Received: 29 July 2021 Revised: 16 October 2021
DOI: 10.1111/jerd.12843
REVIEW ARTICLE
Color adjustment potential of resin composites: Optical illusion
or physical reality, a comprehensive overview
Eman H. Ismail DDS, MS, PhD1
1
Department of Clinical Dental Science,
College of Dentistry, Princess Norah Bint
Abdulrahman University, Riyadh, Saudi Arabia
2
Department of Restorative Dentistry and
Prosthodontics, University of Texas Health
Science Center at Houston School of
Dentistry, Houston, Texas, USA
Correspondence
Eman H. Ismail, Clinical Science Department,
College of Dentistry, Princess Nourah Bint
Abdulrahman University, Airport Road, Riyadh,
Saudi Arabia.
Email: ismail.e.h@hotmail.com and ehismail@
pnu.edu.sa
[Corrections updated on 25th Feb 2022; after
first online publication. Table 1 & 2 alignments
have been updated.]
1 | I N T RO DU CT I O N
For a restoration to be esthetically pleasing, the color match between
the resin composite (RC) material and the natural tooth must be so
42 © 2021 Wiley Periodicals LLC.
Accepted: 9 November 2021
| Rade D. Paravina DDS, MS, PhD2
Abstract
Objective: The objective was to provide a comprehensive overview of color interac-
tions between resin composite (RC) and its surroundings, analyze the design and results
of respective research studies, and provide clinical and research recommendations.
Overview: Resin composite (RC) materials can adjust their color to that of surround-
ing enamel and dentin to a different extent. This phenomenon has been referred to
as the “chameleon effect” in dental jargon, while color blending/adjustment/shifting/
assimilation is more scientific terms. Studies that evaluated the color adjustment
potential of RCs have employed different methods. This article discusses the
(a) terminology used to describe color adjustment potential, (b) color science theories
associated with color adjustment, (c) design of respective studies, including methods,
specimens, and calculations, and (d) their outcome and reported results. Clinical impli-
cations and future directions related to the color adjustment potential of RCs are also
provided.
Conclusions: Factors that influence the color adjustment potential of RCs are classi-
fied into three categories: (1) material type, (2) cavity design, and (3) the substrate
surrounding the restoration. Each factor can be optimized to enhance color matching
and the restorative outcome.
Clinical significance: A material that blends well and exhibits pronounced color
adjustment potential would likely improve the color match and therefore the esthetic
outcome. These materials “work” for dental professionals by compensating for their
suboptimal shade matching and/or lack of an excellent match in the used material.
This review aims to further the understanding of the inherent properties of RCs and
allow clinicians to fully utilize them to place RC restorations and minimize the time
spent on modifying or replacing existing ones. Hence, the outcomes would encom-
pass the increased chairside efficiency, enhanced esthetic outcome, and patient
satisfaction.
KEYWORDS
chameleon effect, color adjustment, resin composite, structural color
similar that no difference can be detected by the human eye. When it
comes to color appearance, the selection of RC for restorative proce-
dures depends on its color compatibility, color stability, and color
interactions. Selecting the RC that will provide the closest match to
wileyonlinelibrary.com/journal/jerd J Esthet Restor Dent. 2022;34:42–54.
ISMAIL AND PARAVINA
natural tooth color requires a thorough understanding of light interac-
tions with the tooth surface and RC restorations under varying condi-
1
tions. One of the major limitations of RCs is the inconsistency of
different materials of the same shade designation, lack of color stabil-
ity and limited coverage of the color range of human teeth.2–4 Despite
this, clinicians commonly observe that the color difference between a
RC restoration and the natural tooth is minimal when RC is in situ.
Thus, it is believed that RC takes on the color of its surroundings, also
known as the “chameleon effect,” compensating for its suboptimal
shade match.
1.1 | Definition of terms
Different terms have been used to describe the phenomenon that the
color of some dental materials can be perceived to match that of the
surrounding tooth cavity. The “chameleon effect” is a term commonly
used by manufacturers of RCs and was first mentioned in a scientific
5
paper in 1991. Chameleons are types of lizards that have the ability
to change the color of their skins as a protective mechanism, and the
term “chameleon effect” has also been used by psychologists to
describe a social phenomenon where individuals mimic and take on
the behaviors and values of others in order to adjust socially to a new
group or society.6
In 2006, a research group studying the perceptual aspect (i.e., the
visual component) of color blending between a restoration and its sur-
roundings, referred to the color-matching phenomenon of RC as the
“Blending effect (BE).”7 Later in 2008, the focus of this group shifted
toward studying the physical aspects of the BE, which are more objec-
tive and measurable properties. According to the English dictionary,
“blending” refers to the physical mixing and integration between two
substances so they form one mass.8 With this, a new term, “color
adjustment,” was introduced to the field,9 as the “adjustment” of one
thing to another refers to the act of “a small alteration or movement
10
made to achieve a desired fit, appearance, or result.”
“Color Assimilation” has also been used in the literature to
describe the color adjustment that RC undergoes in the context of
natural teeth,11 which is the scientific name that explains this phe-
nomenon. “Color Shifting” and “Color Change” are also simple terms
used by other research groups to describe the color adjustment that
occurs specifically at the border of an RC restoration/tooth
interface.12–14 The term “shift” means “change” and in the context of
restorative dentistry refers to the mutual reflection shift of optical
properties between the RC restoration and tooth structure, thus cre-
ating a harmonious appearance and enhanced color match between
two different objects. “Color Shifting” was recently defined by the
International Organization for Standardization (ISO) technical report
no. 28642 as “Color shifting of esthetic restorative materials is the
change in perceived color that is a sum of the BE (not measurable by
any instrument, an optical illusion) and the effect of physical translu-
15
cency.” Hence, color shifting accurately defines this phenomenon and,
since it has been defined by the ISO, could become the standard term.
However, as summarized in Table 1, the term “color adjustment” has
43
been the most commonly used in the field, although all terms used by
authors are correct descriptive terms and can be used interchangeably.
For clarity, the term “color adjustment” will be used in this review to
describe this phenomenon.
Color adjustment of RC has been studied and measured in vitro by
using visual testing methods and specialized instruments to detect the
amount of color change that occurs between teeth and the restorative
materials. A previous study suggested that the color of the surrounding
environment could influence the color of RC by up to 39% when com-
pared with RC with no surroundings.16 However, the mechanisms
behind the color adjustment of RC are still unclear, and it is one of the
least explored interactions in dental color science. Thus, there is a critical
need to fully understand the qualities of RC that enable its color adjust-
ment in order to provide better options for a variety of different condi-
tions requiring its use in restorative treatment.
The aim of this current review was to provide insight into the
recent discoveries and findings obtained through research on RC color
adjustment. Furthermore, the current limitations on making advances
in the area of color interaction and the possibilities for future research
that will improve the understanding of this unique phenomenon will
be discussed.
1.2 | Scientific background
The human visual system is complex, requiring the transmission of
visual signals from the eye into chemical signals that travel through
and are processed by the brain.17 Thus, there is no single explanation
for the mechanisms by which regular visual phenomena occur.18
Visual perception is subjective, but it has a good adaption mechanism
for maintaining a logical interpretation for some distorted special
images through color constancy. Some patterns or unusual contexts
upset the perceptual system more than others, but in unusual circum-
stances, an optical illusion means that the brain sees something differ-
ent than the eyes see.19 Yet, optical illusions are not a glitch in the
visual system but more akin to the misinterpretation of a normal
image or scene that is experienced in an unusual context.20 Many sci-
entific theories have attempted to explain how the human vision sys-
tem fails to detect the color difference between two objects such as
“color induction,” “color assimilation,” “spreading effect,” “spatial
color mixing,” “chromatic adaptation,” and the “Bezold-Brucke
effect.”21–25 However, the descriptions and examples of the theories
that explain this phenomenon typically refer to a shift in hue.25 In con-
trast, in dentistry, the variations in color differences in the color
“white” are in chroma and value parameters and not so much in hue.
Also, these theories do not consider the transparency/opacity of the
two adjacent colored objects, which is believed to be the primary
mechanism attributed to the color adjustment phenomenon in den-
tistry.7,26 Further, the size and geometry of the two adjacent objects
with different colors would significantly affect how the color adjust-
ment manifests itself.27
Therefore, while color science theories explain some aspects of
the color adjustment of RCs that are observed in dental practice, the
44 ISMAIL AND PARAVINA

TABLE 1 List and summary of articles included in this review in chronological order

Paravina and colleagues 20067

Term used Blending effect
Specimen design Disc shaped RC: dual versus single
Method Visual: scoring system 1–5
Device Viewing booth (Judge II, GretagMacbeth, New Windsor, NY USA)
Calculation Difference between visual scores of dual discs compared to single discs
Main finding Smaller size inner RC have better blending
Paravina and colleagues 200628
Term used Blending effect
Specimen design Disc shaped RC: dual versus single
Method Visual: scoring system 1–5
Device Viewing booth (Judge II, GretagMacbeth, New Windsor, NY USA)
Calculation Difference between visual scores of dual discs compared to single discs
Main finding More translucent RC has better blending
Paravina and colleagues 20089
Term used Color adjustment potential
Specimen design Disc shaped RC: dual versus single
Method Instrumental: two measurements at the center (P0) and 1 mm away (P1)
Device Spectroradiometer (Spectrascan PR-670, Photo Research, Chatsworth, CA)
Calculation CAP ¼ 1  ðΔEab Dual=ΔEab Single Þ
Main finding CAP is composite and shade dependent. There is a physical measurable component to CAP
Tsubone and colleagues 201212
Term used Color shifting
Specimen design Extracted human teeth (premolars)
Method Instrumental: 4 selected spot–ΔE 76: (ΔEab 1–4, ΔEab 1–2, ΔEab 2–3, ΔEab 3–4)
Device Image spectrophotometer (Crystaleye, Olympus, Tokyo, Japan)
Calculation Ratio: ΔEab 2–3/1–4
Main finding Color shifting happens on the tooth side as well as the RC side
Deeper cavities have increased color adjustment
Lee and colleagues 201511
Term used Color shift
Specimen design RC sticks
Method Instrumental: specimens were placed between black and white ceramic tiles on an adjustable stage. Color readings were taken
in 2 mm interval (7 readings)
Device Spectroradiometer (Spectrascan PR-670, Photo Research, Chatsworth, CA)
Calculation ΔE*ab between each 2 points
Color shift parameter was defined as the mean difference between the color reading of the 2nd point and the 6th point of
measurement.
Main finding Color shift parameter is influenced by the brand and shade of RC
Tanaka and colleagues 201532
Term used Color adjustment potential
Specimen design Extracted human teeth (premolars) old versus young
Method Instrumental: 4 selected spots: ΔE 76: (ΔEab 1–4, ΔEab 1–2, ΔEab 2–3, ΔEab 3–4)
Device Image spectrophotometer (Crystaleye, Olympus, Tokyo, Japan)
Calculation Ratio: ΔEab 2–3/1–4, ΔEab 3–4/1–4, ΔEab 1–2/1–4
Main finding Older teeth have reduced color adjustment compared to younger teeth
Aida and colleagues 201614
Term used Color change
Specimen design Bovine enamel discs, middle preparation. Three groups: (45 bevel, 45 revers bevel, and no bevel)
Method Instrumental: L*, C*, h* values
Device XYZ Digital Camera (RC500, PaPaLaB, Shizuoka, Japan)
Calculation Comparisons between L*, C*, h* values, plotted values in mesiodistal direction from cavity to restoration
Main finding Enamel bevel configuration affected the color adjustment of the border of RC and enamel
Abdelraouf and Habib 201627
Term used Blending effect
Specimen design Discs shaped RC, tooth-like RC, extracted human teeth (molars) (in vitro), and natural teeth (in vivo).
Method Visual: scoring system 1–5, Instrumental: ΔEab and translucency parameters
ISMAIL AND PARAVINA 45

TABLE 1 (Continued)

Device Color Matching Light Box (CAC60, VeriVide, Leicester, UK), Spectrophotometer (UV-Shimadzu 3101nPC-Spectrophotometer,
Tokyo, Japan), (VITA Easyshade, VITA, Zahnfabrik, Germany)
Calculation Difference between visual score of dual shade samples compared to single shade
ΔEab and TP comparisons between double shades and single shade.
Main finding Bulk fill universal shade RC has better blending effect in vivo rather than in vitro.
Suh and colleagues 201729
Term used Color adjustment potential
Specimen design RC blocks between red and white tile
Method Instrumental: CIE a*, translucency parameter
Device Spectroradiometer (Spectrascan PR-670, Photo Research, Chatsworth, CA)
Calculation CIE a* value was in the form of a reduced functional index and follow a (y ¼ a ebx þ C) function
Main finding Blending effect increased with increase filler content and was not affected by RC filler size
Trifkovic and colleagues 201716
Term used Color adjustment potential
Specimen design Disc shaped RC: dual versus single
Method Visual: scoring system 0–4, Instrumental: ΔE*ab
Device Viewing booth (Judge II, X-Rite, Grand Rapids, MI), Spectroradiometer (Spectrascan PR-670, Photo Research, Chatsworth, CA)
Calculation The difference between visual and instrumental score of dual discs compared to single discs
CAP  I ¼ 1  ðΔEab Dual=ΔEab Single Þ
CAP  V ¼ 1  ðΔVR Dual=ΔVR Single Þ
Main finding Instrumental testing is highly correlated with visual testing
Kano and colleagues 201813
Term used Color shifting
Specimen design Bovine enamel discs
Method L*, C*, h* values
Device XYZ Digital Camera (RC500, PaPaLaB, Shizuoka, Japan)
Calculation Comparing L*, C*, h* values, color shifting rate
Main finding Diagonal cut enamel found in coronal portion is more favorable to color shifting than cervical with longitudinal cut
Pereira Sanchez and collogues 201931
Term used Color adjustment potential
Specimen design Acrylic denture teeth versus duplicate made from full composite teeth
Method Visual (scoring system 0–4), Instrumental: ΔEab
Device Viewing booth (Judge II, X-Rite, Grand Rapids, Michigan), Spectroradiometer (Spectrascan PR-670, Photo Research,
Chatsworth, CA)
Calculation Difference between visual score of dual discs compared to single discs
CAP  I ¼ 1  ðΔE Dual=ΔE Single Þ
CAP  V ¼ 1  ðΔVR Dual=ΔVR Single Þ
Main finding Omnichroma exhibited the most pronoun CAP for instrumental and visual. (Omnichorma > Tetric > TPH = Hercul = Filtek)
Hatayama and colleagues 201930
Term used Color adjustment
Specimen design Bovine enamel disks 1 mm thick, punched with 3 mm diameter hole
Holes are filled with 4 different RC, L*, C*, h* were measured
Method Comparing L*, C*, h* values
Device XYZ Digital Camera (RC500, PaPaLaB, Shizuoka, Japan)
Calculation Color shifting rate = slope between coronal and cervical parts at enamel/composite border
Main findings Color adjustment was influenced by direction of enamel rods (incisal more than cervical). Light illumination direction affected
the degree of color adaptation
Durand and colleagues 202029
Term used Color adjustment potential
Specimen design Disc shaped: dual versus single
Method Instrumental, (ΔE00 ,ΔL00 ,ΔC00 , ΔH00 ,ΔTP00 Þ:
Device Spectroradiometer (Spectrascan PR-670, Photo Research, Chatsworth, CA)
Calculation CAP  I ¼ 1  ðΔEab Dual=ΔEab Single Þ
LAP ¼ 1  ðΔL00 Dual=ΔL00 Single Þ
ChrAP ¼ 1  ðΔC00 Dual=ΔC00 Single Þ
HAP ¼ 1  ðΔH00 Dual=ΔH00 Single Þ
TAP ¼ 1  ðΔTP00 Dual=ΔTP00 Single Þ
Main findings Ominchroma has the highest color and translucency adjustment potential among the tested RC brands
46
mechanisms that enable the visual system to detect or ignore the
color difference between two objects are still not fully understood.
Another optical illusion associated with eye sensitivity to light-
ness and darkness is the Craik-O'Brien illusion, also known as the
“cornsweet” illusion (Figure 1), which can be also linked to the color
adjustment phenomenon observed in dentistry.17 The two sides of
the image appear different (Figure 1A); one appears darker than the
other, while the other color gradually gets darker. If a small piece of
paper or pencil is used to mask the vertical line that is separating the
two colors, the color of the two sides appears as a perfect match.
Hence, the visual system relies on the effect of an edge to adjust for
the change in illumination and lighteness.17 This could explain why RC
samples do not match the color of natural teeth when they are viewed
side by side, but once the RC is in situ, its color blends in and the color
difference almost disappears. The perceived blending of color adjust-
ment is related to the perception of darkness and lightness. Thus, one
of the lessons of this visual illusion is that hiding the edge effect
between two colored objects (i.e., a beveled margin for a restoration),
will enhance the color adjustment between the tooth and the restora-
tion. Collectively, the previously mentioned theories have contributed
to the understanding of the color adjustment effect of RCs, but as also
illustrated here, there is no single explanation for this phenomenon.
1.3 | Significance and impact
These visual phenomena have puzzled optics scientists and have been
extensively studied. Thus, although it might be difficult to comprehend
FIGURE 1 Craik-O'Brien's illusion (adapted from Seeing the Light, 1986 Chapter 7)17
ISMAIL AND PARAVINA
how it happens, one can learn how to optimize and maximize the use of
color adjustment of RCs from previous experiments done in the field of
optics.
Their color adjustment properties have been reported since the
development of RCs, but dentists can utilize the inherent color adjust-
ment feature of RCs to their advantage to compensate for shades that
are not included in the shade guide or to improve the color match of
existing shades. Furthermore, color adjustment can vary depending on
the RC system or shade used. However, the mechanisms behind the
color adjustment of RC are not fully understood, and the manifesta-
tions and limitations of the color adjustment of RCs should be recog-
nized in order for clinicians to fully harness their benefits.
Furthermore, it would help in establishing a standardized method to
test for the color adjustment of RCs that can translate into guidelines
for clinicians and researchers so that manufacturers can develop a
standardized scale to describe objectively the level of color adjust-
ment for a specific material. Thus, the clinician can make an informed
decision when purchasing or using a specific RC material.
2 | M A TE R I A L S A N D M ET H OD S U SE D I N
C O L O R A D J U S T M E N T R E S E A RC H
One of the objectives of this review was to describe the methods of
studies pertaining to the color adjustment of RCs. Table 1 lists and
summarizes the studies included in this review. Specimens, color mea-
surement, and color adjustment calculation methods are further dis-
cussed in the following subsections.
ISMAIL AND PARAVINA
2.1 | Methods used for specimen design
As studies investigating the color adjustment of composites have used
different methodologies, the design of specimens or samples used in
the articles reviewed varied accordingly. This section will discuss the
types and shapes of specimens used in the research of color adjust-
ment of RCs.
Some studies used disc-shaped RC specimens of only one shade
and then compared their color to a control, single-shade disc.28
Others studies compared dual-shade discs to a single-shade
7,9,16,26,29
disc. Dual-shade discs simulate teeth restored with RC; they
are composed of a circumferential RC that is a control shade, and the
middle section is filled with different types and shades of RC. The
dual- and single-shade disc dimensions were between 10 and 11 mm
in diameter, but the thickness of the discs has varied between 2 and
4 mm.7,9,16,26,29 One study used discs that were 1 mm thick,28 despite
the fact that the majority of studies found a thickness of 2 mm to be
the minimum needed to measure the inherent color of RC specimens
to prevent the color measurement being influenced by the back-
ground color.
For studies that used dual-shade samples, the inner shade that
was surrounded by the control shade of RC was not through and
through within the disc specimen; a 2–2.5 mm layer of RC of the con-
trol shade served as a background.7,9,16,26,29 Furthermore, the inner
shade diameter varied among studies depending on the aim. The
majority of the studies with this specific specimen design used a
9,16,26
4 mm inner RC diameter, with the exception of one study that
used a 5 mm inner RC diameter.29 Further, one study set out to inves-
tigate the relationship between the size of the restoration and the
visual blending; hence, the study used different sizes of the inner RC
7
(2, 4, and 6 mm).
Three other studies used frozen bovine teeth to fabricate enamel
discs from a coronolabial section (1-mm thick and 6 x 8-mm
wide).13,30,31 Cylindrical punched cavities were then created in the
13,30,31
middle of the discs. Among these studies, one used discs with a
1-mm-diameter cavity with some variation in cavity preparation bevel
design of 90 , 45 , and a reverse 45 cavosurface angle.30
RC tooth-like specimens were also used.28,32 Acrylic resin
denture-teeth were replicated to create molds for RC specimens. One
study prepared the denture teeth with class I cavities of different sizes
and then replicated them to fabricate molds with cavities.28 The nega-
tive replica of the prepared acrylic resin teeth was filled with a control
shade of RC. Subsequently, the negative space for the cavity within
the RC tooth was filled with the tested shades. In these studies, the
control RC shades were all A-shades (i.e., A1, A2, A3, A4), and the
tested RC shade was a bulk fill material of one universal shade. The
small class I dimensions were buccolingual (BL) = 1.2 mm, mesiodistal
(MD) = 7 mm, and 2 mm deep, whereas, for the large class I, the
dimensions were BL = 3.2 mm, MD = 7 mm, and 4 mm deep).
Another study fabricated an RC block with dimensions of
10  5  2 mm by using a custom-made acrylic resin mold as a spec-
3
imen design. The blocks were then placed between a red and white
30
tile and positioned on a movable stage. Instrumental color
47
evaluation was done starting from the red tile and moving toward the
white tile. The stage movement was 0.25 mm, resulting in a total of
32 color measurement readings per block.
2.2 | Methods used for color evaluation
Human tooth specimens have been used in vitro to test the color
adjustment phenomenon. Two studies used extracted sound human
A2-shade premolars.12,33 One of these investigated the effect of
tooth age on the BE: young teeth extracted for orthodontic reasons
from patients who were 20–28 years-old, and older teeth were
extracted from patients who were 45–69 years-old.33 In these speci-
mens, cylindrically shaped cavities that were 2 mm in diameter were
prepared on the buccal surfaces. However, the effect of the depth of
the cavity on the color blending was investigated using 2 depths: 1.5
or 3 mm.12 Both studies used instrumental color measurements made
on four preselected points: the center of the restoration, the edge of
the restoration, the tooth edge, and the sound tooth.12,33
Another in vitro study used sound human mandibular molars pre-
pared with class I cavities of two different sizes, which were then
filled with a universal shade RC. This study evaluated the BE visually
by comparing the shade of the restored teeth with RC discs with “A”
shades.28 Meanwhile, the other in vivo part of the same study used
human teeth from 10 patients with occlusal caries on their mandibular
molars.28 However, the recruitment process for the participants and
the selection criteria for class I cavities inclusion were not very clear.
Color was measured visually by scoring the degree of shade matching.
It was also evaluated with instruments before the preparation of the
restoration and then again, once the restoration was in place.28
Hence, most of the studies used RC samples, and only a few used
extracted human or bovine teeth. Collectively, all the samples men-
tioned in these studies were designed to suit the evaluation methods
described in the next section.
Color has typically been evaluated via visual and/or instrumental
evaluation methods. Visual color evaluation was used by some studies
discussed in this review,7,16,26,28,32 This involves placing the speci-
mens inside a viewing light booth with a gray or black background.
The light source used to illuminate the booth was a CIE D50 standard
light source (D series represents daylight, 50 = 5003 Kelvin horizon
light) with a geometry of 0/45 (i.e., zero-degree angle between the
illuminant and the object and a 45-degree angle between the viewer
and the illuminant) and a sample holder placed 25 cm away. A head-
rest was used to ensure a consistent visual angle of 2 among exam-
iners. The visual scoring system of early studies used the 1–5
categorical judgment scale: a score of 1 corresponded to shade mis-
match, and a score of 5 to a perfect match.7,26 Later research groups
also used the same 5-point categorical scale but with the numbering
updated to 0–4.16,32
Instrumental color evaluation was used as the primary color eval-
uation method for the majority of the studies included in the
review.9,12–14,29–31,33 However, it was used in conjunction with visual
color evaluation for some other studies.7,16,26,28,32 The device
48
selection for color evaluation has usually been compatible with the
specimen shape and geometry. Various instruments were used, all of
34
which were compliant with the color measurement standards. Image
spectrophotometers, the Coloreye 7000/Crystaleye (Olympus, Tokyo,
Japan) or Shimazdzu 3101 PC-Spectrophotometer (Tokyo, Japan)
were used in two studies.12,33 A commercially available intraoral spec-
trophotometer such as the VITA Easyshade (VITA Zahnfabrik, Bad
Säckingen, Germany) has also been used.28Spectrophotometers and
image spectrophotometry are widely used in dental color research, as
these methods are feasible, convenient, and suitable for assessing
both the anterior and posterior teeth.35
Spectroradiometers such as the SpectraScan PR-670 (Photo
Research, Syracuse, New York) and the PR-705 (Photo Research,
Chatsworth, CA) were used in several studies.9,11,16,29,30,32 Color mea-
surements that are obtained from spectroradiometers are in the form
of spectral data that are converted mathematically into CIELAB color
parameters. Spectral data provide comprehensive information about
the color of a specimen and so could be used to calculate the scatter-
ing coefficient and other inherent optical properties of an object.
In addition, a few studies have used a specialized digital camera
to collect color data and measure the degree of color adjustment.
Such digital cameras, including the CIE XYZ (RC500, PaPaLaB, Shizu-
oka, Japan), contain three filters, an embedded color calibration sys-
tem, and a spectrophotometer, all within the optical system.13,14,31
The research teams followed a standardized procedure to capture the
images of each tooth specimen. The camera was placed inside a black
box to minimize the light interference from outside sources, with an
illuminant (D65) positioned at a geometry of 45/0 . The distance
between the camera and the specimens was 20 cm, the exposure time
was 0.2 s, and the shutter speed was 1/1000–1/15 s. The authors
selected four fixed spots for color evaluation, and, for each selected
spot, the CIE L*a*b color data were obtained and transferred into
L*C*h* parameters. The data were then analyzed in a vertical order
from the coronal to cervical sides. An advantage of using such an
instrument to evaluate color is that images can be saved and stored
for further analysis. Unfortunately, the RC500 has been discontinued
by the manufacturer.
The goniophotometer (Model GP-200, Murakami color research
laboratory, Tokyo, Japan) is a supplemental instrument that has been
used to test some of the inherent optical properties of materials, such as
of light scattering.12–14,33 In addition, the Color-Eye 7000 device
(Gretag-Macbeth LLC, New Windsor, NY, USA) has been used to deter-
mine the translucency parameters (TPs) of RC specimens in order to cor-
relate these values with its color adjustment capacity.7,11,26
Both visual and instrumental color evaluation are valid methods
of determining the color adjustment phenomenon of RC materials;
however, both these evaluations are recommended because the per-
ceived color changes under different circumstances and conditions. A
study that used both visual and instrumental color evaluation methods
found that the results obtained were positively correlated (r = 0.69).16
Given that perceptual color adjustment potential component (BE) is
an optical illusion (not measurable with any instrument), the difference
between the instrumental and visual color adjustment potential can
ISMAIL AND PARAVINA
be described as an indirect measure of illusion. Subtleness of these
findings underlines the critical importance of carefully monitored, con-
trolled, and reported reliability of instrumental and visual color mea-
surements in color adjustment potential studies and color research in
general.35,32,35,36
2.3 | Methods used for measurement of color
adjustment
To evaluate the color adjustment capacity of RC, studies have focused
on developing new and different approaches to quantifying the
degree of color adjustment objectively. Table 2 groups studies that
used similar designs and summarizes the methods used.
The first group has been the most extensively used in this area of
research. Two of the earlier studies that used the dual- and single-
shade specimens compared the ΔΕab values of both types of speci-
mens to determine which RC had the better color adjustment.7,26 For
dual-shade specimens, color measurements were made at two loca-
tions: one in the middle of the inner restoration and one from the
outer RC border. The single-shade specimen represented both the
inner and outer RC but in two separate specimens; thus, the color dif-
ference ΔΕab was calculated between the separate specimens. The
ΔΕab was compared between the two sets of specimens, that is,
single-shade and double-shade. A smaller ΔΕ ab represents a better
match between the two specimens and was the parameter used for
evaluating the BE.
Later the research team advanced the same concept of dual- and
single-shade specimens but developed a new way of measuring the
color of the samples to calculate the color adjustment of RC material.9
With this new method, the color measurement of the dual sample
was made from 2 spots of the inner RC, one in the center and the
other 1 mm away from the center. The instrumental color adjustment
potential (i.e., CAP-I) was then measured by developing a ratio of the
difference between the two readings.9
CAP ¼ 1  ðΔE D=ΔE SÞ,
where ΔE D represents the color difference between the outer and
inner RC in the dual-shade specimen and ΔE S represents the color
difference between the single specimens (separate) comprising the
dual specimen. The study also correlated the ΔE with ΔL, ΔC, Δh.9
The same research team further developed this concept and
referred to this formula as CAP-I to distinguish it from CAP-V.16,32
This is calculated based of the visual ratings (VR) obtained from the
study raters of dual versus single specimen as shown in the following
formula:
 
ΔVR Dual
CAP  V ¼ 1  Single :
ΔVR
Another research group further applied the CAP-I method of cal-
culation to investigate the adjustment potentials of lightness, chroma,
ISMAIL AND PARAVINA 49

TABLE 2 Summary of methods used for measurement of color adjustment categorized by research groups to quantify the color adjustment

Authors Summary of methods used to determine the color adjustment

Paravina et al 2006
Paravina et al 2006
Paravina et al 2008
Trofkivoc et al 2017
Pereira-Sanchez et al
2019
Durand et al 2020
Tsobune et al 2012
Tanaka et al 2015
Lee et al 2015
Suh et al 2017
Aida et al 2016
Kano et al 2018
Hatayama et al 2019
RC specimens: dual versus single shade specimens
Color measurement was done either visual and/or instrumental
Then color adjustment was measures CAP ratio then evolved to CAP-I
More derived color adjustment formulas were added:
CAP  V, TAP, LAP, ChAP, HAP
Extracted premolars with class V RC restoration. Color measurement was taken from 4 spots, 2 on the tooth side and 2 on
the RC
Ratio was calculated between color difference measurements of each 2 points
RC specimen sticks on a movable stage between two tiles
One study calculated the mean values of color differences between 6 points
The other calculated the blending effect distance using the CIEa* parameter
Bovine enamel discs with punched out rounded cavities that were filled with RC. CIE XYZ imaging device was used. Data was
converted into L*C*h*. Color adjustment was measured by a slope between 2 points on a graph of plotted data: one point
on the edge of the RC restoration and one on the edge of the enamel

hue, and TPs.29 The authors noted that color adjustment effect of RC
is a result of shifts in lightness and hue, and studied the influence of
individual color dimensions. Furthermore, calculating the TP adjust-
ment potentials seems rational since the translucency attribute of RC
is the main factor in producing this phenomenon.29
However, two other studies used a completely different
approach, recording the color measurement of four predetermined
spots, two on the side of the RC restoration and two on the side of
the tooth surface (Figure 2).12,33 ΔΕab was calculated between two
different areas (1–4 and) yielding four ΔΕab values. Then, a ratio of:
ΔΕab are2–3 to ΔΕab area1–4, ΔΕ ab area3–4 to ΔΕab area1–4, and ΔΕab area1–2
to ΔΕab area1–4 was calculated and statistically analyzed, with a smaller F I G U R E 2 The color adjustment calculation method used by two
ratio indicative of a higher color adjustment potential. studies performed by the same research group: Tsubone et al 201212
A third research group tested RC sticks fixed between two tiles and Tanaka et al 201533
(black and white) on a movable stage, recording seven consecutive
color measurements along the RC stick by using spectroradiometers.11
The color adjustment parameter was determined as the mean value of The fourth research group which used the method of CIE XYZ
the six color differences (ΔΕab P1/P2, ΔΕab P1/P3, ΔΕab P1/P4, ΔΕab images was interested in the L*, C*, h paramters.13,14,31 The L*, C*, h
P1/P5, ΔΕ ab P1/P6, ΔΕab P1/P7). A greater color adjustment parame- values were each plotted and analyzed in separate graphs, and the
ter conveys a large color difference between the two tiles, indicating color adjustment measurement rate was calculated as the slope
less color adjustment.11 between two points on the graph, one on the enamel and one on the
Another research group further developed this methodology and RC.13,14,31
recorded 32 color measurements readings that were 0.25 mm apart.30
Another change was that the RC sticks were placed between red and
white tiles. After the conversion of spectral data into CIELAB color 3 | RE S U LT S A N D C O N C L U S I O N S O F
parameters, the research team selected the CIEa* as the metric of RC STUDIES
color adjustment, which represents the red-green axis. The CIEa*
denotes a narrower range than the L* and the b* in human teeth. RC The color adjustment of RC has been the recent focus of many
specimens showed high-CIEa* values on the side closest to the red tile, research groups. While some focused on developing new metrics or
and the a* values decreased as the color measurement moved toward methods to measure the color adjustment phenomenon, others have
the white tile until it finally reached a point of convergence. Hence, the been more focused on studying the mechanism behind the interaction
color adjustment was calculated mathematically as the distance at which of the two main components involved: the RC restoration and the sur-
the CIEa* converged, referred to as the BE distance.30 The BE distance rounding substrate. Based on the current review of the literature, this
was then correlated with the RC filler load and the TP.30 study classified the factors affecting each component into three
50
FIGURE 3 Findings of color adjustment research reviewed in this article
categories: the RC material, factors affecting the cavity prep, and the
tooth substrate that surrounds the RC restoration (Figure 3).
3.1 | RC material
3.1.1 | RC brand and shade
One of the shortcomings of RCs is shade inconsistency among differ-
ent manufacturers.37 RCs come in different shades with varying
degrees of translucency,38 with inherent color coming from the addi-
tion of colorants to the resin matrix, typically inorganic iron oxides.39
Less translucent RCs have increased inorganic filler content than more
translucent shades,40 but RC manufacturers do not specify the exact
difference between the two types and often provide a general range
of the filler content for their RC system. The pigment content in RCs
is considered a trade secret and is not revealed by manufacturers. The
color adjustment capacity of RCs has been reported to be very spe-
cific and depends on the shade and the brand of each RC system.9,26
Thus, specific language is required when comparing results, such as
“shade X from brand Y shows better color adjustment than shade
X from brand Z.”One study concluded that the blending effect was
increased as the initial color differences of the RC and its surround-
ings decreased.26 This finding makes sense because if the original
shade of the RC is close to the color of the substrate or its surround-
ing, the probability of color blending or adjustment is more likely.
3.1.2 | Structural color
In contrast with relying on additive color pigments, a recent develop-
ment in manufacturing RC shade systems has used an enhanced nano-
structure of RC fillers and their organization and distribution within
the RC matrix, which results in “structural color” and produces an
improved blending effect.41 Structural color is a form of biomimicry,
similar to the appearance of peacock feathers or butterfly wings
(e.g., Morpho butterflies), which have brown pigmentation but appear
brightly colored.42 The colorful appearance is the result of multiple
layers of photonic structures, which are minute enough to interfere
ISMAIL AND PARAVINA
with the visible light, thus resulting in structural coloration.42–45 The
organization of the internal structure causes either constructive or
destructive light interferences between the layers, with each layer
having both selective absorption and selective reflection at specific
color wavelengths.42,46,47 In other instances, the hue of the perceived
color changes as the observer alters the angle of view, a process called
irradiance, which happens as a result of variation in the refractive
index between the different layers.43
Another example of how structural organization affects the per-
ceived properties and translucency is in the structure of the cornea
and sclera in the human eye.48,49 While both tissues are composed of
the same type of collagen and both arise from the same embryonic
origin, the sclera appears opaque white, whereas the cornea appears
translucent. The difference can be attributed to the different func-
tions of each tissue, which requires a different organization of the
internal collagen, thus altering the perceived appearance of each
structure.48,49
The effects in the eye resemble the structural color described and
advertised by the newly released RC “Omnichroma” (Tokuyama
Dental, Tokyo, Japan). While the compositions of the commercially
available RC and the Omnichroma are similar,32 the latter incorpo-
rated uniformly spherical particles that are evenly spaced and
arranged in a way that facilitates the transmittance of light through
the restoration, which then reflects the color of the cavity surrounding
the restoration and results in enhanced blending.32 Omnichroma
comes in a single shade as the manufacturer claims its structural color
enables a single shade to match any tooth color. The particle size and
structure of Ominchroma is designed in such a way that its translu-
cency increases after polymerization. As such, the color of the restora-
tion would seem to match its surroundings. However, it is open for
interpretation as to whether the color produced is considered “struc-
tural color,” as in the peacock feather, or just enhanced structural
organization, as in the sclera and cornea of the eye, and whether this
actually explained the blending effect. Of RC.
One study confirmed that the color adjustment effect of
Omnichroma RC was indeed better for color matching than samples
made from the VITA Classical 16-shades or the color matching of four
other brands of RC with multiple shades.32 A simplified RC color sys-
tem with only one shade, such as the Omnichroma RC, would be
ISMAIL AND PARAVINA
convenient, minimizing time spent on shade selection and the need for
multiple shades in each clinic. Another study compared the color attri-
butes and translucency adjustment potential for Omnichroma and in
fact confirmed its positive blending effects on all attributes when com-
pared with two other popular RC brands.29 Omnichroma showed an
exceptionally high shift in the TP among the tested RCs (an 86%–94%
increase). This finding demonstrates that the translucency of
Omnichroma increased significantly in situ, enabling it to largely reflect
the color surrounding it, leading to improved color adjustment.29
However, more data are needed to confirm its color matching
ability for multiple procedures in the posterior and anterior regions.
Furthermore, studying whether the color adjustment capacity of
Omnichroma changes when layered over Omnichroma Blocker, an
opaque RC from the same manufacturer, would be worthwhile.
3.1.3 | RC filler size and content
The optical properties of RC vary with different components and
brands.50,51 As the inherent optical properties of materials are highly
associated with their chemical and physical properties, variation in the
components of RCs makes it difficult to generalize associations
between the ingredients and the perceived color adjustment. To study
the effect of the particle size of RC on the color adjustment potential
in isolation, one study used a custom-made RC with filler sizes of 0.7,
1.00, and 1.5 μm. The authors reported that RC filler size did not have
a significant effect on color adjustment. However, an increase in filler
content increased the opacity of the RC, which significantly reduced
its color adjustment and blending.30 The authors of this study used a
custom-made RC with controlled and known ingredients with specific
percentages and sizes for the fillers. The fillers used in their RC for-
mula were not in clusters or aggregate shapes, which is necessary to
enhance the mechanical and physical properties of RC. Furthermore,
opacifiers were excluded from their RC mix to reduce the number of
variables that could affect the translucency of the RC material. Thus,
the custom RC used in this study does not accurately represent com-
mercially available RCs.30
An RC with diffused light transmission properties was found to
have better color adjustment potential, which is also an interesting
finding related to the internal structure of the RC.12 The light scatter-
ing properties of RC could be desirable in order to disperse the light in
all directions of the cavity preparation and help reflect the shade of
the color of the cavity walls through the RC.
3.1.4 | RC translucency
The filler content and filler load are associated with an inherent
degree of RC translucency.52,53 Studies also found that the enhanced
blended appearance of a restoration within its surroundings was posi-
tively correlated with increased translucency.7,26 In contrast, the study
that used the experimental custom-made RC with different particle
sizes and filler loads reported that the increased translucency of their
51
RC, as a result of the lack of an opacifier; negatively affected the color
adjustment. Titanium oxide or aluminum oxide were not added to the
RC mix because it would have influenced the results and prevented
the direct association between the color adjustment and the experi-
mental resin. Thus, an excessively translucent RC has undesirable
effects on blending and color adjustment.
Another study assessed the blending effect of a bulk-filled RC
and found that this increased as the opacity increased (e.g., reduced
TP).30 As bulk-filled RCs are known to be more translucent than con-
ventional RC, not surprisingly, the bulk-filled RC, X-Tra Fil (Voco,
Cuxhaven, Germany), showed improved color adjustment in vitro
when compared with experimental in vitro tests,28 demonstrating that
results obtained from in vitro testing do not necessary reflect the clin-
ical situation.
3.2 | Cavity
3.2.1 | Size and depth of the cavity
The color adjustment of RC was reported to be higher in smaller simu-
lated cavity preparations than in larger and wider cavity preparations.7
The human visual system detects smaller color differences with larger
objects, making color differentiation harder to observe when the
objects are small. The effect of the cavity depth was also investigated
by comparing the color adjustment of RCs placed in 1.5-mm- and
3.0-mm-deep cavity preparations.12 Deeper cavities showed
improved color adjustment, indicating they can influence the color of
RC restorations more than shallower cavites.12 Light penetration
though a deeper restoration is limited and depends on the tooth loca-
tion in the oral cavity. In addition, deeper cavities are likely located
deeper within the dentin, which is darker and more chromatic in color
than enamel. Thus, dentin provides a more chromatic background,
with light reflected through the restoration.
3.2.2 | Beveling of cavity margins
Cavosurface margins should be beveled in class III and IV cavities
where the highest degree of blending is required because of the
esthetic requirement when restoring anterior teeth. A beveled enamel
cavity margin surrounding the RC provides a better color transition
between RC and the tooth surface, thus enhancing the color adjust-
ment of RC. Additionally, beveled enamel is expected to minimize
marginal staining from food and drink consumption. While many clini-
cians bevel enamel margins, research on the actual effect of beveling
in regard to increased longevity of the restoration or color stability
and color blending is sparse.
One study investigated the effect of cavity margin beveling on
color adjustment and concluded that color adjustment was enhanced
depending on the material used.14 This study tested two types of
bevel, a 45-degree bevel, and a reverse 45-degree bevel and com-
pared them with non-beveled cavity margins. The authors suggested
52
that the 45-degree beveled margin enhanced color adjustment when
compared with the reversed bevel. However, the lightness, hue, and
chroma were not statistically different between the beveled margins
and the center of the restoration, and the change in the color light-
ness (L*) was gradual and not abrupt. This finding indicates that the
value transition was smoother between the restoration and the tooth,
suggesting a better blending effect and color adjustment. The study
does not support the use of the reverse bevel because it leaves
unsupported enamel, which scatters the light away from the RC resto-
ration, thus diminishing or minimizing the color adjustment of the RC
restoration. The finding of this study supports the color science the-
ory mentioned earlier (the Craik-O'Brien or Cornsweet illusion).
Hence, the bevel eliminates the sharp line or junction between the
tooth and restoration, “tricking” the mind into seeing one continuous
surface with a smooth color transition between the two media, lead-
ing to the perception of a single color.
3.3 | Surrounding
3.3.1 | Tooth age
Tooth type, age, and position within the oral cavity have been reported
to affect overall tooth color.54 An in vivo study investigating the effect
of tooth age on the color adjustment potential found that younger teeth
donated by participants between 20 and 28 years old were associated
with the increased color adjustment of RC materials when compared to
older teeth that were donated by participants between 45 and 69 years
old.33 As a result of physiological aging, enamel wears and the thickness
of this layer is reduced, which also affects the internal structure of per-
itubular dentin. Thus, aging causes teeth to appear darker and less trans-
lucent.55 Furthermore, aging affects the structure of dentin, causing it to
appear darker and affecting the internal arrangement and mineral com-
position of natural teeth. Consequently, light transmission through aged
natural teeth varies because of differences in the mineral composition
that develop over time. Young and old dentin react differently with light:
light diffuses with young dentin, whereas light is transmitted by older
dentin. Therefore, younger dentin is a better medium or background for
the color adjustment of RC materials.While color adjustment happens
on the RC restoration side, studies have reported that the color of natu-
ral teeth has a greater color adjustment when compared to the color
adjustment occurring on the restoration side and that this especially
12,33
occurs in younger teeth. This finding is crucial as it indicates that
the light that goes through the RC is also transmitted through the
enamel margin of the cavity and thus affects the visual perception of
the enhanced color match, contributing to the overall color adjustment.
3.3.2 | Enamel prism orientation
Enamel is an unmineralized prismatic translucent structure that works
as a light filter (i.e., collects and distributes light).55,56 Within the
enamel substrate, enamel prisms are organized in a parallel fashion at
ISMAIL AND PARAVINA
a 90-degree angle to the dentino-enamel junction at the cervical part
of the tooth. As the enamel prisms extend coronally, they become
arranged in a diagonal pattern, and the orientation of the enamel
prisms affects the way light is scattered on the tooth. A research team
set out to investigate the influence of the orientation of enamel
prisms at the cavosurface margin of an RC restoration on the color
adjustment potential of RC. The authors used bovine enamel speci-
mens and assessed two regions of the specimen: the cervical and cor-
onal parts.13,31 The two studies concluded that coronal enamel was
associated with the better color adjustment of RCs than the cervical
enamel of the same specimen.13,31
This group also studied the association between the angle at
which light is projected on the sample and the orientation of enamel
prisms. They found that the direction of light projected on the enamel
prisms affected the degree of color adjustment. As such, the visual
angle of the restoration to the viewer may affect their ability to per-
ceive color difference between the RC and the tooth.31
Thus far, the clinical findings from this group have illuminated fac-
tors regarding tooth structure that may affect the color adjustment
phenomenon.
4 | DI SCU SSION OF CLI N ICAL
APPLICATIONS
The studies discussed in this review established a connection between
the color adjustment of RCs and different physical factors, many of
which can be modified.
Smaller but deeper cavity preparations showed improved color
adjustment potential. The opposite is evident in clinical practice, as,
for example, shallow buccal pits in posterior teeth appear slightly
grayish when restored with a translucent RC despite the shade
matching before polymerization. Hence, the enamel layered RC did
not have enough depth to shine through the color of the dentin layer.
In such situations, an opaque shade (universal, dentin, or body shades)
rather than a translucent shade is recommendd.57,58 Clinical practice
also showed that beveled tooth margins greatly enhance the blending
effect by making the transition of the RC material and its color fade
gradually on the tooth surface.59 Another important factor observed
clinically is that the color of the RC should be close to that of the
shade of the tooth for the color adjustment to occur; thus, CAP will
not work if the shade of RC is much darker or lighter than that of the
tooth.
With through and through cavity preparation designs such as
class IV, color adjustment would be an undesirable feature of an
RC. In these preparations, the RC will adopt the color of the back-
ground of the oral cavity, making the restoration look grayish.60 Color
adjustment is typically only desirable on the visible side (facial aspect)
and not for the entire depth of the restoration. Blocker shades that
are opaque should be used as a lingual layer to prevent the reflection
of the dark background of the oral cavity. This requires using the
widely used layering technique.38,61 The effect of color interaction
between RC layers to improve the final esthetic outcome of the
ISMAIL AND PARAVINA
restoration is beyond the scope of this review as the methods used
for studying such color interaction are exceptionally complex.62
5 | G E N E R A L C O N C LU S I O N S
Special consideration of RC material, cavity design, and the substrate that
surrounds the restoration will enable clinicians to maximize the color
adjustment effect for each individual restoration. More research in this
area will further our understanding of the physical variables of this inher-
ent property. Thus, it can be translated into clinical recommendations to
allow dentists to perform a variety of different restorative procedures
with improved color-matching success, individualized for each patient.
DIS CLOSURE
The authors declare that they do not have any financial interest in the
companies whose materials are included in this article.
DATA AVAI LAB ILITY S TATEMENT
Data sharing not applicable to this article as no datasets were gener-
ated or analysed during the current study.
ORCID
Eman H. Ismail https://orcid.org/0000-0003-1539-798X
Rade D. Paravina https://orcid.org/0000-0002-8459-5528
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How to cite this article: Ismail EH, Paravina RD. Color
adjustment potential of resin composites: Optical illusion or
physical reality, a comprehensive overview. J Esthet Restor
Dent. 2022;34(1):42-54. doi:10.1111/jerd.12843