The esthetic demands placed on today’s restorative dental practice are growing greater and greater. As patients become more informed and discerning consumers, their expectations for natural looking, esthetically pleasing restorations are on the rise. Even when working with the best dental laboratories, proper shade taking and conveyance is crucial.
Those offices who cannot rely on an in house technician, or can’t send their patient to their laboratory due to geography, need a systematic approach to shading. Giving the ceramist the best pos- sible information helps them produce the best result. The trick is to give them what they need.
There are three main components to a positive outcome: The in- formation has to be gathered accurately, conveyed properly and then executed consistently. Listed for simplification: taking, conveying and executing.
The shade taking process can be very involved, but these tips for each of the three components will help make it easier:
Rest your eyes. Look at something neutral and relax. This is an important part of the patient’s appointment, try not to rush.
Take the shade before teeth are prepared. Dry teeth can look brighter and cause extrinsic effects to become much more pronounced, leading to a false perception of the shade.
Use Vita’s 3D Master shade guide. It may seem intimidating at first, but it offers a systematic approach. Once you are com- fortable with it, it is hard to imagine using anything else.
Start with value. Without going over the three components (value, chroma, and hue) of the aforementioned shade system in detail, just remember the most important is value or gray scale. When this is incorrect, it is easily recognized by patients, even if they are not sure how to describe the problem.
Use a good camera. It’s worth the investment. Using an intra- oral or phone camera just won’t cut it. There are many places that have pre-configured dental camera set ups for sale. Unless you prefer to find all the components yourself, the slight up charge can be worth it for the resource alone.
Hold the shade tab under the tooth that is being matched. Many people want to put the tab over the temporary, or in the space for a future implant-supported crown. This isn’t helpful.
Hold the tab in the same plane as the tooth. When photo- graphing the tabs, if the tab is too far in front on the tooth it can look brighter. Conversely, if it is too far back it can look too dark.
Use cheek retractors. Shadows can be misleading. Light needs to fully illuminate the teeth being matched. Patients don’t love cheek retractors, but it’s a half measure to not use them. There are many on the market. Non-colored plastic ones work best.
Work with a good laboratory. Sending great information to a laboratory that is ill-equipped to produce great work leaves both parties frustrated.
Be prepared to spend more for custom work. As in most cases in life, you get what you pay for. There are a lot of talented ceramists who can do great color work, but they are still in the minority, and they generally command higher fees.
Build a relationship with your lab. Custom shading, whether done in the lab or dental office, is challenging. Clinicians and technicians who both want an exceptional result and have an open dialogue tend to have the best outcomes.
Just like bad or incomplete impressions lead to poorly fitting restorations, incomplete or bad shade information leads to “ugly crowns”. Taking the time to gather the right kind of information leads to the best results and therefore happier patients.