A Guide to Better Shade-Taking in Dentistry

Why not transform shade-taking in the esthetic zone into a delightful and predictable experience? However, shade-taking isn't always straightforward; factors like lighting conditions, patient expectations, and material variations can influence the process. In this article, I’ll provide crucial insights and practical tips to ensure that your patients not only receive exceptional care but also enjoy a smooth and reassuring process during shade-taking in dentistry.

When Shade-Taking in Dentistry Goes Wrong

We’ve all been part of the story. The prep and provisional are done on #9, the shade is taken, and life is good. The day of the insert appointment, the dentist and assistant are excited, and the patient is happy because she will no longer have to wear the provisional. The temporary is removed, the abutment is cleaned, and finally-- after all our efforts — the crown is placed. The dentist tries to convince himself that it looks good, the assistant is giving him venomous stares, mouthing “no” in the background, and the patient using the mirror is wondering why it doesn’t look like her other front teeth. At this point, the discussion shifts to the lab. It would have all been good if the lab had made it the right shade!

How did this happen and what can we do to find out what went wrong? When I practiced, I must admit that I was not very good at taking shades in the esthetic zone. We would pull out the old shade guide we had glued together and took a shade under an operatory light. My assistant would write something like “A2’ tooth number 8 on the prescription and send the case off to the lab.”

My problem was that I had no idea how to communicate shades to my lab.

How can dentists and labs provide a better shade-taking experience for their customers? Are there better ways to communicate shades to our labs? The good news is that there are protocols in place to get shades mostly right the first time. There are also several problem-solving protocols when things just do not match.

Tips for Improving Shade Matching

Achieving precise shade-taking in dentistry requires effective communication between dentists and dental labs. This section explores key techniques and considerations — from advanced photography tools to understanding lighting impacts and substrate characteristics — that enhance the accuracy of shade communication and ensure consistent esthetic outcomes.

Photography

There are multitudes of cameras such as SLRs and cameras specially designed for shade-taking that work well when communicating shades to your lab. Using your smartphones for shades in the esthetic zone can help in the process if you keep in mind that smartphones use computational photography algorithms, the computer in your phone decides what picture to take. There are also instances where shades taken with scanners and intraoral cameras can be effective lab communicative devices. No matter what system you use it is important to stay consistent with what you send to your lab. It is much easier to problem solve if the crown does not match.

Shade Guides

We thought we were doing everything right: perfect lighting, great pictures, and the tab positioned correctly. However, when the crown came back it didn't match; this happened more than once. When I talked to my lab technician about it, he asked, “how old are your shade guides?”

At that point I was at a loss. Subsequent research indicated that the guides were at least eight years old and had been glued together more than once. We also considered how many times those tabs were disinfected with whatever we were using at the time. This simple problem-solving act allowed us to proceed with more consistent shade-taking experiences. Once we figured it out, we bought two of the same shade guides, leaving one as a control and one for operatory use. Our lab does the same thing. After a year, we discarded the old one and bought a new one.

Light

Our lab uses 5500k bulbs with a color rendering index over ninety-two in its shade-taking operatory and working areas, employing blue napkins and neutral wall colors. We are also fortunate to have a south facing window, so we ask the patient to visit between 10 and 2. We try to position the shade guide in the same plane as the adjacent teeth.

I had questions about whether using a flash to document the shade would override the light ambiance in the shade-taking area after we have already confirmed the shade with ambient light. When I asked Dr. Jeff Rouse this question, he said, “The flash changes everything. The camera also impacts the color.” He goes on to state that “while you are developing a relationship with a lab, post-op photos are important on every case. They have to be able to see how the photos matched their reality.”

Abutment Color and Translucency

Substrate color can significantly affect the result. When using translucent ceramics such as lithium disilicate and the different types of zirconium oxide, research shows that translucency, abutment color, and cements can all affect the final esthetic outcome.

Strategies to consider would be to increase the thickness of the ceramic where diffuse reflection mainly occurs in the ceramic itself rather than the underlying substrate. Aging of materials can also have an effect on long term success. It is shown that over time, zirconia will continue to change from tetragonal phase to a monoclinic phase causing unfavorable esthetic changes. Cements can shift their color over time to yellow because of water absorption.

Enamel Conditioning

Teeth can dehydrate quickly during longer procedures, and they are exposed to dental materials of various pH levels. A study found that after 45 minutes of dental procedures, the relative translucency of enamel decreased by 33-34% compared to wet enamel. Water is replaced by air leading to this effect. We do recommend the shade be taken prior to dessication and material exposure to ensure more consistent results.

Staining and Glazing

Whether you prescribe polishing or glazing for your final finish can have a significant effect on the final esthetic outcome of your case. Polishing instead of glazing can result in a different surface texture and can affect color perception. Polished surfaces appear more opaque than glazed surfaces.

Polymerization of Cements and Associated Color Shift

If your esthetic case presents with a need for thin crowns or veneers, you may want to keep in mind that all cements, whether light cured or dual-cured show that color changes do occur during curing. These changes can be due to water absorption, tertiary amine oxidation (yellowing), incomplete polymerization, and a host of other factors and can influence the final esthetic outcome.

Custom Shades

When all else failed, I had the benefit of having a skilled technician who was able to match my shades for me, saving time and reducing frustration for me and my patient. Skilled technicians who have devoted time to gain knowledge of the nuances of shade matching are peerless when performing this procedure. They actually make what we are prescribing, employing their knowledge of light, and the composition of materials to give us the great esthetic effect we demand.

My suggestion is to find a lab tech locally within driving distance for your patients to visit. Your lab will be prepared with all of the appropriate armamentarium and make it an efficient, pleasant experience for you and your patient. An alternative would be to have your technician visit your office. We find this cumbersome, considering your loss of chair time and the fee that the technician charges for an in-office visit often using a light source of unknown wavelength.

Pursuing Excellence in Dentistry

Dr. Frank Spear always talks about making dentistry more fun. The fun begins with a happy patient who appreciates your efforts on their behalf and will gladly pay your extra fee for esthetic cases. Shade-taking in the esthetic zone can be a rewarding experience for you and your patient if we all keep in mind the importance of continuous communication with our lab.

Clear communication, updated techniques, and a commitment to excellence ensure that shade-taking in dentistry not only meets but exceeds patient expectations, fostering trust and satisfaction in every smile-enhancing endeavor.

Edward J. Roman, D.D.S. is a dental laboratory owner who maintained a private practice in Washington, Pennsylvania. His educational emphasis is improving dentist-lab communication. He is a member of Spear Visiting Faculty and a contributor to Spear Digest.