Effect of surface sealant and staining on the fluorescence of resin composites

Yong-Keun Lee, DDS, PhD,a Huan Lu, DDS, PhD,b and John M. Powers, PhDc
Department of Dental Biomaterials Science, College of Dentistry, Seoul National University, Seoul,
Korea; The University of Texas Dental Branch at Houston, Houston, Tex
Statement of problem. Natural teeth and several commercial resin composites emit a strong blue
fluorescence when exposed to ultraviolet (UV) light, which makes teeth whiter and brighter in daylight. Surface
sealant and staining may change the fluorescence of resin composites.
Purpose. The purpose of this study was to determine the effect of surface sealant application and staining/stain
removal on the fluorescence of resin composites.
Material and methods. Spectral reflectance and color of 4 resin composites (Filtek Supreme, Gradia Direct,
Simile, and Vit-l-escence) were measured with/without application of a surface sealant (BisCover) at baseline
and after staining/stain removal (n = 5). A UV filter was used to exclude or include the UV component of
illumination. Fluorescence spectra were calculated by subtracting the spectral reflectance values of the UV
component excluded condition from those of UV included condition. For staining, specimens were sequentially
immersed in mucin, chlorhexidine, and a tea solution. Stain removal was performed by ultrasonic cleaning and
PBS (phosphate buffered saline) immersion. Color difference (DE00) by the UV component was calculated
based on CIEDE2000 color system. Delta E00 due to staining and stain removal were also calculated. Changes
in color and fluorescence by the staining and stain removal were analyzed by 2-way analysis of variance (a=.05).
Results. Sealant application decreased fluorescence of resin composites. After staining, fluorescence was not
detected except for 1 composite. After stain removal, a decrease in fluorescence from the baseline was observed,
and 2 composites showed significant decrease (P,.05).
Conclusion. Fluorescence of resin composites decreased or disappeared after surface sealant application and/
or staining procedure. (J Prosthet Dent 2005;93:260-6.)

CLINICAL IMPLICATIONS
Surface sealant and staining decrease the fluorescence of resin composites, which can destroy color
matching between restorative resin and a tooth, especially under UV light. Therefore, to
maximize the fluorescent property of resin composites, sealant should not be applied, and the
restoration should be cleaned regularly.

T he purpose of a resin composite restoration is to re-

place lost tooth structure in a manner that blends in with
the surrounding teeth. Natural teeth emit blue fluores-
cence when exposed to ultraviolet (UV) light, which
makes teeth whiter and brighter in daylight.1
Fluorescence may also be used to brighten dark teeth.2
Ideal restorative materials should have fluorescence sim-
ilar to that of natural teeth.3 If fluorescence is absent, the
esthetic qualities of the restorations suffer predomi-
nantly under UV illumination conditions (black light).
Since resin composites may be applied by layering to
a
Associate Professor, Department of Dental Biomaterials Science,
College of Dentistry, Seoul National University.
b
Assistant Professor of Oral Biomaterials, Department of Restorative
Dentistry and Biomaterials, Houston Biomaterials Research
Center, The University of Texas Dental Branch at Houston.
c
Professor, Department of Restorative Dentistry and Biomaterials,
and Director, Houston Biomaterials Research Center, The
University of Texas Dental Branch at Houston.
mimic the natural stratification of dentin and enamel,
optical properties such as fluorescent and opalescence
are important, as in dental porcelains.4,5
Fluorescence, although minimally perceptible under
normal viewing conditions, is clinically significant.
Restorations should match the color of the natural teeth
not only in daylight, but also under different light
sources. Fluorescence is important in black light for ac-
tors or people participating in social activities in dance
clubs or other environments that use black lighting.
Under these conditions the fluorescence of a restoration
is very important to natural appearance.3 The fluores-
cence of resin composites was measured with a color-
measuring spectrophotometer, and some commercial
resin composites exhibit similar fluorescence to natural
teeth.3
The fluorescence spectra of anterior restorative mate-
rials have been shown to vary by the material and are af-
fected by the application of a glaze.3 The application of
surface sealant to resin composite restorations is

260 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 93 NUMBER 3

LEE, LU, AND POWERS THE JOURNAL OF PROSTHETIC DENTISTRY

Table I. Materials used in this study

Code Brand name Shade Composition Batch no. Manufacturer

FSP Filtek Supreme A2E 58-60 vol.% filler of primary particle size of 5-20 nm 3AF 3M ESPE, St. Paul, Minn
GRD Gradia Direct A2 64-65 vol.% filler of 0.85 mm 0305132 GC America, Alsip, Ill
SIM Simile A2 68 vol.% filler of 0.7 mm and 0.04 mm 77325 Pentron Clinical Technologies,
Wallingford, Conn
VIT Vit-l-escence A2 58 vol.% filler of 0.7 mm 56V4 Ultradent Products,
South Jordan, Utah

intended to fill in surface defects, improve marginal in-
tegrity, and increase resistance to abrasion.6 Surface
sealant may provide better resistance to staining than
a polished resin composite by reducing the porosity of
the surface and by providing a more thoroughly poly-
merized surface.7
The accumulation of exogenous staining can also in-
fluence the fluorescence of resin composites. Intraorally,
the first deposit to accumulate on dental resin is mucin,
with subsequent plaque accumulation acting as a matrix
for the deposition of stain.8 High–molecular weight sal-
ivary mucin is common to both the enamel pellicle and
the acquired denture pellicle.9 The influence of surface
roughness and chemical composition of glass ionomer
and resin composite on the biofilm formation was exam-
ined.10 The combined effect of tea, chlorhexidine, and
saliva on the staining of resin composites is higher
than that with tea alone.11 Staining of teeth following
a large consumption of tannin-containing beverages or
a prolonged use of chlorhexidine is well known.12
Chlorhexidine can precipitate or bind to surface anionic
chromogens contained in foods and beverages.13,14
Instrumental technologies that quantify color and
color difference are widely used to study color in
dentistry. The CIELAB-based color difference
(DE
ab), which is calculated by the equation:
2 2 2
DE
ab ¼ ½ðDL
Þ 1 ðDa
Þ 1 ðDb
Þ 1=2 , is generally
15
used. However, parameters for the size of perceptible
or acceptable color differences in esthetic restorations
vary from 1.1 to 3.7DE
ab.16-18 Since the sizes of
DE
ab values for perceptible or acceptable color
difference are also dependent on chromaticity, a new
color difference formula including hue and chroma
functions has been used for more accurate color discrim-
ination.19 The CIEDE2000 color difference (DE00) for-
mula is based on CIELAB and showed improved
performance in color discrimination for several colors
compared to CIELAB-based DE
ab formula.19
Although individual studies have been performed,
the combined effect of surface sealant application, stain-
ing, and stain removal on the fluorescence of dental resin
composites is still unclear.6,7 The purpose of this study
was to determine the effect of surface sealant application
and staining/stain removal on the fluorescence of resin
Table II. Immersion solutions
Batch
Immersion solution Concentration no. Manufacturer
Phosphate buffered 0.01 mol/L 014K8210
Sigma, St. Louis,
saline (PBS) Mo
Mucin in PBS (MCP) 3 g/L in PBS 113K1012 Sigma
Chlorhexidine 0.2% in PBS 307-826 STERIS Corp,
digluconate (CHX) St. Louis, Mo
Tea solution (TEA) 10 g/L in DW 3K25SB052 Lipton, Engle
wood Cliffs, NJ
composites with a color-measuring spectrophotometer
and to evaluate the correlations between changes in
fluorescence and color. The null hypothesis was that
there was no significant change in the fluorescence of
resin composites after surface sealant application, stain-
ing, and stain removal.
MATERIAL AND METHODS
Four resin composites of A2 shade were evaluated
(Table I). Resin composite was packed into a polytetra-
fluoroethylene mold (10 mm in diameter and 2 mm in
thickness) on a polyethylene film. After packing the
composite, another polyethylene film was pressed on
the top of the specimen and loaded with a 5-kg load
for 3 minutes to produce a uniform thickness. The spec-
imen was then light polymerized for 40 seconds in 3
overlapping areas with a light-polymerizing unit (The
Max; Dentsply/Caulk, Milford, Del). The output of
the polymerizing light was verified with a radiometer
(Kerr/Demetron, Orange, Calif). Specimens were pol-
ished with a 600-grit silicon carbide paper. Ten speci-
mens were fabricated for each composite and divided
into 2 groups. A surface sealant (BisCover, Lot number
0300007354; Bisco Inc, Schaumburg, Ill) was applied
in 1 group (SS group) according to the manufacturer’s
instructions and was not applied in the other group
(NO group). In the SS group, the surface of the speci-
men was etched, rinsed, and dried. Then, 1 thin coat
of sealant was applied, air thinned to distribute the seal-
ant evenly, and light-polymerized. All specimens were

MARCH 2005 261

THE JOURNAL OF PROSTHETIC DENTISTRY LEE, LU, AND POWERS

Table III. Fluorescence peak wavelength, height, and area by surface treatment and staining
Baseline After staining After stain removal
Wavelength Height Area Wavelength Height Area Wavelength Height Area
Code TX
(nm) (a.u)y (a.u) (nm) (a.u) (a.u) (nm) (a.u) (a.u)

FSP NO ND ND ND ND ND ND ND ND ND
SS ND ND ND ND ND ND ND ND ND

GRD NO 440 2.0 (0.1)z 171 (12) 450 0.6 (0.2) 73 (27) 450 1.2 (0.3) 94 (24)
SS 440 1.6 (0.0) 124 (4) ND ND ND 450 0.9 (0.1) 69 (13)

SIM NO 440 1.3 (0.2) 89 (21) ND ND ND 440 1.2 (0.3) 100 (38)
SS ND ND ND ND ND ND 440 0.3 (0.1) 22 (2)

VIT NO 440 2.4 (0.1) 201 (11) ND ND ND 450 0.8 (0.1) 66 (15)
SS 440 2.3 (0.4) 226 (42) ND ND ND ND ND ND
ND, Not detected.


Sealant application; NO = 600-grit polishing and no treatment, and SS = 600-grit polishing and surface sealant application.
y
Arbitrary unit.
z
Mean (standard deviation).

immersed in distilled water for 24 hours, and spectral re-
flectance and color were measured after blot drying
(baseline). Spectral reflectance and color were measured
after each step after blot drying, according to the
CIELAB color scale relative to standard illuminant
D65, over a white standard tile on a reflection spectro-
photometer (Color-Eye 7000; GretagMacbeth
Instruments Corp, New Windsor, NY). The aperture
size was 3 3 8 mm, and illuminating and viewing config-
urations were CIE diffuse/10-degree geometry.
Measurements were repeated 3 times for each specimen.
An ultraviolet (UV) filter was inserted or removed to ex-
clude or include the UV component of illumination.
Fluorescence was determined by comparison of spectral
reflectance values based on the inclusion or exclusion of
the UV component.
Staining procedures consisted of 3 steps. Immersion
solutions are listed in Table II. Amounts of immersion
solutions were 15 ml/specimen. The first step was de-
veloping a pellicle-like layer with mucin (MCP).
Specimens were immersed in 37°C MCP for 72 hours.
The second step was alteration of adsorbed mucin with
chlorhexidine (CHX). Specimens were immersed in
37°C CHX for 24 hours. After each of first and second
steps, specimens were dried for 2 hours in a 37°C oven
to create a stable coating. The third step was staining
of treated specimens with tea solution (TEA).
Specimens were immersed in 37°C TEA for 72 hours,
and spectral reflectance and color were measured after
drying for 2 hours in a 37°C oven instead of blot drying,
because deposits by staining could be changed by blot-
ting. Specimens were ultrasonically cleaned for 1 hour
and immersed in 37°C phosphate-buffered saline
(PBS) for 72 hours to detach and dissolve the stain.
From the spectral reflectance values, differences in
reflectance by the inclusion or exclusion of UV
component (fluorescence spectra) were calculated.
Preliminary subtraction spectra from 410 to 750 nm
were obtained by subtracting the spectral reflectance
value obtained with the UV component excluded at
each wavelength from that obtained with UV compo-
nent included. Then, to eliminate the distortion in illu-
mination by the inclusion or exclusion of UV
component, the difference in spectra at each wavelength
of the white standard tile by the inclusion or exclusion of
UV component was subtracted from the preliminary
subtraction spectra of material at each wavelength.
Peak wavelength, height, and peak area (from 410 to
550 nm) were calculated for the final subtraction
spectra.
Difference in color (DE00) based on the inclusion
or exclusion of UV component was calculated. The
DE00 values after staining and stain removal for
the UV included condition were also calculated. Color
difference, DE00, was calculated as: DE00 ¼ f½DL0 =
2 2
ðkL SL Þ2 1 ½DC0 =ðkC SC Þ 1 ½DH0 =ðkH SH Þ 1 R T ½DC0 =
0 1=2 19
ðkC SC Þ 3 ½DH =ðkC SC Þg . The DL#, DC#, and
DH# are the differences in lightness, chroma, and hue be-
tween the 2 measurements being compared. SL, SC, and
SH are the weighting functions for the lightness, chroma,
and hue components, respectively. KL, KC, and KH are
the parametric factors to be adjusted according to differ-
ent viewing parameters.19 In the present study, all func-
tions and factors were set to 1.
Fluorescence peak height and area were analyzed by
3-way analysis of variance (ANOVA, SPSS 11.0; SPSS,
Chicago, Ill) at a=.05 with the independent variables
of composite, sealant application, and staining. Color
differences (DE00) by the inclusion or exclusion of
the UV component at each condition of baseline, after
staining and stain removal, were analyzed by 2-way
ANOVA at a=.05 with the independent variables of

262 VOLUME 93 NUMBER 3

LEE, LU, AND POWERS THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 1. Changes in fluorescence of FSP (100% reflectance = Fig. 2. Changes in fluorescence of GRD (100% reflectance =
total reflectance). total reflectance).

composite and sealant application. Color changes

(DE00) after staining and after stain removal were ana-
lyzed by 2-way ANOVA at a=.05 with the independent
variables of composite and sealant application. Means by
the composites were compared with Scheffe’s multiple
comparison test (a=.05). The correlation between the
fluorescence peak height and color difference (DE00)
by the inclusion or exclusion of the UV component
(fluorescence) was also determined.

RESULTS
Fluorescence peak wavelength, height, and area are
listed in Table III. Fluorescence peak height and peak
area were influenced by the composite, sealant applica-
tion, and staining, and there were significant interac-
tions—between composite and sealant application, and
composite and staining (P,.05) based on the 3-way
ANOVA. In GRD (NO, no surface sealant, and SS, sur-
face sealant groups) and VIT (NO group), peak height
and area decreased significantly after stain removal com-
pared with the baseline.
Differences in spectral reflectance due to the UV
component of D65 illumination (fluorescence spectra)
are shown in Figure 1 for FSP, Figure 2 for GRD,
Figure 3 for SIM, and Figure 4 for VIT. In FSP, fluores-
cence was not detected. In GRD, fluorescence peaks
were observed in the NO group regardless of staining
and stain removal. A peak was not detected in SS group
after staining, however, the peak reappeared after stain
removal. In SIM, fluorescence was detected in
NO-baseline, NO-stain removal, and SS-stain removal.
VIT showed fluorescence at NO-baseline, SS-baseline,
and NO-stain removal.
Fig. 3. Changes in fluorescence of SIM (100% reflectance =
total reflectance).
Color difference, DE00, due to the fluorescence is
shown in Figure 5. Delta E00 values at baseline and after
stain removal were influenced by the composite but not
by the surface sealant application (P=.05), and DE00 val-
ues after staining were not influenced by the composite
and the surface sealant application based on the 2-way
ANOVA. The ranges of DE00 values were 0.2-0.6 for
FSP, 0.6-1.4 for GRD, 0.5-1.1 for SIM, and 0.6-1.5
for VIT. The correlation coefficient (r) between DE00
due to the fluorescence and the fluorescence peak height
was 0.89 (P,.05).
To quantify the color changes by staining/stain re-
moval procedures, DE00 values associated with these

MARCH 2005 263

THE JOURNAL OF PROSTHETIC DENTISTRY LEE, LU, AND POWERS

Fig. 5. Color difference by inclusion or exclusion of UV

component.

Fig. 4. Changes in fluorescence of VIT (100% reflectance =

total reflectance).

Fig. 6. Range of color changes after staining (- represents Fig. 7. Range of color changes after stain removal from
average value). baseline (- represents average value).

procedures were calculated. The ranges of mean DE00 DISCUSSION

values after staining were 7.8-22.6 from the baseline
The combined effect of surface sealant application
(Fig. 6), and 2.2-17.4 after stain removal from baseline
and staining/stain removal on the fluorescence of resin
(Fig. 7). Color changes (DE00) after staining and after
composites was assessed with a spectrophotometer in
stain removal were influenced by the composite and sur-
this study. The null hypothesis was rejected because
face sealant application, and there were significant inter-
the fluorescence of resin composites was changed after
actions between composite and sealant application
surface sealant application, staining, and stain removal.
(P,.05) based on the 2-way ANOVA. There was no
In fluorescence spectra (Figs.1 through 4), negative val-
correlation between color change and decrease in fluo-
ues might reflect the range of experimental error; how-
rescence peak. Color changes after staining and stain re-
ever, in conditions for fluorescent emission, clear
moval were influenced by the surface sealant application
positive peaks were observed. One resin composite
for VIT composite (Figs. 5 and 6).

264 VOLUME 93 NUMBER 3

LEE, LU, AND POWERS
(FSP) did not show fluorescence at baseline, and color
difference (DE00) by the inclusion or exclusion of the
UV component was small (0.2-0.6), which seemed to
be in the range of measurement error. Delta E00 values
of FSP after staining and stain removal were smaller
than for the other composites (Figs. 6 and 7).
GRD, SIM, and VIT showed fluorescence at baseline,
which changed after sealant application and staining/
stain removal procedures. For SIM, fluorescence was
not detected after sealant application, and the other
composites showed small changes in fluorescence after
sealant application (Table III). This phenomenon can
be explained in part by the fact that the fluorescence of
GRD and VIT was higher than that of SIM before seal-
ant application. However, the ratio of change in fluores-
cence after sealant application varied by composite. This
result is in agreement with a previous study that reported
that surface sealant reduced the fluorescence of resin
composites.3 The reduction could have been caused by
reduced transmission through the surface sealant of
the UV radiation and/or by absorption of fluorescence
from the resin composites by the surface sealant.3 The
penetration depth of the UV component of illumination
from the spectrophotometer (360-400 nm), which in-
duced fluorescent emission, might be limited to the out-
er surface of resin composite, or within surface sealant,
although the polymerizing irradiation (around 470 nm)
for resin composites could penetrate 1.5 mm deep into
composites.20 The thickness of surface sealant on resin
composite could range from 0-70 mm.6 In the present
study, the surface sealant apparently blocked out fluo-
rescence in SIM, which showed relatively small fluores-
cence at baseline for NO group.
Color difference due to fluorescence ranged from 0.5
to 1.5 for all the groups and was not affected by the sur-
face sealant application and staining/stain removal.
Since the acceptability thresholds of color differences
were 1.1 DE
ab units for red-varying ceramic crowns
and 2.1 DE
ab units for yellow-varying crowns, they
were found to be dependent on chromaticity.21
Therefore, DE00 values by the UV component of D65
illumination of the present study might be regarded as
visually unacceptable under in vitro optimal lighting
and environment conditions. Conversely, if one were
to apply Johnston and Kao’s acceptability tolerance
(3.7 DE
ab units), determined for resin composite ve-
neers under intraoral in vivo conditions, the alterations
in fluorescence would not be considered unaccept-
able.18 Moreover, the condition of the present study
was normal daylight condition (D65), not intense UV
illumination. Therefore, this difference in color may be
emphasized under intense black light.
In the study by Monsenego et al,22 UV light pene-
trated the 1.5-mm-thick ceramic disks and excited the
underlying cement to emit fluorescence. Therefore,
the fluorescence of the cemented ceramic disk was the
MARCH 2005
THE JOURNAL OF PROSTHETIC DENTISTRY
sum of its own fluorescence and the fluorescence of un-
derlying cement filtered by the ceramic. This result was
different from that of the present study, in which
fluorescence of resin composites was blocked out by
the thin layer surface sealant. This discrepancy might
be caused by the fact that the ceramic in the previous
study emitted fluorescence but the surface sealant might
not emit fluorescence, and the penetration of the UV
component was different for the ceramic and the surface
sealant. After staining, fluorescence was not detected ex-
cept for the NO group of GRD. Color change due to
staining reflects the amount of stain deposits and there-
fore may reflect the degree of reduction in transmission
of UV and fluorescent light. The color change for
VIT was high regardless of surface sealant
(DE00 = 16.5-22.6). This may partially explain the
apparent disappearance of fluorescence in VIT after
staining.
In the present study, stain removal was performed by
ultrasonic stain removal and immersion in PBS for simple
comparisons; however, if bleaching agents were used for
this step, the results might be different. After stain re-
moval, fluorescence was detected in all specimen groups
except VIT-SS. Interaction of stain with sealant appar-
ently made fluorescence disappear. In some conditions,
the fluorescence peak wavelength changed after stain re-
moval. This might be explained by the surface optical
properties that were changed during staining and stain re-
moval, and also the small changes in peak position that
were expressed as large changes in wavelength (10 nm)
since the interval of measurement was 10 nm. Further
studies on the addition of fluorescent substance in sealant
would enhance the fluorescence of resin composites.
CONCLUSIONS
Within the limitations of this study, sealant applica-
tion and staining decreased or blocked the fluorescence
of the resin composites tested. Stain removal might
restore fluorescence to some extent.
REFERENCES
1. Spitzer D, Bosch JJ. The total luminescence of bovine and human dental
enamel. Calcif Tissue Res 1976;20:201-8.
2. McLaren EA. Luminescent veneers. J Esthet Dent 1997;9:3-12.
3. Panzeri H, Fernandes LT, Minelli CJ. Spectral fluorescence of direct ante-
rior restorative materials. Aust Dent J 1977;22:458-61.
4. Lee YK, Powers JM. Calculation of colour resulting from composite/
compomer layering techniques. J Oral Rehabil 2004;31:1102-8.
5. Primus CM, Chu CC, Shelby JE, Buldrini E, Heckle CE. Opalescence of
dental porcelain enamels. Quintessence Int 2000;(33):439-49, 2002.
6. Bertrand MF, Leforestier E, Muller M, Lupi-Pegurier L, Bolla M. Effect
of surface penetrating sealant on surface texture and microhardness of
composite resins. J Biomed Mater Res 2000;53:658-63.
7. Doray PG, Eldiwany MS, Powers JM. Effect of resin surface sealers on im-
provement of stain resistance for a composite provisional material. J Esthet
Restor Dent 2003;15:244-50.
8. Keng SB, Lim M. Denture plaque distribution and the effectiveness of a per-
borate-containing denture cleansers. Quintessence Int 1996;27:341-5.
9. Edgerton M, Levine MJ. Characterization of acquired denture pellicle
from healthy and stomatitis patients. J Prosthet Dent 1992;68:683-91.
265
THE JOURNAL OF PROSTHETIC DENTISTRY LEE, LU, AND POWERS

10. Carlen A, Nikdel K, Wennerberg A, Holmberg K, Olsson J. Surface char- 20. Soh MS, Yap AU, Siow KS. Comparative depths of cure among various
acteristics and in vitro biofilm formation on glass ionomer and composite curing light types and methods. Oper Dent 2004;29:9-15.
resin. Biomaterials 2001;22:481-7. 21. Douglas RD, Brewer JD. Acceptability of shade differences in metal
11. Khokhar ZA, Razzoog ME, Yaman P. Color stability of restorative resins. ceramic crowns. J Prosthet Dent 1998;79:254-60.
Quintessence Int 1991;22:733-7. 22. Monsenego G, Burdairon G, Clerjaud B. Fluorescence of dental porce-
12. Nordbo H, Eriksen HM, Rolla G, Attramadal A, Solheim H. Iron lain. J Prosthet Dent 1993;69:106-13.
staining of the acquired enamel pellicle after exposure to tannic acid or
chlorhexidine: preliminary report. Scand J Dent Res 1982;90:117-23. Reprint requests to:
13. Addy M, Prayitno SW. Light microscopic and color television image anal- DR YONG-KEUN LEE
ysis of the development of staining on chlorhexidine-treated surfaces. ASSOCIATE PROFESSOR
J Periodontol 1980;51:39-43. DEPARTMENT OF DENTAL BIOMATERIALS SCIENCE
14. Leard A, Addy M. The propensity of different brands of tea and coffee to COLLEGE OF DENTISTRY, SEOUL NATIONAL UNIVERSITY
cause staining associated with chlorhexidine. J Clin Periodontol 1997;24: 28 YEONGEON-DONG, JONGRO-GU
115-8. SEOUL, KOREA
15. CIE (Commission Internationale de l’Eclairage). Colorimetry-Technical FAX: 82-2-740-8694
Report. CIE Pub. No. 15, 2nd ed. Vienna, Austria: Bureau Central de la E-MAIL: ykleedm@snu.ac.kr
CIE, 1986 (corrected reprint 1996).
16. Ruyter IE, Nilner K, Moller B. Color stability of dental composite resin 0022-3913/$30.00
materials for crown and bridge veneers. Dent Mater 1987;3:246-51. Copyright Ó 2005 by The Editorial Council of The Journal of Prosthetic
17. Seghi RR, Hewlett ER, Kim J. Visual and instrumental colorimetric assess- Dentistry.
ments of small color differences on translucent dental porcelain. J Dent
Res 1989;68:1760-4.
18. Johnston WM, Kao EC. Assessment of appearance match by visual obser-
vation and clinical colorimetry. J Dent Res 1989;68:819-22.
19. Luo MR, Cui G, Rigg B. The development of the CIE 2000 color-difference
formula: CIEDE2000. Color Res Appl 2001;26:340-50. doi:10.1016/j.prosdent.2004.12.017

Loss of teeth and coronary heart disease

Noteworthy Abstracts Ragnarsson E, Eliasson ST, Gudnason V. Int J Prosthodont 2004;17:441-6.
of the
Current Literature
Purpose. This study examined the possible association of three dental factors with total mortality and death
from coronary heart disease.
Materials and Methods. Samples from two studies were combined, for a total of 2,613 individuals aged 25 to
79 years; a total of 353 deaths occurred, of which 82 were from coronary heart disease. The hazard ratio was
calculated for total and coronary heart disease mortality by regression for the dental components; conventional
risk factors were controlled for in a stepwise manner.
Results. For total and coronary heart disease mortality, associations with both edentulousness and number of
years of edentulism were statistically significant until smoking was added into the analysis; then, all significance
was lost. When the effect of the oral parameters was studied in relation to total and coronary heart disease mor-
tality, after adjusting for age and gender, there was a significant hazard ratio for total mortality, but only for
edentulousness. When examined by stepwise regression of the coronary heart disease risk factors, all significance
of risk from the three oral parameters was lost, smoking having the largest effect of all risk factors.
Conclusion. Number of remaining teeth, edentulousness, and number of years of edentulism were not inde-
pendent risk factors for total or coronary heart disease mortality, but they were surrogate markers for the risk
from smoking.—Reprinted with permission of Quintessence Publishing.

266 VOLUME 93 NUMBER 3