Digitalization in

tooth shade selection

Tabatabaian F, Beyabanaki E, Alirezaei P, Epakchi S. Visual and digital tooth shade selection methods, related
effective factors and conditions, and their accuracy and precision: A literature review.
Journal of Esthetic and Restorative Dentistry. 2021;33(8):1084-1104.

Presented by:
Dr. Surabhi Mahajan
1st Year MDS
Date: 05.04.2022
Content

➢ Introduction
➢ History
➢ Visual methods
➢ Digital methods
➢ Digital cameras
➢ Colorimeter
➢ Spectrophotometer
➢ Intraoral Scanner
➢ Take home message
➢ Conclusion
 Introduction
• Tooth shade selection is fundamentally affects esthetic outcomes of restorative treatments.
• To improve the accuracy and precision of shade determination, successful efforts have been made to make a shift
from subjective visual methods to objective digital methods.
History
Munsell in 1904
Introduced a color notation and specification of a color space with three color properties.
• Lightness or value (luminous intensity of a color)
• Hue (color appearance or perception of an object's color, e.g., red, green)
• Chroma (color saturation or purity).

Cochrane S. The Munsell Color System: A scientific compromise from the world of art. Studies in History and Philosophy of Science Part A. 2014;47:26-41.
Human eyes possess three kinds of rod cells for color perception according to the wavelength of the visible light
reflected from an object.

Long wavelengths
(530–700 nm)

Short wavelengths Medium wavelengths

(380–500 nm) (430–600 nm)

The CIE-
✓ Concept of standard observer based on the average human reaction to light wavelengths
✓ Indicating the manner of an average human to see color across the visible spectrum (xyz equivalent of RGB).
Need for color measuring instruments led to employ tristimulus cameras/colorimeters in order to read visible
spectrum using photodetectors in digital imaging.
In 1940, Beckman and his colleagues invented a spectrophotometer

This instrument is used to-

• Measure the reflection/transmission properties of an object as a basis of wavelength.
• Quantify the CIE color attributes.
The first commercial dental shade guide- VITA Lumin Vacuum was launched in 1956.
This was not based on color parameters.
• CIE (1976) introduced the CIELab (L: lightness; a: redness-greenness; b: yellowness-blueness) color system.
• Based on the opponent colors theory stating that two colors cannot be both red and green simultaneously,
and comparably, yellow and blue.

• CIELCh (L: lightness; C: chroma; h: hue) was later released.

 Methods

Visual Digital
Methods Methods
✓ Digital cameras
✓ Colorimeters
✓ Spectrophotometers
✓ Intraoral scanners
Visual methods
VITA Classic A1-D4 VITA Toothguide 3D-Master VITA Linearguide 3D-Master

Chromascop Bioform IPN Portrait IPN

Vintage Halo NCC

Video
Factors to consider

Light correcting Age

devices

Regions of the Gender

tooth
Digital methods
Digital cameras

✓ A digital single-lens reflex (DSLR) camera

✓ Interchangeable lenses
✓ RAW file format
✓ Custom white balance
✓ Permits manual exposure
Colorimeters

✓ An optical device that can read the visible spectrum by using

filtered photodetectors.

✓ Various dental colorimeters with diverse accuracies and

precisions have been assessed, controversial results have been
obtained when comparing colorimeters with other shade
measuring methods.
✓ Hence, the generalization of results is not rational and more
research is needed.
✓ Fuji S20 Pro digital camera with Adobe Photoshop CS2
software could be used as a substitute for a ShadeEye NCC
colorimeter in terms of accuracy.
Spectrophotometers

✓ Can measure the color by assessing the spectral reflectance or

transmittance curve of objects.
✓ Contain a tungsten-filament bulb or LED lamp as a white light
source to create a light output with the wavelength between
400 and 700 nm.
Video
 ✓ VITA Easyshade spectrophotometer measures CIELab/CIELCh values and determines the tooth shade based
on VITA 3D-Master and VITA classical.

✓ SpectroShade Micro combines digital color imaging with spectrophotometry based on a LED technology.
✓ Compared to other shade taking devices, spectrophotometers show higher accuracy with longer working life
without sensitivity to object metamerism.
 Based on the findings of the present study, the following
conclusion was drawn:
The e-Skin system provided skin replicas that matched the
skin color within clinically acceptable thresholds and with
ratings of at least “good” by experienced dental clinicians.

Kurt M, Karakoca Nemli S, Bankoğlu Güngör M, Turhan Bal B. Visual and instrumental color evaluation of computerized color matching system for color reproduction of maxillofacial prostheses.
The Journal of Prosthetic Dentistry. 2021.
Intraoral scanners

✓ Color imaging and data processing- Two major

requirements for intraoral scanners to be considered as a
viable means for shade selection.
✓ This tool uses a high definition camera included into a
handheld digital scanner.

Newer scanners such as TRIOS 3 show not only

superiority over the visual method, but also comparable
results to spectrophotometers.
Video
 Relevant Articles

Based on the findings of this clinical study, the following

conclusions were drawn:
1. Instrumental methods for tooth color selection were more
reliable than the visual method.
2. The VITA 3D-MASTER shade guide showed a better
interrater agreement than the VITA Classical shade guide.
3. The use of a light-correcting device associated with the
visual shade guides provided some improvement in
interrater agreement.

Liberato W, Barreto I, Costa P, de Almeida C, Pimentel W, Tiossi R. A comparison between visual, intraoral scanner, and spectrophotometer shade matching:
A clinical study. The Journal of Prosthetic Dentistry. 2019;121(2):271-275.
 ➢ Instrumental methods for shade selection using
spectrophotometer or intraoral scanner were
more repeatable than the visual method.
➢ Trios3 intraoral scanner showed higher
repeatability than Easy shade
spectrophotometer.
➢ Visual shade repeatability was influenced by the
operator’s experience.

Fattouh M. Repeatability Of Visual, Spectrophotometer And Intraoral Scanner Methods In Shade Matching: A Comparative In-Vivo Study.
International Journal of Dentistry and Oral Science. 2021;:2439-2445.
 ➢ IPS emax Shade Navigation Application (SNA App)
gives a baseline suggestion of choice which ideally
can be used for monochromatic, monolithic or a
coping for layered restoration.
➢ As the application is material specific, it demands
the use of specific shade guides and particular
ceramic blocks or ingots which limits the use of
this application.

Nemane A, Sampat S, Mistry S, Chawla K, Walke A. Shade Navigation App - A Connecting Link. The Journal of Prosthodontics and Dental Materials. 2021;2(1).
Take Home Message
➢ Munsell color system involves three dimensions of appearance of color: Hue, Value and Chroma.
➢ CIE introduced the CIELab colour system in 1976 and later, CIELch.
➢ Shade selection can be done by either visual or digital method.
➢ Visual method employs various shade guides.

Principles
• Make shade comparison at beginning of the appointment in
natural daylight.
• Patient should be in upright position.
• Mouth at clinician's eye level.
• Remove bright colours from field of view-
Makeup/tinted eye glasses
Bright gloves
Neutral operatory walls
• Should be made quickly to avoid eye fatigue.
• Teeth to be matched must be clean.
• Shade tab should be held as close to the tooth as possible.
➢ Digital methods include-
• Digital cameras
• Colorimeters
• Spectrophotometer
• Intraoral scanner
➢ Dental spectrophotometers provide the highest overall accuracy and precision among different
shade selection methods.
➢ Intraoral scanners and spectrophotometers have been documented to be more precise than visual
methods using shade guides by expert clinicians with or without a light-correcting device.
Conclusion
➢ Digital shade selection methods have proved to be a boon.
➢ Although they show higher accuracy and precision, knowledge of conventional visual shade selection
methods is crucial.
➢ Both the methods can be used simultaneously to provide better results and to improve dentist-patient
as well as dentist-laboratory communication.
References
1. Tabatabaian F, Beyabanaki E, Alirezaei P, Epakchi S. Visual and digital tooth shade selection methods, related effective
factors and conditions, and their accuracy and precision: A literature review. Journal of Esthetic and Restorative Dentistry.
2021;33(8):1084-1104.
2. Cochrane S. The Munsell Color System: A scientific compromise from the world of art. Studies in History and Philosophy of
Science Part A. 2014;47:26-41.
3. Kurt M, Karakoca Nemli S, Bankoğlu Güngör M, Turhan Bal B. Visual and instrumental color evaluation of computerized
color matching system for color reproduction of maxillofacial prostheses. The Journal of Prosthetic Dentistry. 2021.
4. Fattouh M. Repeatability Of Visual, Spectrophotometer And Intraoral Scanner Methods In Shade Matching: A Comparative
In-Vivo Study. International Journal of Dentistry and Oral Science. 2021;:2439-2445.
5. Liberato W, Barreto I, Costa P, de Almeida C, Pimentel W, Tiossi R. A comparison between visual, intraoral scanner, and
spectrophotometer shade matching: A clinical study. The Journal of Prosthetic Dentistry. 2019;121(2):271-275.