Oral Health Group
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A Versatile Single Shade Universal Composite

July 11, 2022
by Ross W. Nash, DDS; Tyler Wurmlinger, DDS


Innovative one-colour universal light-cured shade adaptive composites are trending, and it is essential to evaluate them from the perspectives of accurate clinical shade matching and saving of chairside time and effort. SpheriChrome (Oxford Scientific, Elmshorn, Germany) is based on an advanced shade-adaptive solution to colour matching based on the naturally occurring “universal structural colouration principle”.

Adaptive colour matching is based on structural colouration which is a naturally occurring result of the wave interference principle and can be seen in peacock feathers and soap bubble film. Structural colouration was first observed in 1665 by Robert Hooke. In 1892 Thomas Young explained it further with the wave interference principle. Structural colouration has been used commercially in photography and fashion. SpheriChrome was developed using the wave interference principle producing structural colour generation.

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It has been designed for accurate shade-matching in all classes of dental restorations. “Structural colouration” is colour production by microscopically structured surfaces fine enough to interfere with visible light, sometimes in combination with pigments.1

Fillers of specific size and shape must be controlled in the generation of red-to-yellow colouration as ambient light passes through composite manufactured without dyes or pigments. The spherical fillers create a red-to-yellow that combines with the patient’s natural dentition, yielding a perfect match.

One composite with adaptive nano fillers offers multiple shades to match virtually all clinical situations, eliminating the need to individually shade match each restoration. This saves significant chair time and eliminates the concerns of variable ambient light, clinical error and metamerism.

Two separate recent studies addressed the colour adjusting principle CAP of resins utilizing differing compositions that permit the filling material to better reflect the natural tooth colour.

High CAP resins blend with surrounding enamel and dentin improving esthetics, simplifying shade matching and compensating for shade differences.2,3 This was confirmed by simply creating a restoration and placing it among artificial teeth of varying shades. SpheriChrome produced shade A2 colour when placed in a mouth with shade A2 teeth and the same restoration produced shade B2 when placed in a mouth with B2 teeth.

Many current composites utilize the addition of red and yellow dyes or pigments to simulate tooth colouration; thus, each practice must stock a considerable inventory of shades to adequately serve its patients. Structural colour SpheriChrome employs 200nm spherical fillers that refract ambient light and combine with the reflected colours of the patients’ remaining dentition to generate shade-matching Al to D4 red-to-yellow colouration without additional pigments or dyes.

Case Reports

Case 1

A middle-aged female patient exhibited wear and occlusal carries in her mandibular left first and second molars. (Fig. 1) Minimal preparation with a small round diamond bur under rubber dam (Fig. 2) was followed by 10 seconds of phosphoric acid etching, thorough rinsing and gentle air drying. A 7th generation bonding agent was applied to the prepared areas and light-cured for ten seconds. SpheriChrome flowable was applied in several increments, each light-cured for twenty seconds. The composite was contoured with a carbide finishing bur and polished with a composite polishing brush. The final restorations before (Fig. 3) and after (Fig. 4) rubber dam removal.

Fig. 1

Patient with occlusal and pit caries.

Patient with occlusal and pit caries.

Fig. 2

Decay removed and preparations complete.

Decay removed and preparations complete.

Fig. 3

Restorations performed with SpheriChrome.

Restorations performed with SpheriChrome.

Fig. 4

Molars restored.

Molars restored.

Case 2

The patient asked to have the central diastema (Fig. 5) closed for a more “normal looking” smile without orthodontic treatment. It was decided to directly veneer all four incisors with composite to establish correct proportionality. After minimal preparation with fine diamond burs, (Fig. 6) SpheriBlock was placed at the interproximal space between the central incisors. Regular SpheriChrome was layered over the entire facial surfaces of each tooth, providing the patient’s desired aesthetic result. (Fig. 7)

Fig. 5

 Patient with malposed anterior teeth.

Patient with malposed anterior teeth.

Fig. 6

 Minimal preparation for composite veneers

Minimal preparation for composite veneers

Fig. 7

. SpheriChrome veneers placed on the maxillary incisors.

SpheriChrome veneers placed on the maxillary incisors.

Case 3

The chipping of the two central incisors (Fig. 8) offered minimal dentin exposure (Fig. 9). With minimal preparation and a slight bevel, SpheriChrome was added to restore the original tooth morphology. SpheriBlock was needed only at the mesial corner of the left central incisor, followed by layered SpheriChrome on the facial aspect and incisal edges. (Figs. 10 & 11) SpheriBlock is useful for masking for tooth discolouration or interdental/incisal show-through.

Fig. 8

Chipped central incisors, facial view.

Chipped central incisors, facial view.

Fig. 9

Chipped central incisors, incisal view.

Chipped central incisors, incisal view.

Fig. 10

 Incisal and Class IV repairs with SpheriChrome, facial view

Incisal and Class IV repairs with SpheriChrome, facial view

Fig. 11

 Incisal and Class IV repairs with SpheriChrome, Incisal view..

Incisal and Class IV repairs with SpheriChrome, Incisal view.

Case 4

A mature patient wished to improve the appearance and alignment of her mandibular anteriors without orthodontics. (Fig. 12) She selected direct composite veneers on the basis of affordability.

Fig. 12

Crowded mandibular anterior teeth

Crowded mandibular anterior teeth

Eight mandibular anteriors were recontoured to make room for approximately 0.5mm of composite. (Fig. 13) The lower left lateral was direct veneered with SpheriChrome, using the SpheriBlock only at the incisal. SpheriChrome was layered over the entire facial surface. (Fig. 14) The final result shows a fine gloss finish that matches the natural dentition, (Fig. 15) easily accomplished chairside as SpheriChrome polishes like a microfill, quickly and esthetically.

Fig. 13

. Tooth preparation for direct composite veneers.

Tooth preparation for direct composite veneers.

Fig. 14

Right central incisor restored with SpheriChrome.

Right central incisor restored with SpheriChrome.

Fig. 15

SpheriChrome direct veneers for all six mandibular anterior teeth

SpheriChrome direct veneers for all six mandibular anterior teeth

SpheriChrome’s flowability makes it easy to place. The Calset Thermal Unit composite warmer (Addent, Inc., Danbury CT) can readily adjust or modify the handling properties. (Figs. 16,17) The ability to change the viscosity and flow by warming can achieve excellent marginal adaptation.4

Fig. 16

Compex dispenser with unit dose. (Addent Inc., courtesy, Dr. Josh Friedman).

Compex dispenser with unit dose. (Addent Inc., courtesy, Dr. Josh Friedman).

Fig. 17

Calset Thermal Unit (Addent Inc., courtesy, Dr. Josh Friedman).

Calset Thermal Unit (Addent Inc., courtesy, Dr. Josh Friedman).

Rueggeberg (2003) indicated that the maximum intrapulpal temperature rise from the application of a 57.2˚C composite material was approximately 1.6˚C, well within the established pulpal tolerance of more than 10˚C. 5, 6, 7, 8 Further, the preheating insertion technique provided better adaptation to the cavity walls than those of the conventional and sonic insertion techniques.

Physical properties

In-house testing demonstrated that SpheriChrome has decreased surface roughness, (Graph 1) lower shrinkage, (Graph 2) and better flexural strength when compared to a competing product. A smoother restorative surface permits less biofilm to form, decreasing esthetic and maintenance problems.9,10,11 Lower shrinkage decreases the likelihood of microleakage and related marginal discolourations and secondary caries.12

Graph 1

 Surface Roughness (All tests are done according to DIN ISO 4049, Oxford Scientific).

Surface Roughness (All tests are done according to DIN ISO 4049, Oxford Scientific).

Graph 2

Shrinkage in Water (All tests are done according to DIN ISO 4049, Oxford Scientific).

Shrinkage in Water (All tests are done according to DIN ISO 4049, Oxford Scientific).

Compressive strength is important but needs to be examined in perspective. (Graph 3) The generally accepted range of dentin compressive strength is 200-350 MPa; enamel 300-450MPa. The figures are greatly variable due to anatomical location, age, and method of testing. The ideal compressive strength of a restorative material should not be so high that it can damage the remining dentition during mastication. SpheriChrome’s compressive strength falls well within the acceptable range of value.13,14

Graph 3

Compressive Strength (All tests are done according to DIN ISO 4049, Oxford Scientific).

Compressive Strength (All tests are done according to DIN ISO 4049, Oxford Scientific).

Conclusion

SpheriChrome is a versatile composite that colour matches for most restorative applications. Available in the two most popular dispensing systems, syringes, and unit dose, SpheriChrome can be pre-warmed with the Addent Calset Thermal Unit or Compex dispenser. All of these features combine to make SpheriChrome one of the newest paradigms of the dental industry.

Oral Health welcomes this original article.

Additional pioneering books that discuss the theory of Structural colouration and Wave Interference studies and principles from history:

  • Beddard, Frank Evers (1892). Animal Colouration, An Account of the Principal Facts and Theories Relating to the Colours and Markings of Animals. Swan Sonnenschein, London – 2nd Edition, 1895.
  • Hooke, Robert (1665). Micrographia, John Martyn and James Allestry, London.
  • Newton, Isaac (1704). Opticks, William Innys, London.

References

  1. Zack, L. Cohen G., 1965 “pulp Response to exernally applied heat” Oral surgery. Oral Med. Oral Pathol. 19: 515-530.
  2. Natalie Pereira Sanchez, John M Powers, Rade D. Paravina; Instrumental and Visual evaluation of Color Adjustment Potential of Resin Composites J Esthet Restor Dent. 2019 Sep; 31 (5): 465-470.
  3. Joao Luiz Bittencousrt de Abreu, Camila Sobral Sampaio 4, Ernesto Byron Benalcazar Jalkh, Ronaldo Hirata: Analysis of the color matching of universal resin composties in anterior retoartions: j Estheer Restor Dent 2021 Mar; 23(2) 269-276.
  4. G Demirel, AI Orhan, O Irmak, F Aydin, A Buyuksungur, B Bilecenoglu, K Orhan, Effects of Preheating and Sonic Delivery Techniques on the internal Adaptation of Bulk-fill Resin composites, Operative Dentistry, 2021, 46-2, 226-233.
  5. M Quirynen, C M Bollen; “The influence of surface roughness and surface-free energy on supra- and subgingival plaque formation in man. A review of the literature”; J. Clinical Periodontology1995 Jan;22(1):1-14.
  6. J W Park, C W Song, J H Jung, S J Ahn, J L Ferracane; “The effects of surface roughness of composite resin on biofilm formation of Streptococcus mutans in the presence of saliva”; Oper Dent Sep-Oct 2012;37(5):532-9.
  7. Attends to the chart for the test method used for polymerization shrinkage of poly-based restorative materials (ISO 17304:2013).
  8. Göhring TN, Besek MJ, Schmidlin PR (2002) Attritional wear and abrasive surface alterations of composite resin materials in vitro. J Dent 30:119-127.
  9. Sripetchdanond J, Leevailoj C (2014) Wear of human enamel opposing monolithic zirconia, glass ceramic, and composite resin: An in vitro study. J Prosthet Dent 112:1141-1150.
  10. Tobias T Taubock, Zrinka Tarle, Danijela Marovic, Thomas Attin Preheating of high viscosity bulk-fill resin composites; Effects on shrinkage force and monomer conversion. Journal of Dentistry 43 (2015) 1358-1364.
  11. Freedman, G. Clinical Benefits of Pre–Warmed Composites; Private Dentistry JUNE 2003 8:5 111–114.
  12. Freedman, G., Krejci, I. Warming up to Composites; Compendium MAY 2004 25:5 371–376.
  13. Freedman, G. Composites Are Warming Up; Oral Health July 2009 99:7 40–46.
  14. Branka Trifkovic, John M powers, Rade D Paravina, Color adjustment potential of resin composites; Clin Oral Investig. 2018 Apr, 22 (3):1601-1607.

About the Author

Ross Nash maintains a private general practice in Huntersville, NC, where he focuses on cosmetic, aesthetic and full mouth rehabilitative treatment. He presents workshops and lectures nationally and internationally and has authored chapters in two clinical textbooks. He is the co-founder of the Nash Institute for Dental Learning in Huntersville and is a member and accredited fellow in the American Academy of Cosmetic Dentistry.

Tyler Wurmlinger is a practising dentist in Huntersville, NC. He earned his Doctorate of Dental Surgery at the University of Detroit Mercy in 2011. Since 2015, Dr. Wurmlinger has been practising dentistry in the greater Charlotte area, focusing on cosmetic dentistry. He is a member of The American Academy of Cosmetic Dentistry.


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