Skip to main content
Download PDF

Final shade and whiteness: impact of various ultra-thin CAD/CAM veneers and tooth-colored resin substrates

BMC Oral Health volume 25, Article number: 504 (2025) Cite this article

This article has been updated

Abstract

Background

Achieving optimal color control in chairside CAD/CAM ultra-thin veneers, remains a significant challenge for dental clinicians and technicians. This study aims to investigate the effect of ultra-thin CAD/CAM medium translucency (MT) lithium disilicate veneers and tooth-colored resin substrates on final tooth shade and whiteness.

Materials and methods

Disk-shaped ceramic veneers (IPS e.max CAD MT, Ivoclar Vivadent, Liechtenstein) with a thickness of 0.3 mm were fabricated in BL2, BL3, BL4, B1, A1, A2, and A3 shades. Additionally, 4-mm thick resin substrates (Tetric N-Ceram, Ivoclar Vivadent, Liechtenstein) were prepared in A2, A3, A3.5, and A4 shades to simulate tooth-colored substrates. Veneer-resin composites were prepared by combining veneer specimens and resin substrates. Color coordinates of tooth-colored resin substrates (R), veneer-resin composites (C) and the shade guide tabs (G) were obtained using a spectroradiometer. Color differences of ΔE00(C-R), ΔE00(C-G) and ΔE00(R-G) were then calculated with the CIEDE2000 formula. The initial and final shades were considered matched when ΔE00(R-G) or ΔE00(C-G) was clinically acceptable or minimal. Additionally, whiteness differences (ΔWID) between R and C specimens were recorded. Two-way analysis of variance (ANOVA) was performed, followed by the Tukey HSD. The significance level was set at p < 0.05.

Results

Both the shades of resin substrates and veneer shades had significant effects on ΔE00(C-R) and ΔWID (p < 0.001), while no interaction effects were observed (p > 0.05). They increased with darker resin substrates and lighter veneers, except for no significant differences among BL4, B1, and A1 veneers. The largest color difference was observed for BL2 veneers on A4 substrates (ΔE00(C-R) = 6.9 ± 0.3, ΔWID = 19.0 ± 1.5), while the smallest occurred with A3 veneers on A2 substrates (ΔE00(C-R) = 2.4 ± 0.6, ΔWID = 5.6 ± 1.0). Final tooth shades were maximally transformed to lighter shades, with A2, A3, A3.5, and A4 substrates shifting to 2M1, 2L1.5, 2R2.5, and 3L1.5, respectively.

Conclusions

Both resin substrates and veneer shades significantly influence final tooth shade and whiteness independently. 0.3-mm thick CAD/CAM MT lithium disilicate veneers produce substantial shade and whiteness transformations, making them effective for shade enhancement.

Graphical Abstract

Peer Review reports

Introduction

The emergence of ceramic veneers offers clinicians a minimally invasive solution for various aesthetic concerns, including morphological defects, diastema closure, and mild tooth discoloration [1, 2]. The integration of chairside CAD/CAM systems enables the fabrication of high-quality, same-day ultra-thin veneers, meeting patients'growing demands for efficient and minimally invasive treatments [1, 3, 4]. Preserving maximal tooth structure, especially enamel, has been shown to reduce risks of fracture and debonding, improve aesthetic and functional outcomes, and enhance long-term survival rates [5,6,7,8]. These benefits, particularly with no-preparation veneers as thin as 0.3 mm [9, 10], have made ultra-thin restorations increasingly popular. However, achieving optimal color control in chairside CAD/CAM ultra-thin veneers, remains a significant challenge for dental clinicians and technicians, which is limited by the shade of the chosen block.

There are factors can influence the optical color of CAD/CAM ultra-thin veneers, including ceramic thickness, the shade of the ceramic block, and the color of the underlying tooth substrate [10]. Studies have shown that darker veneers have minimal impact on darker substrates, while lighter substrates are affected by both lighter and darker veneers when using feldspathic ceramics [10]. Many previous [11,12,13] studies have focused on masking the underlying tooth color to match the shade of the ceramic block used. However, this is challenging with ultra-thin veneers, particularly those that are 0.3-mm thick, as the final color is significantly influenced by the substrate's color [4, 14,15,16]. It also has been found that the high translucency (HT) lithium disilicate ceramics shown limited color change ability [17, 18], so decreasing ceramic translucency enhance the color change ability over the various substrate [19]. Medium translucency (MT) lithium disilicate ceramic stands out for its superior flexural strength [20, 21] and is optically brighter than its HT counterparts [19]. These properties make it a promising material for ultra-thin veneers and potentially yielding more color change capabilities than HT ceramics [11]. However, the specific impact of ultra-thin MT ceramics on different tooth-colored substrates has not been extensively explored, leaving a gap in the understanding of their clinical application.

In dental practice, color parameters are commonly recorded using the International Commission on Illumination Lab (CIELAB) color space system, which provides a three-dimensional representation of colors [22, 23]. The CIEDE2000 formula, which incorporates not only lightness (L*) and chroma (a*, b*) but also hue weighting functions and an interactive term between chroma and hue differences, has been found to provide a significantly better fit for human observer responses, especially when dealing with small color differences. This is in contrast to the CIELAB formula, which only accounts for lightness and chroma [24]. While ΔE00 is widely used to quantify color differences objectively, few studies evaluate final shades by comparing ΔE00 values of restorations with the shade guide tabs [23]. Accurate detection of the tooth color and shade is a critical point particularly with aesthetic restoration. Accurate shade detection seems to be subjective, accordingly, there is an agreement that we need a unique formula for calculating differences between colors that most closely match human perception to aid both clinicians and technician. When the color difference between compared different objects can be accurately detected by 50% of observers (there are other 50% that will notice no difference), this could be assigned to what is called the 50:50% perceptibility threshold. Similarly, When the color difference is considered acceptable by 50% of observers (there are other 50% would consider it unacceptable), this could be assigned to the 50:50% acceptability threshold. A perceptible color match in dentistry is a color difference at or below the perceptibility threshold; an acceptable color match is a color difference at or below the acceptability threshold [23]. Additionally, the growing demand for whiter teeth [25,26,27,28] underscores patients'preference for evaluating the"degree of whiteness"when comparing restorations to adjacent teeth or shade guide tabs [29]. Although whiteness can be described using three color coordinates, the Whiteness Index for Dentistry (WID)—a one-dimensional index—offers a more straightforward and patient-friendly communication tool [29,30,31].

To address this, it is crucial to integrate shade variation with changes in WID to accurately reflect color differences. This in vitro study investigated the impact of various ultra-thin (0.3-mm thick) CAD/CAM MT lithium disilicate veneers and tooth-colored resin substrates on final tooth shade and whiteness. The findings aim to explore the whiteness and shade variation of ultra-thin CAD/CAM lithium disilicate veneers, guide optimal shade selection, and improve communication among clinicians, technicians, and patients. The null hypothesis posited that the shade of both tooth-colored resin substrates and ultra-thin CAD/CAM veneers would not affect the final shade and whiteness.

Materials and methods

Specimen preparation

Thirty-two disk-shaped resin substrates (Tetric N-Ceram, shades A2, A3, A3.5, and A4, Ivoclar Vivadent, Liechtenstein) were fabricated using silicon molds to mimic various tooth substrate colors (n = 8 per shade) [32, 33]. Each disk was light-polymerized on both surfaces (Elipar S10, 3 M ESPE, USA; 20 s per side) [34]. Post-polymerization, specimens were sequentially wet-polished using silicon carbide papers (407Q, 3 M, USA) from 600- to 1200-grit [35] to achieve final dimensions of 8 × 8 × 4 mm [10, 12]. Dimensional accuracy was verified through five-point measurement using a digital caliper (01412 A, Neiko Tools, USA) [10, 34]. All substrates underwent ultrasonic cleaning in distilled water for 10 min followed by air drying.

Fifty-six lithium disilicate ceramic disks (IPS e.max CAD MT, Ivoclar Vivadent, Liechtenstein) were CAD/CAM-milled in shades BL2, BL3, BL4, B1, A1, A2, and A3 (n = 8 per shade) [11]. Following the same polishing protocol as resin substrates [35], ceramic specimens were processed to final dimensions of 8 × 8 × 0.3 mm, with dimensional verification using the digital caliper. Crystallization and glazing were performed in a ceramic furnace (Programat P700, Ivoclar Vivadent, Liechtenstein) according to the manufacturer’s protocol [36].

Color measurement

Color measurements were performed on the middle third of each shade tab (Linearguide 3D-MASTER, VITA Zahnfabrik, Germany) using an intraoral spectrophotometer (Easyshade advance 4.0, VITA Zahnfabrik, Germany) [37, 38]. All measurements were conducted against a neutral gray background (L* = 64.1; a* = 0.3; b* = − 3.4) [39, 40]. For each shade tab, five consecutive measurements were taken to determine mean CIE L*a*b* values (designated as L0*, a0*, and b0*). Similarly, five measurements were obtained from the central region of resin substrates, with corresponding mean values recorded as L1*, a1*, and b1*.

Ceramic specimens were assembled with their corresponding resin substrates using optical gel (Optical Gel, Cargille Labs, USA) as a refractive medium, forming veneer-resin composites [41,42,43,44]. Color coordinates (L2*, a2*, b2*) were recorded for each veneer-resin composite. Color differences were calculated using the CIEDE2000 (ΔE00) formula, including:

  1. 1.

    Between veneer-resin composites (C) and resin substrates (R): ΔE00(C-R), ΔL(C-R)*, Δa(C-R)*, and Δb(C-R)*

  2. 2.

    Between shade guide tabs (G) and veneer-resin composites (C): ΔE00(C-G)

  3. 3.

    Between shade guide tabs (G) and resin substrates (R): ΔE00(R-G)

Shade matching was evaluated against the clinically acceptable threshold (AT, ΔE00 = 1.8) [23]. Matches were considered acceptable when ΔE00(C-G) or ΔE00(R-G) values were below AT. When exceeding AT, the minimal ΔE00 value was used for shade determination.

The formula for ΔE00 was as follows:

$${{\Delta}{E}}_{00}\text{=}\sqrt{{\left(\frac{{\Delta}{L}^{\prime}}{{\text{K}}_{L}{{\text{S}}}_{L}}\right)}^{2}+{\left(\frac{{\Delta}{C}^{\prime}}{{\text{K}}_{C}{{\text{S}}}_{C}}\right)}^{2}+{\left(\frac{{\Delta}{H}^{\prime}}{{\text{K}}_{H}{{\text{S}}}_{H}}\right)}^{2}+{\text{R}}_{\text{T}}\left(\frac{{\Delta}{C}^{\prime}}{{\text{K}}_{C}{{\text{S}}}_{C}}\right)\left(\frac{{\Delta}{H}^{\prime}}{{\text{K}}_{H}{{\text{S}}}_{H}}\right)}$$

  • ΔL', ΔC', and ΔH'represent differences in lightness, chroma, and hue, respectively.

  • SL, SC, and SH are weighting functions for spatial uniformity correction in CIELAB color space [24].

  • KL, KC and KH are parametric factors (set to 1 in this study).

  • RT is the rotation function accounting for elliptical non-uniformity in the blue region [45].

Furthermore, the whiteness index for dentistry (WID) was calculated for shade guide tabs, resin substrates, and veneer-resin composites, denoted as WID(G), WID(R), and WID(C), respectively. The whiteness difference (ΔWID) values between WID(R) and WID(C) were determined using the following formula [29]:

$${\text{WI}}_{\text{D}}{=}{\text{0.511L}}^{*}-{\text{2.324a}}^{*}-{\text{1.100b}}^{*}$$
$${\Delta}{\text{WI}}_{\text{D}}{=}{\text{WI}}_{\text{D(C)}}-{\text{WI}}_{\text{D(R)}}$$

Statistical analysis

Based on the existing sample size, the power values for the data (ΔE00(C-R), ΔL(C-R)*, Δa(C-R)*, Δb(C-R)* and \({\Delta}{\text{WI}}_{\text{D}}\)) were calculated using PASS 15.0 software (NCSS LLC, USA). All the data were also analyzed with SPSS software (SPSS version 22.0; SPSS). The normality was assessed using the Shapiro–Wilk test. Levene’s test was applied to check for homogeneity of variances. Two-way analysis of variance (ANOVA) was performed, followed by the Tukey HSD. The significance level was set at p < 0.05. To ensure adequate sample size, the power analysis was conducted using PASS 15.0 software (NCSS LLC, USA).

Results

The power values for the data (ΔE00(C-R), ΔL(C-R)*, Δa(C-R)*, Δb(C-R)* and ΔWID) were exceeded 97%. All the data showed normality and homogeneity. Both the tooth-colored resin substrate shade and the ceramic shade significantly affected ΔE00(C-R), ΔL(C-R)*, Δa(C-R)*, Δb(C-R)* and ΔWID values (p < 0.001). No interaction effect was found between the resin substrate shade and the ceramic shade among these variations (p > 0.05).

Table 1 displayes the L*, a* and b* values of four tooth-colored resin substrates. As shown in Fig. 1, all ΔE00(C-R) values surpassed the clinically acceptable threshold (AT, ΔE00 = 1.8) [23]. Generally, the ΔE00(C-R) values increased as tooth-colored resin substrates became darker and veneers became lighter (p < 0.05), except for BL4, B1, and A1 veneers, which showed no significant differences (p > 0.05). The highest ΔE00(C-R) value was with the BL2 veneer over the A4 substrate (6.9 ± 0.3), whereas the lowest value was with the A3 veneer over the A2 tooth substrate (2.4 ± 0.6). Figure 1 also presents the color parameters variations from tooth-colored resin substrates to veneer-resin composites. Overall, the a* values exhibited a slight decrease, the b* values experienced a dramatic reduction, while the L* values generally increased. In addition, the ΔL(C-R) values showed the similar trend with ΔE00(C-R) values, besides that no significant differences were observed among A3 and A2 resin substrates (p > 0.05). For Δa(C-R)* value, the descending order of tooth-colored substrates was A4, A3.5, A2 and A3 (p < 0.05). Veneer shades were grouped in descending order as follows: B1, BL2, A1; BL2, A1, BL3; BL3, BL4, A3; and BL4, A3, A2 (p < 0.05), with no significant differences within each group (p < 0.05). Finally, the Δb(C-R)* values mirrored the trend of ΔE00(C-R) values, except for no significant differences between A4 and A3.5 substrates (p > 0.05).

Table 1 L*, a*, and b* coordinates of four tooth-colored resin substrates
Full size table
Fig. 1
figure 1

The results of ΔE00(C-R), ΔL(C-R)*, Δa(C-R)* and Δb(C-R)*

Full size image

Figure 2 presents a heatmap illustrating the mean values of ΔE00(C-G) and ΔE00(R-G). The green represents the value lower than AT, blue indicates the lower value, while the red means the higher value. Table 2 illustrates the shade variation from resin substrates to veneer-resin composites. The result revealed that A2, A3, A3.5 and A4 were shade matched to 2R2.5, 3L2.5, 3M3 and 4L2.5, respectively. The shades of tooth-colored resin substrates were transformed as follows: A2 to 2M1 and 2R1.5, A3 to 2L1.5 and 2R2.5, A3.5 to 2R2.5 and 3L2.5, and A4 to 3L1.5 and 4M2.

Fig. 2
figure 2

The heatmap of the mean values of ΔE00(C-G) and ΔE00(R-G). The green represents the value lower than AT, blue indicates the lower value which close to AT, while the red means the higher value

Full size image
Table 2 The shade variation from resin substrates to veneer-resin composites
Full size table

As presented in Fig. 3A, the bar graph of showed the whiteness value of tooth-colored resin substrates and veneer-resin composites, while the line graph demonstrated the whiteness value of shade guide tabs. The result presented a near-linear decrease in the WID(G) values across each lightness group from second to fifth lightness level group. WID(C) values significantly increased from the WID(R) and experienced a decrease as the veneers and resin substrates darken. The ΔWID values were outlined in in Fig. 3B. It indicated that all the ΔWID values exceeded the 50:50% whiteness acceptability threshold (WAT, 2.62 WID units) [29]. The trend of ΔWID values generally mirrored that of ΔE00(C-R). Specifically, ΔWID values increased as resin substrates became darker and veneers became lighter (p < 0.05), with no significant differences observed among BL4, B1, and A1 veneers (p > 0.05). The largest whiteness difference was noted when the BL2 ceramic covered the A4 tooth substrate (19.0 ± 1.5), while the smallest difference occurred with the A3 ceramic combined with the A2 tooth substrate (5.6 ± 1.0).

Fig. 3
figure 3

The result of whiteness value. A The results of WID(C), WID(R), WID(G). The bar graph demonstrates the WID(C) and WID(R). The line graph outlines the WID(G). B The results of ΔWID

Full size image

Discussion

Based on the present findings, the null hypothesis was rejected. The final shade and whiteness were affected by the shade of both tooth-colored resin substrates and veneers. The shades of veneers and underlying resin substrates showed no interaction effect between each other using 0.3-mm CAD/CAM MT lithium disilicate veneers.

Fabricating chairside CAD/CAM ultra-thin lithium disilicate ceramic veneers presents challenges in achieving accurate color matching with adjacent natural teeth and creating lifelike restorations. Minimally invasive veneers, which do not require tooth preparation, are typically 0.3-mm thick [10]. At this thickness, the final color of the veneer restorations can be significantly affected by the underlying tooth substrates [10], not the dentin [12]. Consequently, dental clinicians and technicians may place greater emphasis on the color-changing capacity of ultra-thin veneers rather than their masking ability. Therefore, this study evaluated the color-changing potential of 0.3-mm CAD/CAM MT lithium disilicate veneers over various tooth-colored resin substrates. Specifically, we tested all shades of CAD/CAM MT lithium disilicate ranging from lighter to darker as provided by the manufacturers, including BL2, BL3, BL4, B1, A1, A2, and A3, as well as the common anterior tooth shades A2, A3, A3.5, and A4. Notably, A2 and A3 resins simulated typical tooth colors [32, 33], while A3.5 and A4 represented darker or discolored teeth.

In the present study, the L*, a*, and b* values of the Vita Linearguide 3D-MASTER shade guide tabs, tooth-colored resin substrates, and veneer-resin composites were measured using a spectrophotometer [46,47,48], a reliable tool for both clinical and research applications [49, 50]. The ΔE00(C-R) values, which indicated the color differences between resin-veneer composites and tooth-colored resin substrates, were used to assess the color-changing ability of ultra-thin veneers over four tooth-colored resin substrates. Higher ΔE00(C-R) values suggested a greater ability to alter the substrate color. As shown in the line graph of Fig. 1, all ΔE00(C-R) values exceeded the clinically acceptable threshold (AT, ΔE00 = 1.8) [23], indicating that 0.3-mm CAD/CAM MT lithium disilicate veneers produced significant color differences over the four tooth-colored resin substrates. This capability appears to be enhanced by the veneer shades lighten and the underlying substrate color darken consistently with previous studies, including ultra-thin feldspathic ceramic veneers and 0.5-mm CAD/CAM lithium disilicate restorations [19].

As depicted in Fig. 1, all the L* values generally increased, indicating enhanced brightness. This may be attributed to the glazed surface of the veneers and the inherent brightness of the MT blocks [11]. The a* values exhibited a slight decrease, while the b* values experienced a significant reduction. This suggested that ultra-thin ceramic veneers significantly reduce yellowing (b* value) but have a minimal attenuating effect on redness (a* value). In other words, the chroma values, which is coordinated by a* and b* value, were reduced after being covered by the ultra-thin CAD/CAM MT lithium disilicate veneers. While darker substrates generally exhibited greater ΔE00(C-R), ΔL (C-R)*, and Δb(C-R)* values, some exceptions were noted among specific shade combinations. The lack of significant differences between A3 and A2 substrates in ΔL(C-R)* and between A4 and A3.5 substrates in Δb(C-R)* suggests that the initial color parameters of the substrate play a crucial role in determining the final optical outcome (See Table 1).

Previous studies have primarily focused on color differences to assess the color change capabilities of various veneers [51]. However, there is limited knowledge regarding the shade variations produced by these veneers, and a lack of visual presentation for clinicians and technicians. In the present study, the final shade was matched when ΔE00(R-G) and ΔE00(C-G) were clinically acceptable [52]. Otherwise, the minimal value was used for shade matching. ΔE00(C-G) denoted the color differences between veneer-resin composites and the shade guide tabs, indicating the final shade of the veneer restorations. ΔE00(R-G) pointed to the color differences between tooth-colored resin substrates and the shade guide tabs, enhancing comparability between the substrate shade and the final shade. The results revealed that A2, A3, A3.5, and A4 were shade matched to 2R2.5, 3L2.5, 3M3, and 4L2.5, respectively. Regardless of the resin substrate shade, the BL2 veneer exhibited the most significant shade change, while the A3 veneer showed the least. The BL4, B1, and A1 shades yielded comparable results, suggesting their potential as viable alternatives in clinical settings. The largest shade change capacity was observed when the BL2 veneer covered the A4 resin substrate, with the shade ranging from 4L2.5 to 3L1.5. In clinical practice, if ΔE00(C-G) exceeds the clinically acceptable threshold from the shade guide tabs, adjustments can be made using resin cements with different colors [53]. However, the 0.1 mm thickness of the resin cement limits the range for color adjustment [11, 12, 15, 54], making the choice of ceramic block shade critical. For example, the color differences of resin cement beneath 0.5-mm CAD/CAM MT lithium disilicate veneers were found to be less than 1.0 [19]. The other way to adjust the final color is to stain, which takes more chairside time. Additionally, the final aesthetic outcome was significantly influenced by the shade of the underlying tooth substrates. Thus, the shade matching of the abutment tooth is crucial to achieve the optimal outcome.

For the Whiteness Index for Dentistry (Fig. 3A), the WID(R) and WID(C) values were compared with WID(G) values to assess whiteness variations. Results revealed a near-linear decline in WID(G) values within the same lightness groups. WID(C) values significantly increased compared to WID(R), by up to one lightness level, but decreased as the veneers and resin substrates darkened. Figure 3B shows that all ΔWID values exceeded WAT, indicating that all resin substrates are significantly whitened by applying ultra-thin MT lithium disilicate veneers. This whitening effect was attributed to increased lightness and reduced chroma, consistent with ΔL(C-R)*, Δa(C-R)*, and Δb(C-R)* results [55]. Consistent with the trend in ΔE00(C-R), ΔWID values also varied depending on the veneer and resin substrate shades. These findings suggest that WID values are valuable for dentist-patient communication, enabling an effective evaluation of color changes achieved with ultra-thin veneers.

The findings support the use of ultra-thin MT lithium disilicate veneers (0.3-mm thick) for enhancing the color and whitening of anterior teeth, particularly with BL2 ceramics. Shades such as BL4, B1, and A1 demonstrated similar effects and may serve as viable alternatives in specific cases. These results not only provide guidance for optimal veneer shade selection but also facilitate more effective communication among dental clinicians, technicians, and patients. However, it is important to note that this study was conducted in vitro, which does not fully replicate the complexities of the in vivo environment. Additionally, the study used only four shades of tooth-colored resin substrates, limiting its ability to fully simulate the coloration and optical properties of natural abutment teeth. Furthermore, no resin cement was incorporated, which could influence the final aesthetic outcomes. Future research should address these limitations, including clinical studies to verify the in vitro findings. Additionally, the development of a final color prediction model for CAD/CAM ultra-thin MT lithium disilicate veneers, incorporating the interplay of various factors, could be a valuable direction for further exploration.

Conclusions

Within the limitations of this study, the following conclusions were drawn:

  1. 1.

    The final shade and whiteness are affected by the shade of both tooth-colored resin substrates and veneers, with all 0.3-mm thick CAD/CAM MT lithium disilicate veneers yielding notable shade differences and whiteness enhancement over various tooth-colored resin substrate shade.

  2. 2.

    Both color differences and whiteness differences increase as tooth-colored resin substrates became darker, and veneers became lighter, indicating whiteness values could be used as a crucial evaluation parameter in dentist-patient communication to evaluate color changes with ultra-thin veneers.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Change history

  • 27 April 2025

    The duplicate reference 11 was removed.

Abbreviations

CAD-CAM:

Computer-aided design and computer-aided manufacturing

ANOVA:

Analysis of variance

LT:

Low translucency

MT:

Medium translucency

HT:

High translucency

References

  1. Nejatidanesh F, Savabi G, Amjadi M, Abbasi M, Savabi O. Five year clinical outcomes and survival of chairside CAD/CAM ceramic laminate veneers - a retrospective study. J Prosthodont Res. 2018;62(4):462–7.

    Article  PubMed  Google Scholar 

  2. Sun Y, Luebbers HT, Agbaje JO, Schepers S, Politis C, Van Slycke S, et al. Accuracy of dental implant placement using CBCT-derived mucosa-supported stereolithographic template. Clin Implant Dent Relat Res. 2015;17(5):862–70.

    Article  PubMed  Google Scholar 

  3. Maunula H, Hjerppe J, Lassila LLV, Narhi TO. Optical properties and failure load of thin CAD/CAM ceramic veneers. Eur J Prosthodont Restor Dent. 2017;25(2):86–92.

    PubMed  Google Scholar 

  4. Sari T, Ural C, Yuzbasioglu E, Duran I, Cengiz S, Kavut I. Color match of a feldspathic ceramic CAD-CAM material for ultrathin laminate veneers as a function of substrate shade, restoration color, and thickness. J Prosthet Dent. 2018;119(3):455–60.

    Article  PubMed  Google Scholar 

  5. Albanesi RB, Pigozzo MN, Sesma N, Lagana DC, Morimoto S. Incisal coverage or not in ceramic laminate veneers: A systematic review and meta-analysis. J Dent. 2016;52:1–7.

    Article  PubMed  Google Scholar 

  6. Blunck U, Fischer S, Hajto J, Frei S, Frankenberger R. Ceramic laminate veneers: effect of preparation design and ceramic thickness on fracture resistance and marginal quality in vitro. Clin Oral Investig. 2020;24(8):2745–54.

    Article  PubMed  Google Scholar 

  7. Morita RK, Hayashida MF, Pupo YM, Berger G, Reggiani RD, Betiol EA. Minimally invasive laminate veneers: clinical aspects in treatment planning and cementation procedures. Case Rep Dent. 2016;2016:1839793.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Aslan YU, Uludamar A, Ozkan Y. Retrospective analysis of lithium disilicate laminate veneers applied by experienced dentists: 10-year results. Int J Prosthodont. 2019;32(6):471–4.

    Article  PubMed  Google Scholar 

  9. Christensen GJ. Thick or thin veneers? J Am Dent Assoc. 2008;139(11):1541–3.

    Article  PubMed  Google Scholar 

  10. Tamam E, Gungor MB, Nemli SK. How are the color parameters of a CAD/CAM feldspathic ceramic of the material affected by its thickness, shade, and color of the substructure? Niger J Clin Pract. 2020;23(4):523–33.

    Article  CAS  PubMed  Google Scholar 

  11. Fachinetto E, Chiapinotto GF, Barreto VSM, Pecho O, Pereira GKR, Bacchi A. Masking ability of CAD/CAM monolithic ceramics: effect of ceramic type and thickness, and try-in paste shade. Quintessence Int. 2023;54(6):442–50.

    PubMed  Google Scholar 

  12. Zhu J, Xia Y, Lui S, Wang W, Liang S, Huang C. Masking ability of CAD-CAM resin-matrix ceramics with different translucencies and thicknesses combined with four cement shades against varying background colors when facing veneer restorations. BMC Oral Health. 2024;24(1):1198.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ayata M, Kilic K, Al-Haj Husain N, Ozcan M. Effect of thickness and translucency on color change and masking ability of ceramic materials used for laminate veneers. Eur J Prosthodont Restor Dent. 2023;31(4):383–90.

  14. Xing W, Chen X, Ren D, Zhan K, Wang Y. The effect of ceramic thickness and resin cement shades on the color matching of ceramic veneers in discolored teeth. Odontology. 2017;105(4):460–6.

    Article  CAS  PubMed  Google Scholar 

  15. Christopher Igiel MW, Barbara M, et al. Effects of ceramic layer thickness, cement color, and abutment tooth color on color reproduction of feldspathic veneers. Int J Esthet Dent. 2018;13(1):110–9.

    PubMed  Google Scholar 

  16. Çömlekoğlu ME, Paken G, Tan F, Dündar-Çömlekoğlu M, Özcan M, Akan E, et al. Evaluation of different thickness, die color, and resin cement shade for veneers of multilayered CAD/CAM blocks. J Prosthodont. 2016;25(7):563–9.

    Article  PubMed  Google Scholar 

  17. Skyllouriotis AL, Yamamoto HL, Nathanson D. Masking properties of ceramics for veneer restorations. J Prosthet Dent. 2017;118(4):517–23.

    Article  CAS  PubMed  Google Scholar 

  18. Likitnuruk W, Sripetchdanond J, Srisawasdi S. Effect of variations in translucency of CAD/CAM lithium-disilicate ceramic and abutment color on optical color of veneer restoration. J Dent Assoc Thai. 2024;74(3):124–30.

    Google Scholar 

  19. Radeesujalitkul P, Sripetchdanond J, Srisawasdi S. Influence of ceramic translucency, ceramic thickness, and resin cement shades on the color of CAD-CAM lithium disilicate veneers. J Dent Assoc Thai. 2024;74(4):180–7.

    Google Scholar 

  20. Fabian Fonzar R, Carrabba M, Sedda M, Ferrari M, Goracci C, Vichi A. Flexural resistance of heat-pressed and CAD-CAM lithium disilicate with different translucencies. Dent Mater. 2017;33(1):63–70.

    Article  CAS  PubMed  Google Scholar 

  21. Hallmann L, Ulmer P, Kern M. Effect of microstructure on the mechanical properties of lithium disilicate glass-ceramics. J Mech Behav Biomed Mater. 2018;82:355–70.

    Article  CAS  PubMed  Google Scholar 

  22. Pecho OE, Ghinea R, Alessandretti R, Pérez MM, Della BA. Visual and instrumental shade matching using CIELAB and CIEDE2000 color difference formulas. Dent Mater. 2016;32(1):82–92.

    Article  PubMed  Google Scholar 

  23. Paravina RD, Ghinea R, Herrera LJ, Bona AD, Igiel C, Linninger M, et al. Color difference thresholds in dentistry. J Esthet Restor Dent. 2015;27(Suppl 1):S1–9.

    PubMed  Google Scholar 

  24. Lee YK. Comparison of CIELAB DeltaE(*) and CIEDE2000 color-differences after polymerization and thermocycling of resin composites. Dental materials : official publication of the Academy of Dental Materials. 2005;21(7):678–82.

    Article  CAS  PubMed  Google Scholar 

  25. Daneshvar M, Devji TF, Davis AB, White MA. Oral health related quality of life: a novel metric targeted to young adults. J Public Health Dent. 2015;75(4):298–307.

    Article  PubMed  Google Scholar 

  26. Samorodnitzky-Naveh GR, Geiger SB, Levin L. Patients’ satisfaction with dental esthetics. J Am Dent Assoc. 2007;138(6):805–8.

    Article  PubMed  Google Scholar 

  27. Tin-Oo MM, Saddki N, Hassan N. Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics. BMC Oral Health. 2011;11:6.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kwon SR, Wertz PW. Review of the mechanism of tooth whitening. J Esthet Restor Dent. 2015;27(5):240–57.

    Article  PubMed  Google Scholar 

  29. Perez MM, Herrera LJ, Carrillo F, Pecho OE, Dudea D, Gasparik C, et al. Whiteness difference thresholds in dentistry. Dent Mater. 2019;35(2):292–7.

    Article  PubMed  Google Scholar 

  30. Perez Mdel M, Ghinea R, Rivas MJ, Yebra A, Ionescu AM, Paravina RD, et al. Development of a customized whiteness index for dentistry based on CIELAB color space. Dent Mater. 2016;32(3):461–7.

    Article  PubMed  Google Scholar 

  31. Joiner A, Luo W. Tooth colour and whiteness: A review. J Dent. 2017;67S:S3–10.

    Article  PubMed  Google Scholar 

  32. Kim HK. A study on the color distribution of natural teeth by age and gender in the Korean population with an intraoral spectrophotometer. J Esthet Restor Dent. 2018;30(5):408–14.

    Article  PubMed  Google Scholar 

  33. Smith PW, Wilson NH. Shade selection for single-unit anterior metal ceramic crowns: a 5-year retrospective study of 2,500 cases. Int J Prosthodont. 1998;11(0893–2174 (Print)):302–6.

  34. Dede DO, Sahin O, Ozdemir OS, Yilmaz B, Celik E, Koroglu A. Influence of the color of composite resin foundation and luting cement on the final color of lithium disilicate ceramic systems. J Prosthet Dent. 2017;117(1):138–43.

    Article  CAS  PubMed  Google Scholar 

  35. Öztürk E, Bolay Ş, Hickel R, Ilie N. Effects of ceramic shade and thickness on the micro-mechanical properties of a light-cured resin cement in different shades. Acta Odontol Scand. 2015;73(7):503–7.

    Article  PubMed  Google Scholar 

  36. de Kok P, Pereira GKR, Fraga S, de Jager N, Venturini AB, Kleverlaan CJ. The effect of internal roughness and bonding on the fracture resistance and structural reliability of lithium disilicate ceramic. Dent Mater. 2017;33(12):1416–25.

    Article  PubMed  Google Scholar 

  37. Park JH, Lee YK, Lim BS. Influence of illuminants on the color distribution of shade guides. J Prosthet Dent. 2006;96(6):402–11.

    Article  PubMed  Google Scholar 

  38. Knezović D, Zlatarić D, Illeš I, Alajbeg M, Žagar. In Vivo and in Vitro Evaluations of Repeatability and Accuracy of VITA Easyshade® Advance 4.0 Dental Shade-Matching Device. Acta stomatologica Croatica. 2015;49(2):112–8.

  39. Bagis B, Tüzüner T, Turgut S, Korkmaz FM, Baygın Ö, Bağış YH. Effects of protective resin coating on the surface roughness and color stability of resin-based restorative materials. Sci World J. 2014;2014: 832947.

    Article  Google Scholar 

  40. ISO 7491:Dental materials-Determination of colour stability. 2000.

  41. Chang J, Da Silva JD, Sakai M, Kristiansen J, Ishikawa-Nagai S. The optical effect of composite luting cement on all ceramic crowns. J Dent. 2009;37(12):937–43.

    Article  CAS  PubMed  Google Scholar 

  42. Dede DÖ, Armaganci A, Ceylan G, Cankaya S, Celik E. Influence of abutment material and luting cements color on the final color of all ceramics. Acta Odontol Scand. 2013;71(6):1570–8.

    Article  CAS  PubMed  Google Scholar 

  43. Jalali H, Alizadeh ES, Sadighpour L, Shabestari GO, Fard MJK. The effect of background and ceramic thickness on the color of an all-ceramic restorative system. J Calif Dent Assoc. 2010;38(3):179–86.

    PubMed  Google Scholar 

  44. Li Q, Yu H, Wang YN. Spectrophotometric evaluation of the optical influence of core build-up composites on all-ceramic materials. Dent Mater. 2009;25(2):158–65.

    Article  CAS  PubMed  Google Scholar 

  45. Ghinea R, Pérez MM, Herrera LJ, Rivas MJ, Yebra A, Paravina RD. Color difference thresholds in dental ceramics. J Dent. 2010;38(Suppl 2):e57–64.

    Article  CAS  PubMed  Google Scholar 

  46. Hardan L, Bourgi R, Cuevas-Suarez CE, Lukomska-Szymanska M, Monjaras-Avila AJ, Zarow M, et al. Novel trends in dental color match using different shade selection methods: a systematic review and meta-analysis. Materials (Basel). 2022;15(2):468.

    Article  CAS  PubMed  Google Scholar 

  47. Abdelraouf RM, Habib NA. Color-matching and blending-effect of universal shade bulk-fill-resin-composite in resin-composite-models and natural teeth. Biomed Res Int. 2016;2016:4183432.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Abdelraouf RM, Moussa TA, Hamdy TM, Abuhaimed RA, Alotaibi AM, Jurado CA, et al. Effect of ceramic thickness and technician variability on the shade duplication of dental ceramo-metallic restorations. J Funct Biomater. 2023;15(1):12.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Posavec I, Prpic V, Zlataric DK. Influence of light conditions and light sources on clinical measurement of natural teeth color using VITA easyshade advance 4.0((R)) spectrophotometer pilot study. Acta Stomatol Croat. 2016;50(4):337–47.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Klotz AL, Habibi Y, Corcodel N, Rammelsberg P, Hassel AJ, Zenthofer A. Laboratory and clinical reliability of two spectrophotometers. J Esthet Restor Dent. 2022;34(2):369–73.

    Article  PubMed  Google Scholar 

  51. Malallah AD, Hasan NH, Qasim MH. Influence of ceramic material type and cement shade on the translucency of lithium disilicate ceramic veneers. Int J Dent. 2024;2024:2540174.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Nakamura T, Saito O, Fuyikawa J, Ishigaki S. Influence of abutment substrate and ceramic thickness on the colour of heat-pressed ceramic crowns. J Oral Rehabil. 2002;29(9):805–9.

    Article  CAS  PubMed  Google Scholar 

  53. Öztürk E, Chiang YC, Coşgun E, Bolay Ş, Hickel R, Ilie N. Effect of resin shades on opacity of ceramic veneers and polymerization efficiency through ceramics. J Dent. 2013;41(Suppl 5):e8-14.

    Article  PubMed  Google Scholar 

  54. Turgut S, Bagis B. Effect of resin cement and ceramic thickness on final color of laminate veneers: an in vitro study. J Prosthet Dent. 2013;109(3):179–86.

    Article  CAS  PubMed  Google Scholar 

  55. Pan Q, Westland S. Tooth color and whitening - digital technologies. J Dent. 2018;74(Suppl 1):S42–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Thanks to Prof. Zhijian Hu, Public Health School of Fujian Medical University, for his guidance on statistic.

Funding

This research was funded by Fujian Province Natural Science Foundation of China (grant number 2020 J01645) and Major Project of Fujian Province Science and Technology Innovation Joint Fund (grant number 2018Y9103).

Author information

Authors and Affiliations

  1. Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China

    Yinghui Wang, Xia Wei, Yu Pan, Hao Yu & Hui Cheng

  2. Institute of Stomatology & Research Center of Dental Esthetics and Biomechanics, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China

    Linjuan Gao, Dingkun Liu, Xing Chen, Liujun Lin & Hui Cheng

  3. Division for Globalization Initiative, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, 4 - 1 Seiryo-Machi, Aoba-Ku, Sendai, 980 - 8575, Japan

    Guang Hong

Authors
  1. Yinghui Wang
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Xia Wei
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Linjuan Gao
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Dingkun Liu
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Xing Chen
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Liujun Lin
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Yu Pan
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Hao Yu
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Guang Hong
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. Hui Cheng
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

H.C., G.H., and Y.W. designed the study. Y.W., X.C., and L.L. conducted the experiments and collected the data. X.W. and L.G. analyzed the data. Y.W., X.W., and Y.P. drafted the manuscript. D.L., L.G. and Y.P. prepared the figures and tables. H.Y., H.C., and G.H. reviewed and edited the manuscript. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Guang Hong or Hui Cheng.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Y., Wei, X., Gao, L. et al. Final shade and whiteness: impact of various ultra-thin CAD/CAM veneers and tooth-colored resin substrates. BMC Oral Health 25, 504 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12903-025-05901-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12903-025-05901-x

Keywords

BMC Oral Health

ISSN: 1472-6831

Contact us