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Shade-Matching -- Eliminating the Guesswork By Michael J. Melkers DDS

More by this author (7)
One of the greatest aesthetic restorative challenges we face in our practices is the restoration of a single maxillary central incisor. Unlike a full rehabilitation or “smile makeover,” where we have total control of shade, shape, surface anatomy and characterization, the single central must conform to the existing environment. Subjective and objective criteria apply to the communication process between doctors and laboratories.

Subjective language regarding the myriad of communication requirements for a successful restoration can lead to misinterpretation, misunderstanding, unacceptable results and frustration for everyone involved.
Case Presentation
The following case presents the use of new and exciting communication tools in a treatment scenario that we are all faced with quite frequently.

The patient came to our office following an industrial accident that fractured several teeth, including the distal third of #9. Following evaluation, #9 was endodontically treated and provisionally stabilized with a composite build-up (Fig. 1). For aesthetics and structural longevity a full coverage, all porcelain restoration was recommended.

As #8 was not damaged in the accident, it was used as a template for desired shade, translucency, surface anatomy and finish. Considerable variations in shade were present, varying from B1 to D2 and 1M1 to 4M1. Even with intraoral slides, including shade tabs, we found it difficult to adequately communicate the desired shade and nuances present (Fig. 2).

Fig. 1

Fig. 2a

Fig. 2b
Fig. 2c
Our patient was referred to a local dental laboratory for custom shade mapping utilizing digital shade mapping technology. The process is amazingly simple and provides a wealth of information. The tooth to be shade mapped is scanned utilizing a hand held device (Fig. 3). The information is transferred to a computer and can be modified to suit your needs. The data can be translated to any of the major shade guides, as is appropriate, for the restorative material to be used (Fig. 4). Value, hue, chroma and translucency mappings are also available from the initial recording.

Fig. 3a


Fig. 3b
Fig. 4
Additional information was also communicated to the laboratory, to provide them with as much information as necessary to produce an excellent result. Photographs of the tooth preparation, including a shade tab, were provided to communicate the underlying effect of the preparation on the final restoration (Fig. 5). We also provided the technician with black and white intraoral camera images (Vipersoft by Integra Medical) taken at various angles to communicate the light reflective and deflective zones of the surface anatomy (Fig. 6). These images may be electronically submitted to the lab. I have found that, for this purpose, adequate communication can be achieved using plain paper in our inkjet printer.

Fig. 5

Fig. 6a
Fig. 6b
The restoration was returned from the lab, tried in and bonded, following accepted protocol, with a translucent resin cement (Nexus by Kerr Corp.). The finished restoration blended in with the existing natural dentition, with no modification to the color or surface anatomy (Fig. 7).

Fig. 7
For demonstration purposes, the restoration was also scanned following cementation and compared to the pre-operative scan of #8 (Fig. 8). Of the nine shades present in the pre-operative scan of #8, all nine were present in the final restoration. While there were subtle differences in characterization, the restoration complimented the natural dentition very nicely. The patient was very happy with the results and appreciated the “higher level of service” that we were able to provide.

Fig. 8
Discussion
While some new technologies may seem cost or time prohibitive, I have certainly not found this to be the case with digital shade scanning. To the contrary, I have actually found myself spending either equal or less time providing this higher level of service for my patients. While I certainly would love to have an electronic shade scanning systesm in our office, I unfortunately have not been able to afford one, just yet. I will purchase one as soon as I can fit it into my budget. Until then, I’ll continue to use the lab to achieve absolutely dead on results. Our local laboratory conveniently provides the shade mapping service for a very reasonable fee.

As the price tag on these units decreases, as it has historically for all “new” technologies, I see the digital shade mapping technology becoming standard equipment in many offices. The use of this technology will not be restricted to lab-fabricated restorations, but will also be used with direct placement anterior composites. Imagine scanning the shade for a polychromatic, large Class IV restoration. With the stress of complex shade mapping removed, we will be able to concentrate on the finer aspects of the artistic process. The technology is here and it is an exciting addition to our dental toolbox.

As aesthetic demands and expectations of our patients continue to “raise the bar”, traditional communication of “A2 and make it pretty” is insufficient. While subjective shade evaluation, mapping and communication continue to be the standard in our offices, several emerging technologies are now available to help us provide our patients with highly aesthetic restorations that mimic the natural dentition.
Acknowledgements
The author would like to thank Lauren Rants, CDT and Ryan Braun, CDT of AU Dental Ceramics for their contributions to this case and commitment to the communication between the doctor and the ceramist. The author holds no financial interest of any kind in the products mentioned in this article. DT
Dr. Melkers is a 1994 graduate of Marquette University School of Dentistry. He and his wife practice general dentistry in Spokane, Washington with an emphasis on comprehensive and restorative care. Dr. Melkers is currently serving as President for the Washington Academy of General Dentistry and is very involved with the AGD at the national level.

Dr. Melkers can be contacted by email at mcmelk@aol.com or at his office at 509-891-7770.

He is available for speaking engagements on communication between the doctor and the ceramist as well as comprehensive, aesthetic full mouth rehabilitation.
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September 2025
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