At Burbank Dental Laboratory we receive hundreds of cosmetic cases a month, most of which originate from outside the greater Los Angeles area. One of the most common questions that precede these cases is, “How can I effectively communicate shades from a distance?”
Following are a few tips that will get you excellent, predictable results when choosing a shade for your dental cosmetic patients. We will focus on these five areas:
1. The timing of the shade-taking procedure; when should you take the shade?
2. The positioning of the camera to the teeth.
3. The positioning of the shade tab.
4. The light source or flash.
5. The restorative material and prep shade.
Timing of the Procedure
ALWAYS take your shade at the very beginning of the appointment. As you do procedures with the mouth open and saliva evacuated, the teeth will dry out and can lighten a shade of more. If you wait until the end of the appointment you will tend to request shades that are too bright.
Position of the Camera
It is important for accurate shade communication to position the lens of the camera on the same horizontal plane as the facial surface of the teeth. The position should be almost perpendicular, but slightly to the right or left to reduce glare. Take the shade with the patient sitting up, eye to eye. Often shades are taken while patients are somewhat reclined in the dental chair. Instead, try sitting them in the assistant's chair, or have them stand.
Position of the Shade Tab
In order to give the technician the most useful information, it is best to position the shade tab or tabs in the correct position.
- Incisal edge to incisal edge of the guide.
- Keep the facial plane of the teeth parallel to the facial surface of the guide.
- Do not hold the guide outside of the mouth or lingual of the teeth. See Fig. 1
The Light Source and Flash
Ambient lighting in your room and the light source from the flash are both factors in accurately capturing the shade information. It is important to use full-spectrum, color corrected lighting (5000 K) in your operatory. Wall color is also critical; use neutral gray or a light blue/gray color. Avoid dark colors because intense wall colors of any kind will reflect onto the tooth surface and create an incorrect shade.
Making corrections to minimize flash bounce back is essential.
- Use a ring flash or dual point flash with diffuser. (See Fig 2 a b)
- Use a diffuser or diffusing shields over the flash to reduce glare. This can be as simple as using paper taped over flash or diffusers
- Use a Polarizing filter. (Try Polar Eyes cross-polarizing filter) Fig. 3, a b.
Consider the Restorative Material and Prep Shade
Today the majority of restorations are all-ceramic; therefore it is very important to consider what effect the remaining prep color will have in the cemented restoration's final shade in the mouth. This is why it is imperative to capture a prep shade in a photo as well. The most commonly used prep shade guide is Ivoclar’s Natural Die Material Guide. (See Fig. 4 & 5) This will allow the lab to create a prep-shade die (Fig. 6) that will be used inside the restoration to fine tune and check the outbound shade in the lab.
The most important aspect in shade communication with your lab is RELATIONSHIP. Developing an open two-way communication loop with a knowledgeable dental lab technician will go a long way toward increasing your patient’s satisfaction and WOW factor, which in turn increases patient referrals and ultimately your bottom line.