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Fundamentals of Color: Shade Matching and Communication in Esthetic Dentistry

Editorial Reviews

From Book News, Inc.
Illustrated throughout with high-quality clinical photographs, this guide for dental professionals explains the basic science and art of color as it applies to the shade matching process. It also describes the many clinical elements that can affect t he perception of color and outlines the processes of conventional and technology-based shade matching. A number of clinical cases are included in the appendix. In addition to maintaining a private practice, Chu teaches aesthetic dentistry at New York University.Copyright © 2004 Book News, Inc., Portland, OR

Table of Contents:
Foreword vii
Preface ix
Chapter 1 Color Theory 1
The Physics of Color
Color Reproduction
Color in Dentistry
Chapter 2 Elements Affecting Color 19
Contrast Effects
Viewer-Associated Effects
Restorative Materials Selection
Chapter 3 Conventional Shade Matching 51
Step-by-Step Process
Shade Guide Systems
Recommended Protocol
Special Considerations for Direct Composites
Chapter 4 Technology-Based Shade Matching 77
Development of Technological Shade Systems
Measurement Systems
Types of Technological Shade Systems
Step-by-Step Process
Recommended Protocol
Chapter 5 Recommended Shade-Matching Protocol 101
Seven Steps to a Successful Shade Match
Appendix: Clinical Cases 117
Single Anterior All-Ceramic (Procera) Crown
Single Anterior All-Ceramic (In-Ceram) Crown
Single Anterior Implant-Supported Metal-Ceramic Crown
Single Anterior Ceramic Laminate Veneer
Two Anterior All-Ceramic Crowns
Two Anterior All-Ceramic Crowns with One Anterior Metal-Ceramic Crown
Four Anterior Ceramic Laminate Veneers
Single Posterior All-Ceramic Crown
Ten Ceramic Laminate Veneers to Match Bleached Teeth
Two Anterior Direct Composite Restorations
Index 155

In the span of my dental career, dentistry has made spectacular improvements in mimicking the natural colors of teeth with restorative materials. In the early 1960s, metal ceramics presented exciting new possibilities for tooth colors, as well as soft tissue response, longevity, and esthetics. In general, clinicians have had little understanding about color, and even less has been taught. Several contemporary clinicians contributed enormously to our knowledge of the art and science of color. There was Bruce Clark in the 1930s and then Robert C. Sproull, Jack D. Preston, and Stephen F. Bergen in the 1970s.

John W. McLean, a giant in the dental profession, introduced us to high-strength all-porcelain restorations with aluminous porcelain in 1965. The bar was raised for color in dental porcelain. Artistic laboratory technicians made immense progress with internal colors and the management of opacity and translucency. By the 1990s, adhesive dentistry, composites, and myriad all-ceramic materials gave us the artistic capacity to reproduce the colors and light response of natural teeth.

The authors of this text, Stephen J. Chu, Alessandro Devigus, and Adam J. Mieleszko, have made an outstanding contribution to the practice and theory of color management in contemporary dentistry. Updating is a way of life, and the flood of new materials and techniques makes this text all the more valuable to students, general practitioners, and specialists. A concise introduction to color theory and how it applies to dentistry is followed by important information about elements affecting color to aid the clinician and technician with problem solving. Special attention has been given to shade matching with a step-by-step protocol. Direct composites and layering techniques receive careful attention. In particular, the chapter on digitized shade-matching technology provides the reader with valuable insight into color measurement technology and its applications for laboratories and patients. Finally, an extensive presentation of clinical cases from single anterior crowns and composites to multiple anterior restorations is used to illustrate the full extent of the text.

It should be noted that the science of color in dentistry always requires skill by the user. In particular, there is a lack of standards in the production of dental ceramic frits. The variables of hue, value, chroma, and translucency from batch to batch and between companies require unusual artistic skills from ceramists to produce prescriptive shades. Perfect shade measurement will not produce comparable shade matching unless realistic standards are established by manufacturers. In the meantime, we need to be especially empathetic to dental laboratories until the science and art of color in dentistry come together.

The authors have produced a text that fulfills a genuine need on shade matching and communication. I found it to be a refreshing approach to color and am especially privileged to write this foreword.

Lloyd L. Miller, DMD
Clinical Professor
Graduate and Postgraduate Prosthodontics
Tufts University School of Dental Medicine
Boston, MA

The study of color is an integral part of esthetic dentistry. If the color of a restoration is off—even slightly—the mistake can be glaringly evident; it looks fake, and the patient is unhappy. Obviously, this is an undesirable result.

Unfortunately, color is also tricky. Slight variances in shade play with our eyes, our minds, and, ultimately, our dentistry. The illumination in the dental treatment room, optical illusions, color blindness, nutrition, and fatigue are among the dental professional’s ongoing obstacles to successful shade matching. It is necessary to understand these challenges and the basic mechanisms of color in order to achieve consistent esthetic shade results. However, most of the dental literature on color theory does not further the reader’s understanding; rather, it further compounds the complexity. Moreover, color education seems to be absent within the dental school curriculum. What is needed is a resource that distills all the data and breaks down the abstract science of color into the essential details. This text was written to simplify the study of color and help readers quantify and communicate shade easily and accurately.

Fundamentals of Color first explains the basics of color theory, then illuminates the factors that can affect the perception of color. Next, the recommended protocol for conventional and technology-based shade matching are detailed separately. Finally, an approach combining both methods is outlined in chapter 5, providing the reader with a technique that almost ensures an accurate shade match the first time, every time. Throughout the text, there are hints and tips to enhance the reader’s comprehension and clinical results. Also included is an appendix describing clinical cases in which the recommended protocol was followed to achieve esthetic and predictable results.

This book is intended for anyone seeking to gain a better understanding of the complexities of shade matching, advance their esthetic dentistry skills, and increase the natural quality of their restorative work. Although we are all health care providers first, we are also artists. With a good working knowledge of color, your artistry will become as natural as your dentistry.

Without the support, dedication, and passion of many people, this book would not have been possible.

First, we would like to thank the people at X-Rite, Inc: Mike Ferrara, Tom Nyenhuis, Kevin Aamodt, Jim Overbeck, and Shannon Gary, who greatly contributed to our knowledge in the field of color science. We would also like to recognize Dustin Ewing from MHT Optic Research for explaining the use of the SpectroShade system. Thanks to Dr William Devisio and Bernal Stewart from Colgate-Palmolive Co for the present and future collaborative clinical research projects in the area of vital bleaching. To the Heraeus-Kulzer-Jelenko Co, especially Gerrit Steen, Chris Holden, Dr Mark Pitel, and Dennis Fraioli, thank you for providing the beautiful synthetic ceramic material used in the case restorations. We would also like to recognize Steve Wright, from Lanmark Group, who helped distill our thoughts and ideas in the writing of this body of knowledge. Special thanks to the staff of Quintessence Publishing Co, who made this book into a reality.

We would also like to thank Dr Irfan Ahmad, whose contributions not only to this book but also to the specialties of fixed prosthodontics, esthetic dentistry, and dental photography have been an inspiration to practitioners globally. We are indebted to Dr Didier Dietschi, whose research in direct restorative composite materials has set the standards in resin composite color science, and his colleagues, Dr Stephano Ardu and Ivo Krejci, for the direct restorative case report they contributed to this book. Our appreciation also goes to Drs Stefan Paul and Ed McLaren, whose previous and ongoing studies in the field of technology-based color systems have considerably increased our knowledge base. We would also like to thank Giordano Lombardi, CDT, whose technical skills, techniques, and working relationship have solidified the highest standard of excellence in the area of esthetic restorative dentistry in Switzerland.

Special thanks to Dr Galip Gürel (Istanbul, Turkey), whose textbook on ceramic laminate veneers opened our eyes to the world of cosmetic restorative dentistry and color. Thanks also to Assistant Dean Kendall Beachman and Dr Dennis Tarnow at New York University College of Dentistry for their motivation and inspiration. Finally, our appreciation goes to Jason Kim, CDT, for imparting his knowledge and skill in the arena of color and translucency.

Stephen J. Chu, DMD, MSD, CDT, MDT
Director, Advanced and International CDE Programs in Aesthetic Dentistry
Clinical Associate Professor
Department of Implant Dentistry
Division of Reconstructive and Prosthodontic Sciences
New York University College of Dentistry
New York, New York

Alessandro Devigus, Dr med dent
Private Practice
Bülach, Switzerland

Adam J. Mieleszko, CDT
New York, New York