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TOOTH SHADE SELECTION

CONTENTS
Introduction: Light and Color Color has Quantity and Quality. Color Atlases Atlases based on Subtractive or Additive Color Mixture Perceptually Uni or!ly Spaced Color Atlases Color Matching and Colori!etry Measure!ent and Matching o "u!an #eeth Color Matching o $ental Prosthetic Materials Methods o Colori!etry #he %le!ents o %sthetics&Application o Color Science #he %le!ents o %sthetics 'ptical %le!ents "ue (alue Chro!a )saturation* Color 'rdering Shade +uide Use Sur ace #exture Controlled %nviron!ent Clinical Procedures Color Modi ications 'ther 'pti!al Properties ,hat lies AheadSu!!ation o #echni.ue

INTRODUCTION: LIGHT AND COLOR Light is an electro!agnetic radiation in the optical region that is capable o sti!ulating the eye0 the range o 1avelengths being 234 n! to 564 n!. ,hen light sti!ulates the eye0 a pattern o physiological perception is aroused. #he perceptions are related to the distribution o light in the retinal i!age in ter!s o space0 ti!e0 and spectral po1er distribution. #he light co!ing ro! an ob7ect !ust there ore be treated as co!ing ro! a uni or! ele!ent o area and as constant in respect ti!e. "o1ever0 1hen tooth 1hich has an a181ard three&di!ensional shape0 1ith texture or !ar8ing and di erences in gloss or si9e0 it is di icult or any hu!an observers & dentists are no exception & to !atch color. In such a situation even photoelectric instru!ents !ay not be capable o giving a valid color speci ication.

COLOR HAS QUANTITY AND QUALITY. #he co!!on units used in photo!etry are the lu!en or lu!inous lux0 the lux )lu!en per s. !* or lu!inance on a sur ace0 and the candela

per s. ! or the lu!inance or ob7ective brightness o a sur ace. #he perceptual attribute corresponding to lu!inance is lu!inosity. ;rightness is sub7ective i the ob7ect is a source o light0 or lightness i the ob7ect is not a source o light. ;ut the sur ace color is 7udged in relationship to its surroundings. #he .uality o color needs a pair o concepts or variables to describe it. #hree di!ensions are needed. 'ne !ethod o dealing 1ith this is to sort out all sa!ples o a given lightness )eli!inating lu!inance as a variable*0 1hen it is ound that they can al1ays be arranged syste!atically in a t1o < di!ensional array.

#he arrays o sa!ples considered above0 one array or each distinct level o lightness0 could be placed on sti cards and asse!bled 1ith

spacers one above the other 1ith progressive increase in lightness. #he co!plete set o sa!ples 1ould no1 exist0 set out in three di!ensions0 to delineate 1hat is called a color solid or color space. Such a color solid could also be or!ed ro! the sa!e large collection o sa!ples in a di erent ashion by selecting all non&gray sa!ples o a given hue and arranging the! syste!atically on a vertical card 1ith variations o lightness increasing up1ards and variations o saturation increasing out1ards. #his second !ethod o arranging all possible colors o sa!ples

to !a8e a syste!atic color solid has been !uch !ore popular than the one described irst0 and or!s the basis o !ost types o color atlas.

COLOR ATLASES A color atlas is a syste!atic arrange!ent o a large range o colored sa!ples0 usually sur ace colors0 as described above0 but 1ith an i!portant additional eature: the colors have been spaced out regularly according to so!e stated criterion or re.uire!ent. ;ecause o the three di!ensional nature o color space0 all color atlases consist o a collection o charts0 each to represent a t1o&di!ensional section through the color space. #he particular color solid represented by the sa!ples in a color

atlas is a color order syste!. It is i!portant to reali9e that the color ga!ut that can be covered depends on the glossiness o the sa!ples: the higher the gloss the !ore saturated or dar8 a sa!ple can be. >urther0 the value o an atlas depends on the per!anence o its speci!ens.

In the criterion o

color spacing bet1een sa!ples and the ollo1s0 spacing is

uni or!ity 1ith 1hich the sa!pling actually

i!portant. #here are three basic 1ays o spacing the sa!ples in ter!s o color di erence in a color atlas: i* by colorant !ixture variation0 ii* by additive !ixture variations and iii* by sa!pling to obtain perceptual uni or!ity o color spacing.

ATLASES BASED ON SUBTRACTIVE OR ADDITIVE COLOR MIXTURE Colorant !ixture spaced atlases have been !ade to de!onstrate the coloration produced by syste!atic ad!ixture o certain base colorants0 or exa!ple0 using subtractive color !ixture. #hese are o value to dyers and users o pig!ents in paint0 plastics0 printing etc. #he ?u&"ue custo! Color Syste! has /0444 !atte painted cards developed ro! a 1hite0 a blac80 and six chro!atic single&pig!ent paints. #he Colori9er )/@=5* has /02:: !atte painted chips developed ro! a 1hite0 a gray0 a blac80 and

t1elve chro!atic base paints. #he Plochere Color Syste! )/@=3* is another exa!ple0 1ith /0:=3 !atte painted cards.

#he Pantone Matching Syste! )/@620 revised /@5=* uses a 1hite0 a blac80 and eight chro!atic base pig!ents to give A35 sa!ples printed in both a glossy and a !atte series. #he color range is extended by A6 additional saturated colors or!ed by !a8ing use o an extra seven saturated base pig!ents. #he syste! is 1idely used as an aid to

speci ying and or!ulating printed colors.

#he ICI Color Atlas )/@6@* has /025@ opa.ue sa!ples !ade 1ithout using blac8. #he ICI Color Atlas thus gives the closest gradations bet1een neighboring colors o any atlas0 and they are close enough or all co!!ercial dyeing purposes. Additive color !ixture spaced atlases sho1 the se.uences o colors that can be produced by additive color !ixture. #he original conception in /@/5 1as that o 'st1ald )/@24*0 1ho devised a color syste! 1ith a central gray scale and radial sections containing colors o nearly the sa!e hue. #he original atlases o 'st1ald had so!e de ects and are not available or practical use0 but in !odern ti!es a !uch better version called the Color "ar!ony Manual 1as produced.

#here are t1o notable color atlases that are partly based on subtractive color !ixture o colorants and partly on additive color !ixture. #hese are based on screen plate printing color !ixture0 and are o particular value to the printing industry.

PERCEPTUALLY UNIFORMLY SPACED COLOR ATLASES #he inal class o color atlas is based on grading the color spacing o the sa!ples to produce sub7ectively uni or! spacing 1ith perceptually e.ual di erences bet1een successive sa!ples in a se.uence. syste!s are i!portant in psychological0 aesthetic0 Such

and design

applications. #he !ost a!ous color atlas and syste! o this type is the Munsell. #his 1as originally produced as the Munsell ;oo8 Color using a central vertical gray scale and =4 radial sections0 each 1ith colors o a given hue. #he three perceptual attributes o light na!ely lightness0 hue0 and saturation are represented by scales o value0 hue and chro!a0 respectively.

#here is another perceptually uni or!ly spaced color atlas and syste!0 the $I? 6/6= Color Syste! 1hich 1as produced originally as tinted transparent gelatine ilters in arrays0 1ith sur ace color versions beco!ing available later. In the $I? 6/6= Syste! there are three

variables: arbton )hue* #0 sattigung )saturation* S and dun8elstu e )dar8ness* $. As 1ith the Munsell syste!0 the hues o the $I? syste! are perceptually uni or!ly spaced round the co!plete ga!ut o hues. #he $I? 6/6= colors have been speci ied in ter!s o the Munsell and CI% colori!etric syste!s.

A very recent color atlas0 the ?atural Color Syste!0 described by "ard )/@54*0 uses perceptual 7udg!ent to subdivide color space in ter!s o hue0 saturation0 and blac8ness0 1ith sa!ples o a given hue being arranged in a triangular array 1ith lines o e.ual saturation and e.ual blac8ness sa!ples. A !a7or de ect is that the nu!ber o hue steps bet1een the perceptually BpureB red0 yello10 green0 and blue hues 1as orced to be e.ual )i!plying that these particular hues !ust be arranged at @4 to each other in the space*0 1ith the result the si9es o unit steps are not e.ual in the our .uadrants o the circle o hues.

In dentistry0 the principle o color !atching and !easure!ent by re erence to a suitable color atlas has !uch to co!!end it. "o1ever0 the general&purpose color atlases described above0 are not able to !eet the needs o dentists or color !atching and !easure!ent0 though they could be applied to the aesthetic ield. )such has !atching gu! colors in poly!er. * #he colors o teeth cover a very restricted region o color space0 and a special&purpose color atlas containing perhaps :44 or 244 sa!ples 1ould enable neighboring sa!ples to be never !ore than three 7ust noticeable di erences apart and usually about t1o.

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COLOR MATCHING AND COLORIMETRY - COLOR MATCHING PROPERTIES OF REAL OBSERVERS #he three la1s o +rass!ann and that o Abney or! the basis o colori!etry. #he !ost i!portant corollary o these la1s is: increasing or decreasing the a!ounts o t1o lights o the sa!e color by the sa!e actor0 8eeping the relative spectral co!positions o each unchanged0 1ill not destroy the color !atch. #he above state!ents provide the basis o the additive )additivity* concept in colori!etry0 1hich is o unda!ental i!portance in allo1ing prediction o color !atches and color

speci ications0 is per!itting data in ter!s o any triad o !atching sti!uli to be trans or!ed to values in ter!s o any other triad o !atching or re erence sti!uli. #he la1s o colori!etry and photo!etry stated above are valid over !ost o the operating range o the eye0 and under all co!!on conditions. #he la1s apply to light entering the eye0 1hether it

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is directly or! a pri!ary source )an illu!inant* or 1hether it co!es indirectly ro! such a source via a secondary source )a sur ace color*.

#he concept o metamerism can be extended to hu!an observers as 1ell. In this case it is ter!ed observer !eta!eris!0 and it arises because o the variation in color !atching ound a!ong the nor!al trichro!atic observers !a8ing up the bul8 o the population. 'bserver !eta!eris! !eans that 1hat is a color !atch or one observer is not exactly so or another. #hus i there is !eta!eric color !atch bet1een t1o sur aces o di erent spectral re lectance pro ile0 then or the Standard observer they 1ill !atch under a stated illu!inant. >or any other

illu!inant or 1ith that illu!inant or those real observers 1ho di er ro! the Standard 'bserver0 there 1ill probably be so!e degree o !is!atch. So!e !eta!eric !atched sur ace colors have spectral di erences such that they happen to !atch under t1o or even three illu!inants but not under other illu!inants.

MEASUREMENT AND MATCHING OF HUMAN TEETH $entistry is an occupation 1here aesthetics is o considerable i!portance0 especially 1hen patients are stage or public igures.

"o1ever it is interesting to note that color science has not so ar been applied very success ully in dental shade !atching to give .uantitative

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ans1ers to the proble!s. #here are very good reasons or this0 1hich are discussed belo1.

#he needs0 ho1ever0 are clear enough and !ay be stated as the selection0 coloring0 and processing o the right dental prosthetic !aterials so as to produce a convincing !atch in appearance to the natural teeth o the patient. #his is a !uch harder proble! than those !et 1ith by the color production industries0 such as textiles paints0 and plastics0 or reasons0 1hich 1ill no1 be explained. TEETH AS COLORIMETRIC SAMPLES #he properties o sa!ples presented or !easure!ent 1ith

colori!eters and spectro&photo!eters that give rise to di iculties and syste!atic errors have been !entioned in previous sections: luorescence0 !eta!eris!0 non&uni or!ity across the sur ace0 inho!ogeneous internal structure in layers0 translucency0 s!all si9e0 irregular shape0 and surrounding pro7ections 1hich 1ould prevent their close presentation against the instru!ent !easuring port. #he reasons 1hy teeth !ust be 7ust about the only ob7ects to have all the properties at once and in abundant !easure.

#he

luorescence is readily seen by illu!inating 1ith near&

ultraviolet light and its e!ission is a pale bluish&1hite in color. As the

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near ultraviolet is present in natural daylight0 it is li8ely that luorescence in luences the color o teeth 1hen illu!inated by daylight.

Meta!eris! is inevitable 1hen synthetic !aterials such as colored dental porcelains0 ce!ents0 and poly!ers are !atched against natural teeth. "o1ever0 it is the geo!etrical properties in the above list o a181ard sa!ple properties that !a8e instru!ental colori!etry unli8ely to be ully success ul.

A cross&section through a hu!an tooth is sho1n in plate 30 1hich sho1s the three principal layers 1ithin it: ena!el0 dentine0 and nutritional pulp. #hese layers have di erent scattering coe icients0 and hence

di erent opacity and translucency properties. #he spectral absorption property o the pulp is !ar8edly di erent ro! that o the ena!el and dentine0 giving it the pin8y red color. #he ena!el and dentine are a yello1ish 1hite0 but the ena!el 1ith about @5C hydroxyapatite content is !ore translucent than the dentine0 1hich has about 54C hydroxyapatite content. So!e teeth that are very translucent see! al!ost bluish&1hite in parts. #his is probably due to the bluish rays light scattering o s!all sub& 1avelength particles0 seen against the yello1ish 1hite o the !ore densely scattering parts 1here the short 1ave absorption and natural yello1ish color predo!inate.

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>ro! the preceding in or!ation it is clear that teeth are translucent and inho!ogeneous in several di erent 1ays. #his0 co!bined 1ith the s!all si9e and the geo!etrically co!plicated shape o a tooth and o its neighboring teeth and gu! tissue0 !eans that a di erent raction o an incident ray o illu!inating light 1ill be scattered bac8 as re lected light or al!ost every angle o illu!ination0 and 1ith each given angle o illu!ination or al!ost every portion o a tooth illu!inated. #he only 1ay to try to even out the selective local and angular e ects 1ould be to use he!ispherical0 or nearly he!ispherical0 di use illu!ination o a tooth as 1ell as its ad7oining teeth and gu! tissues. In vie1 o 1hat has been !entioned earlier0 it is clear that the general&purpose co!!ercial colori!etric instru!ents do not o er the possibility o !easuring teeth in vivo satis actorily. #he !ain

re.uire!ent there ore0 is that the 1hole !outh should be di usely and uni or!ly illu!inated 1ith only a s!all area vie1ed0 o perhaps 2 or = !! across. #his i!plies a large integrating sphere and hence a lo1 overall optical e iciency0 so that a high po1er la!p or la!ps 1ould be needed. #here are instru!ents that can be applied locally to a tooth sur ace. So!e colori!eters )photoelectric and visual* have a ibre&optic lexible !easuring head 1ith =AD4 or 4D=A illu!inating and vie1ing geo!etry.

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A eature o teeth that urther co!plicates the issue is local staining0 o ten con ined to crac8s or super icial issures. ,hereas the hu!an observer can ignore this and concentrate on the !ain tooth body color0 photoelectric instru!ents cannot do anything but !easure the average color 1ithin the sa!pled area. A dentist needs to !atch the !ain body color o the natural teeth and can apply artistically si!ulated stain !ar8ings a ter 1ards to the selected prosthetic cro1n !aterial. A

uni or! !aterial o the average color o the natural teeth 1ould not loo8 right0 i the teeth have stain !ar8ings0 a point discussed by McLean )/@5@* and Preston and ;ergen )/@34*. Measure e!"s #! Tee"$ a" "$e Na"%#!a& P$'s%(a& La)#ra"#r' In order to support a progra!!e o 1or8 at ;ritish Cera!ic Eesearch Association on dental porcelains0 the ?ational Physical Laboratory !ade an investigation o the color and luorescence o teeth and o so!e dental porcelain. %xtracted teeth preserved in or!alin solution 1ere observed to be unnaturally dar8 and bro1nish0 due to their being 1aterlogged because o the correct os!otic balance no longer being !aintained. Atte!pts at drying the! led to the !easured color being progressively lighter and lighter 1ith no stable endpoint. A ter a 1hile they loo8ed unnaturally light and started to cra9e0 eventually alling to pieces. ;ecause o this it 1as decided that no credible colori!etry could

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be carried out on extracted teeth0 even 1hen stored under ideali9ed conditions0 and that !easure!ents in vivo 1ere necessary.

#he i!plication o this 1or8 is that dental prosthetic !aterials should not only !atch the natural teeth in the visible region o the spectru!0 but their luorescence should roughly !atch as 1ell. In the case o sho1&business and other patients 1ho are public igures0 the luorescence needs to !atch .uite 1ell0 to cover public appearances in discos0 theatres0 or other places 1ith orna!ental ultraviolet illu!ination. C#&#r Ma"($%!* #+ De!"a& Pr#s"$e"%( a"er%a&s

#he 1idely used general&purpose colori!etric instru!ents are unsuitable or dental proble!s0 due to si9e o the !easured area0 and that the special&purpose instru!ents 1ith s!all !easured areas have co!pletely unsuitable !eans o illu!inating the 1hole !outh )or at least part o the !outh to include the tooth and all neighboring structures and tissues*. In the absence o this special dental spectrophoto!eter0 visual !ethods 1ill have to be relied on or so!e ti!e to co!e. "o1ever0 the proble! is that dental prosthetic !aterials are not nor!ally available to the dentist in the right or!. #hey should be abricated as tooth shaped sa!ples or!ing a dental color atlas0 that is0 a shade guide constructed to sho1 the three&di!ensional variation o color ound in natural teeth0 1ith the variations being syste!atic and uni or!ly graded according to so!e

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stated criteria. #he !aterials should be selected to give !ini!al !eta!eris! 1ith natural teeth0 this is also applying to the luorescence seen under near&ultraviolet irradiation. #he second step is to de ine a a!ily o spectrophoto!etric curves to avoid proble!s o !eta!eris! and luorescence. I leave it to the dental pro ession to suggest the

re!aining steps in such an endeavor.

Me"$#,s #+ C#&#r% e"r' #here are three basic !ethods o colori!etry: Matching the test sa!ple against standardi9ed and inely graded re erence sa!ples organi9ed as in a color atlas and interpolating to ind the best esti!ate o the color speci icationF Measuring the color speci ication directly by !eans o a tristi!ulus colori!eterF and Measuring the spectrophoto!etric characteristic o the sa!ple and calculating the tristi!ulus values.

In principle0 all these three !ethods could be i!ple!ented by visual or by photoelectric !eans. #he use o a color atlas is too slo1 and inaccurate or nor!al industrial use. Inaccuracies arise !ainly ro!

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!eta!eris!0 o 8eeping the re erence sa!ples clean0 unda!aged0 and 1ithin calibration. (isual tristi!ulus colori!etry is slo1er and less

precise than photoelectric !ethods0 but is reliable. #he !ost 1idely used types o visual colori!eter are !ade by the #into!eter Ltd and it !a8es use o sets o graded colored glass trans!ission standards as described.

S-e("r#-$# e"r%( C#&#r% e"r' Spectrophoto!eters are instru!ents that !easure0 1avelength by 1avelength0 the spectral variation o trans!ittance or re lectance o a sa!ple.

FOUR GREAT PROBLEMS IN COLORIMETRY F&u#res(e!" Sa -&es Certain substances exhibit the pheno!enon o photolu!inescence0 1hereby radiant energy is absorbed in one part o the spectru! and re& e!itted in another part o the spectru!. I the e!ission appears to be si!ultaneous 1ith the absorption0 the e ect is co!!only called luorescence0 although strictly spea8ing those e!issions occurring a ter intervals longer than 10-8 sec should be called phosphorescence. Most luorescent substances including all organic ones0 have their e!ission spectra overlapping 1ith their excitation spectra0 but in all cases the !axi!u! region o e!ission is at a longer 1avelength than the

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!axi!u! region o excitation. #his is because energy is lost in the optical transition0 and the energy o a photon. An opa.ue luorescent sa!ple seen by re lected light has its apparent di use re lectance actor !ade up o to1 parts0 the true re lective co!ponent 1here a raction o the incident light at each 1avelength is scattered bac8 1ithout change o 1avelength and the luorescent co!ponent 1here a raction o the light incident at 1avelengths in the excitation region is re&e!itted in a 1aveband centered at a longer 1avelength. ?or!al colori!etric

instru!ents or sur ace colors are capable o handling correctly the ordinary re lected co!ponent o light0 but not the luorescent co!ponent. #he luorescent co!ponent o the total radiance actor o a sa!ple is0 ho1ever0 dependent on the relative spectral po1er distribution o the incident light0 as sho1n.

METAMERISM ,hen t1o sur aces !atch or nearly !atch or color under so!e illu!ination0 but !is!atch under one or !ore other illu!inants0 they are said to be !eta!eric0 and their spectral re lection pro iles 1ill be ound to be di erent or any color. #here are0 in general0 !any possible spectral distributions0 a act that ollo1s ro! the trivariance o hu!an color vision. Any color0 regardless o spectral distribution0 can be !atched by a suitable !ixture o any or !any di erent possible sets o !atching

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sti!uli.

Meta!eris! arises to so!e extent 1henever a target color

sa!ple is !atched using di erent colorants0 substrates0 or 8inds o !aterial. It is never possible to duplicate exactly the target colors o spectral re lection pro ile 1hen such changes o !aterials are involved.

THE ELEMENTS OF ESTHETICS-APPLICATION OF COLOR SCIENCE "istory has recorded !an8indGs interest in his personal appearance and the e ect that sel i!age has on con idence0 per or!ance0 and social inter course. $ental esthetic has igured pro!inently in this role o sel & i!age and various ethnic groups have adorned and altered their dentitions in diverse !anners. Si!ilarly0 any treatise on esthetics is sub7ect to individual interpretation. #he dentist !ust0 there ore0 atte!pt to use the technical and conceptual ability to develop or the patient a restoration that best !eets the patientGs psychological and biological needs and desires. %sthetic excellence is largely an art 1ith pri!arily sub7ective interpretation0 though not enough has been done to e ectively analy9e and or!ulate it. Although a consideration o color and shade !atching 1ill receive !a7or e!phasis0 the relative role o this ele!ent !ust be placed in the right context.

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THE ELEMENTS OF ESTHETICS %sthetic ele!ents can be approached ro! a nu!ber o di erent vie1points and any approach to taxono!y or grouping results in so!e redundancy and inade.uacy. #he ele!ents o esthetics 1ithin the

headings o or!0 texture and color. >or 1ant o a better syste! I shall herein approach the dissection o co!ponents o esthetics into BspatialB0 BopticalB0 and BbiologicalB considerations.

SPATIAL Spatial co!ponents are those actors0 1hich apply to

tridi!ensional or! and the relation o the teeth to one another as 1ell as to the approxi!ating or enclosing ele!ents. #here are also perceptual ele!ents0 1hich include linear har!ony0 perspective vie10 and orientation to the so t tissue. #hese ele!ents individually and in concert deliver the greatest i!pact to the vie1er. Additionally0 the actual and inite !ay not be as i!portant as the e ect perceived. Illusion is a !ost signi icant entity.

OPTICAL Anyone 1ho has tried to !atch teeth 1ith a restorative !aterial recogni9es that the procedure is co!plex. #he optical appearance is not

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!erely one o BcolorB as great a concern as that pheno!enon is0 but also involves light and shado10 sur ace texture0 translucency0 and opacity.

BIOLOGIC #he biologic ele!ents include those vital actors0 1hich separate the dyna!ic and physiologic ro! the static and li eless. ANALYTICAL PROBLEMS ,hen all o these considerations are expanded into their

subordinate co!ponents it is little 1onder that obtaining esthetic excellence has presented so!e analytical proble!s. #his !ay be si!ply stated by noting that the dentist !ust )a* understand 1hat the patient 1ants )psychologic*0 )b* 1hat the patient needs )physiologic*0 and )c* o 1hat dental science0 especially as expressed by the dental tea! rendering the speci ic service0 is capable )technical*. Unless the psychologic

physiologic0 and technical ele!ents can be brought into consonance0 therapy should not be initiated.

PLANNING %ssential to the planning o a restoration or prosthesis is an ade.uate set o diagnostic casts that reproduce the patientGs so t and hard tissues 1ith idelity. It is advisable to !a8e a duplicate set o casts to provide a baseline record that 1ill have both therapeutic and legal value.

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Such casts should usually be !ounted0 although si!pler procedures can be acco!plished on un!ounted casts.

DIAGNOSTIC .AXING Modi ication to !eet both esthetic and unctional needs can best be planned or through the use o a diagnostic 1axing procedure. Although the diagnostic 1axing procedure is li!ited by the inani!ate properties o the cast0 it nonetheless can reveal !any o the eatures that !ay indicate or li!it success. #ogether 1ith clinical 7udg!ent developed ro!

observing the lip lines0 phonetics0 and in or!ation gleaned ro! the patient intervie10 a precursor o the inal restoration can be developed. #his incorporation o the patientGs desires enhances acceptance and greatly reduces the possibility o dissatis action or disappoint!ent at the ti!e o place!ent o the co!pleted restoration. It is essential to ascertain the desired esthetic result or !etal cera!ic units in advance in order to allo1 1axing0 a ra!e 1or8 that provides proper !etal support0 yet does not inter ere 1ith translucency and color nor in ringe upon the ad7acent tissues.

Porcelain is a !aterial that has intrinsic li!itations that !ust be recogni9ed. #he !arriage o !etal to porcelain in the !etal cera!ic restoration is an atte!pt to ta8e advantage o the strength o !etal and the beauty o porcelain. Si!ilarly0 all the cera!ic restoration e!ploying an

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alu!inous core is a procedure that enhances success through dispersion and strengthening. Porcelain ails in either syste! 1hen there is excess bul8 or0 to phase it in the negative0 inade.uate support. #here ore0 the strengthening support syste! )either !etal or alu!ina* !ust be developed to allo1 as little o the esthetic veneering glass as possible )to allo1 or strength* yet leave su icient bul8 to cover the substructure and develop the esthetic optical properties desired. Such an acco!plish!ent re.uires 8no1ledge and planning. #he desired result !ust be pre& established i both opti!u! strength and esthetic excellence are to be obtained.

IMPLIED GENDER Anthropologically0 there is no sexual di!orphis! o hu!an teeth. ,hereas it has been convenient to consider the !ale or! as one that is !ore cuboidal )robust* and the e!inine as being !ore rounded )gracile*0 atte!pts to veri y this have ailed. As the dentition 1ears as a result o unction or para& unction0 the !ore 7uvenile incisal edge contours are lost0 and the rounded or! evolves into one that is !ore angular. #hus0 it appears that 1ear and aging have been translated into B!asculineB0 1hile the !ore youth ul or unaltered or! is as B e!inineB.

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EMBRASURES All o the our e!brasure spaces )incisal0 cervical0 labial0 and lingual* are i!portant0 but o ten the irst perception o or! is the

silhouette o the teeth against the dar8 bac8ground o the oral cavity. #his silhouette is generated by the incisal e!brasures and the connecting incisal edges. #here is0 obviously0 an inter ace bet1een the incisal and cervical e!brasures0 1hich or!s the inciso&gingival contact area.

OPTICAL ELEMENTS #here are !any voids in the 8no1ledge o esthetic or!ulation0 but so!e o these are slo1ly being illed. #he study o color in dentistry !ust include translucency0 opacity0 and the e ect o light and shado1. Indeed0 it !ust be recogni9ed that color and light are a single entity 1ith di erent !ani estations. 'ne cannot study color 1ithout studying light0 As $r. ;ruce Clar8 noted al!ost A4 years ago Bcolor&li8e or! has three di!ensionsB. #hese three di!ensions or! the cornerstone o the logical approach to clinical shade !atching. Color is a co!plex pheno!enon and its recognition involves a physical sti!ulus0 a psycho&physical inter change bet1een the receptor cells o the eye0 and the sub7ective response by the brain to the in or!ation trans!itted ro! the receptor organ.

Hust as dental esthetics !ust be dissected into its co!ponent parts to be co!prehended0 so BcolorB !ust be dissected into its three di!ensions

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i it is to be BseenB and shade co!parisons !ade. ,hen a shade guide and a tooth do not !atch0 it is not enough to note that a B!atchB is lac8ing0 but deviations in each o the three di!ensions !ust be noted. #his re.uires a basic and clear understanding o those three di!ensions.

HUE #he irst di!ension0 hue0 is usually de ined as Bthe na!e o the colorB. #his is an inade.uate de inition because it ails to recogni9e that hue na!es are very i!precise. #here are !any di erent reds0 oranges0 greens0 etc. "ue is generated by the 1avelength o the sti!ulus. (isible light is co!posed o 1aves o bet1een 234 ad 564 nano!eters. #he shortest 1aves are seen as violet0 1hile the longest are red. #he physical se.uence0 dictated by 1avelength0 is violet0 blue0 green0 yello10 orange0 and red. It !ay0 then0 be said0 Bhue is the .uality o color designated by a convenient a!ily na!e0 and deter!ined by the 1avelength o the sti!ulus.

VALUE #he second di!ension0 value0 is !erely the .uality o blac8ness or 1hiteness. It is the e.uation o the color to a gray scale. "ue and value are independent0 or value can exist 1ithout hue )the converse is not true*. #hese are !erely one&di!ensional renditions. ;ecause the hu!an

:5

observer is so very sensitive to slight di erences in value0 it is this di!ension that is !ost i!portant in dentistry.

CHROMA /SATURATION0 Although value exists in the absence o hue0 chro!a is only present 1hen there is hue. Chro!a is !erely the intensity0 concentration0 or strength o the hue. Any one o the three di!ensions !ay be varied independent o the others0 but in dentistry this rarely happens.

COLOR ORDERING Many syste!s have been devised to interrelate the various colors possible by changing hue0 value0 and chro!a. So!e are best suited to !easure!ent by colori!eters or spectrophoto!eters. Munsell !erely related hue0 value0 and chro!a in the sa!e !anner that length0 1idth0 and depth are related. #he hues 1ere !ade a continuu! by ta8ing advantage o the act that the shortest 1avelengths )violet* contained visual ele!ents o the next shorter )blue* and the longest )red*. #here ore0 a visual circle could be !ade 1ith violet as the connecting lin8. Using the six hues previously na!ed0 this circle 1ould read Bviolet0 blue0 green0 yello10 orange0 red0 violet0 blue0 etc.B Munsell then established a value scale o 4

:3

)blac8* to /4 )1hite*. "ues can be related to values !uch the sa!e 1ay a 1heel is related to an axle. "ues o a lo1 value appear dull0 those o high value0 bright.

Chroma0 the third di!ension0 1ould be analogous to the spo8es o a 1heel and represents the intensity o the color at any hue or value. #his ordered color syste! !a8es possible the expression o all colors in ter!s o hue0 value0 and chro!a. Color !atching can be done ro! a standard and interpolation bet1een available color chips can be !ade in hue0 value0 and chro!a. Contrast to this ordered logic 1ith the procedures is no1 used in dentistry. ?o shading syste! has both logical order and ade.uate distribution. ,or8 done by Clar80 )/@2/*0 Sproull )/@52*0 Le!ire and ;ur8 )/@5A*0 and Miller )/@3/* has docu!ented the lac8 o correlation bet1een the hue0 value0 and chro!a o natural teeth and that o available shade guides.

+enerally0 shade guides do not include enough lo1 value and higher chro!a sa!ples. A conservative esti!ate had been !ade that les than i ty percent o the population !ay be satis actorily !atched by dental shade guides. Should one be ortunate enough to ind a shade tab that apparently satis ies the patientsG needs0 the proble! is not solved. Meta!eris! is a continually perplexing actor0 since the spectral curves

:@

o porcelain do not !atch those o natural teeth. As a result0 the B!atchB that is apparent in the clinical environ!ent !ay not be present in other areas o illu!ination.

Meta!eris! in shade !atching has evolved ro! !ore areas than 7ust the discrepancy o spectral curves o natural teeth and porcelain )or resins*. #here are only a very or shade guides that are used or porcelain !atching although !any co!panies !anu acture porcelain syste!s that are based on these guides. 'pa.ue and body porcelains0 sho1n by the 1or8 recently done by Miller and "e!!en $inger0 have .uite di erent hue0 value0 and chro!a plots. #his !eans that the opa.ue is applied to !as8 the !etal and then the body porcelain !ust be applied in a .uantity great enough to !as8 the opa.ue.

,hen this co!plex series o inaccuracies is considered0 the recurring proble! o !is!atched shades is not surprising. Acceptance o a shade is an individual actor and no absolute para!eters are de inable. #hus the restoration o a single central incisor continues to be the greatest challenge or the less co!pensation.

24

IMPOSING LOGIC ON AN ILLOGICAL SYSTEM ,hen co!parison bet1een the teeth to be !atched and the shade guide is !ade then an assess!ent o Bdi erenceB or Bno di erenceB is then necessary. I the di erence exceeds the acceptable level0 a description o that di erence is needed so that !odi ication !ay be !ade to correct the deviation. #hree .uestions 1ill !a8e that description possible.

IIs the shade guide yello1er than or redder than the tooth being !atched-B #his .uestion deals 1ith the di!ension o hue and

ac8no1ledges that since teeth are only in the yello1&to&yello1 red range0 no other hue error can be present.

BIs the shade guide hue !ore saturated or less saturated than that o the tooth being !atched-B Again0 this !ay be di icult to separate hue ro! value0 and either value saturation0 or both deviations !ay be present.

2/

#hese three .uestions 1ill help de ine the di erence bet1een a shade guide tooth and the tooth to be replicated. I no satis actory !atch is available0 a guide tooth that is higher in value and lo1er in chro!a should be selected. A higher value shade can be rather easily lo1ered 1ithout loss o translucency by the use o the co!ple!entary color externally or gray or co!ple!entary !odi iers internally. ,hen the ten hues Munsell na!ed 1ere given0 nothing 1as said o Bbro1n0B or bro1n is not a hue0 it is a color. ;ro1n is a lo1 value o several hues0 but or our purposes in dentistry0 the bro1ns are lo1 value yello1 reds.

SHADE GUIDE USE It is help ul or the dentist 1ho o ers porcelain restorations to patients to have 8no1ledge o ho1 such units are abricated. %ven though there in no intention o actually doing oneGs o1n laboratory 1or80 the 8no1ledge can greatly i!prove.

Su ice it to say that porcelain is built up in layers using opa.ue0 body0 and incisal porcelains. %ach o these contributes to the inal optical e ect and each !ay be !odi ied 1ith colorants to create the desired e ects. Shade guides re.uently have characteri9ed areas that !ay or !ay not be appropriate to the teeth being !atched. >or this reason0 at least three o each o the shade guides used should be available to the dentist.

2:

#he irst is an un!odi ied guide. #his guide !ay )and probably does* have a cervical or that is di erent ro! the standard body shade. #he second guide should have this cervical section0 co!posed o Bspecial e ectB porcelain0 re!oved. #he third guide should have the gla9e

re!oved )1ith stones0 discs0 or abrasive spray* or !odi ication 1ith cera!ic colorants. A ourth guide 1ith both cervical and incisal areas re!oved !ay be desirable.

#he overlay o the ena!el portion on the body !ay be done in di erent .uantities and at di erent angles and !ay not be at all li8e the standard guide. #he BopticalB ele!ents o translucency and opacity can be as i!portant as BcolorB in developing an esthetically acceptable restoration0 but tangible !eans o !easuring or co!!unicating the! are largely lac8ing. Most porcelain syste!s have a series o di erent incisal porcelains that !ay be used0 though !ost dentists are una1are o their i!portance.

#he shade guide tab should be occupied by the restoration being abricated. #his is easier to do or a pontics than or a cro1n. #he gingival area o the shade guide should approxi!ate the gingival portion o the tooth being !atched0 and the incisal edge o the guide should be in

22

the sa!e position as that o the natural tooth. #he goal is to have the light to be incident on the guide the sa!e 1ay the intended restoration 1ill receive and re lect light. >re.uently the re!aining teeth 1ill exhibit di erent shades and the goal !ust be not to !atch any particular one but to achieve an acceptable blend.

#he position o teeth in the arch alters light re lection and so!eti!es acco!!odations !ust be !ade. >or exa!ple0 i the tooth that is !ore pro!inent is !ore li8ely to re.uire restoration )because it is !ore sub7ect to trau!atic da!age*. ,hen the restoration is planned0 a shade that is slightly lo1er in value !ight be selected in order to blend 1ith the ad7acent central incisor.

SURFACE TEXTURE Since color is entirely a result o light0 the !anner in 1hich the light is re lected is i!portant. #he sur ace topography o both the shade guide and the tooth !ay alter the .uantity and .uality o light. #he replication o sur ace !orphology is i!portant in order to e ectively produce natural tooth appearances. #his is done by proper carving o the sur ace and obtaining the correct degree o gla9e. ?ot only does sur ace texture e ect the apparent value o a restoration0 but there are indications that it also a ects hue.

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CONTROLLED ENVIRONMENT It has been repeatedly stated that the light incident to and re lected ro! an ob7ect entirely control color. #he ob7ect has the ability to absorb or re lect certain spectra o light. I it absorbs all light0 it is seen as blac8F i it re lects all light0 it is seen as 1hite0 provided a ull spectral light is incident upon it. ,hen the ob7ect re lects so!e rays and absorbs others0 the nature o the re lected rays deter!ines the sti!ulus to the eye to receive and the brain to perceive BcolorB. I the dental shade !atching procedure is to be controlled0 then the incident light !ust also be controlled.

#here are three areas that re.uire attention i environ!ental control is to be e ective. >irst0 the light radiated !ust be co!plete spectru! lighting0 at least co!plete as is reasonably possible. $aylight changes hour&to&hour0 day&to&day0 and season&to&season. It varies in intensity and in .uality. #o ensure that the tubes selected are acceptable0 three criteria should be !et. First, the tube should have a correlated color te!perature si!ilar to that o standard daylight. )Standard daylight is de ined in the U.S as that light available in ,shington0 $.C. during the !onth o Hune bet1een the hours o /::44 ad /:44 oGcloc80 1ith a slightly overcast s8y*. #his te!perature is approxi!ately A0A44 Jelvin. Second, the spectral curve o the light source should be si!ilar to that o this sa!e Bstandard

2A

daylightB. >inally0 the illu!inant should have a Color Eendering Index )C.E.I.* o @4 or greater.

#he .uantity o light re.uired is !ediated by !any actors0 once the .uantity and .uality o light have been achieved. Attention !ust be given to several actors to preserve both. In order to !aintain the spectral .uality and brightness0 no intense colors or dar8 sur aces should be used in the roo!. Ee!e!ber that 1hen light hits a body0 so!e rays are absorbed and so!e are re lected. #he dar8er that body0 the !ore the hue 1ill be re lected. #he dar8er that body0 the e1er are the rays re lected. #he !ore highly colored the body0 the !ore hue 1ill be re lected and the less spectrally pure 1ill be the light in the environ!ent. %very colored ob7ect alters the light that is incident upon it. #here ore0 the larger the sur ace )such as 1alls or cabinet ronts* or the closer it is to the critical color !atching area&the patientGs !outh ) or exa!ple*. A third factor0 a ter the light source and re lecting sur aces0 is the acuity o the vision o the observer !a8ing the evaluation. #his acuity can be di!inished by sustained vie1ing0 and the evaluation period should be li!ited to ive seconds. A ter the shade guide&tooth co!parison0 the vie1er should avoid hue adaptation by loo8ing at a !ediu! blue or grapy card (this writer prefers the bl e! be ore !a8ing another co!parison. #he control o light

26

source0 roo! eatures0 and vie1er perception is essential to e ective color !atching.

CLINICAL PROCEDURES ,hen a restoration is received ro! the laboratory0 it !ay be either in a gla9ed or ungla9ed condition0 although !etal cera!ic porcelains are al1ays carried to !aturity )gla9ed* and then shaped prior to inal gla9ing. At the try&in o the restoration0 the !odi ications o or! are !ade irst. #he principles or this procedure have been discussed at length

previously. ?ext0 the proper sur ace texture is achieved using dia!ond stones0 dis8s0 or other instru!ents. In the process o reshaping0 the gla9e !ay be re!oved in so!e areas and not in others. #he gla9e should be re!oved ro! all sur aces 1ith the possible exception o tissue sur aces o pontics or non&visible areas such as the lingual aspect. #he gla9e is best re!oved 1ith an abrasive spray0 but i this is not possible e!ery dis8s or ine dia!ond stones !ay be used. Ee!oving the gla9e ro! all sur aces allo1s ho!ogenous regla9ing rather than having sur aces 1ith di erent degrees o gla9e on various areas o the restoration. I colorants are to be added to the sur aces0 they 1ill be ired at the sa!e ti!e the restoration is regla9ed.

25

It is i!portant to achieve proper sur ace texture

irst. #he

restoration is then cleaned0 either 1ith stea!0 distilled 1ater in an ultrasonic cleaner0 or by si!ply scrubbing 1ith a clean brush under running 1ater. #he restoration is then ready or regla9ing0 or the addition o sur ace colorants.

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COLOR MODIFICATIONS ,hen any shade other than a basic shade guide color is indicated0 the color !odi ication !ay be either intrinsic0 i.e.0 added into the porcelain at the ti!e o abrication0 or extrinsic i.e.0 applied to the sur ace a ter iring. ;oth procedures have advantages and disadvantages. Intrinsic additions o er the broadest range o shade alteration. Internal

!odi ication0 ho1ever0 re.uires s8ill0 and is reversible only by re!oval o the porcelain itsel 0 and cannot be previe1ed prior to iring. "o1ever0 sur ace colorants are easily applied or re!oved0 loo8 very !uch the sa!e be ore iring as a ter0 and do o er a si!ple !anner o !a8ing inal shade corrections and adding characteri9ations.

>or !ore intense e ects0 the !ore concentrated colors called BstainsB can be added to either the basic porcelain or !odi iers. #hese stains are !etal oxides in a luxed porcelain base. Metal oxides are opa.ue and !ust be dispersed through the glass !atrix to give the desired optical e ect. #he opa.ue porcelain po1ers !ay be !ore intensely

colored 1ithout any detri!ental e ects0 since they are0 by necessity0 already opa.ue. Conversely0 sur ace !odi ications are li!ited in the degree o saturation possible0 since the translucency o the restoration !ay be lost as concentration increases.

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EXTRINSIC MODIFICATION #o understand the e ect o !odi iers on porcelain color it is necessary to recogni9e the !any ele!ents that enter into the generation o color in a restoration.

Since extrinsic colors )stains* are applied to the sur ace0 they produce their e ect di erently than do intrinsic color !odi iers. Much o the e ect is the result o spectral re lectance. #he !ore heavily the sur ace stain is applied0 the greater 1ill be the spectral re lectance and the less 1ill the color be generated ro! 1ith in. #he cause o this is t1o old. First0 less incident light 1ill pass through the sur ace !odi iers0 since they are opa.ue0 and 1ill be directly re lected ro! the!. Second0 so!e o the light that did pass through the sur ace layer to the underlying porcelain 1ill be re lected ro! the undersur ace o the extrinsic stains bac8 into the restoration.

In spite o the li!itations o extrinsic !odi ication0 the procedure has !any applications that can enhance the esthetic acceptability o a restoration and should be in the ar!a!entariu! o every restorative dentist. An essential prere.uisite to e ective extrinsic !odi ication is the !ixing o the colorant po1ers 1ith the li.uid !ediu! to achieve a suitable consistency. (arious !edia are used0 but all have a higher

viscosity than 1ater to reduce lo1. Prophylene glycol is o ten used.

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I the !odi ications are to be !ade at chair&side0 the colorants should be !ixed and applied to the restoration a ter it has been placed in the !outh. 'nce the proper e ect has been achieved the !outh be cleaned. #his !ay be done !ost e ectively 1ith stea!0 but this acility is rarely available in a dental o ice. %ither distilled 1ater in an ultrasonic cleaner or vigorous brushing 1ith a clean brush under running 1ater 1ill su ice. #he restoration is then dried and the colorants reapplied. #he need or this apparently repetitious procedure is to obviate conta!ination ro! saliva0 cervicular luid0 or debris. 'nce the desired colorants have been !ixed and the e ect visuali9ed0 it is a si!ple !atter to reproduce the e ect in the second application.

'ne o the si!plest shade !odi ication procedures is increasing chro!a. I the inal restoration is lo1 in chro!a0 the properly hued colorant is chosen. $ecreasing value is si!ilarly si!ple. #he perception is o ten expressed as a need or B!ore grayB. +ray stain0 ho1ever0 is not the colorant o choice. I the value decrease is to give the i!pression o greater translucency or neutrali9e hue0 violet is the proper colorant. #his use o a co!ple!entary color to achieve a lo1er value is one o the !ost co!!on applications o extrinsic colorants.

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#he dental colorants do not !eet the re.uire!ents o subtractive color syste!. Instead o

the

cyan )pri!ary* and green

)secondary*0 yello1 and red0 !agenta and blue0 cyan is o!itted and orange is added. >or this reason0 violet 1or8s or nearly all shades 1hen an increase in apparent translucency is needed or value needs to be lo1ered !oderately. ;ro1n is !ost e ective or !ore signi icant value decreases 1hen chro!a is being raised conco!itantly. ,hen bro1n is !ixed 1ith the colorant being used to increase chro!a0 the value lo1ering e ect is !uch greater than 1hen violet is used.

FLUORESCENCE Another actor that has been the sub7ect o great concern and re.uent consternation to those !anu acturing dental porcelain is that o luorescence. >luorescence is a or! o lu!inescence 1herein a sti!ulus belo1 the visible spectru! )ultraviolet* causes a body to e!it light 1ithin the visible spectru!. ,hen ultra violet )blac8 light* is the pri!ary source0 the di erence bet1een natural teeth and !ost restorations is gross. So!e recent luorescence or!ulas have been innovatively success ul in

achieving excitation e!ission properties si!ilar to natural teeth0 yet so!e porcelains lac8 any signi icant luorescence.

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OTHER OPTIMAL PROPERTIES #he replication o ano!alous teeth 1ith porcelain can still be rustrating. Color is not the only variable that re.uires ad7ust!ent0 since relative translucency and opacity !ust also be considered. So!e teeth actually !ay be seen to beco!e !ore opa.ue as they dry0 and each shade co!parison is di erent. Much o the inal success co!es only 1ith patience and s8illed artistry0 and so!eti!es success is si!ply not obtained to the degree desired.

.HAT LIES AHEAD1 #he advent o an era in dentistry 1hen porcelain is the ocus o so !uch attention should not be perceived as an indication that this is the ulti!ate !aterial. Porcelain has excellent esthetic properties and the abrication procedures0 1hile not entirely si!ple0 allo1 the production o a signi icant percentage o the restorative !aterials in use. Porcelain by itsel lac8s tensile strength and ailures are not unco!!on. ,hen bonded to !etal to achieve greater strength0 a hostile environ!ent or the ra!e1or8 is established. #he abrasiveness o porcelain against natural teeth creates a rather destructive occlusal proble! in so!e situations. #he iring te!peratures preclude the use o organic pig!ents li!iting the procedures available or color control. Eesin poly!ers can be bonded to !etal oxides 7ust as glass poly!ers can. +ra ting procedures see! to

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!a8e virtually any property possible. It see!s probable that resins 1ithout !etal support can be developed or dental use. >or the present0 ho1ever0 so!e interesting !odi ications o current techni.ues are at hand.

SUMMATION OF TECHNIQUE I there is one 1ord that holds the best advice or i!proved esthetics it 1ould be BobserveB. It is the natural0 pleasing dental

co!position 1e see8 to e!ulate and it is the hu!an dentition and its associated tissues that beco!e the textboo8 o study.

A second 1ord or success is BplanB.

#he result should be

envisioned be ore de initive therapy is initiated. #his anticipated BresultB !ust be the sa!e in the !ind o the patient as it is in the !ind o the dentist0 i dissatis action and esthetic ailure are to be avoided.