Effect of carbonated beverages on composite and ceramic dental restorations

INTRODUCTION

Dental restorations have a wide variety of forms and shapes in dentistry; they are challenged by the material-hostile, highly dynamic, and complex environment of the oral cavity.¹ The clinical success of a restoration is essentially measured by its long-term durability.² Material durability plays a great role in the capacity to withstand various external forces, including those of a chemical, mechanical, biological, and thermal nature.^1,3 An inadequate existing restoration may lead to various interventions with varying degrees of invasiveness and subsequent consequences for dental prognosis.⁴

These consequences may include replacement of the restoration, sealing, refurbishment or repair procedures, up to endodontic treatment, which may be alongside prosthetic restoration, tooth-preserving surgery, or even extraction, known as a “death spiral” and “patient’s lifetime restorative cycle”.^5-7 Replacement of restoration results in increased risk of iatrogenic tooth damage and cavity enlargement, damage to adjacent anatomical structures, and compromise of the pulpal vitality. It also leads to the next more invasive procedure.^8-10 Thus, it is important that dentists do each therapeutic intervention with maximum care, conservatism, predictability, and longevity.^7,8

Dietary behavior has become under observation for clinicians and patients in recent years. It has garnered substantial and continuous attention in both the pertinent literature and the public media.⁴ Recently, more focus has been targeted towards carbonated, sugary, and acidic foods, such as soft drinks, due to their erosive and cariogenic nature which can worsen the oral health.¹¹ Carbonated beverages can cause significant side effects on oral health and general health. Although the food and drug administration indicated that the ingredients in such drinks are safe, they still have side effects, particularly with prolonged consumption.¹² It is important to be aware of the side effects of these carbonated beverages when making a diet plan and nutritional choices.

Multiple studies have evaluated the effects of carbonated beverages on normal teeth and dental restorations materials functions. Carbonated beverages (e.g. Soft drinks) can lead to demineralization processes and loss of substance by various mechanisms, including the direct erosive effect on the hard tooth substance exposed to the medium that can be regarded as a probable element of exogenous ‘biocorrosion’, the elevated tooth wear which occurs due to the combined interactions between erosion, attrition, and abrasion, and the fermentable carbohydrates that act as a microbial substrate and elevate the metabolic activity of the plaque.^13-16 This can result in increased risk of dental caries, dental erosion with dentine hypersensitivity, periodontitis, impaired aesthetic appearance and function, pain, and ultimately tooth (substance) loss, particularly when consumed in high-frequency and between-meal.^16-18

Considering the longstanding and widespread global rise in carbonated beverage consumption across various age groups over the past decades, it is essential to thoroughly examine their potential effect on the function of various dental restorative materials.⁴ Thus, the aim of this review is to discuss the effect of carbonated beverages on two types of dental restorations: composite dental restorations and ceramic dental restorations.

LITERATURE SEARCH

A comprehensive literature search was performed in PubMed, Scopus, and Embase of until April 23, 2025, using combinations of the following keywords: “carbonated beverages”, “composite dental restorations”, and “ceramic dental restorations” and related MeSH terms. Studies were included if they addressed effect of carbonated beverages on composite and ceramic dental restorations. All languages are included. Full-text articles, case series, and abstracts with the related topics are included. Case reports, comments, animal studies and letters were excluded.

DISCUSSION

Composite dental restoration

Composite dental restoration is the most prevalent and significant dental procedure in advanced dentistry. It is commonly recognized and used by both dental professionals and patients globally, confirming its popularity and effectiveness. Composite resin material is usually formed of Bis‐GMA and other di-methacrylate monomers. It is a popular alternative to silver fillings. While these materials possess sufficient strength, they may not match the hardness of amalgam fillings. Additionally, some studies suggest they could have adverse effects on the oral environment.¹⁹ Various types of composite restorations are available such as conventional (macro-filled) composites, micro-filled composites, hybrid composites, micro-hybrid composites, nano-filled composites, bulk-fill composites, flowable composites, and packable (condensable) composites.

Carbonated beverages effect on composite dental restoration

A recent study investigated the effect of carbonated beverages on two types of composite restorative materials commonly used in dentistry which are bulk fill and regular flowable composite.²⁰ Color stability of the composite materials was measured by determining the delta E value. The used beverages (Appy fuzz and 7up) in the study showed significant color changes in both composites; however, the bulk fill resin showed more color change than the flowable composite, indicating that they are less color stable. Discoloration of tooth‐colored normal and bulk fill resin composite materials is considered a major cause of dental restoration replacement in cosmetic field. Both dentists and patients are affected by this complication. To overcome discoloration, various cosmetic restorative materials have been assessed in vitro for color stability.²⁰

In previous studies, carbonated beverages resulted in increased staining by weakening the resin matrix of composites. Carbonated beverages also resulted in surface roughness on composite filled teeth.²¹ In addition, a recent study showed a remarkable color difference in flowable composites and bulk fill resin when immersed in the carbonated beverages. The delta E value estimated by this study was >3.5 times that is regarded as a remarkable color change in the composite materials. It was also regarded as clinically unacceptable and visually visible.²²

Future research should focus on evaluating the color stability of various composite materials to enhance the quality of dental restorations. Such studies can assist dental practitioners in selecting the most suitable composite material that meets both clinical requirements and patient expectations.

Another study evaluated the effect of carbonated beverages on the flexural strength of two types of composites samples: Ivoclar and Restofill.¹² The flexural strength was measured before and after immersion in carbonated drinks by putting samples in a three-point bend test with a span length of 16 mm and a crosshead speed of 1 mm/min on an INSTRON E3000 universal testing machine (ElectroPuls), the maximum force and flexural displacement were measured. The study showed that, before immersion, the Ivoclar composite has a flexural strength of 59.79 MPa, while after immersion, the flexural strength of two Ivoclar samples increased to 69.12 MPa and decreased to 48.69 MPa in Sprite and Coke, respectively.¹² On the other hand, the Restofill composite showed a flexural strength of 95.37 MPa before immersion, while after immersion, the flexural strength of two Restofill samples showed a decreased flexural strength to 49.02 and 21.00 MPa in Coke and Sprite, respectively. Thus, a reduction occurred in flexural strength of both the Restofill and Ivoclar composites after immersion in carbonated beverages such as Sprite and Coke.¹²

Cola soft drinks are considered the most recognized carbonated soft drinks, especially the one presented by the Coca-Cola brand.⁴ As a globally recognized company with strong brand equity, The Coca-Cola company actively promotes its products across numerous countries, maintaining a consistent brand presence in our daily lives through impactful and well-executed advertising strategies.²³

Multiple studies have evaluated the effects of Coca-Cola on normal teeth and dental restorations materials functions. In general, soft drinks can lead to demineralization processes and loss of substance by various mechanisms: (1) the direct erosive effect on the hard tooth substance exposed to the medium that can be regarded as a probable element of exogenous ‘biocorrosion’, (2) the elevated tooth wear which occurs due to the combined interactions between erosion, attrition, and abrasion, (3) the fermentable carbohydrates that act as a microbial substrate and elevate the metabolic activity of the plaque.^13-16

This can result in increased risk of dental caries, dental erosion with dentine hypersensitivity, periodontitis, impaired aesthetic appearance and function, pain, and ultimately tooth (substance) loss, particularly when consumed in high-frequency and between-meal.^16-18

A recent study investigated the effect of Coca-Cola on direct restorative materials, including composite dental restorations.⁴ The study demonstrated that Coca-Cola results in moderate color changes in composited, particularly flowable, bulk-fill, micro-hybrid, and nanohybrid types. Color changes always tend to be brownish or yellowish hues.^2,24,25 Notably, the discoloration increases with repeated or prolonged exposure, which means it is time- and frequency-dependent.^2,26 Coca-Cola also leads to a reduction in surface hardness of composite materials, especially during the initial phase of exposure.^27,28 Furthermore, microhardness loss was observed in various studies which is caused by sorption and matrix degradation, particularly in micro-hybrid, nanohybrid, and flowable composites.^29-31 On the other hand, various studies reported that Coca-Cola has no effect on elasticity, compressive strength, and flexural strength of composites unless exposure is prolonged.^32-34

Exposure to Coca-Cola results in surface degradation, including matrix breakdown, microcracks, increased surface roughness, and pore formation, particularly in bulk-fill and flowable composites.^25,35,36 Notably, roughness correlates with longer contact time and exposure frequency and these roughness surfaces are more prone to discoloration and mechanical wear.^2,27,35 In addition, Coca-Cola can cause chemical changes such as monomer elution (TEGDMA, UDMA, Bis-GMA) from nanohybrid composites, indicating chemical degradation.³⁸ When surface analysis was done, phosphoric acid interaction with polymer matrices occurred, changing elemental composition.^39,40

Biological effects for Coca-Cola on composite dental restorations were also observed, as it increased bacterial biofilm accumulation, especially in degraded or roughened areas.^41,42 Coca-Cola can impair marginal adaptation and increase microleakage at the restoration-tooth interface, especially in bulk-fill and conventional composites.²⁹

Ceramic dental restorations

Ceramics are inert and biocompatible materials which can be safely used in the oral cavity due to their high degree of intra-oral stability. However, the brittle nature of ceramics makes them prone to be easily fractured.⁴³ Therefore, ceramics are supported by metal, reinforced with particles, or made purely of polycrystalline material to overcome this weakness. Ceramic dental materials are always the materials of choice when aesthetics are of utmost importance, since they can visually simulate the character of the tooth substance successfully.⁴⁴ This is why the usage of ceramic dental restorations has greatly increased in recent years.^45,46 There is a wide variety of ceramic materials and devices available on the market for use in dentistry, such as Feldspathic porcelain, Lithium disilicate (e.g., IPS e.max), Zirconia, and porcelain-fused-to-metal (PFM).^43,47,48 All-ceramic restorations may be fabricated as bi-layered systems, where a core or framework is overlaid with more aesthetic veneering ceramics. Alternatively, they can be produced as full-contour (monolithic) restorations, which can be stained to enhance their appearance when needed.⁴⁹

Carbonated beverages effect on ceramic dental restorations

Al-Hiyasat et al investigated the effect of carbonated beverage on the wear of human enamel and different ceramic dental restorations materials.⁵⁰ Three dental ceramics were investigated: a machinable ceramic (Vita Mark II), a hydrothermal low-fusing ceramic (Duceram-LFC), and a conventional porcelain (Vitadur Alpha).

The study tested the tooth-against-ceramic specimens in a wear machine at a rate of 80 cycles per minute, under a load of 40 N and for a total of 25,000 cycles. It was done with intermittent exposure to a carbonated beverage (Coca-Cola) or in distilled water. The depth of wear track in the ceramic specimens and the height reduction of the tooth specimens were both measured to detect wear. Results showed that Duceram-LFC, alpha porcelain led to similar enamel wear when exposed to carbonated beverages, while Vita Mark II produced the least amount of enamel wear. Overall, Duceram-LFC and Vita Mark II had increased wear with exposure to the carbonated beverages.⁵⁰

Another study evaluated the effect of carbonated beverages (Coca-Cola) along with other substances on the surface roughness of two ceramic dental materials (IPS e.max Ceram and Noritake).⁵¹ Noritake® super porcelain EX-3 is a high-quality dental ceramic designed for metal-ceramic restorations, such as crowns and bridges. It is renowned for its stable coefficient of thermal expansion, allowing repeated firings without compromising structural integrity and ideal for complex cases like long-span bridges. IPS e.max® Ceram is a fluorapatite glass-ceramic veneering material developed by Ivoclar. It is designed to provide highly esthetic and natural-looking restorations when layered over lithium disilicate (IPS e.max) or zirconia frameworks.⁵¹

Two methods to measure surface roughness are currently available: contact and non-contact methods.⁵² The contact method, which was used in this study, operates by moving the stylus vertically along the object's surface, tracing its profile as it goes. While the non-contact methods usually utilize a laser beam or a light+ beam to obtain a surface profile. However, shiny surfaces cause a scattering effect of the reflected light making it harder to measure these surfaces, leading to false documented values.⁵² Results showed that the surface roughness increased, in all dimensions, when both Noritake and IPS e.max ceram were immersed in Coca-Cola.⁵¹

Furthermore, a previous study evaluated the effect of Coca-Cola and other beverages (green tea and coffee) on the surface changes, including mean color changes, depth, and roughness on computer-aided design-computer-aided manufactured (CAD/CAM) ceramic veneers materials of varying thicknesses using digital spectrophotometer.⁵³ The study stated that Coca-Cola can dissolve alkaline ions and silica from ceramics glaze layer resulting in surface corrosion, higher color change, and increased surface roughness. Results showed that Coca-Cola caused greater color change than other tested beverages. Additionally, significant differences in color stability were noted especially in thicker ceramic samples (1.00 mm) when immersed in Coca-Cola compared to thinner ones (0.07 mm).⁵³ Color change values exceeded clinically acceptable thresholds (over 4.2 units in some cases), indicating visible and unacceptable color change. These results are supported by similar findings in multiple previous studies.^54-56

CONCLUSION

The frequent consumption of carbonated beverages poses a clear risk to the longevity and aesthetic stability of direct dental restorative materials, particularly composites. While extensive research has documented the detrimental effects on composite restorations, studies examining ceramic restorations remain comparatively scarce. Given the growing popularity and clinical use of ceramic materials, further high-quality investigations are warranted to better understand their behavior and degradation mechanisms in response to acidic challenges, ensuring informed material selection and enhanced patient care.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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