Malaysian Dental Journal (2012) Volume 34 Issue 2

© 2012 Malaysian Dental Journal

MALAYSIAN DENTAL JOURNAL

Colour Stability of Composite Resins: A General Overview

Yew HZ, Qamaruz Zaman J

Department of Operative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia

ABSTRACT
Composite resins have been shown to be susceptible to discolouration on exposure to oral environment over a
period of time. Discolouration of composite resins can be broadly classified as intrinsic or extrinsic. Intrinsic
discolouration involves physico-chemical alteration within the material, while extrinsic stains are a result of
surface discolouration by extrinsic compounds. Although the effects of various substances on the colour stability
of composite resins have been extensively investigated, little has been published on the methods of removing
the composite resins staining. The purpose of this paper is to provide a brief literature review on the colour
stability of composite resins and clinical approaches in the stain removal.

Key Words: Not available

Please cite this article as: Yew HZ and Qamaruz Zaman J. Colour stability of composite resins: a general overview. Malaysian
Dental Journal 2012; 34(2): 1-9.

INTRODUCTION the clinical performance of the material, colour

stability of composite resins remains problematic. 7
The first plastic material, a self cured methacrylate Clinical studies of composite resin revealed
resin was developed by German chemist during median survival rates of 4.9-8 years.9-12 While the
World War II to replace the only dental aesthetic materials showed acceptable clinical
13-16
material previously available; silicate cements. performance, some of the main reasons for
Despite their initial success, chemically cured acrylic failure include secondary caries, wear, bulk
resins were plagued with poor colour stability and fracture, and discolourations.10,17 Kiremitchi et al
associated with inferior mechanical properties. 1 In 200918 found that 4 out of 47 restorations displayed
an attempt to minimize the drawbacks of acrylic staining and marginal discoloration after six years. A
resin, many researchers added filler particles to the 12 year clinical evaluation by Wilder et al (2009)19
acrylic resin. One of these researchers, Dr Rafael using the modified U.S. Public Health Service criteria
Bowen, explored the possibility of adding methyl showed that 12% of the restorations received
methacrylate groups to the end groups of the epoxy ‘bravo’ scores for staining. In another study, colour
resin resulting in the discovery of the famous Bis- change with surface staining was noted at 18
GMA (bisphenol-A-glycidyl methacrylate) in 1959.2 months.20 A retrospective study by Redman et al
Together with acid etching of dental enamel, 200111 found that most discolouration of composite
proposed by Buonocore in 1955,3 the breakthrough resins was detected in the first year. The failure
has led to the introduction of composite resins into peaks again at the fifth year. This is further
the mainstream of restorative dentistry.4 substantiated by reports from several short term
Since then, composite resins have become studies. Majority of the failures of composite resins
the popular choice of material, owing to their that occurred within 1-2 years service were due to
inherent property to emulate the natural colour of discolouration.21-23
teeth5 and the increasing demand amongst patients “Colour stability” or the ability of the
for aesthetics.6 The last few decades saw significant material to retain the matched shade over a long
development of the material resulting in evolution period of time is crucial for a lasting impression of
of a multitude of contemporary composite resins.7 the esthetic outcome9. Mjor et al (2000)24 pointed
Notwithstanding the remarkable improvement in out that patient’s dissatisfaction with the

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discolouration of composite resins was one of main monomers hydrophobicity28 and their water
reasons for costly replacement of restorations in absorption properties.31-33 Water absorption
the general practice. Therefore, it wouldseem produces deleterious effects including hygroscopic
reasonable that dental practitioners have an swelling, plasticization, softening and hydrolysis of
understanding of the aetiology of composite resins the resin matrix that leads to penetration of staining
discolouration so that the appropriate treatment pigments.34,35 Composite resins with lower water
can be instituted. The purpose of this paper is to sorption rates arising from the use of hydrophobic
provide a clinically relevant discussion with respect (less affinity to water) resin monomers are less
to colour stability of composite resins as well as to prone to discolouration.32 It has been shown that
review current knowledge of methods of the stain the hydrophobic urethane dimethacrylate (UDMA)
removal. exhibits less staining compared to Bisphenol A-
glycidyl methacrylate (Bis-GMA), which is the
COLOUR STABILITY OF COMPOSITE RESINS common resin monomers used31. Conversely,
composite resins with hydrophilic monomers e.g.
Aetiology tri-ethylene glycol dimethacrylate (TEDGMA)
Horsted – Bindslev and Mjor (1988) 25 describe the exhibit higher water absorption,28 and therefore
discolouration of the composite resins may be permits penetration of any hydrophilic colourant
caused by intrinsic and extrinsic factors. Intrinsic into the resin matrix. However, Bis-GMA monomer
factors involve alterations or changes in the has been a predominant constituent in most of the
chemical structure of the composite resins under commercial composite resins6, and the above
physical and chemical conditions, while extrinsic findings are largely in vitro observations. Therefore,
factors are mainly due to surface staining from the clinical significance of these findings remains to
absorption or adsorption of exogenous substances. be seen.
The influence of fillers on the staining
Intrinsic Discolouration potential of composite resins is related to its surface
In restorative dentistry, dental composite resins structure.36,37 Fillers appear to affect how well a
consist of three main components: (1) organic resin composite finishes38. During the polishing
(matrix phase), (2) inorganic filler particles procedure, fillers may dislodge from the matrix
(dispersed phase), and (3) the coupling agent that leaving voids on the restorative surface. In general,
chemically bonds the inorganic filler to the larger filler particles leave bigger defects, thus
resinmatrix (surface interfacial phase).26 Any producing a rougher surface.39 The rougher the
alteration or changes to any of these components surface, the more susceptible the material is to
within the material may result in a permanent staining.40
discolouration at the subsurface and internal layers The effect of daylight41 or ultraviolet
of composite resins.25 irradiation,42 thermal changes and water41,43-47 on
Traditionally, it is believed that changes in colour properties of composite resins have been
amine compound (N,Ndimethyl-p-toluidine) in the widely documented. The colour change of
initiator system of chemically cured resin produce composite resins upon exposure to various aging
intrinsic colour change in composite resins.27 This is conditions is time and dose dependent, and may be
thought to be related to the tendency of isomeric attributed to changes in the surface microstructure
dimethacrylates to form yellow-tinted charge- and chemical composition within the matrix of the
transfer complexes with the tertiary aromatic composite resins and also at the interface between
amines.28 Studies have also found that the organic matrix and filler particles.46 On this note,
photoinitator (camphoroquinone) in light Schulze et al.46 postulate that a weakening of the
polymerized based cement may oxidize into a chemical bonds in the organic polymer create pores
yellowish-brownish coloured compound thus within the resin matrix as well as exposure of filler
leading to the discolouration of the composite particles, thereby contributing to the colour
resins.29,30 changes in composite resins. Surface deterioration
The colour change due to alteration in the induced by the physico-chemical changes creates
organic resin matrix may be directly related to microcracks within the material that facilitate the

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penetration of stains. A slow intermittent organic matrix of composite resins. Another group
temperature fluctuation in a humid or moist of researchers found that addition of sugar in coffee
environment such as in the oral environment has accentuates the staining by coffee.63 This is thought
been shown to produce darker and less translucent to be caused by the sticky effect produced by
materials.48,49 sugar.63
Results from laboratory studies revealed Presence of alcohol and low pH (such as in
that the degree of polymerisation also plays a role red wine) resulted in surface degradation of the
in the colour stability of composite resins.50 composite resins, thereby contributing to the colour
Suboptimal polymerisation leaves unreacted change.64 SEM analysis of a composite resin after pH
initiators or accelerators in the composite resins cycling revealed that there was disintegration of the
that in turn result in a yellowing of the composite polymer matrix and degradation of silane bonding
resins.27 Furthermore, incomplete conversion of between filler and organic matrix leading particle
monomers as a result of insufficient polymerisation loss.65 Consequently, surface roughness was noted.
is related to increased water absorption of the Similarly, alcohol affects the colour of composite
composite resins which subsequently could resins through softening of the surface material,66
potentiate the risk of discolouration.51 facilitating the absorption of external pigments.67 In
addition, Satou et al33 believe that the
Extrinsic Discolouration discolouration of composite resins is the result of
Unlike intrinsic staining, extrinsic discolouration of binding between hydrophilic un-reacted
composite resins may occur as a result of staining by component in the initiators in the composite resins
the pigments from exogenous contaminants. and the hydrophilic pigments in the exogenous
Extrinsic discolouration involves surface or agents e.g. red wine.
subsurface adsorption or absorption of Staining by alcohol based
chromogenic substances and can be removed mouthwashes,47,53,59 fluoride varnishes68 and
mechanically or chemically.52 bleaching agents64 has been described. Khokhar et
Colour alteration of composite resins after al31 and Omata et al57 found that the addition of
immersion in various liquid beverages has been a chlorhexidine and saliva increased the staining
subject of great interest in many studies. Research effect of coffee and tea. Leard et al53 explains that
has found that beverages including coffee,52-59 this phenomenon may be attributed to the binding
tea,52-57,59 alcohol beverages,52,57,59,60 carbonated of the cationic (positive charged) in the anti-septic
drinks,52,55,60-62 and fruit juices60-62 caused significant mouthwash surface anionic (negative charged)
colour changes in composite resins. Composite surfaces of chromogenic agents in beverages.
resins are also susceptible to staining by artificial The staining potential of composite resins
food dyes (erythrosine and sunset yellow).39 is related to its surface structure. The rougher the
Significant colour change was observed by Stober et surface, the more susceptible the material is to
al (2001)59 when composite resins were exposed to extrinsic staining.40 The surface characteristic of
0.1% turmeric solution. composite resins depends on types of fillers and
There has been a lot of speculation about finishing or polishing technique.38,69 For this reason,
the discolouration of composite resins by coffee and a wide variety of burs, diamonds, abrasives, strips
tea. According to Um and Ruyter (1991),54 and pastes have been introduced by manufacturers
discolouration caused by coffee and tea is due to for finishing and polishing composite resins.70 Many
yellow colourants in the beverages. The studies have been conducted to establish a finishing
investigators believe that yellow colourants in tea and polishing procedure that will produce a
have higher polarity compared with coffee. smooth-surfaced restoration. However, there is no
Therefore, tea caused adsorption of colourant on consensus in the literature about the effectiveness
surface of composite resins and can be mechanically of different finishing and polishing procedures in
removed. While coffee stains composite resins by relation to the staining susceptibility of composite
adsorption and absorption of colourant into the resins.
organic matrix of material as a result of the
compatibility of yellow colourant in coffee with the

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© 2012 Malaysian Dental Journal

METHODS OF STAIN REMOVAL This result is consistent with a report by

Mundim et al (2011).72 They concluded that re-
At this point the question might be raised as to polishing decreased the degree of coffee staining to
whether the discolouration of composite resins a clinically acceptable level. Similar findings have
could be removed. This is the most relevant aspect also been published on the effect of re-polishing
in clinical practice as premature replacement of and nicotine staining.73 However, the method may
functional composite resin has both financial and not return the original colour of the material and
biological implications. Several emerging could lead to surface alteration of the composite
researches have sought to evaluate the possibility resins.
of removal of the composite resins staining. The effectiveness of bleaching in
A recent study by Anfe et al 201171 eliminating both extrinsic and intrinsic staining of
measured the colour changes in some of the teeth has been well established.74,75 One might
contemporary composite resins after immersion in wonder if similar result could be achieved with
red wine and coffee. Following the staining process, composite resins. Research has shown changes in
the composites were subjected to abrasive wear of the physical characteristics of composite resins
20, 40, 60 µm. They found that staining by red wine after bleaching. Alteration of surface microhardness
and coffee occurs superficially (~20 µm) and can be and roughness, staining susceptibility, tensile
removed through re-polishing. strength and marginal intergrity following bleaching
has been reported.76 Torres et al (2012)77 found
significant changes in the colour and fluorescence of
composite resins after exposure to 20-35% of
hydrogen peroxide bleaching gels. Considerable
alteration in colour,76,78,79 gloss79 and refractive
index80 of composite resins have been reported. It is
believed that the colour change in composite resins
may be attributed to the alteration of the resin
matrix in the restorative material.76 The inadvertent
changes in colour of the composite resins produced
by the bleaching procedure may be beneficial in
Figure 1. Discolouration of distal palatal 11 (left) and
removing the stained composite resins.
buccal (right). History indicated no particular
An in vitro study by Villata et al (2006)64
exogenous subtance that could contribute to the
demonstrated complete removal of wine stains
discolouration. Courtesy of Dr Ahmad Fauzi
from composite resins with at-home bleaching
Muhairriri.
system (Crest Night Effects, Colgate Simply White
Night, or Opalescence Quick). Earlier study by
Turkun et al (2004)81 showed composite resins
stained by coffee and tea responded positively to
both bleaching and polishing. The colour of
composite resins tested returned to almost baseline
colour. In removal of deeply penetrated stains,
bleaching with 15% hydrogen peroxide was shown
to be more effective than repolishing.
Recently, the use of whitening tooth paste
and ozonated gel have also been found to be
helpful.82,83 Composite resins seem to display
diverse degree of whitening depending on the types
of composite resins and the concentration
Figure 2. Labial discolouration of 22,23,24. Daily bleaching agents used.84 Hafez et al (2008)82
chlorhexidine mouthwash usage was identified in examined the effects of Beyond (Beyond
the history. Technology Corp), LumaWhite-Plus (LumaLite, Inc.)

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© 2012 Malaysian Dental Journal

and Opalescence-Boost (Ultradent Products, Inc.) especially dietary agents have potential deleterious
in-office bleaching systems in lightening the coffee effect on the colour of composite resins. Therefore,
stained microfilled and hybrid composite resins. patients should be educated on the possible colour
Only the microfilled composite resins showed changes in the restorative material on exposure to
significant reduction of stain after bleaching with these substances.
Beyond and Luma White-Plus.

Figure 3. Possible coffee discolourations of anterior

proximal restorations 12 (mesial), 11 (mesial &
distal), 21 (mesial).

Figure 5. Labial staining on 12 and 13. Rough and

irregular surface was detected in the clinical
evaluation.

Although the susceptibility of composite

resins to discolouration has been widely
investigated, studies that specifically address the
clinical management of composite resins
discolouration have been limited. In clinical
practice, it may be difficult to ascertain the
mechanism of staining by clinical assessment alone.
Figure 4. Marginal and bulk staining of anterior Figure 1-6 are some of the clinical examples
composite resins. History taking revealed regular illustrating composite discolouration cases. To
tea and red wine consumption. determine the cause of staining, clinical evaluation
of the restoration may need to be supplemented by
Clinical Implications thorough history taking and investigation. The
The composite resins were introduced in the 1950s determination of the mechanism of staining is
to overcome some of the problems associated with crucial as the treatment options and outcome of the
previous tooth-coloured materials. Nevertheless, treatment largely depend on the diagnosis of the
the performance of this material seems to be composite staining.
obscured by its historical innuendo; poor colour Dietary history, dental history e.g. oral
stability. From the above discussion, it is apparent hygiene practices or usage of mouthwashes and
that extensive research has been carried out in habits such as smoking are useful information in
search of mechanism of discolouration of establishing the extrinsic nature of the
composite resins. Most of the factors involved in the discolouration. Clinical records of the types of
intrinsic discolouration are beyond the control of composite resin used may be helpful in verifying the
clinicians. It is also likely that various physico- intrinsic cause. Intraoral examination of the
chemical conditions that exist naturally in the oral restorations such as surface texture and quality of
environment may alter the chemical structure the polished surface may shed some light on the
within composite resins leading to inevitable colour possible origins of the discolouration. As part of the
change in restorations. Various substances diagnostic investigation, a clinician may try to

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mechanically remove the stains. In general, most 2. Bowen R. Properties of a silica-reinforced

extrinsic stains are noted to be superficial, polymer for dental restorations. . J Am Dent
approximately 3-5 µm56 and could be reduced Assoc 1963;66:57-64.
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From aforementioned experiments, tooth the adhesion acrylic filling material to enamel
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and bleaching procedures have all showed promise 4. Bowen RL. Composite and sealant resins--past,
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removal is very much material-dependent and is change of newly developed esthetic restorative
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Dent Mater J. 2006;25:352-9.
CONCLUSION 9. van Dijken JW, Pallesen U. Fracture frequency
and longevity of fractured resin composite,
The susceptibility of composite resins to intrinsic polyacid-modified resin composite, and resin-
staining varies according to the chemical modified glass ionomer cement class IV
composition of resin matrix, types and amount of restorations: an up to 14 years of follow-up.
filler and initiator and accelerator system. A Clin Oral Investig. 2010;14:217-22.
multitude of common dietary agents have been 10. Gulamali AB, Hemmings KW, Tredwin CJ, Petrie
shown to have potential to stain composite resins. A. Survival analysis of composite Dahl
Instead of premature replacement of the restorations provided to manage localised
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67. Asmussen E, Hansen EK. Surface discoloration 78. de Andrade IC, Basting RT, Lima-Arsati YB, et al.
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