© Mireille Feghali
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Shade selection in complex esthetic
restorations with composite
Mireille Feghali Fares
Département de Dentisterie Restauratrice et Esthétique
Université Libanaise
mireillefeghali@hotmail.com
Formation Continue LDA 2013
© Mireille Feghali
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Buts
• Quesque l’adhésion?
• Quels sont les différents adhésifs présents?
• Quelle est la meilleure technique?
© Mireille Feghali
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Outline
1- Introduction
2- Cleaning Phase
3- Segmentation Phase
4- Identification Phase
5- Conclusions and Perspectives
© Mireille Feghali
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Plan
1)
2)
3)
4)
INTRODUCTION
2.1. Basics of color
2.2. Munsell’s classification
2.3. Translucency
and opacity
3.1. Anatomy
of natural teeth
NATURAL TEETH
2.4. Color contrast
and metamerism
3.2. Optical
properties of human teeth
COLOR
3.3.
Color
range of natural
teeth
RESIN COMPOSITES: TYPES
AND
AVAILABLE
SHADES
OF RESIN COMPOSITES
5) SHADE SELECTION
6)
5.1. Shade guides
5.2. Thickness of the material
5.3. Type of tissue to restore
FACTRORS THAT AFFECT THE COLOR OF THE
RESTORATION
7) CONCLUSION
6.1. Color stability
6.2. Aging
6.3. Staining
6.4. The effect of polishing
Introduction
Creating a lifelike appearance in a restoration is certainly one of the most
complex, challenging, and controversial tasks in dentistry.
Direct resin restorations require a thorough knowledge of the resin system(s)
being used and clinical proficiency in layered placement. However, when
skillfully manipulated, these materials can be virtually indistinguishable
from the natural tooth substance.
Paravina (RD.), Evaluation of a newly developed visual shade-matching apparatus, Int J Prosthodont, 2002; (15), 528.
2) Color
2.1. Basics of color
The color of an
object is not
contained within the
object. The color is
the result of the light
which strikes the
object and is
reflected by it.
ComPadre, The physics classroom, Color and Vision; 2011
Baratieri (LN.) et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005; Quintessence Books
2) Color
2.1.) Basics of color
Nature of incident light
Assessment of
the observer
Physical
properties of the
object
Assessment of
the observer
O’Brien. (W.) , Dental material and their selection, Quintessence Books, Fourth edition, 2008; p 25-80.
2) Color
2.2. Munsell’s classification
Quality of an
object: by
measurement of
hue, chroma and
value
Sproull (R.), Classical article -color matching in dentistry - part I- The three dimensional nature of color – J Prosthet Dent
2001; (86), 453-457.
2) Color
2.2. Munsell’s classification: Hue
Baratieri (LN.) et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005; Quintessence Books
2) Color
2.2. Munsell’s classification: Chroma
The intensity or saturation of a hue
Low Chroma
High Chroma
Sproull (R.)- Classical article- color matching in dentistry – part I- the three dimensional nature of color – J Prosthet Dent
2001; (86), 453-457.
2) Color
2.2. Munsell’s classification: Value
The relative darkness or lightness of a color, or
brightness of an object
Low value
High value
Sproull (R.)- Classical article- color matching in dentistry – part I- the three dimensional nature of color – J Prosthet Dent
2001; 86, 453-457.
2) Color
2.2. Munsell’s classification
Quality of an
object: by
measurement of
hue, chroma and
value
Sproull (R.), Classical article -color matching in dentistry - part I- The three dimensional nature of color – J Prosthet Dent
2001; (86), 453-457.
2) Color
2.3. Translucency and opacity
Baratieri (LN.) et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005; Quintessence Books.
2) Color
2.4. Color contrast and metamerism
Color contrast: The notion of color contrast is essential to a modern
understanding of color perception.
The yellow band on the right
appears darker and yet both are
identical. This Is due to the effect
of absorption of the yellow color
by the surrounding red
B3 appears identical to A3.5
simply because of the
absorption of color by the
proximity of the gum.
TOLILA (Y.); Comment transmettre la bonne « teinte » grâce à la photo et la colorimétrie numériques?, 2004; 7.
2) Color
2.3. Color contrast and metamerism
Sometimes colors may appear to be the same, even when they are composed of different spectral
transmission curves. However, when illumination is changed, that apparent match is lost. Colors which
appear to be the same in a given illumination but which are evolved by different spectral curves are said
to be metamers.
Light source # 1
Light source # 2
Light source # 3
Irfan Ahmad ; Three-Dimensional shade analysis: perspectives of color-part II; Pract Periodont Aesthet Dent 2000; 12(6):
557-564.
Sproull (R.), Preston (JD.), Understanding color in Goldstein RE, Esthetics in dentistry, 1998; (2).
3) Natural teeth
3.1. Anatomy of natural teeth
Anatomy
and
histology
of the
dental
tissues
The effect
of these
tissues on
light
Optical
properties
of teeth
Bosch Ten (JJ.), Coops (JC.),Tooth color reflectance as related to light scattering and enamel hardness, J Dent Res, 1995;
(74), 374.
3) Natural teeth
3.1. Anatomy of natural teeth1 . Vertical ridges
2. Vertical grooves
3. Horizontal ridges
4. Horizontal grooves
5. Perikymata
6. Enamel pits and
vertical irregularities
Baratieri (LN.) et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005.
3) Natural teeth
3.2. Optical properties of human teeth
Enamel is very translucent and
might transmit up to 70% of
light through a section that is 1
mm thick.
Dentin is less translucent than
enamel and can transmit up to
30% of light through a 1 mm
thick section.
Raptis (N.), Optical Behavior of Current Ceramic Systems, The International Journal of Periodontics & Restorative
Dentistry, Dent Technol, (26), 2006; 31.
3) Natural teeth
3.3. Color range of natural teeth
Differences in tooth
color exist within the
same tooth.
Central incisors had
the highest lightness.
Women’s teeth in
general were lighter
and less chromatic,
than men’s.
Tooth color
was best
represented
by its middle
third.
Aging produced
darker and more
reddish teeth.
Baratieri (LN .)et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
Vaarkamp (J .)et al, Propagation of light through human dental enamel and dentine, Caries Res, 1995; (8), 29.
4) Resin composites:Types and available shades of resin composites
Resin composites
acceptable alternative to
amalgam.
To achieve the best esthetics, resin composite restorations
must match natural teeth in appearance and must maintain that
appearance over time.
O’Brien. (W.) , Dental material and their selection, Fourth edition, 2008; Quintessence Books, p 25-80
4) Resin composites:Types and available shades of resin composites
Shades
Sizes and
shapes.
Natural teeth
Opacities
Textures
O’Brien. (W.) , Dental material and their selection, Fourth edition, 2008; Quintessence Books, p 25-80
4) Resin composites:Types and available shades of resin composites
Resin composites are classified by use (anterior, flowable, laboratory, packable,
posterior, universal) or by type of filler particle (microhybrid, microfill, nanofill).
Composites are also designated by shades: universal shades, bleaching shades, and
highly esthetic (layered) shades.
O’Brien. (W.) , Dental material and their selection, Fourth edition, 2008, Quintessence Books, p 25-80
4) Resin composites:Types and available shades of resin composites
MICROFILLED
MICROHYBRID
NANOFILLED
Filler size
0.01-0.12μm
0.01-3 μm
0.005-0.1μm
Appearance
Optical properties
similar to enamel
Good gloss, luster
and smoothness
Good gloss, luster
and smoothness
Polishability
Highly polishable
Polishable
Highly polishable
Usage
Non-stress bearing
esthetic restorations
Anterior and
posterior restorations
Very high
aesthetic
properties
(anterior
restorations)
O’Brien. (W. ), Dental material and their selection, Fourth edition, 2008, Quintessence Books, p 25-80
Beuna (S.), Glorieux (T.), Characterization of nanofilled compared to universal and
microfilled composites, dental materials, ELSEVIER, 2006; 1-9.
4) Resin composites:Types and available shades of resin composites
Close to 80% of dentists prefer to execute monochromatic restorations, since they are
much easier, faster and less stressful than polychromatic restorations.
Unhappily, however, these are not always acceptable.
Baratieri (LN .)et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
5) Shade selection
Several clinical studies confirm that computer-assisted
(spectrophotometer, digital camera..) shade analysis is more
accurate and more consistent compared to human shade selection [
Paul et al, in 2002]
Yilmaz (B.), Karaagaclioglu (L.), Comparison of visual shade determination and an intra-oral dental colorimeter, Journal of
Oral Rehabilitation, 2008; (35), 789-794
5) Shade selection
5.1. Shade guides
An adequate shade matching method is of the highest
importance in esthetic dentistry.
The selection of a shade
the appointment period.
The most important part of
PARAVINA (R D.), New Shade Guide for Evaluation of Tooth Whitening-Colorimetric Study , Blackwell munksgaard, J
Esthet Restor Dent , 2007;(19), 276–283.
5) Shade selection
5.1. Shade guides
PARAVINA (R D.), New Shade Guide for Evaluation of Tooth Whitening-Colorimetric Study , Blackwell munksgaard, J
Esthet Restor Dent , 2007;(19), 276–283.
5) Shade selection
5.2. Thickness of the material
To obtain high quality in aesthetic dentistry
Layer thickness
of the composite
Texture
Translucency and
opacity
Vichi (A.), Fraioli (A.), Influence of thickness on color in multi-layering technique, Dental Materials, 2007; 1-6.
5) Shade selection
5.2. Thickness
of the
material
Any mistake
during
application of resin
composite may lead to an excessively
translucent or opaque restoration, because
a single shade may present different
grades of translucency and opacity
depending on the thickness of the resin
composite layer applied.
Vichi (A.), Fraioli (A.), Influence of thickness on color in multi-layering technique, Dental Materials, 2007; 1-6.
Baratieri LN et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
5) Shade selection
5.2. Thickness of the material
The greater
the opacity
The less the
translucency
The greater
the thickness
Vichi (A.), Fraioli (A.), Influence of thickness on color in multi-layering technique, Dental Materials, 2007; 1-6.
Baratieri LN et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
5) Shade selection
5.3. Type of tissue to restore
Dietschi (D.), A new shading concept based on natural tooth color applied to direct composite restorations; Quintessence
International, 2006; (37), 92.
5) Shade selection
5.3. Type of tissue to restore
Natural humidity of the oral cavity
Clean tooth
Rubber dam
Koubi S., A. Faucher, Restaurations antérieures directes en résine composite : des méthodes classiques à la stratification,
EMC, Elsevier, Odontologie, 2005;(23), 136.
5) Shade selection
5.3. Type of tissue to restore
Baratieri LN et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
5) Shade selection
5.3. Type of tissue to restore
Baratieri LN et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
5) Shade selection
5.3. Type of tissue to restore
Schematic drawing of the tooth, showing details of the shade and surface texture: THE KEY TO
OBTAIN A SUCCESSFUL RESTORATION
Baratieri LN et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
5) Shade selection
5.3. Type of tissue to restore
The
lingual
aspect
of
teeth
Application of translucent resin to reproduce the palatal portion of the
tooth. Note the translucency achieved by the resin composite.
Baratieri LN et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
5) Shade selection
5.3. Type of tissue to restore
Shade A3 for dentin of the restorative material system-specific shade guide was
applied at the internal region because of the more opaque characteristic.
Baratieri LN et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
5) Shade selection
5.3. Type of tissue to restore
Reproduction of dentinal mamelons: more superficial and thus less opaque dentin
This reduction in hue at this step is important for achievement of a natural-looking restoration.
Baratieri LN et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
5) Shade selection
5.3. Type of tissue to restore
Translucent resin applied at regions with greater incisal translucency. After this stage, the existing
space should correspond to the enamel thickness.
A2E shade was applied over the other shades, reproducing the buccal enamel.
Baratieri LN et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
5) Shade selection
5.3. Type of tissue to restore
Baratieri LN et al, Composite restorations in anterior teeth, fundamentals and possibilities, 2005, Quintessence Books
•
The dentist’s eyes should be on the level of the patient’s tooth. Regarding shade matching distance, visual acuity for near
vision is tested in ophthalmology at the standard reading distance of 25 or 33 cm; the suggested minimum standard of visual
acuity for dental practitioners is 6/7.5 at 33 cm. Based on all these facts, a working distance of 25 to 33 cm appears to be
acceptable for everyone. The shade tab should be placed parallel with the tooth whose shade is being matched, and with the
same relative edge position. lf possible, it should be in the same plane with the tooth, not in front of it, or it will appear
lighter; and not behind it, or it will appear darker. The tab carrier, especially if metal, should be put along its normal axis to
avoid possible impact on the tab color, especially in the incisal/occlusal region, where teeth are the most translucent
•
The first impression is frequently the best match, and shade matching trials should be limited to 5 seconds at a time to
prevent eye fatigue. The vision pigment is used up quickly in the mechanism of color perception. (Fortunately, it is
regenerated continuously and almost instantaneously). The recommendation to relax the eyes by observing a blue card
between two shade matching trials (because blue and yellow are complementary colors) has been given many times in dental
literature. It was explained that this would cause blue fatigue and increase the eye sensitivity to differentiate yellow color
(predominant tooth color).
6) Factors that affect the color of the restoration
6.1. Color stability
Color instability: The major disadvantage of resin composites, which may be a major
cause for replacement of restorations.
Dimensions of filler particles
Depth of
polymerization
Resin matrix
Coloring agents
Pires de Souza (F.), Color Stability of Composites Subjected to Accelerated Aging after Curing Using Either a Halogen or a
Light Emitting Diode Source; Color stability of composites; Braz Dent J ,2007; (2),119-123.
6) Factors that affect the color of the restoration
6.2. Aging
Stefano (A.) et al; A long-term laboratory test on staining susceptibility of esthetic composite resin materials; Quintessence
International, 2010; (41), 695-702.
6) Factors that affect the color of the restoration
6.3. Staining
Incomplete
polymerization
Smoothness of
the restoration.
Staining
Chemical
reactivity
Diet, oral
hygiene
Iffat (N.), Prasanna (N.) et al, Color stability of microfilled, microhybrid and nanocomposite Resins -An in vitro study,
journal of dentistry , 2010; e 137 – e1 42.
6) Factors that affect the color of the restoration
6.4. Effect of polishing
Esthetics and longevity
of resin composite
restorations
Watanabe (T.), Influence of polishing instruments on the surface texture of resin composites, Quintessence International,
2006; (37), 61-67
7) Conclusion
Are the restorations with composites similar to natural tooth possible?
YES
Principal characteristics
Because
of these difficulties
of anterior
teeth and the improvements
offered by other restorative systems such as indirect
restorations: Aren’t they gaining favor in the field of
Technique
for the dentistry?
esthetic restorative
selection of the shade
Having materials
available