Shade matching in modern dentistry

Colour me intrigued

Oral health and appearance have a well-known impact on an individual’s psychological well-being.[i]Adolescents and young adults, in particular, place great significance on their facial characteristics, and when expectations aren’t met, they could experience a detrimental impact on their self-perception, self-image and overall quality of life.ⁱ

Tooth colour will inevitably play a part in this subconscious judgement. Studies have shown that irrespective of age and gender, whiter teeth are seen to optimise appearance.[ii] It should come as no surprise that teeth whitening is one of the most heavily demanded aesthetic procedures today, with many individuals motivated by social media.[iii]

However, tooth colour is obviously relevant in many other aspects of dentistry. In particular, when providing a restoration, it is vital to make it look as natural as possible. Colour matching here can be difficult, but when done well, the difference in outcome could transform from tolerable to exceptional.

Clinical vision

Colour theory and dentistry combine when judging the value (or lightness), chroma (saturation) and hue (dominant colour) of a tooth visually.[iv] This conventional technique is based on the Munsell colour system, which challenges the colour wheel by expanding it into three dimensions.^iv

Applying a solely visual approach is not completely reliable, though.

Firstly, the clinician could make a mistake. This can be attributed to something as simple as colour blindness (which affects up to 4.5% of the UK population)[v] or nerve fatigue, which may require short glances at a tooth for a more accurate decision.[vi] The lighting conditions may also affect colour matching, as could brightly coloured clothing and lipstick since colour perception is affected by an object’s surroundings.^iv

We must also consider that a tooth isn’t just one block colour; there is nuance that must be accommodated for. The primary colour of the teeth will be strongly determined by the dentine, and the more translucent enamel would play a small role with its ability to scatter wavelengths in the blue range. Hydroxyapatite crystals in the enamel contribute enormously to light scattering, as do the tubules within the dentine.[vii] Once again, under different lighting conditions, these may each react differently, resulting in contrasting decisions on the tooth shade depending on the practitioner or time of day.

At the cutting edge

In order to obtain a superb, objective judgment, many clinicians use modern and increasingly effective tools.

For example, cross-polarised photography reduces or completely eliminates specular reflections on the teeth, which goes a long way to help correct the overestimation of white opacities that can occur when using flash photography. The technique can also avoid issues with colour difference discrepancies when using shade guides. Research has shown that digital images taken with a polarising filter are superior to those without, especially in conditions of excess light, proving this to be a useful solution for enhanced shade matching.[viii]

Another technique clinicians are using is the eLAB system, designed by Dr Sascha Hein. This involves using a polar-eye filter alongside AI and advanced image processing algorithms to auto-calibrate RAW photographs and then automatically shade map teeth for exceptionally well colour matched restorations.[ix]

When used in addition to a purely visual technique, these techniques can help clinicians make valuable decisions that change the course of cosmetic dental treatment dramatically. They also enhance communication between the dentist and dental technician, by transferring a more accurate representation of the shade required for restorations. Of course, it’s important to be fully trained with the equipment available, ensuring a complete understanding of the processes and technologies involved.

Expand your horizons

To build this knowledge and experience, clinicians could throw themselves into high quality training courses, or attend seminars on the topic by respected names in dentistry. By seeking insight from leading professionals, you can ensure you are at the edge of innovative treatment plans and equipment offerings. This way, you can continue to provide beautiful yet natural-looking outcomes that your patients will adore.

Expanding your experience and skillset in the cosmetic dental field is simple as a member of the British Academy of Cosmetic Dentistry (BACD), a world leading authority composed of professionals passionate about developing the future of aesthetic and restorative dentistry. BACD membership provides access to world-class speakers and exceptional CPD content, with educational events regularly covering subjects such as colour matching, whitening and restorative dentistry. It also connects you directly to the BACD community, which consists of many individuals who can provide help and advice on a variety of aspects of cosmetic dentistry.

Cosmetic dentistry is built on providing patients brilliant aesthetic results. Tooth colour is an enormous component of this, but with the right knowledge and experience, and tools at the cutting edge of the field, clinicians can make seamless restorations easier and more accurate than ever before.

For further enquiries about the British Academy of Cosmetic Dentistry visit www.bacd.com

[i] Militi, A., Sicari, F., Portelli, M., Merlo, E. M., Terranova, A., Frisone, F., … & Settineri, S. (2021). Psychological and social effects of oral health and dental aesthetic in adolescence and early adulthood: An observational study. International Journal of Environmental Research and Public Health, 18(17), 9022.

[ii] Newton, J. T., Subramanian, S. S., Westland, S., Gupta, A. K., Luo, W., & Joiner, A. (2021). The impact of tooth colour on the perceptions of age and social judgements. Journal of dentistry, 112, 103771.

[iii] Abbasi, M. S., Lal, A., Das, G., Salman, F., Akram, A., Ahmed, A. R., … & Ahmed, N. (2022, October). Impact of Social Media on Aesthetic Dentistry: General Practitioners’ Perspectives. In Healthcare (Vol. 10, No. 10, p. 2055). MDPI.

[iv] Sikri, V. K. (2010). Color: Implications in dentistry. Journal of conservative dentistry: JCD, 13(4), 249.

[v] Colour Blind Awareness (2023). About Colour Blindness. (Online) Available at: https://www.colourblindawareness.org/colour-blindness/ [Accessed September 2023]

[vi] Goldstep, F., Freedman, G. (2015) 7: Color and Shade. Pocket Dentistry. (Online) Available at: https://pocketdentistry.com/7-color-and-shade/ [Accessed September 2023]

[vii] Pustina-Krasniqi, T., Xhajanka, E., Ajeti, N., Bicaj, T., Linda, D. U. L. A., & Zana, L. İ. L. A. (2018). The relationship between tooth color, skin and eye color. European oral research, 52(1), 45-49.

[viii] Sarkisians E, Parichha P, Sharma G, Mong C, Vaderhobli V. Utilising of cross-polarizing photography in dental shade matching. June 2023. Journal of Multidisciplinary Care. Decisions in Dentistry. https://decisionsindentistry.com/article/utility-of-cross-polarized-photography-in-dental-shade-matching/ [Accessed October 2023]

[ix] Elabprime.com. How it works. https://elabprime.com/#howitworks [Accessed October 2023]