Influence of Oral Habits on Color Changes and Patient Satisfaction for Cemented Ceramic Prostheses: A Preliminary...

In the presence of different oral habits, cemented prostheses should maintain the color and aesthetic for a long clinical period, which results in a high degree of patient satisfaction. This study aims to evaluate the mean color change (ΔE₀₀) values of multilayer zirconia and lithium disilicate restorations after 3, 9 and 12 months among patients with different social oral habits (coffee drinking, khat chewing, and smoking).

This prospective clinical study was conducted over a 12-month period during 2022-2023 and included 16 participants (mean age: 29.8 ± 8.4 years) with a total of 122 cemented ceramic prostheses (92 zirconia, 30 lithium disilicate). The participants were categorized based on various characteristics, including oral habits, type of ceramic material used, retainer type, and tooth type. Color parameters were measured using a spectrophotometer that adheres to the International Commission on Illumination (CIE) L*a*b* color space system. The ΔE₀₀ was calculated by measuring the L*a*b* at baseline and after 3, 9, and 12 months to assess color changes. Also, the VitaPan Classical Shade Guide was used. Patient satisfaction was measured using a Visual Analog Scale (VAS), which categorized responses from "very satisfied'' to "not satisfied''. Independent t or Mann-Whitney U tests and One-Way Analysis of Variance (ANOVA) or Kruskal-Wallis H were used to compare ΔE₀₀ values across materials, arch types, retainer types, and social habits, with significance set at p < 0.05.

Smoking recorded the greatest ΔE₀₀ for zirconia (5.72 ± 2.74), while coffee showed the lowest (5.02 ± 2.96). For lithium disilicate, coffee had the highest ΔE₀₀ (6.065 ± 2.49) and smoking had the lowest (5.57 ± 2.18). Significant changes were observed in mandibular lithium disilicate compared to zirconia after exposure to coffee and smoking (p = 0.006 and 0.009) and (p = 0.001 and 0.014) at 3 and 9 months. Smoking, coffee drinking, and khat chewing showed a non-significant difference between pontic and separate crown zirconia after all 3, 9, and 12 months (p > 0.05). One-Way ANOVA and Kruskal-Wallis revealed no significant differences in overall mean ΔE₀₀ across coffee, khat, and smoking for both material types. VAS revealed that most patients were satisfied with all parameters assessed over a 12-month period.

After 12 months, both multilayer zirconia and lithium disilicate prostheses showed color changes due to coffee, khat chewing, and smoking, with no significant differences between materials, arch types, retainer types, or habits. Although color shifts surpassed clinically acceptable levels, lithium disilicate exhibited better shade stability according to VitaPan Classical Shade Guide assessments. Patient satisfaction remained high throughout the study.