MEASURING TOOTH

COLOUR
 Measuring Tooth Colour

VISUAL METHOD

SHADE GUIDES
Shade matching tools are called colour standards or shade guides are most commonly
by the clinicians in day to day practice. There are different types of shade guides in
dentistry, depending on their purpose and the tissue for which they are used. As
dental, gingival and facial shade guides, are used for tooth, soft tissue and facial
prosthesis respectively.36, 1

Clark introduced a custom shade guide in 1931 based on visual assessment of human
teeth, recorded in Munsell hue, value and chroma.

Acknowledging the deficiencies of the available guides, Sproull, in the early 70s,
suggested that an ideal shade guide should consist of shade (colour) tabs that are well
distributed and logically arranged in colour space, preferably based on the Munsell
colour system.

A new generation of shade guides was developed to address these deficiencies. Shofu
offered the natural colour concept (NCC) The NCC system consists of 208 colour
blends based on 38 basic shades. The manufacturer purports that these blends are
logically arranged in L* a* b* colour space according to Munsell hue, chroma and
value. In addition, the shade guides and veneering material are made of the same
material to avoid the effect of metamerism.

Vita introduced a 3-dimensional shade guide system (Vita 3D-Master). This shade
guide features a systematic colourimetric distribution of 26 shade tabs within the tooth
colour space. This shade guide have an equidistant distribution in the colour space.
The shade guide is organized into five primary value levels, with a secondary
distribution based on chroma and hue. These value groups are arranged from the
lightest (value level 1) to the darkest (value level 5), left to right. But intermediate
shades can be achieved based on mixing formulas.1

Page 88
 Measuring Tooth Colour

REQUIREMENTS OF TOOTH SHADE GUIDES

According to Sproul (1973) logical arrangement in colour space and an adequate

distribution in colour space is prime requirement.

Overall tab arrangements of some shade guides seem illogical as they contain light
and dark tabs within each of the groups. As tab arrangement can influence shade-
matching results increases the importance of this issue.

So it is required Group division of shade guides to reduce 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.

To achieve consistent group division, the total colour difference (E*) between the
lightest and the darkest tab should be divided into several equal segments.

A guide which do not fulfil the prime requirements in colour space would have
problems like taking too long to decide where to begin, lack to check the chosen
match for accuracy, and the volume of colour space occupied by the materials to be
matched may be impossible to reach within the guide.36

TYPES OF SHADE GUIDE

The most popular shade guides currently used for dental shade matching are:

Vita Classic (Vita Zahnfabrik, Bad Sackingen, Germany)

Vitapan 3D-Master (Vita Zahnfabrik, Bad Sackingen, Germany)

Chromascop (Ivoclar - Vivadent, Schaan, Liechtenstein)

Custom or specific chroma and value guides

Page 89
 Measuring Tooth Colour

VITA CLASSIC SHADE GUIDE: It is a very popular shade guide and has been in
use since 1960’s. Tabs of similar hue are grouped into letter groups like:

A (hue of red-yellow) - A1, A2, A3, A3.5, A4

B (hue of yellow) - B1, B2, B3, B4
C (hue of gray) - C1, C2, C3, C4
D (hue of red-yellow-gray) - D2, D3, D4

Chroma is designated with numerical values 1, 2, 3 and 4.

SEQUENCE FOR SHADE MATCHING WITH VITA CLASSIC SHADE

GUIDE

STEP 1: HUE SELECTION: Operator should select hue closest to that of natural
tooth.

STEP 2: CHROMA SELECTION Once the Hue selection has been made, for
example B. Chroma is selected from gradations within the B tabs - B1, B2, B3, and
B4. Several comparisons should be made.

Avoid retinal fatigue. Rest eyes between comparisons (look at gray walls).

STEP 3: VALUE SELECTION

Final value is selected by using a second shade guide whose samples are arranged
with light shade tabs first and dark shade tabs last.

Page 90
 Measuring Tooth Colour

Value oriented shade guide: B1, A1, B2, D2, A2, C1, C2, D4, A3, D3, B3, A3.5, B4,
C3, A4, C4,
Value is most easily determined by observing the guide and teeth to be matched at a
distance, standing slightly away from the chair and squinting.

SQUINTING reduces the amount of light that reaches the retina. Therefore
stimulation of the cones is reduced while rods become more sensitive to the
increasingly achromatic conditions. The dentist should concentrate on which
disappears first - the tooth or the shade tab. The one the fades first has the lower
value.

STEP 4: FINAL CHECK / REVISION

Following value selection, tabs selected for hue and chroma do not coincide with
shade tab of value. If the Value of shade tab is lower than natural teeth then select
new shade tab with higher value because value of restoration with extrinsic staining
cannot be increased because it will only increase opacity of the restoration. If the
Value of shade tab is higher than natural teeth then select new shade tab with lower
value or compensate the difference with intrinsic or extrinsic staining.67

VITAPAN 3D-MASTER:

Miller demonstrated that the classical shade guide was too low in chroma and too high
in value when compared to natural extracted tooth samples. The inaccurate“value
scale”exhibit redundancy and uneven lightness differences among neighbouring tabs,
which compromises the results of shade selection.

Page 91
 Measuring Tooth Colour

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 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. concluded that the colour distribution of the Vitapan 3D master shade
guide was more ordered than previously reported colour distributions of other,
traditional shade guides. However, the interval in the colour parameters between
adjacent tabs was not uniform.

According to the literature, the new Vita Bleached guide 3D master shade guide,
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 colour range is almost doubled, the colour distribution is more
uniform, and the chroma steps are consistent.

Unlike the majority of dental shade guides, the 3D-Master attempts a three
dimensional analysis of tooth colour. The tabs are arranged systematically and
logically, rather than randomly as in the Classic guide.

The tabs are grouped into five categories, sequentially numbered, with an increasing
value (1, 2, 3, 4 and 5). All tabs within a value group have the same brightness. In a
given value group, the chroma increases from top to bottom. All groups, with the
exception of 1 and 5, are designated three letters, L, M and R, corresponding to
varying hue. For example 2M2 corresponds to the second value group, the M hue
subgroup and a 2-chroma level.67,70

Page 92
 Measuring Tooth Colour

CHROMASCOP:

In the chromascop guides the tabs are arranged in five clearly discernible value levels.
Within each level are tabs that represent different chromas and hues.

The Chromascop uses numbers to distinguish hue, e.g., 100 (white), 200 (yellow), 300
(orange), 400 (grey) and 500 (brown). Chroma is indicated by another set of numbers,
10 are high value with low chroma, while 40 is low value with high chroma.
A conversion chart is available to convert Chromascop shade tabs to the Vita Classic
shades. Custom guides:1,67

Hayashi guide. Hayashi’s guide is simple and logical. Its limits are based on his
measurements of the limits in colour space of the teeth of the Japanese people, and the
colour space intervals are as follows:

1. Five Hues-8.75 YR to 3.75 Y in 1.25 intervals.

2. Five Values for each Hue-6/ to 8/ in 0.5 intervals.
3. Five Chromas for each Hue-/l to /5 in unit intervals.

The 1.25 intervals in Hue present us with five different “pages” (8.75 YR, 10 YR,
1.25 Y, 2.50 Y, and 3.75 Y-Fig. 1 of Part I). Twenty-five colour tabs are arranged on
each “page” in five steps of Value (6/, 6.5/, 7/, 7.5/, and 8/) and five steps in Chroma
(/l, /2, /3, 1’4, and /5).36

Page 93
 Measuring Tooth Colour

METHOD OF USE

1. Determine the approximate Value of the tooth or teeth to be matched. This reduces
the number of tabs that must be considered from 125 to 25.
2. Determine the approximate Chroma or saturation of the tooth or teeth to be
matched. This reduces the number of tabs that must be considered from 25 to 5.
3. Determine, from the live Hue tabs of the Value and Chroma, the one that appears to
be the closest match.
4. If this tab does not appear to be as close as one I would like, probe in three
dimensional colour spaces for a closer match. The next closest matches must lie in the
vicinity of the initial choice, and probing is simply a matter of analysing Hue. Value
and Chroma differences and moving in the appropriate direction.36

CLARK TOOTH COLOUR SYSTEM. Clark’s system is based upon his analysis
of the colours of more than 6,000 teeth. The total number of colours available with his
system was 703, but his actual shade guide, the Tooth Colour Indicator, had 60.
Clark felt a need for only three basic Hues, but required 19 value steps and six
Chroma steps.

Each tab had a gingival colour and an incisal colour; it shows the location of the
gingival colours. Of the 703 colours, 342 were gingival, and 361 were incisal colours.
The 19 additional incisal colours were formulations without Hue and reflected 19
Value steps of gray for those incisal colours without a trace of Hue. Clark’s 703
colours were available from 13 porcelain powders, and the formulation of each shade
was published in a special formulary.

Clark believed that Value (referred to as “brilliance” at that time) was the most
important dimension to control. Chroma (“saturation” in his writings) was considered
the next most important dimension. Hue differences in his experience were so
unimportant that he seldom used other than the yellow hues and his Tooth Colour
Indicator contained only this hue.36

Page 94
 Measuring Tooth Colour

EXTENDED RANGE SHADE GUIDES

Most commercial shade systems cover a more limited range than the colours found in
natural teeth, and the steps in the guide are greater than can be perceived visually.
Some porcelain systems are available with extended range shade guides, and other
manufacturers have extended their range over the years. The use of two shade guides
is a practical way to extend the range of commercial guides.

DENTIN SHADE GUIDES

When using a translucent all-ceramic system for a crown or veneer, communicating
the shade of the prepared dentin to the dental laboratory is helpful. One system
provides specially coloured die materials that match the dentin shade guide and enable
the technician to judge restoration esthetics

CUSTOM SHADE GUIDE

Unfortunately, certain teeth may be impossible to match to commercial shade
samples. In addition, difficulties may be encountered in reproducing the shade guides
in the final restorations. The extensive use of surface staining has severe drawbacks,
because the stains increase surface reflection and prevents light from being
transmitted through the porcelain. One approach to this problem is to extend the
concept of a commercial shade guide by making a custom shade guide. An almost
infinite number of samples can be made by using different combinations of porcelain
powders in varying distributions. However, the procedure is time consuming and is
generally confined to specialty practice. If extremes of value and chroma are required,
specific detailed chroma and value guides are available. These may be necessary with
aged teeth of deep chroma, or youthful teeth with high values.

Page 95
 Measuring Tooth Colour

Shade Distribution Chart. Shade distribution charting is a practical approach to

accurate shade selection and is recommended even when a fairly good match is
available from the commercial shade sample. The tooth is divided into three regions:
cervical, middle, and incisal. Each region is matched independently. The junctions
between these areas are normally distinct and can be communicated to the laboratory
in the form of a diagram. The shade distribution and thickness of the enamel porcelain
are particularly important. Individual characteristics are marked on such a sketch and
will allow the ceramist to mimic details like hairline fractures, hypocalcification, and
proximal discolourations.

Page 96
 Measuring Tooth Colour

While shade guides are commonly used in dental practices, they have several
limitations both in the operatory and in clinical trials. The subjective nature of shade
matching increases the odds of variability. Two dental professionals may select
different shades under the same set of conditions (intergrader variability). Moreover,
the same dental professional may select different shades when assessing the same
patient under the same conditions on two separate visits (intragrader variability).
Finally, research indicates that the order of certain shade tab systems does not
correspond with consumer perception of whiteness ranking and the change in
brightness from tab to tab varies.

A small percentage of dentists have deficient colour vision (anomalous colour vision)
and it has been determined that these individuals make more errors in the chromatic
aspects of colour (Hue and Chroma). Dentists with colour deficiencies need to be
aware of their condition and make corrections by enlisting the help of other office
personnel with normal colour vision to assist them in the shade selection process as it
relates to Hue and Chroma. 80

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.

Page 97
 Measuring Tooth Colour

GINGIVAL SHADE GUIDES

Dummet described that the colour of gingiva is variable ranging from a pale pink to
deep bluish purple.

Colour depends on intensity of melanogenesis, epithelial cornification, and depth of

epithelization. Comparisons of the imagined colour of gingiva and an actual visual
colour measurement are of doubtful scientific value.

The findings of Nakashima showed that imaginable colour 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
redder compared to male.

Colour assessments of the attached gingiva have been evaluated using Munsell colour
tabs. Use of helium neon gas laser to record the reflectance of interdental papilla was
documented. Dummet was the first to describe the colour of intraoral soft tissues.

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. Okubo et al. stated the most
popular method to be the visual shade selection with the help of shade guides.

Bayindir 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).70

Page 98
 Measuring Tooth Colour

DENTAL SHADE GUIDES

Shade guides are examples of the various colour combinations available from
manufacturers of denture teeth, restorative resins, and porcelain. Clinical shade
selection involves direct visual comparison of the different colour samples that are
present in a shade guide with the natural teeth and determination of which one best
matches the teeth. 80

TOOTHGUIDE
The colour samples in the tooth guide shade guide are divided into one of six groups,
based on Value: group 0 (3 tabs); group 1 (2 tabs); groups 2, 3 and 4 (7 tabs each);
and group 5 (3 tabs). Within the groups, tabs of different Chroma are available. Hue
variations are available only in groups 2, 3 and 4.

LINEARGUIDE
The Linearguide shade guide has the same 29 tabs as the Toothguide but its
organizational structure is different and shade matching is thereby reduced to two
steps. There is a dark-gray base holding 6 shade tabs and it is labeled as the VITA
Valueguide 3-D MASTER and is designed for selecting Value. The linear tab
arrangement and small number of tabs greatly simplifies the selection of Value. There
are 5 other small shade guides, labeled as VITA Chroma/Hue guides. The
Chroma/Hue guide to be used is determined by the previously completed Value
choice. Using the appropriate Chroma/Hue guide, the second step is completed by
selecting the best Chroma and Hue.

BLEACHEDGUIDE
The bleachedguide shade guide is the only shade guide developed specifically for
shade matching of teeth which have been previously bleached and not matched with
other shade guides. Bleachedguide exhibits a wider colour range than earlier shade
guides.

No single shade guide or combination of guides includes all of the colour

combinations that may be encountered in clinical practice. As a result, exact matches
are not common. While the use of shade guides is common for matching restorations,

Page 99
 Measuring Tooth Colour

they are of limited value in measuring colour changes resulting from tooth bleaching
procedures. This is due to the non-uniform spacing of the shades throughout 3-
dimensional colour space. No techniques exist to eliminate the subjective nature of
shade guides. However, careful attention to the environmental conditions will help
optimize matches.

INSTRUMENTAL METHODS
The conventional visual tools used to determine shade are highly susceptible to
various optical illusions and contrast effects. 70

Instrumental colour analysis, on the other hand, offers a potential advantage over
visual colour determination because instrumental readings are objective, can be
quantified and are more rapidly obtained.1

Due to the errors with the use of commercial shade guides, many different devices
and machine tools are used in order to make the colour assessment more simple,
rapid, precise, and perfect and there are no influence of surroundings or lighting and
the results being reproducible.70 Several clinical studies have confirmed that computer
assisted shade analysis is more accurate and more consistent compared with human
shade assessment.

RECENT ADVANCES IN SHADE MATCHING

The first measurement analysis system was the Spectroshade system from MHT Optic
Research in 2001 followed by Shade vision system (colourimeter) from X-rite in
2002.70

BASIC DESIGN:

All colour – measuring devices consist of a detector, signal conditioner, and

software that process the signal in a manner that makes the data usable in the dental
operatory or laboratory. Because of the complex relationship between these elements,
accurate colourimetric analysis is difficult at best.44

Technology based shade matching devices

• Digital cameras
Page 100
 Measuring Tooth Colour

• Spectrophotometers
• Colourimeters.

DIGITAL CAMERAS
Digital camera capture images using charged coupled devices, which contain millions
of microscopically small light-sensitive elements. Camera records each of the three
colours at each pixel location. 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.

Factors such as illumination and the angle of the photograph will alter how colour is
perceived by the camera.

Alvin et al. stated the use of Commercial SLR cameras when combined with the
appropriate calibration protocols showed potential for use in the colour replication
process.70,1

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.

There are two basic optical light settings used in reflectance spectrophotometer
instruments: Illumination at 0 degrees and observation at 45° (0/45) or illumination at

Page 101
 Measuring Tooth Colour

45° and observation at 0° (45/0). Because of the limited access afforded by the oral
cavity, only the 45/0 option is suitable for clinical use.

Stephen et al. stated the disadvantage being expensive, complex, and difficult to
measure the colour of teeth in vivo with these machines.

Spectrophotometers allow the user to measure metamerism, therefore independent of

filters and changing light sources.

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.

The SpectroShade is the spectrophotometer developed for clinical use that combines
digital imaging with spectrophotometric analysis. The unit consists of a high-intensity
halogen light source that is directed to the tooth through fiber-optic bundles and
lenses to uniformly illuminate the field at a 45° angle.

The Vita EasyShade is a handheld spectrophotometer for tooth shade matching. The
fiber optic tip is approximately 5 mm in diameter and contains nineteen 1 mm
diameter fiber-optic fibers.
Page 102
 Measuring Tooth Colour

A new spectrophotometer Crystaleye, is an extremely precise dental colour analysis

system, which provides extremely precise colour measurement based on spectral
estimation using a
LED light source.

COLOURIMETERS

Colourimeters provide measurements in CIELAB units (L*, A*, B*) that can compare
the colour parameters of different objects when analyzed mathematically.

Colourimeters can be of two types mainly the photoelectric tristimulus colourimeters

(Microcolour) and silicon photodiode array (Orient Scientific Ltd).

Filter colourimeters generally use three or four silicon photodiodes that have spectral
correction filters. These filters act as analog function generators that limit spectral
characteristics of light striking the detector surface. The filter colourimeters are
considered inferior to scanning devices like spectrophotometers because of the
inability to match the standard observer functions. However, because of their
consistent and rapid sensing nature, these devices can be used for quality control.

Microcolour colourimeter (a photoelectric tri-stimulus colourimeter) 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;

Page 103
 Measuring Tooth Colour

it is a compact colour measuring instrument that is less prone to overheating and is

cost effective.

The various colourimeters 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.72, 64

THE MEASUREMENT SYSTEM INCLUDES

Spot measurement (SM) devices measure a small area on the tooth surface, while
complete-tooth measurement (CTM) devices measure the entire tooth. For SM
devices, the size or diameter of the optical device aperture (generally about 3 mm2)
will determine how much of the tooth surface and subsequent shade is measured.
Examples of such SM technologies are the Shofu ShadeEye-NCC chroma meter
system and the Vita EasyShade system.

CTM systems measure the entire tooth surface and provide a topographical map of the
tooth in one image. Measurement of the complete surface gives the operator more
consistent and reproducible information about the tooth structure.1

RGB DEVICES

Acquire RED, GREEN, BLUE image information to create a colour image. They do
not control key variables associated with accurate colour determination.

Robert 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.1, 70

Page 104
 Measuring Tooth Colour

COMPARISON BETWEEN SPECTROPHOTOMETERS AND

COLOURIMETERS
The use of the digital system that can qualify and quantify shade maps provides Delta
(E) measurements for shade comparison. Delta E is a colourimetric value that
delineates the difference between two colours. To distinguish this value, three
reference points are available generally CIE L*A*B* OR CIE Lch.

Chu stated that colourimeters are tri-stimulus and can measure in either CIE Lab or
CIE Lch. It is however impossible to produce precise colourimeter, since filters must
be well controlled and the characteristic of light well.70

Page 105