Improve your Shade-Matching Techniques— BY: David French

As dental restorative materials and techniques continue to advance, laboratories are able to offer higher quality and more natural-looking prosthetics. To achieve case presentation acceptance, dentists skillfully work on improving their communication skills. For the patient, the well-known adage, “A picture is worth a thousand words” really applies. Dentists have learned to rely on visuals to effectively communicate with their patients. Providing a photo can also be a key factor in determining if shade-matching communication with your lab will be successful and not result in an expensive remake. New cameras, especially well suited for dental needs, are making photo communication extremely viable.

When selecting a camera for your practice, you’ll find there are three basic categories to select from:

The classic standard—35mm (slides).

Digital cameras

Polaroid, instant photography, has been used in many applications within dentistry for years.

From my experience as a Senior Technical Advisor for Burbank Dental Laboratory, I would like to share the reasons I feel qualify the new Polaroid Macro 5 as a leader in obtaining custom shade matching.

The Macro 5 SLR Camera is a complete compact camera system for generating instant close-up photographs. It features SLR viewing for precise picture framing, twin light beam focusing, dual point flashes and 5 “dial-up” magnifications (.2x, .4x, 1x, 2x, 3x). To switch between magnifications, simply turn a dial on the top of the camera. The camera uses Spectra High Definition film or grid film. There are no pictures to time or to peel apart. The Macro 5 SLR is also the only Polaroid close-up camera that includes a databank for date or time imprinting on each picture. Light-beam focusing means not having to guess or estimate the correct camera-to-subject distance. Also, nothing comes in contact with the subject.

Why the Macro 5? Instant feedback: Digital and the Polaroid’s Macro 5 both provide ‘instant’ verification of photo quality and composition.

Ease of Use: The Macro 5 requires less technical skills to obtain a hard copy from the system. Just dial-in settings and push the button. There are no complicated settings, specific printer or computer to deal with as in digital or 35 mm. Digital photography requires at least novice computer skills.

Predictable Results: Since the Macro 5 has definite magnification and light settings, getting consistent results is predictable and easy.

Economical to Use: The Macro 5 fairs very well considering an initial investment of under $800, including a polarizing filter and the cost of each photo ranging between $0.80 and $1.30. Basic 35 mm systems range between $900 and $1400 and their general film and developing costs average $0.25 and $ 0.80 per picture.

While current prices for digital cameras and associated costs are beginning to drop, right now digital is the highest cost solution available. With an initial investment hovering at $2000 and up, plus the required fast computer system and/or printer, in addition to the cost of paper and ink that ranges from $0.80 to $1.50 per image—digital photos can be very expensive.

Image quality: In general, 35mm photography is still considered to have exceptional quality but photos from the Polaroid Macro 5 are providing dentists with the exceptional clarity necessary for dental applications. Dentists who are using the Macro 5 to communicate shade matching with our lab are consistently obtaining excellent results. Not only is the Macro 5 a practical camera for shade matching but also for patient records and for before and after patient presentations.

Dr. Edward Walk, a DMD from Boston, has developed a photo layering technique that is used in conjunction with shade tabs to enable the ceramist to produce an optimum match with surrounding teeth. At Burbank Dental Laboratory, we have been using this procedure for almost four years with exceptional results. We have found that dentists currently combining the use of the Macro 5 with the shade matching technique have been able to reduce their remakes to a negligibly low percentage—often times less than 2%.

How to Use the Macro5 for shade communication
The first step to successfully use photography for shade matching is to match as closely as possible a shade tab to the desired tooth. You should make this selection at the beginning of the patient’s visit, when the tooth is fully bathed in saliva—its most natural state. Once you have selected the shade tab(s) you are ready to use Dr. Walks “photo layering” technique.

Place the patient upright, with head propped. Position the lip retractors to allow the flash to illuminate the teeth without creating shadows— also eliminate the cheeks, lips and tongue from the photo field. Place the shade guide next to the tooth to be matched, incisal edge to incisal edge. To obtain a correct match, the facial surfaces of the tooth and the shade button should be on the same plane and parallel to the lens and flash so that they will receive equal illumination. Using the magnification dial on the top of the Macro5 dial in the “3X” magnification. This setting will fill the frame of the picture with a single tooth and shade tab.

Be sure to hold the camera with both hands to allow for maximum clarity and composition. Ideally you should take 3 photos at a different light setting for each. The light settings are very easy to use on the Macro5, just toggle the light setting indicator and take one photo at each of the 3 lowest light settings. Write the level of exposure on each print after allowing the photos to fully develop—usually four minutes. Send all three photos to the lab.

Include the shade tab in the photo—
this is a critical part of this technique. It is virtually impossible to capture a 100% color accurate photo in a dental operatory. Including the shade tab in the photo creates a reference point for the ceramist to evaluate the shade composition. The ceramist can use this to replicate the shade by comparing their shade tab to the restoration and achieving the similar relationship as the photo indicates.

Capture the fine details of a shade fast and accurately. If you want to go to the next level of detail with your shade communication there is a faster more accurate way to do so than the detailed shade mapping many of you may currently be using. Begin with your shade photo, then tape a plastic overlay (overhead projector film) to the photo, so that it flaps down over the image. Now you can use indelible markers on the plastic to “shade map”, identify colors in the photo, and write short notes with arrows. This allows you to be accurate but spend less time trying to position colors where they should be. It also helps the ceramist to see your map and the photo in relation to each other.

Remember when using Dr. Walk’s photolayering technique, the ceramist is not using the photos for shade information but to determine natural characteristics of the patient’s teeth, such as, translucent mapping, craze lines, simulated cracks, hypercalcifications and stains. By comparing all the photos, the ceramist can also obtain information about the internal structure of the teeth, including subsurface information.

Increased communication with your lab will not only provide your patient with a natural looking restoration and confidence in your skills but also decrease costly remakes. Incorporating new equipment with improved procedures will ultimately lead to your continued success and personal satisfaction with your caliber of dentistry.

David French has a wide range of experience in dentistry including: in-house technician in a busy restorative practice, owner of a small lab, technical sales for laboratory supplies and as a crown and bridge manager in a busy 35-man lab.

Currently, he is Senior Technical Advisor and Marketing Director at Burbank Dental Laboratory Inc. You can contact David directly at: 800-336-3053 or email him at BurbDental528@aol.com.

Resources

For a limited time, when you purchase both a Polaroid Macro 5 and the intraoral mirror kit, you receive a rebate of $100. The kit allows you to go from extraoral to intraoral photography by attaching the easy-to-use mirrors to the Macro 5. You can get up-close pictures of the entire oral cavity—without ever having to change cameras. For more information call 1-800-662-8337 ext. H092 or go to their website at: www.polaroidwork.com. Offer is valid through 12/31/01.

The Macro 5 is also available through PhotoMed, located in Van Nuys, CA. The company offers specially-priced packages that include the Macro 5, SLR, additional film, mirror attachments and Before and After smile folders. The folders are custom cut to perfectly frame two photos and there are cutouts on the back for your business card. You can contact PhotoMed directly by visiting their website at www.photomed.net or calling 800-998-7765. They will be exhibiting at both the upcoming ADA convention in Kansas City, MO and the Greater New York Dental Meeting in November.