Color in Dentistry

A Clinical Guide to Predictable Esthetics

Stephen J. Chu, Rade D. Paravina, Irena Saile, Adam J. Mieleszko

• Publisher: Quintessence Publishing Co, Inc
• Year: 2019
• eBook ISBN: 9780867157611
• Topic: Medicine
• Subtopic: Dentistry

Predictable shade matching in dentistry remains a significant challenge for clinicians in daily practice. Color is an important aspect in the esthetics of teeth and dental restoration fabrication, and color discrepancy can mar restorative results, even when other aspects (marginal fit, occlusion, and morphology) are adequate. This book provides step-by-step protocols to help dental professionals accurately match, communicate, and reproduce the color of teeth and gingiva. These authors demonstrate how to implement color science in simple problem-solving instructions for predictable esthetics in both clinical protocols and laboratory techniques. An extensive presentation of clinical cases is included to illustrate the use of recommended protocols in general practice. An outstanding contribution to the practice and theory of color management in contemporary dentistry.

COLOR EDUCATION AND TRAINING

IN THIS CHAPTER:

•Cultivating the skill of shade matching

•Currently available shade-matching publications and programs

Many factors influence our ability to achieve accurate shade-matching results, including subjectivity, shade-matching tools, materials, methods, and conditions. Nonetheless, the importance of color education and training should not be underestimated, as Sproull noted in 1974: “The technology of color is not a simple matter that can be learned without study; neither is it a complicated matter beyond the comprehension of dentists.”¹ Color appearance is frequently of critical importance to the final outcome of dental restorations and their acceptance by patients. This is why education and training should be the first step of a process that should result in the predictable and enhanced esthetic outcome of dental restorations.

Cultivating the Skill of Shade Matching

Successful musicians, painters, and other artists are both gifted and well educated in their craft, and yet they continue to practice and improve their skills. In contrast, little effort is made to assess whether the average dental professional has an eye for shade matching. Moreover, education on color is frequently not even part of the undergraduate or graduate dental school curriculum.^1–3 Years of shade-matching experience practiced under inappropriate conditions, using inadequate tools and methods, can hardly be called color training. The literature shows that dentists often overestimate their color-matching and reproduction abilities. When asked to match 16 corresponding pairs from two VITA classical A1-D4 shade guides using the visual method, the pre- and postdoctoral participants correctly matched only 50%.⁴ In another study, which closely resembled clinical dentistry in that there was no exact match, the observer’s choice was the second or third best match.⁵

Several surveys have been conducted on color education. The first one, in 1967, revealed that only three institutions (of the 115 institutions that responded) offered a color science course, and only 2.3 classes, on average, referred to color topics.¹ In another survey, core curriculum and elective courses on color were taught at 26% and 17%, respectively, of the 69 responding schools.² A third survey related to teaching of color in predoctoral and postdoctoral dental education was published in 1992. Responses were received from 138 institutions.³ The mean number of hours devoted to color topics was 6.6, and 50% of the schools reported a lack of a color-balanced environment. In addition, 85% of respondents believed that there was a need to develop a new, systematic shade guide. It was concluded that additional efforts should be made regarding the study, research, and application of color science in the dental profession, particularly in undergraduate education.

A fourth survey was published in 2010.⁶ There were a total of 130 responses from North America, Europe, South America, Asia, and Africa. It was reported that a course on color in dentistry was included in the dental curriculum of 80% and 82% of pre- and postdoctoral programs, respectively. Significant differences in the number of hours dedicated to teaching of color were recorded at each level (4.0 versus 5.5 hours, respectively). Significant differences were also reported between the levels for the following: teaching on negative afterimages, color rendering index, VITA Bleachedguide, VITA 3D-Master shade guide, digital camera and lens selection, composite resins, and maxillofacial prosthetic materials, with significantly higher percentages recorded for postdoctoral programs. VITA classical A1-D4 and VITA 3D-Master were the most frequently taught shade guides.

It has been demonstrated in multiple studies that shade-matching devices are more reliable than the predominantly used visual method.⁷ It should be noted that shade-matching results obtained using the visual method were most probably below the expectations of many. Two similar studies, performed on different continents and on different shade-matching tasks, reported pretty similar results: 70% to 80% of the participating dental students were not able to select the best matching tab from the shade guide, while barely 50% of students selected one of three best matches. However, the latter percentage increased to over 72% upon color education and training, which is in accordance with other studies that reported that education and training can improve one’s color-matching skills.^7,8

● TABLE 1-1 Shade-matching publications and programs
	Format	Publisher	Features
Color Matching Curriculum	Half-day continuing education module, didactic and hands-on	Society for Color and Appearance in Dentistry (www.scadent.org)	Educational and training tool; good for building foundational knowledge and shade-matching skills.
Dental Color Matcher	Software: Online and CD-ROM	Society for Color and Appearance in Dentistry, Vita Zahnfabrik (www.scadent.org)	Comprehensive training software and video available free online.
A Contemporary Guide to Color & Shade Selection for Prosthodontics	DVD	American College of Prosthodontists	Educational tool; good for building foundational knowledge.
Toothguide Trainer & Toothguide Training Box	Online software and training box	Vita Zahnfabrik (www.toothguide.com)	Easily accessible digital practice can be supplemented by physical shade tabs.
Esthetic Color Training in Dentistry	Book and CD-ROM	Mosby	Interactive CD-ROM enhances understanding of the text.

Currently Available Shade-Matching Publications and Programs

Several multimedia color education and training programs are now available (Table 1-1). Each program has its own unique features, but they all are designed with the same intention: to educate/train dental professionals in color matching. A brief description of each program is provided below.

Color Matching Curriculum (CMC; Fig 1-1) is a half-day continuing education (CE) module published by the Society for Color and Appearance in Dentistry (SCAD) and available through the SCAD website upon request.⁹ This CE module has been developed for dental students and dental professionals. The main motivation for this CE course was the notion that shade matching in clinical dentistry still leaves a lot to be desired. Color mismatch of restorations in the anterior zone is a ubiquitous situation causing frustrations to the patient and practitioner alike, while the repetitive corrections of mismatches are time-consuming and expensive. Given patients’ demands to receive restorations that emulate the natural dentition, this state-of-the-art combined didactic/hands-on course is designed to enhance clinical outcomes. The course provides an update on new developments on this subject, revisits traditional teaching materials and introduces improvements, and provides a hands-on section on visual and instrumental shade matching. It consists of the following segments:

•Color concepts and resources

•Visual color matching

•Hands-on I

•Color-matching instruments

•Hands-on II

•Dental Color Matcher (homework)

The didactic por...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Contents
• Foreword
• Preface
• 1 COLOR EDUCATION AND TRAINING
• 2 COLOR THEORY
• 3 ELEMENTS AFFECTING COLOR
• 4 THE UNITED COLORS OF DENTISTRY: WHITE, PINK. AND SKIN
• 5 CONVENTIONAL VISUAL SHADE MATCHING
• 6 TECHNOLOGY-BASED SHADE MATCHING
• 7 DIGITAL PHOTOGRAPHY
• 8 MATERIAL SELECTION
• 9 CLINICAL MANAGEMENT OF HARD AND SOFT TISSUE DISCOLORATIONS
• 10 ESTHETICS WITH PINK RESTORATIVE MATERIALS
• 11 PREDICTABLE COLOR REPRODUCTION AND VERIFICATION
• 12 CLINICAL CASES
• Appendix
• Index