Journal of Oral Rehabilitation 2006 33; 31–35
Shade selection performed by novice dental professionals
and colorimeter
E . K L E M E T T I * , A . - M . M A T E L A †, P . H A A G ‡ & M . K O N O N E N †
† ‡
University, Kuwait, Institute of Dentistry, University of Helsinki, Helsinki, Finland and Nobel Biocare Norden, Gothenburg, Sweden
SUMMARY The objective of this study was to test
inter-observer variability in shade selection for por-
celain restorations, using three different shade
guides: Vita Lumin Vacuum, Vita 3D-Master and
Procera. Nineteen young dental professionals acted
as observers. The results were also compared with
those of a digital colorimeter (Shade Eye Ex; Shofu,
Japan). Regarding repeatability, no significant dif-
ferences were found between the three shade
guides, although repeatability was relatively low
Introduction
Good shade selection for porcelain restorations is a
demanding task even for experienced dental practition-
ers, as traditionally the selection has been performed
visually using shade guides provided by porcelain
manufacturers. For young dental professionals com-
fortable shade selection is often an overwhelming task.
During the last two decades the use of colorimeters
has also rapidly escalated in dentistry, as reliable tools
for shade selection have become available. The first
colorimeters were developed already in 1870s, but until
1990s their main uses were in chemistry where
concentrations of substances were determined by
measuring colour intensities (1). According to Douglas
and Brewer (2), under intraoral conditions, the resolu-
tion of digital colorimeters is above that of a human
eye. Also, Dancy et al. (3) reported that the use of
photocolorimetric analysis in shade selection can serve
as an alternative to conventional visual shade selection.
They stated that there is no significant difference in the
results of shade selection whether it is performed by
experienced specialists or with the colorimeter. Reports
of this finding have also been introduced earlier (4–7).
ª 2006 Blackwell Publishing Ltd
*Faculty of Dentistry, Kuwait
(33–43%). Agreement with the colorimetric results
was also low (8–34%). In conclusion, shade selection
shows moderate to great inter-observer variation. In
teaching and standardizing the shade selection pro-
cedure, a digital colorimeter may be a useful educa-
tional tool.
KEYWORDS: chroma, colorimeter, hue, porcelain res-
toration, shade guide, value
Accepted for publication 13 April 2005
For young dental professionals reliable shade selec-
tion may be a problem. For those with limited experi-
ence, the essence and organization of the shade guide
may also be important. In this study, novice dental
professionals performed shade selection for porcelain-
fused-to-metal crowns using three different commercial
shade guides. Shade selection was also done by using a
digital colorimeter.
Our aim was to test inter-observer variability in shade
selection, when using different brands of shade guides,
in a group of young dental professionals, and to
compare the results with those of a digital gadget.
Materials and methods
Ten voluntary dental students and nine dental techni-
cian students participated in this study as observers. For
calibration a 1Æ5-h introduction lecture about the
principles in shade selection was given to them in
advance. The colour acuity status of the observers
was not recorded in advance in this study. This was
because the students in the graduating class had
undergone thorough medical examinations when
starting their dental studies, including examinations
31
32 E . K L E M E T T I et al.

Table 1. Characteristics of the ‘patients’ and their teeth for which
the shade was selected
Observed
Patient Sex Age tooth Description of tooth
A Female 25 11 Normal, yellowish
B Male 23 22 Darkened by trauma
C Male 20 21 Light
D Female 60 41 Multicoloured
for colour blindness. None of the observers reported
about personal problems in this respect.
All 19 observers carried out shade selection for one
tooth of four patients using three different commercial
shade guides. The shade guides were as follows:
1 Vita Lumin Vacuum* 16 colour tab guide.
2 Vitapan 3D-Master shade guide* with 25 colour tabs.
3 Procera† shade guide with 12 colour tabs.
The manufacturers provided new shade guides,
assumed to be identical, for the study. Every patient
station had a detached shade guide, thus the selections
for each patient were performed with one and same
shade guide. Every rotation for selections was set to
2 min.
Four voluntary staff members from the Institute of
Dentistry, University of Helsinki, participated as pa-
tients. The description of the patients and the teeth for
which the shades were selected is presented in Table 1.
The dental units, where the shade selections were
made, share windows on the same wall of the Institute,
thus ensuring identical illumination conditions. The
illumination consisted of natural light from the window
and artificial light from a dental light source‡ as daylight
was limited because of permanent cloud cover, typical
for the time of the year. The dental lights were
identical, but not colour correcting. In terms of the
colour of the walls and floor the dental units were
identical. The personal clothing of the patients was
covered with a mat white coat. The observations were
carried out at same time (10 AM–2 PM) on three
successive days.
The shade for each tooth was also determined by
using Shade Eye Ex§ colorimeter. The gadget was
calibrated according to the manufacturer’s instructions
before every session.
*VITA, Bad Sackingen, Germany.
†
Nobel-Biocare, Gothenburg, Sweden.
‡
Planmeca, Helsinki, Finland.
§
Shofu, Japan.
Chi-square test was used for statistically analysing the
scoring of shades in selections with different shade
guides and colorimeter. Inter-observer reproducibility
of the shade of each tooth, and the selections of the
colorimeter agreeing with the visual selections were
expressed as percentages.
Results
Shade selection results, performed by dental and dental
technician students, did not statistically differ.
Vita Lumin Vacuum
When using Vita Lumin Vacuum shade guide on the
four test subjects, the 19 observers reached on the
average 41% agreement for their selections. If the two
best scoring choices were included, the agreement was
64%. On average, 5Æ75 (range 4–8) out of 16 colour
shades were proposed, which is 36% of the colours in
the shade guide. Agreement with the digital Shade Eye
Ex colorimeter was verified in 34% of the selections.
Vitapan 3D-Master
With Vitapan 3D-Master shade guide the agreement of
selections was 33%, and the average distribution was
8Æ25 (range 5–12). This equals to 32% of all 26 tabs in
the shade guide. If the two best scoring choices were
included, the agreement was 53%. As the Vitapan 3D-
Master shade guide is not keyed to the Vita
concept
that also Shade Eye Ex shares, no comparison with
colorimeter results is available here.
Procera
When using Procera shade guide the observers agreed
on the average in 43% of the selections, and an average
of 5Æ75 shades (range 4–8) per patient out of 12 shade
tabs were suggested. If the two best scoring choices
were included, the agreement was 71%. Agreement
with the digital Shade Eye Ex colorimeter was regis-
tered in 8% of the selections.
Regarding repeatability, when the best scoring shades
were compared, no significant differences were found
between the three shade guides. When the two best
scoring shades were included, the difference between
Vita Lumin Vacuum and Procera or Vitapan 3D-Master
was not significant, but the selections performed using

ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 31–35

 NOVICE DENTISTS AND COLORIMETER 33

Procera shade guide were significantly better repeated Table 4. Scores and percentages of different shades for patient C
than those performed using Vitapan 3D-Master shade by visual selection. Shade selection, made by the colorimeter was
A1
guide (Chi-square 4Æ74, P < 0Æ05).
When the shades with the highest inter-observer
Vita Lumin Vitapan
score were compared against the data produced by Vacuum 3D-Master Procera
Shade Eye Ex colorimeter, the results attained with Vita
B1 7/37% 2M1 7/37% Ivory D2 6/32%
Lumin Vacuum shade guide were significantly better
A1 6/32% 1M1 5/26% Banana B1,B2,B3 6/32%
than those with Procera shade guide (Chi-square 17Æ87, A2 4/21% 2R1.5 3/16% Flamingo A1,A2 4/20%
P < 0Æ0001). If the two best scoring shades were C1 2/10% 2L1.5 2/11% Peach A2,D3 3/16%
included, the agreement with Vita Lumin Vacuum 1M2 1/5%
shade guide was still significantly better (Chi-square 3M1 1/5%
72Æ31, P < 0Æ0001).
The breakdown of all data for the four patients are
presented in Tables 2–5. Table 5. Scores and percentages of different shades for patient D
by visual selection. Shade selection, made by the colorimeter was
C4
Discussion
Vita Lumin Vitapan
Nowadays it is still common that the information of the
Vacuum 3D-Master Procera
desired shade, or combination of shades, for ceramic
and metalloceramic restorations is sent to the techni- A4 5/26% 5M2 4/21% Caramel A3.5 8/42%
cian by using simple codes selected from a shade guide. C4 4/21% 4M2 3/16% Amber,Mango A4 3/16%
A3.5 4/21% 4L1.5 2/11% Ivory D2 3/16%
B3 2/11% 4R1.5 2/11% Flamingo A1, A2 2/10%
Table 2. Scores and percentages of different shades for patient A C3 2/11% 3M3 1/5% Terra C3,C4 1/5%
by visual selection. Shade selection, made by the colorimeter was B2 1/5% 3L2.5 1/5% Peach A2,D3 1/5%
A2 D4 1/5% 3R1.5 1/5% Apricot D4 1/5%
4M1 1/5%
Vita Lumin Vitapan 4M3 1/5%
Vacuum 3D-Master Procera 4R2.5 1/5%
5M1 1/5%
B2 7/37% 2L1.5 3/16% Ivory D2 10/53% 3M2 1/5%
A2 4/21% 3M1 3/16% Banana B1,B2,B3 5/26%
A3.5 2/11% 2M3 2/11% Flamingo A1,A2 1/5%
B1 2/11% 2M2 2/11% Orange A3 1/5%
B3 1/5% 2R1.5 2/11% Canari B3,B4 1/5%
Although the guidelines for ideal shade selection
C2 1/5% 3R1.5 2/11% Peach A2,D3 1/5% technique have been known for long, the use of shade
D4 1/5% 3M2 2/11% guides still often is an obstacle in attaining acceptable
D3 1/5% 1M1 1/5% aesthetic results (6).
4M1 1/5% In this study, because of the time of the year (fall) in
4M2 1/5%
Finland, illumination in the study area was partly
artificial as the availability of natural daylight was
Table 3. Scores and percentages of different shades for patient B
limited. The dental light sources did not have colour
by visual selection. Shade selection, made by the colorimeter was correcting qualities, as the units originated from the late
A4 1970s. On the contrary, these circumstances very much
reflect the conditions where the dentists in Nordic
Vita Lumin Vitapan countries are forced to work, and has to be accepted as a
Vacuum 3D-Master Procera
‘force majeure’ cause.
A4 12/63% 5M3 11/58% PeachA2,D3 9/47% B4 According to recent data, there is no significant
4/21% 5M2 5/26% Orange A3 6/32% difference whether the shade selection is performed by
A32/11% 3M2 1/5% Terra C3,C4 2/11% an experienced clinician or with a colorimeter (2, 3).
C41/5% 4M3 1/5% Banana B1,B2,B3 1/5%
However, it seems that better results are gained with
4R2.5 1/5% Ivory D2 1/5%
growing experience (4–7). Based on these conclusions,

ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 31–35

34 E . K L E M E T T I et al.
in this study where students acted as observers, we
considered the shade selected by the colorimeter as the
correct one. The reproducibility of the colorimetric
results was not tested.
Inter-observer agreement and selection matching
with colorimeter, performed by general clinicians, has
been relatively low in numerous studies (8, 9). In 1998
Okubo et al. (10) tested recognition of Vita Lumin shade
tabs using another identical shade guide and, at that
time, a new colorimeter. The colorimeter was successful
in 50%, and the visual examiners in 48% of the cases.
Tung et al. (11) reported that when using Vita Lumin
Shade guide, experienced clinicians reached 55–64%
agreement with a colorimeter. On the contrary, in their
study the repeatability of colorimeter measurements
was at the level of 82%. The clinicians agreed with each
other worth 73%. Based on their study Paul et al. (8)
reported only 27% reproducibility among three human
observers who determined the shade for the maxillary
central incisors of 30 subjects. At same time three
spectrophotometric assessments produced 83% repro-
ducibility. In a more recent study (12), spectrophoto-
metric shade analysis was considered superior to visual
shade selection.
The 26 colour tabs in Vita 3D-Master shade guide
are arranged by the value of the shades. Also the
shade of the dentine and the clinical crown are
selected separately (13). Paravina et al. (14) analysed
and compared the shade tab arrangement of Vitapan
Classic and Vitapan 3D-Master shade guides. Accord-
ing to them, the value based arrangement of the
Vitapan 3D-Master shade guide was more consistent
and they recommended that the tabs of Vitapan
Classic guide should also be arranged according to
the value of the shades. According to another report
(9), by using Vita Lumin Vacuum shade guide, intra-
rater repeatability among prosthodontists was signifi-
cantly higher than among general practitioners. How-
ever, when using Vitapan 3D-Master shade guide,
intra-rater repeatability among general practitioners
improved significantly.
In this study, students with relatively little experi-
ence acted as observers. The repeatability of shade
selection and the agreement with colorimeter did not
reach the level of the studies where experienced
specialists were involved. However, the results did not
differ from those of the studies with general practition-
ers. On the contrary, when the two best scoring shades,
that according to a sensory impression were very alike,
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 31–35
were considered, repeatability markedly improved. This
suggests that over time, with some more experience,
repeatability in shade selection could also improve in
this group of students. In this study, Vita Lumin
Vacuum and Procera shade guide tabs were grouped
traditionally, according to the hue of the shades.
However, in the students’ hands, the use of Vitapan
3D-Master shade guide, with its higher number and
value based arrangement of tabs, did not seem to be
more difficult than using the other two shade guides.
The reason why the selections done with Procera shade
guide correlated so poorly with those of the colorimeter
may result from the more intense chroma of the
Procera shade guide. According to the Procera concept
determining tooth shades builds upon defining the core
pigment of the tooth, instead of defining it through the
tooth substance, as with the Vita (Haag P. Procera
Shade Registration. In: NobelBiocare Norden AB, Chairside
Information, 2001).
As mentioned before, the repeatability with Procera
guide was at the same level with others.
In conclusion it can be stated that shade selection
shows marked inter-observer variation. Thus, digital
colorimeter may be a useful educational tool in teach-
ing and standardizing the shade selection procedure,
and in the use of traditional shade guides.
References
1. Stock JT. The Duboscq colorimeter and its inventor. J Chem
Educ. 1994;71:967–970.
2. Douglas RD, Brewer JD. Variability of porcelain color repro-
duction by commercial laboratories. J Prosthet Dent.
2003;90:339–346.
3. Dancy WK, Yaman P, Dennison JB, O’Brien WJ, Razzoog ME.
Color measurements as quality criteria for clinical shade
matching of porcelain crowns. J Esthet Restor Dent.
2003;15:114–121.
4. Douglas RD. Precision of in vivo colorimetric assessment of
teeth. J Prosthet Dent. 1997;77:464–470.
5. Hindle JP, Harrison A. Tooth colour analysis by a new
optoelectronic system. Eur J Prosthodont Restor Dent.
2000;8:57–61.
6. Chu SJ. Precision shade technology: contemporary strategies
in shade selection. Pract Proced Aesthet Dent. 2002;14:79–83.
7. Hovden K. Computerized shade selection and the complex
Class IV composite. Dent Today. 2002;21:62–65.
8. Paul SJ, Peter A, Pietrobon N, Hammerle CH. Visual and
spectrophotometric shade analysis of human teeth. J Dent
Res. 2002;81:578–582.
9. Hammad IA. Intra-rater repeatability of shade selections with
two shade guides. J Prosthet Dent. 2003;89:50–53.
 NOVICE DENTISTS AND COLORIMETER
10. Okubo SR, Kanawati A, Richards MW, Childress S. Evaluation
of visual and instrument shade matching. J Prosthet Dent.
1998;80:642–648.
11. Tung FF, Goldstein GR, Jang S, Hittelman E. The repeatability
of an intraoral dental colorimeter. J Prosthet Dent.
2002;88:585–590.
12. Paul SJ, Peter A, Rodoni L, Pietrobon N. Conventional visual
vs spectrophotometric shade taking for porcelain-fused-to-
metal crowns: a clinical comparison. Int J Periodontics
Restorative Dent. 2004;24:222–231.
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 31–35
35
13. Marcucci B. A shade selection technique. J Prosthet Dent.
2003;89:518–521.
14. Paravina RD, Powers JM, Fay RM. Dental color standards:
shade tab arrangement. J Esthet Restor Dent. 2001;13:254–
263.
Correspondence: Esa Klemetti, Faculty of Dentistry, Kuwait Univer-
sity, PO Box 24923, Safat 13110, Kuwait.
E-mail: klemetti@hsc.edu.kw