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The Essence of the Internal Staining Technique: Application and Fabrication

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The Essence of the Internal Staining Technique: Application and Fabrication The Essence of the Internal Staining Technique: Application and Fabrication Naoto Yuasa, RDT1 ne of the most difficult tasks in dentistry is to ENAMEL AND DENTIN reproduce the esthetic characteristics of natu- Oral teeth using ceramic restorations. The in- Natural tooth color depends on two dental structures: troduction of the internal live staining technique in the enamel and dentin. Enamel is both highly translucent 1980s revolutionized the fabrication of highly esthetic and opalescent as a result of the hydroxyapatite crys- ceramic restorations due to its ease of use and reliabil- tals that compose enamel rods. These features must ity. This article discusses the application of the internal be reproduced to create natural-looking restorations. live staining technique in anterior ceramic crown res- Opalescence leads to the appearance of blue or or- torations. ange enamel shades, depending on how the light in- teracts with the enamel. Dentin comprises inorganic and organic compo- nents. The inorganic portion consists of hydroxyapatite crystals, which promote intense light scattering result- 1Otani Dental Clinic, Tokyo, Japan. ing in translucency and high value. The light reflection within dentin varies drastically in different areas. The Correspondence to: Naoto Yuasa, Otani Dental Clinic, 2-3-2-1F apex is highly translucent compared to the coronal Shitaya, Taito-Ku, Tokyo, Japan 110-0004. Email: naotoyuasa0114@ gmail.com dentin, which yields high light reflection. Published originally in the Japanese QDT (2009;34[November]: The precise anatomical structure of the tooth de- 133–151). pends on the combination of enamel and dentin. The QDT 2011 133 YUASA.indd 133 3/28/11 2:36 PM YUASA 1a 1b Figs 1a and 1b Porcelain crown samples fabricated using internal live staining (Super porcelain AAA, Noritake Dental Supply). Figs 2a to 2d With the proper base porcelain, the internal staining technique allows for accurate reproduction of the natural teeth. Figs 3a and 3b Subtle color variations in multiple-teeth restorations can be achieved by controlling the shade of internal staining: (a) zirconia fixed dental prosthesis spanning the maxillary incisors; (b) porcelain-fused-to-metal prosthesis spanning the maxillary incisors and right canine. Figs 4a to 4c Characterization of a posterior restoration using internal and external staining. gingival area has a thin enamel layer and thick dentin For this reason, ceramic modifiers or internal staining layer; therefore, the shade is primarily generated by techniques become important tools to build natural the dentin. In other words, the gingival third is the best characteristics in a porcelain restoration. area to view the shade of dentin by itself. The middle Natural three-dimensional color reproduction can third has relatively thick enamel and dentin layers, be achieved using ceramic modifiers; however, these creating a well-blended shade. The incisal third has a are technique sensitive since they must be fired before thick enamel layer and a very thin or nonexistent den- the final shade is visible. It is very difficult to reproduce tin layer. Thus, this area shows a pure enamel color and the subtle and delicate colors of a natural tooth using translucency, except at the mamelons. only ceramic modifiers. It is important to understand this correlation be- Single central incisor crowns are the most challeng- tween the thicknesses of the enamel and dentin struc- ing restorations because there is no room for error dur- tures that build natural tooth color. When porcelain ing shade matching. For such procedures, the internal restorations are fabricated, porcelain layering must live staining technique is the method of choice. The mimic this relationship to appear truly natural. use of specific ceramic modifiers or internal staining is dependent on the case (Figs 1 to 4). Enamel, mam- elon, and translucent porcelain are built to create a mix of translucency and value. The layering process should INTERNAL STAINING be carried out with the understanding that internal live staining will be used to provide minor shade correc- During shade taking, commercial shade guides are tion. In other words, the porcelain should be layered to rarely able to match the natural tooth shade exactly. provide a proper base for internal live staining. 134 QDT 2011 YUASA.indd 134 3/28/11 2:36 PM The Essence of the Internal Staining Technique: Application and Fabrication 2a 2b 2c 2d 3a 3b 4a 4b 4c QDT 2011 135 YUASA.indd 135 3/28/11 2:36 PM YUASA Figs 5a and 5b White porcelain is diluted with Bright powder and applied. The luster porcelain is then applied and fired. Ratio between White porcelain and Bright powder (from left to right): White only, 1:2, 1:5, 1:10, 1:20, Bright only, no stain. (Samples fabricated with Noritake Cerabien ZR.) Figs 6a to 6d Bright dilution powder 5a can be added when complex char- acterizations such as mamelons or different translucencies are needed. Figs 7a to 7c Mamelon character- ization. The color concentration is adjusted by adding Bright powder and a small amount of IS liquid into a Mamelon Orange + White base porcelain mixture. This will reproduce translucent mamelons. For more transparent mamelon characteriza- 5b tion, Mamelon Orange 2 and slightly more Bright are thinly and carefully applied for staining. Figs 8a and 8b A White + Bright mixture is thinly applied on the entire surface to produce enamel white- ness. Fig 9 Fast drying can be performed in front of the furnace to provide uni- form staining without any running. Fig 10 Final restoration. 6a 6b 6c 6d DILUTION POWDER This procedure can be difficult depending on the liquid used to mix the stains (eg, IS liquid, Noritake) because Internal staining of ceramic restorations allows for bet- of powder shift during application and drying. Special ter shade matching and a more lifelike appearance. attention must be paid when using White, Mamelon The Noritake Internal Stain Kit (Noritake Dental Sup- Orange, or Incisal Blue stains. These stains are opaque ply, Osaka, Japan) was specially developed for this and have high color peak emission and thus can easily purpose, offering high color emission and color stabil- become uneven during application. ity even after firing. To produce a more natural result, The Noritake Internal Stain Kit has an interesting the staining layer must be thin and evenly distributed. porcelain dilution powder called Bright. When Bright 136 QDT 2011 YUASA.indd 136 3/28/11 2:36 PM The Essence of the Internal Staining Technique: Application and Fabrication 7a 7b 7c 8a 8b 9 10 dilution powder is mixed with internal stains, the final celain mixing. Since the Bright dilution powder has a color becomes more vibrant and the mixed porcelain coefficient of thermal expansion similar to that of the more stable and easy to apply (Figs 5 and 6). This di- body porcelain, cracks should not be a problem even lution powder is used mainly for characterization of if a thicker layer is fired. In other words, the Bright dilu- mamelons, white bands, crack lines, dark zones, and tion powder makes it possible to control value not only opalescent blue. This powder also allows the techni- by modifying the stain value, but also by altering the cian to control the value (Figs 7 to 10). thickness of the powder layer. The consistency of the staining layer can be con- trolled by altering the amount of IS liquid during por- QDT 2011 137 YUASA.indd 137 3/28/11 2:36 PM YUASA Fig 11 In some cases, the natural tooth possesses similar Fig 12 The natural teeth appear to have higher translu- shade layer construction as the shade guide. cency and lower value compared to those of the shade tabs. However, only the enamel has high translucency. The cervical dentin has almost the same value as the shade guide’s body area. SELECTION OF BODY PORCELAIN can be used to create enamel cracks and mamelons. If the purpose of internal staining is to adjust the color of a What is the most important factor to match the color crown, a thick layer of opaque porcelain may be applied. of a porcelain restoration to the natural teeth? Color The degree of translucency and opacity of the porcelain consists of three elements: value, chroma, and hue. will change depending on the stain used. A thick layer The human eye is more sensitive to value than it is to of opaque stain applied on top of dentin porcelain will chroma and hue. For example, when a patient with affect the overall translucency. As the dentin porcelain one ceramic crown (eg, a maxillary central incisor) is becomes more opaque, light cannot be transmitted to observed from a distance, we might recognize differ- the inner layers, thus compromising the translucency. ences in value, but differences in hue and chroma will To avoid this problem, the internal stain should be mini- be more challenging to identify. Dentin is the primary mized or applied in different layers. determinant of a tooth’s value. This means that for a The primary criterion for selecting body porcelain ceramic crown, the primary determinant of value is the should be the highest value of the dentin. As previous- body porcelain. ly mentioned, the gingival region of the tooth offers The application of internal staining produces one of the best view of the dentin shade. However, healthy the following effects: gingival tissues reflect a reddish color onto the gingival third that may interfere with shade selection. Thus, the 1. Decrease in value, depending on the stain color, dentin shade must be observed at the middle-coronal type, and amount applied. (In some cases, the ap- portion of the gingival third. Dentin often presents the plication of a nontranslucent layer can increase the highest value at this region.
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