A comparison between Visual , Digital,

and Digital photography assisted dental shade selection – A clinical study

 INTRODUCTION

 Tooth shade matching is mostly a trial and error method influenced by

clinician proficiency,visual fatigue, and surrounding light source.The
clinical success of a restoration claimed to be aesthetic relies not only on
the shape, size, surface irregularities and translucency of teeth, but also on
the difficult and complex task of color assessment,color communication
and reproduction.

 Thus, perfect agreement in tooth color between the natural dentition and
the restoration is the central criterion of quality for the patient and the key
to a successful incorporation.
 AIM AND OBJECTIVE

 To compare the conventional visual and newer instrumental methods of

dental shade selection
 INCLUSION AND EXCLUSION
CRITERIA

 The inclusion criteria is the presence of an unrestored tooth (without any

history of endodontic therapy or any restorative procedures),Vital tooth.

 The exclusion criteria are those with pathological discolorations

(tetracycline aetiology), solid deposits, stains, brackets,Non vital tooth will
be excluded.
 MATERIALS AND METHODS

 All participants will receive verbal and written information about the study
and will sign an informed consent before inclusion. Visual shade matching
will be performed by 2 experienced clinicians. Each clinician will be been
screened for color deficiencies using the Ishihara plates.

 The teeth selected for color matching are the maxillary right central
incisor.
INFORMED CONSENT
 In advance, all subjects will undergo a professional tooth cleaning.

 The middle one‑third of the right maxillary central incisor is selected for
shade selection.The teeth is moistened by asking the subject to rinse with
water.
 Visual shade matching will be carried out separately by each clinician with
the VITAPAN® 3-D MASTER shade guide at the same time of the day
and in the same dental office, and a window with natural lighting and
under a light source (GDP True Shade) with a color temperature of 5500K.
 To ensure standardization during the study, all the shade matching
procedures were performed by making the subject sit in the same dental
chair directed toward northern facing sunlight. The time selected for the
shade matching procedures was between 11:00 am and 1.00 pm on a clear
day.

 For an accurate assessment, the intensity of the light was reduced and the
device kept at a constant distance of 6 cm from the tooth’s surface.For each
assessment, a time restriction of approximately 10 s was imposed. The
teeth and the standards (shade tabs) were observed simultaneously under
same lighting condition

 First, the Hue was selected from the nearest shade color available on the
shade guide; following which Chroma was selected from within the Hue
group which was based on the saturation of color.
 Therefore, for each subject, the appropriate shade will be noted based on
the corresponding shade tabs. Each patient will be seated on the dental
chair, and each examiner will perform the shade-matching procedure.Each
examiner is blinded to the shade color selected by the other examiners.

 The digital camera used for the study was a Canon 500D series,
single‑lens reflex (SLR) camera with a Harison tripod stand (3D EV) and
with a polarised light. The digital camera is connected to a laptop (Lenovo
G575) which has the image analyzing software (Adobe Photoshop ,Adobe
Systems,Inc.)They record a dimensionally accurate image.A digital
photograph will be captured for each subject and stored as a JPEG file.
• The same camera settings are used : Macro lens with auto focus of
100mm,an aperture of f20,and a shutter speed of 1/125 seconds.The
distance between the object and the lens was 35cm.
 Only well exposed digital photographs will be taken for analysis.Under
or over exposed photos are discarded and replacement photos will be
taken.

 Standardized color value system (L*a*b*) were used, and the natural
tooth color and all shade tabs from the shade guide were recorded.The
color difference between tooth and shade tabs were calculated using
CIELAB formula . The shade tab which deviated least from natural tooth
will be determined to match.
 For the digital color image analysis obtained with an intraoral scanner
Trios 3 Basic Wireless connected to a computer , the squared tip (size: 19 ×
23 mm2) of the scanner was aligned parallel to and in close contact with
the labial surfaces of the experimental tooth.
 Due to the size of the tip, the examined area covers the entire surface of
each experimental tooth . The scanned 3D image of each tooth was
resolved on a color LCD monitor (Resolution: 2880 pixels in width and
1800 pixels in height).

 The digital scanner will be configured to VITAPAN 3D-Master shade

guide which will report the actual shade of the middle third of central
incisor.
 SAMPLE SIZE AND SAMPLING
TECHNIQUE

 The cross sectional study will include 40 dental students who will be
randomly selected.
 INSTRUMENTS FOR DATA
COLLECTION

 Form which includes Name ,Age ,Sex,Oral hygiene and diet, Prophylaxis
details, Visual shade selection data by 3 clinicians,Digital and Digital
photography assisted shade selection values.
 DATA ANALYSIS

 The Fleiss’ kappa statistical test for multiple measurements will be used
to assess method reliability.

 The weighted kappa statistical test will assess the agreement between the
shades matched by the different methods tested.
 CLINICAL SIGNIFICANCE

 In an attempt to provide a more esthetic restoration in agreement with

natural tooth shade and for complete satisfaction of the patients.
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