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Color and Shade Management in Esthetic Dentistry

Article · December 2013

DOI: 10.4103/2249-9725.123975

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Color and Shade Management in Esthetic Dentistry

Vineet S. Agrawal, Sonali Kapoor
Department of Conservative and Endodontics, M.P. Dental College, Hospital and Oral Research Institute, Vadodara, Gujarat, India

ABSTRACT
The color and appearance of teeth is a complex phenomenon, with many factors such as lighting conditions, translucency,
opacity, light scattering, gloss and the human eye and brain influencing the overall perception of tooth color. To achieve
esthetics, four basic determinants are required in sequence; viz., position, contour, texture and color. The knowledge of
the concept of color is essential for achieving good esthetics. This review compiles the various aspects of color, physics
behind perception of color, measurements and shade matching in dentistry for various esthetic treatments.

KEY WORDS: Chroma, colorimeter, hue, shade matching, shade selection, value

INTRODUCTION The surge of interest in the use of tooth colored restorative

materials and systems in recent years has been attributed
Think of the world without the color. Color can turn partly to rapid developments in dental materials science
everything, even the unsightly, into a visual pleasure. and also to patient demand and operator interest. This has
Properly used, color creates atmosphere, defines space made several conservative esthetic treatment modalities
and proportion, establishes order and exudes emotion. To available. Although restorative dentistry has been defined
perceive all these one has to have the so‑called color sense; as being a blend of art and science, conservative esthetic
i.e., the ability to make the right color choice. dentistry truly emphasizes the artistic component.

Today’s dental restoration is consolidated around three

mainstays: The use of non‑metallic materials, such PHYSICS OF COLOR
as composite resins and ceramics; adhesion to dental
structures; and the achievement of a natural cosmetic Sir Isaac Newton was the first to break down the physics
look.[1] The first step to achieving clinical success in of color. He found that a beam of white light could be
cosmetic dentistry will therefore be to correctly identify separated into component colors, or wavelengths, by
the tooth color we need to imitate and material that most passing it through a prism. Newton described resulting
closely matches and to communicate this information continuous series of colors as a spectrum and named these
to the laboratory if the restoration is to be fabricated colors in the following order: Red, orange, yellow, green,
out there.[1] blue, indigo and violet, as represented by commonly used
mnemonic association Roy G. Biv. These wavelengths are
The color of the tooth is determined by the combined effects perceived by three types of color receptors (called cones)
of intrinsic and extrinsic colorations.[2,3] Intrinsic tooth in the human eye as variations of red, green and blue light,
color is associated with the light scattering and absorption hence the term visible light spectrum. In physical terms,
properties of the enamel and dentine.[2,4] Extrinsic color is the wavelengths of visible light range from approximately
associated with the absorption of materials (e.g., tea, red 400 to 700 nm.[2,6]
wine, chlorhexidine, iron salts) onto the surface of enamel
and in particular the pellicle coating and which ultimately Without light, color does not exist. It is the interaction
cause extrinsic stain.[2,5] of light with the object that allows the perception of
color. If the light interacts with an object, some of the
Access this article online light is absorbed by an object. The wavelength that are
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emitted directly to the eye) are perceived by receptor cells

Address for Correspondence:

Dr. Vineet S. Agrawal,
DOI:
101, Vinay Complex, Near Dudhdhara Dairy, Bholav,
10.4103/2249-9725.123975
Bharuch ‑ 392 002, Gujarat, India.
E‑mail: vineetdent@yahoo.co.in

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Agrawal and Kapoor: Color and shade in esthetic dentistry

(i.e., rods and cones) in the eye and recognized by the depends on the object’s capacity to modify the color of the
brain as specific color.[7] incident light. Color appears because the material absorbs
the radiating visible light, with the exception of the
wavelength reflected to the viewer’s eyes. A transparent
PRIMARY PREREQUISITE FOR PERCEPTION medium will allow visible light to pass through almost
OF COLOR (COLOR TRIAD) unaltered. Translucent object scatter, transmit and absorb
The primary prerequisites for color perception include portions of wavelengths of visible light, while opaque
three variable elements: The object, a light source for materials do not transmit, but reflect and absorb various
illumination and an observer [Figure 1]. wavelengths of visible light.

Light source The observer

Color perception depends on the quality of light illuminating Visible light enters the eye through the transparent area
the object. The ideal light source is natural light, occurring of the cornea and is focused by the crystalline lens on the
around mid‑day for accurate color comparison. The time of retina. The retina is composed of two types of specialized
the day, month and weather conditions affect the color of photosensitive cells and is the receptor system for vision.
sunlight. If the light source changes, then the light reflected These specialized receptor cells are called rods and cones
from an object changes too; in that case, a different color and they contain photosensitive pigments.[7]
is perceived. The absence of ideal conditions has led to
the use of artificial lighting for color matching. The light THREE DIMENSIONS OF COLOR
source that approximates standard daylight is ideal for
shade matching. Color temperature, spectral reflectance Color is usually described according to the Munsell color
curves and color rendering index (CRI) are all used to space in terms of hue, value and chroma. When color is
measure the capacity to reproduce standard daylight (CRI determined using the Munsell system, value is determined
over 90 is recommended for color matching).[8,9] Dental first followed by chroma. Hue is determined last by
unit lights are usually incandescent lights that emit light matching with shade tabs of the value and chroma already
high in the red–yellow spectrum and are low at the blue determined[10] [Figure 2].
end. Regular cool white fluorescent lights are high in
the green–yellow spectrum. Color‑corrected fluorescent Hue
lights are also available, which render the color more “Hue” is the quality that distinguishes one family of
accurately.[8] Full‑spectrum light‑emitting diodes (LEDs) color from another. It is specified as the dominant range
are now replacing incandescent bulbs. The shade‑matching of wavelengths in the visible spectrum that yields the
ability is better with a light‑correcting source than under perceived color, even though the exact wavelength of the
natural light.[2] perceived color may not be present.[11]

The object Value

Color is a physical property of the light that is modified Value is defined as the relative lightness or darkness of
by the object and the total appearance of the material a color or the brightness of the object. The brightness of
any object is a direct consequence of the amount of light
energy the object reflects or transmits. Munsell described
the value as a white‑to‑black gray scale. Bright objects
have lower amounts of gray and low‑value objects have
larger amounts of gray and will appear darker.[12]

Figure 1: Color triad Figure 2: Three dimensions of color

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Agrawal and Kapoor: Color and shade in esthetic dentistry

Chroma color can be added to that restoration to make the shade

Chroma is defined as the saturation, intensity or strength grayer and hence lower in value.
of hue. Envision placing red food dye into a glass of
water. Each time more of the same color dye is added, the
METAMERISM
intensity increases, but it is the same red color (hue). As
more dye is added, the mixture also appears darker, so the Metamerism occurs when the perception of color of two
increase in chroma has a corresponding change in value. objects is different because one of the variables of the
As chroma is increased, the value is decreased; chroma color triad (object, light source, or observer) is altered
and value are inversely related.[10,12] while the other two remain the same. The phenomenon
of two objects to match in color under one condition but
showing apparent differences under another is termed
COLOR IN DENTISTRY
metamerism.[13] There are two types of metamerism:
Color perception and reproduction processes can be Object metamerism and observer metamerism.
applied in dentistry, specifically to shade matching
techniques. The important concept includes pigment Object metamerism occurs when the two items appear
colors and the dimensions of color. the same in one lighting condition, but appear differently
when the light source is changed. In dental terms, it occurs
when crown is matched to the natural dentition under
PIGMENT COLORS incandescent light, but, when viewed under color‑corrected
or fluorescent light, appears not to match the natural
Pigment colors are inherent hues of an object. Because
teeth. To prevent metamerism, objects should have the
these colors are perceived through either transmission
same spectral reflectance curves, since only materials with
or reflection of light, they are same as the subtractive
identical spectral energy distribution curves will match
color used in color reproduction for reflective and
under all light sources. Color match does not require the light
transmissive media. In dentistry it is necessary to
source and objects to have the same reflectance spectrum.
understand pigment colors as they are inherent in
Therefore, to obtain an acceptable shade determination,
restorative materials (e.g., ceramic, composites and
it is advisable for the viewer (technician, clinician and
acrylic resins).
assistant) to observe the color matching under three
Primary colors: Red, yellow, blue different lighting conditions – daylight, color – corrected
The primary pigment colors are similar to subtractive light and dim light.[14]
primaries, but they are referred to as red, yellow and blue,
Observer metamerism occurs when the light source
rather than magenta, yellow and cyan, respectively.
remains the same and the observer changes, caused by
Like subtractive primaries these are the colors that are either human visual stimulus or instrumental stimulus.
perceived when one of the RGB, wavelengths is absorbed; Since color perception is dependent upon physiological
red is perceived when green is absorbed, yellow when blue spectral response sensitivities of the cones in the fovea
is absorbed and blue when red is absorbed. and psychological interpretation by the brain, it is
recommended that a third observer (assistant, technician,
Secondary colors: Orange, green, violet friend, or family member) evaluate the selected color prior
Secondary colors are formed by combining two of the to cementation of any final restoration.
primary colors: Red and yellow create orange, yellow and
blue create green, blue and red create violet. MEASUREMENT OF COLOR
Complementary colors Color determination in dentistry can be divided into two
Complementary colors are those that, when combined categories:
in equal proportions, will form a dull gray that absorbs • Visual
and reflects/transmits all wavelength in equal amounts. • Instrumental.
Complementary pigment color pairs are blue/orange,
red/green and yellow/violet. Visual technique
A popular system for visual determination of color
Additive principle of complementary color may be used is the Munsell color system, the parameters of which
to alter the value of restorations; for example, if the value are represented in three dimensions [Figure 3]. Value
of a restoration needs to be lowered, the complementary (lightness) is determined first by the selection of a tab that

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Agrawal and Kapoor: Color and shade in esthetic dentistry

most nearly corresponds with the lightness or darkness of in dentistry. Photoelectric tristimulus colorimeters have
the color.[15] Value ranges from white to black. Chroma is the potential to remove some of the shortcomings of
determined next with tabs that are close to the measured the visual method and have been shown to provide accurate
value but are of increasing saturation of color. Chroma and repeatable measurements; however, they are not
ranges from achromatic or gray to a highly saturated error‑proof. In dentistry, the results of a colorimetric device
color. Hue is determined last by matching with color tabs can be altered because the standardized illuminating light
of the “value” and “chroma” already determined. Hue is emitted from the device may be scattered, absorbed,
measured on a scale from 2.5 to 10 in increments of 2.5 transmitted, reflected and even displaced in a sideways
for each of the 10 color families (red, R; yellow‑red, YR; direction as a result of the translucent optical properties
yellow, Y; green‑yellow, GY; green, G; blue‑green, BG; of teeth and dental ceramics.
blue, B; purple‑blue, PB; purple, P; red‑purple, RP).

Visual color determination of a patient’s tooth is the most SHADE TAKING DEVICES
frequently applied method in clinical dentistry. However, Shade guides
visual determination of shade selection has been found to Shade matching tools are called color standards or shade
be unreliable and inconsistent. Visual color assessment is guides. There are different types of color standards
dependent on the observer’s physiologic and psychologic for dentistry, depending on their purpose and the tissue
responses to radiant energy stimulation. Inconsistencies
for which they are intended. Tooth color standards, color
may result from uncontrolled factors such as fatigue,
standards for oral soft‑tissues and color standards for
aging, emotions, lighting conditions, previous eye
facial prostheses‑commonly known as dental, gingival
exposure, object and illuminant position and metamerism.
and facial shade guides, respectively ‑ are possible.
Paravina[16] evaluated a newly developed visual
shade‑matching apparatus, Shademat visual+ (SV+). Clark introduced a custom shade guide in 1931 based on
The SV+ apparatus enabled better shade‑matching visual assessment of human teeth, recorded in Munsell hue,
results than daylight. Correlated color temperature of the
value and chroma. Acknowledging the deficiencies of the
daylight varied from 4500 to 6800 K, while light intensity
available guides, Sproull, in the early 70s, suggested that an
varied from 140 to 1000 lux. In SV+ trials, these values
ideal shade guide should consist of shade (color) tabs that
were constant at the measuring place: 5000 K and 1400
are well distributed and logically arranged in color space,
lux. There is a need for a more scientific and consistent
preferably based on the Munsell color system. Quality
means of shade matching in restorative dentistry.
control issues regarding color mismatches of shade tab and
porcelain batches from the same manufacturer could be
Instrumental technique
as problematic as mismatches among manufacturers. The
In this system, the color space consists of three coordinates:
limitations of shade guides are factors that compromise
L*, a* and b* [Figure 4].[15] The L* refers to the lightness
shade‑matching procedures in dentistry and contribute to the
coordinate and its value ranges from 0 for perfect black to
dissatisfaction of clinicians, technicians and patients. A new
100 for perfect white. The a* and b* are the chromaticity
generation of shade guides has been developed to address
coordinates in the red–green axis and yellow–blue axis,
these deficiencies. Shofu offered the natural color concept
respectively. Positive a* values reflect the red color
(NCC)[17] while Vita introduced a 3‑dimensional shade guide
range and negative values indicate the green color range.
Similarly, positive b* values indicate the yellow color range system (Vita 3D‑Master). The NCC[18] system consists of
while negative values indicate the blue color range. The 208 color blends based on 38 basic shades. The manufacturer
differences in the lightness and chromaticity coordinates purports that these blends are logically arranged in L* a* b*
(ΔL*, Δa*, Δb*) as a result of ultraviolet light exposure are color space according to Munsell hue, chroma and value. In
determined first and the total color change (ΔE*ab) can be addition, the shade guides and veneering material are made
calculated using the relationship. of the same material to avoid the effect of metamerism.
The Vita 3D‑Master shade guide[6] [Figure 5a] features a
∆E* ab = ( ∆L * 2 + ∆a * 2 + ∆b*2 )½ systematic colorimetric distribution of 26 shade tabs within
the tooth color space. The manufacturer purports that this
Instrumental color analysis, on the other hand, offers a shade guide demonstrates an equidistant distribution in
potential advantage over visual color determination because the color space. The shade guide is organized into five
instrumental readings are objective, can be quantified primary value levels, with a secondary distribution based on
and are more rapidly obtained. Spectrophotometers and chroma and hue. These value groups are arranged from the
colorimeters have been used with modifications in an lightest (value level 1) to the darkest (value level 5), left to
attempt to overcome problems with visual shade matching right. Intermediate shades can be achieved based on mixing

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Agrawal and Kapoor: Color and shade in esthetic dentistry

formulas. The manufacturer advocates a three‑step process: and the color is confirmed in natural daylight after initial
Value is determined first in making a shade determination selection under incandescent and fluorescent lightening
and then the chroma and hue are determined. The selection • The teeth to be matched should be clean
process is simplified because the number of choices decreases • Shade comparison should be made at the start of the
throughout the procedure. The shade tabs arrangement patient visit
in the Vita classical[6] [Figure 5b] is by hue, whereas in the • Brightly colored clothing should be draped and lipstick
chromascop guides[6] [Figure 5c], the tabs are arranged in five should be removed
clearly discernible value levels. Within each level are tabs that • Shade comparison should be made quickly, with the
represent different chromas and hues. The five levels cover color samples placed under the lip directly next to the
that area of the CIELAB color solid occupied by natural tooth being matched
teeth. The lightest value level has only two chroma steps of a • The eye should be rested by focusing on a gray-blue
single hue and the darkest value level has three chroma steps surface immediately before a comparison since
of one hue. Groups 2, 3 and 4 have three chroma levels of the this balances all the color sensors of the retina and
middle and orange hue and two chroma levels in each hue re‑sensitizes the eye to the yellow color of the tooth.
shift toward yellow or red. The sequence of shade selection is
value, then chroma, followed by hue. Technology based shade matching devices
• Digital cameras
There are certain principles that should be followed during • Spectrophotometers
shade selection.[13,14,19‑21] These are as follows: • Colorimeters.
• Patient should be viewed at the eye level so that the
most color‑sensitive part of the retina will be used Spot measurement (SM) devices measure a small area
• Shade comparison should be made under different lighting on the tooth surface, while complete‑tooth measurement
conditions. Normally, the patient is taken to a window (CTM) devices measure the entire tooth.[1,7] For SM

Figure 3: Munsell color system Figure 4: CIELAB system

a b c

a b

d e f
cc
Figure 6: Technological based shade matching devices; (a) Shade
Figure 5: Shade guides; (a) Vitapan 3D master shade guide; (b) Vita scan; (b) Spectro shade; (c) Vita easy shade; (d) Crystal eye;
lumin shade guide; (c) Chromascop shade guide (e) Shade eye NCC; (f) Shade vision

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Agrawal and Kapoor: Color and shade in esthetic dentistry

devices, the size or diameter of the optical device aperture These filters act as analog function generators that limit
(generally about 3 mm2) will determine how much of the spectral characteristics of light striking the detector
tooth surface and subsequent shade is measured. Examples surface.[6] The filter colorimeters are considered inferior to
of such SM technologies are the Shofu ShadeEye‑NCC scanning devices like spectrophotometers because of the
chroma meter system and the Vita EasyShade system. CTM inability to match the standard observer functions. However,
systems measure the entire tooth surface and provide a because of their consistent and rapid sensing nature, these
topographical map of the tooth in one image. Measurement devices can be used for quality control.[25‑27] The ShadeEye
of the complete surface gives the operator more consistent NCC chroma meter [Figure 6e] is example of tristimulus
and reproducible information about the tooth structure. colorimeter. The ShadeVision system [Figure 6f] is a
device that combines digital color image technology with
Digital cameras colorimetric filtering technology.
Digital photography, like many of the newer electronic
technologies in the industry, offers significant benefits to
dental practices. The digital camera is extremely efficient THREE STEP SHADE MATCHING
and easy to use. Instead of focusing light on the film to PROCEDURES
create a chemical reaction, digital cameras capture images First lightness, then chroma and then hue should be
using charged coupled devices, which contain millions matched. It is the same order as for Clark’s, Hayashi’s and
of microscopically small light‑sensitive elements.[22] The Hall’s shade guides as well as in vitapan 3D master.
advantage of this method is that the camera records each of
the three colors at each pixel location. ShadeScan [Figure 6a] What is actually needed is to reduce the number of
combine digital color analysis with colorimetric analysis, potentially adequate tabs to between 2 and 4 as quickly
but SpectroShade [Figure 6b] is the only one that combines as possible, by choosing tabs from the same or different
digital color imaging with spectrophotometric analysis. groups.

Spectrophotometers The next step is to choose the closest tab or combination

A spectrophotometer measures and records the amount of of appropriate shade tabs.
visible radiant energy reflected or transmitted by an object
one wavelength at a time for each value, chroma and hue If there is no perfect match, a lighter and less chromatic tab
present in the entire visible spectrum.[23] There are two basic should be chosen, because it would be easy to do extrinsic
optical light settings used in reflectance spectrophotometer correction later.
instruments: Illumination at 0 degrees and observation
at 45° (0/45) or illumination at 45° and observation at Dentists position
0° (45/0). Because of the limited access afforded by the oral A tooth should be viewed along its normal axis (the line of
cavity, only the 45/0 option is suitable for clinical use.[23,24] sight perpendicular to the surface), using a diffuse light
source.
The SpectroShade (MHT Optic Research, Niederhasli,
Switzerland) is the spectrophotometer developed The dentist’s eye should be at the level of the patient’s
for clinical use that combines digital imaging with tooth. Regarding shade matching distance, visual acuity
spectrophotometric analysis. The unit consists of a for near vision is to be tested by Ophthalmologist at the
high‑intensity halogen light source that is directed to standard reading distance of 25‑33 cm. Viewing distance
the tooth through fiber‑optic bundles and lenses to should enables a viewing angle of not less than 2°.
uniformly illuminate the field at a 45° angle. The Vita
EasyShade [Figure 6c] is a handheld spectrophotometer for Tab placement
tooth shade matching. The fiber optic tip is approximately The shade tab should be placed parallel to the tooth being
5 mm in diameter (SM technology) and contains nineteen matched and with the same relative edge position. If
1 mm diameter fiber‑optic fibers. A new spectrophotometer possible it should be in the same plane with the tooth‑not
Crystaleye [Figure 6d], is an extremely precise dental in front of it or it will appear lighter and not behind it or it
color analysis system, which provides extremely precise will appear darker.
color measurement based on spectral estimation using a
LED light source. Time length and pauses
The first impression is frequently the best match and
Colorimeters shade matching trials should be limited to 5 s, at a time to
Filter colorimeters generally use three or four silicon prevent eye fatigue and the recommendation to relax the
photodiodes that have spectral correction filters. eyes by observing a blue card between two trials.

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Agrawal and Kapoor: Color and shade in esthetic dentistry

PROBLEMS DURING SHADE MATCHING Binocular difference

Binocular difference is the perception difference between
Color vision problem/color blindness the left and the right eye. To test for binocular difference,
Most complex and misunderstood area of color sensation two objects are placed side by side under uniform
is the detection of radiant energy by the receptors in the illumination. They may appear different, e.g., the one on
human eye and the interpretation of this visual stimulation right may seem slightly lighter than the one on the left.
by human brain.
Placing shade tabs either above or below (rather than next
Color blindness is caused by a deficiency in or absence of to) the tooth to be matched will help to eliminate error
one or more of the three types of photosensitive pigments caused by binocular difference.
able to detect red, green and blue.
Environmental influences
Different types of color vision confusion exist: The setting in which an object is viewed can influence the
• Achromatism: Complete lack of hue sensitivity perceived color. The background and surroundings can
• Dichromatism: Sensitivity to only two primary hues affect the saturations and the hues perceived. Patient’s
usually either red or green is not perceived complexion, make‑up and even reflection from the operatory
• Trichromatism: Sensitivity to all three hues with equipment and walls can modify the color of the oral
deficiency or abnormality of one of the three primary environment and the shade sample, which can influence the
pigments in the retinal cones. shade determination. Therefore, it is advisable to remove the
patient’s make‑up and utilize a neutral gray background in
Age
the operatory to reduce the influence of surrounding colors
Aging is detrimental to color‑matching abilities because
and to prevent an inaccurate shade determination.
the cornea and lens of the eye become yellowed with age,
imparting a yellow‑brown bias. This process begins at
age 30, becomes more noticeable at age 50 and has clinical CONCLUSIONS
significance after 60 years of age. After age 60, many people
have significant difficulties in perceiving blues and purples. The color and appearance of teeth is a complex phenomenon,
with many factors such as lighting conditions, translucency,
Fatigue opacity, light scattering, gloss and the human eye and
Tired eyes cannot perceive color as accurately as alert brain influencing the overall perception of tooth color.
eyes. Compromised visual perception is due to systemic, Continued research on the human visual system has given
local or mental fatigue. Successive shade observations us greater insight into how color discrimination is affected
(treating many patients requiring shade assessment during by environment and other features such as disease, drugs
a single workday) can be primary cause of fatigue. and aging. The basic fundamentals of color and light, the
radiation spectrum and the optical characteristics of the object
Emotions is to be understood before evaluating and selecting the proper
Color can function as a language. For, e.g., many places color shade for the restoration. The measurement of tooth
in world, red suggest anger, yellow represents joy, blue is color is possible through a number of methods including
associated with sadness. visual assessment with shade guides, spectrophotometry,
colorimetry and computer analysis of digital images.
It is generally known that emotion can affect papillary
diameter, causing dilation or constriction and this has a
direct effect on color discrimination. REFERENCES
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Universal Research Journal of Dentistry · September-December 2013 · Vol 3 · Issue 3 127

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