C O N T I N U I N G E D U C A T I O N 2

ANATOMICAL FORM DEFINES COLOR:

FUNCTION, FORM, AND AESTHETICS
Douglas A. Terry, DDS*
Willi Geller, CDT†
Olivier Tric, CDT‡
Mark J. Anderson, CDT§

TERRY
Monte Tourville, CDTII
Alvin Kobashigawa, BS**

14
1

JANUARY/FEBRUARY
Contemporary composite materials enable the repro- *Faculty Member, UCLA Center for Esthetic Dentistry,
Los Angeles, California; private practice, Houston, Texas.
duction of polychromatic effects within a tooth. A broader †Laboratory Technology Section Editor, PPAD; Laboratory
technician, Oral Design, Zürich, Switzerland.
definition of color that incorporates the anatomy and ‡Laboratory technician, Olivier Tric Laboratory,

optical properties of a tooth must be developed so the Elmhurst, Illinois.

§Faculty Member, UCLA Center for Esthetic Dentistry, Los

dental professional can better understand the infinite Angeles, California; laboratory technician, Oral Design
Center, West Bountiful, Utah.
possibilities of color that exist within the tooth and restora- IILaboratory technician, Dental Design Science, Seattle,
Washington.
tion. This article describes a direct protocol for the devel- **Senior Research Scientist, Kerr Corporation, Orange,
California.
opment of natural restorations in the posterior dentition
Douglas A. Terry, DDS
through the integration of function, form, and color. 12050 Beamer
Houston, TX 77089
Key Words: color, opalescence, iridescence, aesthetics, hue, Tel: 281- 481-3470
Fax: 281- 481-0953
value, chroma E-mail: dterry@dentalinstitute.com

Pract Proced Aesthet Dent 2002;14(1):59-67 59

Practical Procedures & AESTHETIC DENTISTRY

T he advent of aesthetic restorative materials requires

the clinician to include color in the traditional restora-
tive equation. Due to advances in material science
and adhesive technology, the restorative concept has
evolved to posit that form follows function,1,2 and anatom-
ical form defines color. While form has been described
in the three dimensions (ie, height, length, and width),3,4
color provides a more complex description of the opti- Figure 1. The metallic restorative materials of the past such
as these gold three-quarter crowns required the restorative
cal properties of both the tooth and restorative material dentist to be concerned solely with function and form.
(Figure 1). The successful determination and transfer of
color to an aesthetic reproduction of the natural denti-
tion depends on the clinician’s understanding of the inter-
relation of these optical properties to the anatomical
morphology of the tooth.
Restorative clinicians can now integrate traditional
concepts of function and form with knowledge of color
and anatomy to create aesthetic restorations. This process
requires the clinician to anticipate the definitive function,
form, and color in order to achieve an optimal result.
This article describes the adhesive technique and pro-
tocol for the development of tooth-colored composite
restorations in the posterior dentition by integrating the
concepts of function, form, and color.
Figure 2. Although the chromatic component
Conventional Definition of Color of the wine in this glass (Gigondas, 1997)
decreases in intensity as water is added,
Most methods of describing color use a three-dimensional the hue remains the same.
coordinate system that includes hue, chroma, and value.5
These coordinates define how materials modify light by
absorption, reflection, refraction, transmission, dispersion,
diffraction, and interference.6,7 In teeth, hue corresponds
to the wavelength of reflected light.8 As light passes
through the natural tooth, it is reflected, refracted,
absorbed, or transmitted by a multilayered complex tooth
structure that varies according to the optical densities of
its hydroxyapatite crystals, enamel rods, and dentinal
tubules.9 Visual stimuli are determined by these reflected
or refracted wavelengths, which are transformed in the
Figure 3. Hue and chroma can be determined by color
viewer’s cerebral cortex into perceptions of color.10 photographic comparisons.
Chroma can be defined as the intensity of a color
or the degree of hue saturation (Figure 2). The chromatic
component only compares colors of equal hue,11 and characterization. Value can be defined as the “brightness”
while the same hues are frequently found in the middle of color (in the Vita “R” scale, from the greater to lower
and cervical thirds, distinct hues can be identified at the value, as with B1, A1, B2, D1, A2, through C4).11 Value
incisal third due to the way light is refracted, reflected, is the most easily discernable of the three primary opti-
absorbed, and transmitted. Chroma can be varied in cal characteristics, and this aspect distinguishes light from
the utilization of tints and modifiers to create internal dark colors (Figures 3 and 4).11,12

60 Vol. 14, No. 1

 Terry

in the natural dentition must be properly interpreted

so the clinician can fabricate aesthetic restorations.13
A broader definition of color is, therefore, necessary
based upon anatomy, optical properties, and polychro-
maticity to appropriately describe tooth color and aes-
thetics. This definition is based upon the natural dentition
and the relative contribution of dentin and enamel to
color. Dentin and enamel have drastically different opti-
cal properties, and the relative contribution of each should
be considered separately during shade determination.
Figure 4. Value can be determined by black-and-white
photographic comparisons of shade tabs. In addition to hue, chroma, and value, more sub-
tle optical properties are also included in the authors’
definition of color. These properties include translucency,
opacity, opalescence, iridescence, surface gloss, and
fluorescence. These secondary optical properties con-
tribute significantly to the total aesthetics of the tooth and
may be better explained in terms of tooth anatomy.
Translucency and opacity have been viewed as the
most important of these secondary properties, since they
are an indication of the quality and quantity of light reflec-
tion.9 The degree of translucency or opacity is determined
by the structure and the thickness of enamel and dentin
A B as well as the amount of light that penetrates the tooth
Figure 5A. Aesthetic translucency is evident at the incisal or the restoration. Although both dentin and enamel
edge and at the mesial and distal incisal angles of the are translucent in natural dentition, the enamel layer is
maxillary left lateral. 5B. Observe the opacity in similar
regions on another maxillary left lateral incisor. virtually transparent and colorless (Figure 5).14
Opalescence can be defined as the milky, iridescent
appearance of a dense, transparent medium or colloidal
system when illuminated by visible light. Opalescence
in the tooth occurs when visible light is scattered and
causes a reflection of the shorter wavelengths of light
(bluish tones), transmission of longer wavelengths, (yellow-
orange), and absorption of medium wavelengths (green-
ish tones) (Figure 6). This feature is primarily observed
in enamel and in teeth it appears as a light-scattering
effect that is associated with the diameter of enamel
rods. In posterior teeth, these characteristics are exem-
Figure 6. The opalescent characteristics of the tooth impart
a yellow/orange appearance under transmitted light and plified on cusp tips and marginal ridges. In anterior
a bluish appearance under reflected light. teeth, this effect is observed in the incisal edges and
proximal incisal surfaces. Since the color of dentin is
Morphology and Color dominated by light absorption and reflection that cre-
In natural, polychromatic teeth, differing colors are dis- ates a yellow/orange appearance and masks opal-
tributed, and various optical characteristics are observed escent effects, opalescence is not readily discernible in
through the enamel and dentin. This polychromatic effect
10
these structures.
is manifest in different optical characteristics, and the Iridescence produces a rainbow effect within the
relationships between these characteristics and their role object being viewed (Figure 7). While colors change

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Practical Procedures & AESTHETIC DENTISTRY

Figur 7. Varying degrees of iridescence can be observed Figure 8. Surface morphology of natural teeth influences
base on the direction, location, and illumination of the surface gloss and color perception. Note the diffuse
an object. reflection produced by the macromorphologically rough-
ened or coarse surface.

upon alterations to viewing direction, location, and Restorative Material Selection

illumination of an object, the manner in which these Since composite does not have hydroxyapatite crystals,
parameters change is dependent upon the wavelengths enamel rods, or dentinal tubules, an illusion of the way
of dispersion, interference, and diffraction of light. light is reflected, refracted, transmitted, and absorbed
Surface gloss affects the appearance and vitality of by these microstructures must be created during the restora-
teeth and aesthetic dental materials. On the labial sur- tion of the occlusal surface.9 A similar orientation of enamel
face of anterior teeth, light reflected from tertiary anatomy and dentin is, therefore, required. Contemporary com-
adds to vitality, whereas less vitality is evident when this posite resins possess many optical properties that render
anatomy is worn with age. Surface gloss (eg, specular a polychromatic result, and a variety of hues, trans-
gloss, sheen, luster, distinctness of image gloss) has been lucencies, fluorescencies, and opalescents are available.
described as the optical property that produces a lus- Color modifiers and opaquing resins can also be layered
trous appearance. 15
Luster is the ratio of light reflected to enable an infinite number of color combinations.20
specularly at a material surface to the light diffusely The successful determination and transfer of color to an
reflected to the surface, and it can be related to any opti- aesthetic restoration, however, depends on the clinician’s
cal scattering that occurs at the surface or within the understanding and interpretation of color and its relation-
body of a restorative material. The surface morphology
16
ship to the anatomy of the tooth. The limitations of current
of natural teeth influences the surface gloss. While macro- composite restorative materials must also be understood.
or micromorphologically roughened or coarse surfaces
allow diffuse reflection, flat or smooth surfaces allow Dentin Layer
specular reflection (Figures 8 and 9).17 This optical scat- The dentin layer contains varying distributions of yellow,
tering has an effect on the color perception and trans- orange, and red color, and it remains thickest at the
lucency of the tooth or restorative material, and it should gingival and central thirds of anterior teeth. While pre-
be considered during shade matching between a restora- vious generations of composite systems were designed
tive material and natural tooth structure.15,18 to produce tooth color and translucency with a single
Fluorescence occurs when ultraviolet (UV) light rays filling material, the entire restoration had to be filled with
are absorbed and blue or white visible light is emitted one shade, and multiple shades or modifiers were then
(Figure 10).17,19 Due to the organic composition of dentin, incorporated to provide color adjustments. To compen-
UV light rays penetrate the enamel and excite the dentin sate for this limitation, dentin shades can be placed in
photosensitivity. The emitted light enhances the brilliance the upper two thirds of the tooth, and enamel shades
and vitality of teeth. Both dentin and enamel fluoresce, can be placed in the incisal third. When selecting dentin
and the combination of these structures enhances the shades, it is important to also consider opacious shades
whiteness or value of teeth. that provide strength and sufficient chroma. It is often

62 Vol. 14, No. 1

 Terry

provide natural aesthetics.21 Arbitrary and subjective

shade designations (eg, universal, yellow, light) further
complicate precise shade selection. Since the standard
shade guides for composite resins are manufactured with
unfilled methacrylates, they do not accurately represent
the true shade, translucency, or opacity of the final poly-
merized restorative material.11 In addition, many of the
composite systems are synchronized to a shade guide
(ie, Vita Lumin, Vident, Brea, CA), that was designed
for porcelain, not resins. Since many shade tabs are
Figure 9. A flat or smooth surface allows specular fabricated using this basis, custom shade tabs may be
reflection.
beneficial for a variety of direct applications.

Tints
necessary to extend this layer to the dentinoenamel junc- Tints can be applied during the stratification process
tion (DEJ) in order to maintain the shade and prevent to adjust the hue and chroma of the restoration, lower
the transmission of a darker, low-value appearance. its value, and establish natural characteristics for a spe-
cific area of the tooth. Tints can also be placed over
Enamel Layer the dentin-colored composite and beneath the artificial
Although tooth enamel is virtually colorless, these struc- enamel to enhance the realistic distribution of color
tures possess many of the optical properties (ie, trans- throughout the restoration. Contemporary resins are gen-
lucency, fluorescence, opalescence, and gloss) that erally translucent and colored with pigments or dyes to
contribute to the vitality of the tooth enamel. These char- achieve the desired optical effect. Opaquers can be
acteristics are exemplified on the cuspal tips and mar- used to conceal light or dark underlying structures, and
ginal ridges of posterior teeth, as well as the incisal edges they can be applied to duplicate difficult-to-match areas
and proximal incisal surfaces of anterior teeth. The enamel (eg, hypocalcification).
layer has a white or gray appearance, and remains thick-
est at the incisal edge of the anterior teeth and thinnest
at the cervical aspect. Contemporary enamel shades
have high translucency, are fluorescent and opalescent,
and maintain a high clinical gloss. Enamel shades tend
to reduce the value of a restoration and cannot be used
to anatomically replace human enamel. Although enamel
shades can be used on incisal edges and cuspal sur-
face, the shade of the restoration is ultimately provided
by the dentin shades. If enamel shades are used to cover
the entire labial surface, the materials must be layered
and used sparingly at the cervical third.

Shade
Due to the variety of colors and their orientation within
natural teeth, appropriate shade selection remains
challenging for composite restorations. Since composite
materials are monochromatic and cannot duplicate the
Figure 10. Natural teeth exposed to ultraviolet (UV) light
complex orientation of the colors seen in the natural rays possess fluorescence with an emission spectrum
dentition, a variety of resin shades must be selected to that varies from intense white to light blue.

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Practical Procedures & AESTHETIC DENTISTRY

Figure 11. Preoperative occlusal view Figure 12. A caries-disclosing solution Figure 13. The carious tooth structure
of a defective amalgam restoration. was applied to facilitate detection was removed as indicated by the
and identification of the irreversibly reapplication of caries-detecting dye.
infected carious tissue.

Figure 14. Occlusal view of the Figure 15. An A3 shaded flowable Figure 16. An A3 shaded opacious
completed preparation. composite was injected as the syringe hybrid composite was applied in
tip was slowly removed and uniformly increments using a lateral condensa-
distributed. tion technique.

Operative Procedure control and protect against contamination. Upon removal

Prior to initiating the restorative procedure, an occlusal of any existing restorations, a caries-disclosing solution
analysis of tooth morphology is performed, and a shade (eg, Seek, Ultradent Products, South Jordan, UT) can
map is created to communicate existing dentin and be applied to the internal surfaces of the preparation,
enamel intercolor contrasts, translucency patterns, crazing, occlusal fissures, and grooves to facilitate carious tissue
hypocalcification spots, incisal and gingival blending, detection and removal (Figures 12 and 13).24 Any cari-
and/or occlusal stain patterns. The preoperative shade ous dentin can then be removed using slow- and high-
and orientation of composite resins, tints, and modifiers speed carbide burs and spoon excavators (Figure 14).
is also recorded. Shade selection should be accom- The occlusal outline should include carious enamel, pro-
plished prior to rubber dam placement to prevent vide access to the carious dentin, remove any residual
improper color matching as a result of dehydration and amalgam staining on the molar, and provide access
elevated values ( Figure 11). Preoperative occlusal stops
22
for the application of restorative materials. Healthy tooth
and excursive guiding planes can be recorded with artic- structure should only be removed when the occlusal out-
ulation paper and transferred to an occlusal diagram, line requires extension beyond or within the previously
recorded using a digital camera, or reviewed on a stone indicated functional stops. Preparations can then be
model. This registration may facilitate the placement completed with a finishing diamond, cleaned with a
of centric stops beyond or within the confines of the 2% chlorhexidine solution, (eg, Consepsis, Ultradent
restoration, determination of proper restorative material Products, South Jordan, UT), rinsed, and lightly air dried.
thickness, and minimize finishing procedures. 23

Adhesive Protocol
Restorative Stage The “total-etch” technique can be used to minimize poten-
Once anesthesia is administered, the treatment site is tial microleakage and enhance bond strength.25-27 The pre-
isolated with a rubber dam to achieve adequate field pared tooth surfaces should be etched for 15 seconds with

64 Vol. 14, No. 1

 Terry

Figure 17. An ochre-tinted resin was Figure 18. A brown tint was used to Figure 19. A diluted whitewash was
applied in the previously formed create the illusion of occlusal fissure applied to create the milky white
invagination and polymerized for staining. stains indicated during the preopera-
10 seconds. tive shade-mapping procedure.

Figure 20. A clear, translucent hybrid Figure 21. The occlusal anatomy was Figure 22. The margins were etched
composite was sculpted with a curved refined using #12 and #30 fluted, with a 37.5% phosphoric acid and a
metal instrument and smoothed with egg-shaped finishing burs. composite surface sealant was applied
a sable brush. and cured to seal any cracks or
microscopic porosities.

37.5% phosphoric acid, rinsed for 5 seconds, and gen- protects this pulp-dentin interface, provides resistance to
tly air-dried for 5 seconds. A light-cured adhesive (eg, microleakage, and allows retention of the restoration,
Optibond Solo Plus, Kerr/Sybron, Orange, CA) can then regardless of the depth of the preparation.28,30
be applied with a disposable applicator for 20 seconds
using a continuous motion and reapplied every 5 seconds. Internal Adaptation
Any excess material can be removed with the applicator, The use of a flowable composite resin allows the adhe-
and the agent should be light cured in “boost” mode for sive system to develop an intimate contact with the dentin
10 seconds. Although a small amount of excess adhe- bonding agent and enhanced internal adaptation.29 An
sive can be applied over the margins to improve sealing, A3 shaded flowable composite (eg, Revolution, Kerr/
this excess should be removed during finishing procedures. Sybron, Orange, CA) can be injected as the syringe
While pulp tissues have demonstrated the inherent tip is slowly removed and uniformly distributed with a
ability to repair, heal, and to form reparative mineral- composite applicator (Figure 15). This technique reduces
ized bridges under several restorative materials,28 recent the possibility of entrapping bubbles and ensures opti-
studies reveal that the failure of composite restorations mal adaptation of the resin material to the adhesive inter-
may be related to adequate sealing and adaptation face. A small increment (1 mm to 2 mm in thickness)
of the tooth/restorative interface. Bacterial infiltration
28
can then be applied to the pulpal floor of a Class I cav-
and microleakage have been attributed to pulpal inflam- ity preparation. Confining the curing thickness to 2 mm
mation and necrosis of exposed vital dentin, regardless or less of composite will result in reduced shrinkage and
of the restorative material selected. 28
The use of non- stresses, and it improves marginal adaptation.31
adhesive restorative materials (eg, calcium hydroxide),
however, may generate a gap at this interface and The “Artificial Dentin” Layer
result in bacterial colonization.28,29 The hybridization of The preparation should be incrementally filled with an
the exposed dentin with an adhesive system effectively A3 shaded hybrid composite (eg, Point 4, Kerr/Sybron,

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Practical Procedures & AESTHETIC DENTISTRY

Orange, CA) based on the shade selected during

the preoperative mapping procedure (Figure 16). An
opacious dentin replacement with an increased color
saturation should be used for enhanced light reflection.
Each increment should be gently condensed to ensure
complete adaptation to the underlying resin and tooth
structure. A composite hybrid with a low volumetric
polymerization shrinkage can also be used to reduce
the possibility of cuspal flexure. The hybrid can also
be diagonally layered in 1-mm to 2-mm increments to
further reduce potential failure. Feathering the material Figure 23. The final polish was performed with rubber
points (FlexiPoints, Cosmedent, Chicago, IL) and polishing
up the cavity wall according to the anatomical contours
cups (Enhances Polishing Cups, Dentsply/Caulk, Milford, DE).
will minimize shrinkage and reduce intercuspal stress.
Each increment should be light cured for approximately
10 seconds using the boost mode (Optilux 501, Sybron/
Kerr, Orange, CA), and the composite resin should be
methodically condensed and shaped to correspond to
cusp development and dentin replacement.
Once the dentin layer is developed, an invagina-
tion is made with an interproximal instrument (eg, IPCL
TN, Cosmedent, Chicago, IL) while the material is soft.
A thin layer of resin can be applied and cured to cre-
ate a “light diffusion layer” and provide an illusion of
depth for restorations of limited thickness. This translucent Figure 24. Black-and-white photography was used to
layer will cause an internal diffusion of light and verify the definitive value and light reflectance.

control luminosity within the internal aspects of the

restoration. Internal characteristics (eg, pits, fissures,
grooves) can then be applied, and an ochre-tinted resin
can be applied in the predetermined regions; untinted
resin can be used to dilute any areas of excess chroma
(Figure 17). These tints should be polymerized prior to
the placement of additional stratification materials to sta-
bilize the characterization and prevent mixing of colors
(Figure 18). A smooth, natural transition can be obtained
between the occlusal planes and higher-valued tooth
structures using diluted whitewashed shades, and any
necessary staining can be developed at this time Figure 25. Postoperative occlusal view of the definitive
(Figure 19). This color variation allows the development restorations reflects the harmonious integration of color
with anatomical form and function.
of a three-dimensional appearance within the restoration.

The “Artificial Enamel” Layer Orange, CA) should be sculpted with a curved metal
In order to allow space for the proper enamel thickness instrument and smoothed with a sable brush to repro-
and position, the definitive aesthetic result should be duce form in addition to the optical effects of enamel
visualized during the development of the artificial dentin (Figure 20). This procedure will provide aesthetic trans-
and internal characterization stages. A clear, translucent- lucency and allow development of functional and
shaded (T-1) hybrid composite (eg, Point 4, Kerr/Sybron, anatomical occlusal morphology.

66 Vol. 14, No. 1

 Terry

Finishing and Polishing Acknowledgment

Occlusal refinement can be achieved with fluted, egg- The authors declare no financial interest in any of the
shaped finishing burs, and the lingual surfaces should products cited herein.
be finished using needle-shaped burs (Figure 21). Once
the initial finishing procedures are complete, the margins References
1. Sorenson DA. Form follows function: Occlusion based rationale
and surface defects can be sealed. All accessible mar- for esthetic dentistry. J Indiana Dent Assoc 1998;77(2):25-30.
2. Schlott W J. Form follows function. J Am Dent Assoc 1999;
gins can be etched using a 37.5% phosphoric acid semi- 130 (11) :1562,1564.
3. Baratieri LN, Andrada MAC, Montiero JR, et al. Dentistics
gel, rinsed, and dried. A thin layer of composite surface Predimentos Preventivos e Restauradores. 2nd ed. Sao Paulo,
sealant (OptiGuard, Kerr/Sybron, Orange, CA) should Brazil: Quintessence Publishing, 1992.
4. Clark EB. Tooth color selection. J Am Dent Assoc 1933;20:
then be applied to all margins with a brush and cured 1065-1073.
5. Berns RS, ed. Principles of Color Technology. 3rd ed. New York,
to seal any cracks or microscopic porosities that may NY: John Wiley & Sons, Inc, 2000.
6. ten Bosch J J, Coops JC. Tooth color and reflectance as related
have formed during the finishing procedures (Figure 22). to light scattering and enamel hardness. J Dent Res 1995;
74(1):374-380.
Rubber points (FlexiPoints, Cosmedent, Chicago, I L ) , 7. Fisher MP, Zelanski P. Color. Englewood Cliffs, NJ: Prentice
Hall, 1988.
polishing cups (Enhance Polishing Cups, Dentsply/ 8. Sproull RC. Color matching in dentistry. I. The three-dimensional
nature of color. J Prosthet Dent 1973;29(4):416 - 424.
Caulk, Milford, DE), and regular and extrafine composite 9. Winter R. Visualizing the natural dentition. J Esthet Dent 1993;
5(3):102 -117.
resin polishing paste (Prisma-Gloss/Prisma-Gloss 10. Rinn LA. Applied Theory of Color. The Polychromatic Layering
Extra Fine, Dentsply/Caulk, Milford, DE) should then Technique — A Practical Manual for Ceramics and Acrylic Resins.
Carol Stream, IL: Quintessence Publishing; 1990:11- 30.
be incorporated for the final polishing procedures 11. Baratieri LN. Esthetic Principles. Sao Paulo, Brazil: Quintessence
Publishing; 1998:48.
(Figure 23). Occlusal contacts and centric, protrusive, 12. Touati B, Miara P, Nathanson D. Esthetic Dentistry & Ceramic
Restorations. London, UK: Martin Dunitz LTD; 1999:39-60.
and lateral excursions should be evaluated following 13. Exner HV. Predictability of color matching and the possibilities
for enhancement of ceramic laminate veneers. J Prosthet Dent
rubber dam removal. Any necessary equilibration can 1991; 65(4):619 -622.
14. Muia PJ. The Four Dimensional Tooth Color System. Carol
be accomplished with #12 and #30 egg-shaped finish- Stream, IL: Quintessence Publishing, 1985.
15. Vanini L. Light and color in anterior composite restorations.
ing burs, and the final polish should be repeated. Pract Periodont Aesthet Dent 1996;8(7):673-682.
16. Ahmad I. Three-dimensional shade analysis: Perspectives of color
Interproximal contacts should be evaluated using — Part II. Pract Periodont Asthet Dent 2000;12(6):557-564.
unwaxed floss to ensure the absence of sealant in the 17. O’Brien WJ, Johnston WM, Fanian F, Lambert S. The surface
roughness and gloss of composites. J Dent Res 1984;63(5):
contact zone, and the margins should be inspected 685- 688.
18. Judd DB, Harrison WN, Sweo BJ, et al. Optical specification of
(Figures 24 and 25). light-scattering materials. J Res Nat Bur Stand 1937;19:287-317.
19. Campbell PM, Johnston WM, O’Brien WJ. Light scattering and
gloss of an experimental quartz-filled composite. J Dent Res
1986;65(6):892-894.
Conclusion 20. Dietschi D. Layering concepts in anterior composite restorations.
J Adhes Dent 2001;3(1):71- 80.
Form and function are interdependent aspects of the 21. Kim HS, Um CM. Color differences between resin composites
and shade guides. Quint Int 1996;27(8):559-567.
restorative formula. The restorative clinician can now 22. Fahl N Jr, Denehy GE, Jackson RD. Protocol for predictable
restoration of anterior teeth with composite resins. Pract Periodont
integrate traditional restorative concepts of function and Aesthet Dent 1995;7(8) :13 -21.
form with an understanding of color and anatomical 23. Liebenberg WH. Successive cusp build-up: An improved place-
ment technique for posterior direct resin restorations. J Canad
morphology for the development of aesthetic restorations. Dent Assoc 1996;62(6):501-507.
24. Hornbrook DS. Optimizing form and function with the direct pos-
A precise protocol is required for the incremental appli- terior composite resin: A case report. Pract Periodont Aesthet
Dent 1996;8(4):405- 411.
cation of composite resins, tints, and modifiers to enable 25. Kanca J III. Improving bond strength through etching of dentin
and bonding to wet dentin surfaces. J Am Dent Assoc 1992;
the creation of natural-looking restorations. While this 123(9) :35-43.
26. Nakabayashi N, Nakamura M, Yasuda N. Hybrid layer as a
article primarily focuses on the parameters of color and dentin-bonding mechanism. J Esthet Dent 1991;3(4):133 -138.
27. Kanca J III. Resin bonding to wet substrate. II. Bonding to enamel.
aesthetics within directly fabricated restorations, Part II Quint Int 1992;23(9):625-627.
28. Baratieri LN, Ritter AV, Perdigao J, Felippe L A. Direct posterior
of this discussion will address this critical aspect within composite resin restorations: Current concepts for the technique.
laboratory-fabricated restorations. Regardless of the type Pract Periodont Aesthet Dent 1998;10(7):875-886.
29. Goracci G, Mori G. Scanning electron microscopic evaluation
of restoration selected, the definitive aesthetic result will of resin-dentin and calcium hydroxide-dentin interface with resin
composite restorations. Quint Int 1996;27(2):129 -135.
be based on the professional’s ability to create a “form 30. Van Meerbeek B, Perdigao J, Lambrechts P, Vanherle G. The
clinical performance of adhesives. J Dent 1998;26(1) :1-20.
that follows function,” and imagination and artistry to 31. Eakle WS, Ito RK. Effect of insertion technique on microleakage
in mesio-occlusodistal composite resin restorations. Quint Int
ensure that the anatomical form defines color. 1990;21:369-374.

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CONTINUING EDUCATION CE 2
CONTINUING EDUCATION

(CE) EXERCISE NO. 2

To submit your CE Exercise answers, please use the answer sheet found within the CE Editorial Section of this issue and complete as follows:
1) Identify the article; 2) Place an X in the appropriate box for each question of each exercise; 3) Clip answer sheet from the page and mail
it to the CE Department at Montage Media Corporation. For further instructions, please refer to the CE Editorial Section.
The 10 multiple-choice questions for this Continuing Education (CE) exercise are based on the article “Anatomical form defines color:
Function, form, and aesthetics,” by Douglas A. Terry, DDS, Willi Geller, CDT, Olivier Tric, CDT, Mark J. Anderson, CDT, Monte Tourville, CDT,
and Alvin Kobashigawa, BS. This article is on Pages 59-67.

Learning Objectives:
This article presents a modified definition of color and incorporates an analysis of the anatomical morphology and optical properties of a
tooth to facilitate a thorough shade determination. Upon reading this article and completing this exercise, the reader should:
• Understand the infinite possibilities of color that exist within the tooth and restoration.
• Be aware of the adhesive protocol for the development aesthetic posterior composite restorations.

1. All of the following three-dimensional properties have 6. The surface morphology of natural teeth influences the
been traditionally used to define color EXCEPT: surface gloss. While macro- or micromorphologically
a. Hue. roughened or coarse surfaces allow diffuse reflection,
b. Value. flat or smooth surfaces allow specular reflection.
c. Chroma. a. Both statements are true.
d. Texture. b. Both statements are false.
c. The first statement is true, the second statement is false.
2. Once the artificial dentin layer is developed, an
d. The first statement is false, the second statement is true.
invagination is made and a “light diffusion layer”
should be placed for all of the following reasons EXCEPT: 7. Why are tints and opaquers applied during the direct
a. To provide sufficient opacity to conceal underlying stratification process?
discolored structures. a. To adjust the hue and chroma of the restoration.
b. To provide an illusion of depth for restorations of b. To enhance the realistic distribution of color throughout
limited thickness. the restoration.
c. To cause an internal diffusion of light. c. To lower value of the restoration and establish natural
d. To control luminosity within the internal aspects of characteristics for a specific area of the tooth.
the restoration. d. All of the above.
8. Which of the following effects result in light alteration
3. The term “hue” corresponds to:
for subsequent color variances?
a. The intensity of a color.
a. Reflection and refraction.
b. The wavelength of reflected light.
b. Absorption and transmission.
c. The principle determinant of light from dark colors.
c. Dispersion, diffraction, and interference.
d. The iridescent appearance of a dense medium or
d. All of the above.
colloidal system when illuminated.
9. During preparation for direct posterior restorations,
4. Opalescence in teeth appears as a light-scattering effect the occlusal outline should:
that is associated with the diameter of enamel rods. a. Provide access to the carious dentin.
Where is this occurrence most visible in the natural or b. Include and remove carious enamel.
restored dentition? c. Remove any residual amalgam staining and provide
a. On the cusp tips and marginal ridges of posterior teeth. proper restorative access.
b. In the incisal edges and proximal incisal surfaces of d. All of the above.
anterior teeth.
10. How is a 3-dimensional appearance developed within
c. Both a and b.
a restoration during the final stratification process?
d. Neither a nor b.
a. By the application of internal characteristics and
5. What effect does iridescence produce on natural aesthetic staining.
and restored dentition? b. By the placement of a diluted whitewashed shade
a. A lustrous appearance is produced. between the occlusal planes and higher valued
b. An emission of blue or white visible light. tooth structures.
c. A rainbow effect within the object being viewed. c. Both a and b.
d. All of the above. d. Neither a nor b.

68 Vol. 14, No. 1