See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/221741678

Repeatability of color-measuring devices

Article  in  European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The · December 2011
Source: PubMed

CITATIONS READS

37 3,026

6 authors, including:

K.M. Lehmann Alessandro Devigus

73 PUBLICATIONS   661 CITATIONS   
University of Zurich
51 PUBLICATIONS   294 CITATIONS   
SEE PROFILE
SEE PROFILE

Christopher Igiel Stefan Wentaschek

Universitätsmedizin der Johannes Gutenberg-Universität Mainz Universitätsmedizin der Johannes Gutenberg-Universität Mainz
29 PUBLICATIONS   937 CITATIONS    36 PUBLICATIONS   208 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Implantology View project

Dental Implants - Current Concepts and Innovations View project

All content following this page was uploaded by Alessandro Devigus on 14 February 2017.

The user has requested enhancement of the downloaded file.

 CLINICAL RESEARCH pyrig
No Co

ht
t fo
rP

by N
ub

Q ui
lica
tio
n
Repeatability of Color-Measuring te ot

n
ss e n c e fo r

Devices
Karl Martin Lehmann, DMD
Resident, Department of Prosthetic Dentistry, University Medical Center,
Mainz, Germany

Alessandro Devigus, DMD

Private Practice, Bülach, Switzerland

Christopher Igiel, DMD

Resident, Department of Prosthetic Dentistry, University Medical Center,
Mainz, Germany

Stefan Wentaschek, DMD

Resident, Department of Prosthetic Dentistry, University Medical Center,
Mainz, Germany

Mehdi Sattari Azar, DMD

Resident, Department of Prosthetic Dentistry, University Medical Center,
Mainz, Germany

Herbert Scheller, DMD, PhD

Medical Director, Department of Prosthetic Dentistry, University Medical Center,
Mainz, Germany

Correspondence to: Karl Martin Lehmann

Resident, Department of Prosthetic Dentistry, University Medical Center, Augustusplatz 2, 55131 Mainz, Germany;

tel: +49-6131 17 2871; fax: +49-6131 17 5517; e-mail: karl.lehmann@unimedizin-mainz.de

428
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 4 • WINTER 2011

Abstract
Introduction: The objective of this study
was to evaluate the intra- and inter-
device repeatability in different tooth
regions using three color-measuring
devices under clinical conditions.
Materials and methods: Fifteen shade
measurements (cervical, body, incisal)
were recorded on 15 patients by one in-
vestigator using three color-measuring
devices (VITA Easyshade compact,
DeguDent Shadepilot, X-Rite Shade-
Vision). CIE Lab values were deter-
mined for all maxillary anterior teeth.
Intraclass correlation coefficients (ICCs)
were used to statistically analyze intra-
and inter-device repeatability for differ-
ent tooth regions. Color differences (ΔE)
between measurements were also com-
puted to evaluate the clinical acceptabil-
LEHMANN ET ALopyrig
No C
ht
t fo
rP
by N
ub
Q ui
lica
tio
ess c e n
ity of repeatability values. The datatwere
ot
n
fo r
en
evaluated using analysis of variance
and Bonferroni’s adjustment to control
for multiple testing. Differences were
deemed significant when P < 0.016.
Results: The three color-measuring de-
vices generally exhibited high repeat-
ability of color coordinates for all tooth
regions (ICC > 0.516–0.986, ΔE < 3.03).
In contrast, inter-device repeatability
was lower for all tooth regions (ICC =
0.010–0.922, ΔE = 4.06–16.04).
Conclusions: High intra-device repeat-
ability of color coordinates could be
achieved for all tooth regions when the
same color-measuring device was used.
However, because of low inter-device re-
peatability, results using different color-
measuring devices are not comparable.
(Eur J Esthet Dent 2011;6:428–435)
429
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 4 • WINTER 2011
 CLINICAL RESEARCH pyrig
No Co

ht
t fo
rP

by N
ub

Q ui
lica
tio
te ot n

n
Introduction ss e n c e
fo r
Launch

Tooth color is routinely defined by visual

date

2008

2006

2001
perception in dental practice, but visual
tooth shade selection is characterized
by high intra- and inter-examiner vari-
resolution
Spectral

ability.1 The measurement of natural tooth

color and the subsequent use of this in-
25 nm

10 nm

N/A

formation for the production of artificial

dentures thus present a challenge to
dentists and technicians.2-9 Commonly-
Measurement

used shade guides lack standardization

measurement

and differ among manufacturers.5 Vis-

entire tooth

entire tooth

ual color identification is subjective and

region

depends on many factors, such as the

spot

observer’s color sensation,3,8,10-13 light-

ing conditions,8,14 translucency,5,15,16
Measurement

surface structure,5 and the properties of

400–700 nm

400–720 nm

the materials used.1 Electronic shade-

selection devices improve the accuracy
range

and reliability of dental shade selec-

N/A

tion because they are based on optical

sensors and thus are not influenced by
Searchlight

significant visual selection parameters,

White LED

illuminator
source

such as illumination and operator vari-

Specifications of the color-measuring devices.

Light

ability.3,13 Numerous studies have ana-

LED
D65

lyzed the repeatability,13,17–23 and accu-

racy23–27 of commercial color-measuring
Calibration

two reflection

devices.
standards

reflection
standard

standard

The most common device types are

ceramic

colorimeters and spectrophotometers,

which calculate tooth color by measur-
ing the amount and spectral composition
Operation

of light reflected from the tooth surface.

photometer

photometer

colorimeter
imaging,

These devices usually express results

spectro-

spectro-
mode

using the CIE system and one or more of

the conventional shade-guide systems.
CIE values are the standard by which all
X-Rite Shade

visible colors are described, using three

Shade Pilot
Easyshade

DeguDent

basic coordinates. Spectrophotometers

compact
Device
Table 1

estimate color by measuring the inten-

Vision
Vita

sity of reflected light in all visible wave-

lengths, whereas colorimeters measure

430
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 4 • WINTER 2011
 LEHMANN ET ALopyrig
No C

ht
t fo
rP

by N
ub

Q ui
lica
tio
te n ot

n
the intensity of reflected light filtered by
ss e n c e fo r
red, green, and blue filters (simulating
RGB absorbance). These differences
in the interpretation of reflected light by
intraoral shade-matching instruments
may directly affect the devices’ measur-
ing functions and indirectly affect their
matching functions. Shade matching
is based on the extrapolation of color
measurement values into values that are
more meaningful to clinicians, such as
the shade tabs of a guide system. This
process introduces a source of variation
that affects the repeatability and accur-
acy of color-measuring devices and
visual matching methods.1,28 Thus, the
aim of this in vivo study was to evaluate
the intra- and inter-device repeatabil-
ity of three color-measurement devices Fig 1 The VITA Easyshade compact.

under clinical conditions by measuring

the L*, a*, and b* color coordinates. The
first null hypothesis was that the color
differences (ΔE) between the measure-
ments made with each device would not
exceed 3.5 units for each tooth region.
The second null hypothesis was that the
color differences (ΔE) between meas-
urements among devices would also not
exceed 3.5 units.

Materials and methods

Color-measuring devices

This study examined three dental color-

measuring devices (Table 1) with dif-
ferent operating modes: the VITA Easy-
shade compact (Fig 1; Vita Zahnfabrik,
Bad Säckingen, Germany), Shadepilot
(Fig 2; DeguDent GmbH, Hanau, Ger-
many), and ShadeVision (Fig 3; X-Rite,
Grand Rapids, MI, USA). The specifica- Fig 2 The DeguDent Shadepilot.

431
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 4 • WINTER 2011
 CLINICAL RESEARCH
Fig 3 The X-Rite ShadeVision.
tions of the devices are summarized in
Table 1. Each device was used accord-
ing to the manufacturer’s instructions.
Patients
All patients were instructed to place
their heads against the headrest of the
treatment chair and to keep their mouths
slightly open during measurement. The
devices were used and calibrated ac-
cording to the manufacturers’ instruc-
tions. CIE Lab values were recorded at
three sites (cervical, body, incisal) on the
maxillary canines and incisors. To pre-
vent false measurements due to altered
tooth translucency, the participants
were instructed to keep the tongue in a
relaxed position away from the maxillary
teeth during measurement. The process
was repeated to acquire a second se-
quence of shade measurements using
each of the devices. Patients were pro-
vided with water after each sequence to
prevent dehydration of the teeth. Gauze
432
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 4 • WINTER 2011
pyrig
No Co
ht
t fo
rP
by N
ub
Q ui
lica
tio
remove tany
n
ot
n
squares were used to ess ex-
e nc e
fo r
cess surface moisture before shade
measurement.
Test conditions
All measurements were made by a sin-
gle trained operator under standardized
test conditions. According to the CIE
standard, the daylight illumination con-
ditions (Just Normlicht, Weilheim an der
Teck, Germany) were set at 6500 K and
1000 Lux, or 93 foot-candles. Natural
daylight was excluded using an optical
opaque louver. Five consecutive meas-
urement series were taken on each pa-
tient using each of the three dental color-
measuring devices. The CIE Lab color
coordinates of each measurement were
recorded.
Statistical analyses
Data were imported into statistical pro-
grams (SPSS ver. 17.0; SPSS, Chicago,
IL, USA; SAS ver. 9.2; SAS Institute,
Cary, NC, USA). Intra- and inter-device
repeatability were assessed by calcu-
lating intraclass correlation coefficients
(ICCs) adapted from variance compo-
nents (VCs) and residual variance (RV)
for different tooth regions (cervical, body,
incisal). Color quantification was based
on CIE Lab values. Intra- and inter-de-
vice color differences (ΔE) were calcu-
lated for each tooth region, according to
the following equation:
ΔE = [(L*i - L*ii)2 + (a*i - a*ii)2 +
(b*i – b*ii)2]½
(where i and ii represent two different
measurements)
 LEHMANN ET ALopyrig
No C

ht
t fo
rP

by N
ub

Q ui
lica
tio
tein the otn

n
Table 2 Intraclass correlation coefficients for intra-device repeatability and color differences (ΔE)
ss e n c e
measurement of CIE L*a*b* color coordinates for different tooth regions with the VITA Easyshade compact,
fo r
DeguDent Shadepilot, and X-Rite ShadeVision color-measuring devices.

Region VITA Easyshade DeguDent Shadepilot X-Rite ShadeVision

L* a* b* ΔE L* a* b* ΔE L* a* b* ΔE

Cervical 0.759 0.783 0.881 2.84 0.967 0.933 0.973 0.91 0.804 0.516 0.730 2.17

Body 0.845 0.916 0.914 2.49 0.986 0.976 0.984 0.69 0.957 0.800 0.809 1.02

Incisal 0.743 0.905 0.923 3.03 0.969 0.948 0.978 0.95 0.945 0.794 0.980 1.35

The color coordinates of the three
color-measuring devices were
pared using analysis of variance (ANO-
VA) and Bonferroni adjustment to control
for multiple testing. The P values < 0.016
were deemed to indicate significance.
Results
Table 2 shows the ICC coefficients for
intra-device repeatability and ΔE be-
tween the measurements for each de-
vice. Table 3 presents the ICC coeffi-
cients for inter-device repeatability and
ΔE between the measurements among
devices. The L*, a*, and b* coordinates
differed significantly (P < 0.001) among
the color-measuring devices tested.
Discussion
Due to the nature of color science, the
true tooth colors of the participants in
this study are unknown. Consequently, it
was not possible to assess the accuracy
of measurements according to stand-
ard guidelines.29 The only standard by
com- which the machines could be judged
was the repeatability of the results. In
this in vivo study, measurements were
performed under clinical conditions and
strictly controlled parameters that may
have affected the instrumental shade-
matching process. The CIE Lab color
system, which defines color space using
three coordinates, is frequently used in
dental color research. The strength of
this system lies in the ability to clinically
interpret results. Equivalent differences
across the CIE Lab color space rep-
resent approximately uniform steps in
human color perception, improving the
interpretation of color measurements.
Thus, the magnitude of perceptible and/
or acceptable color difference can be
defined between measurements taken
with a single color-measuring device
(intra-device repeatability) and between
measurements taken using two devices
(inter-device repeatability). This mag-
nitude of color difference is based on
the human perception of color; color
differences of ΔE < 1 unit are visually
detectable by 50% of human observers

433
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 4 • WINTER 2011
 CLINICAL RESEARCH pyrig
No Co

ht
t fo
rP

by N
ub

Q ui
lica
ti
te in the on ot

n
Table 3 Intraclass correlation coefficients for inter-device repeatability and color differences (ΔE)
ss e n c e
measurement of CIE L*a*b* color coordinates for different tooth regions with the VITA Easyshade compact,
fo r
DeguDent Shadepilot, and X-Rite ShadeVision color-measuring devices.

Easyshade vs. Easyshade vs. Shadepilot vs.

Region
Shadepilot ShadeVision ShadeVision

L* a* b* ΔE L* a* b* ΔE L* a* b* ΔE

Cervical 0.205 0.033 0.647 11.24 0.096 0.010 0.408 16.04 0.638 0.616 0.716 5.82

Body 0.458 0.237 0.842 10.77 0.237 0.194 0.702 14.63 0.726 0.879 0.906 5.04

Incisal 0.296 0.296 0.626 10.35 0.094 0.231 0.499 13.31 0.471 0.814 0.922 4.06

under ideal lighting conditions.30 How-
ever, such small color differences may
not be detected under normal clinical
conditions; average color differences of
ΔE < 3.5 have been rated as a match in
the oral environment.3,31
All of the measurement devices gen-
erally exhibited higher repeatability for
the L*, a*, and b* coordinates in the cen-
tral region than in the incisal or cervical
regions. This superior performance may
be attributed to the absence of influen-
cing variables, such as the reddish color
of adjacent gingiva, the greater curva-
ture of the tooth surface in the cervical
region, or higher translucency in the in-
cisal region. However, intra-device re-
peatability for all tooth regions was clin-
ically acceptable for all devices tested
(ΔE < 3.5 units). Thus, the first null hy-
pothesis was accepted.
In contrast, inter-device repeatability
was clearly lower than the intra-device
repeatability of each device for all tooth
regions. This lack of inter-device repeat-
ability resulted in differences between
color measurements that were not within
the clinically acceptable range (ΔE > 3.5
units). This may be attributed to the fact
that although the color-measuring devic-
es tested offered high repeatability, they
deviated (in some cases markedly) from
a CIE- conforming color-measurement
system.23 Consequently, the second null
hypothesis was rejected. Thus, manu-
facturers should improve the accuracy
of color-measuring devices with respect
to conforming to the CIE color measure-
ment system to make the results of den-
tal color measuring systems compar-
able. Further studies must confirm these
findings and evaluate the repeatability
and accuracy of dental color-measure-
ment devices as CIE-conforming color
measurement systems.
Conclusions
All of the color-measuring devices
tested in this study exhibited clinically
acceptable intra-device repeatability for
all tooth regions when using the same
color-measuring device. In contrast,
inter-device repeatability was clearly
lacking; thus, results obtained with dif-
ferent color-measuring devices are not
comparable.

434
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 4 • WINTER 2011
 LEHMANN ET ALopyrig
No C

ht
t fo
rP

by N
ub

Q ui
lica
tio
te ot n

n
References 13. Khurana R, Tredwin CJ,
Weisbloom M, Moles DR.
22. Smith RN, Collins LZ, Nae-
ss e n c e
fo r
eni M, et al. The in vitro and
A clinical evaluation of the in vivo validation of a mobile
1. Klemetti E, Matela AM,
individual repeatability of non-contact camera-based
Haag P, Kononen M. Shade
three commercially available digital imaging system for
selection performed by nov-
colour measuring devices. tooth colour measurement.
ice dental professionals and
Br Dent J 2007;203:675–680. J Dent 2008;36:S15–20.
colorimeter. J Oral Rehabil
14. Ahn JS, Lee YK. Difference 23. Lehmann KM, Igiel C,
2006;33:31–35.
in the translucency of all- Schmidtmann I, Scheller
2. Devigus A, Lombardi G.
ceramics by the illuminant. H. Four color-measuring
Shading Vita YZ substruc-
Dent Mater 2008;24:1539– devices compared with a
tures: influence on value and
1544. spectrophotometric ref-
chroma, part I. Int J Comput
15. Chen YM, Smales RJ, erence system. J Dent
Dent 2004;7:293–301.
Yip KH, Sung WJ. Translu- 2010;38:e65–70.
3. Chu S, Devigus A,
cency and biaxial flexural 24. Billmeyer FW Jr. Compara-
Mieleszko A. Fundamentals
strength of four ceramic tive performance of color-
of Color. Chicago: Quintes-
core materials. Dent Mater measuring instruments. Appl
sence Publishing, 2005.
2008;24:1506–1511. Opt 1969;8:755–783.
4. Douglas RD, Brewer JD.
16. Kourtis SG, Tripodakis AP, 25. Billmeyer FW Jr, Campbell
Variability of porcelain color
Doukoudakis AA. Spectro- ED, Marcus RT. Compara-
reproduction by commercial
photometric evaluation of the tive performance of color-
laboratories. J Prosthet Dent
optical influence of different measuring instruments:
2003;90:339–346.
metal alloys and porce- second report. Appl Opt
5. Seghi RR, Johnston WM,
lains in the metal-ceramic 1974;13:1510–1518.
O’Brien WJ. Spectrophoto-
complex. J Prosthet Dent 26. Billmeyer FW, Saltzman M.
metric analysis of color
2004;92:477–485. Principles of color technol-
differences between porce-
17. Karamouzos A, Papa- ogy. New York: John Wiley &
lain systems. J Prosthet Dent
dopoulos MA, Kolokithas G, Sons, 1981.
1986;56:35–40.
Athanasiou AE. Precision 27. CIE_Publication. Abso-
6. Sproull RC. Color matching in
of in vivo spectrophoto- lute methods for reflection
dentistry. I. The three-dimen-
metric colour evaluation of measurements. Paris:Bureau
sional nature of color. J Pros-
natural teeth. J Oral Rehabil central de la CIE, 1979;
thet Dent 1973;29:416–424.
2007;34:613–621. (No. 44 (TC-2.3)).
7. Sproull RC. Color match-
18. Dozic A, Kleverlaan CJ, 28. Hassel AJ, Koke U, Schmit-
ing in dentistry. II. Practical
El-Zohairy A, Feilzer AJ, ter M, Beck J, Rammelsberg
applications of the organiza-
Khashayar G. Performance P. Clinical effect of different
tion of color. J Prosthet Dent
of five commercially avail- shade guide systems on the
1973;29:556–566.
able tooth color-measuring tooth shades of ceramic-
8. Sproull RC. Color match-
devices. J Prosthodont veneered restorations. Int J
ing in dentistry. 3. Color
2007;16:93–100. Prosthodont 2005;18:422–
control. J Prosthet Dent
19. Kim-Pusateri S, Brewer JD, 426.
1974;31:146–154.
Dunford RG, Wee AG. In 29. Billmeyer FW Jr, Alessi PJ.
9. Devigus A. Implant dentistry
vitro model to evaluate Assessment of color-meas-
and esthetics. Eur J Esthet
reliability and accuracy of uring instruments. Color Res
Dent 2007;2:257–258.
a dental shade-matching Appl 1981;6:195–202.
10. Culpepper WD. A compar-
instrument. J Prosthet Dent 30. Kuehni RG, Marcus RT. An
ative study of shade-match-
2007;98:353–358. experiment in visual scaling
ing procedures. J Prosthet
20. Tung FF, Goldstein GR, of small color differences.
Dent 1970;24:166–173.
Jang S, Hittelman E. The Color Res Appl 1979;4:
11. Donahue JL, Goodkind RJ,
repeatability of an intraoral 83–91.
Schwabacher WB, Aeppli
dental colorimeter. J Prosthet 31. Johnston WM, Kao EC.
DP. Shade color discrimin-
Dent 2002;88:585–590. Assessment of appearance
ation by men and women.
21. Billmeyer FW Jr. Precision of match by visual observation
J Prosthet Dent
color measurement with the and clinical colorimetry. J
1991;65:699–703.
GE spectrophotometer. J Opt Dent Res 1989;68:819–822.
12. Jarad FD, Russell MD,
Soc Am 1965;55:707–716.
Moss BW. The use of digital
imaging for colour match-
ing and communication in
restorative dentistry.
Br Dent J 2005;199:43–49;
discussion 33.

435
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 4 • WINTER 2011

View publication stats