Chroma-dependence of CIEDE2000 acceptability thresholds for dentistry.

OBJECTIVES: Determine visual 50:50% color difference acceptability thresholds (AT) for regions of the dental color space with varying chromaticity. METHODS: A 40-observer panel belonging to two different groups (dentists and laypersons) evaluated 144 dental resin composites pairs (divided in three different sets of 48 pairs according to chroma value: Low Chroma (LC), Medium Chroma (MC) and High Chroma (HC) placed 40 cm away and inside of a viewing cabinet (D65 Standard light source; diffuse/0° geometry). A Takagi-Sugeno-Kang (TSK) fuzzy approximation was used for fitting the data points and calculate the 50:50% acceptability thresholds in CIEDE2000. A paired t-test was used to evaluate the statistical significance between thresholds differences and Bonferroni correction was applied. RESULTS: The CIEDE2000 50:50% AT were ∆E00 = 2.84, ∆E00 = 2.31 and ∆E00 = 1.80 for LC, MC and HC sets of sample pairs, respectively. The 50:50% AT values were statistically significant between the different sets of sample pairs, as well as the 50:50% AT values obtained for different observer groups. CONCLUSIONS: 50:50% CIEDE2000 acceptability thresholds for dentistry are significantly different depending on the chromaticity of the samples. Observers show higher acceptability for more achromatic samples (low chroma value) than for more chromatic samples. CLINICAL SIGNIFICANCE: The difference in the AT for distinct regions of the dental color space can assist professionals as a quality control tool to assess clinical performance and interpret visual and instrumental findings in clinical dentistry, dental research, and subsequent standardization processes.

Multicenter study on visual color difference thresholds. A secondary analysis of light, medium, and dark tooth-colored specimens.

PURPOSE: This secondary analysis further analyzed variations in the 50:50% perceptibility and acceptability thresholds (PT and AT, respectively) pertaining to light, medium, and dark tooth-colored specimen sets. METHODS: Primary raw data from the original study was retrieved. Visual thresholds (Perceptibility - PT and Acceptability - AT) were analyzed among the three specimen sets - light, medium, and dark. The Wilcoxon signed-rank test was used for paired specimens, and the Wilcoxon rank-sum nonparametric test was used for independent specimens (α= 0.001). RESULTS: The 50:50% CIEDE2000 PT and AT values were significantly higher for the light-colored specimen set when compared with the medium and dark-colored specimens: 1.2, 0.7, 0.6, respectively (PT) and 2.2, 16, 14 (AT), respectively (P< 0.001). Independent of the observer group, the highest PT and AT values were always found for the light-colored specimen sets (P< 0.001). Dental laboratory technicians had the lowest visual thresholds, but not significantly different from the other observer groups studied (P> 0.001). Similarly, all research sites had statistically higher visual thresholds for the light-colored specimen set than for the medium- or dark-colored sets, except for two sites that showed statistically similar results for medium-colored specimens but were significantly different from the dark-colored set. Among the different research sites, sites 2 and 5 registered significantly higher PT thresholds for the light specimens (1.5 and 1.6, respectively), and site number 1 had a significantly higher AT threshold relative to the other sites. The 50:50% perceptibility and acceptability thresholds were significantly different among light-, medium-, and dark-colored specimens for different research sites and observer groups. CLINICAL SIGNIFICANCE: The visual perception of color difference related to light-, medium-, and dark-colored specimens varied based on observer group and their geographic location. Therefore, a greater understanding of factors that affect visual thresholds, with the observers being "the most forgiving" for color differences among the light shades, will allow diverse clinicians to overcome some of the challenges of clinical color matching.

Development of Thickness-Dependent Predictive Methods for the Estimation of the CIEL*a*b* Color Coordinates of Monolithic and Layered Dental Resin Composites.

Usually, dentin and enamel shades are layered in dental restorations with the purpose of mimicking the natural appearance of teeth. The main objective of this study was to develop and assess accuracy of a color-prediction method for both monolithic and layered dental resin-based composites with varying shades and under different illuminants. A total of 15 different shades of VITAPAN Excell, VITAPAN Dentine and VITA Physiodens as well as VITA Enamel of five different thicknesses (0.5-2.5 mm range) were used to manufacture monolithic and layered samples. A non-contact spectroradiometer with CIE 45∘/0∘ geometry was used to measure the color of all samples over a standard ceramic black background. Second-degree polynomial regression was used as predictive method for CIE-L*a*b* color coordinates. Performance of predictive models was tested using the CIEDE2000 total color difference formula (ΔE00), while accuracy was evaluated by comparative assessment of ΔE00 with corresponding 50:50% acceptability (AT00) and perceptibly (PT00) thresholds for dentistry. A mean color difference between measured (real) and predicted color of ΔE00=1.71, with 62.86% of the color differences below AT00 and 28.57% below PT00, was registered for monolithic samples. For bi-layered samples, the mean color difference was roughly ΔE00=0.50, with generally 100% and more than 85% of the estimations below AT00 and PT00, respectively. The predictive method allowed highly accurate color estimations for both monolithic and layered dental resin-based composites with varying thicknesses and under different illuminations. These results could be useful to maximize the clinical success of dental restorations.

Coverage error of three resin composite systems to vital unrestored maxillary anterior teeth.

OBJECTIVE: Define the color of anterior teeth of a selected population and correlate it (by using coverage error [CE] and the frequency of best match) with the final color of all possible enamel-dentine combinations of three different resin composite systems. MATERIALS AND METHODS: Color of 636 vital unrestored anterior teeth (central incisors, lateral incisors and canines; n = 212) and disk specimens (12 mm diameter, varying thickness) corresponding to enamel-dentin combinations of all available enamel (0.5 mm and 1.0 mm thickness) and dentin shades (3.0 mm thickness) of Essentia, Enamel Plus HRi and IPS Empress Direct composite systems was measured using a clinical dental spectrophotometer (Spectroshade Micro). CE and frequency of best match for all composite systems were calculated for the measured in-vivo teeth color space. RESULTS: Natural in-vivo teeth exhibit higher lightness when compared to enamel-dentin composite combinations, independently of the enamel thickness used. The best (lowest) CE was found for IPS Empress, while the highest values were found for Enamel Plus Hri independently of tooth type and enamel thickness (p < 0.001). The use of 0.5 mm instead of 1.0 mm enamel thickness within enamel-dentin composite combinations resulted in a lower CE for in-vivo tooth color (p < 0.001). CONCLUSIONS: The color space defined by all possible enamel-dentin combinations of the studied resin composite systems does not fully match the color range of anterior teeth. All composite systems examined lack combinations with lightness values as high as the population's. IPS Empress Direct composite system represented better the in-vivo teeth color. CLINICAL SIGNIFICANCE: The use of 0.5 mm enamel shade thickness is suggested when building layered restorations, as it provided better color coverage than using 1.0 mm thickness.

Validation of a Hyperspectral Imaging System for Color Measurement of In-Vivo Dental Structures.

A full comprehension of colorimetric relationships within and between teeth is key for aesthetic success of a dental restoration. In this sense, hyperspectral imaging can provide point-wise reliable measurements of the tooth surface, which can serve for this purpose. The aim of this study was to use a hyperspectral imaging system for the colorimetric characterization of 4 in-vivo maxillary anterior teeth and to cross-check the results with similar studies carried out with other measuring systems in order to validate the proposed capturing protocol. Hyperspectral reflectance images (Specim IQ), of the upper central (UCI) and lateral incisors (ULI), were captured on 30 participants. CIE-L*a*b* values were calculated for the incisal (I), middle (M) and cervical (C) third of each target tooth. ΔEab* and ΔE00 total color differences were computed between different tooth areas and adjacent teeth, and evaluated according to the perceptibility (PT) and acceptability (AT) thresholds for dentistry. Non-perceptible color differences were found between UCIs and ULIs. Mean color differences between UCI and ULI exceeded AT (ΔEab* = 7.39-7.42; ΔE00 = 5.71-5.74) in all cases. Large chromatic variations between I, M and C areas of the same tooth were registered (ΔEab* = 5.01-6.07 and ΔE00 = 4.07-5.03; ΔEab* = 5.80-8.16 and ΔE00 = 4.37-5.15; and ΔEab* = 5.42-5.92 and ΔE00 = 3.87-4.16 between C and M, C and I and M and I, respectively). The use of a hyperspectral camera has proven to be a reliable and effective method for color evaluation of in-vivo natural teeth.

Visual and instrumental coverage error of two dental shade guides: an in vivo study.

OBJECTIVES: This study aims to evaluate in vivo the color agreement between natural teeth and dental shade guides by means of visual and instrumental coverage error ([Formula: see text]) index. MATERIALS AND METHODS: The color of the middle third of 735 incisors was visually determined by two evaluators using the Vita Classical (VC) and Vita 3D Master (V3DM) shade guides. The color match between the natural tooth and the shade tab was rated as poor (P), good (G), or optimum (O) by each observer. CIE color coordinates of the target teeth and shade tabs of VC and V3DM were instrumentally measured using a clinical spectrophotometer. Visual ([Formula: see text]) and instrumental ([Formula: see text]) coverage error indexes were computed using CIELAB and CIEDE2000 metrics for both shade guides. For [Formula: see text] calculation, only the concordant inter-observer determination on tooth shade rated as O-O or O-G was used. The results were evaluated using perceptibility (PT, [Formula: see text]= 1.2, [Formula: see text]= 0.8) and acceptability (AT, [Formula: see text]= 2.7, [Formula: see text]= 1.8) color thresholds for dentistry. RESULTS: VC and V3DM exhibited [Formula: see text] (2.5, 3.2, and 3.2, 2.7 CIELAB units; 1.9, 2.3, and 2.8, 2.4 CIEDE2000 units, respectively, for O-O and O-G match) and [Formula: see text] (4.7, 4.8, and 4.1, 4.6 CIELAB units; 3.3, 3.4, and 3.4, 3.6 CIEDE2000 units, respectively, for O-O and O-G match) values greater than 50:50% AT for both color difference formulas. [Formula: see text] contributes more than 50% (53.2-82.4% range) to the [Formula: see text] value. This contribution depends on the shade guide used and the quality of the visual rating. CONCLUSIONS: The evaluated shade guides exhibited visual coverage errors above acceptability thresholds, largely due to the contribution of the instrumental coverage error to the visual coverage error. CLINICAL RELEVANCE: It necessary to further improve commercially available dental shade guides to facilitate achievement of satisfactory esthetics results in clinical practice.

Reflectance and color prediction of dental material monolithic samples with varying thickness.

OBJECTIVE: To assess accuracy of reflectance reconstruction and color estimation of different dental materials with varying thicknesses using Principal Component Analysis (PCA). METHOD: A1, A2, A3, A3.5, B2, C2 and D2 shades and 5 thicknesses (within 0.5-2.5 mm range) of Vita Suprinity (VS-PC) and Vitapan Dentine (VD), were used. Reflectance measurements were performed over black background using a non-contact spectroradiometer with CIE 45∘∕0∘ geometry. A PCA based algorithm was proposed to reconstruct spectral data and color of samples, using both extrapolation and interpolation approaches. Root Mean Square Error (RMSE), Goodness of Fit (GFC), correlation coefficient (R2) as well as ΔE00 with corresponding 50:50% acceptability and perceptibly thresholds (AT and PT) were used as performance assessment. RESULTS: The interpolation approach provided an average RMSE = 0.01 and GFC > 0.999 when comparing predicted and measured spectral reflectances for both materials, while for the extrapolation approach RMSE = 0.02 and GFC > 0.999. Interpolation approach also resulted in lower overall mean color difference ΔE00 = 0.8 (ΔE00 = 0.9 for VS-PC and ΔE00 = 0.7 for VD), while using extrapolation approach resulted in higher overall mean color difference ΔE00 = 1.6, although below the AT (ΔE00 = 1.8 for VS-PC and ΔE00 = 1.5 for VD). Correlation values between predicted and measured spectral reflectances of R2 = 0.987 and R2 = 0.993 were globally obtained for VS-PC and VD, respectively. SIGNIFICANCE: The proposed PCA-based algorithm is able to efficiently predict reflectance spectrum and color of monolithic samples of different dental materials with varying thickness. It can be used to optimize dental materials manufacturing processes and to improve chromatic accuracy of clinical dental restorations.

Applications of artificial intelligence in dentistry: A comprehensive review.

OBJECTIVE: To perform a comprehensive review of the use of artificial intelligence (AI) and machine learning (ML) in dentistry, providing the community with a broad insight on the different advances that these technologies and tools have produced, paying special attention to the area of esthetic dentistry and color research. MATERIALS AND METHODS: The comprehensive review was conducted in MEDLINE/PubMed, Web of Science, and Scopus databases, for papers published in English language in the last 20 years. RESULTS: Out of 3871 eligible papers, 120 were included for final appraisal. Study methodologies included deep learning (DL; n = 76), fuzzy logic (FL; n = 12), and other ML techniques (n = 32), which were mainly applied to disease identification, image segmentation, image correction, and biomimetic color analysis and modeling. CONCLUSIONS: The insight provided by the present work has reported outstanding results in the design of high-performance decision support systems for the aforementioned areas. The future of digital dentistry goes through the design of integrated approaches providing personalized treatments to patients. In addition, esthetic dentistry can benefit from those advances by developing models allowing a complete characterization of tooth color, enhancing the accuracy of dental restorations. CLINICAL SIGNIFICANCE: The use of AI and ML has an increasing impact on the dental profession and is complementing the development of digital technologies and tools, with a wide application in treatment planning and esthetic dentistry procedures.

The effects of thickness and shade on translucency parameters of contemporary, esthetic dental ceramics.

OBJECTIVE: To analyze translucency variations among four different contemporary esthetic ceramic systems having different shades and thicknesses. MATERIAL AND METHODS: Ceramic specimens having different shades and translucencies were tested: leucite reinforced glass-ceramic (ECAD), conventional feldspathic ceramic (Noritake), zirconia reinforced lithium silicate glass-ceramic (Suprinity) and hybrid ceramic (Enamic). Specimens of 0.6, 0.9, 1.2, 1.5 and 2.0-mm thickness (n = 3/group, 615 total) were prepared. Translucency (TP) and Relative Translucency (RTP) Parameters were calculated from spectroradiometric color readings. Effects of shade and thickness for a given system were statistically analyzed using MANOVA and Tukey post-hoc multiple comparisons tests. Translucency variations were assessed comparatively with literature-based perceptibility and acceptability thresholds. RESULTS: TP/RTP values of all ceramic materials decreased with increasing thickness. The most translucent specimens were 0.6-mm thick ECAD HT-A3.5 (TP = 31.99) and ECAD HT-C2 (RTP = 23.75), while the least translucent was 2-mm thick Enamic T-3 M2 (TP = 7.27; RTP = 4.79). Thickness and material type significantly influenced translucency (p < 0.001). Noritake and ECAD LT showed similar translucency values, as well as Suprinity HT and ECAD LT. CONCLUSIONS: For ceramic restorations thicker than 0.9-mm, any thickness increase of 0.3-0.5 mm produces a perceptible but clinically acceptable translucency variation. Increases in thickness larger than 0.6-mm will result in an unacceptable translucency shift. Dental practitioners need to recognize key factors that influence translucency of ceramic restorations in order to choose the optimal material, shade, translucency, and thickness suitable for different clinical scenarios. While shade plays a minor role in translucency variation, ceramic type and restoration thickness significantly affect overall translucency.

Color compatibility between dental structures and three different types of ceramic systems.

BACKGROUND: To assess color compatibility between dental structures (human enamel and dentine) and three different types of ceramic systems. METHODS: Samples (1 and 2 mm-thick) of extracted tooth (containing dentine and enamel areas) and three ceramic systems with different shades and opacities (HT-High Translucent, T-Translucent) were prepared for this study: Vita Suprinity-VS (HT, T; A1, A2, A3, A3.5, B2, C2, D2) (Vita Zahnfabrik); Vita Enamic-VE (HT, T; 1M1, 1M2, 2M2, 3M2) (Vita Zahnfabrik) and Noritake Super Porcelain EX-3-NKT (A1, A2, A3, A3.5, B2, C2, D2) (Kuraray Noritake Dental). Reflectance measurements of all samples were performed over black backgrounds using a non-contact spectroradiometer (SpectraScan PR-670, Photo Research) under a CIE 45°/0° geometry. CIE L*a*b* color parameters were measured and CIELAB/CIEDE2000 color differences (ΔE00/ΔE*ab) and corresponding Coverage Error (CE) of ceramic system for dentine or enamel samples were calculated. Color data was analyzed using one-way ANOVA and post-hoc multiple comparisons tests. CE values were interpreted by comparisons with available 50:50% acceptability color threshold (AT) for dentistry. RESULTS: Statistically significant differences in lightness were found among all ceramic systems and human dentine (p < 0.001), while no significant differences were registered between enamel and VSHT, T and VEHT. 1 mm dentine showed no statistical differences with VST and VSHT for a* coordinate, while 2 mm dentine showed no significant differences (p > 0.05) with VEHT. Thin samples (1 mm) of dentine and enamel showed significant statistical differences (p < 0.05) for b* coordinate with less translucent materials (NKT, VET and VST). For dentine samples, none of the ceramic materials provided a CE lower than AT. VSHT provided the best CE for 1 mm-thick (CE00 = 1.7, CEab = 1.9) and for 2 mm-thick (CE00 = 2.3; CEab = 2.5) enamel samples. CONCLUSIONS: Color coordinates of evaluated esthetic ceramic systems were statistically different from those of human dentine in almost all cases. The evaluated ZrO2 lithium silicate glass-ceramic (VS), with its two levels of translucency, provided lower CE values with human enamel samples while conventional feldspathic ceramic (NKT) and hybrid ceramic systems (VE) demonstrated a better color compatibility with dentin samples.

Impact of short-term dental dehydration on in-vivo dental color and whiteness.

OBJECTIVE: To determine in-vivo chromatic and whiteness changes produced by short-term dental dehydration. METHODS: Spectral reflectance of 452 upper incisors (226 centrals and 226 laterals) of 113 participants were measured using a spectroradiometer at baseline and after short-term dehydration (minutes 2, 4, 6, 8 and 10). CIE L*a*b* color coordinates (L*, a*, b*, C*ab and hab) and whiteness index for dentistry (WID) were calculated. Color differences (ΔE00, ΔEab*) and whiteness differences (ΔWID) were computed and interpreted based on their respective 50:50% perceptibility (PT) and acceptability thresholds (AT). Statistical analysis was performed using the related samples Wilcoxon signed-rank test. RESULTS: L* showed an increasing trend with dehydration, while a*, b*, C*ab and hab have a decreasing tendency. All chromatic coordinates showed statistically significant differences (p < 0.003) at each interval of dehydration compared with baseline, except a* for all teeth. For ΔE00 and ΔEab* values were higher than PT after 2 min of teeth dehydration and higher than AT after 6 and 8 min, respectively. The percentage of teeth exceeding corresponding PT was higher than 50% after 2 min. WID index increased with dehydration time, while whiteness differences were clinically perceptible after 4 min. Statistically significant differences were found for WID between all dehydration intervals (except 8-10 min). The percentage of teeth exceeding whiteness PT was higher than 50% after 6 min of teeth dehydration. CONCLUSIONS: Short-term dental dehydration produces clinically unacceptable changes in tooth color and clinically perceptible increase in tooth whiteness level. CLINICAL SIGNIFICANCE: Clinical shade matching must be done within the first two minutes of any clinical procedure that requires precise chromatic determination but implies a risk of tooth dehydration.

Color, lightness, chroma, hue, and translucency adjustment potential of resin composites using CIEDE2000 color difference formula.

OBJECTIVE: To evaluate color, lightness, chroma, hue, and translucency adjustment potential of resin composites using CIEDE2000 color difference formula. METHODS: Three resin composites (Filtek Universal, Harmonize, and Omnichroma) were tested. Two types of specimens were prepared: an outer base shade with an inner hole filled with test shades and single-composite specimens of all shades. Spectrorradiometric reflectances measurements and subsequent CIELAB color coordinates and translucency parameter (TP) were performed. Color (CAP00 ), lightness, chroma, hue, and translucency (TAP00 ) adjustment potential using CIEDE2000 color difference were computed. Color and transparency differences among composite materials and shades were statistically tested (P < 0.05). RESULTS: Positive CAP00 and TAP00 values were found for majority of tested materials. CAP00 values ranged from -0.14 to 0.89, with the highest values found for Omnichroma (>0.75 in all cases). TAP00 values ranged from -0.06 to 0.86 with significant translucency differences among dual and single specimens. Omnichroma exhibited the highest adjustment potential for all color dimensions studied. CONCLUSIONS: Lightness, hue, chroma, and translucency adjustment potential have been introduced using CIEDE2000 color difference formula, and have shown their usefulness to evaluate blending effect in dentistry. Color coordinates and translucency adjustment potential were dependent on dental material. Omnichroma exhibited the most pronounced blending effect. CLINICAL SIGNIFICANCE: Resin composites with increased color and translucency adjustment may simplify shade selection, making this process easier and less time consuming. Furthermore, these materials might facilitate challenging and complex color matching situations.

Masking ability of indirect restorative systems on tooth-colored resin substrates.

OBJECTIVE: To evaluate the masking ability of different indirect restorative systems (IRS) on tooth-colored resin substrates. METHODS: A1-shaded specimens from 5 IRS (LDC-IPS e.max® CAD; YZW-Zenostar Zr Translucent; PICN-Enamic; YLD-T-IPS e.max® ZirCAD + IPS e.max Ceram; CAD-on-Zenostar Zr Translucent + Crystall./Connect + IPS e.max® CAD) were fabricated. Specimens (n = 5) were cemented with a resin luting agent (Variolink® N; shade White) on three different shades (ND3, ND8 and ND9) of a tooth-colored resin substrate (IPS Natural Die Material). Spectral reflectance and color coordinates were measured using a spectroradiometer under standardized lighting conditions (CIE D65 illumination) and optical geometry 0/45°. Color differences (ΔEab* and ΔE00) from cemented specimens and CIELAB- and CIEDE2000-based translucency parameter (TP and TP00) from non-cemented specimens were calculated. Data was statistically analyzed using one-way ANOVA and Tukey's tests (α = 0.05). ΔE values were also analyzed using perceptibility (PT = 1.22 ΔEab* units; 0.81 ΔE00 units) and acceptability (AT = 2.66 ΔEab* units; 1.77 ΔE00 units) thresholds. RESULTS: The cemented specimens of CAD-on, LDC, YZW and PICN on different substrates (ND3-ND8, ND3-ND9 and ND8-ND9) showed different ΔEab* and ΔE00 values (p ≤ 0.05), which were above AT. YLD-T showed ΔEab* and ΔE00 values below AT for all comparisons. Lowest and highest TP and TP00 values were obtained for YLD-T and PICN, respectively (p ≤ 0.05). SIGNIFICANCE: Resin-cemented YLD-T on different tooth-colored substrates showed less translucency as well as smaller color differences (below acceptability threshold), indicating the best masking ability among evaluated systems.

Acceptability and perceptibility thresholds in dentistry: A comprehensive review of clinical and research applications.

OBJECTIVE: The objective was to provide a literature review on perceptibility and acceptability thresholds in dentistry and corresponding recommendations. OVERVIEW: A literature review on visual thresholds included findings on the judgments of the color and appearance of tooth-, gingiva- and skin-colored restorative dental materials. Discrepancies in study design contributed to inconsistencies in the research findings of some studies. These differences are related to (a) number of observers and inclusion criteria, (b) specimen number and size, (c) color measurement instrument and the setup and formulas used, (d) psychophysical experiment, (e) data processing (fitting method), and (f) % perceptibility or % acceptability values. A straightforward, consistent and practical model for the clinical and research application and interpretation of visual thresholds and recommended protocols for threshold research were provided. CONCLUSIONS: Visual thresholds are of paramount importance as a quality control tool and guide the evaluation and selection of dental materials and their clinical performance. Although clinical shade matching conditions and method are rarely controlled, research on visual thresholds, especially when aiming to set standards for the profession, must be carefully planned and executed. CLINICAL SIGNIFICANCE: Perceptibility and acceptability thresholds define visual match or mismatch of color, translucency, and whiteness in dentistry. Clinical and research findings cannot be fully interpreted in terms of real-life relevance without comparison with perceptibility and acceptability tolerances.

Whiteness difference thresholds in dentistry.

OBJECTIVE: To determine the visual whiteness thresholds for esthetic dentistry using the whiteness index for dentistry based on CIELAB color space (WID). METHODS: A total of 60 observers (Dentists and Laypersons; n=30) from three research sites participated in the study. A psychophysical experiment based on visual assessments of simulated images of teeth on a calibrated display was performed. Images of simulated upper central incisors (SUCI) were consecutively displayed in pairs (60) and the whiteness of each SUCI pair was compared. WID was used to calculate the visual thresholds (WPT- perceptibility threshold; and WAT- acceptability threshold) with 95% confidence intervals (CI) and a Takagi-Sugeno-Kang (TSK) Fuzzy Approximation model was used as fitting procedure. Data was statistical analyzed using paired t-test (α=0.05). RESULTS: WPT and WAT were 0.72 (CI: 0.0-2.69; r2=0.52) and 2.62 (CI: 0.2-7+; r2=0.57) WID units, respectively. Significant differences (p<0.05) were found between WPT and WAT, and between dentist (WPT=0.46WID units; WAT=2.20 WID units) and layperson (WPT=0.94 WID units; WAT=2.95 WID units). SIGNIFICANCE: The visual whiteness difference thresholds determined with WID index can serve as reference values for research and manufacturing of dental materials, and for clinical practice situations such as assessing the effectiveness of bleaching treatments.

Color Compatibility of Gingival Shade Guides and Gingiva-Colored Dental Materials with Healthy Human Gingiva.

The CIELab and CIEDE2000 coverage error (ΔE*COV and ΔE'COV, respectively) of basic shades of different gingival shade guides and gingiva-colored restorative dental materials (n = 5) was calculated as compared to a previously compiled database on healthy human gingiva. Data were analyzed using analysis of variance with Tukey-Kramer multiple-comparison test (P < .05). A 50:50% acceptability threshold of 4.6 for ΔE* and 4.1 for ΔE' was used to interpret the results. ΔE*COV / ΔE'COV ranged from 4.4/3.5 to 8.6/6.9. The majority of gingival shade guides and gingiva-colored restorative materials exhibited statistically significant coverage errors above the 50:50% acceptability threshold and uneven shade distribution.

Gingival shade guides: Colorimetric and spectral modeling.

OBJECTIVE: To design colorimetric and spectral models of gingival shade guides that adequately represent the color of human gingiva. MATERIALS AND METHODS: A previously compiled database on the spectral reflectance of healthy keratinized gingiva was used for optimization. Coverage Error (CE) and Maximal Error (ME) were optimized using CIELAB and CIEDE2000 color difference formulas. A two-phase process included an FCM algorithm and a nonlinear optimization. A t test was used to compare the performance of the different numbers of clusters/tabs in gingival shade guide models (α = .05). RESULTS: CIELAB CE and ME for shade guide models with 3 to 6 clusters ranged from 3.1 to 3.9 (P = .028 for 3 vs. 4; and P = .033 for 5 vs. 6 cluster/tab comparison), while the corresponding CIEDE2000 range was from 2.1 to 2.8 (P < .001 for 3 vs. 4 tabs; P < .025 for 4 vs. 5; and P = 0.029 for 5 vs. 6 tab comparisons). The percentage of data points exhibiting a CIELAB color difference lower than the acceptability threshold ranged from 48.7% to 71.4%, and from 52.9% to 82.4%. for CIEDE2000. CONCLUSIONS: An increase in the number of clusters in the gingival shade guide models was associated with a decrease in coverage error (better match) to human gingiva. Gingival shade guide models with only 4 tabs provided a CIELAB and CIEDE2000 coverage error lower than the acceptability threshold for gingival color. Spectral clustering of human gingiva was determined to be valid. CIEDE2000 color difference formula outperformed the CIELAB formula in the optimization process. CLINICAL SIGNIFICANCE: Providing a shade guide model with a small number of tabs and a coverage error lower than the 50:50% acceptability threshold would be an optimal solution for shade matching in dentistry. However, no actual gingival or tooth shade guide complies with this. The clustering method, with optimization of both Coverage Error and Maximal Error and spectral clustering that enables more reliable color formulation of cluster representatives of shade guide models, represents an advance when it comes to computer modeling in dentistry.

Color difference thresholds for computer-simulated human Gingiva.

OBJECTIVE: To determine 50:50% perceptibility threshold (PT) and 50:50% acceptability threshold (AT) for computer-simulated samples of human gingiva using CIEDE2000 and CIELAB color difference formulas. MATERIALS AND METHODS: Each of the 60 pairs of simulated human gingiva was displayed on a calibrated monitor, together with three pairs of upper central incisors of different lightness. The color of gingiva left and right from the midline was compared. A total of 30 observers (15 dentists, 15 laypersons) participated in the study. CIEDE2000 and CIELAB formulas were used to calculate the thresholds and a Takagi-Sugeno-Kang Fuzzy Approximation model was used as fitting procedure. Paired t-test (α = 0.05) was used in evaluation of statistical significance of differences. RESULTS: The PT and AT for CIEDE2000 and 95% confidence intervals were 1.1 [0.4, 1.7] and 2.8 [1.8, 4.0], respectively. Corresponding CIELAB values were 1.7 [0.2, 2.6] and 3.7 [2.1, 5.7]. Significant differences (P < .01) were recorded between PT and AT, between the corresponding threshold values in CIEDE2000 and CIELAB formulas as well as between dentists and laypersons. CONCLUSIONS: The difference between the perceptibility and acceptability threshold for gingiva was statistically significant in both CIEDE2000 and CIELAB. The same was true for differences between the corresponding thresholds using two color difference formulas, and between dentists and laypersons. Visual thresholds of human gingiva were not dependent upon lightness of adjacent teeth. Overall, CIEDE2000 color difference formula provided better fit than CIELAB formula in the evaluation of color difference thresholds of human gingiva. CLINICAL SIGNIFICANCE: The data on visual thresholds for healthy human gingiva can be used as quality control tool/guide for selection and evaluation of dental materials, interpretation of color-related findings in clinical dentistry and research, and for standardization in dentistry. It is of particular value that this study was designed based on in-vivo color evaluation of healthy keratinized gingiva of subjects of different ethnicities, age groups, and gender.

Reliability of visual and instrumental color matching.

OBJECTIVE: The aim of this investigation was to evaluate intra-rater and inter-rater reliability of visual and instrumental shade matching. MATERIALS AND METHODS: Forty individuals with normal color perception participated in this study. The right maxillary central incisor of a teaching model was prepared and restored with 10 feldspathic all-ceramic crowns of different shades. A shade matching session consisted of the observer (rater) visually selecting the best match by using VITA classical A1-D4 (VC) and VITA Toothguide 3D Master (3D) shade guides and the VITA Easyshade Advance intraoral spectrophotometer (ES) to obtain both VC and 3D matches. Three shade matching sessions were held with 4 to 6 weeks between sessions. Intra-rater reliability was assessed based on the percentage of agreement for the three sessions for the same observer, whereas the inter-rater reliability was calculated as mean percentage of agreement between different observers. The Fleiss' Kappa statistical analysis was used to evaluate visual inter-rater reliability. RESULTS: The mean intra-rater reliability for the visual shade selection was 64(11) for VC and 48(10) for 3D. The corresponding ES values were 96(4) for both VC and 3D. The percentages of observers who matched the same shade with VC and 3D were 55(10) and 43(12), respectively, while corresponding ES values were 88(8) for VC and 92(4) for 3D. CONCLUSIONS: The results for visual shade matching exhibited a high to moderate level of inconsistency for both intra-rater and inter-rater comparisons. The VITA Easyshade Advance intraoral spectrophotometer exhibited significantly better reliability compared with visual shade selection. CLINICAL SIGNIFICANCE: This study evaluates the ability of observers to consistently match the same shade visually and with a dental spectrophotometer in different sessions. The intra-rater and inter-rater reliability (agreement of repeated shade matching) of visual and instrumental tooth color matching strongly suggest the use of color matching instruments as a supplementary tool in everyday dental practice to enhance the esthetic outcome.

Influence of Gender on Visual Shade Matching in Dentistry.

OBJECTIVE: Accuracy on visual shade matching (VSM) is one of the most difficult procedures in esthetic dentistry. Some variables can influence on this process and gender is one of the most controversial. This observational study evaluated the influence of gender on accuracy of VSM. MATERIALS AND METHODS: One-hundred observers (65 females and 35 males) shade matched four human upper central incisors (UCI) to shade tabs from Vita Classical (VC) shade guide. In addition, the spectral reflectance values from the four UCI and from the 16 VC shade tabs were measured using a spectroradiometer (SP). Measurements were performed over a gray background, inside a viewing booth and under D65 illuminant (diffuse/0º geometry). CIELAB coordinates (L*, a*, and b*) were calculated according to CIE D65 illuminant and CIE 2º Standard Observer. Instrumental shade matching for each UCI, based on minimum color difference, was performed using two color difference metrics (CIELAB and CIEDE2000(2:1:1)). Data was analyzed using descriptive statistics and McNemar test (α = 0.05). RESULTS: Irrespective of the color difference metric, the most prevalent shade performed by females showed greater success (50% for CIELAB and 100% for CIEDE2000(2:1:1)) than males (25% for CIELAB and 50% for CIEDE2000(2:1:1)). However, such difference on gender was statistically significant only when using CIEDE2000(2:1:1) color difference metric (p ≤ 0.05). CONCLUSIONS: The most prevalent shade option resultant from VSM performed by females using VC shade guide perfectly agreed (100% success rate) with measurements from SP and CIEDE2000(2:1:1) color difference metric. CLINICAL SIGNIFICANCE: The ability to understand and distinguish color differences in VSM is critical in clinical dentistry. Variation in shade perception due to observer gender can be minimized using additional observers and/or improving shade matching ability. (J Esthet Restor Dent 29:E15-E23, 2017).