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Esthetics and
Shade Communication:
A Practical Approach
Ernst A. Hegenbarth, MDT

Bruchkbel, Germany
Correspondence to: Ernst A. Hegenbarth

Zen Line Dental GmbH, Innerer Ring 1 d, 63486 Bruchkbel, Germany;
fax: 49 6181 740455; e-mail: hegenbarth@zenline-dental.com.
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THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 1 NUMBER 4 WINTER 2006
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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;1:340360.)
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Fig 1 (a and b) Modern dental ceramics contribute considerably to the natural appearance of dental restora-
tions, as demonstrated by these laminate veneers on the maxillary central incisors.
mixtures, other methods of shade selection

and color matching must be found. There
are no cut-and-dried solutionsthe chal-
lenge of reproducing natural tooth colors is
certainly best met by a deeper knowledge
of light and color, optical phenomena relat-
ed to the natural tooth, the optical effect of
the materials we use, and systematic pro-
cedures in shade selection and subse-
quent ceramic buildup. But beyond these
rather scientific, logical criteria, 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 ceramists experience, sensitivity,
data on the distribution and extension of translucency
and even intuition in mixing materials and
and opalescence of natural teeth.
colors.
There is hardly any communication be- Traditional shade selection

tween clinician and dental technician that
methods
is as fraught with imponderables as that of
tooth color communication. But on the oth- The rapidly expanding market for dental
er hand, there is hardly anything in dentistry ceramic materials, driven by the increasing
that has been as incompletely researched global demand for esthetic restorations,
as the true colors and textures of natural has seen the development of a number of
teeth. Since no manufacturer of ceramic new products in recent years, broadening
materials can possibly make all natural considerably the range of available ceram-
tooth colors available as pre-formulated ic materials (Fig 1). It is doubtful that there
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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. (a and b) Full mouth rehabilitation using Procera NobelRondo
Alumina and Zirconia ceramics (Nobel Biocare). (Case treated by PD Dr S. Holst, University Erlangen, Germany;
ceramics by D. Hildebrandt and E. A. Hegenbarth, Bruchkbel, Germany).
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.2,3
of new products in the ceramics field alone, The introduction of the Vitapan 3-D Mas-
allowing the formation of his or her own inter shade guide (Vita Zahnfabrik) for shade
formed opinion. 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- tional system (still available under the
erence to the classic Vita shade guide (Vi- name of Vitapan Classical) as a standard
ta Lumin Vacuum shade guide, Vita Zahn- frame of reference. However, the author
1
fabrik). Generations of young ceramists has always been one of the strongest crit-
have practiced the fine art of replicating ics of established shade systems.
these shade patterns on a day-to-day ba- The question today is whether we have
sis according to the dentists requests, us- actually fulfilled the prerequisites for solving
ing whatever material was specified. It was the color problem in dental ceramics as
not until recently that attempts were made postulated by Bruce E. Clark as early as
to recognize the variety and the rich nu- 19314:
ances characterizing a natural tooths col-
or and to reproduce them in detail when 1. Basic knowledge of color science
creating dental restorations (Fig 2). For cre- 2. A method for the visual analysis of tooth
ative ceramists, shade patterns are no shades, a system for specifying the
longer as important; natural appearance shade found, and a formula for repro-
and harmonic colors as well as the pa- ducing this shade in ceramics
tients individual wishes have moved to the 3. A corresponding range of pigments
center of attention (Fig 3). Yet, despite all permitting duplication of all tooth colors
these attempts at individualization and its
well-known shortcomings, the Vita shade In 1979 Lemire and Burke5 wrote that the
guides have maintained their dominant current means of shade selection were out
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of date and incomplete, based on shade
patterns that were not organized based on
any visual system, and did not utilize the
current knowledge of light and color. The
current author68 has previously noted that
the field of shade selection continues to be
dominated by traditional shade guides and
patterns, even though these were long ago
found deficient. 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, and colors manifested in standard patterns. In
optical phenomena are rarely taken into consideration the observers brain, shade recognition is
when using conventional shade guide samples.
unilaterally limited and restricted to the on-
ly available shade patterns, which disal-
lows any true vision of subtle shade nu-
ances (Fig 4).
The Vitapan 3-D Master shade guide is
subject to the same problems. It is true that
this shade selection system is organized
more logically than the previous Vita Clas-
sical shade guide. Here, too, however, prac-
titioners will be guided in the direction of
certain shade groups, quickly resulting in a
preference for a very few specific patterns.
a
This preference is not related to the actual
incidence of tooth colors, but rather a psy-
chologically understandable desire to use
certain shade patterns thought to yield rou-
tinely good or at least acceptable results.
Previous attempts at improving on con-
ventional shade selection methods have
followed either of two fundamentally differ-
ent approaches:
1. Traditional. Variations on visual compar-

ative shade selection using tooth-
shaped patterns, organized within the
b three-dimensional color space in a log-
ical pattern (eg, Vitapan 3-D Master).
Fig 5 (a and b) Spectrophotometers (eg, Shade-
2. Color measuring systems. Color meas-
Scan, Cynovad) are used to electronically measure
dental shades according to conventional shade pat- uring systems and spectrophotometers
terns. used in dentistry are mechanical, com-
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puter-assisted devices that electronical- chroma and hue are then determined vi-
ly determine the shade of natural teeth sually. This results in a total of 26 patterns
(Fig 5). 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. Available publications on this
whole spectrum of visible light is creat- new shade system do not offer any con-
ed. 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. The internal com- thus postulated.
puter analyzes over 2 million reference This situation contrasts with that for
points. Images of hue, value, chroma, the electronic measurement methods pre-
and translucency are created in different sented by M. Yamamoto.12 In describing
9
mappings (Fig 6). sources of potential errors in visual shade
selection, he stated that visual assessment
Both of these approaches are based on the was unreliable, regardless of the observer.
three-dimensional Munsell color system Yamamoto also cited the classic Vita shade
(hue, value, and chroma). However, be- guide as the foremost obstacle to precise
cause natural teeth are partially permeable shade analysis, listing, among others, the
by light, this set of three-dimensional pa- following two factors: (1) Vita shade guides
rameters needs to be supplemented by a specific color system makes correct color
fourthoptical light transmission. This assessment difficult and (2) since the Vita
optical property, called transparency or shade guide does not cover the whole
translucency, may be defined as the ratio range of colors present in natural teeth,
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.
given fixed light source. Because of these uncertainties, Ya-
Aspects of relative translucency and rel- 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- electronic shade measurement.12 Howev-
tralian dentist and material scientist N. R. er, most of the technological shade sys-
Hall, published in Australia as early as tems are based on conventional shade
1991, are considered the scientific founda- guides with all their shortcomings. An ori-
tion of the Vitapan 3-D Master shade entation on natural teeth and the different
guide.11 Hall described the shortcomings ceramic materials would be an advantage.
of the classic Vita shade guide and devel- 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. In this new of a ceramist into consideration in its
group orientation, the value is determined analysis. Furthermore, electronic tools
first. This value leads to one of five equidis- cannot measure optical phenomena such
tant shade value groups. Within the deter- as opalescence and fluorescence. Even
mined group, the (reddish or yellowish) computer-defined ceramic formulas have
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a
b
c d e
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to be mixed and built up. However, in this can they be determined objectively. The
age of global cooperation and communi- physiological and neurological process of
cation, dentistry is making use of digital color vision itself continues to be a scien-
photography and Internet communication. tific enigma, and the psychological as-
Electronic transmission of CAD/CAM da- pects connected to our ability to perceive
ta and electronic shade selection is going color can hardly be underestimated.13 It
to come into increased use in the future. If was not until 1995 that American re-
electronic shade measurements are tak- searchers were able to watch the brain
en, they should be supplemented by pho- see using functional magnetic resonance
tographs in order to include individual de- imaging techniques. The team at Memori-
tails in the restoration. al Sloan-Kettering Cancer Center in New
York discovered the brains 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.14
Color exists only as a sensual percep-
Natural tooth properties tion, in the eye of the beholder, whose vi-
and color perception sual organ is only an accessory; that is, we
The various approaches to shade selec- do not see color, but color is created in the
tion for natural teeth illustrate that there still visual center of our brain. This is why the
is no generally accepted standard proce- perception of tooth color is a highly sub-
dure for approaching this difficult problem. jective process. It is not possible to assign
Both electronic measurements and visual natural teeth to any set color categories
shade selection claim to determine hue, since color nuances will vary depending
chroma, and value of a tooth. Some sys- on the nature of the incident light. Part of
tems also include translucency to some the light reaching a tooth will be absorbed,
degree. However, the tooths individual while another part is allowed to pass
characteristics remain largely beyond con- through (transmitted). Light that is not ab-
sideration. The study of natural teeth shows sorbed or transmitted is reflected by the
an almost unlimited array of possible col- tooth and perceived by the eye as a color
or variations (Fig 7). In this flurry of colors stimulus. The color nuances perceived are
and optical phenomena, 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 spectral composition of this col-
determining and organizing tooth colors. or stimulus will vary depending on the
Tooth colors are not really constant, nor spectral composition of the incident light
Fig 6 Natural left central incisor and Procera crown on the right central incisor (a). Spectrophotometric meas-
urement of the crown (b to d) and the natural tooth (e to h) show an almost perfect color match regarding hue,
value, and chroma, but a slight deviation in the translucency at the incisal edge of the crown (d and h).
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light conditions by re-tuning the retinal
receptors. This is why colors can still be
judged fairly adequately despite differ-
ences in lighting conditions. Nevertheless,
the use of a standardized light source for
shade selection and color matching in
dental ceramics remains a requirement. 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, Tru-
shade, Optident). A small portable light
source with a broadband spectrum of light
(5,500K) and a high linear optical trans-
mission in the visible range guarantees
uniform light conditions. 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).
Shade selection
for metal-free restorations
The objective in dental shade matching, in
Fig 7 Cross sections of natural teeth lead the way to addition to reproducing the hue, 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, making them worthy of
anced color harmony and color nuances by
further investigation. Light reflection from the surface,
refraction within the enamel, and absorption and light contrasts and individual characterization.
transmission add to the complexity of this subject. The systematic approach to color analysis
presented later in this article requires a
planned and logical procedure. There are a
during shade selection. Tooth colors can number of prerequisites:
only be compared if ambient light condi-
tions were identical when the colors were 1. Basic knowledge of color science (hue,
determined. Neutral northern daylight or a value, and chroma)
corresponding artificial light source (color 2. Knowledge of the optical properties of
temperatures of 5,000 to 5,500 K) is con- natural teeth (optical scatter and refrac-
sidered ideal for shade selection. Our visu- tion, translucency, fluorescence, opales-
al organ possesses adaptive mechanisms cence, etc)
that attempt to adjust incoming stimuli to a 3. Study of the tooths internal structures
steady average, thus compensating, to a (mamelons, secondary dentin, discol-
certain degree, for differences in ambient orations, etc)
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Fig 8 (a to c) Trushade artificial light source with

color-corrected dimmable light (5,500 K) and 2x mag- c
nification.
4. Knowledge of the texture and structure rience has shown that accurate informa-
of dental enamel and the correspon- tion is best obtained by shade selection
ding ceramic materials modalities individually tailored to the
5. Knowledge of the optical results of sur- restorative procedure contemplated. In
face properties (eg, multi-hued mother- case of metal-free restorations the color of
of-pearl effects) the substrate, eg, nonvital teeth or posts
and cores, also may influence the optical
All shade selection methods described appearance of a restoration. Even the var-
thus far are being used, regardless of the ious degrees of light transmission of differ-
type of restoration to be provided. Whether ent core materials must be taken into con-
the shade selection can be identical for dif- sideration. The peculiarities of the materials
ferent types of restorations such as metal to be used, but also the individual ce-
ceramics, laminate veneers, or all-ceram- ramists work habits, are factors that need
ic crowns remains open to question. Expe- to be given more attention.
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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 Light, Novoflex flash holder).
Intraoral digital photography equipped with a 100-mm macro lens with

and color communication a twin flash system (eg, Canon Macro Twin
Intraoral photography is usually consid- Light, Nikon Macroflash) provide images
ered one of the less reliable adjuncts for with a more three-dimensional appear-
reproducing the shades of teeth. The im- ance.16,17 A special flash holder (eg, 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, on the film mate- brightness is more constant in the manual
rial, and the mode of processing. Howev- mode (M) and an aperture stop f22.
er, digital photography combined with dig-
ital shade measurement tools may play a
more prominent role in the future.15 Pho- Six steps for successful
tographs are practically indispensable for
shade analysis
creating structures, contrasts, and individ-
ual crown characteristics. The use of digi- The following procedure for shade commu-
tal images is greatly enhanced by calibrat- nication, which is easily applicable to daily
ing the computer monitor for correct color practice,1821 will be presented using the
reproduction. Procera system and the new NobelRondo
The primary advantage of images is im- porcelain as an example of a computer-
proved communication between dentist aided design/computer-assisted manufac-
and ceramist. Photographing shade pat- ture (CAD/CAM) all-ceramic system. Using
terns on their transparent discs along with this method, shade analysis is performed
the teeth gives a clearer indication of col- incrementally. The well-established shades
or mixtures and characteristics. 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- (Super Bright, High Value, Warm Chroma,
tography (Fig 9). Digital single lens cameras Sunny Chroma, Pearl Chroma, and Low
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Value). The increasingly popular bleached Step 2: Basic hue e ss e n z
shades (Super Bright) are already includ- 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. first 20 to 30 seconds usually provides a
The six-step shade evaluation method is good starting point (Fig 11). However, expe-
opening new paths of communication re- rienced ceramists or dentists will not even
garding dental esthetics amongst patients, need a shade guide; they can rely on visu-
dentists, and ceramists. The patient is a al experience. Of course, the conventional
major player and is involved in a specific shade guides should still be consultedit
way. It is the esthetic expectations of the pa- will frequently confirm the accuracy of the
tient that should be the focus, not a strict ori- hue spontaneously chosen by freehand
entation to traditional color designs with all selection. On closer observation, however,
their limitations. Modern possibilities of dig- the clinician will often discover differences
ital photography and image communica- between the tooth and the closest available
tion can be integrated simply into the con- shade pattern selected. These differences
cept. Basically the six steps follow the way must be recognized and interpreted cor-
a ceramist will build up a crownfrom the rectly, which leads to the next logical step.
inside to the outside. Even surface charac-
teristics are implemented in this method. Vi- 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. Sometimes chroma must be en-
properties and their replication in different hanced by adding some chromatizer from
dentin, enamel, transparent, and colored the corresponding shade group. A com-
translucent, as well as fluorescent and parison of the dentin shade patterns, which
opalescent, ceramics. are made of the actual material and
mounted on transparent trays, 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, which are made of a differ-
shade (eg, Warm Chroma for A2 to A4 ent material (Fig 12). The necessary in-
shades), but also by the patients prefer- crease in chroma can be documented by
ence. Thus psychological aspects are im- checking the corresponding box on the
plemented into this concept as well. The shade registration form. The ceramist fa-
main characteristics of the shade groups miliar with high-chroma porcelains will
are expressed in their names (Fig 10): Su- add between 5% and 20% of a chromatiz-
per Bright (A0, B0), High Value (A1, B1), er, harmonizing the hue to the body mate-
Warm Chroma (A2 to A4), Sunny Chroma rial (eg, Dentin A3 + Chromatizer Warm
(B2 to B4), Pearl Chroma (D2, D3), and Chroma 10%20%; Dentin B3 + Chroma-
Low Value (C1 to C3). tizer Sunny Chroma 10%20%; Dentin D3
+ Chromatizer Pearl Chroma).
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a b
Fig 10 The NobelRondo ceramic shade tabs are

arranged on six transparent disks, organized as dentin,
enamel, modifier, or stain (a and b), corresponding to
the arrangement of the bottles on the tray (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- tooth or crown. Internal characteristics like
tions. At this stage, internal tooth character- mamelons, discolorations, or wear facets
istics and tooth structures must be consid- will be selected carefully with the original
ered. A tooths character is determined, to ceramic samples of internal modifiers (Fig
a large extent, by the changes it undergoes 13). Any discoloration detected at the in-
during its life. This is a functional aspect cisal edges during shade selection should
that must never be neglected. The natural be addressed. Sketching these incisal
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Fig 11 Spontaneous visual selection of the shade group (Warm Chroma) and
basic hue (A3) using a common shade guide.
Fig 12 The ceramic samples provide accuracy for Fig 13 Samples of the internal modifiers (eg, Ivory
determining the basic dentin shade and variations in and Flamingo for mamelons) are useful for determin-
color intensity (chroma). ing internal characterizations.
characterizations on the tooth outline on Step 5: Value, translucency,

the shade registration form gives the ce- enamels, and contrasts
ramist important information about the lay- Within the three-dimensional color space
ering of these structures. In this manner, a of a color scale, value is usually expressed
two-dimensional drawing assists in a in grayscale terms, that is, on a scale be-
crowns three-dimensional design (ie, tween black/dark and white/bright. Teeth,
depth layering). however, being semi-translucent objects,
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should not be forced into a grayscale. Ob- 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. able tooth colors by a considerable mar-
Brighter means more reflected light, while gin. By adding suitable amounts of
darker means more absorbed light. This chromatizers and transparent materials
means that the value of a ceramic materi- harmonically adapted to the selected hue,
al is influenced by certain optic effects. An it is possible to obtain well-defined inter-
increase in value (high value) may be cre- mediate shades (ie, variations in chroma).
ated by adding bright fluorescent materi- Opacity is increased by using more fluo-
als inside the crown or by using strongly rescent inner core material. Translucency
opalescent materials (eg, Opal Enamel 0 is increased by adding transparent porce-
or Opal Enamel 1, also Mother-of-Pearl lain (up to 30%)a much more frequent
materials from NobelRondo porcelains) to occurrence. Note, however, that adding
the body porcelain. 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, Transpa Neutral, duced value, making the crown appear
Special Enamel Smoky, or Grey) or by us- darker. These examples show how the var-
ing master kit modifiers with a low value ious body, transparent, and intensifier
(eg, Pearl, Taiga, Caramel). Here, too, com- porcelains may interact. 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.
form. 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, personal
tooths relative opacity or translucency. communication, September 1998). This is
Translucency, the fourth dimension of tooth where the difference in structures and light
color, deserves special attention since it refraction factors of the natural tooth enam-
cannot be captured using any of the con- el on the one hand and those of our ce-
ventional shade guides. Between low ramic materials on the other is most
translucency (high opacity) and high painfully obvious. The refractive index of
translucency (low opacity) are many vari- ceramics is 1.5 and that of natural enamel
ations. In general, we can increase translu- is 1.65. Whether the enamel layer is thick-
cency by adding Transpa Opal or Transpa er or thinner, whether it has a higher value
Clear to the dentin porcelain; however, this (is brighter), whether it is grayish in ap-
may lead to a slight decrease in value. All pearance or shows colored transparen-
these examples clearly demonstrate that cyall these factors can substantially influ-
we cannot look at one aspect of color in ence the overall appearance of a dental
isolation. Chroma, value, and translucency restoration. The enamel patterns of the No-
are always interacting. belRondo ceramic color patterns, the col-
This system of dentin modifications is ored translucencies (eg, CT Melon, CT Pa-
not a set of recipes for reproducing exist- paya, CT Lemon), and the opalescent and
ing shade patterns. Rather, it is important transparent porcelains of the NobelRondo
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basic kit as well as the opalescent Mother-
of-Pearl modifiers (eg, Oyster White, Light
Coral, Pale Shell, and Pink Pearl) from the
master kit help capture many enamel vari-
ants quickly and easily (Fig 14).
Contrasts such as bright spots, colored
translucencies in the tooths cervical third,
exposed root segments, or pronounced
bluish opalescent regions in the tooths in-
cisal third can also be captured using the
original ceramic shade patterns (eg, Spe-
cial Enamel Opal Blue, Opal Blue Light). A Fig 14 The correct selection of enamels will lead to
mesial line angle of a central incisor may better control of lightness (value), translucency (amount
of light transmission), and opalescence. The interaction
appear more prominent by using a bright,
between these aspects should not be overlooked.
highly opalescent material like Oyster White
because of the light-reflecting character of
this specific material. To increase the illu-
sion of more concavity on the distal aspect light. Objects whose surface is even when
of a crown, colored translucencies with seen through a microscope will reflect light
more light-absorbing quality can be used. very directly, resulting in a high degree of
gloss (glaze). If, by contrast, the surface of
Step 6: Surface structure the object is more highly structured, the re-
and gloss sult is greater light refraction, so that it ap-
The next step is to determine the color nu- pears semi-glossy or semi-matte. Still
ances and characteristics of the tooth sur- more highly structured or rougher surfaces
faces. Surface staining techniques should with a lower degree of glossiness will ap-
be restricted to exceptional cases. Minor pear to have a matte finish.
characterizations, however, may well en- Particle sizes and light refraction indices
hance the illusion of a natural-looking crown. of different ceramic materials used to cre-
It is regrettable that the connection be- ate enamel structures have a considerable
tween the surface structure of a tooth and influence on their optical appearance. The
its optical appearance has been given on- structure of the NobelRondo porcelains
ly scant attention to date. The color of permits an optimized surface structure
opaque objects is determined by the ex- through proper firing cycles and its ex-
tent (quantity) of light reflected from the tremely fine grain structure. Mechanical
surface of the respective object in different surface treatment using different polishes
regions of the visible light spectrum. This will become an exceptional step and will
is, however, only an illusion in the case of only be performed to achieve a particular
translucent objects such as dental enam- type of surface gloss. The ultra-fine parti-
el, since the light does in fact enter the ob- 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. If particles are
before leaving the object again as diffuse used whose refraction index is high (eg,
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refractive index of zirconium oxide = 2.3,
Conclusion
aluminum oxide = 1.8), strong light reflec-
tion will result, and the crown will appear The system of shade selection presented
brighter. This is the case, for instance, here (Fig 15) is based on the authors
when using strongly opalescent enamel many years of experience with the Cre-
porcelains (eg, Opal Enamel 0, Opal ative Color system he developed. With the
Enamel 1, Mother-of-Pearl). Utilizing non- introduction of the Procera system, 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. The
translucency, since more light will be trans- scientific basis of general color science,
mitted and absorbed in deeper layers of optics, and aspects of material science, as
the ceramic restoration. well as the development of a logical sys-
The examples given show how the sur- tem, 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. Successful co-
crown. 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, even if
look unnatural. A subtle reduction in glossi- the patient him- or herself was unavailable
ness using a felt wheel and somewhat for shade selection or shade adaptation in
coarser polishes (porcelain/pumice mix- the laboratory.
tures) yields better results. The best way of A spirit of cooperation between ce-
showing the surfaces of models or crowns ramist, clinician, and patient; consistent im-
is to use a silver or gold powder. 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- restorations; high-quality photographic
al angle and using black-and-white film. procedures and image communications;
and also patience and understanding in
the event that perfect success is not imme-
diateall these will result in more success-
ful results in dental esthetics.
Fig 15 (a) A patient presented with four insufficient porcelain-fused-to- metal crowns. Her chief complaints were
gingival recessions and the discoloration and unnatural appearance of the crowns. (b) Initial shade selection us-
ing the classical Vita shade guides. (c) More reliable determination of the basic shade with NobelRondo dentin
samples (A1, A2). (d) Selection of internal structures (Ivory internal modifier). (e) Selection of enamels (Opal Enam-
el 2, Enamel 3, Opal Blue Light). (f) NobelRondo shade communication form. Digital images can be printed on
this simple form, which also includes information on hue, value, chroma, translucency, and surface characteris-
tics. (g) The individual CAD Procera densely sintered alumina copings have excellent fit and optimized translu-
cency. (h) The provided shade information guides the ceramist in the creative ceramic buildup. (i) The four Pro-
cera alumina crowns veneered with NobelRondo alumina ceramics after glazing. (j) Marginal fit, function, form,
texture, and color reproduction are verified at try-in of the crowns. (k) The Procera crowns from the lingual as-
pect after cementation. (l to n) Dental esthetics has many individual aspects, and the patient is our focus. The
importance of ethical aspects and the beauty of a happy smile can never be underestimated. (Case treated by
Dr C. Meyding, Wetzlar, Germany; ceramics by D. Hildebrandt and E. A. Hegenbarth, Bruchkbel, Germany.)
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Acknowledgments
The author would like to express his gratitude to the cre- cians supporting the documentation of the clinical cas-
ative team of ceramists in his laboratory and to all clini- es presented in this publication.
References
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dont 1991;4:4550. analysis of human teeth. J 17. Bengel W, Devigus A. Prepar-
2. Miller L. Organizing color in Dent Res 2002;81:577582. ing images for publication: Part
dentistry. J Am Dent Assoc 10. Zena RB, Hegenbarth EA. 2. Eur J Esthet Dent
1987;115(special Transparenz - die vierte Farb- 2006;1:112127.
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matching. Quintessence Int tion: The application of colour sion and esthetics in all-
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und Zahnersatz. Berlin: Quin- CCS-SystemsComputerges- BR. Procera: A new way to
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360
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All C opyrig

Ernst A. Hegenbarth, MDT

Correspondence to: Ernst A. Hegenbarth

mixtures, other methods of shade selection

There is hardly any communication be- Traditional shade selection

is a dental professional who can claim market position as a common adjunct in

1. Traditional. Variations on visual compar-

Fig 8 (a to c) Trushade artificial light source with

Intraoral digital photography equipped with a 100-mm macro lens with

Fig 10 The NobelRondo ceramic shade tabs are

Step 4: Internal structures character of a tooth is determined by sub-

characterizations on the tooth outline on Step 5: Value, translucency,

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