A New Approach to Compare the Esthetic Properties of Different Composite Materials

Abstract

Modern composite systems are either very simple with few shades or very complex with an array of shades. Which approach gives the best esthetic results? The study aims to use a new approach to compare the esthetic properties of different composite materials and evaluate the ability of four different composite systems to imitate the natural shade of teeth. Seventeen extracted teeth were restored using four different composite materials (Filtek Supreme XT [3M ESPE, Glostrup, Denmark], Ceram-X Duo [Dentsply-Friadent, Roskilde, Denmark], Tetric EvoCeram [Ivoclar Vivadent AB, Solna, Sweden], Enamel Plus HRI [Micerium, Avegno, Italy]). In total, 68 restorations were fabricated using the 17 teeth as their own control. This was made possible utilizing a device designed to remove exactly the same piece of tooth/composite every time. The time for placement and shades used were recorded. Two dentists evaluated the esthetic match of the restorations using slightly modified Extended Visual Rating Scale for Appearance Match criteria. There was a statistically significant difference (p ≤ 0.05) between Filtek Supreme XT and Tetric EvoCeram and between Enamel Plus HRI and Tetric EvoCeram regarding the esthetic match. However, this was not deemed clinically relevant in most cases. Filtek Supreme XT required the most time, whereas Ceram-X Duo required the least time. There was a high intra- and interobserver agreement regarding ratings. The study concluded that: (1) it was possible with all four composite systems to make restorations that were judged clinically acceptable in 91 to 96% of the cases; (2) more time was needed when using the more "advanced systems"; and (3) the new standardized, simple, and clinically relevant evaluation method was capable of comparing different composite systems' ability to imitate natural teeth.