A shade selection technique

Bruce Marcucci, DDSa San Francisco, Calif.

The purpose of this article is to present a variation on the standard technique of shade selection by use of the Vitapan 3-D master tooth guide and the Vitapan 3-D master dentin guide together. The dentin guide is used rst to select the shade determinants, and the tooth guide is used to verify them. (J Prosthet Dent 2003;89:518-21.)

n 1908, Black1 published his monumental work on operative dentistry. This work was the rst reference in the dental literature to the importance of value in the shade determining process. Black1 stated that the best esthetic result was obtained when the proper color (hue) and translucence (value) were found. Of these attributes, he believed that translucence was of greater importance than the exact color. He suggested that translucence be assessed rst and that chroma (saturation) should be determined before color. Various shade guides existed at this time, but they were designed for the operator to use 1 tab to decide all 3 determinants: value, chroma, and hue. It was not until the 1930s when Clark2,3 published a series on color science that the current use of shade guides began. In one publication,2 he spoke of brilliance as the most important attribute in the study of tooth color. He was, of course, speaking of value: the brightness or dullness, whiteness or blackness, lightness or darkness of a restoration. Clark3 incorporated the importance of value into his own design for a guide he called the Tooth Color Indicator. It had 60 tabs and only 1 hue (yellow), but provided for the selection and use of 342 gingival colors and 342 incisal colors.3 Although this custom guide worked very well with its primary emphasis on value and chroma, the guide contained too many tabs and was confusing to the average dentist, then and now. In fact, it was never marketed. A simplied shade guide (the Vita Lumin Vacuum Shade Guide) was developed in the 1960s and was well received by the dental profession. Vita (Vita Zahnfabrik, Bad Sackingen, Germany) changed the name of the Vita Lumin Vacuum Shade Guide to the Vitapan Classical Shade Guide in February 1998. This name change was to differentiate it from Vitas newest guide, the Vitapan 3-D Master. The instructions for the Vitapan Classical Shade Guide explain the arrangement according to hue and chroma. They also explain how to arrange the guide according to value (Fig. 1). Unfortunately, this aspect of the guide is not used by most dentists (Personal communication; Dan Carr, ceramist, March 2001). The clinician therefore has 16 choices with variability in hue and chroma but no method to
a

Fig. 1. Upper guide set to hues and lower guide set to value (highest to lowest), with gingivals and incisals removed.

Private practice.

assess the most important determinant: value. If the directions were followed completely, the choices would be 16 16 or 256 value-chroma-hue combinations. Another problem with the Vitapan Classical Guide was that the tabs were not dispersed evenly throughout the 3-dimensional color space.4 In the 1970s, Sproull4-6 published a 3-part series on color. In this series, he suggested that once dentists fully understood the denitions and relative importance of value, chroma, and hue, they would be able to solve the color-matching problems in a step-by-step manner. He also suggested that dentists were not prepared in dental school to logically analyze color-matching problems.6 This perception appears to still be valid today. The exception is that dentists now have a new tool based in color science, the Vitapan 3-D Master Shade Guide, to approach the problem of shade matching. Sproull5 did not devise a shade guide design of his own but made suggestions for what he believed would be the ideal design. One suggestion was a proposition that Clarks Tooth Color Guide3 (60 tabs) and Hayashis guide4 (125 paper tabs) should be studied for their similarity of putting prime importance on the dimensions of color. Again, the recurring solution involved a large numbers of tabs. As a means of extending the effectiveness of the existing guides, Sproull5 suggested, among other things, that porcelain stain kits should include 5 value choices.4 Five value choices are
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Fig. 2. Blue tooth guide (top) and red color guide (bottom).

the starting point for the Vitapan 3-D Master Shade Guide. In 1980, Preston and Bergen7 published a workbook that identied value as the most important determinant of color. The workbook was a teaching aid for training the eye to discern the differences between levels of value, chroma, and hue. Two hundred ninety-ve colored paper squares were used and sorted onto grids in increments of increasing value, chroma, and hue. The authors solution for a shade-determining tool was to use the existing Vitapan Classical Shade Guide in 3 permutations: ordered by hue, incisals and gingivals removed, and glaze removed for custom staining. Preston and Bergen7 advocated selecting value rst. In 1988 Sorenson and Torres8 published a 3-part series on improved color matching of metal ceramic restorations. In the summary, it was stated that there are 5 areas of weakness in shade-matching procedures, one of which was the commercially available shade guides. The authors solution to this problem, when utilizing Vital Metal Keramik (VMK)-68 porcelain, was to use the shade indicator chart and ring of tabs (52 tabs). These tabs are broken down into opaque, body, and incisal porcelains. This seemed to provide an excellent solution that gave the operator control of all 3 determinants separately. However, it required that the dentist be able to extrapolate the resulting color from stratication of these porcelain layers. In 1991 Hall9 stated that it was possible to minimize the difculties of color matching by quantifying the determinants of value, chroma, and hue. This article was the basis for the design of the Vitapan 3-D Master Shade Guide that the Vita company introduced to dentists in February 1998. Hall worked with Vita to design a simple guide that incorporated all of the shade determinants in logical sequence: (1) value, (2) chroma, and (3) hue. One of the 5 value tabs would be chosen rst. These are the tabs at the top of each of the 5 groups (Fig. 2). They have the least amount of hue and chroma which allows the rods in the eyes to more easily determine gradations
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of value because the rods are more sensitive to gradations of black and white than the cones are sensitive to color.7 Three sections have 7 tabs, and 2 sections have 3 tabs. The sections with 7 tabs contain the majority of tooth colors within the 3-dimensional color space. After the value determination, all tabs in the same group have the same value and vary only in chroma and hue. These chroma-hue combinations are dispersed evenly throughout the color space. Chroma is selected second by moving, within the same value section, vertically down the M row (yellow-red) for increasing chroma. It is also possible to obtain half shades with value or chroma. Because this is an ordered system of equal intervals, meaning the amount of distance between 2 points in the 3-dimensional color space is the same, value determinations of 1.5, 2.5, 3.5, and 4.5 are possible. Chroma levels of 1.5 and 2.5 are possible as well. To determine hue, stay in the same row or move to the L row (more yellow) or the R row (more red). Because it is difcult to differentiate the hues, move to the gingival third of the canine because it has the highest chroma for the dominant hue of the natural dentition.8 The blue-labeled tooth guide has shade tabs that exhibit gingival, middle, and incisal colorations. Vita also manufactures a red-labeled color guide with tabs that show only dentin color. This color guide should be used rst because, along with removing the gingival and incisal porcelains, it helps the practitioner to more easily visualize the value, chroma, and hue in each third of the tooth (Fig. 2). In many situations, there will be differences in chroma and value between the thirds of a tooth that do not match up to the gradations of color on the blue-labeled tooth guide. So the red-labeled color guide becomes a somewhat custom guide to complement the tooth guide. The shade should be selected at the beginning of the appointment when the teeth are hydrated in a natural state. Magnication of at least 3.5 to 4.5 (4 teeth in focus) is essential so the practitioner can focus on onethird sections of a tooth when using the red color guide. Select the determinants in a dynamic way. Place the patient under different lighting conditions because the spectral reectance from natural, incandescent, uorescent, or halogen light will be relatively different between the porcelain and tooth. Spectral reectance is the distribution of light waves off an object.7 Color is not a characteristic of objects but rather the reection of light that enters the eyes from the object. Spectral reectance is color. Be aware of the specter of metamerism because it may be necessary to alter the shade prescription for the best average under all light conditions. Metamerism is dened as occurring when colored objects that do not have the same spectral components, such as teeth and porcelain, do not match under different lighting conditions.7 This problem can be minimized but not elimi519

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Fig. 3. With red guide used to determine value of maxillary right canine. 2MI is too high in value. A, Color. B, Black and white.

Fig. 4. A, 3MI is close in value to more opaque gingival third of maxillary right canine. B, Black-and-white photo shows this more clearly.

Fig. 5. 4 MI is similar in value to more translucent incisal third of maxillary right canine. A, Color. B, Black and white.

nated by not staining the surface of porcelain and providing the ceramist enough reduction of tooth structure to internally layer the colors (Personal communication; Dan Carr, ceramist, March 2001). Rest the eyes every 10 seconds by looking at a blue or gray background to resensitize color vision. With only 26 tabs and primary importance on value, these are the guides for which the technique and variations on usage are reviewed.
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TECHNIQUE
1. Using red color guide, select value tab that match the areas in question (Figs. 3, 4, and 5). Squint to reduce angular light reection and to increase light on rods in eye.4,7 2. Select chroma by moving down M row in previously selected value group.
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3. Select hue from the M row (yellow-red), L row (yellow), or R row (red-yellow). 4. Verify nal value, chroma, and hue determinants with the tab from the blue guide that matches the 3 determinants chosen from the red guide. 5. For anterior teeth and more complex shades of posterior teeth, start again with the red guide. 6. Divide the tooth into gingival, middle, and incisal thirds. 7. Determine value, chroma, and hue for each third separately.

and that it can be used in determining both anterior and posterior tooth shades.
REFERENCES
1. Black GV. A work on operative dentistry. Chicago: Medico-Dental Pub Co; 1908. p. 347. 2. Clark EB. An analysis of tooth color. J Am Dent Assoc 1931;13:2097-8. 3. Clark EB. The color problem in dentistry. Dent Dig 1931;37:581. 4. Sproull RC. Color matching in dentistry. II. Practical applications of the organization of color. J Prosthet Dent 1973;29:556-66. 5. Sproull RC. Color matching in dentistry. I. The three-dimensional nature of color. J Prosthet Dent 1973;29:416-24. 6. Sproull RC. Color matching in dentistry. III. Color control. J Prosthet Dent 1974;31:146-54. 7. Preston JD, Bergen SF. Color science and dental art. St. Louis: Mosby; 1980. p. 6. 8. Sorenson JA, Torres TJ. Improved color matching of metal-ceramic restorations. Part I: A systematic method for shade determination. J Prosthet Dent 1987;58:133-9. 9. Hall NR. Tooth colour selection: the application of colour science to dental colour matching. Aust Prosthodont J 1991;5:41-6. Reprint requests to: DR BRUCE MARCUCCI 323 PACIFIC AVE SAN FRANCISCO, CA 94111 FAX: (415) 956-9573 E-MAIL: drmarcucci@juno.com Copyright 2003 by The Editorial Council of The Journal of Prosthetic Dentistry. 0022-3913/2003/$30.00 0 doi:10.1016/S0022-3913(03)00076-3

SUMMARY
The ability to control and alter value, chroma, and hue between each third of a tooth and to visualize it with an individual tab is the most important benet of this altered technique. The clinician, when starting with the red guide, can more easily see and choose value, chroma, and hue combinations for each third of a tooth (gingival, middle, and incisal or cusp). The red guide becomes a custom shade guide, but a premanufactured one. The blue guide is then used to verify the determinants. The nal shade may be the same as one of the blue tabs or a combination of tabs, such as a gingival and middle from one tab and incisal from another. The advantages of this technique are that it gives the practitioner a wider range of choices without having to fabricate a custom guide

Noteworthy Abstracts of the Current Literature

Computer prediction of hard tissue proles in orthognathic surgery Loh S, Yow M. Int J Adult Orthodon Orthognath Surg 2002; 17:342-7.

The purpose of this retrospective study was to analyze the accuracy of computer predictions by CASSOS (Computer-Assisted Simulation System for Orthognathic Surgery) 2001 software (2000 SoftEnable Technology). Forty adult patients who had undergone orthognathic surgery were evaluated. Pre- and postsurgical lateral cephalographs were scanned into the computer, and 71 landmarks for each cephalograph were digitized. Digitization error was assessed from repeated digitizations. A customized cephalometric analysis consisting of 14 measurements was used in this study. Predicted and actual postsurgical hard tissue landmarks were compared using the Student t test. Results showed good correlation between repeated digitization for all measurements. There were no statistically signicant differences in 10 of the 14 measurements. The differences that were statistically signicant were in angular measurements for SNA angle, upper incisor to maxillary plane angle (U1-MxP), interincisal angle (U1-L1), and upper incisor to anterior cranial base angle (U1-SN). The greatest mean difference measured was the interincisal angle (U1-L1) which, although statistically signicant, was clinically insignicant. This investigation showed that CASSOS 2001 software provides accurate hard tissue prediction for orthognathic surgical procedures. Reprinted with permission of Quintessence Publishing.

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