Aplicación del Color en Odontología Restauadora

7/28/2019 Aplicacin del Color en Odontologa Restauadora

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804Indian Journal of Dental Research, 22(6), 2011

Received : 30-11-10

Review completed : 25-01-11

Accepted : 09-02-11

review article

Role of colors in prosthodontics: Application of color sciencein restorative dentistry

Vinaya Bhat, Krishna Prasad D, Sonali Sood, Aruna Bhat

ABSTRACT

Shade selection procedure depends on various factors including translucency, contour andsurface texture. Tooth shade selection using a conventional means involves a high degree ofsubjectivity. Traditional shade guides are available that use several methods for quantifyingshade. Technology-based systems provide with an advantage of natural looking restorations. Theyinclude RGB devices, colorimeters, spectrophotometers. The impact of the color science can beseen on various restorative materials ranging from ceramics to maxillofacial prosthetic materials.

Key words:Color, material science, maxillofacial, shade guides, technology

Department of Prosthodonticsand Crown and Bridge,A.B. Shetty MemorialInstitute of DentalSciences, NITTE University,Mangalore,Karnataka,India

color. Teeth are often termed polychromatic and have thevariation in hue, value, and chroma within the teeth andgive three dimensional depth and characteristics. He statedthat a number of related factors in selecting shades must alsobe understood to achieve a successful result. These factorsincludes (Winter 1990) translucency, contour, surfacetexture, luster, and uorescence.

TRANSLUCENCY

Generally, increasing the translucency of a crown lowers its

value because less light returns to the eye. With increased

translucency, light is able to pass the surface and is scattered

within the restoration. The translucency of enamel varies with

the angle of incidence, surface texture and luster, wavelength,

and level of dehydration.[2]

SURFACE TEXTURE

Sulikowski et al. explained that surface texture inuencesaesthetics by determining the amount and direction of lightreected of the facial surface. Texture should be designedto simulate the reectance pattern of the adjacent natural

teeth. Young teeth may have a lot of characterization withstippling, ridges, striations, and lobes. These features maybe worn away with age leaving smoother, highly polishedsurfaces.[3]

FLUORESCENCE

It is the absorption of light by a material and the spontaneousemission of light in a longer wavelength. [4] Vital teeth lookbrighter and alive as higher amount of organic material ispresent.

Restorative dentistry represents a signicant portion ofdental services encompassing on the blend of science andart. Although color may be unimportant to the physiologic

success of a dental restoration, it could be the decidingfactor in patient acceptance. The basis of color science is a

vast subject applicable to many elds. The applied aspect ofcolor science to the restorative dentistry includes the various

factors involved for correct shade matching and its impacton the science of color. The recommended protocol for

conventional and technology-based shade matching shouldbe followed for better understanding of the complexities

involved in it. This article discusses the different selectionprocedures involved for correct shade matching, the varioussystems available for the restorative dentist, and the recent

developments in this eld.

SHADE MATCHING IN RESTORATIVE DENTISTRY

Christopher[1] stated that the difculty of shade selectionis that clinicians must be able to interpret a multi-layered

structure of varying thickness, opacities, and optical surfacecharacteristics. This can affect the way that the eye perceives

Address for correspondence:

Dr. Sonali SoodE-mail: [email protected]

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DOI:

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Indian Journal of Dental Research, 22(6), 2011805

Role of colors in restorative dentistry Bhat, et al.

Laren stated that the more the dentin uoresces, the lowerthe chroma.[5] These powders are added to crowns to increasethe quantity of light returned back to viewer and to decreasethe chroma.[5]

OPALESCENCE

Sunder and Amber dened it as a phenomenon in which amaterial appears to be one color when light is reected fromit and another color when light is transmitted through it.[6]

AFTER IMAGE AND VISUAL DISTORTION

Fondriest[2] stated that after images are frequent physiologiceffects of the cone receptors with normal function that causealterations in the perception. It includes spreading effect:when light is removed from the retina, the receptors continuefor a short time to be active and send signal to the brain.

BRUNESCENCE

Pensler dened it as the natural browning of the corneathat occurs with age. It acts as a lter and changes theappearance of colors. Hence, the age of the dentist also formsan important factor in shade determination.[7]

APPERCEPTION

Apperception is how the mind interprets what the eyeperceives. Optical illusions exemplify the perceptionand apperception phenomenona. Shade selection is acombination of perception and apperception, and henceinvolves a thought process. Teaching dentists about thisphenomenon could minimize the inuence of this factoron the shade selection.[7]

LIGHT INTENSITY

The intensity of the light conditions is also important. Ifthe amount of light (measured in foot-candles or lumensper ft) is too small, ne details are missed and the eye hasdifculty perceiving hue. The ideal luminosity for dentalshade matching is 75 to 250 ft-candles.[8] To have 150 ft-candles intensity in the operatory at the level of the dentalchair, ten to twelve 4 ft bulbs would be needed in a 1010ft room with 8-foot ceilings.[9] The diffusion panels covering

the uorescent bulbs are also important because they screenout wavelengths. As they age, the panels change whatwavelengths they absorb. The best diffusers are those thatdo not lter out any wavelengths of the spectrum, preferablythe egg-crate type.[2]

REQUIREMENTS OF TOOTH SHADE GUIDES

The prime requirements for a tooth color guide consideredby Sproul (1973) are a logical arrangement in color spaceand an adequate distribution in color space.

A guide which did not fulll the prime requirements in color

space would pose certain problems like taking too long to

decide where to begin, lack to check the chosen match for

accuracy, and the volume of color space occupied by the

materials to be matched may be impossible to reach within

the guide.[1]

SHADE SELECTION PROCEDURE

Christopher[1] suggested the shade selection sequence to be

as follows:

When matching teeth, the shape, surface geography,

and the value are the most important characteristics.[2]

Shade selection should be completed before preparation

as teeth can become dehydrated and result in higher

values. Value is the most important dimension of shade

rendering.[10]

Ensure surgery surroundings are of neutral color so that

there is no color cast onto the teeth. [11]

Remove lipstick; ask patients not to wear lurid clothingor any items that may distract the attention of the

teeth. Make sure teeth are clean and unstained before

attempting shade selection.

Patient should be in an upright position at a level similar

to the operator and the shade guide should be at arm

length. This ensures that the most color-sensitive part

of the retina will be used.

Observations should be made quickly (5 s) to avoid

fatiguing the cones of the eyes. If longer than this, the

eye cannot discriminate and the cones become sensitized

to complement the observed color.[2]

Fondriest[2] stated the use of chromatic backgrounds

available: 18% reflective gray cards, Kulzers small

intraoral gray cardboards, Pensler shields screen.

Use color-corrected light illumination, which should be

of a diffuse nature.

Viewing tabs through half-closed eyes can decrease

ability to discriminate color but increases the ability to

match value. Look at the other parts of the teeth, dividing

the teeth into nine sections from apical to incisal, and

mesial to distal.

Hold the shade tab incisal edge to the incisal edges of

the teeth. This effectively isolates the shade tabs from

the teeth so they do not reect onto each other reducing

afterimages.[12]

Most humans have eye dominance and one eye will

preferentially perceive shade.[13] It is wise to hold the

shade guide on both sides of the tooth at each vector.

Different light wavelengths reect off a rough surface in

different ways. Shades should be evaluated looking at the

tooth at different angles. This re-evaluation at different

angles is called vectoring.[13]

If in doubt as to the hue family, choose the A family. [14]

Most natural teeth have more red than B.


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Describe surface texture and luster as heavy, moderate,

and light therefore giving nine different combinationsof surface characteristics. Because these surface featuresdetermine the character of light reection and affect the

amount of light that enters the tooth (opacity), the surfacetexture of a crown must be designed to simulate the lighttransmission and reectance pattern of adjacent teeth.[2]

MEASUREMENT OF COLOR

Color determination in dentistry can be divided into two

categories.

Visual

Instrumental

Visual techniqueShade guide systems

Dental shade guides are shade matching tools used mostcommonly by the clinicians in day to day practice. Althoughthe groups of tabs of most shade guides appear to be well

arranged, the overall tab arrangements of some shade guidesseem illogical because they contain light and dark tabswithin each of the groups. The fact that tab arrangement can

inuence shade-matching results increases the importanceof this issue.[15] For consistency, tabs can be rearranged

according toincreasing color difference related to the tabthat appearslightest (not necessarily the tab having thehighest lightness,L*). Group division of shade guides is

necessaryfor reducing the number of potentially adequatetabs asquickly as possible. It is easier to work with fewertabs,because the vision pigment depletes within seconds

(itregenerates quickly, as well). To achieve consistent group

division, the total color difference (E*) between the

lightestand the darkest tab should be divided into several equal

segments. Laboratory and simulated clinical conditions

have demonstrated the effectiveness of this tab arrangement(small discrepancies recorded by different color-measuring

devices only conrm the efcacy).[15]

The most popular shade guides include the vitapan classical

shade guide, Vita 3D master shade guide system, and thechromascop shade guide system. The shade tabs arrangementin the Vita Classical is by hue whereas in the Chromascop

guides,[16] the tabs are arranged in ve clearly discerniblevalue levels. VITAPAN introduced in 1956, the current

American Dental Association gold standard for monitoringof tooth whitening, is supposed to correspond to decreasinglightness (from left to right). A very popular shade guide

where in tabs of similar hue are clustered into letter groupsA (red-yellow), B (yellow), C (grey), D (red-yellow-gray),and chroma designated with the numerical values (e.g. A1).

The manufacture protocols include hue selection followedby chroma and value.

Miller[17] demonstrated that the classical shade guide wastoo low in chroma and too high in value when compared

to natural extracted tooth samples. The value scale isinaccurate in terms of decreasing L* values, exhibitingredundancy and uneven lightness differences amongneighboring tabs, which to a certain extent compromises theresults of clinical studies that have been performed so far.[15]

The Vitapan 3D master shade guide, introduced in 1998,

system reects systematic and equidistant coverage of thenatural tooth shade spectrum. The design features selectionof value levels followed by the chroma and determinationof hue.

Bayindiret al[18] stated that the Vitapan 3D master shadeguide system results in lower coverage errors than the Vitalumin or Chromascop shade guide systems. Ahn et al. [19]

concluded that the color distribution of the Vitapan 3D master

shade guide was more ordered than previously reported color

distributions of other, traditional shade guides. However, the

interval in the color parameters between adjacent tabs was

not uniform.

According to the literature, the new Vita Bleached guide3D master shade guide (Vident), designed primarily fortooth-whitening monitoring, has signicant advantages overthe Vitapan Classical: the tab arrangement corresponds tovisual nding, it includes extra light shades, the color rangeis almost doubled, the color distribution is more uniform,and the chroma steps are consistent.[20]

Instrumental methodsThe conventional visual tools used to determine shade arehighly susceptible to various optical illusions and contrasteffects. In 2001, Chu and Tarnow[21] used a clinical case report

to describe the subjective deciencies in the conventionalshade selection process and compared the method tocomputerized aided information. Due to the errors withthe use of commercial shade guides, many different devicesand machine tools are used in order to make the colorassessment more simple, rapid, precise, and perfect. Thesemi-translucent structure, small size, and irregular surfaceof teeth contribute to the complexity of this procedure.

Several clinical studies have conrmed that computer-assisted shade analysis is more accurate and more consistentcompared with human shade assessment. The advantages

are no inuence of surroundings or lighting and the resultsbeing reproducible.[22,23]

Bergon et al.[22] experimented with spectrophotometers andcomputers. Yamamoto was instrumental in the developmentof the Shofu eye chroma meter. In the late 1990s, a companycalled Cortex Machina was established in Montreal, rstones to start with technology-based shade guides system.The rst measurement analysis system was the Spectroshadesystem from MHT Optic Research in 2001 followed by Shadevision system (colorimeter) from X-rite in 2002.


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maintained. Spectrophotometers allow the user to measuremetamerism, therefore independent of lters and changinglight sources.

SpectrophotometersIt measures and records the amount of visible radiant energyreected or transmitted by an object one wavelength at a

time for each value, chroma, and hue present in the entirevisible spectrum.[28,29] Stephen et al.[22] stated the disadvantagebeing expensive, complex, difcult to measure the color ofteeth in vivowith these machines.

The various systems available are spectroshade described byCherkes et al. [30](Posey dental technology), Vita easy shade(Vident), and Shade pilot system (Degudent). The mainadvantage of spectroshade lies in the split screen featureencouraging the comparison of before and after imagesproviding full face pictures on an intraoral camera. TheVita easyshade provides a prescription in both Vitapan 3Dmaster and classic VITA shades.

ColorimetersColorimeters provide measurements in CIELAB units (L*,A*, B*) that can compare the color parameters of differentobjects when analyzed mathematically.

Colorimeters can be of two types mainly the photoelectric tri-stimulus colorimeters (Microcolor) and silicon photodiodearray (Orient Scientic Ltd). Microcolor colorimeter (aphotoelectric tri-stimulus colorimeter) is a self-containedmeasuring system that requires no external power sourcewhile a silicon photodiode array requires both an external

power source and a standard light source; it is a compact

color measuring instrument that is less prone to overheatingand is cost effective.

The various colorimeters available are X-Rite Shade VisionSystem and Shade NCC (Shofu). The shade vision systemadds the advantage of shade information being sent to thedental laboratory via e-mail, disk, or by printout.

Pusateri et al.[31] studied the reliability and accuracy offour dental shade-matching instruments and concluded the

spectrophotometers (shade vision and vita easy shade) to

be more reliable and accurate compared to colorimetric

devices. This is in agreement with the study by Browninget al.[32] where they stated the use of vita easy shade tobe frequently an exact match when compared to otherdevices.

Dennison [33] described the photometric assessment of toothcolor using commonly available software. He concludedthat digital camera are almost an integral part of each dentalofce whereas the limiting factors of spectrophotometersare their cost, complexity of handling, and bulk of involvedgadgets.

The Measurement system includes [22] the spot measurementsystems measuring small areas on the tooth surface (e.g.

Shofu Shade Eye-NCC, Chroma meter system, Vita easyshade system) or complete tooth measurement systems thatmeasures the entire tooth surface and provide a color mapof the tooth in one image.

TYPES OF TECHNOLOGICAL SHADE SYSTEMS

RGB devices Digital cameras Spectrophotometers Colorimeters

RGB devicesAcquire RED, GREEN, BLUE image information to create

a color image. They do not control key variables associatedwith accurate color determination.[22]

Robert[24] in 2000 introduced Shade Scan from Cynovad

which is a popular system that creates an image of the toothwith a translucency and characterization map, and then willgenerate a printed report.

Digital camerasThey are efcient and easy to use and can be an idealsupplement for the clinician and lab technician inquantifying shade but alone not a very reliable method forshade analysis.[22]

Factors such as illumination and the angle of the photographwill alter how color is perceived by the camera. Alvin

et al.[25] stated the use of Commercial SLR cameras whencombined with the appropriate calibration protocols showed

potential for use in the color replication process.

Spear stated the use of color-corrected professional quality

lm (e.g. Kodak EPN-100, E100-S, or EPP) and have a goodphoto lab to develop them, taking vector shots at 65-70looking down with an incisal edge away from chroma andhue helps in increasing the amount of reection thus bettercolor accuration.[26]

Comparison between spectrophotometers andcolorimeters

The use of the digital system that can qualify and quantifyshade maps provides Delta E (E) measurements for shadecomparison. Delta E is a colorimetric value that delineatesthe difference between two colors. To distinguish this value,three reference points are available generally CIE L*A*B*OR CIE Lch.

Chu[27] stated that colorimeters are tri-stimulus and can

measure in either CIE Lab or CIE Lch. It is howeverimpossible to produce precise colorimeter, since ltersmust be well controlled and the characteristic of light well


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STUMP SHADE GUIDES

With the increasing use of all-ceramic restorations, it isimportant to communicate the prepared tooth or stumpshade to the ceramist so that they can build the restorationwith the right opacity/translucency.[1]

Chu stated the most popular stump shade guides to be usedas Ivoclar, (vivadent) and Finesses guide (Ceramco).

GINGIVAL SHADE GUIDES

Dummet[34] described that the color of gingiva is variableranging from a pale pink to deep bluish purple. Color dependson intensity of melanogenesis, epithelial cornication, anddepth of epithelization. Comparisons of the imagined colorof gingiva and an actual visual color measurement are ofdoubtful scientic value.

The ndings of Nakashima[35] showed that imaginable color

is more yellow red and higher in chroma. Fukai using aspectrophotometric technique found that free marginalgingiva in maxilla is higher in value and that female gingivatends to be more red compared to male.

Color assessments of the attached gingiva have beenevaluated using Munsell color tabs. Use of helium neon gaslaser to record the reectance of interdental papilla wasdocumented. Dummet was the rst to describe the color ofintraoral soft tissues.[34,36]

Currently, methyl methacrylate is the most frequently usedresin. Thus one shade of pink for partial dentures is not

acceptable for all patients, especially when the acrylic angeis adjacent to the gingiva in the esthetic zone.[37] Okuboet al.[38] stated the most popular method to be the visual shadeselection with the help of shade guides. Bayindir[39] describedthe use of commonly used gingival shade guides presentlyi.e. Lucitone 199 shade guide system (Densply trubyte),Ivoclap plus gingival indicator set (Ivoclar vivadent), andIPS gingival shade guide (Ivoclar vivadent).[40]

IMPACT OF MATERIAL SCIENCE ON COLORS

The importance of restorative materials and their effect

on color shade cannot be overemphasized.[41]

Mc leans-one of the leaders and innovators in dental ceramicsdeveloped a variety of present day available ceramics.[42] Theimproved characteristics are primarily in material density,which correlates directly to light transmission and colorcoordination.

Sulikowinski and Yoshida[43] proposed that the depth of toothpreparation be based on the present level of discolorationfor the veneer fabrication. Greater depth of reduction isrequired to allow greater thickness of cosmetic restorative

materials to mask the underlying tooth shade.Aoshima[44]stated the use of pressable ceramic restorative material forthe shade matching of single veneer restoration.

Dietschi et al.[45] described that the use of modern fabricationof composite restorations is based on the natural layeringconcept. This approach embraces the typical optical and

anatomic characteristics of natural teeth.

Individual color characterization is important in acceptanceof an external facial prosthesis by a patient, yet it remainsone of the greatest challenges faced by the clinicians(Bergstrom, 1998). Basic method by Barnhat et al. (1978)stated the use of intrinsic color characterization and extrinsiccolor modication. Schaaf (1970) described the tattooingmethod carrying some pigments below the surface for bettercolor matching in maxillofacial prosthesis.[46]

DISCUSSION AND CONCLUSIONS

The study of color is one of the most integral parts of estheticdentistry. Matching the right color leads to a pleasingappearance and satisfaction for the patient and the clinician.

The recommended protocol for conventional andinstrumental shade matching should be followed toachieve esthetic and predictable results. Successful shadetaking involves a combination of technology, shade tabs,and reference photograph. In spite of the limitationsin materials and techniques, a harmonious restorationcan almost always be achieved if a methodical andorganized manner is followed during shade selection. Theconsiderations mentioned in this article are associated withthe application of color science to dentistry. Color sciencein fact complements the artistic talents of clinicians, dentalassistants, and ceramists, providing both an appropriatefoundation and a frame for their artwork.

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How to cite this article: Bhat V, Prasad DK, Sood S, Bhat A. Role of colors

in prosthodontics: Application of color science in restorative dentistry. Indian

J Dent Res 2011;22:804-9.

Source of Support: Nil, Conict of Interest: None declared.


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