I was fortunate to have been a dental lab tech prior to and during dental school. In fact most of my dental school professors had me do their crown and bridge. Because I continued to be trained as a master ceramist and had a full service lab in my office for over 30 years, I had the opportunity to improve our shade taking systems to a pretty fine art. Through the years I have picked up a few shortcuts and systems to make your life a lot easier. I want to give you a few quick tricks in getting shading right every time.
In the past, shade matching has been a combination of science, art, and luck. Our goal has always been to fabricate undetectable restorations, not good looking crowns. I would have to say, and this may be an aberration, but dental professors have to be among the worst shade takers I have ever seen. I am going to assume that unless you do hundreds of crowns a month (and if you did you would have a lab technician in your office) you are not going to go out and purchase a whole tooth scanning device like Cynovad ShadeScan ($8,995), or the X-Rite Shade Vision ($6,000). So let’s take a quick look at what the average dentist could do to improve the results and cosmetics of their shade selection.
1. Grind off the neck shades from your shade guides. The most popular (but not necessarily the best) guides are Vita Clasic, Vita 3D, Ivoclar, and Bioform. Really good cosmetic dentists should collect any and every guide you can find that helps you select the nearest shade. I have hundreds of guides in a drawer and half of them are not even made anymore. Failure to remove the collar will result in at least a half of a shade error in selection. Takes five minutes with a high speed diamond. NOTE: All color guides darken with age. If your shade guide is over 3-5 years old, replace it.
2. Make sure that your ops are all equipped with color corrected lights that reproduce “sunlight”, not the conventional fluorescent tubes. They just replace the bulbs you already have in the op and without them your color selection will always be off. Look for True-Lite, BlueMax, or CRS lights. You will be amazed at the difference in visibility and color matching in crown and bridge and anterior composites. I couldn’t work without them, and once you see the difference, neither will you.
3. Never, never, never, never, never ever paint your ops with any other color than a light blue. Ever wonder why every manufacturer of a shade guide includes a blue cardboard piece in the bottom of the box the shade guide was shipped in? Of course you don’t. It is called retinal fatigue. You work under poor fluorescent lighting, augmented with LEDs and loops, inside a room with funky colors that screw up your ability to differentiate slight changes in color. That blue card you threw away ten years ago was designed to be looked at prior to taking the shade to neutralize those influences on your ability to make fine color determinations. NOTE: Males have a 1:13 chance of being color blind where females have a 1:300 chance. If you are a male, do not select the color of the tooth. Delegate it to your female staff members. Also, never ever use any other color patient bib than a light blue one. It frames the patients face and will help neutralize the colors of the walls and what the patient is wearing.
4. Prior to any work, use the shade guide. Once you begin, the tooth is desiccated and you will be off on your Chroma and Hue. Make sure the tooth and the shade guide are wet in taking the shade. Do it from the front and rear of the tooth and always take a “stump” shade after the tooth is prepped so that the technician knows the shade of the dentin. A photograph will help, but not much due to the saturation caused by a flash.
5. HERE IS THE TRICK: Take my word for it. This will rock your world! I am going to need for you to put together a few things. I need for you to buy a Lab Wet Mixing Tray ($47). It is a usually a porcelain dish with depressions for storing porcelain stains around the periphery, flat surface in the middle, and a cover to keep the stains clean. Any lab supply will have them. Secondly, I need you to purchase a set of dental porcelain stains from the same place: Taub Porcelain Stains. Now you are ready. When technicians make crowns or stain an EMax or Zirc crown, they open their tray, place a drop of distilled water in the middle of the wetting tray and take a small paint brush and begin to alter the color of the crown: Violet or blue adds translucency, yellow to the neck, pink to cover grey, white to create opaque spots, etc. Next they place it in a glazing oven and the water evaporates and the stains “melt” into the porcelain. Here is what we are going to do: You remember the fact that I told you to collect all of the shade guides you can beg borrow or steal, right? Your female staff member has already selected the shade, but in this case you are doing number 8 while 9 and 7 are natural teeth. You are close, but no cigar. You are mailing the impression 1000 miles away, and you can’t take the chance of not getting it back correctly. Take out the wet tray with stains, but instead of water, place a drop of tooth sealant (yes, like the hygienists use) and add small portions of stain and paint them on the shade guide that most closely approximates the tooth color. Play with the color. If you make a mistake or don’t like it, wipe it off and start all over again. When you finally have the color you want, hit it with your curing light and you are done. Just box up the impression, send along a photo, and your customized shade tab and you are done. The neat thing about this is that when you get the shade tab back, all you have to do is wipe off the stain with nail polish remover and you are ready to go again.
This works awesome, and only takes a bit of practice to make you look like a superdupercosmeticaestheticLVIPAKLiveSeatleStudyClubSuperDoc.
Start today, because this is how you Summit.
Michael Abernathy, DDS