The importance of aesthetic tooth shades is well known. Clinicians have to consider them when devising restorative solutions for patients, creating harmony with the pre-existing dentition. The literature even states that tooth colour must work with other factors like skin and eye colour for the best results.
Clinicians often work with the Vita Classical Shade Guide when creating restorative solutions for patients. It is not the only guide used, Bioform and Chromascop are also popular, amongst others. However, it is immediately recognisable – in name and appearance – and is a measure of aesthetics that has informed many restorative solutions.
It's vital that dental professionals understand how the Vita Classical Shade Guide is best used, and how the subjective experience of shade matching can be optimised. When considering how the anatomy of the dentition affects appearance, dental professionals must take care in their approaches to restorative care, ensuring results appear natural in the dentition.
Whittling down to 16 shades
The human brain has the ability to identify and differentiate between nearly 1m shades of colour, and current technology has pushed this boundary further, recognising approximately 10m different shades. The colours present within the dentition differ significantly, and whilst electronic devices can identify around 100,000 dental shades, the human eye can only interpret 1 per cent of these.
The Vita Classical Shade Guide consists of 16 colours, which typically cover most restorative dentistry needs. Three additional colours make up the Vita Bleach Shade Guide, which may be favoured by patients looking for a brighter smile. When comparing to a guide, dental professionals should target the middle site of a given tooth, as it best represents its true colour – the incisal and cervical sites are more affected by the surroundings. The colour it matches closest on the Vita Shade Guide can then be chosen for a restorative solution, such as a composite material.
Colourimeters and spectrophotometers are potentially effective adjuncts for shade identification, but are prone to reading inaccurate results because of issues such as edge loss. This is where light is scattered laterally through the translucent portions of a tooth, out of the measuring area of the instrument – the incisal thirds of anterior teeth are particularly susceptible.
Incisal translucency
Enamel and dentine change in density as you measure from the incisal edge to the periodontium, so the colour of the tooth is also modified.
There is a progressive decrease in the chroma (saturation) of a natural tooth from the cervical to the incisal area, as well as from the most internal to the external aspect of the tooth. Reproducing this is key to achieving a harmonious and natural appearance for a restoration.
Transparency near the incisal edge is apparent for a number of reasons. Firstly, the prevalence of dentine decreases, leaving the semi-translucent enamel as the most prominent aspect of the dentition’s structure. However, this could be impacted through wear. If patients consume high volumes of acidic food and drink, experience acid reflux or frequent vomiting, or have conditions such as enamel hypoplasia or celiac disease, they may be at a greater risk of enamel erosion, creating thinner tooth surfaces.
When creating a restorative solution for patients, it’s important to consider whether a translucent appearance is necessary to look natural within the surrounding dentition. If it is required, but not considered, a patient may receive a high-quality restoration that would be fantastic for someone else – but ultimately looks out of place in their smile.
Implementation
To create an aesthetic restorative solution that gives the appearance of a natural tooth shade, including translucency at the incisal edge, clinicians have a number of options. They could employ multiple composite solutions, using a Vita Classical Shade Guide (if appropriate) to assess the option for the body of the tooth, and another shade for the incisal edge.
Dental professionals could, however, simplify the process without compromising on aesthetics by choosing the Filtek Easy Match Universal Restorative from Solventum, formerly 3M Health Care. This composite range simplifies the shade selection process by providing three solutions – Bright, Natural and Warm. They match the Vita Classical Shade Guide, and allow for intuitive care with excellent results.
Understanding how to implement the Vita Classical Shade Guide is important for all clinicians providing restorative care. By factoring in the need for translucency at the incisal edge, composite restorations can be provided with fantastic natural results. After all, the best dental restorations are the ones you barely notice at all.
References available on request.
For more information visit https://www.solventum.com/en-gb/home/oral-care/