In terms of shade-matching hardware technology, dentistry has been a recipient of “technology transfer” that uses hardware developed primarily from the printing and camera industries; companies modify existing technologies to work in dentistry. For example, camera manufacturer Olympus adapted their camera technology and created dental-specific software with modifications to their image capturing devices for use in dentistry. X-Rite is another company whose core business is matching automotive paint, photography, and printing. They have adapted their technologies for use in dentistry.
The dental market for both companies is a very small fraction of their core business, so resources for development are proportional. As a result, X-rite has discontinued production of both of their dental products (eg, ShadeVision and Shade-X devices), although they will continue to be supported by their distributor, Henry Schein.
The most well-recognized company in dental shade-matching innovation is VITA, which is releasing an upgraded product, the Easyshade® Advance (www.vita-zahnfabrik.com) in the fourth quarter. It has the added capability of selecting the shade of their commercially available VITA-blocks CAD/CAM blocks. VITA has made several subtle changes to their industry standard “VITA Classical” shade guide, and it is now completely autoclavable. These changes have the added benefit of making the tabs more color stable. Usually the tabs were cold-sterilized by either soaking or spraying and wiping, which would strip the glaze off and alter the color.
Several small laboratory-based tab systems or photograph reference guides have been developed to enhance dentist/technician communication. The reference tabs are similar to existing VITA tabs that dentists are accustomed to using. Two of these new systems are the Chairside Shade Guide, a photograph reference guide created by Luke S. Kahng, CDT; and the Esthetic Guide, “Visual Elements Technique,” a tab-based system for color and translucency created by Gerald M. Cruz, CDT, from Libra Dental Lab, Inc.
Both systems address issues not covered by classic shade tab systems. The classic shade guides do not convey information about non-homogenous anomalies, such as surface characterizations like crack lines, hypocalcifications, translucency, and opacity. These can now be referenced, recorded, and sent or photographed to add another dimension to dentist/technician communication.
Fortunately, these new tab-based or photograph reference systems are fairly intuitive. They do not have a difficult learning curve as there can be with computer-based technology. These systems are simple: match what you see, then photograph the match with the shade or reference in the photograph. You can then have your laboratory technician purchase these guides to have the same set of references. You can alternatively send your tab references to the technician, along with your case, to reduce the costs passed on to your laboratory technician. These could also possibly help with the costs associated with remakes or “try-in” crowns.
The benefit of these new tab and photograph reference systems are numerous. They are easy to master and learn. They are very economical to purchase, usually only several hundred dollars, not thousands like the electronic-based systems. They are an adjunct to photographs, which often cannot pick up the subtle nuances of translucency, opacity, or surface characterization and texture. Anytime you can provide your off-site laboratory technician additional visual or reference information, it allows them to provide you with a better product, yielding a closer match. Better matching restorations are confidence inspiring to you, your staff, and the patient. It can also reduce the number of remakes, which can effectively reduce your costs and frustration, along with improving your profitability.
If you are adding an electronic shade-matching device to your armamentarium, make sure you take the time to familiarize yourself with the technology and understand the limitations of the information. Also, learn how to properly interpret this information.
Although shade tabs and reference photograph guides can be advertised as stand-alone products, I find that they are better used as adjuncts to your existing shade matching protocol. They can provide the missing elements of sub-surface characterization that is often missed in flash photography alone. These new guides can also provide visual reference about surface features and texture that can also be difficult to convey to your laboratory technician.
As the saying goes, “A picture is worth a thousand words.” This may be true, but it may not guarantee a perfectly matched restoration. These newest shade guides can provide valuable information to help you and your technician collaborate to achieve a more clinically successful outcome.
About the Author
Chad J. Anderson, MS, DMD
Tufts University School of Dental Medicine