Abstract
Purpose This study aimed to evaluate the impact of substrate material, esthetic material type and thickness, and cement shade on the final color reproduction of implant-supported fixed restorations. The goal was to identify optimal combinations for achieving clinically acceptable esthetic outcomes. Material and methods An in vitro study was conducted using four substrate materials, hybrid polyetherketoneketone (PEEK)-based ceramic-reinforced polymer (BioHPP), chromium-cobalt alloy (CrCo), grade 5 titanium (Ti), and white zirconium oxide ceramic (WZirCAD), and three esthetic materials, lithium disilicate ceramic (e.max CAD), polymethyl methacrylate (PMMA), and zirconia oxide ceramic (e.max ZirCAD), at five different thicknesses (0.5, 1, 1.5, 2, and 2.5 mm). Color differences (ΔE*) were measured using a spectrophotometer, both with and without cement application. Statistical analysis was performed using the Kruskal-Wallis test and Bonferroni correction to assess the effects of material combinations on color reproduction. Results The study found that a 1 mm thickness of e.max CAD on BioHPP and CrCo substrates provided the best color matching, with ΔE* values closest to clinical acceptability. PMMA showed higher ΔE* values, indicating lower color stability compared to e.max CAD and e.max ZirCAD. Cement shade had a near-significant influence on final color perception, particularly with e.max ZirCAD on CrCo substrates. Conclusions The study suggests that using e.max CAD at 1 mm thickness on BioHPP or CrCo substrates provides superior esthetic results, underscoring the need for careful material selection in clinical practice. Further in vivo research is recommended to validate these findings and explore long-term outcomes.