Escolar Documentos
Profissional Documentos
Cultura Documentos
OF
PROSTHETIC
DENTISTRY
AUGUST 1987
FIXED PROSTHODONTICS
VOLUME
58
NUMBER 2
OPERATIVE DENTISTRY
SECTION EDITORS
WILLIAM LEFKOWITZ
SAMUEL E. GUYER
JOHN E. RHOADS
WILLIAM F. MALONE
ROBERT C. SPROULL
D.M.D.,*
election of the proper porcelain shade and colormatching ceramic restorations to the natural dentition
continues to be one of the most perplexing and frustrating problems in fixed prosthodontics. Inadequate technology to aid the ceramist and dentist in the appropriate
selection of porcelain shades has rendered this part of
dentistry more of an art form than a science. Unlike
science, art form is subordinate to the individual abilities
of the dentist that influence the predictability
and
reproducibility
of the finished restoration.
Traditionally,
communication
between dentist and
ceramist on color and shade matching has been poor.
Lack of clarity, errors of omission, and variability in the
amount of information conveyed are just a few reasons
for this communication
gap. As a consequence, frustration can be anticipated when the dentist subjectively
determines the shade and communicates shade information in an inconsistent manner. A ceramic restoration
drastically different from that originally prescribed often
results.
This series of articles presents a simplified systematic
approach for shade selection, improved methods of
communication,
and porcelain application
procedure.
This information will assist the dentist-ceramist
team in
its goal of consistently producing inconspicuous life-like
ceramic restorations. The techniques presented in this
series are aimed toward dentists who are willing to exert
extra effort and time to achieve the greatest esthetic
potential for their patients. Some dentists may find these
procedures too time-consuming
to justify their use.
OF PROSTHETIC
DENTISTRY
THE PROBLEM
The observer. In general, dentists have little or no
training in vision physiology or color science.lV3 A survey
in 1967 revealed that only 23 of 112 dental schools had
color education in their curriculum.* More recent surveys are not available but inadequate training in color
science is still prevalent.
Although color perception is subjective and varies
between individuals,4-8 Bergen9 demonstrated that color
discrimination,
perception,
and description
can be
improved with training in dental procedures.
Culpepper
found disagreement between dentists in
shade matching the same tooth, and individual dentists
could not duplicate their shade selections on different
days. The problem of determining and communicating
shade selections from dentist to ceramist becomes readily
apparent.
These factors, in addition to the easily fatigued nature
of the cones responsible for color perception, would seem
to make accurate color matching nearly impossible.
Viewing conditions. Color and shade selection is
highly affected by viewing conditions. The light sources
in the operatory and laboratory, color of the walls,
amount of sunlight, the patients clothing and make-up,
and the viewing angle of the tooth can all affect the
selection of a shade.
Light is composed of different wavelengths dependent
on the source. Fluorescent light tends to accentuate the
blue range of the color spectrum whereas incandescent
light accentuates the yellow-red range. To reduce the
effects of metamerism, the dentist should evaluate and
compare shade determinations
under several light
sources. To standardize lighting conditions, both dentist
and ceramist should use color-corrected lights with a
133
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1987
VOLUME
58
NUMBER
SYSTEMATIC
METHOD
FOR SHADE
DETERMINATION
a smooth surface texture increased the Value of porcelain samples and suggested the use of a textured surface
on opaque to keep the Value level down.
AND SHADE
COLOR MATCHIN
SELECTION GUIDE E INES
1. Create a neutral-colored environment for shade selection.
2. Have the patient remove lipstick or bright makeup.
3. Drape the patient with a neutral-colored cover if the
patient is wearing bright-colored clothing.
4. Have the patients mouth at the dentists eye level.
5. Make the shade selection at the beginning of the
appointment before the eyes are fatigued from dental
procedures.
6. Make rapid shade comparisons for no more than 5
seconds to avoid fatigue of cones in the retina.
Prolonged viewing strains the cones and results in
perception of decreased Chroma and Value of the
sample. First impressions are more accurate.
7. Gaze at a blue card or patient napkin between each
shade evaluation. Prolonged viewing results in a
negative afterimage that is the complimentary color of
the originally observed color. Blue fatigue accentuates
yellow-orange sensitivity, which is the dominate Hue
of teeth.
8. Assess Value levels by squinting. Half-closed eyes
decrease the amount of light entering the eye to
inactivate the cones and allow peripherally located
rods of the retina to discriminate lightness and
darkness.
9. Grind off the necks of shade tabs, which have heavy
extrinsic coloring and may distract shade determination.
10. Rapidly scan the shade guide and, by the process of
elimination, determine several tabs that match the
closest.
11. Compare shade selection under varying conditions
(for example, wet versus dry, lip retracted versus lip
down, and light sources at different angles).
12. Check for metamerism by evaluating shade selection
under different light sources (for example, colorcorrected, incandescent, fluorescent, and daylight).
13. Use the canines for a reference in selecting a shade
because they have the highest Chroma of the dominant Hue of the teeth.31
14. To create natural appearing restorations, be aware
of variation in shade among teeth in the arch.
Maxillary incisors are similar in Chroma to premolars. Mandibular incisors are usually one Chroma
level lower than maxillary incisors. Canines are two
Chroma levels higher than maxillary incisors.z9
15. Select a shade that is of lower Chroma and higher
Value if unable to precisely match a shade. It is
difficult to extrinsically color a restoration to decrease
THE JOURNAL
OF PROSTHETIC
DENTISTRY
APPROACH
TO SHADE
SELECTION
PROCEDURE
135
SORENSEN
AND
TORRES
1987
VOLUME
58
NUMBER
SYSTEMATIC
METHOD
FOR SHADE
DETERMINATION
Fig. 6. B shade group opaque, bond, and incisal shade tabs from VMK shade indicator
chart, with permission.
Fig. 7. Evaluation of canine opaque shade No. 514. (Value is too high.)
OF PROSTHETIC
DENTISTRY
Table I. Dominant
Vita shade group
A
B
C
D
Hue
Orange-brown
Yellow
Grey-brown
Red
AUGUST 1987
VOLUME
58
NUMBER
SYSTEMATIC
METHOD
FOR SHADE
DETERMINATION
the inherent problems in shade selection and communication. This approach enhances the dentist-ceramist
teams ability to esthetically match metal-ceramic restorations to the natural dentition.
Future parts of this series will present procedures for
improved communication
and a system for porcelain
application.
We thank the Word Processing Center of the University
California, Los Angeles, in the preparation of this manuscript,
of
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REFERENCES
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OF PROSTHETIC
DENTISTRY
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