.
Table 4 shows the result of the three-way ANOVA, with the
interaction of the factors: Resin, ST, and SS. It was found that all
Journal of Advanced Clinical & Research Insights ● Vol. 1:2 ● Sep-Oct 2014
Crastechini, et al.
Assessment of color stability of composite resin
Table 2: Mean values and ±SD for the parameter∆E* and the
results of Tukey’s test for the factor CR
Table 5: Mean values and±SD for the parameter ∆E* and the
results of Tukey’s test for the factor CR
Resin (R)
Filtek Z350 XT (F)
Mean
3.02
SD
1.74
Homogeneous sets*
A
CR
Grandio SO (G)
Mean
5.85
SD
2.96
Homogeneous sets*
A
Grandio SO (G)
3.05
1.66
AB
Amelogen plus (A)
6.88
3.66
B
Amelogen plus (A)
3.31
1.87
AB
Charisma opal (C)
7.07
3.83
B
Charisma opal (C)
3.72
1.93
B
Filtek Z350 XT (F)
8.36
3.53
C
*The factors followed by the same letters do not show significant
differences, SD: Standard deviation, CR: Composite resin
*The factors followed by the same letters do not show significant
differences, CR: Composite resin, SD: Standard deviation
Table 3: Mean values and±SD for the parameter∆E* and the
results of Tukey’s test for the factor
Table 6: Mean values and±SD for the parameter ∆E* and the
results of Tukey’s test for the factor ST
ST
CP
Mean
5.36
SD
2.93
Homogeneous sets*
A
A
Saliva (S) (control)
5.43
3.32
A
A
Plax (P)
7.61
3.70
B
B
Listerine (L)
7.86
3.20
B
Oral B (O)
8.95
3.47
C
ST
Listerine (L)
Mean
2.99
SD
2.15
Homogeneous sets*
A
Plax (P)
3.04
1.98
Oral B (O)
3.16
1.76
CP
3.91
1.09
*The factors followed by the same letters do not show significant
differences, ST: Surface treatment, CP: Carbamide peroxide
Table 4: Three‑way ANOVA results for the reading after exposure
to SS
*The factors followed by the same letters do not show significant differences,
ST: Surface treatment, CP: Carbamida perox, SD: Standard deviation
Table 7: Mean values and±SD for the parameter ∆E* and the
results of Tukey’s test for the factor SS
gl (df)
3
MQ (MS)
105.94
F
51.34
P
0.00*
ST
4
201.26
97.54
0.00*
SS
GT
Mean
4.30
SD
1.69
Homogeneous sets*
A
SS
3
769.69
373.01
0.00*
AB
5.02
2.37
B
R×ST
12
22.48
10.90
0.00*
CF
9.27
2.45
C
R×SS
9
20.34
9.86
0.00*
GJ
9.60
3.84
C
*The factors followed by the same letters do not show significant differences,
SS: Staining solution, GT: Green tea, AB: Acai berry, CF: Coffee, GJ: Grape
juice, SD: Standard deviation
Factors
R
ST×SS
12
30.48
14.77
0.00*
R×ST×SS
36
8.09
3.92
0.00*
*Significant differences, SS: Staining solution, ST: Surface treatment, R: Resin,
df = Degree of freedom, MS = Mean square, F = F-statistics, p = p-value
the factors analyzed showed statistically significant interaction
and influence (P < 0.05) on color variation and interaction
among them.
After the exposure of CR to SS, it can be identified in Table 5
the mean values, SD, and the results of the Tukey’s test for
the factor CR. The lowest MCV was found in Group G, while
Group F showed the highest variation. Both groups differed
statistically and from the other groups. Groups A and C
presented statistically similar mean values.
Regarding ST after exposure to SS, it can be seen in Table 6
the mean values, SD, and the results of Tukey’s test for the
factor ST. The highest MCV was found in Group O that differed
statistically from the other groups. Groups CP and S presented
lower mean values, but statistically similar. Groups P and L
presented statistically similar MCV.
After the exposure to the SS, the data found are presented in
Table 7 that shows the mean values, SD, and the results of the
Tukey’s test for the factor SS. Group GT presented the lowest
MCV that statistically differed from the other groups. Group GJ
caused the highest mean variation and had a statistically similar
effect as Group CF. Group AB differed statistically from the
other groups and caused the second highest MCV.
Discussion
In this study, all the CR studied (microhybrid, nanoparticle, and
nanohybrid) showed statistically significant MCV when along
with exposed to MW, BA, and SS. Filtek Z350 XT, Amelogen
Plus and Grandio SO CR showed the lower mean value for color
variation when exposed to ST. But Filtek Z350 XT showed the
highest MCV when exposed to the SS.
This color variation in the presence of SS is in agreement with
previous studies of Nasin, et al.,[4] who also found lower values
for color stability for Filtek Z350 XT (nanoparticle) resin and
stated that staining of this resin may be related to the nature of
the matrix and disposition of the filler particles.
Ertas, et al.[3] concluded in their study that resins that do
not contain TEGDMA in their composition show higher color
stability than the materials that do contain TEGDMA. However,
the latter study differs from our study with regard to grandio CR,
Journal of Advanced Clinical & Research Insights ● Vol. 1:2 ● Sep-Oct 201439
Crastechini, et al.
Assessment of color stability of composite resin
which contains TEGDMA in its composition, and showed lower
MCV after exposure to SS. Topcu, et al.[14] affirmed in another
study that Filtek Z 250, which contains ethoxylated bisphenol
A-methacrylate (Bis-EMA) in its composition, presented higher
color alteration when exposed to SS than other materials studied
that had TEGDMA in their composition. Bis-EMA has a more
hydrophobic structure than TEGDMA.
With regard to ST, when MW and CP were compared, a
statistically significant difference was found among them.
Group Oral B (alcohol-free) showed the highest MCV.
According to Yap, et al.[15] the MW with or without alcohol may
affect the hardness of restorative materials, but it depends on the
chemical composition, type, and load of the materials. According
to Gugan et al.[16] ethanol causes greater softening of the matrix of
CRs that contain Bis-GMA in their composition, but concluded
that alcohol is not the only factor that has a softening effect
on CRs. However, Almeida, et al.[17] concluded that the use of
MW containing alcohol with low pH may increase sorption and
solubility of CRs. Furthermore, due to a larger surface area and
volume of its filler particle system, the nanoparticle resin (Fittek
Z 350) may suffer greater degradation than the hybrid resin
(Filtek P 60).
In a disagreement with these studies, Lucena, et al.[7]
concluded that the exclusive action of MW tested in their study
(listerine, plax classic and plax kids) did not cause significant
alteration in surface roughness; and Gurdal, et al.[18] found
that the effects of MW did not differ statistically from distilled
water with regard to color stability and microhardness of three
different esthetic restorative materials assessed.
Differently from the MW, CP showed a statistically similar
MCV to the saliva group in our study. Thus, it may be affirmed
that it does not increase susceptibility of resins to different SS. This
result was also found by Celik, et al.[11] According to Silva Costa, et
al.[19] the BA used in their study did not cause deleterious effects
on the microhardness of nanoparticle CRs when compared with
the control group (artificial saliva). On the other hand, Wang, et
al.[20] concluded that the changes in surface roughness of CRs after
bleaching depend on time. They also found that Filtek Z350 CRs
were not as affected as Grandio and Filtek Supreme resins when
CP gel was used during a 4-week at-home bleaching treatment.
Therefore, the nanoparticle material showed better performance
than the control group. Other resins such as Filtek Z 250, opallis,
and dental enamel, used as control showed greater surface
roughness alterations over a period of time. Polydorou, et al.[21]
also concluded that the in-office and at-home bleaching effect
on the surface morphology of materials were time dependent
and observed that the polished samples were more stable than
the non-polished ones. Therefore, they recommend re-polishing
the restorations after bleaching to overcome problems such as
staining, biofilm formation, and bacterial adhesion that could be
caused by the morphological change of the surface.
With regard to our third hypothesis, we found that the type
of SS does influence the susceptibility to staining of CRs. GJ
caused the highest MCV showing a statistically similar effect as
CF, followed by AB and GT in all the resins studied. In previous
40
studies as Fontes, et al.[22] the results showed that GJ caused
greater color change followed by CF. Other authors tested
red wine instead of GJ and also found higher color variation in
comparison with other SS.[3,5,14] Park, et al.[23] tested GT, the
same used in our study, among other SS, which also promoted
slight color change of CRs.
Conclusion
It may be concluded that:
• The type of CR influences color stability. The color variation
after immersion in MW and CP was low for the CR groups:
F, G, and A. But after immersion in the SS, the CR group F
showed higher color mean variation than the other resins
• ST with MW and CP increases the susceptibility to staining
of CR. However, immediately after the ST, the color variation
was lower for the MW when compared to the CP. After the
SS, the Group O showed higher MCV
• The type of SS influences the susceptibility to staining of
CRs. GJ and CF showed higher color variation than the other
SS for all CR studied.
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How to cite this article: Crastechini É, Barbosa PS,
Rêgo HMC, Holleben P, Torres CRG, Gonçalves SEP,
Gomes APM, Huhtala MFRL. Assessment of the effects of
staining solutions, carbamide peroxide, and mouthwashes
on color stability of composite resin. J Adv Clin Res Insights
2014;2:36-41.
Journal of Advanced Clinical & Research Insights ● Vol. 1:2 ● Sep-Oct 201441