all-ceramic restorations

Written by Andrew Sedler

Written by Andrew Sedler

Written by Andrew Sedler

Shades:

Increasing Predictability

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The restoring of a patient’s form and function is extremely important in terms of a successful case. Teeth can often become damaged from trauma, congenital issues, or poor oral health. The first goal in restorative dentistry is to create stability in the oral cavity. However, for patients, restoring their smiles to achieve a better aesthetic appearance is an essential factor. Managing a balance of these two fundamental restorative goals is imperative to the patient’s overall satisfaction.

While there are many steps to ensuring a positive experience, one of the basic areas that play a critical role is in the ability to communicate color accurately.

The color perception process in humans is complicated. It is dependent on the physical limits of light, the complexity of brain neurons, and the reflective quality of light on an object. Therefore, the perception of color can be attributed to the physiological feedback of physical input. The scientific knowledge of the basic principles of color is essential in meeting the demands of matching tooth color to the esthetic expectations of patients. Color then can be described by classifying it into three categories: hue, value, and chroma.

Color Categories Illustration

Shade Taking Environment

The most influential factor when taking a shade is the quality of the light source. It is commonly known that the natural light that occurs mid-day is the most accurate for color matching. Since using this light is not conducive to a dental practice, the use of artificial lighting is a more common practice. Using a light source that is most like natural sunlight is the most ideal. Color-corrected lights are available that can show color more accurately. Also, using full-spectrum LED lights works just as well. The key is to have balanced lighting as close as possible to natural light. Lighting that is as close to 5,500°K with a 100% color rendering index is ideal. Many factors can affect the ability to achieve this, including:

  • The tint on the office windows. Make sure to have window coverings to cut out the outside light altogether.
  • The color of the walls, floors, and furniture. Make sure these are nonreflective and colored with low saturation shades.

Because color perception is so profoundly affected by surrounding colors, it is essential to neutralize these before taking a shade. Influencers could be factors such as lipstick or clothing. Ask patients to remove lipstick and neutralize their clothing by draping a neutral gray cloth over the patient. Also, it is crucial to take shades quickly. A tooth should not be looked at for more than 5 seconds to avoid hue accommodation. To give eyes a break during the shade taking process, look at a neutral gray background to screen out color glare.

Taking the Shade

The shade taking process is an important one as it is critical to provide the laboratory with accurate information to have the case fabricated. The accuracy of this step is crucial in reducing adjustments, remakes, and ultimately profitability. It also significantly affects the patient’s experience with the process and influences their overall satisfaction. Below are the steps that improve the ability to take an exact shade:

  • 1

    Take the shade at the beginning of the process, especially before prepping. Dehydration can occur after only a couple of minutes of having the patient’s mouth open. When teeth dry out, their value increases, and the chroma and translucency decrease.

  • 2

    Sit the patient in an upright position. How light enters the mouth can affect how the color is recognized. Only use lighting that is color corrected. 

  • 3

    Use cheek retractors to reduce the possibility of shadows.

    Use cheek retractors

  • 4

    Make sure the patient's teeth are at eye level with the person taking the shade.

  • 5

    Hold the shade tab in the same position as the tooth being evaluated. 

    • Place the incisal edge of the guide to the incisal edge of the tooth.

      Place the incisal edge of the guide to th eincisal edge of the tooth.

    • Keep the facial surface of the guide parallel to the facial plane of the teeth
    • Make certain the guide is not lingual of the teeth or outside of the mouth. 
  • 6

    To increase accuracy, hold the entire shade guide up to the mouth. Use the mid-buccal of the tooth to determine the hue.

    Tooth Shades

  • 7

    For all-ceramic restorations, such as porcelain veneers, take a shade of the preparation. The color of the prep will significantly affect how the laboratory fabricates the restorations.

    Take a shade of the preparation

  • 8

    Get the patient involved in the color selection. When the patient is evaluating the selection, they should hold a mirror at arm’s length to allow for adequate light to enter the mouth.

  • 9

    If you become stuck between two shades, choose the lighter of the two. Choosing the lighter shade will make corrections easier should they be necessary.

  • 10

    Take photos and include the shade tab in the picture.

  • 11

    If the patient is bleaching, wait a week after the last bleaching session to take the shade to allow the color to settle.

Photography

While photography does not provide for accuracy in shade evaluation, it does provide valuable information for the laboratory technician. To fully communicate the shade, make sure to provide the following pictures: natural smile, full face, retracted lips, and finally, pictures with the shade tabs.

Light Source

It is essential to minimize any flash bounce back. We recommend using a ring flash or dual point flash with a diffuser to reduce the flash bounce back.

figure 6a
figure 6b

The diffuser helps to reduce glare. Again, it is crucial to use full-spectrum color-corrected lighting in the operatory and ensure that there are no outside color influencers such as walls or clothing as these will reflect into the shade and create discrepancies. Position the camera in the same plane as the patient’s teeth. This position should be almost perpendicular, with just a slight variation to the left or right to remove glare.

Several factors can affect a person’s ability to match a shade accurately. These factors include age, an individual’s degree of color perception, and experience. Because shade taking is such an essential part of the restorative process, it is a good idea to have the dental practice staff’s color vision tested. These tests are relatively simple and can provide information regarding whether a person has a color vision deficiency and can show an individual’s ability to discern small color differences.

Color communication is exceptionally vital in the success of any restorative procedure. Managing the patient’s esthetic expectations is crucial to their satisfaction. Burbank Dental Lab understands the vital role we play in this process and are available to offer suggestions and support to help your practice thrive.

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Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.

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