Selecting a Crown Shade

DENTAL EDUCATION

Selecting a Shade

Top: Ivoclar Vivadent Shade Guide

Bottom: Ivoclar Vivadent Prep Shade Guide

Selecting the appropriate shade for a patient's crown or bridge can sometimes by trying. There are many factors that contribute to the way a patient's teeth look, which can result in varied outcomes. To assist with obtaining an objective shade, take into consideration the following factors:

• Light
  • Location
  • Color & Temperature
  • Source
• Surrounding Objects
  • Operatory Walls​
  • Clothing of Patient
• Shade-Taker
  • ​2nd Opinion from Staff Member
• Digital Camera
  • Shade Tabs​
  • Clarity
• Prep Shade
• Shade Tabs

Ensure the source of light is directed relative to the patient as they would normally be seen (i.e. have the patient sit up in the chair, and use passive light from above). When possible, use natural light, or use color-corrected bulbs.

If a patient is wearing a red shirt and pink lipstick in a room with yellow walls, the light will reflect off of these objects and onto the teeth, presenting a skewed shade.

Everyone's eyes interpret color differently. It never hurts to ask a second opinion.

When taking a shade photo to send to your dental lab, include the shade tabs in the photo, holding them up as they would read on adjacent teeth (match Gingival to Gingival, etc.). 

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If an all-porcelain crown is requested, providing a stump/prep shade is extremely helpful to the dental lab technician in determining the material shade. Most all-porcelain materials are translucent, allowing light to shine through, reflect off the prepped tooth, and transmit it's shade back through the porcelain material. 

Referenced from: Charles J. Goodacre, DDS, MSD; Paul A. Sagel, BSChE "Dental Esthetics in Practice:
Part 3 - Understanding Color & Shade Selection" Crest® Oral-B®
at dentalcare.com Continuing Education Course, Revised October 27, 2011

The Missing Link

This week we welcomed Dr. Gene Withrow as our guest blogger. Dr. Withrow has had over 40 years experience as both a general dentist and a board certified prosthodontist. He has held positions as a clinician, researcher, and educator. He also has been a private practitioner in South Carolina, North Carolina and Alabama. Dr. Withrow serves as a technical consultant to Mountain Dental Lab, to share his knowledge and experience to MDL and the clinicians we serve, to provide the best quality of dentistry possible. We would appreciate your feedback on his helpful hints and your areas of interest for future topics.

The Missing Link

In my years in clinical practice I had the opportunity to visit many labs, both commercial and private. I am always amazed how little attention is given to study models…our missing link! The study model for me is the key to success. I would never start a large fixed or removable case with it. Think of the information a study model provides by accurately mounted casts. Size and shape are obvious. Casts can be duplicated and diagnostic wax-ups can be shown to the patient to discuss restorative possibilities. This communication is invaluable to make sure the doctor and patient are on the same page regarding final expectations.

Once all parties agree on the overall design of the case, temporaries can be made from the wax ups. This allows the patient to see the anticipated result in the mouth. The doctor will be able to analyze esthetics and function, making the delivery of the final prosthesis without problem. Duplicating the wax up in hard stone and a vacuum matrix can provide you a temporary shell and/or preparation guide. When you have all this information from the beginning of a case you will eliminate many variables that can go wrong and provide yourself a road map to success!

My technical tip is to have a clean, bubble free study cast. If you use alginate, make sure the impression is poured before any distortion takes place. Make sure you have an accurate bite. Several manufacturers make an alginate replacement that is distortion free, which can also be repoured. If you would like a list of those products, send me an email and I will get back to you. Also, feel free to contact me with any questions.

Dr. Withrow

Digital Photography for Shade Selection

Recently I received a photo album from one of our dentists. It was pictures of some of the cases we had completed in the past year and he wanted us to see these cases in the mouth. He and the patients were thrilled with the result. I was impressed with the results as well; mostly with how well the crowns blended in with the natural dentition. You have a hard time telling which tooth was the crown! While I was musing on this I had a thought. We have always enjoyed doing good work , but the real credit goes to the dentist for providing the lab the most important element to a successful case..Information!!

I realized the dentist had made it easy to get a great result by using digital photography to communicate shading. The digital camera puts the tech right in the office with the patient and takes unknown variables out of the equation of the case. Back in the day when all we had was a written shade map, color variations were left up to the interpretation of the person viewing and the person receiving the information. Notes like “a little orange” or “grey on the incisal” were variable. Are there not many levels of orange and grey? Eliminating these variables may seem simple, but it absolutely essential to producing a great restoration. When a ceramist can build a crown looking at a life sized image of the tooth on a computer screen the results are beautiful!

The picture the lab received to communicate shade.

The final result!

I find sometimes people are intimidated by digital photography, assuming it is too complex or expensive. It doesn’t have to be either. Advanced photo equipment can be bulky and expensive, not to mention difficult to operate. There are several point and shoot model cameras with good lenses that achieve what is needed in  communicating information about shade. Along with proper shade tab placement and labeling, excellent  results can be reached. We can help facilitate digital photography for shade selection in your office if you are interested.

I am really happy when we work as a team and produce great crowns for our patients. With the materials we have today and the means of communication available, it is exciting to think of the potential!