Colour and Shade Matching in

Restorative Dentistry
Colour and Perception

 The Human Perception of Colour

1. Interaction of Three Elements:
1. Light Source
2. Object
3. Observer
 Light Source:
• Visible form of electromagnetic (EM) radiation
• Illuminates the object
•Object Interaction with Light:
•Energy is absorbed, transmitted, or reflected
•Subjective Colour Perception:
•Human visual system combines and interprets physical interactions of light and object
•Reflected light reaching the observer’s eyes stimulates a sensation in the brain
•Colour Definition:
•Psychophysical sensation provoked in the eye by visible light
•Interpreted by the brain
 Colour Vision

•Complex System:
•Human eye and brain enable colour vision
•Visual system can identify millions of colours
•Photoreceptors in the Retina:
•Two types: Rods and Cones
•Rods:
•More numerous
•Sensitive to low light levels
•Responsible for peripheral vision
•Detect grayscale in low light; inactive in bright light
 Cones:
• Operate in bright light
• Provide high-acuity colour vision
• Transform light into chemical energies
• Neural signals transported by optic nerve to
the brain
• Three types: Blue (short wavelengths),
Green (medium wavelengths), Red (long
wavelengths)
Colour Deficiency

•Definition:
•Weakness or absence in one or more types of cones
•Colour vision is distorted
•Common Colour Deficiencies:
•Deuteranomaly: Partial green defect
•Protanomaly: Reduced sensitivity to red light
•Tritanomaly: Lack of blue vision
•Monochromacy (Achromatopsia):
•Lack of all three types of cones
•Complete colour blindness
•Challenges:
•Difficulty for clinicians in visual shade matching
•Tests for Colour Vision:
•Ishihara test
•Farnsworth–Munsell test
HUE;
•Definition:
•Enables distinction and differentiation among colours
•Attribute by which an object is judged to appear red, orange, yellow, green, blue,
purple, etc.
•Pure Colours:
•Found on a basic colour wheel or simple box of crayons
•Appear on the visual spectrum
•Continuous Circular Scale:
•Hues are placed on this scale
•Compared to a standard, hues are communicated in terms such as redder, yellower,
greener, or bluer
CHROMA;
•Definition:
•Related to the variation in strength of the same colour
•Chroma Intensity:
•Higher chroma: Stronger, more intense (further from the achromatic vertical axis)
•Lower chroma: Paler, weaker (closer to the achromatic vertical axis)
•Description:
•More chromatic or less chromatic
•Examples:
•A tooth with a redder and/or yellower appearance at the cervical region is more
chromatic
•As chroma increases, the hue becomes more specific
VALUE:

•Definition:
•Refers to the lightness of a colour
•Achromatic Vertical Scale:
•From black to white
•Represents all shades of gray
•Communication:
•Usually described in terms of lighter or darker
•Example:
•A tooth that appears lighter or ‘brighter’ due to
bleaching displays an increase in value
Translucency

•Definition:
•Degree to which an object scatters light upon
transmission
•Appearance Spectrum:
•Between complete opacity and complete transparency
•Complete Opacity:
•Obscures the substrate by blocking the passage of light
•Complete Transparency:
•Transmits light without scattering
•Clearly shows the substrate beneath it
Iridescence

•Definition:
•Rainbow-like effect caused by the diffraction of light
•Changes according to the angle of view or the angle of incidence
of the light source
•Mechanism:
•Occurs when light is diffracted from a thin layer between two
mediums of different refractive index
•(e.g. air and water)
•Examples:
•Seen in soap bubbles or a thin film of oil on water
•Clarification:
•Teeth do not display iridescence
•Often confused with opalescence
Opalescence

 Definition:
• Opalescence is a milky iridescence that resembles
the internal play of colors of an opal.
 Cause:
• Light scattering between two phases of enamel
with different indexes of refraction.
 Light Interaction:
• Short Wavelengths (Blue Hue): Reflected
• Longer Wavelengths (Orange and Red):
Transmitted through the tooth
 Visual Representation: (Note: Add an
appropriate image showing opalescence in a tooth)
Gloss

 Definition:
• Gloss is an attribute of visual appearance originating from the geometrical
distribution of light reflected by surfaces.
 Key Characteristics:
• Describes the relative amount of mirror-like (specular) reflection from the
surface of an object.
 Material Differences:
• Metals: Known for stronger specular reflection compared to other materials.
• Surface Texture: Smooth surfaces appear glossier than rough ones.
 Visual Representation: (Note: Add an appropriate image showing gloss
reflection on different surfaces)
 Key Points:
• Gloss is influenced by surface texture and material composition.
• A critical factor in visual perception and appearance.
  Definition:
Fluorescenc • Fluorescence is a form of luminescence, which is
light emission by a substance due to external

e 
stimuli.
Process:
• Excitation by Light (Usually UV): The substance
absorbs light energy.
• Re-emission: The absorbed energy is re-emitted as
longer wavelengths.
 Phosphorescence:
• When luminescence continues after the source of
excitation has been removed, it's referred to as
phosphorescence or ‘after-glow’.
 Visual Representation: (Note: Add an appropriate
image showing fluorescence and phosphorescence)
Contrast and Assimilation
• Contrast Effect:
• Simultaneous color contrast occurs when
the object's color shifts towards the
complementary color of its surroundings.
• Assimilation Effect:
• Chromatic assimilation occurs when the
perceived difference between the
object's color and its surrounding is
reduced.
 Visual Representation: (Note: Add an
appropriate image showing simultaneous
color contrast and chromatic assimilation)
 Key Points:
• Chromatic induction can generate either
contrast or assimilation effects.
• The visual perception of an object’s color is
influenced by its surroundings.
 Definition:
• Complementary afterimages are illusionary images of the complementary
color produced by retinal fatigue after staring at a solid color for an extended
period.
 Process:
1. Retinal Fatigue:
1. Photoreceptors (cones) become sensitized after focusing on a solid color (e.g., red)
for approximately 30 seconds.
2. Color Shift:
1. After switching gaze to a solid white target, photoreceptors send a strong signal for
complementary colors (e.g., green and blue) but a weak signal for the original color
(e.g., red), creating an afterimage of the complementary color (e.g., cyan).
 Example:
• Staring at a solid red target fatigues the red cones.
Colour and Appearance of Teeth
and Dental Materials
Tooth Colour and Appearance;
 Complex Process:
• The integration of various reflections and transmissions of light to
generate perceived colors in human teeth is complex and not
entirely understood.
 Origin:
• The polychromatic appearance of the tooth originates from the
relative interactions of light signals and perceptions.
 Quantification:
• Tooth color has been quantified by measuring three regions:
• Cervical
• Middle
• Incisal
 Enamel Characteristics:
• The incisal third is typically all enamel.
• Isolated enamel appears achromatic, like transparent or
white frosted glass.
 Factors Affecting Translucency and Value:
• Thickness: Thicker enamel generally appears higher in
value compared to thinner enamel.
• Age: The translucency and value of enamel can vary
with age.
 Additional Characteristics:
• High-value White Patterns: May indicate
hypomineralized regions within the enamel.
• Anterior Teeth: Enamel gets thinner towards the
incisal, appearing gray to bluish against the dark
background of the oral cavity.
• Opalescent Pattern: The incisal third may display an
opalescent pattern with a distinct line of reflection
known as the incisal halo.
 General Tooth Color:
• The color of the tooth is not uniform.
 Role of Dentin:
• Dentin contributes significantly to tooth color.
• Particularly noticeable in the cervical region,
where a thin layer of enamel exists.
• The cervical region is typically the most
chromatic, with chroma decreasing from the
middle to the incisal third.
• Displays hues ranging from yellow to red.
 Tooth Fluorescence:
• Dentin is the primary source of tooth
fluorescence
Colour-related Properties
of Restorative Materials

 Shade Selection:
• Dependent on the brand or system in use.
• Most materials are keyed to a commercially available shade guide.
 Shade Guides:
• Will be further discussed under color-matching tools.
 Material Labeling:
• Some restorative materials may be labeled with shade descriptors, such as
‘universal dentin,’ ‘milky white,’ or ‘pearl frost,’ without reference to a shade
guide.
 Compatibility:
• A material will be most compatible with a tooth when it has shades that
mimic both dentin and enamel.
Stability

 Significance:
• Color stability is a significant concern for appearance in restorative dentistry.
 Comparison of Materials:
• Composite Resins:
• Less color stable after aging.
• Susceptible to extrinsic staining from dietary exposures and intrinsic degradation.
• Can shift color upon curing:
• Microfilled Resins: Become lighter and less translucent.
• Microhybrid Resins: Become darker and more translucent.
• Dental Ceramics:
• More stable in service.
• Can vary by batch.
• Undergo color shifts upon firing and glazing.
Interactions

 Layering:
• Essence of Tooth Anatomy: Layers of
enamel and dentin with different thicknesses
interact to create a polychromatic
appearance.
• Color Changes: Both enamel and dentin
color can change over time due to dietary
habits or aging.
• Restoration Mimicry: Layering is essential
for creating tooth-colored restorations that
mimic natural teeth.
 Blending Effect (BE):
• Desirable Property: A color shift of dental
material (e.g., composite resin or dental
ceramic) towards the surrounding tooth color.
 Blending Effect (BE):
• Desirable Property: A color shift of dental material (e.g.,
composite resin or dental ceramic) towards the surrounding tooth
color.
• Reduction of Color Difference: BE decreases the color
difference between the tooth-material interface, giving the
restoration a more lifelike and natural appearance.
• Relation to Smaller Restorations: Predominantly related to
smaller restorations surrounded by hard dental tissues, such as
composite restorations.
• Examples: Veneers designed with ‘contact-effect’ margins
before and after cementation.
Dental Shade Guides
Vita classical A1–D4 shade guide (VITA
Zahnfabrik
 Arrangement:
• Can be arranged according to:
• Hue Order (A–D arrangement):
Apparent Light to Dark (Value
Scale): Hue Groups:
• Letters represent hue groups according to
the manufacturer:
• A: Reddish-brown
• B: Reddish-yellow
• C: Grey
• D: Reddish-grey
 Chroma and Value:
• The number next to the letter on the tab
label represents the chroma and value
within each of the A–D groups:
• 1: Lowest chroma, lightest
• 4: Highest chroma, darkest
 Observe the Most Chromatic Portion:
Observe • Usually the cervical region of the canine.

Select the Best Hue Group:

Select • Based on the most chromatic portion observed.

Choose the Best Shade:

Choose • Select the closest chroma number within the chosen hue group.

Visual Representation: (Note: Add an appropriate image showing the steps

Add of using the 16-tab shade guide on a patient's tooth)
1. Arrange Shade Tabs:
1. Arrange the shade tabs from light to dark according to the 'Value Scale'.
2. Compare Against Teeth:
1. With the most contrasted end of the shade guide against the teeth,
slide down or up the scale to find the best match.
 Usage:
• The 'Value Scale' is helpful for monitoring changes in color after
bleaching.
 Considerations:
• The change from one tab to the next may vary, leading to
inconsistent value shifts.
Vita 3D-Master shade guide
 Introduction:
• Released by VITA in 2007, specifically
designed for bleach monitoring.
 Advantages over 'Value Scale':
• Wider range of shades.
• More uniform color differences
between adjacent tabs.
• Includes very light shades, enabling
monitoring of whitening efficacy for
initially light teeth (e.g., shade B1
before bleaching).
 Features:
• 29 shades (15 tabs with 14
interpolations).
• Color evenly distributed between tabs.
 )
Dental Photography

 Importance:
• Integral to a complete analysis of tooth color and appearance.
 Equipment:
• Cameras:
• Digital single-lens reflex (DSLR) cameras (recommended)
• Portable cameras
• Cell phones
 DSLR Cameras:
• Lenses:
• General-purpose lens
• Dedicated macro lens
• Flashes:
• Single-point
• Ring
• Dual-point
 Image Formats:
• JPG: Most frequently used, with adjustable compression and
image quality.
• RAW: Preferred by advanced users for minimally processed data.
 Accessories:
• Mirrors and retractors are important for digital photography
Three Preshade-matching Steps

Step 1: Check Colour Vision;

 Importance:
• Prior to performing a shade-matching trial, it's imperative to screen the
vision of the clinician for any color deficiencies.
 Myth about Gender Superiority:
• Common myth: Females are better color matchers than males.
• Statistics: Up to 8% of males and 0.5% of women have a color
deficiency.
• Reality: No gender superiority if both are trichromats (having normal
color vision).
 Visual Representation: (Note: Add an appropriate image illustrating
the importance of color deficiency screening in shade matching)
Step 2: Use Colour Corrected Lighting

 Influence of Light Source:

• The perception of color is greatly influenced by the light source used to illuminate
the object.
• For shade matching, we aim to use an illuminant that best matches the white light of
natural daylight.
 White Light:
• White light is a creation of our minds, resulting from interpreting the spectral colors
present in an illuminant.
• There is no 'color white' on the visible light spectrum.
• White light is actually a mixture of all colors of light.
 Correlated Color Temperature (CCT):
• Understanding correct lighting for shade matching requires consideration of CCT.
• CCT measures the color appearance of the light emitted by a light source, indicating
whether it appears more yellow, white, or blue.
 For shade matching, light sources with a CCT of 5500 K and 6500
K are recommended; the colours are correlated to standard
phases of natural daylight.
 Color Rendering Index (CRI):
• Definition: An average performance rating score for a light
source based on comparisons to reference colors.
• Maximum Score: 100 represents a full-spectrum light source
(like the sun) that affects our color judgment as natural daylight.
• Recommendation: Light sources with CRI of 90 or higher are
recommended for best color rendering results.
 Illuminance:
• Measurement: The intensity of the light source, measured in lux
(lx).
• Recommended Range: Between 1000 and 2000 lx.
 Importance:
• Any surrounding conditions that may influence color perception should
be addressed prior to shade matching.
 Recommendations:
1. Trial Room Setup:
1. Eliminate distracting colors.
2. Walls preferably painted a neutral gray color.
2. Patient Preparation:
1. Eliminate bold colors on the patient.
2. Place a neutral color patient napkin over sparkling jewelry or bright clothes.
3. Have the patient remove reflective glasses and colored lipstick.
Shade-matching Steps

Perform at the Beginning;

 Importance of Timing:
• Visual shade matching should be performed at the beginning of the
appointment.
 Effects of Tooth Dehydration:
• Tooth dehydration occurs during restorative field isolation and alters
tooth color.
• Dehydrated teeth appear lighter, less chromatic, and more opaque.
 Benefits of Early Shade Matching:
• Performing shade matching at the start helps prevent eye fatigue
and strain on the visual system as time progresses.
Set Light and Observer
 Ideal Distance:
• Should correspond to the best reading
distance and visual angle of subtense (>2
degrees).
• For most, this distance falls in the range of
25–35 cm (10–14 in.).
 Optical Geometry:
• The angle of illumination and person
performing shade matching relative to the
shade tab is crucial.
• 45/0 Degrees Geometry:
• Light at 45 degrees (unidirectional,
bidirectional, or circumferential)
• Observing at 0 degrees (perpendicular to
the tooth surface)
• Diffuse/0 Degrees Geometry:
• Typically used for clinical evaluation.
• The viewer’s eyes should be on the
same level as the shade tab.
Shade Tab Positioning

 Ideal Position:
• The tab should be on the same plane and the same vertical (cervical to incisal)
orientation.
• Easy to achieve if the adjacent tooth is missing.
 Alternative Positioning:
• If the adjacent tooth is present, place the shade tab between upper and lower teeth,
vertically or horizontally, to the longitudinal axes of the natural teeth.
 Positioning to Avoid:
• Shade tabs should not be positioned in front or behind the natural teeth.
• When placed in front of the adjacent tooth, the tab may appear lighter due to being
physically closer to the clinician's eye.
 Optimal Angle:
• To avoid discrepancies, incline the shade tab to approximately 120 degrees relative
to the natural tooth and observe from a symmetrical angle.
Shade Matching Duration

 Avoid Staring at Colors:

• Staring at any color during shade matching can create illusions,
such as making teeth appear more yellow when staring at blue.
 Preferred Method:
• It is better to see the true color, not a complementary afterimage.
 Techniques:
1. Gaze at a Neutral Gray Card:
1. To avoid staring at the target color, gaze at a neutral gray card in
between shade-matching trials (see Fig. 17.29).
2. Ideal Glance Duration:
1. Glances at the target shade should last only between 5 and 7 seconds.
Communicate

1. Capture:
1. Record the selected tooth shades.
2. Map Out:
1. Shades observed for direct restorations should be mapped out to
assist in material selection during the restorative procedure.
2. A simple sketch of the tooth illustrating the cervical, middle, and
incisal shades can help document the selected shades even through
color shifts after field isolation.
 Supplementing Visual Shade Matching:
• Use digital photography, software, or data from a shade-
matching instrument to supplement visual shade matching in
color documentation and communication.
Verify

 Visual Verification:
• Use several different lights, shade-matching distances, observation
angles, and/or observers for visual verification of the restoration color.
 Shade-Matching Instruments:
• Verification using shade-matching instruments is also recommended.
• Findings before the restoration is fabricated can supplement
communication and case documentation.
 Direct Composite Resin Restorations:
• Verification can be made with a mock-up restoration.
• Alternatively, apply (and light-cure) a small increment of the selected
composite material to the areas of the tooth corresponding to the
selected shade