Vous êtes sur la page 1sur 21

All C opyrig

eR

ht
CLINICAL APPLICATION ech
te

by
vo
rbe

Qu
ha
nt lte
n

i
e ss e n z
Esthetics and
Shade Communication:
A Practical Approach

Ernst A. Hegenbarth, MDT
Bruchköbel, Germany

Correspondence to: Ernst A. Hegenbarth
Zen Line Dental GmbH, Innerer Ring 1 d, 63486 Bruchköbel, Germany;
fax: 49 6181 740455; e-mail: hegenbarth@zenline-dental.com.

340
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 1 • NUMBER 4 • WINTER 2006

All C opyrig
eR

ht
HEGENBARTH ech
te

by
vo
rbe

Qu
ha
nt lte
n

i
e ss e n z
Abstract
Accurate shade analysis and communica- including information regarding the scien-
tion represent one of the biggest challenges tific basis of general color science, optics,
in restorative and esthetic dentistry today, and aspects of material science; and pro-
especially in light of the rapidly increasing poses a six-step approach to shade analy-
array of ceramic materials available. Tradi- sis in which less emphasis is placed on
tional methods of shade analysis have re- shade guide samples in favor of natural in-
lied upon the use of conventional shade ternal structures and surface properties and
guides or, more recently, digital shade their replication in different dentin, enamel,
measurement. In this article, the author ex- transparent, and colored translucent, as
amines the advantages and disadvantages well as fluorescent and opalescent,
of traditional shade analysis; reviews prin- ceramics.
ciples for optimizing the evaluation process, (Eur J Esthet Dent 2006;1:340–360.)

341
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 1 • NUMBER 4 • WINTER 2006

optical phenomena relat- ed to the natural tooth. It is doubtful that there 342 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . sensitivity. Traditional shade selection tween clinician and dental technician that methods is as fraught with imponderables as that of tooth color communication. data on the distribution and extension of translucency and even intuition in mixing materials and and opalescence of natural teeth. logical criteria. But beyond these rather scientific. broadening materials can possibly make all natural considerably the range of available ceram- tooth colors available as pre-formulated ic materials (Fig 1). other methods of shade selection and color matching must be found. The rapidly expanding market for dental er hand. the optical effect of the materials we use. But on the oth. There are no cut-and-dried solutions—the chal- lenge of reproducing natural tooth colors is certainly best met by a deeper knowledge of light and color. we should Fig 2 None of the current shade guide systems or not underestimate the importance of a pro- concepts is suitable for communicating to the ceramist fessional ceramist’s experience. as demonstrated by these laminate veneers on the maxillary central incisors. There is hardly any communication be. Since no manufacturer of ceramic new products in recent years. colors. driven by the increasing that has been as incompletely researched global demand for esthetic restorations. and systematic pro- cedures in shade selection and subse- quent ceramic buildup. mixtures. All C opyrig eR ht CLINICAL APPLICATION ech te by vo rbe Qu ha nt lte n i e ss e n z Fig 1 (a and b) Modern dental ceramics contribute considerably to the natural appearance of dental restora- tions. there is hardly anything in dentistry ceramic materials. as the true colors and textures of natural has seen the development of a number of teeth.

selection and the resulting new materials One of the few constants found amongst was expected to end the role of the tradi- most of the materials offered was their ref. Clark as early as to recognize the variety and the rich nu. Holst. is a dental professional who can claim market position as a common adjunct in even perfunctory knowledge of the dozens shade selection and color matching. ceramics by D. despite all permitting duplication of all tooth colors these attempts at individualization and its well-known shortcomings. a system for specifying the longer as important. name of Vitapan Classical) as a standard ta Lumin Vacuum shade guide. The question today is whether we have sis according to the dentist’s requests. and a formula for repro- and harmonic colors as well as the pa. 19314: ances characterizing a natural tooth’s col- or and to reproduce them in detail when 1. ter shade guide (Vita Zahnfabrik) for shade formed opinion.3 of new products in the ceramics field alone. Hegenbarth. actually fulfilled the prerequisites for solving ing whatever material was specified. The introduction of the Vitapan 3-D Mas- allowing the formation of his or her own in. All C opyrig eR ht HEGENBARTH ech te by vo rbe Qu ha nt lte n i e ss e n z a b Fig 3 The fulfillment of patients’ desires for beauty and naturalness in complex dental rehabilitations can best be met by metal-free all-ceramic restorations. Germany. us. A. these shade patterns on a day-to-day ba. It was the color problem in dental ceramics as not until recently that attempts were made postulated by Bruce E. natural appearance shade found. frame of reference. However. Hildebrandt and E. A corresponding range of pigments center of attention (Fig 3). For cre. Germany). A method for the visual analysis of tooth ative ceramists. Vita Zahn. Yet. Generations of young ceramists has always been one of the strongest crit- have practiced the fine art of replicating ics of established shade systems. tional system (still available under the erence to the classic Vita shade guide (Vi. (Case treated by PD Dr S. 2. University Erlangen.2. the Vita shade In 1979 Lemire and Burke5 wrote that the guides have maintained their dominant current means of shade selection were out 343 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . the author 1 fabrik). Basic knowledge of color science creating dental restorations (Fig 2). ducing this shade in ceramics tient’s individual wishes have moved to the 3. (a and b) Full mouth rehabilitation using Procera NobelRondo Alumina and Zirconia ceramics (Nobel Biocare). Bruchköbel. shade patterns are no shades.

Cynovad) are used to electronically measure dental shades according to conventional shade pat. which disal- lows any true vision of subtle shade nu- ances (Fig 4). quickly resulting in a preference for a very few specific patterns. prac- titioners will be guided in the direction of certain shade groups. The Vitapan 3-D Master shade guide is subject to the same problems. too. and did not utilize the current knowledge of light and color. Shade- 2. It is true that this shade selection system is organized more logically than the previous Vita Clas- sical shade guide. a This preference is not related to the actual incidence of tooth colors. Traditional. Variations on visual compar- ative shade selection using tooth- shaped patterns. Fig 5 (a and b) Spectrophotometers (eg. Here. and colors manifested in standard patterns. but rather a psy- chologically understandable desire to use certain shade patterns thought to yield rou- tinely good or at least acceptable results. even though these were long ago found deficient. Previous attempts at improving on con- ventional shade selection methods have followed either of two fundamentally differ- ent approaches: 1. The result is the develop- ment of visual habits leading to a mental fixation on the colors of well-known tooth Fig 4 Subtle details. internal characterizations. however. Color meas- Scan. The current author6–8 has previously noted that the field of shade selection continues to be dominated by traditional shade guides and patterns. used in dentistry are mechanical. uring systems and spectrophotometers terns. based on shade patterns that were not organized based on any visual system. Vitapan 3-D Master). Color measuring systems. In optical phenomena are rarely taken into consideration the observer’s brain. shade recognition is when using conventional shade guide samples. organized within the b three-dimensional color space in a log- ical pattern (eg. com- 344 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . All C opyrig eR ht CLINICAL APPLICATION ech te by vo rbe Qu ha nt lte n i e ss e n z of date and incomplete. unilaterally limited and restricted to the on- ly available shade patterns.

electronic tools first. the value is determined analysis. R. thus postulated. This value leads to one of five equidis. However. following two factors: (1) Vita shade guide’s rameters needs to be supplemented by a specific color system makes correct color fourth—optical light transmission. Even mined group. this set of three-dimensional pa. Available publications on this whole spectrum of visible light is creat. the (reddish or yellowish) computer-defined ceramic formulas have 345 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . as opalescence and fluorescence. of the classic Vita shade guide and devel. They contain light-emitting diode said to be logically arranged in a “natural (LED) light sources with a special design tooth color space” determined by scientif- for each wavelength of light so that the ic criteria.12 Howev- tralian dentist and material scientist N. may be defined as the ratio range of colors present in natural teeth. Yamamoto. cannot measure optical phenomena such tant shade value groups. This results in a total of 26 patterns (Fig 5). guide as the foremost obstacle to precise cause natural teeth are partially permeable shade analysis. published in Australia as early as tems are based on conventional shade 1991. value. The internal com. Images of hue. In earlier publications the current author oped a concept based on a logical system has pointed out that no computer in the of arranging colors and a tooth color atlas world can take the individual work habits with evenly distributed colors. given fixed light source. among others. chroma. guides with all their shortcomings. between the visible light passing through there is no method to evaluate and repro- an object and the total incident light from a duce colors outside its range of coverage. the by light. called transparency or shade guide does not cover the whole translucency. All C opyrig eR ht HEGENBARTH ech te by vo rbe Qu ha nt lte n i e ss e n z puter-assisted devices that electronical. are considered the scientific founda. An ori- tion of the Vitapan 3-D Master shade entation on natural teeth and the different guide. Ya- Aspects of relative translucency and rel. In this new of a ceramist into consideration in its group orientation. mamoto was in favor of the dental col- ative opacity are not sufficiently addressed orimeter (M1863d dental colorimeter) de- by any of the shade selection methods veloped by Shofu and Minolta in Japan for 10 mentioned so far. Studies by the Aus. and chroma). er. three-dimensional Munsell color system Yamamoto also cited the classic Vita shade (hue. Furthermore.12 In describing 9 mappings (Fig 6). value. A charge-coupled device (CCD) crete explanation of the scientific basis of sensor reads data within the range of the natural color space for human teeth about 400 to 700 nm. This assessment difficult and (2) since the Vita optical property. electronic shade measurement. puter analyzes over 2 million reference This situation contrasts with that for points. most of the technological shade sys- Hall. the electronic measurement methods pre- and translucency are created in different sented by M. Within the deter. he stated that visual assessment Both of these approaches are based on the was unreliable. chroma and hue are then determined vi- ly determine the shade of natural teeth sually.11 Hall described the shortcomings ceramic materials would be an advantage. Because of these uncertainties. sources of potential errors in visual shade selection. new shade system do not offer any con- ed. regardless of the observer. listing. be.

All C opyrig eR ht CLINICAL APPLICATION ech te by vo rbe Qu ha nt lte n i e ss e n z a b c d e f g h 346 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 .

14 Color exists only as a sensual percep- Natural tooth properties tion. All C opyrig eR ht HEGENBARTH ech te by vo rbe Qu ha nt lte n i e ss e n z to be mixed and built up. perception of tooth color is a highly sub- dure for approaching this difficult problem. It is not possible to assign Both electronic measurements and visual natural teeth to any set color categories shade selection claim to determine hue. jective process. in this can they be determined objectively. or stimulus will vary depending on the Tooth colors are not really constant. imaging techniques. al Sloan-Kettering Cancer Center in New York discovered the brain’s image-pro- cessing center by observing local varia- Principles of optimal tions in the bloodstream and oxygen con- centrations during image perception and color analysis processing. and value of a tooth. see” using functional magnetic resonance tographs in order to include individual de. value. and chroma. but color is created in the tion for natural teeth illustrate that there still visual center of our brain. physiological and neurological process of cation. through (transmitted). do not see color. If was not until 1995 that American re- electronic shade measurements are tak. This is why the is no generally accepted standard proce. we The various approaches to shade selec. on the nature of the incident light. they should be supplemented by pho. that is. tific enigma. since color nuances will vary depending chroma. 347 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . The age of global cooperation and communi. In this flurry of colors stimulus. Some sys. Part of tems also include translucency to some the light reaching a tooth will be absorbed. whose vi- and color perception sual organ is only an accessory.13 It to come into increased use in the future. nor spectral composition of the incident light Fig 6 Natural left central incisor and Procera crown on the right central incisor (a). degree. searchers were able to “watch the brain en. The color nuances perceived are and optical phenomena. and the psychological as- Electronic transmission of CAD/CAM da. tooth and perceived by the eye as a color or variations (Fig 7). However. The spectral composition of this col- determining and organizing tooth colors. the tooth’s individual while another part is allowed to pass characteristics remain largely beyond con. it is obviously thus only a residual portion of the incident very difficult to derive any regularities and light that reaches our eyes by way of the rules that could serve as a foundation for tooth. The team at Memori- tails in the restoration. Light that is not ab- sideration. in the eye of the beholder. but a slight deviation in the translucency at the incisal edge of the crown (d and h). The study of natural teeth shows sorbed or transmitted is reflected by the an almost unlimited array of possible col. Spectrophotometric meas- urement of the crown (b to d) and the natural tooth (e to h) show an almost perfect color match regarding hue. pects connected to our ability to perceive ta and electronic shade selection is going color can hardly be underestimated. dentistry is making use of digital color vision itself continues to be a scien- photography and Internet communication. However.

Knowledge of the optical properties of temperatures of 5. making them worthy of anced color harmony and color nuances by further investigation. is to imitate the study of optical phenomena and structures within the structure of natural teeth and create bal- the different layers of a tooth. and absorption and light contrasts and individual characterization. Light reflection from the surface. Tru- shade.500 K) is con. Basic knowledge of color science (hue. etc) 348 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . refraction within the enamel. translucency. opales- al organ possesses adaptive mechanisms cence. Two lamps with adjustable illumination intensity arranged at an angle of 45 degrees to eliminate specular reflections and a coated lens with 2x magnification conform to color meas- urement standards (Fig 8). and chroma) corresponding artificial light source (color 2. discol- certain degree. the use of a standardized light source for shade selection and color matching in dental ceramics remains a requirement. in Fig 7 Cross sections of natural teeth lead the way to addition to reproducing the hue. for differences in ambient orations. Nevertheless. secondary dentin. natural teeth (optical scatter and refrac- sidered ideal for shade selection. to a (mamelons. The systematic approach to color analysis presented later in this article requires a planned and logical procedure. There are a during shade selection. All C opyrig eR ht CLINICAL APPLICATION ech te by vo rbe Qu ha nt lte n i e ss e n z light conditions by ”re-tuning” the retinal receptors. fluorescence.500K) and a high linear optical trans- mission in the visible range guarantees uniform light conditions. Tooth colors can number of prerequisites: only be compared if ambient light condi- tions were identical when the colors were 1.000 to 5. Optident). transmission add to the complexity of this subject. A small portable light source with a broadband spectrum of light (5. Our visu. Study of the tooth’s internal structures steady average. In order to create a color-corrected environ- ment independent from other artificial light sources new devices were developed with a constant color temperature (eg. Shade selection for metal-free restorations The objective in dental shade matching. determined. thus compensating. etc) that attempt to adjust incoming stimuli to a 3. This is why colors can still be judged fairly adequately despite differ- ences in lighting conditions. tion. Neutral northern daylight or a value.

laminate veneers. Expe. eg. Even the var- thus far are being used. 4. sideration.500 K) and 2x mag. regardless of the ious degrees of light transmission of differ- type of restoration to be provided. nonvital teeth or posts and cores. All C opyrig eR ht HEGENBARTH ech te by vo rbe Qu ha nt lte n i e ss e n z a b Fig 8 (a to c) Trushade artificial light source with color-corrected dimmable light (5. ramist’s work habits. but also the individual ce- ceramics. The peculiarities of the materials ferent types of restorations such as metal to be used. restorative procedure contemplated. case of metal-free restorations the color of of-pearl effects) the substrate. also may influence the optical All shade selection methods described appearance of a restoration. to be given more attention. Whether ent core materials must be taken into con- the shade selection can be identical for dif. 349 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . or all-ceram. tion is best obtained by shade selection ding ceramic materials modalities individually tailored to the 5. are factors that need ic crowns remains open to question. In face properties (eg. Knowledge of the texture and structure rience has shown that accurate informa- of dental enamel and the correspon. c nification. Knowledge of the optical results of sur. multi-hued mother.

High Value. er. The use of digi. ture (CAD/CAM) all-ceramic system.18–21 will be presented using the reproduction. Light. Novoflex ages obtained and the conclusions drawn flash holder) allows individual positioning of may vary greatly depending on the type of the two flashes. The rendition of tooth camera and flash used. Howev. The following procedure for shade commu- tal images is greatly enhanced by calibrat. contrasts. nication. on the film mate. Six steps for successful tographs are practically indispensable for shade analysis creating structures. Nikon Macroflash) provide images ered one of the less reliable adjuncts for with a more three-dimensional appear- reproducing the shades of teeth. and the mode of processing. The well-established shades or mixtures and characteristics. Novoflex flash holder). incrementally. and Low 350 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . (Super Bright. porcelain as an example of a computer- proved communication between dentist aided design/computer-assisted manufac- and ceramist. Photographing shade pat. Using terns on their transparent discs along with this method. Canon Macro Twin Light. brightness is more constant in the manual rial. mode (M) and an aperture stop f22.15 Pho. Intraoral digital photography equipped with a 100-mm macro lens with and color communication a twin flash system (eg.16. The im. Procera system and the new NobelRondo The primary advantage of images is im. Digital single lens cameras Sunny Chroma. ance.17 A special flash holder (eg. and individ- ual crown characteristics. Warm Chroma. tography (Fig 9). digital photography combined with dig- ital shade measurement tools may play a more prominent role in the future. which is easily applicable to daily ing the computer monitor for correct color practice. of the classical Vita shade guide are ar- A high-quality digital camera system is ranged logically into six new shade groups recommended for professional dental pho. shade analysis is performed the teeth gives a clearer indication of col. All C opyrig eR ht CLINICAL APPLICATION ech te by vo rbe Qu ha nt lte n i e ss e n z a b Fig 9 (a and b) Digital photography with a lateral flash system enables the reproduction of high-quality im- ages with reasonable color accuracy (Canon 10D. Canon Macro Twin Intraoral photography is usually consid. Pearl Chroma.

The ceramist fa- main characteristics of the shade groups miliar with high-chroma porcelains will are expressed in their names (Fig 10): Su. Vi. tizer Sunny Chroma 10%–20%. transparent. their limitations. 351 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . Experience has shown that spontaneous ed in the basic kit in order to fulfill modern selection of a shade group and basic hue patients’ desires for brighter or lighter with conventional shade guides within the teeth. Basically the six steps follow the way must be recognized and interpreted cor- a ceramist will build up a crown—from the rectly. These differences cept. Dentin B3 + Chroma- Low Value (C1 to C3). will frequently confirm the accuracy of the tient that should be the focus. Sunny Chroma rial (eg. D3). which opalescent. Step 3: Variations tal-looking all-ceramic restorations require in color intensity or chroma procedures in which less emphasis is Variations in chroma between a shade pat- placed on shade guide samples in favor of tern and natural teeth are relatively fre- natural internal structures and surface quent. and Chroma 10%–20%. ceramics. they can rely on visu- dentists. inside to the outside. are made of the actual material and mounted on transparent trays. not a strict ori. but also by the patient’s prefer. crease in chroma can be documented by ence. High Value (A1. B0). the conventional major player and is involved in a specific shade guides should still be consulted—it way. The shade registration form. The necessary in- shades). which leads to the next logical step. A com- translucent. The patient is a al experience. Pearl Chroma (D2. add between 5% and 20% of a chromatiz- per Bright (A0. with the nat- Step 1: Shade group selection ural tooth demonstrates this more clearly The selection of a shade group is not only than a comparison with conventional determined by the characteristics of a shade guides. Even surface charac- teristics are implemented in this method. However. rienced ceramists or dentists will not even garding dental esthetics amongst patients. Thus psychological aspects are im. shade pattern selected. Dentin A3 + Chromatizer Warm (B2 to B4). It is the esthetic expectations of the pa. as well as fluorescent and parison of the dentin shade patterns. the clinician will often discover differences ital photography and image communica. Sometimes chroma must be en- properties and their replication in different hanced by adding some chromatizer from dentin. B1). between the tooth and the closest available tion can be integrated simply into the con. The increasingly popular bleached Step 2: Basic hue e ss e n z shades (Super Bright) are already includ. er. enamel. harmonizing the hue to the body mate- Warm Chroma (A2 to A4). All C opyrig eR ht HEGENBARTH ech te by vo rbe Qu ha nt lte n i Value). Dentin D3 + Chromatizer Pearl Chroma). On closer observation. which are made of a differ- shade (eg. Modern possibilities of dig. Of course. expe- opening new paths of communication re. and colored the corresponding shade group. first 20 to 30 seconds usually provides a The six-step shade evaluation method is good starting point (Fig 11). hue spontaneously chosen by freehand entation to traditional color designs with all selection. however. Warm Chroma for A2 to A4 ent material (Fig 12). and ceramists. checking the corresponding box on the plemented into this concept as well. need a shade guide.

Any discoloration detected at the in- during its life. discolorations. mamelons. organized as dentin. enamel. by the changes it undergoes 13). modifier. At this stage. c Step 4: Internal structures character of a tooth is determined by sub- The first three steps primarily addressed tle internal structures deep inside of the the basic dentin shade and its modifica. This is a functional aspect cisal edges during shade selection should that must never be neglected. A tooth’s character is determined. to ceramic samples of internal modifiers (Fig a large extent. will be selected carefully with the original ered. Internal characteristics like tions. internal tooth character. The natural be addressed. corresponding to the arrangement of the bottles on the tray (c). Sketching these incisal 352 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . or stain (a and b). All C opyrig eR ht CLINICAL APPLICATION ech te by vo rbe Qu ha nt lte n i e ss e n z a b Fig 10 The NobelRondo ceramic shade tabs are arranged on six transparent disks. or wear facets istics and tooth structures must be consid. tooth or crown.

the shade registration form gives the ce. tween black/dark and white/bright. translucency. Within the three-dimensional color space ering of these structures. characterizations on the tooth outline on Step 5: Value. being semi-translucent objects. Ivory determining the basic dentin shade and variations in and Flamingo for mamelons) are useful for determin- color intensity (chroma). a of a color scale. and contrasts ramist important information about the lay. Fig 12 The ceramic samples provide accuracy for Fig 13 Samples of the internal modifiers (eg. Teeth. enamels. 353 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . however. depth layering). All C opyrig eR ht HEGENBARTH ech te by vo rbe Qu ha nt lte n i e ss e n z Fig 11 Spontaneous visual selection of the shade group (Warm Chroma) and basic hue (A3) using a common shade guide. value is usually expressed two-dimensional drawing assists in a in grayscale terms. that is. ing internal characterizations. on a scale be- crown’s three-dimensional design (ie. In this manner.

An it is possible to obtain well-defined inter- increase in value (high value) may be cre. it is important transparent porcelains of the NobelRondo 354 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . transparent. Transpa Neutral. making the crown appear Special Enamel Smoky. deserves special attention since it refraction factors of the natural tooth enam- cannot be captured using any of the con.65. form. All pearance or shows colored transparen- these examples clearly demonstrate that cy—all these factors can substantially influ- we cannot look at one aspect of color in ence the overall appearance of a dental isolation. to understand that this constitutes an at- serving optical phenomena (more light or tempt to increase the overall range of avail- less light) must be at the center of attention.5 and that of natural enamel ations. ceramics is 1. this (is brighter). the col- This system of dentin modifications is ored translucencies (eg. variations in chroma). porcelains may interact. value. personal tooth’s relative opacity or translucency. All C opyrig eR ht CLINICAL APPLICATION ech te by vo rbe Qu ha nt lte n i e ss e n z should not be forced into a grayscale. These examples show how the var- ing master kit modifiers with a low value ious body. This is Translucency. The enamel patterns of the No- are always interacting. This chromatizers and transparent materials means that the value of a ceramic materi. Pearl. Translucency opalescent materials (eg. CT Pa- not a set of recipes for reproducing exist. and intensifier (eg. able tooth colors by a considerable mar- Brighter means more reflected light. however. Whether the enamel layer is thick- cency by adding Transpa Opal or Transpa er or thinner. harmonically adapted to the selected hue. Chroma. In general. com. also Mother-of-Pearl lain (up to 30%)—a much more frequent materials from NobelRondo porcelains) to occurrence. belRondo ceramic color patterns. Opal Enamel 0 is increased by adding transparent porce- or Opal Enamel 1. CT Lemon). mediate shades (ie. A decrease in value transparent porcelain to the body without (low value) may be obtained by adding first modifying its chroma may result in re- transparent materials (eg. Opacity is increased by using more fluo- als inside the crown or by using strongly rescent inner core material. ated by adding bright fluorescent materi. while gin. whether it has a higher value Clear to the dentin porcelain. The refractive index of translucency (low opacity) are many vari. duced value. Caramel). that adding the body porcelain. Note. paya. and translucency restoration. Here. too. or Grey) or by us. CT Melon. and the opalescent and ing shade patterns. The enamel layer above the dentin is of Using internal modifiers or highly decisive importance for the optical appear- opalescent enamels will influence the ance of the tooth (McLean JW. el on the one hand and those of our ce- ventional shade guides. By adding suitable amounts of darker means more absorbed light. September 1998). Ob. whether it is grayish in ap- may lead to a slight decrease in value. Between low ramic materials on the other is most translucency (high opacity) and high painfully obvious. Rather. darker. however. is 1. al is influenced by certain optic effects. we can increase translu. Taiga. the fourth dimension of tooth where the difference in structures and light color. Clinicians and ce- munication is simplified by placing a ramists are strongly encouraged to con- checkmark on a scale between Low Value duct their own trials including the firing of and High Value on the shade registration samples of the porcelain mixtures. communication.

To increase the illu- sion of more concavity on the distal aspect light. Contrasts such as bright spots. Oyster White. Mechanical surface of the respective object in different surface treatment using different polishes regions of the visible light spectrum. or pronounced bluish opalescent regions in the tooth’s in- cisal third can also be captured using the original ceramic shade patterns (eg. The color of permits an optimized surface structure opaque objects is determined by the ex. Spe- cial Enamel Opal Blue. Light Coral. The ultra-fine parti- el. If. All C opyrig eR ht HEGENBARTH ech te by vo rbe Qu ha nt lte n i e ss e n z basic kit as well as the opalescent Mother- of-Pearl modifiers (eg. ate enamel structures have a considerable tween the surface structure of a tooth and influence on their optical appearance. and opalescence. characterizations. exposed root segments. structure of the NobelRondo porcelains ly scant attention to date. however. If particles are before leaving the object again as diffuse used whose refraction index is high (eg. highly opalescent material like Oyster White because of the light-reflecting character of this specific material. more highly structured or rougher surfaces faces. Minor pear to have a matte finish. only an illusion in the case of only be performed to achieve a particular translucent objects such as dental enam. resulting in a high degree of gloss (glaze). the re- and gloss sult is greater light refraction. The interaction appear more prominent by using a bright. Opal Blue Light). type of surface gloss. Pale Shell. by contrast. A Fig 14 The correct selection of enamels will lead to mesial line angle of a central incisor may better control of lightness (value). Still ances and characteristics of the tooth sur. cles included in the ceramic materials in- ject to some extent and is refracted by the fluence both the absorption and the refrac- microscopic structure of the substances tion of the incident light. so that it ap- The next step is to determine the color nu. between these aspects should not be overlooked. Objects whose surface is even when of a crown. Surface staining techniques should with a lower degree of glossiness will ap- be restricted to exceptional cases. may well en. the surface of Step 6: Surface structure the object is more highly structured. since the light does in fact enter the ob. of different ceramic materials used to cre- It is regrettable that the connection be. very directly. The its optical appearance has been given on. pears semi-glossy or semi-matte. Particle sizes and light refraction indices hance the illusion of a natural-looking crown. This will become an exceptional step and will is. and Pink Pearl) from the master kit help capture many enamel vari- ants quickly and easily (Fig 14). translucency (amount of light transmission). colored translucencies in the tooth’s cervical third. 355 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . however. colored translucencies with seen through a microscope will reflect light more light-absorbing quality can be used. through proper firing cycles and its ex- tent (quantity) of light reflected from the tremely fine grain structure.

Enamel 3. (f) NobelRondo shade communication form. (l to n) Dental esthetics has many individual aspects. form. restorations. and also patience and understanding in the event that perfect success is not imme- diate—all these will result in more success- ful results in dental esthetics. introduction of the Procera system. (h) The provided shade information guides the ceramist in the creative ceramic buildup. clinician. Germany. ceramics by D. and the patient is our focus. (c) More reliable determination of the basic shade with NobelRondo dentin samples (A1. (j) Marginal fit. A subtle reduction in glossi. Excessive glazing or polishing of a operation with clinicians abroad has crown will result in restorations that tend to shown that the system is practical. A. (e) Selection of enamels (Opal Enam- el 2. The translucency. (i) The four Pro- cera alumina crowns veneered with NobelRondo alumina ceramics after glazing. since more light will be trans. Successful co- crown. Conclusion aluminum oxide = 1. for instance. the patient him. All C opyrig eR ht CLINICAL APPLICATION ech te by vo rbe Qu ha nt lte n i e ss e n z refractive index of zirconium oxide = 2. Opal Enamel 0. mitted and absorbed in deeper layers of optics. procedures and image communications. Fig 15 (a) A patient presented with four insufficient porcelain-fused-to. Bruchköbel. and color reproduction are verified at try-in of the crowns. translucency. (d) Selection of internal structures (Ivory internal modifier). value. function. texture. Wetzlar. With the Enamel 1. which also includes information on hue. high-quality photographic al angle and using black-and-white film. Opal Blue Light).metal crowns.8). The best way of A spirit of cooperation between ce- showing the surfaces of models or crowns ramist. as the ceramic restoration. and the crown will appear The system of shade selection presented brighter. tem. Another plementation of the shade selection and way of highlighting the surface structures is color-matching concepts for metal-free by taking photographs from a slightly later. A2). Opal ative Color system he developed. Meyding. Germany. well as the development of a logical sys- The examples given show how the sur. Hildebrandt and E. consistent im- is to use a silver or gold powder. Digital images can be printed on this simple form. and surface characteris- tics. Utilizing non. even if look unnatural. and patient.) 356 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 . Mother-of-Pearl). scientific basis of general color science. strong light reflec- tion will result. chroma. (Case treated by Dr C. (k) The Procera crowns from the lingual as- pect after cementation. tures) yields better results.or herself was unavailable ness using a felt wheel and somewhat for shade selection or shade adaptation in coarser polishes (porcelain/pumice mix. (b) Initial shade selection us- ing the classical Vita shade guides. the laboratory. this ba- opalescent enamels and Transpa Neutral sic concept was developed further and will lead to a lower value and higher adapted to all-ceramic restorations.3. Hegenbarth. Her chief complaints were gingival recessions and the discoloration and unnatural appearance of the crowns. The importance of ethical aspects and the beauty of a happy smile can never be underestimated. (g) The individual CAD Procera densely sintered alumina copings have excellent fit and optimized translu- cency. here (Fig 15) is based on the author’s when using strongly opalescent enamel many years of experience with the Cre- porcelains (eg. laid the groundwork for making the face structure will influence the value as NobelRondo shade registration fit for well as the opacity and translucency of a everyday clinical practice. This is the case. and aspects of material science.

All C opyrig eR ht HEGENBARTH ech te by vo rbe Qu ha nt lte n i e ss e n z a b c d e f 357 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 .

All C opyrig eR ht CLINICAL APPLICATION ech te by vo rbe Qu ha nt lte n i e ss e n z g h i j k 358 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 .

All C opyrig eR ht HEGENBARTH ech te by vo rbe Qu ha nt lte n i e ss e n z l m n 359 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 1 • NUMBER 4 • WINTER 2006 .

Paul S. Berlin: Quin. Hegenbarth EA. Ceramic Color: A Practical Shade Matching and Commu.3:25–27.29:285–296. Burke B. Procera alu- 3. Devigus A. Preston JD. Mastering Digital CL. 1931. Bengel W. dont 1991. An analysis of tooth matching. Hegenbarth EA. 2004. DeLaPaz RL. Hirsch J. spectrophotometric shade Quintessence. 18. Sadan A. 360 THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 01 • NUMBER 01 • JANUAR 2006 .5:41–46. The Develop- color production in dental London: Hatto & Winous. Hall NR. Groh 9. BR. 15. Creative A. Prepar- 2. 12.81:577–582. 2006. way to achieve stability. O’Brien WJ. Mieleszko ic results utilizing a new high- 8. Tooth colour selec.16:47–58. issue):26E–40E.die vierte Farb. ment of NobelRondo™—Aes- porcelain [in German]. Color com.92:6469–6473. Yamamoto M. References 1. Quintessence J oder Vielfalt – die Problematik visual cortex: Evidence from Dent Technol 2004.4:45–50. Chu S. 5.115(special Transparenz . Procera: A new way to tessenz. Odén A.10(suppl):4–9. Dent 1998. Quintes. Organizing color in Dent Res 2002. Visual and Dental Photography. Andersson M. Chicago: Quintessence. Hegenbarth EA. Bengel W. Proc Natl Acad Sci simplified and practical senz Zahntechnik U S A 1995. Current status of technik 1993. Fundamentals of Color: strength all-ceramic system. 2006. Scholten I. Int J Prostho. ing images for publication: Part dentistry. The Art of Seeing. J Am Dent Assoc 1991. es presented in this publication. 1996:19:21–34. Farbe Entwicklung des Vintage-Halo. 6. Miller L. preci- matching.19:1091–1109. Hegenbarth. Huxley A. 20. dimension. Boenke KM. innovative Keramikwerkstoffe. 1998. All C opyrig eR ht CASE REPORT ech te by vo rbe Qu ha nt lte n i e ss e n z Acknowledgments The author would like to express his gratitude to the cre. Hegenbarth EA.2:502–516. Pract Periodontics Aesthet System. J Am Dent Assoc 10. Peter A.18:2093–2103. Die 19. Science and Ergonom- Dent 1982. Aust Prosthodont J sence Dent Technol color. ics of a New Generation of 7. analysis of human teeth. Hegenbarth EA. 16. Pietrobon N. Lang und Zahnersatz. 1943. Lemire PA. sence. konventioneller Farbsysteme in functional magnetic resonance 21. laboratory. Monotonie vate specific regions in human Ceramics. Illusory contours acti. Relkin thetics. 1998. EA. Devigus A. 2. NR. science to dental colour ceramic restorations. Hegenbarth EA. Eur J Esthet Dent 1987. Color selection and 13. Quintessence Int munication between office and Berlin: Quintessenz. CCS-Systems—Computerges. Zena RB. imaging. J 17. method for optimizing aesthet- 1992. A der Dentalkeramik. Quintessence Int tion: The application of colour sion and esthetics in all- 1985.1:112–127. Razzoog ME. Quintes- 4. London: shade guides. et al. Chicago: Quintes. teuerte Farbbestimmung und achieve an all-ceramic crown. cians supporting the documentation of the clinical cas- ative team of ceramists in his laboratory and to all clini. 1989. Clark EB. Hegenbarth EA. Quintessenz Zahn.18:1303–1323. nication in Esthetic Dentistry. Swiss 14. Coverage errors of two Haemmerle CHF. minum oxide ceramics: A new shade selection and color 11. 1979.