Received: 30 July 2021 Accepted: 9 August 2021

DOI: 10.1111/jerd.12816

REVIEW ARTICLE

Visual and digital tooth shade selection methods, related

effective factors and conditions, and their accuracy and
precision: A literature review

Farhad Tabatabaian DDS, MS | Elaheh Beyabanaki DDS, MS |

Parisa Alirezaei DDS, MS | Saied Epakchi DDS, MS

Department of Prosthodontics, School of

Dentistry, Shahid Beheshti University of
Medical Sciences, Tehran, Iran
Correspondence
Farhad Tabatabaian, Department of
Prosthodontics, School of Dentistry, Shahid
Beheshti University of Medical Sciences,
Daneshjoo Blvd., Tehran 1983963113, Iran.
Email: f_tabatabaian@yahoo.com;
f_tabatabaian@sbmu.ac.ir
Abstract
Objective: Despite developments of dental shade selection methods, shade selection
is still a challenge affecting esthetic outcomes. The purpose of this review was to dis-
cuss visual and digital shade taking methods, related effective factors and conditions,
and their accuracy and precision to find out the most accurate, precise shade selec-
tion method available in dentistry.
Overview: The key terms of accuracy, background, ceramic, color, colorimeter, color
analysis, color science, color measurement, color measuring instrument, color matching,
composite resin, dental/tooth shade guide, digital camera, esthetics, imaging, imaging
application/program/ software, intraoral scanner, light source, photography, precision,
shade, shade matching/ determination/prediction/reproduction/selection, shade taking
device, spectrophotometer, spectrophotometry, tooth color measurement, tooth color/
shade, and visual perception were used separately and jointly to detect related English-
language articles published between January 1, 1985, and January 1, 2021. Electronic/
non-electronic searches of Google Scholar/PubMed/Scopus/Web of Science were
accomplished. Consequently, 249 articles were considered. Accordingly, the digital
methods show higher accuracy and precision compared to the visual methods while
requiring to be enhanced regarding accuracy to achieve ideal shade taking results.
Conclusions: Dental spectrophotometers provide the highest overall accuracy and
precision among different shade selection methods while needing clinical setting to
control related effective factors/conditions and technological improvement to per-
form optimally.
Clinical Significance: Different factors can affect the accuracy and precision of tooth
shade selection methods and devices. The understanding of these effective factors may
lead to a standard shade taking protocol using accurate, precise methods and devices.

KEYWORDS
accuracy, color measurement, digital shade matching, precision, visual tooth shade selection

J Esthet Restor Dent. 2021;1–21. wileyonlinelibrary.com/journal/jerd © 2021 Wiley Periodicals LLC. 1

2 TABATABAIAN ET AL.
1 | I N T RO DU CT I O N
For many years, color had been considered as a quality which was dif-
ficult to understand, evaluate, communicate, and reproduce in den-
tistry. Munsell changed ideas about color with introduction of a color
notation and specification of a color space with three color properties
including lightness or value (luminous intensity of a color), hue (color
appearance or perception of an object's color, e.g., red, green), and
chroma (color saturation or purity) in 1904.1,2 He allocated numerical
amounts to the color properties while including physical samples to
3
determine objects' color. Accordingly, the Commission Internationale
de l'Eclairage (CIE) (the International Commission on Illumination)
defined criteria for color measurement in 1931.4
The CIE utilized three coordinates to detect a color in a color
space systematized by identification of the light source, the object,
and the observer.5 Human eyes possess three kinds of rod cells for
color perception according to the wavelength of the visible light
reflected from an object including: short wavelengths (380–500 nm)
related to blue color (B), medium wavelengths (430–600 nm) related
to green color (G), and long wavelengths (530–700 nm) related to red
color (R). The CIE released the concept of standard observer based on
the average human reaction to light wavelengths indicating the man-
ner of an average human to see color across the visible spectrum (xyz
equivalent of RGB). With multiplication of the spectral curve of the
object (derived from wavelengths of the light reflected) by the spec-
tral curve of a standard illuminant (derived from the relative spectral
power of the light source wavelength) and by the tristimulus values of
the standard observer (xyz), the object tristimulus values (XYZ) were
calculated.4
The need for color measuring instruments led to employ tristimu-
lus cameras/colorimeters with transmittance spectra imitating color
coordinates in order to read visible spectrum using photodetectors in
digital imaging.6,7 In 1940, Beckman and his colleagues invented a
spectrophotometer, measured the reflection/transmission properties
of an object as a basis of wavelength, presented the whole spectral
curve with high accuracy, and quantified the CIE color attributes.8,9
However, the first commercial dental shade guide, named the VITA
Lumin Vacuum and launched in 1956, was not based on color parame-
10
ters. Thus, Sproull emphasized the three-dimensional nature of color
and indicated difficulties of shade determination due to several fac-
tors affecting the tooth color and inefficacy of existing shade guides
while suggesting feasible methods for color measurement, control,
11–13
and match in 1973. As a result, different dental shade guides
were fabricated mainly based on color parameters. As observing con-
ditions might impact shade selection using dental shade guides, dental
color measuring devices were launched as well.14
The CIE introduced the CIELab (L*: lightness; a*: redness-greenness;
b*: yellowness-blueness) color system in 1976 based on the opponent-
colors theory stating that two colors cannot be both red and green simul-
taneously, and comparably, yellow and blue,15,16 while releasing another


system, entitled CIELCh (L*: lightness; C*: chroma; h : hue angle), to con-
nect the CIELab to the Munsell system.17 Also, the CIE presented a color
difference formula: ΔEab = [(ΔL)2+(Δa)2 + (Δb)2]1/2,18 which was
upgraded to ΔE94 in 1994: ΔE94 = {[ΔL0 /(kLSL)]2 + [ΔC0 /(kCSC)]2 + [ΔH0 /
(kHSH)]}1/2 to elaborate the color properties of lightness, chroma, and hue
based on their importance using both CIELab and CIELCh parameters.19
In 2000, the CIE suggested the most accurate color difference formula:
ΔE00 = {[ΔL0 /(kLSL)]2 + [ΔC0 /(kCSC)]2 + [ΔH0 /(kHSH)]2 + RT[(ΔC0 /kCSC)] 
[ΔH0 /(kHSH)]}1/2 to modify the lightness errors.19,20 This formula considers
more color attributes and also gives more value to L* which is critical in
dentistry. For clinical judgment, perceptibility and acceptability thresholds
have been defined based on color difference values. A 50:50% percepti-
bility threshold regards as a situation in which 50% of raters discover a
color difference between two objects whereas the other 50% detect no
difference. Also, the color difference which is acceptable for 50% of
raters represents a 50:50% acceptability threshold.10,14,21 As a result, the
former is quantitatively less than the latter.
Nowadays, visual methods using dental shade guides, digital
methods using shade taking devices, imaging systems, and color
matching software programs are available to determine, analyze, and
verify the tooth color.21–23 Despite these improvements, dental shade
selection has been a challenge in dentistry, and therefore, several
review studies have evaluated dental color measuring devices and
systems10–14,21; however, to the best of the authors' knowledge, they
failed to comprehensively assess newly-developed color matching
devices, the effective factors and conditions related to diverse shade
selection methods, and the accuracy and the precision of these
methods in comparison with each other with consideration of the
quantitative data extracted from the current literature. Therefore, the
purpose of this review was to discuss available shade selection
methods, related effective factors and conditions, and their accuracy
and precision based on the literature to find out the most accurate,
precise shade selection method available in dentistry.
2 | METHODS
The key terms of accuracy, background, ceramic, color, colorimeter,
color analysis, color science, color measurement, color measuring
instrument, color matching, composite resin, dental/tooth shade
guide, digital camera, esthetics, imaging, imaging application/program/
software, intraoral scanner, light source, photography, precision,
shade, shade matching/determination/prediction/ reproduction/
selection, shade taking device, spectrophotometer, spectrophotome-
try, tooth color measurement, tooth color/shade, and visual percep-
tion were used both separately and jointly. An electronic search of the
Google Scholar/PubMed/Scopus/Web of Science database was con-
ducted by two reviewers separately to detect related original, review,
or case report English-language articles published between January
1, 1985, and January 1, 2021. Consequently, 367 articles were initially
included. Three reviewers evaluated these articles' relevance to the
subject of the study, as a result, 133 articles were excluded and 234
articles were included after reading the title and the abstract of the
articles. The included articles were collected, cross-checked in terms
of inclusion/exclusion criteria (database type, date, article type, and
relevance), and organized by one reviewer based on the type of shade
TABATABAIAN ET AL.
selection method assessed in the articles. A non-electronic search was
performed by the same reviewer and 15 classic articles of color science
were also added. The articles were divided between four reviewers
based on their subject (visual/digital methods, dental shade guides, digital
cameras, colorimeters, spectrophotometers, and intraoral scanners) to be
analyzed and summarized. Totally 249 articles were considered and
reviewed in different sections and subsections of this study considering
the type of shade selection method, its related effective factors and con-
ditions, and its accuracy and precision.
3 | VISUAL METHOD
Visual methods of shade determination employ dental shade guides,
which are sets of tooth color physical samples, to assess the shade of
teeth and/or restorations. The physical samples (shade tabs) are
placed close to the tooth in the same plane and ensuring incisal align-
ment. Then the most similar shade to the tooth shade and adjacent
teeth/restorations shade is selected and used for the fabrication of a
restoration. Shade guides should express specific characteristics such
as proper distribution in color space, rational arrangement, ease of
manipulation, and acceptable accuracy and precision.24–30
To choose the most matched shade to the tooth shade, well-
distributed shade tabs with proper color differences are necessary.
Shade tabs should be arranged reasonably to make the shade selec-
tion easy and accurate. Additionally, a shade guide should have a sim-
ple, rational process of shade selection. Accuracy or validity shows
how well a test or assessing device actually measures what it is mea-
sured or how correctly it reflects the reality it declares to show, while
precision or reliability is the degree to which a test or assessing device
creates stable results. Accuracy regards systematic errors, whereas
precision relates to random errors.14 Accuracy is tested by the assess-
ment of coverage error and coverage error percentage,31 while preci-
sion is examined by the evaluation of repeatability (same procedure,
observer, or device), reproducibility (different procedure, observer,
and/or device), time interval (short, medium, or long term), and sample
manipulation (with or without sample replacement).14 Also, shade tabs
should be matched with both natural teeth and restorative
31–34
materials, and therefore, manufactures have produced shade
guides according to their restorative materials due to the materials'
diverse optical properties. Different types of dental shade guides,
effective factors and conditions, and accuracy and precision for the
visual shade selection method are discussed as follows.
3.1 | Dental shade guides
Dental shade guides can be classified based on their shape (strip-,
disk-, or tooth-shaped), material (ceramic, composite resin, or acrylic
resin), fabrication type (custom or stock), and concept (theoretical,
empirical, evidence-based). No shade matching accuracy differences
35
exist between disks and tabs. Shade guides have been made of
materials such as ceramics, denture teeth, and composite resins.
3
Moreover, manufacturers have produced their original guides for their
products because different materials and brands show different colors
and optical properties.36–41 The fabrication of shade guides with the
actual restorative material has been suggested, otherwise the shade
and optical properties of the restorative material may differ from
shade guides.42 Using actual ceramic shade guides rather than non-
homogeneous shade guides induces more acceptable color matching
in ceramic restorations.43 Thus, the brand and material of the shade
guide and the restorative material should be the same.44,45 Consider-
ing VITA Lumin Vacuum as a model, numerous dental shade guides
have been produced46; however, this shade guide is not based on the
three-dimensional color space.10 A list of common commercial shade
guides is presented in Table 1.
3.2 | Effective factors and conditions related to
visual method
Three factors affect how an observer perceives the object color
including the light source, the object, and the observer. A light source
releases electromagnetic radiation which can be specified by the color
temperature. The color temperature of a light source is the tempera-
ture of an ideal black-body radiator that emits light of a color similar
to that of the light source. The color temperature is quantified in Kel-
vin (K). Different light sources are defined such as 15,000 to 27,000 K
for clear blue sky, 6500 K for daylight, 6200 K for xenon short-arc
lamp, 5000 K for horizon daylight, 3000 K for warm white fluorescent
and light emitting diode (LED) lamps, 2700 K for soft white fluores-
cent and LED lamps, 2400 K for standard incandescent lamps, and
1900 K for candle flame. Different illuminants such as natural daylight
and artificial light may be employed for shade selection. Daylight with
6500 K is considered as a standard illuminant (D65) because of its
well-distributed visible light wavelengths (from 400 to 700 nm) and
relative spectral power. The CIE defined a color-rendering index (CRI)
for a light source as a measure for the ability of the light source to dis-
close the colors of different objects correctly in comparison with an
ideal or natural light source. Since natural light properties differ, a light
source with color temperature of greater than 5500 K and a CRI
greater than 93 is advised for dental shade selection.47,48 An illumi-
nant should have sufficient intensity to make an equal balance of all
visible wavelengths, an even distribution of the reflected light with
the least light distortion, and an apparent view of tooth details.49
Accordingly, the standard illuminant (D55) for dentistry has been
defined with consideration of some conditions: Washington, DC,
June, 12 AM to 1 PM, a slight overcast, a color temperature of
5500 K, and a CRI of ≥90.47,48
Different light sources may exist in clinics such as natural light,
fluorescents, and LEDs. As standard light conditions can be rarely
obtained in clinics, light correcting devices are suggested for shade
selection. These handheld devices usually have LED lamps with an
illumination degree of 2  45
, a color temperature of 5500 K, and a
watch-through rectangular window. Polarizing filters may be added to
the device window to suppress glare. Indeed, a polarizing filter is a
 4

TABLE 1 Common commercial dental shade guides

Shade guide name Related material Shade tabs number Shade categories Rationale Shade selection steps Manufacturer
VITA classical Ceramic 16 A (reddish-brownish) Questionable 1 step: based on VITA Zahnfabrik H.
A1-D4 B (reddish-yellowish) lightness, or Rauter GmbH & Co.
C (grayish) 2 steps: based on a KG, Bad Säckingen,
D (reddish-gray) preselection of Germany
hue group,
a shade tab is selected.
VITA Toothguide Ceramic 29 (including 26 Lightness levels: 0,1,2,3,4,5 Normally-distributed 3 steps: selection VITA Zahnfabrik
tooth-shaded tabs (light to dark) shades accurately of lightness, H. Rauter GmbH
3D-Master and 3 tabs of VITA Chroma levels: 1, 1.5, determined by color chroma, and hue, & Co. KG, Bad
Bleached Shades: 0 M1, 2, 2.5, 3 (low to high) science respectively Säckingen,
0 M2 and 0 M3) Hue levels: M (neutral), Germany
L (yellow), R (red)
VITA Linearguide Ceramic 29 (the same tabs as VITA Lightness levels: 0,1,2,3,4,5 A VITA value guide 2 steps: based on VITA Zahnfabrik H.
3D-Master Toothguide 3D-Master (light to dark) 3D-Master and 5 VITA a preselection Rauter GmbH &
with different arragement) Chroma levels: 1, 1.5, 2, Chroma / Hue guides from the value Co. KG, Bad
2.5, 3 (low to high) 3D-Master guide 3D-Master, Säckingen,
Hue levels: M (neutral), a selection is made Germany
L (yellow), R (red) from the Chroma/
Hue guide3D-Master.
Chromascop Ceramic 20 Group 100 for white, group An arrangement of shade 2 steps: based on Ivoclar Vivadent AG,
200 for yellow, group 300 tabs in 5 groups of 4 a preselection Schaan,
for light brown, group 400 of the shade Liechtenstein
for gray, group 500 for group, a shade
dark brown tab is selected.
Bioform IPN Porcelain and 24 Four groups of hue, 16 B shades Based on the most popular 1 step: for value Dentsply Sirona,
plastic material from B51 to B93 corresponding shades for both denture arrangement, York, PA
(denture teeth) to the VITA A-D shades and teeth and porcelain 2 steps: based on
8 Biofrom shades from B59 to B81 materials hue/chroma
arrangement
Portrait IPN Plastic material 27 16 “P” shades from P1 to P34 Based on the VITA classical 1 step: for value Dentsply Sirona,
(denture teeth) corresponding to the VITA A-D A1-D4, Bioform B59-B81, arrangement, York, PA
shades, 8 shades from P59 to and bleached shades 2 steps: based on
P81 according to the ‘Base 8’ hue/chroma
Bioform shades, and 3 bleach arrangement
shades (PW2, PW4, PW7)
Bioblend IPN Porcelain and plastic 12 (including central, Bleached shades typified the For imitation of natural In harmonization Dentsply Sirona,
material (denture lateral, and canine three-tooth tabs of the Bioblend decalcification and with the York, PA
teeth) sets of shade tabs) IPN Blend Selector check lines patient's hair, eyes,
and complexion
TABATABAIAN ET AL.
 TABATABAIAN ET AL. 5

neutral gray film decreasing oblique reflection from the object's

glossy surfaces. A cross-polarizing filter eliminates inessential

Shofu Inc., Kyoto,

Dentsply Sirona, reflections in both horizontal and vertical dimensions letting the
Manufacturer

York, PA observer perceive less bright visualization. Overall, shade matching

is significantly better with light correcting devices than with a

Japan
natural light source.50,51 These devices enhance the observers'
agreement on the value of shade tabs52 and their shade matching
counteract the color saturation ability.53 Though some light correcting devices may be located
of the gingiva and place the 5 cm apart the tooth,50 the appropriate distance between the
the tooth shade guide to
The GUMYs are used with

shade tab in the same

teeth and the device differs from one device to another one, and
classical shade guide
comparable to VITA
Shade selection steps
Shade selection steps

therefore, the manufacturer's instruction should be considered in

this regard. Manufactures have launched various light correcting
surroundings.

devices such as Demetron Shade Light (Kerr Corporation, Orange,

CA), Rite-Lite-2 (AdDent, Inc., Danbury, CT), Smile Lite (Smile Lite;
Smile Line, St-Imier, Switzerland), and Shade Wand Dental Shade
Light (Authentic Dental Laboratory, Inc., San Antonio, TX). Rite-
GUMYs available in three
the red shift concept, the

Lite 2 provides three light modes: a color-corrected light at

Corrected to the 3D tooth

shades for gingiva (light,

based on VITA classical

color space; based on

Pre-fired porcelain tabs

5500 K, an incandescent-room light at 3200 K, and an ambient

light at 3900 K. With this device, the tooth shade can be selected
medium, dark)

under the corrected light mode and verified under the other
shade guide

modes. Shade matching ability of inexperienced observers is

Rationale

enhanced by light-correcting devices; however, the addition of

polarizing filters may not positively affect the results.53,54
The object properties affect shade taking results. Teeth
Value Minus shade guide (8 shades),

should be wet when assessing shade and translucency, otherwise

all color attributes including value, hue, and chroma may be
shade guide (16 shades), NCC
(14 shades), NCC Standard

influenced.55–59 Within the first minute of tooth dehydration, the

NCC Value Plus shade guide

tooth color changes even greater than the perceptibility threshold

and Gumy indicator
B (reddish-yellowish)
A (reddish-brownish)

(ΔE00 = 0.8), while tooth rehydration takes 15 min after dehydra-

D (reddish-grayish)
Shade categories

tion.55 Moreover, following 15 min of rehydration, 90% of teeth

Note: Data collected from the manufactures' websites and product brochures/user manuals.

show color changes of greater than the perceptibility threshold,

C (grayish)

and 65% of teeth disclose a color shift of greater than the

acceptability threshold (ΔE00 = 1.8).55 A dehydrated tooth indi-
cates more lightness and less chroma and translucency, and
therefore, using a medium-viscosity clear glaze liquid is suggested
for wetting both teeth and shade tabs.56–58 This can also neu-
Shade tabs number

tralize effects of tooth surface texture and morphology on shade

selection.57,58 Thus, shade selection should be done at the appoint-
ment's beginning within the first minute and before tooth dehydra-
tion due to restorative procedures or isolation.55,59 The tooth region
affects the tooth color. From incisal to cervical regions, both a* and
16

38

b* values rise, while tooth translucency reduces.60 The incisal part is

impacted by backgrounds due to its higher translucency, while the
Related material

cervical part is affected by the color of gingiva, as a result, the middle

part better presents the tooth color.61–65 Thus, the shade should be
Ceramic

Ceramic

taken from the middle part for a one-shade report and/or in all parts
(Continued)

separately for a three-shade report. Nonetheless, the relation

between the color of maxillary anterior teeth in the cervical parts
Shade guide name

Vintage Halo NCC

Ceramco 3 Dentin

seems more reliable than in the other parts.66

The oral cavity, including neighboring teeth/restorations, gin-
TABLE 1

giva, lips, and skin, can affect shade results due to the color con-
trast between these structures and the target tooth.67 As the
color contrast between a surrounding structure and the tooth
6 TABATABAIAN ET AL.
increases, the effect of the structure on the eye perception of
the tooth color increases. Since the red-violet gingiva makes a
great contrast, the eye perception of red-violet color is difficult
leading to impression of only green-yellow colors existed in the
target tooth. To tackle this problem, a manufacturer has presented
gingiva colored shade indicators, named “the Gumy,” available in
shades of pink, light, and medium to counteract the color satura-
tion of gingiva by placing the shade tab in the same surroundings
as the tooth. Comparably, lips and skin make-up and rubber-dam
should be removed before shade selection.68 Dazzling dresses, eye
glasses, or items, which divert visual perception, should be
69
avoided. Using a gray bib, as a patient's cloth coverage, is help-
70,71
ful in this regard. Age may impact the tooth color. As the
age increases, the tooth L* value reduces and a* and b* values
72,73
increases. Thus, a color-matched restoration may become mis-
matched over time.73 Shade selection should be conducted tooth
by tooth, since anterior teeth show different shades except man-
dibular central and lateral incisors.74,75 Also, the color harmony
between teeth, skin, and eyes should be noticed. Patients with
fair skin are more prone to have teeth with low L* values, while
those with dark skin are more likely to have teeth with high
L*values.76,77
The observer's shade matching ability impacts shade selection
results. This ability may be affected by age, gender, experience, type
of shade guide, training, color perception potentials, and diseases.
Although gender has been recognized as a crucial factor by stating the
78,79
superiority of females over males in color perception, some evi-
dence suggests no significant effects of gender and age on color dis-
crimination.80–83 Comparably, the reports on effects of observer's
experience are controversial due to different samples and test condi-
50,84–88
tions. Shade guide type affects the matching ability. Using
VITA 3D-Master rather than VITA classical provides higher accuracy/
precision, regardless of the age, gender, or experience.28,85 As training
improves shade matching skills,54,83,89,90 the use of Toothguide
Trainer Box and software (VITA Zahnfabrik H. Rauter GmbH &Co.
91–93
KG, Bad Säckingen, Germany) is effective.
The color perception ability is affected by color vision defi-
ciencies which may be congenital or acquired. The prevalence of
congenital color vision deficiency is 3.6% in boys and 0.6% in
girls.94 The acquired deficiency may occur following ocular, neuro-
logic, or systemic diseases such as multiple sclerosis, type II diabe-
tes, and glaucoma.95–98 Red-green color vision deficiency should
99
be assessed at dental schools. Also, color-matching competency
100
can be evaluated with testing (ISOTR 28642:2011). The type
of light correcting device affects the color matching results of
those with low skill and poor color discrimination competency
(60–75% accuracy for color matching) and D65 rather than D50
improves their competency.101 Also, the correct shade matching
percentage of red-green color vision-deficient dentists can rise
from 30.73% to 56.25% when using tungsten filaments rather
102
than D65. Controlling the factors discussed is a must for
acceptable shade selection by visual methods. Thus, methods with
less subjectivity have been regarded in dentistry.
3.3 | Accuracy and precision of visual method
The accuracy and precision of the visual method depend on several
factors such as shade guide properties, observer color matching abil-
ity/experience, and light source. Shade guide properties include tabs
extension in tooth color space, tabs coverage error and coverage error
percentage, tabs arrangement and manipulation, and tabs accuracy/
precision.24,28,43,103–105
In the CIELab space, tooth colors are located between light-red
and light-yellow along the L* axis demonstrating a banana-shaped
space.106 Sufficient, well-extended shade tabs can properly cover
teeth color space.107 Coverage error is determined to assess if the
shade tabs of a shade guide can appropriately extend in the color
space of natural teeth. The shade guide coverage error is calculated
by measuring the mean color difference between a given studied set
of natural teeth and its matched shade tabs of the shade
guide.25,108,109 The coverage error/color difference value may be com-
pared with perceptibility and/or acceptability thresholds.10,110–114 For
accurate shade matching, it seems reasonable that the shade guides'
coverage error should be at least less than the acceptability threshold
and ideally less than the perceptibility threshold. A color difference
value of greater than the threshold (perceptibility or acceptability) is
considered as a color mismatch between the tooth and its matched
shade tab. To measure the shade guide's coverage error percentage,
the percentage of shade selection with color mismatches is calcu-
lated.109 Apparently, for achieving an accurate shade selection, the
shade guide coverage error and its percentage should be low.115 The
ΔEab coverage error is reported 7.22 for VITA Lumin Vacuum, 8.39
for VITA 3D-Master, and 7.99 for Vintage Halo NCC in an Indian pop-
ulation.116 Also, ΔEab coverage error of VITA classical is reported
4.1.25 In Quinquagenarians and Septuagenarians, the ΔEab coverage
error is 3.51 for VITA classical and 2.96 for VITA 3D-Master, while
the coverage error percentage is 77% for the former and 76% for the
latter.117 Unacceptable coverage errors (ΔEab > 3.3) are estimated for
commercial dental shade guides28; though VITA 3D-Master and Vin-
tage Halo NCC show the lowest coverage errors.28,104
Since similar dental shade guides of a manufacturer may be uti-
lized interchangeably, similar shade tabs should show similar color
parameters presenting high repeatability, reproducibility, or precision
for shade guides. However, the precision of shade guides has been a
cause for concern. While a clinically significant variation in the color
parameters of identical shade tabs of VITA classical and 3D-Master
has been reported by some investigators,118,119 one study revealed a
high level of repeatability (almost 100%) for VITA classical.120
Professional experience can positively influence the observer
accuracy/precision.82,88 Intraobserver and interobserver precisions
are critical for shade discrimination. The intraobserver precision of
visual method for experienced prosthodontists (50% with VITA Lumin
Vacuum, 60% with VITA 3D-Master) is higher than that for experi-
enced general practitioners (27% with VITA Lumin Vacuum, 54% with
VITA 3D-Master).121 The interobserver precision for observers with-
out color vision deficiency has been reported from 22.5% to
55%,82,122,123 while the intraobserver precision has been estimated
TABATABAIAN ET AL.
from 11% to 64%.121,123,124 The use of VITA 3D-Master rather than
VITA classical may reduce the interobserver color matching
83,85
differences, while controversially one study reported a decrease
in the intraobserver precision from 64% to 48% and the interobserver
precision from 55% to 43% when using VITA 3D-Master.123 The dis-
parity of the results may be due to the different factors affecting the
interobserver and intraobserver precisions related to shade guides
such as the number of the shade tabs and their distribution in the
color space of natural teeth, the observer (inexperienced/experienced,
dentists/dental staff members/laypeople), and the type of samples
tested for shade matching (natural teeth/shade tabs/fabricated resto-
rations). The observer shade matching accuracy has been reported
125,126
from 58% to 86%. However, shade matching accuracy and pre-
cision of experienced dentists are still lower than those of dental
127
spectrophotometers.
Light source, tooth surroundings, and backgrounds can impact
shade matching.50–54 Shade matching ability is improved by using
a light-correcting source rather than natural, clinical, or laboratory
50,51,128,129
light. Incandescent light induces more accurate shade
determination than the filtered LED, LED, and daylight130; however,
there is no difference between D65 and D50 light sources in this
respect.126 Different background colors may be used such as black,
126
white, gray, pink, and blue. The worst accuracy is obtained with a
blue background, while achromatic backgrounds make no difference,126
as a result, a pink background is advocated.52Also, a light-correcting
device enhances the benefit of using a pink background.52
Among the aforementioned factors, the observer experience has
88,131
the greatest impact on the accuracy/precision of visual method,
while factors such as shade guide and light condition become more
prominent for inexpert observers.50,51 Thus, improving shade
matching skills by intensive education and training is strongly rec-
ommended.83,91,132–136 Also, using evidence-based shade guides and
light conditions are advocated for low-skilled dentists.52,53,121
4 | DIGITAL METHOD
Since 1990, numerous digital instruments have been developed for
dental shade selection including digital cameras, colorimeters, spectro-
photometers, and intraoral scanners. A color-measuring device should
have requirements such as shock proof, easy control, rapid measure-
ment, acceptable working life, proper light source, reasonable price,
137
and most of all acceptable accuracy and precision. Generally, digital
methods minimize the subjectivity of measurement.123,138
4.1 | Digital cameras and color measuring software
Digital photography has definitely changed dental practice.139,140
Photos illustrate patients' portrait and oral cavity, inform and educate
patients, enhance patient's acceptance for treatments, communicate
information, serve as documents, help for shade selection, and com-
pare intraoral conditions before and after treatment.141,142 In this
7
respect, a digital single-lens reflex (DSLR) camera, which includes an
image obtaining device (sensor), a liquid-crystal display (LCD) viewer,
and a microprocessor, is a basic need in dental practice.14 The usual
focal length is 50 mm, and therefore, interchangeable lenses with a
shorter focal length for landscape mode and a longer focal length for
telephoto mode are added. Digital cameras employ a lens with an
adjustable aperture to focus light onto the sensor. For digital photog-
raphy, camera settings and imaging conditions should be considered.
The settings include ambient illumination, inter camera-object dis-
tance, camera flash light, aperture size, shutter speed, and the sensi-
tivity of sensor to light (ISO). Unreliable illumination and unfixed
distances confound photographic outcomes143; however, digital pho-
tography under controlled conditions may be feasible for shade
matching.144
Different protocols for shade taking and color analysis by digital
photography have been proposed. Hein et al.144 suggested using
reflective cross-polarized light digital photography with a standardized
white balance gray card, regarded as a reference, in combination with
a specific DSLR camera profile and color processing software
employing the CIELab space. McLaren et al.145 stated some points for
shade selection photography including using a DSLR camera permit-
ting interchangeable lenses, preparing images in a RAW file format,
benefiting from custom white balance, and applying manual exposure.
A RAW format preserves the image's total data; however, image
details are lost by changing the format to other formats such as JPEG,
TIFF, or PNG. The same magnification ratio should be utilized for all
images in all restorative treatment sequences and for all patients.145
The flash should be adjusted the same distance from the teeth in man-
ual modes, while be tested to attain the proper amount of flash power
for a proper exposure. Afterwards, all settings should be kept
unchanged. A standard gray reference card with specific CIELab
values is effective in correcting color changes during photography to
disclose the color of preoperative conditions and record postoperative
results with acceptable accuracy.146 Consequently, the use of mega-
pixel digital cameras for shade selection is advised.147 Images can be
transferred to communicate data such as tooth color, morphology,
surface texture, and color distribution.148 Also, a conjunction of digital
cameras and shade guides through positioning the selected shade tab
near the tooth recorded in an image may be advantageous.149,150
Intraoral cameras have been suggested for minimizing the factors
affecting the image result of extraoral cameras.151–153 Digital intraoral
cameras with LEDs and cross polarization may eliminate unreliable
ambient illumination, unfixed camera-object distance, and balance
set-ups. Using a digital intraoral camera accompanied with software
can improve the accuracy of photographic color measurements.151,153
Another means for digital photography is the use of smartphones hav-
ing advantages of self-computing capability, enriched functionalities,
multiple software applications, wireless connectivity/communication,
and high-resolution photography. Smartphones' captured images may
be used as color references for shade matching; however, like digital
cameras, the color of images taken with smartphones may be affected
by diverse elements such as ambient illumination and device settings
(auto or manual), light sensors, and image processing.
8 TABATABAIAN ET AL.
Different software programs for color measurement/analysis of
digital images are available such as ClearMatch (Clarity Dental, Salt
Lake City, UT), ShadeWave Dentist License (ShadeWave, Issaquah,
WA), Color Scanner 2006 (Nuova Franco Suisse, Vigonza, Italy),
Adobe Photoshop (Adobe Inc., San Jose, CA), MATLAB (MathWorks,
Natick, MA), EasyMatch QC (Hunter Associates Laboratory, Inc, Res-
ton, VA), CT&A and PatchTool (The BabelColor Company, Montreal,
QC, Canada), Color Data Software SpectraMagic NX/DX (Konica
Minolta Sensing Americas, Inc, Ramsey, NJ), and Color iMatch (X-Rite,
Inc, Grand Rapids, MI) which may be used for dental shade matching
148,154
as well. The color measuring software, which is compatible with
a digital camera, needs to be installed in a computer.155 The software
employ color spaces such as CIERGB, CIEXYZ, CIELab, and CIELCh,
while usually providing tooth shade mapping and 1–3 most similar
shades to the tooth shade by using the data set of the shade tabs of
shade guides. Indeed, tooth color attributes is initially determined,
then, color differences between the tooth and all shade tabs are calcu-
lated using a color difference formula. The shade tab with the least
color difference is shown as the tooth shade by the software.
As intact teeth are polychromatic, translucent, and curved, while
colorimeters and spectrophotometers are fundamentally designed for
flat surfaces and also the shade tab thickness may impact color per-
ception, digital cameras may be considered as an alternative to other
156,157
shade selection methods. Digital cameras supply reliable shade
results if lighting conditions, camera adjustments, and object to cam-
era distance are properly set,157–159 while yielding data about dental
143,148,158
morphology, surface texture, and color distribution. As
image data differ in diverse settings/cameras, appropriate calibration
and color adjustment are essentially required to enhance color mea-
suring accuracy.147,160 An extra image may be taken while placing the
matched shade tab/tabs next to the tooth to make the most of digital
imaging and shade guides.14,161,162 The RAW format of image is bet-
145,161
ter seen on a calibrated monitor. Tools such as ColorMunki Dis-
play (X-Rite, Inc, Grand Rapids, MI) can calibrate the color of monitor.
Thus, dentists should control the related influential factors, standard-
ize image taking conditions, and maintain settings when using digital
cameras for shade selection.
4.1.1 | Effective factors and conditions related to
digital cameras
Image color consistency is a must for color measurement using digital
photography and needs characterization and standardization of the
163
camera's input and output. The color consistency is affected by
patient position during image taking, ambient light, tooth hydration/
dehydration, camera setting, shade taking protocol, cross polarization,
image file format, image color balance using shade analysis software,
and laboratory's monitor calibration.
The distance between tooth and camera (shooting distance) is
usually unfixed while being normally set between 14 and
50 cm.143,164 Also, different light temperatures between 3700 and
6500 K may be employed in clinics.143,163 Using consistent shooting
distance and light conditions improves shade results. In this regard,
intraoral cameras with LED lighting of 6500 K may capture better
images by minimizing the effect of shooting distance, as the distance
between the teeth and the intraoral camera can be kept similar and
stable in repeated image-captures.153
Shade selection should be preferably performed before starting
restorative procedures and be prevented within 15 min following
rehydration.55,59 Also, because bleaching with hydrogen peroxide
induces tooth dehydration and color changes,165,166 shade selection
for definitive prostheses must be conducted after bleaching not
before bleaching to let the color changes induced by bleaching occur
and the tooth color become stable.
Camera settings such as lens diameter, aperture, shutter speed,
flash light, light intensity, and ISO impact the color of images. The
most adaptable camera is a 35 mm-single-lens-reflex-camera.167 A
magnification of 1:1 can be obtained with a 100 up to 135 mm-macro
lens.167 Since dental photography has a small field depth, a small aper-
ture such as f22 makes a large area in focus.168 Smaller apertures such
as f32 and f64 provide a greater field depth; however, this may reduce
the image quality and resolution.168 Hence, a 90–105 mm-macro lens
with a focus from 1:1 to infinity and a least aperture of f32 is
suggested for clinical camera brands such as Nikon, Canon, Minolta,
and Sigma.169 The exposure of sensor is adjusted by arrangement of
camera settings including the lens aperture and the shutter speed.168
Indeed, the lens aperture limits light intensity, while the shutter speed
determines the light duration of an open shutter being shown in frac-
tion of seconds.168 A minimum of 1/125 s for the shutter speed is
essential to avoid patient movements and camera jiggles, otherwise
blurring may happen.168 Landscape mode is preferable for intraoral
views meanwhile portrait mode is favorable for extraoral views.170
With photographic condition standardization (light, shooting distance,
camera mode) manual focus is more precise than auto focus.170 Ring
and dual/bilateral source flashes may be more controllable than other
systems, while a dual flash with closeness to the lens supplies more
natural illuminations and a maximum light coverage of the mouth.171
Moreover, ring flashes are not advocated for anterior teeth, because
their uniform burst of light destroys details, translucency, and color
detection.172 Dual flashes may be unidirectional or bidirectional. Uni-
directional dual flashes create shadows, thus adjustable bidirectional
dual flashes are suggested for positioning the flashes based on the
arch form and teeth alignment and omitting shadows.172 With elec-
tronic flashes, blurring rarely occurs, as the flash light output
(1/2000 s) is less than the shutter speed, and also the latter can be
automatically synchronized with the former.168
For close-up photography, the ideal magnification is 1:1.173 As
exposure rises in close-up condition, increasing ISO number and illu-
mination intensity is considered to reduce exposure.168 ISO ranges
from 25 to 6400. The higher the ISO number, the more light-sensitive
the sensor. ISO can be adjusted between 25 and 100, but it is usually
set at 100 as a default.174 Cross-polarization filtering is essential to
remove spectral artifacts induced by flash light reflection from rough-
ness or saliva on the tooth and produce precise and repeatable glare-
free images.175,176
TABATABAIAN ET AL.
Overall, a step-by-step shade taking photographic protocol using
a digital camera with ring or dual flashes, image processing software,
image records of the shade tabs, cross polarization, CIELab space, and
color calibration may lead to acceptable shade selection.138,148,177–179
4.1.2 | Accuracy and precision of digital cameras
The accuracy/precision of information derived from cameras depends
on factors such as settings and calibrations, ambient lighting, object
160
features, and color adjustments. Adjustments of camera's color
profile, white balance, and exposure ensure the perfection of images.
A fixed setting including ISO 200, f25, shutter speed of 1/125 s, white
balance flash, and RAW format is advocated.44,180A stable light source
such as a xenon light source (300 W Xe Arch Lamp, Oriel Instruments,
Stratford, CT) may be added to minimize light source discrepancies.147
Mahn et al.181 found no significant differences between a D7100
Nikon DSLR camera, equipped with an 85-mm macro lens, a R1C1
Nikon external flash-twin-flash system, and a polar-eyes cross-
polarized light filter, and VITA Easyshade spectrophotometer in mea-
sured L* and b* values, and reported that the photographic method
led to acceptable inaccuracies (ΔEab < 6.8)181; however, this level of
color difference seems to be a clearly unacceptable color mismatch
110 180
according to Paravina et al. Based on Hein et al. combining pho-
tography using Canon or Nikon DSLR cameras (with either full frame
or APS-C type sensors) with numeric shade quantification is an alter-
native to shade communication. For accurate photography, the expo-
sure should be set to 1/125 s with the aperture of f22, regardless of
the camera brand and model.180 Non-polarized photography, cross-
polarization photography, and spectrophotometry can be combined to
improve accuracy due to their correlations,182 as color differences
between records of a spectrophotometer and polarized photography
are less than the acceptability threshold (ΔEab = 2.7) only in 23% of
cases.183 Object features impact the accuracy of photography,
143
because darker shades are better matched. Also, including three
predicted shade tabs beside a tooth in an image improves
accuracy.14,184
A support vector machine (SVM) may develop shade matching
accuracy of digital cameras and smartphones.185 In a study by Tam
and Lee185 using a smartphone camera, all images were captured with
auto-mode settings, no flash, 14–20 cm shooting distance, and
4000 K lighting. Though the camera could automatically adjust the
settings according to the environment, the camera sensor might have
experienced unstable illumination in different shots which could be
addressed using SVM algorithms to train the images into various cate-
gories.185 The algorithms for mapping complex color features into a
linearly dimensional space enable considerable data to be manipulated
185
and classified. Despite the use of novel algorithms designed to cor-
rect the color for human perception, the correction of image taken by
cameras may complicate the color matching performed by color mea-
suring software. Moreover, using S, a*, b* features may not resolve
complexities of color matching of images taken by smartphones due
143
to the lack of custom shooting or a flash. Thus, maintaining the
9
same position is advised for enhancing accuracy and precision.
Accordingly, using an intraoral camera with cross-polarization, exter-
nal light isolation, a positioning jig (±0.1 mm position repeatability),
and SVM algorithms may achieve a more than 90% matching accuracy
and a less than 1% failure rate for shade matching.186
The precision of digital cameras for color determination is
improved by proper calibration protocols.147,187–192 Jarad et al.148
reported that using a Nikon Coolpix 990 digital camera with Nikon
SB21B ring flash resulted in higher precision compared to visual shade
matching with shade guides. Camera and light settings and image for-
mat must always be consistent for achieving precise results.14 Despite
advancements of digital cameras and their accessories, establishing a
standard approach to accurate, precise shade selection by digital pho-
tography seems difficult.
4.2 | Colorimeters
A colorimeter is an optical device that can read the visible spec-
trum by using filtered photodectors. Initially, three glass filters
(red, green, and blue), whose transmittance spectra imitated the
CIE color matching functions, were used to simulate response of
the average human visual system.10 Later on, a filter bank was
employed to upgrade the device accuracy. In fact, colorimeters'
sensors assess the sum of different wavelength spectra reflected
from the object to indicate the object color.193 The technology of
sensors has been improved to an accurate level for assessing
even opaque objects.
Dental colorimeters have been introduced to help with shade
selection. These simple, low-price devices analyze reflective light, col-
lect data, convert data to color parameters, and specify teeth
shade.193 As visual methods are not able to quantify the color, color-
imeters raise the accuracy by error reduction.193 A list of available
dental colorimeters is presented in Table 2.
4.2.1 | Effective factors and conditions related to
colorimeters
The disparities between colorimeters may be related to color variabil-
ity among the same nominal shade tabs, complexity in reading translu-
cent objects, and dissimilar algorithms for assessing color
194,195
values. Standard positioning, constant distance between the
tooth and device, and an effective specimen port opening size of
the device are viable for correct measurement.196 Furthermore, color-
imetry seems most consistent in the middle region of labial tooth
surface.197
The object color, especially its chroma and value, can influence
colorimetric outcomes. In other words, when the chroma is greater
than six CIELab units and the value is less than five CIELab units, the
device-reported ΔEab color difference exceeds beyond clinically
acceptable thresholds.197 Thus, using ShadeEye NCC is not suggested
for color measurements above these ranges.198 Also, colorimetric
 10

TABLE 2 Common commercial digital dental shade-taking devices

Spectral/
Digital optical
Device name Type Components Capabilities Light source Recording Measurement area resolution resolution Accuracy Precision Manufacturer

ShadeVision Colorimeter/ Cordless CIELab, Filament 0
Entire tooth 22,000 px Not Reported Reported X-Rite, Inc.,
Digital color handheld several light measurement per image applicable from from 50% Grand
imaging colorimeter, shade 14.1% to to 100% Rapids, MI
docking station, guides, 84.8% and from
calibration value, hue, and from 1.01 0.2 to 2.6
reference, chroma, color to 3.49 ΔEab ΔEab units
20 disposable map feature units, 0.5 ΔEab
tips, software (50 tooth unit minimuma
regions)
ShadeScan Colorimeter/ Handheld VITA classical, Halogen 0
Entire tooth Unknown Not Reported from Reported from Cynovad,
Digital color colorimeter, LCD VITA 3D-Master, bulb, measurement applicable 54.2% 76.5% to Montreal,
imaging screen, docking Chromascop, Shofu 2  45
to 84.5%, 95.0%, 0.5 QC, Canada
station, calibration, Vintage Halo, 0.5 ΔEab ΔEab units
software Noritake, Dentsply, units minimuma
EsthetX, image minimuma
characterization,
shade and
translucency
map
ShadeEye Colorimeter Cordless handheld CIEXYZ, CIELab, Xenon lamp 0
Spot measurement, Not Not Reported from Reported from Shofu Inc.,
NCC colorimeter, Shofu Viintage contact tip applicable applicable 41.3% to 87.5% to Kyoto, Japan
computer base Halo, VITA 43.5% 88.2% and 1.7
station, 1 box classical, VITA and 1.9 ΔEab ΔEab units
of disposable 3D-Master, units minimum minimum
tips, contact tip Chromascop,
holders, calibration Biodent
cap, printer,
software
ShadeStar Colorimeter Cordless handheld Vita classical, Vita Unknown 0
Spot measurement, Not Not Unknown Unknown DeguDent
colorimeter, LCD 3D- Master, contact tip = 3 mm applicable applicable GmbH, Hanau,
screen, calibration, Ceram-X Mono, diameter Germany
disposable tips Ceram-X Duo
(pk 24), barriers
(pk 24)
VITA Spectrophotometer Handheld CIELab, CIELCh, 20 W 0
, specular Spot measurement, Not 25 nm Reported from Reported from VITA Zahnfabrik H.
Easyshade spectrophotometer, VITA classical halogen excluded Probe tip = 5 mm applicable 13.8% to 41.9% to Rauter GmbH
touchscreen, base A1-D4, VITA bulb, 0
diameter 92.6%, 96.4%, and & Co. KG, Bad
unit, protective 3D-Master, and from 0.0 to from 0.0 to Säckingen,
shields, translucency 9.2 ΔEab units 2.28 ΔEab units Germany
calibration block for relative to tab
the white balance
VITA Spectrophotometer Cordless handheld CIELab, CIELCh, White 0
, specular Spot measurement, Not 25 nm Reported from Reported from VITA Zahnfabrik
Easyshade V spectrophotometer, VITA classical LED, 0
excluded Probe tip = 5 mm applicable 78% to 94%, 11.54% to H. Rauter
touchscreen, base A1-D4, VITA diameter acceptable 97.01%, less GmbH &
a
unit, protective caps, 3D-Master, to excellent than ΔEab of 0.1 Co. KG, Bad
calibration block for VITABLOCS (1.2 ΔEab units), Säckingen,
the white balance, shades, and from 2.86 Germany
software, Bluetooth bleached to 3.05 ΔE00
connection, software, index
Android App
TABATABAIAN ET AL.
TABLE 2 (Continued)
Spectral/
Digital optical
Device name Type Components Capabilities Light source Recording Measurement area resolution resolution Accuracy Precision Manufacturer

SpectroShade Spectrophotometer/ Cordless handheld CIELab, CIELCh, LED, 2 x 45
, 0
, polarized, Entire tooth 640 x 480 = 10 nm, 0.03  Reported from Reported from MHT Optic
Micro II Digital color spectrophotometer, 28 shade polarized, telecentric measurement, 307,200 px 0.03 mm for 54.5% to 80.2% 82.7% to 96.9% Research AG,
TABATABAIAN ET AL.

imaging digital camera, LCD guides, telecentric, 18  14 mm with (0.92 MB per each point and from 0.86 and from 0.65 to Niederhasli,
touchscreen. 2 pens, tooth color/ monochromatic 640  480 points image) to 2.45 ΔEab units 1.69 ΔEab units, Switzerland
base unit, 6 sterilizable translucency less than ΔEab
mouthpieces, white map, triple-zone of 0.5 on teetha
and green calibration tooth color
plates, software
Crystaleye Spectrophotometer/ Cordless handheld CIELab, CIELCh, 7-band 0
Entire tooth 434,000 px 10 nm, 1 nm Reported from Reported from Olympus
Digital color spectrophotometer, VITA classical, LED, 2  45
measurement, (1.3 MB per intervals 44.05% to 88.8% to 98.97% Corporation,
imaging digital camera, LCD VITA 3D-Master, 18  11.5 mm tooth image) for each pixel 91.25% and from 0.13 Tokyo, Japan
screen. Cradle, Chromascop and from to 1.4 ΔEab units
contact caps, reference Vintage Halo NCC 1.03 to
calibration plate, shades, Noritake 1.89 ΔEab
Crystaleye Application units
Master (software)
Shade-X Spectrophotometer Cordless handheld VITA classical, LED 0
Spot measurement, Not applicable Unknown Unknown Unknown X-Rite, Inc.,
spectrophotometer, VITA 3D-Master, Probe tip = 3 mm Grand
LCD screen, cradle, Chromascop diameter Rapids, MI
disposable tips (24), Esthet-X,
disposable protective Bioform,
barriers (24), calibration Empress CAD,
plaque e.max
CAD, 3 M
Paradigm C,
body and incisal
shades
Shadepilot Spectrophotometer/ Cordless handheld CIELab, CIELCh, LED, 2  45
, 0
, polarized, Entire tooth 640  480 = 307, 10 nm. 0.03  Reported from Reported from DeguDent
Digital color spectrophotometer, different polarized, telecentric measurement, 200 px (0.92 0.03 mm for 77.7% to 89.4% to 93.8%, GmbH,
imaging digital camera, shade guides, telecentric, 18  14 mm with MB per image) each dot 87.5% and from 0.1 to Hanau,
LCD touchscreen, tooth color/ monochromatic 640  480 dots 2.6 ΔEab units, Germany
2 pens, base unit, translucency less than ΔEab
a
6 sterilizable map, triple- of 0.5 on teeth
mouthpieces, white zone tooth color
and green calibration
plates, software
Zfx Shade Spectrophotometer/ Cordless handheld CIELab, CIELCh, LED, 2  45
, 0
, polarized, Entire tooth 640  480 = 10 nm. 0.03  Unknown Less than ΔEab Zfx GmbH,
Digital color spectrophotometer, different shade polarized, telecentric measurement, 307,200 px 0.03 mm for of 0.5 on teetha Dachau,
imaging digital camera, LCD guides, tooth telecentric, 18  14 mm with (0.92 MB per each point Germany
touchscreen, 2 pens, color/ monochromatic 640  480 points image
base unit, 6 sterilizable translucency
mouthpieces, white and map, triple-zone
green calibration plates, tooth color
software
TRIOS 3 Basic Intraoral scanner Handheld scanner, 3Shape VITA classical, LED Different Entire tooth 1280  1024 px 41.21 points Reported from Reported from 3Shape A/S,
TRIOS Color software, VITA 3D-Master angles measurement (Cart monitor) per mm2 51% to 66% 76.67% to Copenhagen,
color calibration tool 1920  1080 px 86.66% Denmark
(MOVE monitor)
TRIOS 3 Intraoral scanner Wireless handheld scanner, VITA classical, LED Different Entire tooth 1280  1024 px Unknown Reported from Reported from 3Shape A/S,
3Shape TRIOS Color VITA 3D-Master angles measurement (Cart monitor) 27.5% to 53.3%, 87.17% to Copenhagen,
software, color 1920  1080 px and from 2.8 to 90.33% Denmark
calibration tool (MOVE monitor) 3.3 ΔEab units

(Continues)
11
 12 TABATABAIAN ET AL.

measurements are shown to be affected by random and systematic

errors.199

Dentsply Sirona,

Dentsply Sirona,
Manufacturer

York, PA

York, PA
4.2.2 | Accuracy and precision of colorimeters
Reported 51.9%,

Reported 49%
Several studies have evaluated the accuracy/precision of dental color-
imeters. Yamanel et al.156 and Caglar et al.200 reported that a Fuji S20
Precision

Pro digital camera with Adobe Photoshop CS2 software could be used
as a substitute for a ShadeEye NCC colorimeter in terms of accuracy
and from 2.5 to
12.9% to 57%,

3.0 ΔEab units

when a combination of 2700 K and 6500 K lighting, a 10-cm shooting

Reported from

Reported 63%

distance, and proper camera settings were set.200 However, the cam-
Accuracy

era and colorimeter outputs showed only 30% CIELab similarities,156

due to differences in L* and b* values regardless of close a* values.200
Reports on the accuracy and precision of colorimeters have been
79.82 points
per mm2

questionable. Gehrke et al.122 suggested that the use of ShadeVision

resolution

Unknown
Spectral/
optical

colorimeter with software (V.1.20) or Shadepilot spectrophotometer

with software (V. 2.41) was more precise than the visual method,
1920  1080 px

1920  1080 px

while the colorimeter showed 10–20% lower precision and lighter

shades compared to the spectrophotometer.122 Conversely, Li and
(monitor)

(monitor)
resolution

Wang201 reported that the precision of shade selection could not be

Digital

certified by the ShadeEye NCC or Vintage Halo shade guide; nonethe-

less, shade results were better for the colorimeter than for the shade
Measurement area

measurement

measurement

guide. Similarly, Kuzmanovic and Lyons202 observed no significant dif-

Entire tooth

Entire tooth

ference between the ShadeVision and visual method regarding preci-

sion. Also, Klemetti et al.194 showed no significant difference between
the accuracies of ShadeEye NCC and visual method. Knösel et al.203
reported that the differences between the results of digital photogra-
Recording

Different

Different
angles

angles

Note: Data collected from the manufactures' websites, product brochures/user manuals, and the articles cited in this study.

phy and colorimetry were less than the sensitivity of human eyes
(ΔEab < 2.85).
As various dental colorimeters with diverse accuracies and preci-
unpolarized

unpolarized
Light source

White LED,

White LED,

sions have been assessed, controversial results have been obtained

when comparing colorimeters with other shade measuring methods.
Hence, the generalization of results is not rational and more research
is needed.
VITA 3D-Master

VITA 3D-Master
VITA classical,

VITA classical,
Capabilities

4.3 | Spectrophotometers

Spectrophotometers can measure the color by assessing the spectral

color calibration tool

color calibration tool

Connect software,
CEREC software,

reflectance or transmittance curve of objects. A spectrophotometer

Handheld scanner,

Handheld scanner,

has a tungsten-filament bulb or LED lamp as a white light source to

CEREC and
Components

create a light output with the wavelength between 400 and 700 nm.
The light is depressed by a prism into a spectrum of wavelength bands
between 10 and 20 nm, reaches the object, and may then reflect,
pass, or scatter. The amount of light emitted from or transmitted
Intraoral scanner

Intraoral scanner
(Continued)

through the object is assessed for each wavelength band in the visible
declared by the manufacturer.

spectrum. A handheld spectrophotometer should have shockproof

Type

ability, easy control, rapid measurement, acceptable working life,

appropriate light source, reasonable price, and high accuracy and pre-
Device name

Omnicam
TABLE 2

Primescan

cision. Some types of dental spectrophotometers can isolate the oral

CEREC

cavity from external light using a mouthpiece eliminating effects of

ambient light on color measurements.123,137 Spectrophotometers can
a
TABATABAIAN ET AL.
be classified based on their measurement geometry into two types:
entire tooth surface measurement and spot measurement while show-
ing some differences in the angle of irradiance/reflection, lighting,
sensors, and filters.204,205 Color measurements are usually converted
to a corresponding shade tab. Compared to other shade taking
devices, spectrophotometers show higher accuracy with longer work-
206
ing life without sensitivity to object metamerism, while providing a
33% increase in precision14 and representing the most suitable tooth
206–209
color measurements at the present time. A list of available den-
tal spectrophotometers is presented in Table 2.
VITA Easyshade spectrophotometer measures CIELab/CIELCh
values and determines the tooth shade based on VITA 3D-Master and
VITA classical. It has a 20 W halogen bulb providing a D65 illuminant
as declared by the manufacture. Five generations of the device have
been released to enhance its capabilities. VITA Easyshade Compact
and Advance 4.0 are advanced forms, while the newest generation is
named VITA Easyshade V. To prevent the specular/mirror-like reflec-
tion that has a negative effect on measurements, a stainless-steel
probe containing fiber optics with a large diameter has been specially
designed. The probe's diameter is 5 mm and has 2 apertures with 1-
and 3- mm diameters. The device has 2 measurement modes based
on the distance of the probe tip from the surface. The “dental mode”
is used for a longer distance to measure the tooth color, while the
“restorative mode” is employed for a shorter distance to measure the
ceramic color. 10
SpectroShade is another dental spectrophotometer which is accu-
rate, fast, and easy to use and one of the most representative.
SpectroShade Micro combines digital color imaging with spectropho-
tometry based on a LED technology. This instrument benefits from a
linear polarized filter which excludes reflections caused by gloss. Vari-
ous shade guides data are saved in the device memory and captured
images can be compared with different shades. Its software can do
fine and coarse color mapping, send data to laboratories with e-mail,
and overlap the tooth image with the restoration image to allow for
virtual examination. SpectroShade Micro can compare two color mea-
surements allowing evaluations before and after treatment, checking
that the restoration is a faithful copy of the original tooth,
and enabling to map inhomogeneities of the tooth surface.10 An
advantage for the Crystaleye spectrophotometer is the ability of
cross-referencing the virtual shade tabs and superimposing them
on the tooth image.14 A 7-band LED light and external light isolation
of this device provides higher consistency compared to digital
14
photography.
4.3.1 | Effective factors and conditions related to
spectrophotometers
Main factors that may affect spectrophotometric measurements
include the magnitude of the surface being measured (spot vs. entire
tooth surface), correct centering, positioning and angulations of the
probe, the performance of color analysis software of the device, and
the device shade guide mode. Crystaleye and SpectroShade are entire
13
tooth surface measurement spectrophotometers, while they deter-
mine the tooth shade by averaging out the color information and two-
dimensional color mapping of the tooth surface which may lead to
inaccurate shade results.14 In comparison with entire-measurement
devices, spot-measurement devices may not be quite accurate due to
possibly inconsistent measurement of the curved tooth surface,210
uneven shade of the tooth, the likelihood for tooth dehydration, and
errors in image capture.211 Nevertheless, spot-measurements with
the probe tip have been reported to be more accurate.204 Obviously,
handling errors in clinical settings caused by patient movements, fog-
ging, the probe position/angle, and the tooth location/inclination can
affect the results of different devices.
Tooth position impacts spectrophotometric results. Both repeat-
ability and reproducibility of SpectroShade are affected by the tooth
type (posterior teeth, lower incisors) and the tooth surface (mesial or
distal areas)197; thus, caution should be taken when measuring the
color of curved surfaces of posterior teeth and labial surfaces of lower
incisors. Handling conditions (standardized or freehand) definitely
impact the outcomes.208 In this regard, using custom-made acrylic jigs
is proposed for preventing the effect of probe angulation and also
measuring similar tooth areas.212 To tackle handling errors, Angle
Control System incorporated in SpectroShade Micro makes the cor-
rect centering and angulation of image capture possible. However, an
acquisition angle less than 3
is hard to achieve. Only if this angle
deviates more than 5
from the ideal angle, the image is regarded as
incorrect. Image capturing is impacted by the color and morphology of
oral cavity. Hence, potential errors during image acquisition should be
prevented by noticing opposing teeth, lips, and, tongue and gaining
acquisition angles less than 3
.213
Owing to the device color analyzing software which converts the
CIELab format to the shade of a shade guide, the device shade guide
mode may play a role in shade results.208 For example, in contrast to
SpectroShade Micro, the repeatability and accuracy of ShadeVision
are negatively influenced by Vita classical mode.208,211,212 As this
effect may not be related to the device optical geometry, making a
judgment on the effect of shade guide type is difficult.
4.3.2 | Accuracy and precision of
spectrophotometers
The accuracy and precision of various spectrophotometers have been
evaluated by investigators22,122,207,208,210,211,213–222; however, they
are not consistent in terms of the most accurate device or condition.
In a study by Odaira et al.215 the precision of Crystaleye and MSC-
2000 Olympus multispectral camera was measured in comparison
with Color Analyzing Spectrophotometer-Iwate (CAS-ID1) as a stan-
dard device. Though there were no significant differences in the L*
and C* values recorded by the devices, Crystaleye was the most pre-
cise in both lighted and darkened room.215 Crystaleye indicates
acceptable accuracy (44.05%–91.25%, 1.03–1.89 ΔEab units), excel-
lent repeatability (88.81%–98.97%, 0.13 to–0.24 ΔEab units), and
proper reproducibility (similar results with different examiners/
14
illuminants/shade guides/tooth regions),223,224 presents the best per-
formance in the tooth middle region,223 and is capable of shade mea-
216
suring of bleached teeth. Crystaleye Application Master 1 is color
analyzing software that not only delivers numerical color data, but
22
also provides digital images.
In another study comparing five color measuring devices
(ShadeScan, Easyshade, Ikam, IdentaColor II, and ShadeEye), the
highest in vivo precision was reported for Easyshade and Ikam, while
the in vitro performance of the other devices was better.217 However,
the most precise device in either conditions was Easyshade.217 Also, a
high precision (>96%) was reported for SpectroShade, ShadeVision,
Easyshade, and ShadeScan after repeated measurements, while the
highest and lowest accuracies were recorded for Easyshade and
ShadeVision, respectively.207 However, the accuracy and precision of
218
ShadeScan was affected by the shade guide mode.
Easyshade and SpectroShade Micro delivered higher b* and
higher a* values, respectively, in a study,210 maybe because of their
diverse optical geometries and also the smaller irradiation area of
Easyshade that could affect CIELab values. Since CIELab values may
not be reproducible between different devices, the same device
should be used in clinical and laboratory conditions.210 Klotz
et al.219,221 revealed that Easyshade Advance 4.0 and V were accurate
and precise while being comparable regarding color measurements for
incisors and premolars. The accuracy and precision of Easyshade may
be negatively affected in the freehand conditions,208 while
SpectroShade is more precise than Easyshade in vivo.211 Although the
first generation of Easyshade showed less accuracies compared to a
reference device (ΔEab = 13.4–15.4),225 based on a systematic
review, Easyshade provides high accuracy and precision surpassing a
photo-colorimetric method.220 No significant differences may exist
between the color matching results of the crowns fabricated using
Easyshade or Shadepilot, despite their explicit advantage over visual
methods.226 In an in vivo study by Koumpia et al.213 SpectroShade
Micro showed precise color measurements with systematic and ran-
dom errors below the perceptibility threshold (ΔΕab < 1). Spectropho-
tometers may distinguish slight color differences as their limit of
detection during in vitro quantification of monochromatic objects is
ΔΕab = 0.1,as claimed by some manufacturers.
The tooth type affects the reproducibility of measurements, while
only the b* value may not be impacted by the acquisition angle
213
emphasizing the importance of setting this angle correctly. The
most precise measurements have been documented for upper inci-
sors, whereas the greatest color differences have been recorded for
197
lower central incisors and upper first premolars. This might be
because of the surface curvature of premolars and the resulting
adverse effect on the uniform light reflected back to the device.222
Moreover, difficult positioning of the optical head of the device's
imaging camera on lower incisors and possible mandible movements
during image capturing may justify these findings. Using a custom-
made alignment device may avoid the mentioned potential errors
196
when using the handheld devices.
There are low agreements between the CIELab values measured
by visual and digital methods, reported from 38.8% to 67.4% and from
TABATABAIAN ET AL.
3.62 to 4.54 ΔΕab units,227 and also between those of spectropho-
tometers or colorimeters, assessed from 4.06 to 16.04 ΔΕab units.228
Hence, not only should not different devices from various brands be
used interchangeably,195,229 but also the interchangeable use of iden-
tical devices from a brand is a cause for concern. Kim230 reported that
2 EasyShade Vs with diverse serial numbers revealed acceptable
CIELab values regarding repeatability but showed only 52% inter-
device matching accuracy leading to determination of different shades
for the same tooth.
Dental spectrophotometers present remarkable precision rather
than excellent accuracy231,232; however, considering their accuracy
(from 66.8% to 92.6%) and precision (from 87.4% to 99.0%,), they are
a paragon among shade determination methods.123,207,233 Future
studies may help to overcome their limitations and produce state-of
the-art dental spectrophotometers.
4.4 | Intraoral scanners
Although intraoral scanners have been initially used for digital impres-
sion, a tool for dental shade measurement has been added to some
scanners. The tool uses a high definition camera included into a hand-
held digital scanner. After scanning of the tooth with LED light, the
tooth color is estimated with software and shown according to VITA
shades rather than color parameters. The selected shade and the digi-
tal impression are utilized for the restoration fabrication.234 A list of
available intraoral scanners with shade measuring ability is presented
in Table 2.
4.4.1 | Effective factors and conditions related to
intraoral scanners
Color imaging and data processing are two major requirements for
intraoral scanners to be considered as a viable means for shade selec-
tion. Though intraoral scanners can measure the tooth color and col-
lect three-dimensional tooth surface data, their color matching ability
may be affected by some factors emerging some deficiencies.235
Intraoral scanners display the color results based on dental shade
guides. In a study by Liberato et al.236 assessing a TRIOS intraoral
scanner and a VITA Easyshade Advance 4.0, the best performance for
the scanner was configured for the Vita 3D-Master mode. Yoon
et al.235 found significant differences between the TRIOS Pod
intraoral scanner and the ShadeEye colorimeter in color parameters
owing to the lower L* and b* values and higher a* values measured by
the scanner, and therefore, an intraoral scanner might not be mainly
used for shade selection.235 However, benefiting from a high-
definition camera, LED light, color analyzing software, and VITA shade
guides as references,234 newer scanners such as TRIOS 3 show not
only superiority over the visual method,137,237–239 but also compara-
ble results to spectrophotometers.234,238
On the bright side, the shade matching of intraoral scanners is
not affected by the operator gender or experience.239 Exploiting real-
TABATABAIAN ET AL.
color scanning, TRIOS 3 can perform color selection with satisfactory,
low mean ΔEab values.137,238,240 Though some shade taking devices
reduce the tooth color data to a single code (e.g., A2), scanners pre-
241
sent detailed color information.
The variation of reports might be originated from differences in
light reflection/detection system, different light sources (LED and a
fluorescent lamp for scanners and Xenon lamp for colorimeters), and
different color analyzing software algorithms.22,200 Other dipartites
between colorimeters and scanners include the differences between
the size of measuring tips or measurement area which is much smaller
in colorimeters than scanners. Scanners assess the entire surface of
the tooth from different angles; however, colorimeters measure the
color with a parallel alignment in close contact with the surface.242
Moreover, both devices are affected by inaccurate manipulation, dif-
ferent image capture system, and poor color analyzing software.
In contrast to spectrophotometers, shade determination by
intraoral scanners using VITA classical or 3D-Master mode can be
affected by different lighting conditions (10000-, 1000-, 500-, and
243
0-lx.). Thus, the use of an additional instrument is suggested for
shade assessment.243 However, Yilmaz et al.244 stated that lighting
conditions (4000 or 6500 K) had no effect on the shade results of
visual method using VITA 3D-Master and digital methods using
Easyshade Compact or TRIOS. The shade guide mode of scanners
impacts the results. The accuracy/precision of TRIOS 3 is greater
when the color is registered as VITA 3D-Master shades (53.3% for
accuracy, 90.3% for precision) rather than VITA classical shades
245
(27.5% for accuracy, 87.2% for precision). Moreover, the shade
results of an intraoral scanner do not exactly match those of a spec-
trophotometer.245 In general, shade selection using scanners is
influenced by elements such as ambient light, image capture, color
analyzing software, and the shade guide mode used.
4.4.2 | Accuracy and precision of intraoral scanners
Shade matching accuracy/precision of scanners have been studied.
Gotfredsen et al.234 reported that TRIOS was as good as
SpectroShade Micro regarding shade results. Based on Mehl et al.238
TRIOS 3 has a lower shade matching accuracy compared to
SpectroShade Micro, SpectroShade, VITA Easyshade, and VITA
Easyshade Advance 4.0. The precision of TRIOS 3 seems acceptable
(>85%),239,245 but the accuracy of this device is less than that of a val-
245
idated spectrophotometer.
Intraoral scanners and spectrophotometers are more precise than
visual methods using shade guides by expert clinicians with or without
a light-correcting device.236 Although some investigators advocate
the use of an intraoral scanner as an alternative to a spectrophotome-
ter for shade taking,244 others conclude unacceptable shade matching
accuracy for a scanner such as CEREC Omnicam.246 The color mea-
suring precision of TRIOS may be up to 86.66%,236 while the precision
of TRIOS 3 is estimated from 87.17% to 90.33%.245 Ebeid et al.247
assessed the accuracy/precision of different scanners in comparison
with VITA Easyshade V. The accuracy was 78% for Easyshade V, 66%
15
for TRIOS, 57% for Omnicam, and 63% for Primescan, while the preci-
sion ranged between 44.3% (Easyshade V) and 51.9% (Omnicam).247
A positioning jig, as used for other devices,212,248 cannot be utilized to
enhance scanners' precision owing to scanning mechanism. Scanners
may report lighter shades compared to spectrophotometers and visual
methods due to their unpolarized light source.249
In spite of technological differences among available intraoral
scanners, they seem precise but not accurate for shade taking. Hence,
intraoral scanners have not been solely advised for tooth shade
selection yet.
5 | CONC LU SIONS
Tooth shade selection is a complicated task fundamentally affecting
esthetic outcomes of restorative treatments. To improve the accuracy
and precision of shade determination, successful efforts have been
made to make a shift from subjective visual methods to objective digi-
tal methods. Based on the current literature, the digital methods show
higher accuracy and precision compared to the visual methods; how-
ever, the accuracy of the digital methods should be enhanced to
achieve ideal shade taking results. Also, dental spectrophotometers
provide the highest overall accuracy and precision among different
shade selection methods while needing clinical setting to control
related effective factors/conditions and technological improvement to
perform optimally. Further studies are required for tackling the weak-
nesses of digital devices and improving their accuracy and precision in
order to completely replace the visual methods with the digital
methods in the future.
DISCLOS URE
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influ-
ence the work reported in this paper. The authors do not have any
financial interest in the companies whose materials are included in this
article.
FUNDING
This study was not financially supported by any organization or insti-
tute. The authors funded this project.
OR CID
Farhad Tabatabaian https://orcid.org/0000-0003-2394-6643
Elaheh Beyabanaki https://orcid.org/0000-0002-9389-8838
RE FE RE NCE S
1. Nickerson D. The Munsell color system. Illum Eng. 1946;41:549-560.
2. Brennan JG, Newhall SM. I.C.I. specifications of difference limens for
Munsell hue, value, and chroma. J Opt Soc Am. 1948;38:696-702.
3. Billmeyer FW Jr, Webber AC. Three-dimensional color models con-
structed on the CIE and Munsell systems. J Opt Soc Am. 1953;43:
69-70.
4. Smith T, Guild J. The C.I.E. colorimetric standards and their use.
Trans Opt Soc. 1931;33:73-134.
16
5. Wyszecki G, Sanders CL. Correlate for lightness in terms of CIE-
tristimulus values. Ii J Opt Soc Am. 1957;47:840-842.
6. Valberg A. A visual tristimulus projection colorimeter. Appl Optics.
1971;10:8-13.
7. Manly RS. Tristimulus photoelectric colorimetry of human incisors.
J Dent Res. 1947;26:459.
8. Beckman AO, Gallaway WS, Kaye W, et al. History of spectropho-
tometry at Beckman instruments Inc. Anal Chem. 1977;49:280A-
300A.
9. Gibson KS, Balcom MM. Transmission measurements with the
Beckman quartz spectrophotometer. J Opt Soc Am. 1947;37:593-608.
10. Vichi A, Louca C, Corciolani G, Ferrari M. Color related to ceramic
and zirconia restorations: a review. Dent Mater. 2011;27:97-108.
11. Sproull RC. Color matching in dentistry. I. the three-dimensional
nature of color. J Prosthet Dent. 1973;29:416-424.
12. Sproull RC. Color matching in dentistry. II. Practical applications for
the organization of color. J Prosthet Dent. 1973;29:556-566.
13. Sproull RC. Color matching in dentistry. Part III. Color control.
J Prosthet Dent. 1974;31:146-154.
14. Chu SJ, Trushkowsky RD, Paravina RD. Dental color matching
instruments and systems. Review of clinical and research aspects.
J Dent. 2010;38(Suppl 2):e2-e16.
15. McLaren K. XIII—the development of the CIE 1976 (L* a* b*) uniform
colour space and colour-difference formula. J Soc Dyers Colour.
1976;92:338-341.
16. Robertson AR, The CIE. 1976 color-difference formulae. Color Res
App. 1977;2:7-11.
17. Aspland JR, Jarvis CW, Jarvis JP. A review and assessment of numer-
ical shade sorting methods. J Soc Dyers Colour. 1990;106:315-320.
18. Kuehni RG. Color-tolerance data and the tentative CIE 1976 L a b
formula. J Opt Soc Am. 1976;66:497-500.
19. Melgosa M, Huertas R, Berns RS. Performance of recent advanced
color-difference formulas using the standardized residual sum of
squares index. J Opt Soc Am A Opt Image Sci Vis. 2008;25:1828-
1834.
20. Lissner I, Urban P. Upgrading color-difference formulas. J Opt Soc
Am A Opt Image Sci Vis. 2010;27:1620-1629.
21. Tabatabaian F. Color in zirconia-based restorations and related fac-
tors: a literature review. J Prosthodont. 2018;27:201-211.
22. Okubo SR, Kanawati A, Richards MW, Childress S. Evaluation of
visual and instrument shade matching. J Prosthet Dent. 1998;80:
642-648.
23. Glockner K, Glockner K, Haiderer B. Visual vs. spectrophotometric
methods for shade selection. Coll Antropol. 2015;39:801-802.
24. Oh WS, Koh IW, O'Brien WJ. Estimation of visual shade matching
errors with 2 shade guides. Quintessence Int. 2009;40:833-836.
25. Paravina RD, Majkic G, Imai FH, Powers JM. Optimization of tooth
color and shade guide design. J Prosthodont. 2007;16:269-276.
26. O'Brien WJ, Groh CL, Boenke KM. One-dimensional color order sys-
tem for dental shade guides. Dent Mater. 1989;5:371-374.
27. O'Brien WJ, Groh CL, Boenke KM. A new, small-color-difference
equation for dental shades. J Dent Res. 1990;69:1762-1764.
28. Li Q, Yu H, Wang YN. In vivo spectroradiometric evaluation of col-
our matching errors among five shade guides. J Oral Rehabil. 2009;
36:65-70.
29. O'Brien WJ, Boenke KM, Groh CL. Coverage errors of two shade
guides. Int J Prosthodont. 1991;4:45-50.
30. O'Brien WJ, Hemmendinger H, Boenke KM, et al. Color distribution
of three regions of extracted human teeth. Dent Mater. 1997;13:
179-185.
31. Bayindir F, Kuo S, Johnston WM, Wee AG. Coverage error of three
conceptually different shade guide systems to vital unrestored den-
tition. J Prosthet Dent. 2007;98:175-185.
32. Shotwell JL, Johnston WM, Swarts RG. Color comparisons of den-
ture teeth and shade guides. J Prosthet Dent. 1986;56:31-34.
TABATABAIAN ET AL.
33. Paolone G, Orsini G, Manauta J, Devoto W, Putignano A. Composite
shade guides and color matching. Int J Esthet Dent. 2014;9:164-182.
34. Barutcigil C, Harorli OT, Yildiz M, Ozcan E, Arslan H, Bayindir F. The
color differences of direct esthetic restorative materials after setting
and compared with a shade guide. J Am Dent Assoc. 2011;142:
658-665.
35. Barrett AA, Grimaudo NJ, Anusavice KJ, Yang MC. Influence of tab
and disk design on shade matching of dental porcelain. J Prosthet
Dent. 2002;88:591-597.
36. Carney MN, Johnston WM. Appearance differences between lots
and brands of similar shade designations of dental composite resins.
J Esthet Restor Dent. 2017;29:E6-E14.
37. Lee YK, Yu B, Lee SH, et al. Shade compatibility of esthetic restor-
ative materials-a review. Dent Mater. 2010;26:1119-1126.
38. Tabatabaian F, Bakhshaei D, Namdari M. Effect of resin cement
brand on the color of zirconia-based restorations. J Prosthodont.
2020;29:350-355.
39. Migliau G, Piccoli L, Besharat LK, Romeo U. Benchmarking matching
color in composite restorations. Ann Stomatol (Roma). 2016;7:29-37.
40. Kim BJ, Lee YK. Influence of the shade designation on the color dif-
ference between the same shade-designated resin composites by
the brand. Dent Mater. 2009;25:1148-1154.
41. Habib SR, Shiddi IF. Comparison of shade of ceramic with three dif-
ferent zirconia substructures using spectrophotometer. J Contemp
Dent Pract. 2015;16:135-140.
42. Wieder S. Custom shade guide system for composite resins. J Esthet
Dent. 1990;2:10-12.
43. Wee AG, Kang EY, Jere D, et al. Clinical color match of porcelain
visual shade-matching systems. J Esthet Restor Dent. 2005;17:
351-357.
44. Gurrea J, Gurrea M, Bruguera A, et al. Evaluation of dental shade
guide variability using cross-polarized photography. Int J Periodontics
Restorative Dent. 2016;36:e76-e81.
45. Sampaio CS, Gurrea J, Gurrea M, et al. Dental shade guide variability
for hues B, C, and D using cross-polarized photography. Int J Peri-
odontics Restorative Dent. 2018;38:s113-s118.
46. Yap AU. Color attributes and accuracy of Vita-based manufacturers'
shade guides. Oper Dent. 1998;23:266-271.
47. Martinez-Verdu F, Perales E, Chorro E, et al. Computation and visu-
alisation of the MacAdam limits for any lightness, hue angle and light
source. J Opt Soc Am A Opt Image Sci Vis. 2007;24:1501-1515.
48. Dagg H, O'Connell B, Claffey N, et al. The influence of some differ-
ent factors on the accuracy of shade selection. J Oral Rehabil. 2004;
31:900-904.
49. McLaren EA. Luminescent veneers. J Esthet Dent. 1997;9:3-12.
50. Curd FM, Jasinevicius TR, Graves A, Cox V, Sadan A. Comparison of
the shade matching ability of dental students using two light
sources. J Prosthet Dent. 2006;96:391-396.
51. Nakhaei M, Ghanbarzadeh J, Keyvanloo S, Alavi S, Jafarzadeh H.
Shade matching performance of dental students with three various
lighting conditions. J Contemp Dent Pract. 2013;14:100-103.
52. Najafi-Abrandabadi S, Vahidi F, Janal MN. Effects of a shade-
matching light and background color on reliability in tooth shade
selection. Int J Esthet Dent. 2018;13:198-206.
53. Gasparik C, Grecu AG, Culic B, Badea ME, Dudea D. Shade-matching
performance using a new light-correcting device. J Esthet Restor
Dent. 2015;27:285-292.
54. Clary JA, Ontiveros JC, Cron SG, Paravina RD. Influence of light
source, polarization, education, and training on shade matching qual-
ity. J Prosthet Dent. 2016;116:91-97.
55. Suliman S, Sulaiman TA, Olafsson VG, Delgado AJ, Donovan TE,
Heymann HO. Effect of time on tooth dehydration and rehydration.
J Esthet Restor Dent. 2019;31:118-123.
56. Monetti L. How to match the real thing. Tips on choosing shades for
artificial teeth. Dent Teamwork. 1993;6:38-39.
TABATABAIAN ET AL.
57. Paravina RD. Clinical appraisal. Color in dentistry: improving the odds
and correct shade selection. J Esthet Restor Dent. 2009;21:202-208.
58. McLaren EA. Shade analysis and communication. Inside Dent. 2010;
6:58-66.
59. Burki Z, Watkins S, Wilson R, Fenlon M. A randomised controlled
trial to investigate the effects of dehydration on tooth colour.
J Dent. 2013;41:250-257.
60. Hasegawa A, Ikeda I, Kawaguchi S. Color and translucency of in vivo
natural central incisors. J Prosthet Dent. 2000;83:418-423.
61. Goodkind RJ, Schwabacher WB. Use of a fiber-optic colorimeter for
in vivo color measurements of 2830 anterior teeth. J Prosthet Dent.
1987;58:535-542.
62. Schwabacher WB, Goodkind RJ, Lua MJ. Interdependence of the
hue, value, and chroma in the middle site of anterior human teeth.
J Prosthodont. 1994;3:188-192.
63. Joiner A. Tooth colour: a review of the literature. J Dent. 2004;
32(Suppl 1):3-12.
64. Winter R. Visualizing the natural dentition. J Esthet Dent. 1993;5:
102-117.
65. Terry DA, Geller W, Tric O, et al. Anatomical form defines color:
function, form, and aesthetics. Pract Proced Aesthet Dent. 2002;14:
59-67.
66. Dozic A, Kleverlaan CJ, Aartman IH, Feilzer AJ. Relations in color
among maxillary incisors and canines. Dent Mater. 2005;21:187-191.
67. Reno EA, Sunberg RJ, Block RP, Bush RD. The influence of lip/gum
color on subject perception of tooth color. J Dent Res. 2000;79:381.
68. Passon C, Lambert R. Tooth-shade shift after rubber-dam isolation.
Gen Dent. 1994;42:148-152.
69. Bhat V, Prasad DK, Sood S, Bhat A. Role of colors in prosthodontics:
application of color science in restorative dentistry. Indian J Dent
Res. 2011;22:804-809.
70. Fondriest J. Shade matching in restorative dentistry: the science and
strategies. Int J Periodontics Restorative Dent. 2003;23:467-479.
71. Jun SK. Shade matching and communication in conjunction with
segmental porcelain buildup. Pract Periodontics Aesthet Dent. 1999;
11:457-464.
72. Damirel MG, Tuncdemir MT. Influence of age, gender, and educa-
tional background on tooth color. Niger J Clin Pract. 2019;22:
162-166.
73. Kim HK. A study on the color distribution of natural teeth by age
and gender in the Korean population with an intraoral spectropho-
tometer. J Esthet Restor Dent. 2018;30:408-414.
74. Turgut S, Kilinc H, Eyupoglu GB, Bagis B. Color relationships of natu-
ral anterior teeth: an in vivo study. Niger J Clin Pract. 2018;21:
925-931.
75. Pustina-Krasniqi T, Shala K, Staka G, Bicaj T, Ahmedi E, Dula L. Light-
ness, chroma, and hue distributions in natural teeth measured by a
spectrophotometer. Eur J Dent. 2017;11:36-40.
76. Pustina-Krasniqi T, Xhajanka E, Ajeti N, Bicaj T, Dula L, Lila Z. The
relationship between tooth color, skin and eye color. Eur Oral Res.
2018;52:50-55.
77. Al-Nsour HF, Al-Zoubi TT, Al-Rimawi AS. Relationship between
tooth value and skin color in patients visiting Royal Medical Services
clinics of Jordan. Electron Physician. 2018;10:6448-6453.
78. Haddad HJ, Jakstat HA, Arnetzl G, et al. Does gender and experience
influence shade matching quality? J Dent. 2009;37(Suppl 1):e40-e44.
79. Pohlen B, Hawlina M, Šober K, Kopač I. Tooth shade-matching abil-
ity between groups of students with different color knowledge. Int J
Prosthodont. 2016;29:487-492.
80. Poljak-Guberina R, Celebic A, Powers JM, et al. Colour discrimina-
tion of dental professionals and colour deficient laypersons. J Dent.
2011;39(Suppl 3):e17-e22.
81. Alomari M, Chadwick RG. Factors influencing the shade matching
performance of dentists and dental technicians when using two dif-
ferent shade guides. Br Dent J. 2011;211:E23.
17
82. Capa N, Malkondu O, Kazazoglu E, Calikkocaoglu S. Evaluating fac-
tors that affect the shade-matching ability of dentists, dental staff
members and laypeople. J Am Dent Assoc. 2010;141:71-76.
83. Samra APB, Moro MG, Mazur RF, et al. Performance of dental stu-
dents in shade matching: impact of training. J Esthet Restor Dent.
2017;29:E24-E32.
84. Bahannan SA. Shade matching quality among dental students using
visual and instrumental methods. J Dent. 2014;42:48-52.
85. Nakhaei M, Ghanbarzadeh J, Amirinejad S, Alavi S, Rajatihaghi H.
The influence of dental shade guides and experience on the accu-
racy of shade matching. J Contemp Dent Pract. 2016;17:22-26.
86. Milagres V, Teixeira ML, Miranda ME, Osorio Silva CH, Ribeiro
Pinto JR. Effect of gender, experience, and value on color percep-
tion. Oper Dent. 2012;37:228-233.
87. Kitasako Y, Sadr A, Nikaido T, Tagami J. Relationship between per-
ception of difficulty and clinical experience of approximal composite
restorations in final-year undergraduate students at Tokyo medical
and dental university. J Med Dent Sci. 2011;58:1-5.
88. Della Bona A, Barrett AA, Rosa V, Pinzetta C. Visual and instrumental
agreement in dental shade selection: three distinct observer populations
and shade matching protocols. Dent Mater. 2009;25:276-281.
89. Ristic I, Stankovic S, Paravina RD. Influence of color education and
training on shade matching skills. J Esthet Restor Dent. 2016;28:287-294.
90. Alfouzan AF, Alqahtani HM, Tashkandi EA. The effect of color train-
ing of dental students' on dental shades matching quality. J Esthet
Restor Dent. 2017;29:346-351.
91. Olms C, Klinke T, Pirek P, et al. Randomized multi-Centre study on
the effect of training on tooth shade matching. J Dent. 2013;41:
1259-1263.
92. Llena C, Forner L, Ferrari M, Amengual J, Llambes G, Lozano E.
Toothguide training box for dental color choice training. J Dent Educ.
2011;75:360-364.
93. Olms C, Jakstat H. Learning shade differentiation using Toothguide
trainer and Toothguide training box: a longitudinal study with dental
students. J Dent Educ. 2016;80:183-190.
94. Woldeamanuel GG, Geta TG. Prevalence of color vision deficiency
among school children in Wolkite Southern Ethiopia. BMC Res Notes.
2018;11:838.
95. Simunovic M. Acquired color vision deficiency. Surv Ophthalmol.
2016;61:132-155.
96. Piro A, Tagarelli A, Nicoletti G, et al. Impairment of acquired color
vision in multiple sclerosis: an early diagnostic sign linked to the
greatness of disease. Int Ophthalmol. 2018;39:671-676. https://doi.
org/10.1007/s10792-018-0838-x
97. Gella L, Raman R, Kulothungan V, et al. Color vision abnormalities in
type II diabetes: Sankara Nethralaya diabetic retinopathy epidemiol-
ogy and molecular genetics study II report no 2. Indian J Ophthalmol.
2017;65:989-994.
98. Bambo MP, Ferrandez B, Güerri N, et al. Evaluation of contrast sen-
sitivity, chromatic vision, and reading ability in patients with primary
open angle glaucoma. J Ophthalmol. 2016;2016:7074016.
99. Borbély J, Varsányi B, Fejérdy P, et al. Toothguide trainer tests with
color vision deficiency simulation monitor. J Dent. 2010;38(Suppl 2):
e41-e49.
100. International Organization of Standardization. ISO/TR 28642:2016
(en). Guidanceon colour measurement. Geneva: International Organi-
zation of Standardization 2016. p. 10. https://www.iso.org/obp/ui/
#iso:std:iso:tr:28642:ed-2:v1:en.
101. Gáspárik C, Tofan A, Culic B, Badea M, Dudea D. Influence of light
source and clinical experience on shade matching. Clujul Med. 2014;
87:30-33.
102. Gokce HS, Piskin B, Ceyhan D, Gokce SM, Arisan V. Shade matching
performance of normal and color vision-deficient dental professionals
with standard daylight and tungsten illuminants. J Prosthet Dent. 2010;
103:139-147.
18
103. Paravina RD. Performance assessment of dental shade guides.
J Dent. 2009;37(Suppl 1):e15-e12.
104. Öngül D, Şermet B, Balkaya MC. Visual and instrumental evaluation
of color match ability of 2 shade guides on a ceramic system.
J Prosthet Dent. 2012;108:9-14.
105. Lehmann K, Devigus A, Wentaschek S, Igiel C, Scheller H,
Paravina R. Comparison of visual shade matching and electronic
color measurement device. Int J Esthet Dent. 2017;12:396-404.
106. Yuan JC, Brewer JD, Monaco EA Jr, et al. Defining a natural tooth
color space based on a 3-dimensional shade system. J Prosthet Dent.
2007;98:110-119.
107. Ahn JS, Lee YK. Color distribution of a shade guide in the value,
chroma, and hue scale. J Prosthet Dent. 2008;100:18-28.
108. Amer RS, Chandrasekaran I, Johnston WM. Illuminant effect on the
coverage error of a gingiva-colored composite resin shade guide.
J Prosthet Dent. 2016;116:770-776.
109. Ghinea R, Herrera LJ, Pérez MM, et al. Gingival shade guides: colori-
metric and spectral modeling. J Esthet Restor Dent. 2018;30:
E31-E38.
110. Paravina RD, Pérez MM, Ghinea R. Acceptability and perceptibility
thresholds in dentistry: a comprehensive review of clinical and
research applications. J Esthet Restor Dent. 2019;31:103-112.
111. Paravina RD, Ghinea R, Herrera LJ, et al. Color difference thresholds
in dentistry. J Esthet Restor Dent. 2015;27(Suppl 1):S1-S9.
112. Khashayar G, Bain PA, Salari S, Dozic A, Kleverlaan CJ, Feilzer AJ.
Perceptibility and acceptability thresholds for colour differences in
dentistry. J Dent. 2014;42:637-644.
113. Ghinea R, Pérez MM, Herrera LJ, et al. Color difference thresholds
in dental ceramics. J Dent. 2010;38(Suppl 2):e57-e64.
114. Alghazali N, Burnside G, Moallem M, et al. Assessment of percepti-
bility and acceptability of color difference of denture teeth. J Dent.
2012;40(Suppl):e10-e17.
115. Haddad HJ, Salameh Z, Sadig W, Aboushelib M, Jakstat HA. Alloca-
tion of color space for different age groups using three-dimensional
shade guide systems. Eur J Esthet Dent. 2011;6:94-102.
116. Rao D, Joshi S. Evaluation of natural tooth color space of the Indian
population and its comparison to manufacturer's shade systems.
Contemp Clin Dent. 2018;9:395-399.
117. Cocking C, Cevirgen E, Helling S, et al. Colour compatibility between
teeth and dental shade guides in Quinquagenarians and septuage-
narians. J Oral Rehabil. 2009;36:848-855.
118. King KA, de Rijk WG. Variations of L*a*b* values among Vitapan
classical shade guides. J Prosthodont. 2007;16:352-356.
119. Todorovic A, Todorovic A, Spadijer Gostovic SA, et al. Reliability of
conventional shade guides in teeth color determination. Vojnosanit
Pregl. 2013;70:929-934.
120. Tashkandi E. Consistency in color parameters of a commonly used
shade guide. Saudi Dent J. 2010;22:7-11.
121. Hammad IA. Intrarater repeatability of shade selections with two
shade guides. J Prosthet Dent. 2003;89:50-53.
122. Gehrke P, Riekeberg U, Fackler O, Dhom G. Comparison of in vivo
visual, spectrophotometric and colorimetric shade determination of
teeth and implant-supported crowns. Int J Comput Dent. 2009;12:
247-263.
123. Igiel C, Lehmann KM, Ghinea R, et al. Reliability of visual and instru-
mental color matching. J Esthet Restor Dent. 2017;29:303-308.
124. Özat PB, Tuncel _I, Erog lu E. Repeatability and reliability of human
eye in visual shade selection. J Oral Rehabil. 2013;40:958-964.
125. Yılmaz B, Yuzugullu B, Cınar D, Berksun S. Effects of shade tab
arrangement on the repeatability and accuracy of shade selection.
J Prosthet Dent. 2011;105:383-386.
126. Dudea D, Gasparik C, Botos A, Alb F, Irimie A, Paravina RD. Influ-
ence of background/surrounding area on accuracy of visual color
matching. Clin Oral Investig. 2016;20:1167-1173.
TABATABAIAN ET AL.
127. Browning WD, Chan DC, Blalock JS, Brackett MG. A comparison of
human raters and an intra-oral spectrophotometer. Oper Dent.
2009;34:337-343.
128. Jasinevicius TR, Curd FM, Schilling L, Sadan A. Shade-matching abili-
ties of dental laboratory technicians using a commercial light source.
J Prosthodont. 2009;18:60-63.
129. McAndrew R, Chan PW, Milward PJ. An assessment of shade taking
by dental undergraduates. Eur J Prosthodont Restor Dent. 2010;18:13-16.
130. Chitrarsu VK, Chidambaranathan AS, Balasubramaniam M. Analysis
of shade matching in natural dentitions using intraoral digital spec-
trophotometer in LED and filtered LED light sources. J Prosthodont.
2019;28:e68-e73.
131. Corcodel N, Rammelsberg P, Jakstat H, et al. The linear shade guide
design of Vita 3D-master performs as well as the original design of
the Vita 3D-master. J Oral Rehabil. 2010;37:860-865.
132. Corcodel N, Krisam J, Klotz AL, et al. Evaluation of small-group edu-
cation on the shade determination ability of preclinical dental
students-a controlled clinical trial. Eur J Dent Educ. 2018;22:e582-
e587.
133. Alkhudairy R, Tashkandi E. The effectiveness of a shade-matching
training program on the dentists' ability to match teeth color.
J Esthet Restor Dent. 2017;29:E33-E43.
134. Olms C, Jakstat HA, Haak R. The implementation of elaborative
feedback for qualitative improvement of shade matching-a random-
ized study. J Esthet Restor Dent. 2016;28:277-286.
135. Carney MN, Johnston WM. The development of a novel shade
selection program for fixed shade translucent dental materials.
J Dent. 2017;62:81-84.
136. Alshiddi IF, Richards LC. A comparison of conventional visual and
spectrophotometric shade taking by trained and untrained dental
students. Aust Dent J. 2015;60:176-181.
137. Brandt J, Nelson S, Lauer HC, von Hehn U, Brandt S. In vivo study
for tooth colour determination-visual versus digital. Clin Oral
Investig. 2017;21:2863-2871.
138. Chu SJ, Tarnow DP. Digital shade analysis and verification: a case
report and discussion. Pract Proced Aesthet Dent. 2001;13:129-136.
139. Zyman P, Etienne JM. Recording and communicating shade with dig-
ital photography: concepts and considerations. Pract Proced Aesthet
Dent. 2002;14:49, 51, 53.
140. Ahmad I. Digital dental photography. Part 4: choosing a camera. Brit-
ish Dent J. 2009;206:575-581.
141. JD B, Wee A, Seghi R. Advances in color matching. Dent Clin N Am.
2004;48:341-358.
142. Stevenson B. Current methods of shade matching in dentistry: a
review of the supporting literature. Dent Update. 2009;36:270-276.
143. Tam WK, Lee HJ. Dental shade matching using a digital camera.
J Dent. 2012;40(Suppl 2):e3-e10.
144. Hein S, Tapia J, Bazos P. eLABor_aid: a new approach to digital
shade management. Int J Esthet Dent. 2017;12:186-202.
145. McLaren EA, Figueira J, Goldstein RE. A technique using calibrated
photography and Photoshop for accurate shade analysis and com-
munication. Compend Contin Educ Dent. 2017;38:106-113.
146. Hein S, Zangl M. The use of a standardized gray reference card in
dental photography to correct the effects of five commonly used
diffusers on the color of 40 extracted human teeth. Int J Esthet Dent.
2016;11:246-259.
147. Wee AG, Lindsey DT, Kuo S, Johnston WM. Color accuracy of com-
mercial digital cameras for use in dentistry. Dent Mater. 2006;22:
553-559.
148. Jarad FD, Russell MD, Moss BW. The use of digital imaging for col-
our matching and communication in restorative dentistry. Br Dent J.
2005;199:43-49.
149. Spencer LM. Shade selection environment and technique. Dent Clin
N Am. 1996;52:358-362.
TABATABAIAN ET AL.
150. Bengel W. The ideal dental photographic system. Quintessence Int.
1993;24:251-257.
151. Lam WYH, Hsung RTC, Cheng LYY, Pow EHN. Mapping intraoral
photographs on virtual teeth model. J Dent. 2018;79:107-110.
152. Tung OH, Lai YL, Ho YC, Chou IC, Lee SY. Development of digital
shade guides for color assessment using a digital camera with ring
flashes. Clin Oral Investig. 2011;15:49-56.
153. Lasserre JF, Pop-Ciutrila IS, Colosi HA. A comparison between a
new visual method of colour matching by intraoral camera and con-
ventional visual and spectrometric methods. J Dent. 2011;39(Suppl
3):e29-e36.
154. Cal E, Sonugelen M, Guneri P, Kesercioglu A, Kose T. Application of
a digital technique in evaluating the reliability of shade guides. J Oral
Rehabil. 2004;31:483-491.
155. Jarad FD, Albadri SS, Mair LH. The use of objective digital matching
to achieve an esthetic composite restoration. J Clin Dent. 2008;19:
9-13.
156. Yamanel K, Caglar A, Özcan M, et al. Assessment of color parame-
ters of composite resin shade guides using digital imaging versus
colorimeter. J Esthet Restor Dent. 2010;22:379-388.
157. Guan YH, Lath DL, Lilley TH, et al. The measurement of tooth white-
ness by image analysis and spectrophotometry: a comparison. J Oral
Rehabil. 2005;32:7-15.
158. Bentley C, Leonard RH, Nelson CF, et al. Quantitation of vital
bleaching by computer analysis of photographic images. J Am Dent
Assoc. 1996;130:809-816.
159. Schropp L. Shade matching assisted by digital photography and
computer software. J Prosthodont. 2009;18:235-241.
160. Hong GW, Luo MR, Rhodes PA. A study of digital camera colorimet-
ric characterization based on polynomial modeling. Color Res Appl.
2001;26:76-84.
161. Pitel ML. Optimizing your shade-matching success: tips, tools, and
clinical techniques. Dent Today. 2015;34(116):118-121.
162. Small BW. Shade selection for restorative dentistry. Gen Dent. 2006;
54:166-167.
163. Badano A, Revie C, Casertano A, et al. Consistency and standardiza-
tion of color in medical imaging: a consensus report. J Digit Imaging.
2015;28:41-52.
164. Ahmad I. Digital dental photography. Part 7: extra-oral set-ups. Br
Dent J. 2009;207:103-110.
165. Pecho OE, Martos J, Pinto KVA, Pinto KVA, Baldissera RA. Effect of
hydrogen peroxide on color and whiteness of resin-based compos-
ites. J Esthet Restor Dent. 2019;31:132-139.
166. Della Bona A, Pecho OE, Ghinea R, Cardona JC, Paravina RD,
Perez MM. Influence of bleaching and aging procedures on
color and whiteness of dental composites. Oper Dent. 2019;44:
648-658.
167. Bengel W. Standardization in dental photography. Int Dent J. 1985;
35:210-217.
168. Ahmad I. Digital dental photography. Part 6: camera settings. Br
Dent J. 2009;207:63-69.
169. Fan PP. Choosing the right clinical camera. Part I Oral Health. 1998;
88:67-69.
170. Desai V, Bumb D. Digital dental photography: a contemporary revo-
lution. Int J Clin Pediatr Dent. 2013;6:193-196.
171. Fan PP. Choosing the right clinical camera. Part II. 1998;88:35-39.
172. Ahmad I. Digital dental photography. Part 5: lighting. Br Dent J.
2009;207:13-18.
173. Terry DA, Snow SR, McLaren EA. Contemporary dental photogra-
phy: selection and application. Compend Contin Educ Dent. 2008;29:
432-436.
174. Galdino GM, Vogel JE, Vander Kolk CA. Standardizing digital pho-
tography: it's not all in the eye of the beholder. Plast Reconstr Surg.
2001;108:1334-1344.
19
175. Finlay S, Rego N. Achieving highly esthetic anterior restorations with
ideal assessment, communication, and technique. Gen Dent. 2014;
62:36-41.
176. Kim E, Son T, Lee Y, et al. Development of polarization dental
imaging modality and evaluation of its clinical feasibility. J Dent.
2012;40(Suppl 1):e18-e25.
177. Chu SJ. Clinical steps to predictable color management in aesthetic
restorative dentistry. Dent Clin N Am. 2007;51:473-485.
178. Hegenbarth EA. Esthetics and shade communication: a practical
approach. Eur J Esthet Dent. 2006;1:340-360.
179. Villavicencio-Espinoza CA, Narimatsu MH, Furuse AY. Using cross-
polarized photography as a guide for selecting resin composite
shade. Oper Dent. 2018;43:113-120.
180. Hein S, Modric D, Westland S, et al. Objective shade matching,
communication, and reproduction by combining dental photography
and numeric shade quantification. J Esthet Restor Dent. 2021;33:
107-117.
181. Mahn E, Tortora SC, Olate B, et al. Comparison of visual analog
shade matching, a digital visual method with a cross-polarized light
filter, and a spectrophotometer for dental color matching. J Prosthet
Dent. 2020;125:511-516.
182. He WH, Park CJ, Byun S, Tan D, Lin CY, Chee W. Evaluating the
relationship between tooth color and enamel thickness, using twin
flash photography, cross-polarization photography, and spectropho-
tometer. J Esthet Restor Dent. 2020;32:91-101.
183. Lazar R, Culic B, Gasparik C, Lazar C, Dudea D. The accuracy of den-
tal shade matching using cross-polarization photography. Int J Com-
put Dent. 2019;22:343-351.
184. Joiner A, Hopkinson I, Deng Y, et al. A review of tooth colour and
whiteness. J Dent. 2008;36:2-7.
185. Tam WK, Lee HJ. Accurate shade image matching by using a
smartphone camera. J Prosthodont Res. 2017;61:168-176.
186. Kim M, Kim B, Park B, et al. A digital shade-matching device for den-
tal color determination using the support vector machine algorithm.
Sensors (Basel). 2018;18:3051.
187. Smith RN, Collins LZ, Naeeni M, et al. The in vitro and in vivo valida-
tion of a mobile non-contact camera-based digital imaging system
for tooth color measurement. J Dent. 2008;36:15-20.
188. Denissen H, Kuijkens A, Ðozic ´ A. A photographic method to mea-
sure the color characteristics of healthy gingiva. Int J Dent Hyg.
2007;5:22-26.
189. Bayindir F, Bayindir YZ, Gozalo-Diaz DJ, et al. Coverage error of gin-
gival shade guide systems in measuring color of attached anterior
gingiva. J Prosthet Dent. 2009;101:46-53.
190. Carter K, Landini G, Walmsley AD. Automated quantification of den-
tal plaque accumulation using digital imaging. J Dent. 2004;32:
623-628.
191. Sagel PA, Gerlach RW. Application of digital imaging in tooth whit-
ening randomized controlled trials. Am J Dent. 2007;20:7A-14A.
192. Lath DL, Smith RN, Guan YH, Karmo M, Brook AH. Measurement of
stain on extracted teeth using spectrophotometry and digital image
analysis. Int J Dent Hyg. 2007;5:174-179.
193. Ragain J. A review of color science in dentistry: shade matching in
the contemporary dental practice. J Dent Oral Disord Ther. 2016;4:
1-5.
194. Klemetti E, Matela AM, Haag P, Kononen M. Shade selection per-
formed by novice dental professionals and colorimeter. J Oral
Rehabil. 2006;33:31-35.
195. Lagouvardos PE, Fougia AG, Diamantopoulou SA, Polyzois GL.
Repeatability and interdevice reliability of two portable color selec-
tion devices in matching and measuring tooth color. J Prosthet Dent.
2009;101:40-45.
196. Johnston WM. Color measurement in dentistry. J Dent. 2009;37:
e2-e6.
20
197. Karamouzos A, Papadopoulos MA, Kolokithas G, Athanasiou AE.
Precision of in vivo spectrophotometric colour evaluation of natural
teeth. J Oral Rehabil. 2007;34:613-621.
198. Johnston WM, Kao EC. Assessment of appearance match by visual
observation and clinical colorimetry. J Dent Res. 1989;68:819e22.
199. Hugo B, Witzel T, Klaiber B. Comparison of in vivo visual and
computer-aided tooth shade determination. Clin Oral Investig. 2005;
9:244-250.
200. Caglar A, Yamanel K, Gulsahi K, Bagis B, Ozcan M. Could digital
imaging be an alternative for digital colorimeters? Clin Oral Investig.
2010;14:713-718.
201. Li Q, Wang Y. Comparison of shade matching by visual observation
and an intraoral dental colorimeter. J Oral Rehabil. 2007;34:
848-854.
202. Kuzmanovic D, Lyons K. Tooth shade selection using a colorimetric
instrument compared with that using a conventional shade guide. N
Z Dent J. 2009;105:131-134.
203. Knösel M, Attin R, Jung K, Brunner E, Kubein-Meesenburg D,
Attin T. Digital image color analysis compared to direct dental CIE
colorimeter assessment under different ambient conditions.
Am J Dent. 2009;22:67-72.
204. Bolt RA, Bosch JJ, Coops JC. Influence of window size in small-
window colour measurement, particularly of teeth. Phys Med Biol.
1994;39:1133-1142.
205. Kim IJ, Lee YK, Lim BS, Kim CW. Effect of surface topography on
the color of dental porcelain. J Mater Sci Mater Med. 2003;14:
405-409.
206. Posavec I, Prpic V, Zlataric DK. Influence of light conditions and light
sources on clinical measurement of natural teeth color using VITA
Easyshade advance 4,0 spectrophotometer: pilot study. Acta
Stomatol Croat. 2016;50:337-347.
207. Kim-Pusateri S, Brewer JD, Davis EL, Wee AG. Reliability and accu-
racy of four dental shade-matching devices. J Prosthet Dent. 2009;
101:193-199.
208. Tsiliagkou A, Diamantopoulou S, Papazoglou E, Kakaboura A. Evalu-
ation of reliability and validity of three dental color-matching
devices. Int J Esthet Dent. 2016;11:110-124.
209. Llena C, Lozano E, Amegual J, et al. Reliability of two color selection
devices in matching and measuring tooth color. J Contemp Dent
Pract. 2011;12:19-23.
210. Khashayar G, Dozic A, Kleverlaan CJ, Feilzer AJ. Data comparison
between two dental spectrophotometers. Oper Dent. 2012;37:
12-20.
211. Khurana R, Tredwin CJ, Weisbloom M, et al. A clinical evaluation of
the individual repeatability of three commercially available colour
measuring devices. Br Dent J. 2007;22(203):675-680.
212. Greţa DC, Gasparik C, Colosi HA, Dudea D. Color matching of full
ceramic versus metal-ceramic crowns – a spectrophotometric study.
Med Pharm Rep. 2020;93:89-96.
213. Koumpia E, Athanasiou A, Eliades T, et al. Precision of a reflectance
spectrophotometer in measuring anterior tooth color. Open Dent J.
2018;12:884-895.
214. Chen H, Huang J, Dong X, et al. A systematic review of visual and
instrumental measurements for tooth shade matching. Quintessence
Int. 2012;43:649-659.
215. Odaira C, Itoh S, Ishibashi K. Clinical evaluation of a dental color
analysis system: the Crystaleye spectrophotometer. J Prosthodont
Res. 2011;55:199-205.
216. Ishikawa-Nagai S, Yoshida A, Da Silva JD, et al. Spectrophotometric
analysis of tooth color reproduction on anterior all-ceramic crowns:
part 1: analysis and interpretation of tooth color. J Esthet Restor
Dent. 2010;22:42-52.
217. Ðozic A, Kleverlaan CJ, El-Zohairy A, et al. Performance of five com-
mercially available tooth color measuring devices. J Prosthodont.
2007;16:93-100.
TABATABAIAN ET AL.
218. Kim-Pusateri S, Brewer JD, Dunford RG, Wee AG. In vitro model to
evaluate reliability and accuracy of a dental shade-matching instru-
ment. J Prosthet Dent. 2007;98:353-358.
219. Klotz AL, Habibi Y, Corcodel N, et al. Laboratory and clinical reliabil-
ity of two spectrophotometers. J Esthet Restor Dent. 2018. https://
doi.org/10.1111/jerd.12452 [Epub ahead of print].
220. Borse S, Chaware SH. Tooth shade analysis and selection in pros-
thodontics: a systematic review and meta-analysis. J Indian
Prosthodont Soc. 2020;20:131-140.
221. Klotz AL, Habibi Y, Hassel AJ, Rammelsberg P, Zenthöfer A. How
reliable and accurate is the shade determination of premolars by
spectrophotometry? Clin Oral Investig. 2020;24:1439-1444.
222. Chu SJ. Use of a reflectance spectrophotometer in evaluating shade
change resulting from tooth-whitening products. J Esthet Restor
Dent. 2003;15:S42-S48.
223. Chen L, Tan JG, Zhou JF, Yang X, du Y, Wang FP. Reliability and
accuracy of Crystaleye spectrophotometric system. Chin J Dent Res.
2010;13:139-145.
224. Witkowski S, Yajima ND, Wolkewitz M, Strub JR. Reliability of shade
selection using an intraoral spectrophotometer. Clin Oral Investig.
2012;16:945-949.
225. AlGhazali N, Burnside G, Smith RW, Preston AJ, Jarad FD. Perfor-
mance assessment of Vita easy shade spectrophotometer on colour
measurement of aesthetic dental materials. Eur J Prosthodont Restor
Dent. 2011;19:168-174.
226. Kalantari MH, Ghoraishian SA, Mohaghegh M. Evaluation of accu-
racy of shade selection using two spectrophotometer systems: Vita
Easy shade and Degudent. Eur J Dent. 2017;11:196-200.
227. Igiel C, Weyhrauch M, Wentaschek S, Scheller H, Lehmann KM.
Dental color matching: a comparison between visual and instrumen-
tal methods. Dent Mater J. 2016;35:63-69.
228. Lehmann KM, Devigus A, Igiel C, Wentaschek S, Azar MS,
Scheller H. Repeatability of color-measuring devices. Eur J Esthet
Dent. 2011;6:428-435.
229. Sarafianou A, Kamposiora P, Papavasiliou G, et al. Matching repeat-
ability and interdevice agreement of 2 intraoral spectrophotometers.
J Prosthet Dent. 2012;107:178-185.
230. Kim HK. Evaluation of the repeatability and matching accuracy
between two identical intraoral spectrophotometers: an in vivo and
in vitro study. J Adv Prosthodont. 2018;10:252-258.
231. Lehmann KM, Devigus A, Igiel C, et al. Are dental color measuring
devices CIE compliant? Eur J Esthet Dent. 2012;7:324-333.
232. Lehmann KM, Igiel C, Schmidtmann I, et al. Four color-measuring
devices compared with a spectrophotometric reference system.
J Dent. 2010;38(Suppl 2):e65-e70.
233. Fani G, Vichi A, Davidson CL. Spectrophotometric and visual shade
measurements of human teeth using three shade guides. Am J Dent.
2007;20:142-146.
234. Gotfredsen K, Gram M, Ben Brahem E, et al. Effectiveness of shade
measurements using a scanning and computer software system: a
pilot study. Int J Oral Dent Health. 2015;1:25.
235. Yoon HI, Bae JW, Park JM, Chun YS, Kim MA, Kim M. A study on
possibility of clinical application for color measurements of shade guides
using an intraoral digital scanner. J Prosthodont. 2018;27:670-675.
236. Liberato WF, Barreto IC, Costa PP, Almeida Almeida CC,
Pimentel W, Tiossi R. A comparison between visual, intraoral scan-
ner, and spectrophotometer shade matching: a clinical study.
J Prosthet Dent. 2019;121:271-275.
237. Moussaoui H, El Mdaghri M, Gouma A, et al. Accuracy, repeatability
and reproducibility of digital intraoral scanner for shade selection:
current status of the literature. Oral Health Dent Sci. 2018;2:1-6.
238. Mehl A, Bosch G, Fischer C, Ender A. In vivo tooth-color measure-
ment with a new 3D intraoral scanning system in comparison to
conventional digital and visual color determination methods. Int J
Comput Dent. 2017;20:343-361.
TABATABAIAN ET AL.
239. Reyes J, Acosta P, Ventura D. Repeatability of the human eye com-
pared to an intraoral scanner in dental shade matching. Heliyon.
2019;5:e02100.
240. Deferm JT, Schreurs R, Baan F, et al. Validation of 3D documenta-
tion of palatal soft tissue shape, color, and irregularity with
intraoral scanning. Clin Oral Investig. 2018;22:1303-1309.
241. Liu Y, Zhang R, Ye H, et al. The development of a 3D colour
reproduction system of digital impressions with an intraoral
scanner and a 3D printer: a preliminary study. Sci Rep. 2019;9:
20052.
242. Olms C, Setz JM. The repeatability of digital shade measurement–a
clinical study. Clin Oral Investig. 2013;17:1161-1166.
243. Revilla-Leo  n M, Methani MM, Özcan M. Impact of the ambient light
illuminance conditions on the shade matching capabilities of an
intraoral scanner. J Esthet Restor Dent. 2020. https://doi.org/10.
1111/jerd.12662 [Epub ahead of print].
244. Yılmaz B, Irmak Ö, Yaman BC. Outcomes of visual tooth shade
selection performed by operators with different experience. J Esthet
Restor Dent. 2019;31:500-507.
245. Rutku nas V, Dirsė J, Bilius V. Accuracy of an intraoral digital scan-
ner in tooth color determination. J Prosthet Dent. 2020;123:
322-329.
21
246. Culic C, Varvara M, Tatar G, et al. In vivo evaluation of teeth shade
match capabilities of a dental intraoral scanner. Curr Health Sci J.
2018;44:337-341.
247. Ebeid K, Sabet A, Della BA. Accuracy and repeatability of differ-
ent intraoral scanners on shade determination. J Esthet Restor
Dent. 2020. https://doi.org/10.1111/jerd.12687 [Epub ahead of
print].
248. Douglas RD. Precision of in vivo colorimetric assessments of teeth.
J Prosthet Dent. 1997;77:464-470.
249. Hampé-Kautz V, Salehi A, Senger B, Etienne O. A comparative
in vivo study of new shade matching procedures. Int J Comput Dent.
2020;23:317-323.
How to cite this article: Tabatabaian F, Beyabanaki E,
Alirezaei P, Epakchi S. Visual and digital tooth shade selection
methods, related effective factors and conditions, and their
accuracy and precision: A literature review. J Esthet Restor
Dent. 2021;1-21. doi:10.1111/jerd.12816