Prosthodontics

Color, light, and the perception of form

Michel Rogé. D.D.S.. M.S.D. (Ed.) V Jack D, Preston, D.D.S.

Light makes shape

-Robert Beverly Hale

Hislory

Many of the things done iti dentistry today are dotie not
because they arc ratiotial, not because they are sup-
ported scientifically, not because they are practical, but
because they are sitnply the result of habit. The develop-
ment of the lost wax process has lead to a rather tiarrow
technique of wax pattern fabrication. The pattern has
become merely an essential step toward producing a
casting; it has not been approached as an entity that has
merit in itself. The waxes employed have evolved to
fairly standard colors, usually variations of green or
hlue, though the rationale for these choices is not ap-
parent (Fig. 1). Presumably, the contrast of a dark wax
with the color of the die stones generally used was
thought of as an aid in discerning and defining the stone/
wax margin. However, the perception of form with
these waxes is largely lost because they absorh light, Fig. 1 Dark-colored waxes are typically selected lor pattern
making perception and definition difficult. The dilation development.
of the pupil aperture physiologically necessary to view a
dark object decreases visual acuity and can affect the
ability to perceive detail.'
The wax additive technique has added an important
dimension to the comprehension of occlusal concepts by
providing an ordered, rational method of developing
tooth tnorphology. The use of different colors of wax
helps the student to plan and understand each step of
this techniqtie. The color contrast aids in the perception
of the individual elements (Fig. 2). but the comprehen-
sion of overall form is diminished as more attention is
given the components. In fact, increased color op-

University of Southern California, School of Denti.itry, Room

4330, University Park, MC 0641, Los Angeles, Califotni, Fig. 2 The individual elements of the pattern interfere with
0641. the perception of overall form.

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ponency has been demonstrated to decrease spatial dif-

Fig. 3 Exampies ot waxes empioyed in the technique. The
waxes are divided into body and characterizing colors and
incisai waxes.
Figs. 4a and 4b The resuit of the tirst attempt in using
tooth-colored waxes.
Figure 4b
ferentiation- and divert attention from the whole to its
parts.' Personal experience in learning the wax additive
technique was not without frustrations. The perception
and placement of the various colors of wax was not the
difficulty. Rather, it was the learning of morphology,
especially occlusal morphology, that created frustra-
tions. The manner in which occlusal form was devel-
oped made it easy to sec the individual elements of the
drop wax method but difficult to perceive their rela-
tionship to one another. The whole became subordin-
ated to its parts, and the final product did not satisfac-
torily replicate a natural tooth.
The thought persisted that if the labor of the additive
concept was merited by the functional result, would not
a shght amount of additional work be offset hy repro-
ducing the tooth color in wax as well? The other benefits
that were later found to accompany this approach were
not considered at this early stage of development.
Diagnostic waxing has become an essential element
of diagnosis and treatment planning. The diagnostic
waxup is valuable in establishing the proper cusp-fossa
relationship, occlusal plane, and tooth reduction, in
determining the need for and potential of orthodontics
and surgery, and in planning esthetic modifications.
Usually, dark-colored inlay waxes are used for the pos-
terior teeth, while an ivory-colored wax is used to form
the anterior teeth. Ivory wax is usually chosen in an
attempt to more closely replicate natural tooth color
and thus aid in the perception of morphology and anti-
cipated oral appearance. The darker waxes do not offer
the same perceptual response, and it is therefore not as
easy to develop the desired form. The ivory waxes, how-
ever, are too light, and some detail is lost in light reflec-
tion (glare). Such equiluminosity is monotonous and
details are obscured. It has heen demonstrated that
stimuli containing luminance cues enhance visual
acuity."" The difficulty in visualizing the details of the
wax sculpturing and in interpreting the result prompted
oneof us (M.R.) to search for an alternative to the com-
mercially available waxes.
It was reasoned that if the ivory wax was a psychologi-
cal improvement over the dark green or blue waxes, the
development of waxes of the same colors as natural
teeth would similarly enhance perception of the tooth
sculpturing. Berry has noted the positive interactive
effect of color realism and visual perception.''
Obtaining the different colors of wax was not difficult
(Fig. 3). Various commercially available waxes blended
together replicated tooth color quite well. The wax teeth
were developed in the same manner in which porcelain

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Fig. 5 Ivory-colored waxes have too high a reflectance lor

optimum perception.

is layered. It was difficult to control the addition of a

layer without disturbing the integrity of the previous
layer, but the task was accomplished after some practice.
In comparison with teeth prepared by the traditional Fig. 6 Section of the wax pattern illustrating the different
method, the first results were quite spectacular (Figs. 4a layers of body, incisai, and characterizing waxes.
and 4b), The occlusal morphology and tooth form were
dramatically more realistic. The only negative element
was the time required. With a minimum of experience,
the additional time was reduced to 20%. This time
investment is more than repaid by the perceptual, psy-
chological, and educational benefits of the tooth-
colored wax technique. Additional benefits have since
been found.

Educational benefits

Initial educational benefit.^

The use of colored waxes has been a good teaching aid

in the traditional wax additive technique employed in
teaching occlusion. Although no dental studies have
been done, if the use of strongly contrasting colors
enhances perception of the individual elements, it may
disturb the ability of the eye (central nervous system?)
to distinguish the perception of the morphology as a
unit, as opposed to emphasizing the elements of that
unit.- Although the ivory waxes more nearly approach
the hue and value of natural teeth, they have too little
contrast and reflect too much light (Fig. 5), and the
increased value with little color saturation induces eye
fatigue rather quickly. The tooth-colored waxes seem to
effectively address both problems. The layered colored
and translucent waxes absorb and transmit more light
(Fig. 6), and the more-natural tooth color enhances per-
ception.
Fig. 7 The higher chroma of the fossa and the trans-
parency of the cusp tips accentuate the rnorphology and
enhance perceptual evaluation.
There is a unique interaction between the use of color
and the perception of form. Morgan et al. have pointed
out the importance of considering both color and spatial
vision.' Color is thought to add secondary cues to the
perception of spatial vision. The higher chroma in the
fossae and the increased transparency of the cusp
tips accentuate morphology and perceptual evaluation
(Fig. 7). Similarly, the higher-chroma "dentin" waxes
layered by translucent and transparent wax yield good
incisal-gingival contrast (Fig. 8).

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Prosthodontics
Fig. 8 The higher ehroma of the cervical area of this central
incisor, together with the incisai trsnslucency, simulates
nattjral tooth appearance.
The abihty to better perceive form appears to fit in
well with the theory of psychophysical hnking, which is
that physically indistinguishable stimuli cause indistin-
guishable sensations.' The similarity of the color of the
wax to that of the natural tooth color does elicit a better
psychological response toward the manual task of crea-
tion of form. Admittedly, this is a hypothetical applica-
tion of a proven concept, but the feeling of working with
the tooth-colored waxes is unique and effective.
It is common practice to create illusions of form in
porcelain restorations through the artful use of colors.
The use of shadow, highlights, varied saturations, and
characterizations all help create such illusions. Simi-
larly, these effects can be incorporated into the diagnos-
tic waxing by the utilization of colored waxes. Trial
efforts that are effective with the wax can later be incor-
porated into Ihe porcelain layering.
Use in teaching porcelain layering techniques
Another benefit of the use of colored layers in waxing is
the establishment of a foundation for teaching porcelain
teehniques. The building of porcelain, whether for
metal ceramic or all-porcelain restorations, requires the
studied and artistic layering of materials of different
hues, values, chromas, and translucencies and opacities
(Fig- 9). Teaching Ihe student the basic waxing tech-
niques with tooth-colored waxes offers more rapid prep-
aration for later learning of porcelain techniques.
Berry has noted that color realism has been shown to
increase learning effectiveness.'' Afi with porcelain, the
final appearance will be determined not only by the
color of the ''dentin" waxes but also by the thickness and
translucency of the overlying "enamel" waxes. This
394
Fig. 9 Initiai layering of waxes is simiiar to that of the fabri-
cation ot a porcelain restoration.
early comprehension, cerebral and visual, of the inter-
action between morphology and color aids in acquiring
skills in fabricating esthetic porcelain restorations more
quickly. Even surfaee texture and hght reflection are
more nearly replicated (Figs. 10a and 10b).
Use in patient education
The benefit of the colored waxing technique for patient
education is apparent (Fig. 11), Many patients have dif-
ficulty relating dental casts to their own mouth and do
not quickly comprehend the information that the den-
tist is attempting to convey. Certainly, the use of colored
waxes is not going to overcome this problem, but the
naturalness of these waxes does enable the patient to
more quickly understand the integration of the planned
treatment and relate to the appearance aspects. Patients
can see even at the wax stage that teeth are not all the
same color, that there are varying chroma levels, and
that a monotonous monochrome is not a desirable goal.
Even characterizing effects can be included, and the
patient can decide if these are desirable in the finished
restoration. Intrinsic characterization of porcelain
offers excellent reproduction of natural teeth, but some
patients reject such emulations of nature. Removing
intrinsic characterizations from porcelain is time con-
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Figs. 10a and 10b Surface texture can be aitered to sim-
ulate different degrees of giazing and iight refiection.
Fig. 11 Examples of a diagnostic waxing used to improve
dentist-patient communication.
suming and disheartening. The colored wax replica is an
improvement in patient involvement and effective com-
munication.
Use in casiable ceramics
An unexpected benefit of the colored-wax technique
evolved from work with the castable ceramic (Dicor)
restoration fDentsply Corp.). Debris in the wax is easily
incorporated into the cast glass (Fig. 12), and many
refabrications have been necessitated by such wax-
initiated failures. Furthermore, it is essential that the
final tooth form be developed in the wax beeause alter-
ation of the restoration after ceramming results in
partial removal of the surface layer The thin surface
layer absorbs the colorants differently than does the
glass that was not in contact with the ceramming invest-
Quintessence Inlernational Voiume 18, Number 6/1987
Prosthodontics
Figure 10b
Fig. 12 Inclusion cf debris in a cast ceramic restoration.
ment, and a distinct line can be seen where the colorant
is applied at a junction of the two areas.
The colored-wax technique allows the technician to
see debris that would have been masked by a dark-
colored wax. The enhanced visual perception offered by
the tooth-colored waxes allows a finer replication of
form than any other technique. Modeling in the three
dimensions of color as well as in form allows optimat
visual perception (Figs. 13,14a, and 14b).
Summary
The interrelation of color and form is well recognized.
The enhancement of perceptual ability through the use
of wax with a more natural tooth color has many bene-
fits in perception, sculpturing, learning, and teaching.
The technique requires additional time to execute, but
395
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Fig. 13 Characterization and intrinsic coloration can be

achieved.

the result more than repays the investment. The authors

are well aware that many who read this will shrug off the
concept as impractical and eschew trying it. Those tech- Figs. 14a and 14b Transiucency and color saturation can
nicians and dentists who are seeking excellence will find both be reproduced.
the technique rewarding and beneficial.
Even though techniques change, it seems people
remain much the same. A quotation from J. Leon Wil-
liams'' is appropriate:
The dentist should be educating his
people, his patients and others to a finer
appreciation of art in dentistry.. .pre-
pared to produce art work and demand an
adequatefeeforit.That isthe way and the
only way to kill quackery and cheap busi-
ness methods in dentistry. The man who
will start on this course will soon become
so fascinated wilh his work, he will find il
a source of such dehght that he will infecí
his patients with his enthusiasm and they
will become his best friends and sup- Figure 14b
porters of his work.
It is fascinating to have a technique to merge form and
color in the diagnostic and functional waxing. It is aiso
effective, and has educational benefits to the dentist,
technician, and patient that outweigh the necessary
expenditure of time. 3. Rock. I . and Gijtman,D. The effect of inattention on form per-
ception. Esperimental Psychol 7:275-285, 1981.
4. Berry. L., and Dwyer,F. Interaetive effects of color rcalistn and
learners' 10 on effectiveness of visual instruction. Perceptual and
References Motor Skills 54:1087- iOPl, 19S2.
1. ten Doesschate, J.. and Alpein, M. The effects of photo exdtation 5. Brindii3y,G. Physiology ofthe Retina andVisuai Pathway Balti-
of the two retinas on pupil size. Neurophysioi 30:562—576, 1567. more: Williams and Wilkins, 1970, p. 134,
2. Morgan, M,, and Aiba, T. Positional aeiii(y witii cliromiitic 6. Williams, J. L. The esthetic and anatomical basis of dental pros-
stimuli. Vision Res 25:685-695, 1985. thesis. Dent Cosmos 53(1):I911. r-i

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