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journal homepage: www.intl.elsevierhealth.com/journals/dema

Comparison of an absolute and surrogate measure of


relative translucency in dental ceramics

Lisa S. Spink a , Patchanee Rungruanganut b , Spiro Megremis c , J. Robert Kelly b,


a 454 A Avenue Lake Oswego, OR 97034, USA
b Department of Reconstructive Sciences, University of Connecticut School of Dental Medicine, Farmington, CT, USA
c Research and Laboratories, Division of Science, American Dental Association, Chicago, IL, USA

a r t i c l e i n f o a b s t r a c t

Article history: Purpose. The objective was to compare absolute translucency with a frequently used surro-
Received 11 June 2012 gate measure of relative translucency (contrast ratio) from 14 all-ceramic materials having
Received in revised form a wide range of translucencies.
14 September 2012 Materials and methods. Standardized disks were fabricated from fourteen ceramics, varying
Accepted 22 March 2013 both thickness (0.3 mm, 0.5 mm, 1.0 mm, and 1.5 mm) and chroma (high and low). Absolute
translucency (percent transmission) was measured using a spectroradiometer with an inte-
grating sphere. Relative translucency was measured using a spectrophotometer as contrast
Keywords: ratio (contrast ratio; ratio of L* values recorded on black and white backgrounds). Non-linear
Translucency regression was used to compare measurements of absolute versus relative values for each
Dental ceramics of the spectrophotometers.
Contrast ratio Results. Contrast ratio was not able to characterize translucency across the range of materials
studied and became less sensitive with increasing opacity. A non-linear correlation was
found between percent transmission and contrast ratio down to 50% transmission (r2 = 0.97)
and contrast ratio was insensitive to transmission differences below 50% transmission.
Conclusion. Contrast ratio is not a direct measure of translucency and cannot be used below
50% transmission.
2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

used to match spots of internal color and to mimic incisal


1. Introduction characteristics. It is the goal of dental ceramics to imitate a
tooths color and vitality by recreating an appropriate mix of
Choices for specic ceramic systems are driven largely by light absorption and scattering. Thus, information regarding
the translucency of the dentition to be matched. For exam- relative translucency of ceramics is of clinical interest.
ple, older dentitions exhibiting high translucency (low value Although many authors agree that translucency is a key
in Munsell color space) are most easily matched with low characteristic for choosing an all-ceramic system, there is lim-
value ceramics and more opaque dentitions matched with ited quantitative literature available [15]. Heffernan et al. is
higher value ceramics. In this clinical assessment it is the core the most recent study to compare quantitatively the translu-
ceramic that controls Munsell value. Veneering ceramics are cency of various full-coverage, all-ceramic restorations [6]. Yet


Supported by a Tylman Grant Award, American Academy of Fixed Prosthodontics.

Corresponding author at: Department of Reconstructive Sciences, University of Connecticut Health Center, 263 Farmington Avenue,
Farmington, CT 06030-1615, USA. Tel.: +1 860 679 3747; fax: +1 860 679 1370.
E-mail address: kelly@nso1.uchc.edu (J.R. Kelly).
0109-5641/$ see front matter 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.dental.2013.03.021
d e n t a l m a t e r i a l s 2 9 ( 2 0 1 3 ) 702707 703

this study [6] measured the contrast ratio of core ceramics and TP was rst dened by Johnston et al. for use with maxillo-
found no difference between the light transmitted through a facial silicone resins [14] and later by Johnston and Reisbick for
cast metal or a zirconia disk. Based on visual examination, full- changes during curing of esthetic restorative materials [13]. It
coverage, all-ceramic restorations with zirconia cores appear is assumed that TP will be inuenced more by the L term than
to transmit more light than with metal-ceramics yet in this the a and b terms, the relevance of which will be described
study the contrast ratio was 1.00 for both materials indicating below.
equivalently opaque specimens [6]. Such a nding [6] raises The specic aim of this study is to compare abso-
questions about the value of contrast ratios when comparing lute translucency with the more frequently used surrogate
ceramics and forms the basis of this study. measure of relative translucency (contrast ratio) for dental
The primary objective of this research project was to com- ceramics. The null hypotheses are that (1) there is no differ-
pare absolute translucency with a frequently used surrogate ence in capabilities to rank order ceramics by both methods
measure of relative translucency (contrast ratio) among a and (2) that these measurements are linearly related. This
commercially important set of materials used primarily for all- work used a wide range of commercially important ceram-
ceramic restorations. Materials were chosen both to provide ics that are either meant as core ceramics in bi-layered
relative translucency data by material, thickness and chroma systems or alternatively as a mono-layer for full-thickness
for clinicians (in a separate paper) as well as to have a wide restorations.
range of translucencies for the comparison of contrast ratio
with translucency.
Compared to absolute translucency, contrast ratio is rela-
2. Materials and methods
tively easy to measure. Absolute translucency necessitates use
of a dual beam, integrating sphere radiometer or spectropho-
Standardized ceramic disks were fabricated by the manufac-
tometer able to capture all of the light transmitted through a
turers (Ivoclar Vivadent, Amherst, NY; VITA Zahnfabrik, Bad
specimen in comparison to the intensity of light from a split
Sckingen, Germany; 3M ESPE, St. Paul, MN) according to the
beam. By comparison, contrast ratios can be measured with
plan in Table 1. The disks were fabricated using one of the
any device capable of providing standard radiation intensity
following methods: sectioning of pre-fabricated blocks, press-
and detection, as is dened as follows:
ing, or sectioning of pre-fabricated blocks that were then glass
inltrated. Three disks were fabricated for each ceramic with
LB an additional three disks for select high chroma materials.
CR = (1)
LW Ceramic specimens were obtained from the manufacturers at
thicknesses larger than their target value. Final thicknesses
where LB is the luminance ux (reectance) with the spec- and surface nish were achieved by a ceramic machinist
imen on a black background and LW is the luminance ux (BOMAS Machine Specialties, Somerville, MA). The disks were
(reectance) with the specimen on a white background. nished to an optical polish with diamond grinding. Disk
How contrast ratio came to be used in dental research as thicknesses were measured using a digital caliper having a
a measure of translucency or opacity is a relevant question; it resolution of 0.05 mm (Fowler, Boston, MA). Specimen dimen-
appears to derive from an American Society for Testing and sions appear in Table 1.
Materials (ASTM) standard used to measure opacity in papers A quantitative measurement of absolute translucency was
[7]. This protocol was then adopted by the American Dental made by measuring the total transmission of light through the
Association in Specication No. 27 for direct lling resins [8]. In specimen. A spectroradiometer (Minolta Spectroradiometer
both standards opacity was qualitatively observed compared Model CS-1000A, Osaka, Japan) with an integrating sphere and
to standards. In 1978 Powers [9] extended the contrast ratio barium sulfate reectance standard was used. The light source
quantitatively to the examination of parameters affecting the provided D65 illumination through a light guide to the con-
color of direct restorative resins, basing their protocol on the nector on the integrating sphere. Each disk was cleaned with
ASTM standard. Further quantitative development of contrast an alcohol wipe prior to placement in a customized holder.
ratio was provided by Crisp et al. in 1979 [10] with refer- A luminance reading (Lsource )with no specimen in place was
ence back to earlier work at the National Bureau of Standards recorded prior to each measurement. Each specimen was mea-
involving the application of KubelkaMunk theory. This work sured three times. The luminance (Lsample ) was recorded. An
of Crisp et al., also addressed the issue of most white back- average percent of total transmission was calculated for each
ings having a reectivity of 80% while standard tests called specimen using the following calculation:
for a reectivity of 70%.
Contrast ratio has been used to compare commercial  
glass ionomer cements [11], dental ceramics [6,12] and direct Lsample
T% = 100 (3)
restorative materials [13]. An interesting extension of the Lsource
contrast ratio approach was used to dene a translucency
parameter (TP) based on measures of L*, a*, and b* parameters
on white and dark backgrounds, with TP then dened as: A quantitative measurement of relative translucency was
made by comparing the luminance (ratio of the luminance
of a specimen to that of a perfect diffuser) through the test
2 1/2
TP = ((LB LW ) + (aB aW ) + (bB bW ) )
2 2
(2) specimen over a backing with high reectance to that of low
704 d e n t a l m a t e r i a l s 2 9 ( 2 0 1 3 ) 702707

Table 1 The all-ceramic materials investigated, listed by target thicknesses and chroma.
Material Manufacturer Core (mm) Low chroma (n) High Total Description
chroma (n) specimens (n)
Empress CAD HT Ivoclar Vivadent 0.5 3 3 13 10 mm square
Empress CAD HT Ivoclar Vivadent 1.0 3 3 13 10 mm square
Empress CAD LT Ivoclar Vivadent 0.5 3 3 6 14 12 mm square
Empress CAD LT Ivoclar Vivadent 1.0 3 3 6 14 12 mm square
e.max CAD MO1 Ivoclar Vivadent 1.5 3 3 14 12 mm square
e.max CAD LT Ivoclar Vivadent 1.5 3 3 6 14 12 mm square
Empress Esthetic LT Ivoclar Vivadent 0.5 3 3 6 15 mm circle
Empress Esthetic LT Ivoclar Vivadent 1.0 3 3 6 16 mm circle
e.max Press HO Ivoclar Vivadent 1.5 3 3 16 mm circle
e.max Press MO1 Ivoclar Vivadent 1.5 3 3 16 mm circle
e.max Press LT Ivoclar Vivadent 1.5 3 3 6 16 mm circle
Vita Y-Z zirconia VITA Zahnfabrik 0.5 3 3 6 14 mm circle
Vita Y-Z zirconia VITA Zahnfabrik 0.3 3 3 14 mm circle
Vita Alumina VITA Zahnfabrik 0.5 3 3 6 16 mm circle
Vita In-Ceram Alumina VITA Zahnfabrik 0.5 3 3 6 12 mm circle
Vita In-Ceram Alumina VITA Zahnfabrik 0.3 3 3 12 mm circle
Vita In-Ceram Spinell VITA Zahnfabrik 0.5 3 3 6 12 mm circle
Vita In-Ceram Zirconia VITA Zahnfabrik 0.5 3 3 12 mm circle
Lava zirconia 3M ESPE 0.5 3 3 6 17 mm circle
Lava zirconia 3M ESPE 0.3 3 3 17 mm circle
Ivoclar low chroma B1
Ivoclar high chroma A3
Lava/Vita low chroma 2M1
Lava/Vita high chroma 2M3
Note: HT, high translucency; LT, low translucency; MO1, medium opacity 1; and, HO, high opacity.

reectance or high absorbance. This procedure produced a means and standard deviations. These values reinforce that
Minolta contrast ratio: the use of only three specimens per material was sufcient;
coefcients of variation were in the range of tenths of a per-
Lb cent for both instruments. Regression analysis demonstrated
Contrast ratio = (4)
Lw a non-linear relationship between percent transmission and
the Minolta contrast ratio (Fig. 1). The correlation coefcient
where Lb is the luminance ux of the material on a black sur- with all specimens was r2 = 0.80. An outlier was identied
face and Lw is the luminance ux of a material on a white (Vita In-Ceram Zirconia; too opaque for contrast ratio) and
surface its removal from the plot raised the correlation coefcient to
This ratio tends toward unity for opaque materials and r2 = 0.97 (Fig. 2).
toward zero for transparent materials [6]. A calibrated spec-
trophotometer (Minolta Spectrophotometer CM-2600d/2500d,
Osaka, Japan) was used for specimen measurement. The
instruments mask/gloss condition allowed simultaneous
measurement of luminance with the specular component
included and excluded. Only specular excluded L* values
were recorded. The instrument had a measurement area of
3 mm in diameter and was used with the observer set at
10 . Three measurements were made with the white refer-
ence backing (Lw ) and then the black backing (Lb ), resulting
in 6 measurements per specimen. Mean contrast ratios were
calculated as Lb /Lw . Non-linear curve tting and regression
analysis was used to examine absolute translucencies versus
contrast ratios (r2 a priori > 0.9; TableCurve 2D, Systat Software,
Richmond, CA).

3. Results

Actual disk thicknesses appear in Table 2. Translucency of the


specimens was calculated directly as percent transmission Fig. 1 Predicting percent transmission from contrast ratio
and indirectly as contrast ratio. Individual transmission mea- with outlier specimen Vita In-Ceram Zirconia 0.5 mm
sures appear for each disk in Table 3 along with contrast ratio (outlier CR = 1.0, transmission = 15.25%) r2 = 0.80.
d e n t a l m a t e r i a l s 2 9 ( 2 0 1 3 ) 702707 705

Table 2 Measured specimen thicknesses (means and standard deviations).


Specimen thickness Disk 1 (mm) Disk 2 (mm) Disk 3 (mm) Average (mm) Standard deviation
Empress CAD HT low chroma 0.5 0.516 0.512 0.512 0.513 0.002
Empress CAD HT low chroma 1.0 0.998 0.999 0.998 0.998 0.001
Empress CAD LT low chroma 0.5 0.501 0.508 0.507 0.505 0.004
Empress CAD LT high chroma 0.5 0.518 0.517 0.515 0.517 0.002
Empress CAD LT low chroma 1.0 0.986 0.988 0.987 0.987 0.001
Empress CAD LT high chroma 1.0 0.983 0.992 0.983 0.986 0.005
e.max CAD MO1 1.5 1.512 1.517 1.514 1.514 0.003
e.max CAD LT low chroma 1.5 1.517 1.517 1.514 1.516 0.002
e.max CAD LT high chroma 1.5 1.511 1.511 1.51 1.511 0.001
Empress Esthetic LT low chroma 0.5 0.502 0.504 0.5 0.502 0.002
Empress Esthetic LT high chroma 0.5 0.506 0.505 0.502 0.504 0.002
Empress Esthetic LT low chroma 1.0 0.992 0.992 0.984 0.989 0.005
Empress Esthetic LT high chroma 1.0 0.988 0.987 0.987 0.987 0.001
e.max Press HO 1.5 1.526 1.522 1.524 1.524 0.002
e.max Press MO1 1.5 1.513 1.512 1.518 1.514 0.003
e.max Press LT low chroma 1.5 1.507 1.508 1.504 1.506 0.002
e.max Press LT high chroma 1.5 1.504 1.501 1.503 1.503 0.002
Vita Y-Z zirconia low chroma 0.5 0.511 0.511 0.511 0.511 0.000
Vita Y-Z zirconia high chroma 0.5 0.517 0.514 0.513 0.515 0.002
Vita Y-Z zirconia low chroma 0.3 0.32 0.319 0.32 0.320 0.001
Vita Alumina low chroma 0.5 0.505 0.504 0.506 0.505 0.001
Vita Alumina high chroma 0.5 0.504 0.503 0.503 0.503 0.001
Vita In-Ceram Alumina low chroma 0.5 0.5 0.501 0.499 0.500 0.001
Vita In-Ceram Alumina high chroma 0.5 0.517 0.516 0.515 0.516 0.001
Vita In-Ceram Alumina low chroma 0.3 0.319 0.316 0.319 0.318 0.002
Vita In-Ceram Spinell low chroma 0.5 0.509 0.509 0.508 0.509 0.001
Vita In-Ceram Spinell high chroma 0.5 0.509 0.506 0.508 0.508 0.002
Vita In-Ceram Zirconia low chroma 0.5 0.504 0.501 0.504 0.503 0.002
Lava zirconia low chroma 0.5 0.509 0.507 0.509 0.508 0.001
Lava zirconia low chroma 0.3 0.315 0.318 0.315 0.316 0.002
Lava zirconia high chroma 05. 0.527 0.526 0.527 0.527 0.001

Table 3 Individual values and means for transmission measures and means for contrast ratio measures.
%Direct transmission Disk 1 Disk 2 Disk 3 Mean SD Contrast ratio (mean) SD
Empress CAD HT low chroma 0.5 81.68 81.50 81.89 81.69 0.20 0.7198 0.001
Empress CAD HT low chroma 1.0 74.29 74.45 73.87 74.20 0.30 0.8040 0.002
Empress CAD LT low chroma 0.5 78.08 77.44 78.26 77.93 0.43 0.7739 0.000
Empress CAD LT high chroma 0.5 79.34 78.67 78.83 78.95 0.35 0.7461 0.001
Empress CAD LT low chroma 1.0 71.21 71.05 71.13 71.13 0.08 0.8526 0.001
Empress CAD LT high chroma 1.0 70.26 70.21 70.37 70.28 0.08 0.8383 0.002
e.max CAD MO1 1.5 57.25 57.06 57.09 57.13 0.10 0.9514 0.000
e.max CAD LT low chroma 1.5 62.94 62.78 62.80 62.84 0.09 0.9126 0.000
e.max CAD LT high chroma 1.5 61.04 60.98 61.02 61.01 0.03 0.9095 0.001
Empress Esthetic LT low chroma 0.5 78.91 79.28 79.34 79.18 0.23 0.7594 0.000
Empress Esthetic LT high chroma 0.5 83.02 83.23 82.24 82.83 0.52 0.6957 0.002
Empress Esthetic LT low chroma 1.0 71.30 70.62 70.95 70.96 0.34 0.8401 0.005
Empress Esthetic LT high chroma 1.0 74.01 74.01 73.87 73.96 0.08 0.8051 0.002
e.max Press HO 1.5 47.16 48.36 47.88 47.80 0.60 0.9818 0.001
e.max Press MO1 1.5 58.77 58.60 58.91 58.76 0.16 0.9439 0.001
e.max Press LT low chroma 1.5 62.15 61.06 61.52 61.58 0.55 0.9240 0.001
e.max Press LT high chroma 1.5 61.72 61.55 61.74 61.67 0.10 0.9037 0.002
Vita Y-Z low chroma 0.5 68.19 67.45 68.00 67.88 0.38 0.8845 0.001
Vita Y-Z high chroma 0.5 67.76 67.02 67.75 67.51 0.42 0.8905 0.002
Vita Y-Z low chroma 0.3 69.01 69.06 68.88 68.98 0.09 0.8819 0.001
Vita Alumina low chroma 0.5 65.13 63.96 64.44 64.51 0.59 0.9158 0.000
Vita Alumina high chroma 0.5 65.25 64.81 65.26 65.11 0.26 0.9138 0.002
Vita In-Ceram Alumina low chroma 0.5 61.06 61.44 61.35 61.28 0.20 0.9292 0.002
Vita In-Ceram Alumina high chroma 0.5 62.13 62.20 61.95 62.09 0.13 0.9258 0.001
Vita In-Ceram Alumina low chroma 0.3 67.43 67.11 67.03 67.19 0.21 0.8895 0.001
Vita In-Ceram Spinell low chroma 0.5 74.54 72.97 73.78 73.76 0.79 0.8319 0.001
Vita In-Ceram Spinell high chroma 0.5 74.06 73.45 75.62 74.38 1.12 0.8243 0.001
Vita In-Ceram Zirconia low chroma 0.5 15.56 14.72 15.47 15.25 0.46 1.0012 0.001
Lava Zirconia low chroma 0.5 65.78 65.23 65.58 65.53 0.28 0.8976 0.002
706 d e n t a l m a t e r i a l s 2 9 ( 2 0 1 3 ) 702707

can be interpreted as a decreasing sensitivity for contrast ratio


with increasing opacity, consistent with our nding.
It is also worth noting that the translucency parameter (TP,
Eq. (2)) is also limited by the non-linearity in L* and that (LB
LW ) will become 0 as the absolute translucency approaches
50%. Since the values of a* and b* do not vary widely for tooth
colors these second terms likely do not inuence TP greatly.
Thus true transmission using an integrating sphere spectro-
radiometer is better suited than is contrast ratio for purposes
of either clinical comparisons or for research into improving
translucency.

Conclusion

All dental ceramics used in this in vitro study transmit light.


Absolute translucency is the most accurate measurement
Fig. 2 Predicting percent transmission from contrast ratio
for evaluating light transmission. Though relative translu-
without outlier specimen (Vita In-Ceram Zirconia 0.5 mm)
cency (contrast ratio) can be used to accurately describe light
r2 = 0.97.
transmission for ceramics it is limited to materials with a
translucency of at least 50%. Contrast ratio is not a linear
measure of translucency (non-linear r2 = 0.97). Thus, the null
4. Discussion hypothesis of this study was rejected.

Contrast ratio was not able to characterize translucency over


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