The challenge of composite colour management – tips for success
Featured Products Promotional FeaturesPosted by: Dental Design 22nd January 2023
The art of restorative dentistry, the ability to reliably deliver a result that is aesthetically pleasing to the clinician and their patient, cannot be understated. A beautiful-looking smile is the desired end-game for people choosing cosmetic treatments, even if their primary reason for going ahead with, for example, composite bonding, was to restore the shape or size of a tooth or teeth.
Working as an artist, a dentist has to find that often delicate balance between enhancement and something that looks natural. As well as being happier when they look in a mirror, and enjoying the often lifechanging benefits of improved confidence and self-esteem, patients will want their friends and family to notice, too. A happy patient, who cannot wait to tell people how straightforward the process was and what great care they received, will always be your best marketing tool.
What they do not want, is for people to notice for the wrong reasons, including a restoration that doesn’t match the surrounding dentition. Colour matching is part of the art form of dentistry, but the ability to detect the fine differences between tooth shades for a ‘perfect’ result has been called a “complex phenomenon”.[i]
For all of us, our perception of colour depends on a number of factors. These include biological factors, such as age – colour vision can decline as we get older – also how tired you feel that day. Colour vision deficiency affects millions in the UK, and far more men than women. Often inherited from their parents, most adapt easily to being unable to distinguish between shades of yellow, green and red (the most common type).[ii]
Anyone who has spent too long staring at a bright screen, or driving without taking a break, or straining to see in dim light, may experience retinal fatigue, which will impact on various aspects of vision, including colour perception. Lighting is crucial, as colour is determined by light reflected back from an object, for the brain to interpret. The measure of light returned when a surface is illuminated is called its value; increase value, and the object will appear brighter.
In the dental setting, a restoration will appear brighter if you lower the intensity of its hue (its actual colour), or make the surface of the material more reflective. Along with value and hue, chroma is the third element that needs consideration. This refers to how intense, or saturated, a hue is.
Correct shade management is one of the biggest challenges for delivering a good, aesthetic result that everyone is happy with. Get it wrong and an unhappy patient will not hesitate to make a complaint that you’ll have to deal with swiftly, to prevent the situation escalating. Shade management requires a clinician to utilise their knowledge of colour and light, so that the restoration is natural and beautiful. They will need to ensure that other factors, personal and environmental, aren’t negatively influencing their choice, too. The light source(s) in the surgery must be high quality, but background ‘interference’ from surrounding colours must also be considered.[iii]
During shade selection, clinicians can follow certain principles. For example: viewing a patient at eye level, where the most colour-sensitive part of the retina is; ensuring the teeth are clean; confirming an initial selection in natural daylight and making the choice quickly, at the start of the consultation.[iv] Various shade guides are available, enabling a dentist to make a visual assessment, but this must be both up-to-date and, if restorations are being fabricated in a laboratory, the technician must be familiar with the guide you have. You could also take photographs to aid communication with the lab, highlighting any staining, or difference in translucency on the tooth. Computer analysis of digital images is another method a dentist can use.
Also, look for materials that offer flexibility, as well as the ability to support the delivery of reliably beautiful restorations. There are universal composite materials now available on the market, such as BRILLIANT EverGlow™ from COLTENE, that operate within a sophisticated shade system, to give you plenty of options for single and multi-shade layered restorations. A reduced number of universal shades can be combined with opaque and/or translucent shades, layering the composite for shape or colour corrections, or for aesthetic corrections, to mask dark areas, level out chroma differences or if you need to form a dentine core. When you use such premium materials, integration with the surrounding dentition can be harmonious, with near-invisible margins.
Good colour matching and management is fundamental to the clinical success of restorative preparations, as well as happy patients. No matter how good you think your eye is, there are many factors that can impact your ability to make the right choice, some which may not be in your control. Set principles for best practice and use the resources available to help you get it right, including materials that offer flexibility in the widest number of scenarios.
For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.
Author: Nicolas Coomber COLTENE National Account & Marketing Manager
[i] Joiner A. Tooth colour: a review of the literature. Journal of Dentistry. 2004 Jan 1; 32:3-12.
[ii] NHS. Colour vision deficiency (colour blindness). Link: https://www.nhs.uk/conditions/colour-vision-deficiency/ (accessed August 2022).
[iii] Sikri VK. Color: Implications in dentistry. J Conserv Dent. 2010 Oct;13 (4):249-55. doi: 10.4103/0972-0707.73381. PMID: 21217954; PMCID: PMC3010031.
[iv] J Conserv Dent. 2010 Oct;13 (4):249-55.
