DENTAL TECHNIQUE

A smartphone application with a gray card for clinical shade

selection: A technique
George Abraham, BDS, MDS,a Nirmal Kurian, BDS, MDS,b Samiksha Wadhwa, BDS,c and
Kevin George Varghese, BDS, MDSd

Accurate shade matching is ABSTRACT

imperative for achieving Shade selection is an inherently complex procedure, and its accurate reproduction in the definitive
excellent esthetics when restoration involves an in-depth understanding of color science and its effective communication
restoring anterior teeth. The with the dental laboratory technician. A technique is presented that uses a smartphone
procedure involves chair-side application (Snapseed; Google LLC) and a gray card for clinical shade selection. (J Prosthet Dent
shade selection and effective 2023;-:---)
communication of the selected
shade to the dental laboratory technician.1 as a common method of shade communication. Most
Visual and instrumental shade selection are the 2 often, dental laboratory technicians are challenged to
principal methods of shade determination in dentistry. achieve a color match when working only from a pre-
Instrumental methods such as spectrophotometers and scription based on a shade guide.8 Digital images pro-
colorimeters are not typically used because of the high vide intricate details of the clinical situation and can help
cost of the equipment, the potential for edge loss, and the
inability to assume a repeatable position on the tooth.2 In
spite of the availability of different methods and in-
struments, shade selection depends on the reliability,
accuracy, working life, and cost of the equipment
involved.3 Visual shade selection using shade guides re-
mains the most commonly used technique. However,
visual shade selection is associated with a high degree of
subjectivity because of the clinician’s color vision and
shade tab variations.4,5 Also, selection using shade tabs is
affected by lighting conditions, which makes shade
communication for an optimal esthetic outcome
challenging.6
The universality of smartphones with increased
computing capability, enriched functionalities, software
applications, and high-resolution photography has Figure 1. Digital photograph of maxillary left central incisor with gray
made them popular for dental documentation.7 Digital card and shade tabs from closest matching value groups (1M2, 2M2, and
photographs captured with smartphones have emerged 3M2).

a
Technical Head, DentCare Dental Lab, Muvattupuzha, Kerala, India.
b
Associate Professor, Department of Prosthodontics and Crown & Bridge, Christian Dental College, Ludhiana, Punjab, India.
c
Postgraduate Resident, Department of Prosthodontics and Crown & Bridge, Christian Dental College, Ludhiana, Punjab, India.
d
Assistant Professor, Department of Prosthodontics and Crown & Bridge, Christian Dental College, Ludhiana, Punjab, India.

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Figure 2. Tune image, white balance, and black and white option from tools menu.

dental laboratory technicians visualize and integrate
those details.
The use of smartphones in combination with
appropriate light-correcting devices has been reported
to facilitate accurate shade selection.9 Additionally, to
promote a correct white balance of the digital pho-
tographs for both digital cameras and smartphones, a
gray reference card with known color coordinates has
been recommended to accurately record images in
dental digital photography.10 The use of a gray card
during shade determination can help standardize the
photographs captured, irrespective of clinical lighting
conditions.11-15 The present article describes the use
of a shade guide (VITA 3D Master; Vita Zahnfabrik)
according to the manufacturer’s shade selection pro-
tocol and in combination with a gray card and a
smartphone application for shade determination and
communication.

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Figure 3. Standardizing digital image by color correction. A, Image in white balance tool before color correction. B, Color correction using color pick
tool.
TECHNIQUE
1. With the patient seated in the dental chair in an
upright position with the occlusal plane of the
maxillary teeth parallel to the floor, hold the shade
guide (VITA 3D Master; Vita Zahnfabrik) at arm’s
length near the patient’s mouth. Select shade tabs
which are closer in value to the tooth requiring a
Abraham et al
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shade match from each value group of VITA 3D
Master (Fig. 1).
2. Capture a photograph using a smartphone camera
(Redmi Note 10 Pro; Xiaomi) and external light
(LED Video Light; Mobilife) with the gray refer-
ence card (Gray Card; DentCare) and chosen
shade tabs placed close to the tooth of interest
(Fig. 1).
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Figure 4. Shade tabs compared with select tab with closest value.
3. Save the image captured in step 2 and import it to
the photo editing smartphone application (Snap-
seed; Google LLC).
4. Select the “White balance” option from the “Tools”
menu (Fig. 2). Choose the “Color Pick” tool and place
the cursor over the gray card region to standardize the
digital image by color correction (Fig. 3).
5. Select the “Black and white” option from the
“Tools” menu of the application. Choose the “Tune
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Figure 5. Digital photograph of selected value group shade tabs
compared with determine chroma.
image” option and increase the contrast and
decrease the brightness to a level that makes shade
tab selection based on value discernible (Fig. 2).
With this setting, compare the shade tabs and select
the tab with the closest value (Fig. 4).
6. Choose the middle tab of the value group selected
in step 5 to determine the chroma. Fan out the
middle tabs and capture a photograph with a gray
card placed beneath the shade guide (Fig. 5).
7. Decrease the brightness and increase the contrast of
the image to discern the chroma and select the
shade tab. This can further differentiate between the
incisal and body region and highlight the basic
dentinal shade (Fig. 6).
8. Determine whether the tooth to be shade matched
is more reddish or yellowish as compared with the
shade tab selected in step 7.
9. Select the tab that matches the tooth shade based
on the hue determined in step 8.
DISCUSSION
The present technique uses a smartphone application
with a gray card and shade guide (VITA 3D Master; Vita
Zahnfabrik) for color correction and shade determina-
tion. The shade guide allows systematic determination of
value, followed by chroma and hue (https://www.vita-za
hnfabrik.com/en/VITA-shade-guides-31233,98477.html).
Value is the most important attribute of color determi-
nation and is less affected by color deficiency than
chroma or hue.10 In the present technique, a smartphone
application (Snapseed; Google LLC) was used for color
to grayscale conversion of the captured image of tooth
and shade tab, making it easier for the clinician to
ascertain the value component of the clinical shade
selection.
Shade communication with the dental laboratory
technician is mostly carried out through digital images
Abraham et al
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Figure 6. Adjusting brightness and contrast for chroma selection reveals 1M2 as closest matched shade tab. A, Brightness decreased. B, Contrast increased.
sent through smartphone messaging applications. The
different clinic illumination and the camera’s inability to
standardize it makes the photographs received by the
dental laboratory technician highly subjective. The use of
a gray card helps standardize digital images irrespective
of clinic lighting by using a white balance calibration.6,9,10
Since the gray card has a known reflectance value of
18%, its placement beside the shade tab places an object
with a known value which can act as a reference point in
the picture, helping achieve a standard color calibration
that is unaffected by external factors.16 Value determi-
nation is followed by readjusting the saturation of the
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image and converting it back from grayscale to color to
accomplish the next steps of chroma and hue
determination.
Advantages of this technique include the use of a gray
card for image calibration and an open-source applica-
tion in mobile operating systems that enables clinicians
to communicate with the dental laboratory technician by
using photographs that can be easily transferred and
saved for future evaluation. However, the additional
steps during shade selection, such as adjusting the im-
ages in the mobile application, and the lack of compari-
son of results among several shade selection methods
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remain limitations of this technique. Further clinical
research comparing different shade selection methods
(traditional, instrumental, smartphone application) is
needed to validate the reliability of the technique.
SUMMARY
Clinical shade matching assisted by a smartphone
application and gray card can standardize shade docu-
mentation irrespective of clinical lighting conditions and
facilitate better communication between clinicians and
dental laboratory technicians.
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Corresponding author:
Dr Samiksha Wadhwa
Department of Prosthodontics and Crown & Bridge
Christian Dental College
Ludhiana, Punjab 141008
INDIA
Email: samikshawadhwa120@gmail.com
CRediT authorship contribution statement
George Abraham: Conceptualization, Writing e original draft, Investigation,
Data curation, Software, Visualization, Writing e review & editing. Nirmal
Kurian: Conceptualization, Methodology, Writing e review & editing, Investi-
gation. Samiksha Wadhwa: Writing e original draft, Investigation, Data curation,
Methodology. Kevin George Varghese: Methodology, Writing e review &
editing, Investigation.
Copyright © 2023 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2023.01.016
Abraham et al