In vivo tooth-color measurement with a new 3D intraoral scanning system in comparison to conventional digital and visual color determination methods.

STATEMENT OF PROBLEM: Three-dimensional (3D) intraoral scanning systems allow for the simultaneous acquisition of 3D information about tooth surfaces and a photorealistic view of the patient's tooth colors. AIM: The goal of this study was the in vivo comparison of a new 3D scanner with a color acquisition mode and conventional visual and digital color measurements. MATERIALS AND METHODS: The colors of 40 teeth of 20 patients were evaluated in seven ways: 1) By dentists using the Vita 3D-Master; 2) By dental technicians using the Vita 3D-Master; 3) With the 3Shape Trios device; 4) With the Vita Easyshade device; 5) With the Vita Easyshade Advance device; 6) With the SpectroShade device; and 7) With the SpectroShade Micro device. Digital measurements of Groups 3 to 7 were repeated three times for each tooth. For all groups, both the CIE Lab values and the Vita 3D-Master values were recorded. The repeatability and relative accuracy of the Vita 3D-Master values were analyzed statistically using Pearson's chi-squared test (α < 0.05). ΔE values were calculated from the CIE Lab values, which served as a basis for performing multidimensional scaling (MDS) and evaluating differences between the groups using the one-way ANOVA with post hoc Tamhane's test (α < 0.05). RESULTS: The results of the ΔE values showed that clinically relevant differences between the evaluation by dentists, dental technicians, and the intraoral scanning device (3Shape) are negligible. The intraoral 3D scanning device (Group 3) and the digital systems (Groups 4 to 7) did not differ significantly in the repeatability of color shade management. The SpectroShade Micro (Group 7) had significantly better relative accuracy than the other devices. CONCLUSIONS: The results demonstrate that intraoral scanning systems can be used to measure both tooth color and tooth surface in 3D. CLINICAL IMPLICATIONS: Intraoral optical scanning devices allow for the acquisition of accurate 3D surface data. Tooth color can be evaluated simultaneously and can be used to determine the color of restorations without requiring additional conventional color-measurement methods.

A clinical study relating CIELCH coordinates to the color dimensions of the 3D-Master System in a Spanish population.

STATEMENT OF PROBLEM: The 3D-Master System comprises 26 physical shade tabs and intermediate shades. Determining the relationship among all the groups of lightness, chroma, and hue of the 3D-Master System (Vita Zahnfabrik) and the L*, C*, and h* coordinates is important, because according to the manufacturer, 2 Toothguide 3D-Master shades need to be mixed in a 50:50 ratio to create an intermediate shade. PURPOSE: The purpose of the study was to relate the lightness, chroma, and hue groups of the 3D-Master System with the polar coordinates of the CIELAB chromatic space, L*, C*, and h*, and to quantify the shades tabs and intermediate shades of the 3D-Master System according to color coordinates. MATERIAL AND METHODS: The middle third of the facial surface of a natural maxillary central incisor was measured with an Easyshade Compact spectrophotometer (Vita Zahnfabrik) in 1361 Spanish participants aged between 16 and 89 years. Natural tooth color was recorded in the 3D-Master nomenclature and in the CIE L*, C*, and h* coordinates system. The program used for the present descriptive statistical analysis of the results was SAS 9.1.3. RESULTS: In the L* variable, the minimum was found at 47.0 and the maximum at 91.3. In the C* variable, the minimum was found at 5.9 and the maximum at 49.8, while for h*, the minimum was 67.5 degrees and the maximum 112.0 degrees. CONCLUSIONS: Despite the limitations of this study, the 3D-Master System was found to be arranged according to L*, C*, and h* coordinates in groups of lightness, chroma, and hue. The corresponding groups of lightness, chroma, and hue can be estimated on the basis of L*, C*, and h* coordinates.

The effect of various disinfectants on dental shade guides.

STATEMENT OF PROBLEM: Dental shade guides are used to evaluate tooth color before prosthodontic procedures and are subjected to disinfection after use. The effect of disinfection on shade guides has not been thoroughly investigated. PURPOSE: The purpose of this study was to evaluate the effect of disinfectants on the color of shade tabs. MATERIAL AND METHODS: Changes in the color (ΔE) of VITA Classical Shade Guide tabs were measured with a VITA Easyshade spectrophotometer in the CIELAB system and calculated after being subjected to Cavicide, Asepticare TB, Sporicidin, and distilled water (control) over a simulated period of 2 years. Statistical analysis was accomplished by a 2-way analysis of variance followed by the Tukey honestly significant difference (HSD) test (α=.05). RESULTS: A significant difference was noted in the degree of shade tab color change, depending on the type of disinfectant used (F=153.2, P<.001). No significant difference was noted in the amount of shade tab color change that occurred after disinfection among the different shade tabs used (F=0.611, P=.865), nor was a significant interaction noted between the type of disinfectant and the different shade tabs used (F=0.7, P=.919). Asepticare TB showed the least significant amount of change (ΔE=0.401), and Sporicidin (ΔE=0.889) and the control (ΔE=0.969) showed significantly more color change than Asepticare TB but less than Cavicide (ΔE=1.198). CONCLUSIONS: The average total CIELAB color difference for 50% human perceptibility is approximately 1 unit (under standardized laboratory conditions). In the oral cavity, however, an average change of 3.7 ΔE units could still allow teeth to be perceived as having the same color. Therefore, although the results are statistically significant, they may not be clinically important.

Evaluating the ability of dental technician students and graduate dentists to match tooth color.

STATEMENT OF PROBLEM: The ability of dental technician students to match tooth shade with the Vita 3D-Master shade guide and Toothguide Training Box has not been investigated. PURPOSE: The purpose of this study was to evaluate and compare the shade-matching ability of dental technician students and graduate dentists using the Vita 3D-Master shade guide. MATERIAL AND METHODS: Twenty-nine dental technician students (DTS group) and 30 graduate dentists (GD group) participated in this study. The Toothguide Training Box (TTB) was used to train the participants and test their shade-matching abilities. Shade-matching ability was evaluated with 3 exercises and a final test, all of which are components of the TTB. The number of mistakes for each participant for value (L), chroma (c), and hue (h) were recorded during the exercises and the final test, and the mistake ratios were calculated. Color difference (ΔE) values for each shade were calculated from the L*, a*, and b* values of the Vita 3D-Master shade guide for each participant in both groups. The Mann-Whitney U test was used to determine statistically significant differences between the L, c, and h mistake ratios of the 2 groups, and the Student t test was used to determine statistically significant differences between the final test scores and the ΔE values of the groups (α=.05). RESULTS: The mistake ratio for L in the GD group was significantly higher than that of the DTS group (P<.05), whereas the mistake ratio for h in the DTS group was higher (P<.001). No significant differences were observed between the groups regarding the mistake ratios for c (P>.05). With regard to the final test scores and the ΔE values, no significant differences were found between the groups (P<.001), and the DTS group received higher scores than the GD group (912 and 851). The mean ΔE values for the DTS and GD groups were 1.72 and 2.92. CONCLUSIONS: DTSs made more mistakes in the h parameter than GDs, and GDs made more mistakes in the L parameter than DTSs. With regard to the final test scores and the ΔE values, DTSs were more successful in shade matching than GDs.

Evaluation of an optimized shade guide made from porcelain powder mixtures.

STATEMENT OF PROBLEM: Color errors associated with current shade guides and problems with color selection and duplication are still challenging for restorative dentists. PURPOSE: The purpose of this study was to evaluate an optimized shade guide for visual shade duplication. MATERIAL AND METHODS: Color distributions (L*, a*, and b*) of the maxillary left central incisors of 236 participants, whose ages ranged from 20 to 60, were measured with a spectrophotometer. Based on this color map, an optimized shade guide was designed with 14 shade tabs evenly distributed within the given color range of the natural incisors. The shade tabs were fabricated with porcelain powder mixtures and conventional laboratory procedures. A comparison of shade duplication by using the optimized and Vitapan Classical shade guides was conducted. Thirty Chinese participants were involved, and the colors of the left maxillary incisors were selected by using 2 shade guides. Metal ceramic crowns were fabricated according to the results of the shade selection. The colors of the shade tabs, natural teeth, and the ceramic crowns were measured with a spectrophotometer. The color differences among the natural teeth, the shade tabs, and the corresponding metal ceramic crowns were calculated and analyzed (α=.017). RESULTS: Significant differences were found in both phases of shade determination and shade duplication (P<.017). The total number of color errors with the optimized shade guide was 3.5, which was significantly less than that of Vitapan, 5.1 (P<.001). CONCLUSIONS: The optimized shade guide system improved performance not only in the color selection phase but also in the color of the fabricated crowns.

Assessing the accuracy of computer color matching with a new dental porcelain shade system.

STATEMENT OF PROBLEM: In a previous study, a novel computer color matching system for dental ceramic restoration was developed, and 21 new shades were established. Theoretically, a natural tooth color can be accurately reproduced by combining 2 or 3 ceramic mixtures from the database of 21 new shades. PURPOSE: The purpose of this study was to test the use of these shades in conjunction with the computer color matching system to determine their ability to accurately reproduce the body color of 29 shade tabs from a shade guide (VITAPAN 3D-Master). MATERIAL AND METHODS: Disks of 21 reference shades were prepared with porcelain (Cerabien CZR) and polished to 1.0 mm thickness. A spectrophotometer was used to measure the reflectance values from 380 to 780 nm for each disk; the scattering coefficient and absorption coefficient were determined. By using the reflectance values and the scattering and absorption coefficients, the computer color matching program generated porcelain prescriptions incorporating proportions from the 21 reference shades to reproduce the shade tabs. Disks were fabricated from the prescriptions, polished to 1.0 mm thickness, then placed over a zirconia core plate and measured with the spectrophotometer. The color differences (ΔE*) between the shade tabs and the corresponding ceramic disks were calculated. Statistical analysis was performed with the 1-sample t test. RESULTS: The ΔE* values between computer color matching specimens and the target shade tabs varied from 0.5 to 1.9, with an average ΔE* of 1.3, which was significantly less than the clinically detectable ΔE* threshold of 1.6 (P<.001). CONCLUSIONS: The computer color matching system with the established 21 new shades is accurate and effective for reproducing tooth shades.

Shade determination using camouflaged visual shade guides and an electronic spectrophotometer.

The aim of the present study was to compare a camouflaged visual shade guide to a spectrophotometer designed for restorative dentistry. Two operators performed analyses of 66 subjects. One central upper incisor was measured four times by each operator; twice with a camouflaged visual shade guide and twice with a spectrophotometer Both methods had acceptable repeatability rates, but the electronic shade determination showed higher repeatability. In general, the electronically determined shades were darker than the visually determined shades. The use of a camouflaged visual shade guide seems to be an adequate method to reduce operator bias.

[Evaluation of the professional dentists' ability to determine the tooth shade guide: a pilot study]. / Evaluation de la capacité des professionnels en odontologie à déterminer la couleur des teintiers: étude pilote.

BACKGROUND: During its clinical practice, the dentist is often faced with issues concerning the determination of teeth shade. This step is considered sensitive by numerous clinicians and dental laboratories. The objective of this study was to test the ability of professional dentists to visually determine the teeth color. MATERIAL AND METHODS: Eleven dentists classified 35 unmarked samples according to their hue, chroma and value from 2 standardized tooth shade guides Ivoclar-Vivadent (Chromascop) et Vita (3D Master). The ratio between the number of matching samples and the total amount of samples from each group was calculated and converted to a score between 0 and 10. RESULTS: Better scores were obtained for value and chroma with the 3D Master shade guide than with the Chromascop shade guide (p < 0.001). The opposite result was obtained for the hue (p < 0.05). Globally, better results were obtained for the value and chroma, the hue being the most difficult item to evaluate. A satisfying "color perception" was observed in 69% of the cases. CONCLUSION: The results of this study argue in favor of a specific training for tooth shade determination in Odontology.

Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: a new concept in composite layering--Part II.

While restoring an anterior tooth, shade matching is one of the crucial points that we can face to have an esthetic final outcome. After studying the physical and optical characteristics of enamel and dentine in the first part of this article, the second part will propose a new method for color matching and a clinical stratification using a simple and reproducible procedure for anterior restorations with only one dentine and one enamel shade.

Repeatability and reliability of human eye in visual shade selection.

Deficiencies in the human visual percep-tion system have challenged the efficiency of the visual shade-matching protocol. The aim of this study was to evaluate the repeatability and reliability of human eye in visual shade selection. Fifty-four volunteering dentists were asked to match the shade of an upper right central incisor tooth of a single subject. The Vita 3D-Master shade guide was used for the protocol. Before each shade-matching procedure, the definitive codes of the shade tabs were hidden by an opaque strip and the shade tabs were placed into the guide randomly. The procedure was repeated 1 month later to ensure that visual memory did not affect the results. The L*, a* and b* values of the shade tabs were measured with a dental spectrophotometer (Vita Easyshade) to produce quantitative values to evaluate the protocol. The paired samples t-test and Pearson correlation test were used to compare the 1st and 2nd selections. The Yates-corrected chi-square test was use to compare qualitative values. Statistical significance was accepted at P < 0·05. Comparing baseline and 1st month records, statistical significance (P < 0·001) was found among qualitative data regarding repeatability on a yes/no (1/0) basis, revealing a very low percentage of repeatability (11·1%). Comparing baseline and 1st month records, statistical significance was not found (P = 0·000) among the L*, a*, b* and ΔE variables. These results indicate that dentists perform insufficiently regarding repeatability in visual shade matching, but they are able to select clinically acceptable shades.

Proposed shade guide for human facial skin and lip: a pilot study.

STATEMENT OF PROBLEM: Currently, no commercially available facial shade guide exists in the United States for the fabrication of facial prostheses. PURPOSE: The purpose of this study was to measure facial skin and lip color in a human population sample stratified by age, gender, and race. Clustering analysis was used to determine optimal color coordinates for a proposed facial shade guide. MATERIAL AND METHODS: Participants (n=119) were recruited from 4 racial/ethnic groups, 5 age groups, and both genders. Reflectance measurements of participants' noses and lower lips were made by using a spectroradiometer and xenon arc lamp with a 45/0 optical configuration. Repeated measures ANOVA (α=.05), to identify skin and lip color differences, resulting from race, age, gender, and location, and a hierarchical clustering analysis, to identify clusters of skin colors) were used. RESULTS: Significant contributors to L*a*b* facial color were race and facial location (P<.01). b* affected all factors (P<.05). Age affected only b* (P<.001), while gender affected only L* (P<.05) and b* (P<.05). Analyses identified 5 clusters of skin color. CONCLUSIONS: The study showed that skin color caused by age and gender primarily occurred within the yellow-blue axis. A significant lightness difference between gender groups was also found. Clustering analysis identified 5 distinct skin shade tabs.

Shade matching performance of dental students with three various lighting conditions.

AIM: To evaluate the ability of dental students to match shades under three various light conditions. MATERIALS AND METHODS: Sixty senior dental students participated in this study. All students were tested for color deficiency using Ishahara's tests. Nine classical vita shade tabs were randomly selected and their identification codes were concealed. The students were asked to match these 9 selected items by using a complete vita shade guide under three various light conditions (natural light, clinical light, and correcting light source). The chosen shade tabs were recorded and the correct matches were counted. Scores were calculated by adding the number of correct matches. RESULTS: The mean values of correct match scores with natural light, clinical light and correcting light source were 4.82, 4.75 and 6.82, respectively. There was no significant difference in correct matches scores between men and women, nor among various vita A, B, C and D shades. CONCLUSION: The students showed a better performance in shade matching under the correcting light source than natural light and clinical light. Gender had no effect on shade matching selection and there was no difference in shade matching ability among vita A, B, C, D shades. CLINICAL SIGNIFICANCE: Shade matching performance is significantly improved with correcting light source.

A clinical study to correlate maxillary anterior natural teeth with that of the commercially available acrylic and porcelain shade guides.

The success of the dental treatment as perceived by our patients is often preferentially evaluated on the appearance of the restoration. Usually visual determination is unreliable and inconsistent, complicated by the inability of the shade guide to cover the entire dental color range and also there is lack of logical order of arrangement of the tabs. Hence a clinical study is planned to perform visual shade selection in standardized conditions to correlate the shades of maxillary anterior natural teeth in adult subjects of Davengere district origin to one acrylic and three porcelain shade guides commercially available in India.

Reliability of shade selection using an intraoral spectrophotometer.

In this study, we evaluate the accuracy and reproducibility of human tooth shade selection using a digital spectrophotometer. Variability among examiners and illumination conditions were tested for possible influence on measurement reproducibility. Fifteen intact anterior teeth of 15 subjects were evaluated for their shade using a digital spectrophotometer (Crystaleye, Olympus, Tokyo, Japan) by two examiners under the same light conditions representing a dental laboratory situation. Each examiner performed the measurement ten times on the labial surface of each tooth containing three evaluation sides (cervical, body, incisal). Commission International on Illumination color space values for L* (lightness), a* (red/green), and b* (yellow/blue) were obtained from each evaluated side. Examiner 2 repeated the measurements of the same subjects under different light conditions (i.e., a dental unit with a chairside lamp). To describe measurement precision, the mean color difference from the mean metric was used. The computed confidence interval (CI) value 5.228 (4.6598-5.8615) reflected (represented) the validity of the measurements. Least square mean analysis of the values obtained by examiners 1 and 2 or under different illumination conditions revealed no statistically significant differences (CI = 95%). Within the limits of the present study, the accuracy and reproducibility of dental shade selection using the tested spectrophotometer with respect to examiner and illumination conditions reflected the reliability of this device. This study suggests that the tested spectrophotometer can be recommended for the clinical application of shade selection.

Data comparison between two dental spectrophotometers.

OBJECTIVES: The objective of this study was to clinically test whether the data from two different spectrophotometers, based on spot and surface measurements, can be compared. METHODS: Under standardized clinical conditions two devices (Vita Easyshade and Spectro Shade-Micro) were used to record the color of three areas (cervical, middle, and incisal) per tooth for three upper maxillary anterior teeth in 102 participants. Each position was measured three times to attain an average for the CIE L*a*b* coordinates and to attain the corresponding Vita Classical shade tab integrated in the software of both devices. Vita tabs were also described as L*a*b* values using earlier published translations so that color differences (ΔE) could be calculated between them. RESULTS: The regression analysis between the two devices showed that the independent correlation coefficients of the L*a*b* values are low. Yet when the suggested shade codes are compared with Vita colors instead of L*a*b*, 40% of the cases were equal and 51% were clinically acceptable. SIGNIFICANCE: According to this study the two devices do not give a comparable shade selection output, and thus the exchange of L*a*b* values between the two spectrophotometers cannot be recommended.

Matching repeatability and interdevice agreement of 2 intraoral spectrophotometers.

STATEMENT OF PROBLEM: The visual determination of tooth color with standard shade guides is a subjective method of color communication, depending on variables such as the light source, the operator, and the tooth. The assessment of tooth color may be improved by the use of special devices such as colorimeters or spectrophotometers. However, the repeatability and the interdevice agreement of these devices have not been thoroughly investigated. PURPOSE: The purpose of this study was to evaluate the effect of different illuminants (natural daylight, dental unit lamp, and daylight lamp) on the matching repeatability of 2 intraoral spectrophotometers (Easyshade and SpectroShade). MATERIAL AND METHODS: The maxillary right central incisor and canine and the mandibular left central incisor of each of 10 dental students were measured by a single operator using both devices. The color of each tooth was assessed 3 times with each device under each of the 3 different illuminants (natural daylight, a dental unit lamp, and a daylight lamp). The device readings were expressed in Vitapan 3D-Master shade codes. Statistical analysis was performed and the level of agreement was assessed with the Spearman Correlation Coefficient. RESULTS: A particularly high to moderate level of agreement among the readings made under natural daylight, a dental unit lamp, and a daylight lamp was observed for both devices (P<.01), suggesting that their matching repeatability was not completely satisfactory for clinical practice. A moderate and a moderate to high level of agreement was found among Easyshade readings when the 3 different illuminants were used. The level of agreement for the respective SpectroShade readings was particularly high to high (P<.001). A particularly low level of agreement was found among the respective Easyshade and SpectroShade readings performed under any of the illuminants tested (P<.05), suggesting poor interdevice reliability. CONCLUSIONS: The matching repeatability of both devices under natural daylight, a dental unit lamp, and a daylight lamp was not completely satisfactory for clinical practice. The effects of different illuminants seem to be more pronounced for Spectroshade than for Easyshade. The interdevice agreement between the 2 devices tested was poor, suggesting that the 2 devices were not compatible.

Visual and instrumental evaluation of color match ability of 2 shade guides on a ceramic system.

STATEMENT OF PROBLEM: There is limited information on the visual and instrumental evaluation of color match between a natural tooth and a ceramic crown. PURPOSE: The purpose of this study was to evaluate the influence of 2 shade guides on color match, and to evaluate the relationship between color difference (ΔE) values and examiners' assessments of the color match in ceramic crowns. MATERIAL AND METHODS: Thirty-three subjects were selected for a ceramic crown restoration of the maxillary central incisor. Two crowns were fabricated with selected shades from Vitapan Classical and Vita Toothguide 3D-Master shade guides for each subject. The color values of maxillary central incisors, selected shade tabs, and corresponding crowns were measured with a spectrophotometer. The ΔE values between the natural teeth and the crowns and between the selected shade tabs and the corresponding crowns were calculated for each subject and compared with the Student's t test (α=.05). In addition, 3 examiners visually evaluated the clinical acceptability of each crown on a scale from 1 to 6. The agreement among the examiners was assessed with the Kappa test. The scores of examiners for both shade guides were analyzed with the Wilcoxon signed rank test (α=.05). RESULTS: The results revealed that the color difference values between the teeth and the crowns fabricated with the selected shades from the Vita Toothguide 3D-Master shade guide were significantly smaller than those of the Vitapan Classical guide (P=.003). Similarly, the color difference values between the selected shade tabs from the Vita Toothguide 3D-Master guide and the corresponding crowns were significantly smaller than those of the Vitapan Classical guide (P=.001). However, the ΔE values obtained for both shade guides were within the clinically acceptable range (ΔE<3.7). The kappa values implied moderate agreement among the 3 examiners. The median value of the examiners' scores was 2, which denoted an acceptable color match. In addition, the recorded scores of the 3 examiners showed that there was no significant difference in terms of the color match between the crowns fabricated with either of the 2 shade guides. CONCLUSIONS: The ceramic crowns fabricated with the Vita Toothguide 3D-Master shade guide resulted in a closer color match to the natural teeth than those of the Vitapan Classical guide. However, the ΔE values and the examiners' scores were within the clinically acceptable range for both shade guides.

Shade guide optimization--a novel shade arrangement principle for both ceramic and composite shade guides when identifying composite test objects.

STATEMENT OF PROBLEM: The most widely used shade guide for composite materials is made of ceramic and arranged according to a non-proven method. There is a need for a composite shade guide using a scientifically based arrangement principle. PURPOSE: To compare the shade tab arrangement of the Vitapan Classical shade guide and an individually made composite shade guide using both the originally proposed arrangement principle and arranged according to ΔE2000 values with hue group division. MATERIALS AND METHODS: An individual composite shade guide made from Filtek Supreme XT body colors was compared to the Vitapan Classical shade guide. Twenty-five students matched color samples made from Filtek Supreme XT body colors using the two shade guides arranged after the two proposed principles--four shade guides in total. Age, sequence, gender, time, and number of correct matches were recorded. RESULTS: The proposed visually optimal composite shade guide was both fastest and had the highest number of correct matches. Gender was significantly associated with time used for color sampling but not regarding the number of correct shade matches. CONCLUSIONS: A composite shade guide is superior compared to the ceramic Vitapan Classical guide when using composite test objects. A rearrangement of the shade guide according to hue, subdivided according to ΔE2000, significantly reduces the time needed to take a color sample and increases the number of correct shade matches. CLINICAL SIGNIFICANCE: Total color difference in relation to the lightest tab with hue group division is recommended as a possible and universally applicable mode of tab arrangement in dental color standards. Moreover, a shade guide made of the composite materials itself is to be preferred as both a faster and more accurate method of determining color.

Color match of two different ceramic systems to selected shades of one shade guide.

STATEMENT OF PROBLEM: There are no consistent indications given by dental manufacturers on how to layer ceramics to achieve a color match to a shade selected from a dental shade guide. The technique for ceramic layering relies primarily on the skill and experience of ceramists and is not easily predictable. PURPOSE: The purpose of this study was to evaluate, using a clinical spectrophotometer, the ability to color match shades selected with the 3D-Master shade guide using 2 different ceramic systems. MATERIAL AND METHODS: Two ceramic systems were selected for this study, the VITA Omega 900 and VITA VM 13. For both systems, shades 2M3, 3M2, 4M2 of the VITA 3D-Master shade guide were selected. Thirty ceramic discs, 15 mm in diameter, were fabricated with different layer thickness ratios of opaque dentin, dentin, and enamel, maintaining a constant overall thickness. A clinical spectrophotometer (VITA Easyshade) was used for color comparison. The measured ΔE values were statistically analyzed with a 3-way ANOVA and the Tukey HSD test (α=.05). RESULTS: The 3-way ANOVA showed that the ceramic system (P<.001), the selected shade (P<.001), and the layering scheme all significantly influenced the ΔE values (P<.001). CONCLUSIONS: Both VITA VM 13 and VITA Omega 900 ceramic systems showed a color match with the shades 2M3, 3M2, and 4M2 of the VITA 3D-Master shade guide to be within the limits for clinical acceptability (ΔE≤ 3.3). VM 13 showed a statistically better color match. The layering scheme influenced the definitive color of the restoration.

In vitro evaluation of color replication of metal ceramic specimens using visual and instrumental color determinations.

STATEMENT OF PROBLEM: It remains unclear whether or not the performance of intraoral colorimetric devices is accurate. PURPOSE: The purpose of this study was to evaluate the color replication of metal ceramics using an intraoral colorimeter and visual shade determination. MATERIAL AND METHODS: Twenty-five metal ceramic specimens were prepared to match 5 different shades (A1, B1, C3, D3, A3.5) of the Vitapan Classical shade guide. Five clinicians determined the shades of the specimens using the same shade guide. The shade determination was based on the agreement of at least 3 of the 5 observers. Instrumental shade determinations were made with an intraoral colorimeter (ShadeEye NCC) to obtain results in terms of the Vitapan Classical shade guide. Based on these shade determinations, 50 additional metal ceramic specimens (25 visually determined and 25 instrumentally determined) were prepared. The master (initial) and definitive (additional) specimens were analyzed with a spectrophotometer. L*, a*, b* values of each specimen were measured, and the color difference between the master and definitive specimens was calculated. The Wilcoxon signed rank test was used to analyze the color difference (ΔE) values (α=.05). RESULTS: Visual shade determination produced lower ΔE values than instrumental shade determination. The differences between ΔE values of different shade determination methods were significant for master specimens of the shades B1 and A3.5 (P=.02). The ΔE value calculated from the result of instrumental determination of shade B1 (ΔE=2.97) was within the clinically acceptable limit (ΔE=3.5), whereas the ΔE value for A3.5 (4.03) exceeded the limit for clinical acceptability. The ΔE values for C3 exceeded the acceptable limit for both shade determination methods (ΔE>3.5). CONCLUSIONS: Color replication of metal ceramic specimens using visual shade determination was more accurate compared to instrumental shade determination. The replication of the high-value shades (A1-B1) was observed to be reliable with both shade determination methods.