Análisis espectrofotométrico del color de los tejidos blandos periimplantarios

Abstract

Antecedentes: La alta demanda estética en de los últimos años ha modificado los criterios de éxito de los implantes dentales, de tal manera que la evaluación estética exhaustiva del resultado final es uno de los parámetros importantes a considerar. En esta evaluación final parecen influir tanto la restauración protésica como de los tejidos blandos circundantes. La obtención de unos perfiles gingivales armónicos, implica un reto para el profesional, debido por un lado a la dificultad que entraña la obtención de un margen simétrico y un relleno de las papilas, y por otro a la complejidad para imitar el aspecto de la encía, en cuanto a color y textura. Esta dificultad en la obtención del color gingival, es debida en parte al desconocimiento de la capacidad de respuesta de los tejidos a los diferentes materiales de los que disponemos, y a su comportamiento bajo distintos grosores de tejido blando. Objetivos: Los objetivos de esta serie de trabajos fueron testar la reproducibilidad y repetibilidad del espectrofotómetro, para medir cambios de color en la mucosa periimplantaria (Estudio 1), analizar los cambios de coloración que se producen en la mucosa en función del tipo de material utilizado (oro, titanio, zirconia blanca, zirconia coloreada y zirconia fluorescente) y bajo que grosor de tejido, para determinar qué tipo de pilar protésico es capaz de imitan mejor al diente natural (Estudio 2)...

Objective: To evaluate the repeatability and reproducibility of gingival color measurements using a digital spectrophotometer. Measurement error was estimated by determining the interrater agreement and by repeating measurements in different illumination environments with and without contact of the device with the gingiva (Study 1). To determine differences in peri-implant soft tissue color with the utilization of titanium, titanium gold-plated, white zirconia, Vita Classical (VC) A4-shaded zirconia, and fluorescent white zirconia abutments and to establish the influence of gingival thickness on the resulting color (Study 2). Methods: Study 1: Two trained examiners measured the gingival shade around 30 central incisors using a spectrophotometer with/without external illumination and with/without contact of the device with the gingiva. Color data obtained (CIELAB color coordinates; L*, c*, h*, a*, b*) were analyzed using the intraclass correlation coefficient (ICC) and the Student’s t-test for paired samples. Study 2: Four implants were contralaterally inserted in 19 fresh pig mandibles. CIELAB color coordinates lightness (L*), chroma along red axis (a*), and chroma along yellow-blue axis (b*) were obtained at 1, 2, and 3 mm from the central axis of the peri- implant mucosal margin in apical direction. Mean values of L*, a*, and b* were used to calculate the color difference (ΔΕ = (L2 − L1)2 + (a2 − a1)2 + (b2 − b1)2)1/2) between the peri-implant soft tissue and the marginal gingiva of the adjacent tooth. After descriptive analysis of each color parameter, within and between group variations in the resulting color with different abutments were determined by repeated measures ANOVA, applying Duncan’s correction for within-group factors. Interaction effects between soft tissue thickness and color were determined by performing another repeated measures ANOVA for independent measures with post hoc Bonferroni’s correction. Statistical significance was established at the 95% confidence level. The interrelationship of tissue thickness with L*, a*, b*, and ΔΕ was calculated using Spearman rank correlation coefficients...