In my opinion, the hardest thing to do in dentistry is shade-match tooth #8 to an untouched #9 (or vice versa). Yes, it is harder doing an endo on #31 or placing an implant on #18 for a patient who can’t open wide enough.
As dental professionals, our primary goal is to optimize oral health. Often overlooked are the profound psychological and emotional aspects of dentistry, for both the dentist and the patient. One key component of that is shade-matching to adjacent natural teeth, especially in the anterior sextant of the mouth. Achieving the correct shade for a crown on #8, or an implant crown on #6, or a removable partial denture can significantly impact a patient’s mental health and confidence.
Additionally, the feeling dentists get when a prosthesis is inserted with the correct shade, shape, and function in harmony with the rest of the oral cavity is always satisfying. Shade matching is often overlooked as a seemingly quick and straightforward process; however, many dental practitioners encounter difficulties in this area of dentistry.
First, multiple studies have suggested and concluded that dentists, especially prosthodontists, are less satisfied than the patient with the shade match in a significant number of cases. I wanted to get that out of the way before we dive in deeper.
As dentists, we are harder on ourselves when it comes to aesthetics than the general patient population. A study in Turkey compared a group of 120 people, which included dental professionals such as general dentists, specialists, dental assistants, and even dental students, with laypeople in shade-matching. The dental professionals matched the shades better than any other participants. This makes a lot of sense since we are trained to look at value, hue, and chroma more than anyone else.
When it comes to our everyday lives in the office, we have several tools or equipment readily available for shade matching. The first tool most dentists use is basic shade tabs. It’s important to remember that there are many other tools available, and using them along with visual shade tabs is paramount. A study in 2021 compared five of the most common techniques for shade matching, ranked here in order of accuracy according to the study:
- Intraoral scanner
- The following three showed similar accuracy:
- Digital Single-Lens Reflex (DSLR) camera with twin flash and polarized filter
- Smartphone camera with light corrector and polarized filter
- Spectrophotometer
- DSLR camera with a ring flash and polarized filter
They concluded that even though the intraoral scanner showed the highest accuracy, visual shade tabs and a combination of the above techniques, along with a professional learning curve (experience), will result in the most accurate outcomes. From my personal experience, I would add that good communication with an experienced lab technician, with whom you build a long-lasting relationship, will also help get those shades correct and keep you and your patients happy.
From the patient’s perspective, correct tooth shade matching can have all sorts of impacts. A proper, well-matched smile can improve aesthetic appeal, self-confidence, motivation for better oral health, and self-expression. It can also reduce social and dental anxiety, as a patient will build trust in the dentist’s ability to give them a great smile. Most importantly, including the patient in the shade selection process will create a sense of empowerment that can result in increased self-esteem and boost their satisfaction when the final prosthesis comes back.
The sophistication of all the tools available at our disposal can make difficult shade matching a thing of the past. It is important, however, to remember that part of the shade selection process can still involve basic trial and error, especially with some of our more unique patients with unique tooth colors. In those rare circumstances, the best possible way to shade match is to have the patient book an appointment with a local lab for a custom shade match. Modern aesthetic dentistry has made it possible for that to be a very rare occurrence, and as we progress, more and more tools and equipment will be made available.
ABOUT THE AUTHOR
Michael Massoud, DMD, is the co-founder of SiRa Dentistry in Spotswood, New Jersey (siradentistrynj.com). He received his Bachelor of Arts degree in Biological Sciences from Rutgers University and his Doctor of Dental Medicine degree from Temple University Kornberg School of Dentistry. His professional philosophy is to treat patients as family, developing interpersonal doctor-patient relationships by using his passion for the art and science of dentistry.
He is an active member of the New Jersey Dental Association and American Dental Association. Dr. Massoud continuously seeks to advance his knowledge through continuing education courses, especially in aesthetic dentistry, advanced restorative procedures, and dental implants. Growing up in Montreal, Canada, and being raised by an Egyptian family, Dr. Massoud is trilingual and fluent in English, French, and Arabic. He enjoys spending his spare time with family and friends, playing soccer, and traveling the world with his wife, Sherri.
