Review Article

Role of colors in prosthodontics: Application of color science

in restorative dentistry
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Vinaya Bhat, Krishna Prasad D, Sonali Sood, Aruna Bhat

Department of Prosthodontics
ABSTRACT
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and Crown and Bridge,

A.B. Shetty Memorial
Institute of Dental
Sciences, NITTE University,
Mangalore,Karnataka,India
Received : 30-11-10
Review completed : 25-01-11
Accepted : 09-02-11
Shade selection procedure depends on various factors including translucency, contour and
surface texture. Tooth shade selection using a conventional means involves a high degree of
subjectivity. Traditional shade guides are available that use several methods for quantifying
shade. Technology-based systems provide with an advantage of natural looking restorations. They
include RGB devices, colorimeters, spectrophotometers. The impact of the color science can be
seen on various restorative materials ranging from ceramics to maxillofacial prosthetic materials.
Key words: Color, material science, maxillofacial, shade guides, technology

Restorative dentistry represents a significant portion of
dental services encompassing on the blend of science and
art. Although color may be unimportant to the physiologic
success of a dental restoration, it could be the deciding
factor in patient acceptance. The basis of color science is a
vast subject applicable to many fields. The applied aspect of
color science to the restorative dentistry includes the various
factors involved for correct shade matching and its impact
on the science of color. The recommended protocol for
conventional and technology-based shade matching should
be followed for better understanding of the complexities
involved in it. This article discusses the different selection
procedures involved for correct shade matching, the various
systems available for the restorative dentist, and the recent
developments in this field.
SHADE MATCHING IN RESTORATIVE DENTISTRY
Christopher[1] stated that the difficulty of shade selection
is that clinicians must be able to interpret a multi-layered
structure of varying thickness, opacities, and optical surface
characteristics. This can affect the way that the eye perceives
Address for correspondence:
Dr. Sonali Sood
E-mail: sonaliscorpio@yahoo.com
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DOI:
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Indian Journal of Dental Research, 22(6), 2011
color. Teeth are often termed “polychromatic” and have the
variation in hue, value, and chroma within the teeth and
give three dimensional depth and characteristics. He stated
that a number of related factors in selecting shades must also
be understood to achieve a successful result. These factors
includes (Winter 1990) translucency, contour, surface
texture, luster, and fluorescence.
TRANSLUCENCY
Generally, increasing the translucency of a crown lowers its
value because less light returns to the eye. With increased
translucency, light is able to pass the surface and is scattered
within the restoration. The translucency of enamel varies with
the angle of incidence, surface texture and luster, wavelength,
and level of dehydration.[2]
SURFACE TEXTURE
Sulikowski et al. explained that surface texture influences
aesthetics by determining the amount and direction of light
reflected of the facial surface. Texture should be designed
to simulate the reflectance pattern of the adjacent natural
teeth. Young teeth may have a lot of characterization with
stippling, ridges, striations, and lobes. These features may
be worn away with age leaving smoother, highly polished
surfaces.[3]
FLUORESCENCE
It is the absorption of light by a material and the spontaneous
emission of light in a longer wavelength.[4] Vital teeth look
brighter and alive as higher amount of organic material is
present.
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 Role of colors in restorative dentistry
Laren stated that the more the dentin fluoresces, the lower
the chroma.[5] These powders are added to crowns to increase
the quantity of light returned back to viewer and to decrease
the chroma.[5]
OPALESCENCE
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Sunder and Amber defined it as a phenomenon in which a
material appears to be one color when light is reflected from
it and another color when light is transmitted through it.[6]
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AFTER IMAGE AND VISUAL DISTORTION
Fondriest[2] stated that after images are frequent physiologic
effects of the cone receptors with normal function that cause
alterations in the perception. It includes spreading effect:
when light is removed from the retina, the receptors continue
for a short time to be active and send signal to the brain.
BRUNESCENCE
Pensler defined it as the natural browning of the cornea
that occurs with age. It acts as a filter and changes the
appearance of colors. Hence, the age of the dentist also forms
an important factor in shade determination.[7]
APPERCEPTION
Apperception is how the mind interprets what the eye
perceives. Optical illusions exemplify the perception
and apperception phenomenona. Shade selection is a
combination of perception and apperception, and hence
involves a thought process. Teaching dentists about this
phenomenon could minimize the influence of this factor
on the shade selection.[7]
LIGHT INTENSITY
The intensity of the light conditions is also important. If
the amount of light (measured in foot-candles or lumens
per ft) is too small, fine details are missed and the eye has
difficulty perceiving hue. The ideal luminosity for dental
shade matching is 75 to 250 ft-candles.[8] To have 150 ft-
candles intensity in the operatory at the level of the dental
chair, ten to twelve 4 ft bulbs would be needed in a 10×10
ft room with 8-foot ceilings.[9] The diffusion panels covering
the fluorescent bulbs are also important because they screen
out wavelengths. As they age, the panels change what
wavelengths they absorb. The best diffusers are those that
do not filter out any wavelengths of the spectrum, preferably
the egg-crate type.[2]
REQUIREMENTS OF TOOTH SHADE GUIDES
The prime requirements for a tooth color guide considered
by Sproul (1973) are a logical arrangement in color space
and an adequate distribution in color space.
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Bhat, et al.
A guide which did not fulfill the prime requirements in color
space would pose certain problems like taking too long to
decide where to begin, lack to check the chosen match for
accuracy, and the volume of color space occupied by the
materials to be matched may be impossible to reach within
the guide.[1]
SHADE SELECTION PROCEDURE
Christopher[1] suggested the shade selection sequence to be
as follows:
• When matching teeth, the shape, surface geography,
and the value are the most important characteristics.[2]
• Shade selection should be completed before preparation
as teeth can become dehydrated and result in higher
values. Value is the most important dimension of shade
rendering.[10]
• Ensure surgery surroundings are of neutral color so that
there is no color cast onto the teeth.[11]
• Remove lipstick; ask patients not to wear lurid clothing
or any items that may distract the attention of the
teeth. Make sure teeth are clean and unstained before
attempting shade selection.
• Patient should be in an upright position at a level similar
to the operator and the shade guide should be at arm
length. This ensures that the most color-sensitive part
of the retina will be used.
• Observations should be made quickly (5 s) to avoid
fatiguing the cones of the eyes. If longer than this, the
eye cannot discriminate and the cones become sensitized
to complement the observed color.[2]
Fondriest[2] stated the use of chromatic backgrounds
available: 18% reflective gray cards, Kulzer’s small
intraoral gray cardboards, Pensler shields screen.
• Use color-corrected light illumination, which should be
of a diffuse nature.
• Viewing tabs through half-closed eyes can decrease
ability to discriminate color but increases the ability to
match value. Look at the other parts of the teeth, dividing
the teeth into nine sections from apical to incisal, and
mesial to distal.
• Hold the shade tab incisal edge to the incisal edges of
the teeth. This effectively isolates the shade tabs from
the teeth so they do not reflect onto each other reducing
afterimages.[12]
• Most humans have eye dominance and one eye will
preferentially perceive shade.[13] It is wise to hold the
shade guide on both sides of the tooth at each vector.
• Different light wavelengths reflect off a rough surface in
different ways. Shades should be evaluated looking at the
tooth at different angles. This re-evaluation at different
angles is called vectoring.[13]
• If in doubt as to the hue family, choose the A family.[14]
Most natural teeth have more red than B.
Indian Journal of Dental Research, 22(6), 2011
 Role of colors in restorative dentistry
• Describe surface texture and luster as heavy, moderate,
and light therefore giving nine different combinations
of surface characteristics. Because these surface features
determine the character of light reflection and affect the
amount of light that enters the tooth (opacity), the surface
texture of a crown must be designed to simulate the light
transmission and reflectance pattern of adjacent teeth.[2]
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MEASUREMENT OF COLOR
Color determination in dentistry can be divided into two
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categories.
• Visual
• Instrumental
Visual technique
Shade guide systems
Dental shade guides are shade matching tools used most
commonly by the clinicians in day to day practice. Although
the groups of tabs of most shade guides appear to be well
arranged, the overall tab arrangements of some shade guides
seem illogical because they contain light and dark tabs
within each of the groups. The fact that tab arrangement can
influence shade-matching results increases the importance
of this issue.[15] For consistency, tabs can be rearranged
according to increasing color difference related to the tab
that appears lightest (not necessarily the tab having the
highest lightness, L*). Group division of shade guides is
necessary for reducing the number of potentially adequate
tabs as quickly as possible. It is easier to work with fewer
tabs, because the vision pigment depletes within seconds
(it regenerates quickly, as well). To achieve consistent group
division, the total color difference (E*) between the lightest
and the darkest tab should be divided into several equal
segments. Laboratory and simulated clinical conditions
have demonstrated the effectiveness of this tab arrangement
(small discrepancies recorded by different color-measuring
devices only confirm the efficacy).[15]
The most popular shade guides include the vitapan classical
shade guide, Vita 3D master shade guide system, and the
chromascop shade guide system. The shade tabs arrangement
in the Vita Classical is by hue whereas in the Chromascop
guides,[16] the tabs are arranged in five clearly discernible
value levels. VITAPAN introduced in 1956, the current
American Dental Association gold standard for monitoring
of tooth whitening, is supposed to correspond to decreasing
lightness (from left to right). A very popular shade guide
where in tabs of similar hue are clustered into letter groups
A (red-yellow), B (yellow), C (grey), D (red-yellow-gray),
and chroma designated with the numerical values (e.g. A1).
The manufacture protocols include hue selection followed
by chroma and value.
Miller[17] demonstrated that the classical shade guide was
too low in chroma and too high in value when compared
Indian Journal of Dental Research, 22(6), 2011
Bhat, et al.
to natural extracted tooth samples. The “value scale” is
inaccurate in terms of decreasing L* values, exhibiting
redundancy and uneven lightness differences among
neighboring tabs, which to a certain extent compromises the
results of clinical studies that have been performed so far.[15]
The Vitapan 3D master shade guide, introduced in 1998,
system reflects systematic and equidistant coverage of the
natural tooth shade spectrum. The design features selection
of value levels followed by the chroma and determination
of hue.
Bayindir et al[18] stated that the Vitapan 3D master shade
guide system results in lower coverage errors than the Vita
lumin or Chromascop shade guide systems. Ahn et al. [19]
concluded that the color distribution of the Vitapan 3D master
shade guide was more ordered than previously reported color
distributions of other, traditional shade guides. However, the
interval in the color parameters between adjacent tabs was
not uniform.
According to the literature, the new Vita Bleached guide
3D master shade guide (Vident), designed primarily for
tooth-whitening monitoring, has significant advantages over
the Vitapan Classical: the tab arrangement corresponds to
visual finding, it includes extra light shades, the color range
is almost doubled, the color distribution is more uniform,
and the chroma steps are consistent.[20]
Instrumental methods
The conventional visual tools used to determine shade are
highly susceptible to various optical illusions and contrast
effects. In 2001, Chu and Tarnow[21] used a clinical case report
to describe the subjective deficiencies in the conventional
shade selection process and compared the method to
computerized aided information. Due to the errors with
the use of commercial shade guides, many different devices
and machine tools are used in order to make the color
assessment more simple, rapid, precise, and perfect. The
semi-translucent structure, small size, and irregular surface
of teeth contribute to the complexity of this procedure.
Several clinical studies have confirmed that computer-
assisted shade analysis is more accurate and more consistent
compared with human shade assessment. The advantages
are no influence of surroundings or lighting and the results
being reproducible.[22,23]
Bergon et al. [22] experimented with spectrophotometers and
computers. Yamamoto was instrumental in the development
of the Shofu eye chroma meter. In the late 1990s, a company
called Cortex Machina was established in Montreal, first
ones to start with technology-based shade guides system.
The first measurement analysis system was the Spectroshade
system from MHT Optic Research in 2001 followed by Shade
vision system (colorimeter) from X-rite in 2002.
806
 Role of colors in restorative dentistry
The Measurement system includes [22] the spot measurement
systems measuring small areas on the tooth surface (e.g.
Shofu Shade Eye-NCC, Chroma meter system, Vita easy
shade system) or complete tooth measurement systems that
measures the entire tooth surface and provide a color map
of the tooth in one image.
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TYPES OF TECHNOLOGICAL SHADE SYSTEMS
• RGB devices
• Digital cameras
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• Spectrophotometers
• Colorimeters
RGB devices
Acquire RED, GREEN, BLUE image information to create
a color image. They do not control key variables associated
with accurate color determination.[22]
Robert[24] in 2000 introduced Shade Scan from Cynovad
which is a popular system that creates an image of the tooth
with a translucency and characterization map, and then will
generate a printed report.
Digital cameras
They are efficient and easy to use and can be an ideal
supplement for the clinician and lab technician in
quantifying shade but alone not a very reliable method for
shade analysis.[22]
Factors such as illumination and the angle of the photograph
will alter how color is perceived by the camera. Alvin
et al.[25] stated the use of Commercial SLR cameras when
combined with the appropriate calibration protocols showed
potential for use in the color replication process.
Spear stated the use of color-corrected professional quality
film (e.g. Kodak EPN-100, E100-S, or EPP) and have a good
photo lab to develop them, taking vector shots at 65-70°
looking down with an incisal edge away from chroma and
hue helps in increasing the amount of reflection thus better
color accuration.[26]
Comparison between spectrophotometers and
colorimeters
The use of the digital system that can qualify and quantify
shade maps provides Delta E (E) measurements for shade
comparison. Delta E is a colorimetric value that delineates
the difference between two colors. To distinguish this value,
three reference points are available generally CIE L*A*B*
OR CIE Lch.
Chu[27] stated that colorimeters are tri-stimulus and can
measure in either CIE Lab or CIE Lch. It is however
impossible to produce precise colorimeter, since filters
must be well controlled and the characteristic of light well
807
Bhat, et al.
maintained. Spectrophotometers allow the user to measure
metamerism, therefore independent of filters and changing
light sources.
Spectrophotometers
It measures and records the amount of visible radiant energy
reflected or transmitted by an object one wavelength at a
time for each value, chroma, and hue present in the entire
visible spectrum.[28,29] Stephen et al.[22] stated the disadvantage
being expensive, complex, difficult to measure the color of
teeth in vivo with these machines.
The various systems available are spectroshade described by
Cherkes et al. [30] (Posey dental technology), Vita easy shade
(Vident), and Shade pilot system (Degudent). The main
advantage of spectroshade lies in the split screen feature
encouraging the comparison of before and after images
providing full face pictures on an intraoral camera. The
Vita easyshade provides a prescription in both Vitapan 3D
master and classic VITA shades.
Colorimeters
Colorimeters provide measurements in CIELAB units (L*,
A*, B*) that can compare the color parameters of different
objects when analyzed mathematically.
Colorimeters can be of two types mainly the photoelectric tri-
stimulus colorimeters (Microcolor) and silicon photodiode
array (Orient Scientific Ltd). Microcolor colorimeter (a
photoelectric tri-stimulus colorimeter) is a self-contained
measuring system that requires no external power source
while a silicon photodiode array requires both an external
power source and a standard light source; it is a compact
color measuring instrument that is less prone to overheating
and is cost effective.
The various colorimeters available are X-Rite Shade Vision
System and Shade NCC (Shofu). The shade vision system
adds the advantage of shade information being sent to the
dental laboratory via e-mail, disk, or by printout.
Pusateri et al.[31] studied the reliability and accuracy of
four dental shade-matching instruments and concluded the
spectrophotometers (shade vision and vita easy shade) to
be more reliable and accurate compared to colorimetric
devices. This is in agreement with the study by Browning
et al.[32] where they stated the use of vita easy shade to
be frequently an exact match when compared to other
devices.
Dennison [33] described the photometric assessment of tooth
color using commonly available software. He concluded
that digital camera are almost an integral part of each dental
office whereas the limiting factors of spectrophotometers
are their cost, complexity of handling, and bulk of involved
gadgets.
Indian Journal of Dental Research, 22(6), 2011
 Role of colors in restorative dentistry
STUMP SHADE GUIDES
With the increasing use of all-ceramic restorations, it is
important to communicate the prepared tooth or “stump”
shade to the ceramist so that they can build the restoration
with the right opacity/translucency.[1]
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Chu stated the most popular stump shade guides to be used
as Ivoclar, (vivadent) and Finesses guide (Ceramco).
GINGIVAL SHADE GUIDES
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Dummet[34] described that the color of gingiva is variable
ranging from a pale pink to deep bluish purple. Color depends
on intensity of melanogenesis, epithelial cornification, and
depth of epithelization. Comparisons of the imagined color
of gingiva and an actual visual color measurement are of
doubtful scientific value.
The findings of Nakashima[35] showed that imaginable color
is more yellow red and higher in chroma. Fukai using a
spectrophotometric technique found that free marginal
gingiva in maxilla is higher in value and that female gingiva
tends to be more red compared to male.
Color assessments of the attached gingiva have been
evaluated using Munsell color tabs. Use of helium neon gas
laser to record the reflectance of interdental papilla was
documented. Dummet was the first to describe the color of
intraoral soft tissues.[34,36]
Currently, methyl methacrylate is the most frequently used
resin. Thus one shade of pink for partial dentures is not
acceptable for all patients, especially when the acrylic flange
is adjacent to the gingiva in the esthetic zone.[37] Okubo
et al.[38] stated the most popular method to be the visual shade
selection with the help of shade guides. Bayindir[39] described
the use of commonly used gingival shade guides presently
i.e. Lucitone 199 shade guide system (Densply trubyte),
Ivoclap plus gingival indicator set (Ivoclar vivadent), and
IPS gingival shade guide (Ivoclar vivadent).[40]
IMPACT OF MATERIAL SCIENCE ON COLORS
The importance of restorative materials and their effect
on color shade cannot be overemphasized.[41] Mc leans
-one of the leaders and innovators in dental ceramics
developed a variety of present day available ceramics.[42] The
improved characteristics are primarily in material density,
which correlates directly to light transmission and color
coordination.
Sulikowinski and Yoshida[43] proposed that the depth of tooth
preparation be based on the present level of discoloration
for the veneer fabrication. Greater depth of reduction is
required to allow greater thickness of cosmetic restorative
Indian Journal of Dental Research, 22(6), 2011
Bhat, et al.
materials to mask the underlying tooth shade. Aoshima[44]
stated the use of pressable ceramic restorative material for
the shade matching of single veneer restoration.
Dietschi et al. [45] described that the use of modern fabrication
of composite restorations is based on the natural layering
concept. This approach embraces the typical optical and
anatomic characteristics of natural teeth.
Individual color characterization is important in acceptance
of an external facial prosthesis by a patient, yet it remains
one of the greatest challenges faced by the clinicians
(Bergstrom, 1998). Basic method by Barnhat et al. (1978)
stated the use of intrinsic color characterization and extrinsic
color modification. Schaaf (1970) described the tattooing
method carrying some pigments below the surface for better
color matching in maxillofacial prosthesis.[46]
DISCUSSION AND CONCLUSIONS
The study of color is one of the most integral parts of esthetic
dentistry. Matching the right color leads to a pleasing
appearance and satisfaction for the patient and the clinician.
The recommended protocol for conventional and
instrumental shade matching should be followed to
achieve esthetic and predictable results. Successful shade
taking involves a combination of technology, shade tabs,
and reference photograph. In spite of the limitations
in materials and techniques, a harmonious restoration
can almost always be achieved if a methodical and
organized manner is followed during shade selection. The
considerations mentioned in this article are associated with
the application of color science to dentistry. Color science
in fact complements the artistic talents of clinicians, dental
assistants, and ceramists, providing both an appropriate
foundation and a frame for their artwork.
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How to cite this article: 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;22:804-9.
Source of Support: Nil, Conflict of Interest: None declared.
Indian Journal of Dental Research, 22(6), 2011