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Objectives: The aim of this study was to evaluate in vitro color stability of resin ceramic and feldspathic porcelain with two different mouth rinses: non-alcohol based 0.12% Chlorhexidine digluconate (CHX), and alcohol-based Listerine®. Methods: Two types of CAD/CAM ceramic-blocks: Hybrid resin ceramic (VITA ENAMIC® for CEREC®/ inLab®, VITA Zahnfabrik H. Rauter GmbH & Co.KG., Germany, VE) and Feldspathic (Vitablocks MarkII, VITA Zahnfabrik H. Rauter GmbH & Co.KG., Germany, VM) were included in the study. A total of 36 samples of each material were prepared. Groups VE and VM were divided into three subgroups (n = 12 per group) based on the immersion medium: distilled water (control, W), non-alcohol-based mouth rinse, 0.12% Chlorhexidine digluconate (NA), or alcoholbased mouth rinse (A), Listerine®. Samples were stored in 20 mL in one of the mouth rinses for 120 hours, which was reported as the equivalent time to 10 year of 2-min daily mouth rinse use. Samples’ baseline color values were recorded according to the CIE Lab system by using a color spectrophotometer. Color measurements were subsequently obtained following immersion for 120 hours and after samples rinsing with distilled water and allowed to dry. CIE L*, a*, and b* were measured. Color difference (ΔE), were calculated and analyzed using one-way ANNOVA (P<0.05). Results: Immersion in either Non-Alcohol, or distilled water resulted in significantly higher color change values for VE compared to VM, while no significant difference in color change existed between both materials following immersion in Alcohol based Listerine mouth rinse. (704) Mahmoud Abdel Salam Shakal and Hany Aboulfotouh Abdelmohsen Oraby E.D.J. Vol. 64, No. 1 Prevention of dental caries and/or gingivitis is basically maintained by routine and proper oral hygiene. The routine mechanical dental plaque removal in addition to the use of chemical therapeutic agents are considered the usual daily practice for proper oral hygiene maintenance. Chemical plaque control agents are prescribe by dentists for patients susceptible to periodontal disease and/ or dental caries such as those receiving fixed prosthodontics treatments(3). Chlorhexidine digluconate (CHX) is one of the frequently prescribed antibacterial agent that reduces periodontal disease and dental caries. It is presented in many forms as gel, spray, or mouth rinse. CHX administration has been associated with side effects such as, enamel and restorative materials staining, formation of calculus, and temporary unpleasant taste(4, 5). As reported by the findings of many research, that there is discoloration of restorative materials following their immersion in CHX mouth rinse (6). Listerine® is another mouth rinses which is frequently prescribed and used as an anti-plaque agent to treat gingivitis. Initially it contained four essential oils peppermint, eucalyptus, thyme, and wintergreen, they were later replaced by menthol, eucalyptol, thymol, and methyl salicylate. 24%– 27% of the Listerine component volume is ethanol as a vehicle to maintain the phenolic component solvents. Listerine®(7). Discoloration of the composite resin has been reported following the use of Listerine® mouth rinse(8). Researchers have also reported ceramic discoloration following the use of Mouth rinses containing fluoride ingredients as a result of surface roughness after the use of fluoride products (9). Commission International de l’Eclairage introduced a new scientific systemCIE Lab* that described color by number and calculated color differences. The CIE Lab system is a uniform color scale where L represents lightness and b describes chromatic characteristics. In this system, “a” is the green/red coordinate and “b” represents the blue/ yellow coordinate (-a = green, +a = red, -b = blue, and +b = yellow). The color differences are reported by delta values ΔL*, Δa*, and Δb* compared with standard conditions. The total color differences (ΔE) indicate differences between L*, a*, and b* of the sample and the standard values. These differences are calculated according to the following formula(10): ΔE = [(ΔL*)2 + (Δa*)2 +( Δb* ) 2]1/2 . If ΔE is ≤ 3.3, the color changes in the restoration are acceptable on clinical assessment, (11). For better human perceptibility and acceptability of color differences between tooth colors CIE developed new formula ΔE00 (12), where Perceptibility is defined as the color difference detected by the human eye whereas acceptability refers to tolerable differences between colors. A better assessment of color differences among dental ceramics is provided by another formula, CIEDE2000 (13). The thresholds for perceptibility and acceptability of different dental materials has been a controversial issue where Douglas et al. have reported a lower threshold for perceptibility (mean ΔE = 0.4 unit, ΔE = 2.6 unit) than acceptability (1.7-unit ΔE, 5.5-unit ΔE) for PFM and acrylic denture teeth, respectively(14). while, Lindsey reported no significant difference between them(15). Ghinea et al.(13) reported a significant difference between perceptibility and acceptability thresholds for dental ceramics by using ΔE and the new ΔE00 formula for color calculation. Recently devices were introduced to measure color following, the scientific approach to tooth color matching. A simple, inexpensive instrument to measure color on three axes or stimuli such as the human eye is the colorimeter. While other devices developed to measure color by reflection or transmission of an observed object is the IN VITRO EFFECT OF ALCOHOL AND NON-ALCOHOL BASED MOUTH RINSES (705) spectrophotometer which is used to measure changes in the color of the restorative materials more accurate. Other electronic instruments were introduced such as CCDs and fiber optics(11). The combination of composite resins, ceramics, and CAD/CAM technology have led to the introduction of a resin ceramic hybrid CAD/CAM blocks (VITA ENAMIC) which combines the advantages of both ceramics and composites(16-18). VITA ENAMIC, was reported to have high flexural strength values, and elasticity close to dentin due to their fine ceramic structure and the polymer network (19). The minimal invasive restorations are possible with these material as a result of acquiring high strength after adhesive bonding. In addition. VITA ENAMIC had better internal and marginal adaptation than feldspathic ceramics as reported by pervious researches (20). In terms of color matching, the manufacturer stated that VITA ENAMIC offers material properties that are almost identical to those of natural teeth. Mouth rinses together with the mechanical means of oral hygiene helps in preventing and control of caries, periodontal diseases, through cessation of plaque, moreover for diminishing oral malodor. Alcohol and non-alcoholbased mouth rinses are varieties used popularly by patients as a mean for regularly maintaining oral hygiene on daily basis (21). Color stability of restorative materials could be affected by both alcoholcontaining and alcoholfree mouth rinses as reported by some studies (22-24). Therefore, this study was directed to evaluate the in vitro effect of alcohol or non-alcohol-based mouth rinses on color stability of resin ceramic and feldspathic ceramic crowns. The null hypothesis was that after immersion in either NA or A mouth rinses, the color stability of VITA ENAMIC is not significantly different from this of Vitablock Mark II.

In Vitro Effect of Alcohol and Non-Alcohol Based Mouth Rinses on Color Stability of CAD/CAM Resin Ceramic and Feldspathic Ceramics