Color stability of resin-based composites exposed to smoke. A systematic review

Gaetano Paolone, Francesca Pavan, Mauro Mandurino, Sofia Baldani, Paolo Chiara Guglielmi, Nicola Scotti, Giuseppe Cantatore, Alessandro Vichi

Research output: Contribution to journalArticlepeer-review


Objective: To conduct a systematic review on color stability of dental resin-based composites (RBC) exposed to conventional and electronic cigarettes.

Materials and Methods: In vitro studies reporting on the color stability of RBC exposed to conventional cigarettes or to e-cigarettes: both Tobacco Heating Systems (THS) and Electronic Nicotine Delivery Systems (ENDS). The quality of the included studies was assessed with the QUIN tool (risk-of-bias tool for assessing in vitro studies conducted in dentistry). A systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed on four (n = 4) databases (Embase, Medline, Scopus, Web of Science) for articles published until March 28th, 2022.

Results: Of the 365 screened articles, 13 were included in this review. All the included articles analyzed conventional cigarette smoke (CS), four analyzed Electronic Nicotine Delivery Systems (ENDS) and two Tobacco Heating Systems (THS). In terms of study design, smoke exposure time, smoke flow, type and number of cigarettes a high variability was reported.

Conclusions: The available evidence suggests that CS smoke significantly affects color stability. Electronic cigarettes show less color change that seems to be easily recovered under clinical acceptability thresholds, although evidence is scarce.

Clinical Significance: Clinicians should be aware, and should therefore warn their patients, that RBCs are subjected to irreversible color change if exposed to smoke. Electronic cigarettes (both ENDS and THS) induce less color change that can be recovered with repolishing or whitening procedures.
Original languageEnglish
Pages (from-to)309-321
Number of pages13
JournalJournal of Esthetic and Restorative Dentistry
Issue number2
Early online date5 Jan 2023
Publication statusPublished - 1 Mar 2023


  • color stability
  • electronic nicotine delivery systems (ENDS)
  • EVP
  • resin-based composites
  • smoke
  • staining
  • tobacco heating systems (THS)

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