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RESEARCH ARTICLE

The Effect of ColorTraining of Dental Students’on


Dental Shades Matching Quality
AFNAN F. ALFOUZAN, BDS, MS*, HUSSAM M. ALQAHTANI, BDS†,
ESAM A. TASHKANDI, BDS, MS, FDS RCS, PhD‡

ABSTRACT
Objective: To assess the effect of color training on the dental shade matching quality of dental students of both gender
and to study the need to include lectures and exercises about shade selection in the undergraduate dental
curriculum.
Materials and Methods: One hundred and twentyjunior dental students from the College of Dentistry at King Saud
University participated in the present study and were distributed randomly into four testing groups.They were asked
to match the color of four target shade tabs from theVITA Linearguide 3D-MASTER.Group1attended a brief lecture
and a training exercise about dental shade matching,Group 2 only attended the lecture, and Group 3 only performed
the training exercise.Group 4 did not participate in the lecture or the training exercise and served as a control.Exact
matching rates were calculated and analyzed to determine the pre- and post-test matching values.Three way
repeated measures analysis of variance, paired ttest, and independent t-test were used to compare shade matching
quality, with a signif|cance level of p < 0.05.
Results: There was a signif|cant difference between the pre- and post-test values for the students’dental shade matching
qualities for all of the test groups.
Conclusion: The effectiveness of the dental shade matching training about color and dental shade matching for improving
the students’shade matching quality was proven for both genders.

CLINICAL SIGNIFICANCE
Training can improve shade matching quality of dental students.
(J Esthet Restor Dent 29:346^351, 2017)

INTRODUCTION (brightness), and chroma (saturation).3,4 No single


tooth is of uniform color; therefore, shade selection is
The demand for esthetic dentistry in clinical practice is a crucial step in the success of definitive restoration.
consistently increasing.1 The esthetic result of dental Traditional shade selection under ideal conditions is a
treatment is influenced by the shape, form, and color subjective assessment, even among experienced
of the final restoration.2 clinicians.5–7 Culpepper and colleagues found that
dentists disagreed about shade matching for the same
Color is usually described according to the Munsell tooth and that individual dentists could not duplicate
color space system in terms of hue (color), value their shade selections on different days.5

*Assistant Professor, Department of Prosthodontics, King Saud University, Riyadh, Saudi Arabia

Teaching Assistance, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
`
Associate Professor, Department of Prosthodontics, King Saud University, Riyadh, Saudi Arabia

346 Vol 29  No 5  346^351  2017 Journal of Esthetic and Restorative Dentistry DOI 10.1111/jerd.12284 V
C 2017 Wiley Periodicals, Inc.
EFFECT OF COLOR TRAINING Al-Fouzan et al

Recent advances in color matching have been driven Any subject who presented color vision deficiency was
by market demands for high-quality esthetic excluded from the study.
restorations. Furthermore, improved shade guides, the
availability of shade-taking devices and research in the All of the students (n 5 120) were asked to match the
area of human color vision have improved the color of four target shade tabs from the VITA
potential for achieving excellent color-matched Linearguide 3D-master (3D; Vita Zahnfabrik, Bad
restorations.8 Because of the subjective nature of Sackingen, Germany). Four predefined shade tabs
perceptual shade matching, the ability to match shades (2M2, 2R2.5, 3M3, 4R1.5) were labeled with a specific
is acquired through knowledge of basic color principles symbol, and their specific shade designations were
and clinical experience.9,10 concealed with masking tape. These shades were
specifically selected to be distributed evenly within the
A recent survey found that only a few dental schools shade guide color space.
teach the fundamentals of color science in their dental
curriculum. Generally, dental students and most The students were instructed to first select the group
clinicians are not familiar with visual color analysis and (value) from the first toothguide holder, which
are often unable to adequately describe the perceived contained 6 tabs, and to then select (chroma) and
tooth color and appearance to dental laboratory (hue) within the chosen group (1–5) of toothguide
technicians.11 holders, which contained 7 tabs. Shade matching was
performed using a GTI D65 color-corrected, light-
The purpose of the present study was to assess the viewing booth (model PDV-2e/M, Newburgh, New
effect of color training on the dental shade matching York) with 6,500 k. One subject was allowed in the
quality of dental students of both gender and to study test room at a time to prevent influence from the
the need for dental students to participate in lectures other subjects. No specific time restriction was given
and exercises regarding shade selection. The null for the shade matching procedure, and all of the
hypotheses tested were first that color training has no subjects completed the shade matching procedure in
effect on dental students of both gender on their the same room under the same conditions. If
dental shades matching quality and second that there necessary, the subjects were asked to rest their eyes by
is no difference in the effect of training with lectures looking at the neutral grey viewing booth walls for a
and/or exercises on the dental shade matching quality. few seconds.

Upon completion of the pre-test, the subjects were


MATERIALS AND METHODS randomly distributed into the four study groups (the
intervention). The first group attended a brief lecture
The ethical committee of the College of Dentistry about color and dental shade matching and was asked
Research Center (CDRC) at King Saud University, to perform a dental shade matching exercise every
Riyadh, approved the study, and the study was week for three consecutive weeks (Group 1, n 5 30, 15
conducted in accordance with the principles of the males and 15 females). The second group attended the
Helsinki Declaration. One hundred twenty dental same lecture as Group 1 but did not perform the
students (60 female and 60 male) participated in this weekly exercises (Group 2, n 5 30, 15 males and 15
study. The students were in the third year of a five- females). The third group performed the dental shade
year dental program at the College of Dentistry at matching exercises once a week for three consecutive
King Saud University, Riyadh, Saudi Arabia. The weeks but did not attend the lecture (Group 3, n 5 30,
average age of the students was 21 years. 15 males and 15 females). The fourth group did not
attend the lecture or perform the dental shade
All of the subjects were screened for color vision matching exercise (control; Group 4, n 5 30, 15 males
deficiency using the Isochromatic Color Vision tests.12 and 15 females). On the fourth week, the original

C 2017 Wiley Periodicals, Inc.


V DOI 10.1111/jerd.12284 Journal of Esthetic and Restorative Dentistry Vol 29  No 5  346^351  2017 347
EFFECT OF COLOR TRAINING Al-Fouzan et al

TABLE 1. The effect of dental students training groups (intervention) time (before and after) and gender (male and female) on shade
matching quality value
Source Type III sum Degrees Mean F p
of squares of freedom square
Time 1430.817 1 1430.817 39.340 <0.001

Gender 0.017 1 0.017 0.000 0.987

Intervention 647.900 3 215.967 3.337 0.022

Time * intervention 256.150 3 85.383 2.348 .076

Time * Gender 299.267 1 299.267 8.228 .005

Gender * intervention 131.283 3 43.761 0.866 0.460

Time * intervention * 222.233 3 74.078 2.037 .113


Gender

shade matching experiment was repeated by all of the were used to report the statistical significance and
subjects. Correct matches were calculated based on the precision of results.
best-matching shade guide method described by
Paravina, in which the best-matching shade tabs were
ranked from 10 points for the best match to 1 point RESULTS
for the tenth-best match.13
Table 1 shows the effect of time, where a highly
statistically significant change in shade matching
Statistical Analysis quality values was observed at before and after
intervention (F 5 39.340, p < 0.001), significant
The data were analyzed using Statistical Package for difference in the shade matching quality values among
the Social Sciences software (SPSS Version 21, different student training groups (intervention) (F 5
Chicago). Descriptive statistics (mean and standard 3.337, p 5 0.022) and no significant difference between
deviation) were used to describe the quantitative male and female subjects in relation to their
outcome variable (shade matching quality). Three-way assessment of shade matching quality values. There
analysis of variance of repeated measures was used to was statistically significant change in the values of
observe the effect of intervention (dental students shade matching quality, which was observed at before
groups) and gender on the outcome variable (shade and after intervention and difference due to the type of
matching quality). In the model, the intervention intervention and no gender effect there was a
groups and gender were considered as between- difference in the values of shade matching quality. The
subjects factors whereas time (before and after) as interaction between type of intervention groups and
within-subjects factor. Student’s t-test for paired time was toward statistically significance (F 5 2.348,
samples was used to compare the mean values of p 5 0.076). This was due to interaction between time
(before and after) outcome variable in male and female and all groups together, which indicated that the
study groups. And Student’s t-test for independent change in shade quality was not statistically significant
samples was used to compare mean values between across all the four groups. But there was an interaction
male and female student groups at before intervention between gender and time (F 5 8.228, p 5 0.005). And
and after intervention. A p-value of 0.05 also a there was no interaction between gender and type of
Bonferroni correction with a new p-value for multiple intervention (F 5 0.866, p 5 0.460) also non-
comparison was used. The 95% confidence intervals significant interaction in the mean values of shade

348 Vol 29  No 5  346^351  2017 Journal of Esthetic and Restorative Dentistry DOI 10.1111/jerd.12284 V
C 2017 Wiley Periodicals, Inc.
EFFECT OF COLOR TRAINING Al-Fouzan et al

TABLE 2. Comparison of mean values of shade matching quality between male and female study subjects at before and after
intervention
Time Gender Difference p-value 95% Confidence
interval for
Male Female difference of mean
Before 26.90(7.1) 24.65(7.6) 2.25 0.096* 20.41,4.91

After 29.55(7.2) 31.77(7.3) 22.22 0.097* 24.84,0.41

*> 0.025 (Bonferroni corrected level of signif|cance‘‘a’’)çStatistically not signif|cant.

TABLE 3. Comparison of mean values of shade matching quality between before and after intervention, for male and female study
subjects
Gender Time Difference p-value 95% Confidence
interval for
Before After difference of mean
Male 26.90(7.1) 29.55(7.2) 22.65 0.020* 24.86, 20.44

Female 24.65(7.6) 31.77(7.3) 27.12 <0.001* 29.44, 24.79

*<0.025 (Bonferroni corrected level of signif|cance‘‘a’’)çStatistically signif|cant.

matching quality was observed for the three way of before and after the training process, which indicates a
interaction of time, type of intervention groups and need to include lectures and exercises about shade
gender (F 5 2.037, p 5 0.113). selection in the dental school curriculum.

There is no statistically significant difference between The present study shows that the lecture and exercises
male and female subjects in the mean values of shade regarding color shade matching of junior dental
matching quality scores at each of the time points of students led to more accurate shade matching. Some
intervention (before and after the training) by ignoring studies have shown that previous training and
the type of intervention (Table 2). experience in shade matching plays an important role
in the accuracy of shade matching;14–16 however, Curd
Table 3 shows a statistically significant difference in and colleagues reported that experience did not affect
the mean values of shade matching quality scores the shade matching accuracy of dental students.3
between two time points of intervention, before and
after the training for both male and female study The female dental students were better at shade
subjects by ignoring the type of intervention. The matching than the male dental students. This finding
mean scores are significantly higher for both male and agrees with that of Haddad and colleagues;17 however,
female subjects after the training when compared with other studies found no significant influence of gender
their mean scores at before it. on tooth color selection.18

Junior dental students are an appropriate population to


DISCUSSION test shade matching abilities due to their young,
matched age as well as their lack of experience in
Based on the results of this study, the null hypothesis shade selection. Furthermore, these students are likely
was rejected. There was a significant difference to have fewer medical conditions that affect color
between the dental students’ shade matching quality perception.3

C 2017 Wiley Periodicals, Inc.


V DOI 10.1111/jerd.12284 Journal of Esthetic and Restorative Dentistry Vol 29  No 5  346^351  2017 349
EFFECT OF COLOR TRAINING Al-Fouzan et al

Isochromatic color tests were used to exclude students DISCLOSURE AND ACKNOWLEDGEMENTS
who might have color vision deficiency. Only three
(5%) male dental students did not pass the test; they The authors do not have any financial interest in the
were informed about their result and were advised to companies whose materials are included in this article.
seek the help of their auxiliary staff for shade selection This research project was supported by a grant from
in their future practice. However, no female dental the “Research Center of the Center For Female
students were excluded after taking the isochromatic Scientific and Medical Colleges,” Deanship of Scientific
color test. In the present study, the rate of color vision Research, King Saud University.
deficiency was lower than that of the general
population, in which 8% of men and 2% of women are
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