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Quintessence Journals TECHNICAL APPLICATION pyri Co gh Not for Publicationt b y Q u i N n o t t r f e o Color in Natural Teeth and Direct ssence Resin Composite Restorations: Essential Aspects Luiz Narciso Baratieri, DDS, MSD, PhD Professor and Chair, Department of Operative Dentistry Federal University of Santa Catarina, Florianópolis, Brazil Edson Araujo, DDS, MSD, PhD Professor, Dental Clinics Federal University of Santa Catarina, Florianópolis, Brazil Sylvio Monteiro Jr, DDS, MSD, PhD Professor, Department of Operative Dentistry Federal University of Santa Catarina, Florianópolis, Brazil Correspondence to: Dr Luiz Narciso Baratieri Rua Presidente Coutinho, 311 10° Andar Bloco A, 88015-230 Centro, Florianópolis, SC, Brazil; e-mail: [email protected]. 172 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 2 • NUMBER 2 • SUMMER 2007 BARATIERI ETp ALyri Co gh Not for Publicationt b y Q u i N n o t t r f e o Abstract ssence This article presents the essential aspects teeth. The dynamics of color in natural teeth for understanding and reproducing the in relation to age is also discussed, focus- color of natural teeth with the use of direct ing on the age-related changes that occur resin composite. Fluorescence and opal- in enamel, dentin, and pulp. Further, it is escence are discussed, with special em- demonstrated how to reproduce the es- phasis on counter-opalescence, which is thetic features of natural teeth using latest- primarily responsible for the appearance of generation direct resin composites. an orange discoloration at the mamelon dentin tips and incisal edges of anterior (Eur J Esthet Dent 2007;2:172–186.) 173 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 2 • NUMBER 2 • SUMMER 2007 TECHNICAL APPLICATION pyri Co gh Not for Publicationt b y Q u i N n o t t r f e o ssence aaa b b b Fig 1 (a) Maxillary central inci- Fig 2 (a) Maxillary central inci- Fig 3 (a) Maxillary central inci- sors of an 8-year-old patient. (b) sors of a 22-year-old patient. (b) sors of a 72-year-old patient. (b) The same teeth 12 years later. Note The same teeth 12 years later. Note The same teeth 12 years later. Note the incisal wear and changes of the changes of surface texture and the increased thickness and satura- surface texture. incisal border. tion of the dentin. The chromatic expression of natural teeth wear of enamel can also cause areas of is dynamic and depends on the interaction dentin exposure, especially at the incisal of enamel, dentin, and pulp with light dur- edge. In addition, the exposed dentin ab- ing reflection and refraction phenomena. sorbs stains that change the chromatic ex- Enamel, dentin, and pulp suffer noticeable pression of the natural teeth. The changes changes during an individual’s lifetime. that occur in enamel, dentin, and pulp as- Dentin becomes thicker with time as pulp sociated with fluorescence, opalescence, decreases in volume due to the deposition and counter-opalescence create chromat- of secondary dentin. Additionally, dentin ic effects that can be mimicked and repro- becomes less permeable as a result of the duced with the use of specially designed deposition of peritubular dentin. These resin composites. The relation of natural changes increase the chromatic saturation teeth with their antagonists, the soft tissues, of dentin while reducing its opacity.1 Enam- and moisture also interferes in an excep- el becomes more mineralized with time tional manner with color dynamics. The because of the absorption of ions from sali- aim of this article is to help practitioners va and foods. However, it also becomes identify and understand these features in smoother and thinner due to physiologic natural teeth, especially the characteristics wear. This increase of enamel mineral con- of the internal structure of natural dentition, tent and decrease of thickness make it in order to achieve optimal esthetic results.2 more translucent. Physiologic or pathologic 174 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 2 • NUMBER 2 • SUMMER 2007 BARATIERI ETp ALyri Co gh Not for Publicationt b y Q u i N n o presents less microtexture thant enamel t of r f Features of anterior teeth es o e 2 senc related to age young individuals. Usually, bluish and or- ange shades are clearly visible. The tips of The chromatic appearance of natural teeth dentin mamelons are closer to the incisal varies substantially with age because of edge, and may even be exposed. The pulp changes in enamel, dentin, and pulp. shows a decrease in volume, while dentin Dentin is an opaque (less translucent) and becomes thicker, more saturated, and less complex core—rich in hue, chroma, and opaque (Fig 2). fluorescence. It is covered by enamel, which is translucent and opalescent.3 The Old age variety of features and changes of enamel At 70 to 80 years of age, enamel presents and dentin explain the unique nature of the a considerable decrease in thickness and appearance of a natural tooth.4 surface texture and a significant increase in translucency, changing from a bluish Childhood shade to gray and purple shades. Fre- Young individuals usually present anteri- quently, there are large areas of exposed or teeth with great pulp volume. The dentin at the incisal edges, which usually dentin is opaque and completely covered suffer severe extrinsic staining. The pulp by enamel, and the tips of dentin mamel- virtually disappears, while dentin presents ons are located about 1.5 mm from the in- increased thickness and saturation and cisal edge. decreased opacity (Fig 3). Although the enamel is thicker, it is translucent, brilliant, and often presents a Color milky, chalky white color. In freshly erupted The color of natural teeth usually is deter- teeth, the superficial layers of enamel are mined by the three dimensions of color: more opaque, frequently have a frost-white shade, chroma, and value. Color can be appearance, and are less mineralized.5 identified by conventional methods, such They also have more empty space be- as shade guides, or by automatic shade tween enamel crystals, which causes in- guide systems.9 However, there are other creased opacity.6,7 Further, young enamel is extremely important factors regarding more permeable and dehydrates quickly. chromatic expression that cannot be disre- Deeper layers of enamel have fewer air garded, such as translucency, fluores- spaces, are more mineralized, and more cence, opalescence, counter-opalescence, translucent.8 Generally, anterior teeth of and surface texture. young people present remarkable surface texture, which is generally lost over time. As Translucency enamel becomes thinner with age, dentin Human teeth are characterized by a vari- becomes more visible, and the tooth be- ety of degrees of translucency, which can comes less monochromatic (Fig 1). be defined as the gradient between trans- parency and opacity.10 Generally, an in- Adulthood crease of translucency of a direct resin The enamel of an adult’s natural anterior composite restoration lowers its value be- teeth is thinner, more translucent, and cause less light returns to the eye. With in- 175 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 2 • NUMBER 2 • SUMMER 2007 TECHNICAL APPLICATION pyri Co gh Not for Publicationt b y Q u i N n o t t r f e o ssence Fig 4a Buccal and lingual views of an extracted Fig 4b The translucency of enamel is evident when maxillary central incisor. The enamel presents interme- the tooth is immersed in water. Note the bluish aspect diary translucency due to the removal of dentin (the that is acquired. dark background is barely visible through the enamel). creased translucency, the light is able to resins. The translucency is best evaluated pass through the surface and is scattered with a black background or with the within the bulk of the restoration. The tongue, full of saliva, placed against the translucency of enamel varies with the in- palatal surface of the anterior teeth. A sim- cidence angle and wavelength, surface ple manner to evaluate translucent areas is texture and luster, and degree of dehydra- to look for visible opalescent bluish shades. tion of the tooth. To better understand the A black background prevents red shades influence of moisture on the translucency from the back of the mouth from remixing of natural teeth, observe Figs 4a and 4b, with the blue shades.5 which show the same tooth, without dentin, outside and immersed in water. With more Fluorescence translucent artificial enamel layers, the Fluorescence is the absorption of light by resin composite restoration achieves depth objects such as natural teeth or restorative of color and the illusion of a natural vital materials, and the spontaneous emission of tooth. However, if the resin layer related to light with longer wavelengths.11 In natural superficial enamel is slightly translucent, it teeth, fluorescence occurs primarily in will mask the subtleness created by dentin dentin because of the greater amount of or- layers. Actually, one of the most difficult ganic material.12,13 However, enamel is also tasks in direct resin composite restorations fluorescent, although it presents a smaller is to define the degree of enamel translu- fluorescence index than dentin.14,15 Addition- cency and reproduce it with appropriate ally, in many cases enamel presents high- 176 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 2 • NUMBER 2 • SUMMER 2007 BARATIERI ETp ALyri Co gh Not for Publicationt b y Q u i N n o t t r f e o ssence a b Fig 5a Labial aspect of two extracted central incisors. Fig 5b Labial aspect of the teeth exposed to ultravi- The opaque incisal halo presents an orange aspect. olet light. Note the white opaque appearance achieved Further, the bluish regions at the incisal third and by the teeth, including at the incisal third where dentin mamelon tips present an orange blur.
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