Ceramic materials for porcelain veneers.

Part I: Correlation between translucency

parameters and contrast ratio
Karine T.L. Barizon, DDS, MS, MS,a Cathia Bergeron, DMD, MS,b
Marcos A. Vargas, DDS, MS,c Fang Qian, PhD,d
Deborah S. Cobb, DDS, MS,e David G. Gratton, DDS, MS,f and
Saulo Geraldeli, DDS, MS, PhDg
University of Colorado School of Dental Medicine, Aurora, Colo;
Laval University Faculty of Dentistry, Qubec, Canada; The University
of Iowa College of Dentistry, Iowa City, Iowa; University of Florida
College of Dentistry, Gainesville, Fla
Statement of problem. Different parameters are used in the literature to describe translucency, making it difcult for
clinicians to nd clear information on ceramic translucency and compare studies.
Purpose. The purpose of this study was to assess the correlation between the contrast ratio (CR) and translucency parameter
(TP) when the translucency of different types of ceramic systems is compared.
Material and methods. Disks 13 mm in diameter and 0.7 mm thick were fabricated for the following materials (n5): VITA
VM9, VITA PM9, IPS Empress CAD, IPS e.max CAD, IPS e.maxPress, and Lava Zirconia. VITA VM9 served as positive control,
while Lava Zirconia served as negative control. The luminous reectance (Y) and color coordinates (CIE L* a* b*) of the
specimens were measured with a tristimulus colorimeter. The CR (CRYb/Yw) was calculated from the reectance of the light
of the material on a black backing (Yb) to the reectance on a white backing (Yw). The TP (TP[(Lb*Lw*)2(ab*-aw*)2(bb*1/2
bw*)2 ] ) was calculated from the color difference of the material on a black versus a white background. One-way ANOVA
based on ranked data and the Pearson and Spearman rank correlation tests were used to analyze the data (a.05).
Results. A signicant correlation between CR and TP was found when all specimens were included (P<.001). The coefcient
of -0.99 indicated a strong decreasing relationship between the 2 variables.
Conclusions. Either CR or TP can be used to evaluate the relative translucency of ceramic systems. (J Prosthet Dent 2013;110:397-401)

Clinical Implications
Much has been published regarding the translucency of dental ceramics,
but the different parameters used to describe translucency make it
difcult for the clinician to nd clear information on ceramic
translucency and compare studies. A strong correlation between the
contrast ratio and the translucency parameter was found; therefore,
either measurement is an acceptable parameter for assessing the relative
translucency of dental ceramics.

Assistant Professor, Department of Restorative Dentistry, University of Colorado School of Dental Medicine.
Associate Professor, Department of Operative Dentistry, Universit Laval Faculty of Dentistry, Qubec, Canada.
c
Professor, Department of Family Dentistry, The University of Iowa College of Dentistry.
d
Associate Research Scientist, Adjunct Assistant Professor, Biostatistics Unit/Department of Preventive and Community Dentistry,
The University of Iowa College of Dentistry.
e
Associate Professor, Department of Operative Dentistry, The University of Iowa College of Dentistry.
f
Associate Professor, Department of Prosthodontics, The University of Iowa College of Dentistry.
g
Associate Professor, Division of Operative Dentistry, University of Florida College of Dentistry.
b

Barizon et al

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Volume 110 Issue 5

In recent years, the number of
ceramic materials has increased, and
several studies have evaluated their
mechanical and physical properties.1-12
Because esthetics is increasingly important, optical properties, including
the translucency of ceramic materials,
have been the focus of many studies.13-26
The translucency of dental materials
is commonly measured by using the
translucency parameter (TP)27 and
contrast ratio (CR).15,28,29 The CR is
the ratio between the reectance of a
specimen on a black background to
that on a white background of a known
reectance.28-31 The CR values are
calculated according to the equation
CRYb/Yw, in which Yb represents the
spectral reectance of the light of the
specimen on a black background and
Yw on a white background. The CR is a
direct measure of opacity and decreases
as translucency increases.32 The value
of a perfectly transparent material is 0,
while the value of a completely opaque
material is 1.30
Likewise, the TP represents the color
difference between a material of uniform thickness on a black and a white
background and corresponds directly
to a common visual assessment of
translucency.27 The Commission Internationale de lEclairage (CIE) recommends calculating color difference (DE)
based on CIELAB color parameters.33
The CIELAB is a nonlinear transformation of the tristimulus space to agree
with Munsell spacing32 and has been
largely used to compare translucency
among materials. The TP values are
calculated by using the following
equation27: TP [(Lb*-Lw*)2(ab*1/2
aw*)2(bb*-bw*)2 ] , where b refers to
color coordinates on the black background and w refers to color coordinates on the white background.
Although studies have used CR or
TP to assess the difference in translucency among materials, no strong
evidence exists that those 2 variables
correlate with each other. Chu et al19
compared the CR and masking abilities (DE) of 3 types of porcelain veneers
(Procera, Empress 2, and Vitadur
Alpha) and observed signicant

differences in CR and DE among the

ceramics studied. Vitadur Alpha was
found to be the most translucent material with the lowest DE, while Procera
and Empress 2 demonstrated higher CR
and DE.
Yu et al31 found a negative correlation between the mean values of TP and
CR when the translucency of tooth
enamel and dentin were evaluated. The
TP values increased in inverse proportion to thickness. The CR values of
enamel and dentin decreased as the
wavelength increased, similar to those
of dental restorative materials. Human
enamel showed lower CIE L* a* b*
values than dentin of the same thickness, which means that enamel is
darker and more reddish and yellowish
in color compared to dentin.
The purpose of this study was to
assess the correlation between the CR
and TP when the translucency of different
types of dental ceramic systems was
compared. The null hypothesis tested
was that no correlation exists between the
CR and TP values of dental ceramics.

MATERIAL AND METHODS

Thirty disks, 5 per group, 13 mm in
diameter and 0.7 0.01 mm in thickness, were fabricated with the following
ceramic systems: VITA VM9 (VM), VITA
PM9 (VP), IPS Empress CAD (EC), IPS
e.max CAD (IC), IPS e.maxPress (EP),
and Lava Zirconia (LZ). VM served as a
positive control and LZ as a negative
control. All ceramic disks were fabricated with the shade corresponding to
A1 in the Vita Classical Shade Guide
(Vita Zahnfabrik) (Table I).
The conventional feldspathic ceramic
disks were fabricated with a silicone
matrix (Template Ultra Quick; Clinicians Choice Dental Products Inc)
placed over a glass slide. VITA VM9
powder was mixed with build-up liquid
(Vita Zahnfabrik). The porcelain slurry
was then hand-vibrated into the silicone
matrix, and the excess moisture was
removed by slight compression with a
clean paper tissue. The specimens were
red according to the manufacturers
instructions.

The Journal of Prosthetic Dentistry

Lost-wax and heat-press techniques

were used to fabricate the pressable
ceramics (VP and EP) according to
the manufacturers recommendations.
Acrylic resin (Pattern Resin LS; GC
America Inc) patterns of cylindrical
shape were fabricated with a silicone
matrix (Template Ultra Quick; Clinicians Choice Dental Products Inc);
then the patterns were sliced with a
precision saw machine (Isomet 1000;
Buehler) into disks approximately 1 mm
thick and 13 mm in diameter. The
sprueing, investing, and ring processes
were performed according to the manufacturers instructions. All 5 specimens
of each group were pressed in the same
investment ring from 1 ingot.
The machinable ceramic specimens
(EC, IC, and LZ) were obtained by cutting computer-aided design/computeraided manufacturing (CAD/CAM) blocks
with diamond disks in a precision
saw machine (Isomet 1000; Buehler).
IC specimens were sliced in the soft intermediate state, while LZ specimens
were sliced in the presintered state; the
slices were then submitted to the crystallization or sintering process according to the manufacturers instructions.
All specimens were nished at on a
grinding and polishing machine (Rotopol V; Struers Inc) with wet 120-, 240-,
400-, 600-, 800-, and 1200-grit silicon
carbide paper. During this process, the
porcelain disks were repeatedly evaluated with a digital micrometer (Mitutoyo Corp) to ensure a nal thickness
of 0.7 mm.
The luminous reectance (Y) and
color coordinates (CIE L* a* b*) of the
specimens were measured with a tristimulus colorimeter (CR-221 Chroma
Meter; Minolta Co Ltd) with CIE illuminant D65 lighting condition and the
2-degree observer function. The optical
conguration of the colorimeter was
45-degree illumination geometry with a
0-degree viewing angle. The measuring
head of the CR-221 was used in an
inverted position, the tip of the lightprojection tube was facing up, and the
baseplate was locked against it. The
dimension of the window (measuring
area) was 3 mm in diameter, representing

Barizon et al

November 2013

Table I.

399

Product information

Material

Classication

Manufacturer

Vita VM9

Conventional feldspathic

Vita Zahnfabrik

Neutral

VITA PM9

Pressable feldspathic

Vita Zahnfabrik

ENL P-HT

Machinable feldspathic

Ivoclar Vivadent AG

A1

IPS Empress CAD

Shade

IPS e.max CAD

Machinable lithium disilicate

Ivoclar Vivadent AG

HT A1/C14

IPS e.max Press

Pressable lithium disilicate

Ivoclar Vivadent AG

HT A1

Lava Zirconia

Machinable polycrystalline

3M ESPE

NA

NA, Not applicable.

less than 50% of the diameter of the

specimens. The output for each of the
independent readings was an instrumental average of 3 successive measurements made automatically by the
colorimeter.
The measurements were performed
at the center of each specimen on a
white (Y74.01/CIE L*88.81, a*4.98, b*6.09) and black backing
(Y0.61/CIE, L*7.61, a*0.45,
b*2.42). Before and after each series
of measurements for each group, the
instrument was calibrated with a standard glossy white calibration plate (CRA45; Minolta) to validate the reliability
of the instrument. To reduce the edgeloss effect (that is light within the
specimen scattered to the edges
without being absorbed30), a drop of
water was placed between each specimen and the backing to seal the
airspace and ensure the specimen was
in optical contact with the backing.
The CR values were calculated from
the spectral reectance of the light of the
specimen (Y) on a black background
(Yb) and on a white background (Yw),
in which CRYb/Yw.28 The TP values
were evaluated by calculating the color
difference of the specimens on black
and white backgrounds by using the
following equation27: TP[(Lb*-Lw*)2
(ab*-aw*)2(bb*-bw*)2]1/2, where b refers to color coordinates on the black
background and w refers to color coordinates on the white background.
A materials thickness will directly
affect its translucency; therefore, the
translucency measurement is considered inversely related to thickness. To

Barizon et al

ensure consistency in the specimen

thickness, it was evaluated within the
groups and compared between the
groups. Each specimens thickness was
measured 3 times, and the average of
the 3 measurements was then used to
evaluate and compare within and between the groups.
Because of the lack of normality, 1way ANOVA based on ranked data was
performed to detect differences in
thicknesses among 6 ceramic systems
(a.05). The correlation between CR
and TP was assessed with the Pearson
and Spearman rank correlation tests.
SAS for Windows (v9.3; SAS Institute
Inc) was used for the data analysis.

RESULTS
The results of 1-way ANOVA based
on ranked data revealed no signicant
difference in specimen thickness among
the 6 ceramic systems (P.264), and
the mean thickness ranged from 0.70 to
0.71. The standard deviation ranged
from 0.00 to 0.01 among the groups,
conrming consistency in thickness
within groups. Thus, the specimen thickness did not interfere with the results of
the study.
Descriptive statistics for CR and TP
are presented in Tables II and III. Based
on the Spearman rank correlation test,
a signicant correlation between CR
and TP was found when all specimens
were included (P<.001) (Fig. 1). Considering the Spearman correlation coefcient takes values between 1 and
-1, the closer the coefcient is to 1
or -1, the stronger the association.

Therefore, the coefcient of -0.99 indicated a strong inverse relationship between the 2 variables.
When the correlation was assessed
within each material, no signicant
correlation was found between CR and
TP (P>.05 for each instance), except
for EC, in which a signicant negative
correlation between CR and TP was
found (P.014, Pearson correlation
test). In this instance, the coefcient of
-0.95 indicated a strong inverse relationship between the 2 variables for
EC.

DISCUSSION
The null hypothesis was rejected
after statistical analysis revealed a
strong negative correlation between
TP and CR values among all porcelain
groups; the greater the TP, the smaller
the CR. When the correlation was
assessed within each material, no
signicant correlation was found between CR and TP (P>.05 for each
instance), except for EC, in which a
signicant negative correlation between CR and TP was found. The
relatively small sample size of 5
specimens per group of material may
explain why the CR-TP correlation
could not be statistically demonstrated within each group and can be
considered as a limitation of the
present study. However, the CR-TP
correlation among all porcelain
groups can be considered more relevant information because translucency
ranks are commonly used when evaluating the relative translucency of
ceramic materials.15,16,19 The decision
to choose the sample size of 5 specimens per group was based on
Heffernan et al,15,16 who identied
signicant differences among the CR
of ceramics materials by using a protocol similar to that of the present
study and the same number of specimens per group. A previous pilot
study also found signicant differences among the CR and TP values of
the ceramics studied.
The materials tested were chosen
from a great range of ceramic materials

400

Volume 110 Issue 5

Table II.

Descriptive statistics of contrast ratio by material (n5)

Material

Mean

SD

Minimum

Maximum

Median

VITA VM9

0.10

0.00

0.10

0.11

0.10

VITA PM9

0.15

0.01

0.14

0.15

0.15

IPS Empress CAD

0.22

0.01

0.21

0.23

0.22

IPS e.max CAD

0.25

0.00

0.25

0.25

0.25

IPS e.max Press

0.37

0.02

0.35

0.40

0.36

Lava Zirconia

0.73

0.00

0.72

0.73

0.73

Table III.

Descriptive statistics of translucency parameter by material (n5)

Material

Mean

SD

Minimum

Maximum

Median

VITA VM9

46.13

0.89

44.92

46.94

46.57

VITA PM9

40.34

0.52

39.65

40.91

40.30

IPS Empress CAD

35.73

0.67

34.87

36.44

35.65

IPS e.max CAD

33.02

0.07

32.93

33.11

33.03

IPS e.max Press

26.59

0.83

25.40

27.39

27.02

Lava Zirconia

10.43

0.14

10.24

10.58

10.44

0.2

0.3

50
45
40
35

TP

30
25
20
15
10
5
0

0.1

0.4

0.5

0.6

0.7

0.8

CR
1 Correlation between translucency parameter (TP) and contrast ratio (CR)
for all specimens.
currently available for the fabrication of
porcelain veneers. These materials can
be divided into 3 main groups according to the fabrication technique: conventional feldspathic ceramics, pressable
ceramics, and machinable ceramics.
The conventional feldspathic porcelains
are still considered the most translucent ceramic material.15,16,19,23 Pressable ceramics have the advantages
of superior marginal t and fewer intrinsic defects.3,34,35 Finally, machinable

ceramics have become more popular

because of the growing interest of clinicians in chairside porcelain systems and
the possibility of having a 1-appointment
procedure.
The literature has shown that thickness indirectly affects the transmission
of light through dental porcelains. The
greater the material thickness, the lower
its translucency.13,15,18,20,22,31,36 For
this reason, the thickness of each specimen in this study was measured 3 times

The Journal of Prosthetic Dentistry

and the means were compared among

groups. No statistical difference among
groups was noted, and the low standard
deviations conrmed the low variability
within groups, guaranteeing the consistency in thickness among the specimens. Rigorous thickness control ensured
that the differences in translucencies between materials were not due to variable
specimen thickness.
Similar to the present study, Chu
et al19 compared the CR and DE of 3
types of porcelain veneers. The CR and
DE were signicantly different among
the materials. Although the authors
used CR and DE to assess the differences in translucency among materials,
they did not test for correlation between the 2 variables. On the basis of
the results of the current study, apparently that correlation exists. Yu et al31
found a negative correlation between
TP and CR means when the translucency of tooth enamel and dentin
was evaluated. Although these authors
evaluated differences in translucency
between enamel and dentin, they also
tested the correlation between TP and
CR, the same variables tested in the
present study on porcelain specimens.
In this instance, the present study conrms the existence of a correlation between TP and CR. Further studies
should be performed with increased
sample size to conrm the correlation
of CR and TP within materials and to
assess the correlation between CIELAB
and CIEDE 2000 values.

CONCLUSION
Within the limitations of this in vitro
study, a strong correlation was found
between the CR and TP values of the
ceramic systems evaluated. Thus, either
CR or TP may be used to evaluate the
relative translucency of ceramic systems.

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Corresponding author:
Dr Karine T. L. Barizon
13065 E 17th Ave, Rm 201E
Aurora, CO 80045
E-mail: karine.barizon@ucdenver.edu
Copyright 2013 by the Editorial Council for
The Journal of Prosthetic Dentistry.