Laboratory study comparing the influence of different cements on the color of all-ceramic implant crowns supported by titanium base abutments Backgrounds: The esthetic outcome is essential for the overall success of implant therapy. The color appearance of peri-implant soft tissue is one of the key factors influencing the esthetics. It has been often reported that titanium abutment may cause a change in color appearance of the peri-implant mucosa, especially when mucosa thickness is 2mm or less. However, it remains unclear whether the color appearance of the peri-implant mucosa would be influenced by different cements and cementation protocols. The aim of the laboratory study is to evaluate, utilizing spectrophotometers, the influence of different cements on the color of lithium disilicate crowns and the color of peri-implant soft tissue around them. Null hypothesis is distribution of ΔE is the same across different cements. Materials and methods: A case with implant supported screw retained crown on 12 was chosen. The morphology of the peri-implant soft tissue was reconstructed using artificial gingiva on a plastic model. 12 was replaced by a replica.48 monolithic disilicate crowns with identical design were fabricated (3 samples for each group). In 3 of the 15 test groups, 3 temporary cements were used to cement crowns on titanium abutments. In 6 groups, crowns were cemented with 6 different definitive cements on titanium abutments. In another 6 groups, the same 6 cements were used while the abutments were sandblasted. 3 abutments was made using composite die material duplicating the exact shape of the titanium abutment. 3 crowns were cemented with light Try-in paste on the composite die abutments as control groups. A spectrophotometer was used to measure color performance on middel and cervical sites of the crowns, and artificial soft tissue 1mm below the mucosa margin. Readings with CIE Lab color scale were recorded. Results: ΔE between test and control groups were calculated according to the formula: ΔE=(ΔL2+Δa2+Δb2)1/2. ΔE mean values calculated were as follows: With titanium abutments: light Variolink Esthetic Try-in paste® (Ivoclar), 2.52; translucent glue, 1.9; zinc oxide temporary cement (Rely X®, 3M), 1.4; self-curing resin based cement (HO 0, Multilink® Hybrid Abutment, Ivoclar), 1.39; self-adhesive universal resin cement (A2, RelyX® Unicem, 3M), 2.03; dual-cure resin cement (Clear, Panavia®V5, Kuraray), 2.17; dual-cure resin cement (A2, Panavia®V5, Kuraray), 2.3; dual-cure resin cement (White, Panavia®V5, Kuraray), 1.77; dual-cure resin cement (Opaque, Panavia®V5, Kuraray), 1.73. With sandblasted titanium abutments: self-curing resin based cement (HO 0, Multilink® Hybrid Abutment, Ivoclar), 1.93 self-adhesive universal resin cement (A2, RelyX® Unicem, 3M), 1.85; dual-cure resin cement (Clear, Panavia®V5, Kuraray), 1.98; dual-cure resin cement (A2, Panavia®V5, Kuraray), 1.62; dual-cure resin cement (White, Panavia®V5, Kuraray), 1.87; dual-cure resin cement (Opaque, Panavia®V5, Kuraray), 1.78. Independent-Samples Kruskal-Wallis test was performed to compare the ΔE values across different cements. The significance level was set at 0.05. The null hypothesis was rejected. Within the limitation of the study, the following conclusions can be drawn: 1. Cements with different shade from different brands may lead to different color performance on peri-implant soft tissue around all ceramic crowns cemented on titanium abutments. 2. Multilink HO 0 showed the most favorable color performance in the current study, followed by Panavia Opaque. 3. It appears that cements with more opaque shade lead to smaller color change on the labial surface of both peri-implant mucosa and crown. 4. The influence of cements on color performance are different across different part of the crown, and peri-implant mucosa.
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