It is well-known that final esthetics of a restoration influences patient satisfaction, and that poor esthetics – such as a poor shade match – can lead to patient dissatisfaction. Each year 69% of patients visiting the dental office receive a direct restoration and 50% are Class II composites.1, 2 That makes esthetic composite restorations not only a key success factor for patient satisfaction, but also for the financial health of your practice. Here, we’ll look at challenges and solutions in shade matching and esthetics for direct composite restorations.
Tooth color relies on its intrinsic color, which is determined by the manner in which light is absorbed, transmitted, reflected and scattered by the tooth, and is affected by extrinsic stain. Color has three components – hue (color), chroma (intensity of the color) and value (lightness). These fundamental facts are as applicable to composites as they are to teeth.
Visual shade matching is the most common method. This is frequently performed using a VITA® Classical shade guide, which has 16 shades grouped A through D. The A through D tabs represent, respectively, reddish-brownish, reddish-yellowish, greyish and reddish-grey hues. The chroma increases as the number increases – for example, an A3 would be more intense in color than an A1. An alternative method is to arrange the tabs by brightness. Other shade guides include the VITA 3D Master Toothguide with 26 shade tabs based on hue, chroma and lightness, and the VITA Bleached guide 3D-Master. Many composite brands also come with their own shade guide.
Vita Classical shade guide arranged by brightness.
Shade matching devices include spectrophotometers (which are regarded as accurate) and colorimeters (which offer poor reliability). Such devices are expensive and not in common use in dental offices. Intraoral scanners equipped with colorimeters and shade determination software are now available, as well as inexpensive and familiar digital cameras and smartphones. By far, the use of visual shade guides remains the most prevalent method.
Visual shade matching is subjective, challenging, and influenced by several factors, including the lighting, background, operator and tooth attributes.
With all of these variables, it’s no wonder that shade matching can be challenging.
Challenges reported by dentists performing composite procedures include shade selection, staining, and change in color of the composite over time – all of which affect patient satisfaction. Additionally, it’s been reported that perceptible differences in color between restorations and adjacent natural teeth are found by up to 80% of patients.7
In today’s dental office, patient expectations are high, and efficiency is a must, yet these challenges absorb chairside time:
Let’s now look at solutions to these clinical challenges.
Shade matching technique, material selection and the procedure play a role in the ability to address these challenges.
For accurate shade matching, the following is recommended:
If it is still difficult to determine the shade, place a small sample of composite on the adjacent tooth surface to confirm the best match. (Note that if a composite material changes shade when cured, place a small amount on the surface without adhesive and properly light cure to confirm.)
Training in shade selection is recommended – this has been shown to improve efficiency and, in the absence of physiological impediments, color perception and accuracy.
In addition to optimal physical properties and handling characteristics, selection of a composite with the following characteristics is recommended:
With an appropriate technique and composite selection, excellent esthetics can be achieved efficiently!
Together, esthetic excellence in composite restorations and efficiency are important for you and your patients. That’s where Dentsply Sirona’s Neo Spectra® ST Universal Composite Restorative can help. This universal composite offers the physical properties needed for long-term success together with excellent esthetics, efficiency and ease-of-handling.
The distinct chameleon blending effect of Neo Spectra® ST composite is so effective that the A2 CLOUD™ shade easily matches 80% of cases10. The SphereTEC® Filler Technology also optimizes handling with a choice of high or low viscosity composite to meet your preference. It adapts readily to the preparation, is easy to sculpt and shape, resists slumping, isn’t sticky, and enables efficient finishing and polishing.
Before and after amalgam replacement showing final Neo Spectra® ST universal composite restoration with excellent esthetics and gloss retention.
Case courtesy of Dr. Ayad Al-Obaidi (source: Class II Dental Cases | Dentsply Sirona USA)
Finishing is efficient with Dentsply Sirona’s Enhance® Finishing system, which delivers a smooth, contoured surface with a natural looking finish in a single-step. Polishing with Dentsply Sirona’s Enhance® PoGo® Polishing system then results in a lustrous, high gloss surface that optimizes and protects esthetics, discouraging biofilm accumulation and stain.
Here at Dentsply Sirona we want to support you further with our online dental academy complete with webinars, how-to videos, and real-world examples on how to create streamlined esthetic solutions with efficient procedures and even greater patient satisfaction. Contact us now and let’s get started!
1 https://www.cdc.gov/nchs/fastats/dental.htmf
2 Dental Market IQ 2022 Research Report - Calendar Year 2021. For more information, contact Consumables-Data-Requests@dentsplysirona.com. VITA® is not a registered trademark of Dentsply Sirona
3 Dudea D, Gasparik C, Botos A, et al. Influence of background/surrounding area on accuracy of visual color matching. Clin Oral Investig. 2016 Jul;20(6):1167-73. doi: 10.1007/s00784-015-1620-3.
4 Perry, Ron DMD MS. Increasing Accuracy and Esthetics Through Digital Shade-Matching.
5 Moser JB, Wozniak WT, Naleway CA, et al. Color vision in dentistry: a survey, JADA 1985;110:509-510.
6 Visual and Spectrophotometric Shade Analysis of Human Teeth J DENT RES August 2002 81: 578-582.
7 Joiner A. Tooth Color: A Review of the Literature. J Dent. 2004; 32:3-12.
8 Data on file. Dentsply Sirona Restorative. GNY 2016 Attendee Survey. For more information, contact Consumables-Data-Requests@dentsplysirona.com.
9 Dentsply Sirona Procedure Timing Breakdown Study. Data on file. For more information, contact Consumables-Data-Requests@dentsplysirona.com.
10 Internal data on file. For more information, contact Consumables-Data-Requests@dentsplysirona.com.
References
Hardan L, Bourgi R, Cuevas-Suárez CE, et al. Novel Trends in Dental Color Match Using Different Shade Selection Methods: A Systematic Review and Meta-Analysis. Materials 2022, 15, 468. https://doi.org/10.3390/ ma15020468
Igiel C, Lehmann KM, Ghinea R, et al. Reliability of visual and instrumental color matching. J. Esthet. Restor. Dent. 2017, 29, 303–308.
Joiner A, Luo W. Tooth colour and whiteness: A review. J Dent 2017;67S:S3-10.
Jouhar R. Comparison of Shade Matching Ability among Dental Students under Different Lighting Conditions: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2022, 19, 11892. https://doi.org/10.3390/ ijerph191911892
Knezović D, Zlatarić D, Illeš IŽ, et al. In vivo and in vitro evaluations of repeatability and accuracy of VITA Easyshade® Advance 4.0 dental shade-matching device. Acta Stomatol Croat 20 15; 49:112 –118 .