You are on page 1of 5

Effect of Porcelain Shade and Application Time on Shade

Reproduction
Salma Ahmed Bahannan, BDS, MS, ABP, & Mohamed Abdelmageed Awad, BDS, MSc, PhD
Oral and Maxillofacial Prosthodontics Department, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia

Keywords Abstract
Color; ceramic; esthetics; restoration;
technician.
Purpose: To determine the variability in shade reproduction of metal ceramic restora-
tions fabricated by different laboratory technicians at different fabrication times.
Correspondence
Materials and Methods: One hundred thirty five metal copings for metal ceramic
Salma Bahannan, Oral and Maxillofacial restorations were fabricated with a standardized method and distributed among three
Prosthodotics Department, King Abdulaziz dental laboratory technicians (n = 45). Each technician was requested to match three
University, P.O. Box 80209, Jeddah 21589, different shade specifications including 2L1.5, 3M2, 4R2.5 shade tabs of 3D Master
Saudi Arabia. E-mail: sbahannan@kau.edu.sa shade guide following the manufacturer’s instructions. The technicians were instructed
to build up each shade 15 times using the same porcelain at three time periods namely
Presented at The 4th King Abdulaziz first thing in the morning (T1 ), middle of the work day (T2 ), and at the end of the work
University Dental Conference 29 October day (T3 ) (n = 5). Color difference (࢞E) was determined with a spectrophotometer.
2015, Jeddah, Saudi Arabia. Each restoration was measured and recorded nine times. Data were tabulated and
This project was funded by Deanship of
statistically analyzed using a univariate general linear model with Scheffe post hoc
Scientific Research (DSR), King Abdulaziz
test, and one-way ANOVA at 5% level of significance
University, Jeddah, under grant no. Results: The color difference (࢞E) was significantly different among technicians,
1433/165/500. time of application, and shade matched. Technician 1 demonstrated good color repro-
duction for all shades in T1 . That was the same as technician 2 for shades 3M2 and
The authors deny any conflicts of interest. 4R2.5, but the lighter shade (2L1.5) was better in T2 and T3 . Technician 3 had better
results at T3 . The lowest mean value of ࢞E was calculated with technician 3 while the
Accepted March 23, 2016
highest mean value was with technician 2. T2 was associated with higher ࢞E values
in contrast to the other two times for technicians 1 and 2, while T3 was associated
doi: 10.1111/jopr.12498
with lower ࢞E values for technicians 2 and 3.
Conclusion: Within the limitations of this study, it can be concluded that the shade
reproduction is affected by the time of porcelain application. The ability to repro-
duce the target shade differed among laboratory technicians. No specific time can be
considered for all technicians to reproduce the shades with more accuracy.

Effective communication between clinician and laboratory New technology enhances the predictability of achieving ac-
technician is the cornerstone of successful restorations. The curately matched restorations. Electronic devices have been
ability to produce esthetically successful restorations depends used as an attempt to overcome problems with visual matching
mainly on proper shade matching and shade reproduction.1 in dentistry. Spectrophotometers and colorimeters allow quan-
Subjectivity involved in assessing color has been one of the titative, rapidly obtained, and objective assessment of dental
most difficult remaining barriers to accurate communication. shades. In addition, instrumental readings enable communica-
Color matching is complicated by individual differences in tion to be more uniform and precise.4-6 The theoretical benefits
color perception lighting conditions, inadequate range of avail- of using spectrophotometers are that the measurements are not
able shades, and different ability of color discrimination.2,3 affected by human biases, subjectivity, vision deficiencies, or an
Hammad2 showed that prosthodontists demonstrated signifi- unsteady light source.7-11 Such devices provide measurements
cantly superior intrarater repeatability compared with general in CIE LAB units (Commission International del’Eclairage L*
practitioners when the Vita Lumin Vacuum shade guide was a* b* color system), which, when analyzed mathematically,
used, while there was no significant difference in intrarater re- can compare the color parameters of different objects. In the
peatability for prosthodontists and general practitioners when CIE LAB system, L* represents the lightness of a color in the
the Vitapan 3D-Master shade guide was used.2 black-white axis, a* defines color on the green-red axis, and

Journal of Prosthodontics 27 (2018) 227–231 


C 2016 by the American College of Prosthodontists 227
Porcelain Shade, Application Time, and Shade Reproduction Bahannan and Awad

b* defines color along the blue-yellow axis. As stated before, unknown to the researchers, and the evaluation was conducted
the CIE L* a* b* color system is commonly used in perceptual on the samples they produced, and not on the technicians them-
color assessment because of its approximate visually uniform selves. Ethical review board approval was not sought. Each
coverage of the color space.12 In this color space, color differ- technician was requested to build up the restorations using
ence (࢞E) between two objects (L*1 , a*1 , b*1 and L*2 , a*2 , the same porcelain material (VITA VM 13; Vita Zahnfabrik,
b*2 ) can be calculated according to the following formula:12 Bad Sackingen, Germany) to match three different shade spec-
 2  2  2 1/2
ifications, 2L1.5, 3M2, and 4R2.5 shade tabs of 3D Master
E = L ∗ 1 − L ∗ 2 + a∗ 1 − a∗ 2 + b∗ 1 − b∗ 2 shade guide (Vita Zahnfabrik) following the manufacturer’s in-
structions. The technicians were instructed to build each shade
Spectrophotometers measure and record the amount of vis- 15 times. In addition, they were asked to reproduce each shade
ible radiant energy reflected by the teeth one wavelength at a at three different times: first thing in the morning (T1 ); middle
time for each hue, value, and chroma present in the entire visible of the work day, after lunch hour (T2 ); and at the end of the
spectrum.12 They use reflectance technology because they only work day (T3 ) (n = 5). The porcelain applications were done
calculate the quantity and quality of light not absorbed by the under the daylight illuminator (KaVo Dental GmbH, Bismar-
measured tooth. The reflected light from the image is captured ckring, Germany) with correlated color temperature of 5400
at a 0° angle of incidence. A specific and unique fingerprint of K, work block 2400 Lux, and color reproduction factor of RA
the image is then recorded at 10-nm intervals throughout the 90-100.
whole visible light spectrum (400 to 800 nm).6 Several stud- Color difference (࢞E) was determined using an Easyshade
ies have claimed that spectrophotometric shade assessment was Compact device (Vita Zahnfabrik) according to the manufac-
able to produce a higher incidence of selecting the closest shade turer’s instructions. The mode of the device was adjusted to
with a minimum color difference when compared to the visual use the target shade as a standard before measuring the restora-
shade assessment method used by clinicians, dental students, tion. The machine was calibrated after each use. Two examiners
and subjects.5,13 performed the procedure. One measured the color difference,
Errors associated with shade reproduction have been docu- and the other registered the data. There was no separate control
mented in the literature,12,14-19 and include differences in ce- group, because the Easyshade device mode was adjusted to use
ramic alloys,14 thickness of substuctures,12,15 porcelain system the target shade as a standard before measuring the restoration
brand,12,14,16 powder/liquid ratio,17 and subsequent porcelain (measuring control). During measurements, the instrument’s tip
firing.18 It has been reported that the shade of metal ceramic was perpendicular and in complete contact with the restoration
specimens is affected by the type of base metal alloy sub- in the middle third of the labial surface of the restoration. Each
structure and type of overlying porcelain system.14 Jarad et al restoration was measured and recorded nine times.
claimed that changes in enamel porcelain thickness from 0.6 to Data were tabulated and statistically analyzed using SPSS
0.3 mm increase the chromatic shades.19 v.20. The effects of technician, shade, and time on ࢞E values
Although many investigations have examined materials, pro- were investigated. Univariate general linear model with Scheffe
duction techniques, manipulation variables, and their effect on post hoc test was used. The level of significance was set at
shade production, the effect of human variability and time of p ࣘ 0.05, and all tests were two-sided.
production is not known. The null hypothesis of the present
study was that the application of porcelain by different techni- Results
cians at different times would not affect the accuracy of shade
reproduction. The purpose of the study was to determine the The color difference (࢞E) was significantly different among
variability in shade reproduction of metal ceramic restorations technicians (p < 0.01), time of application (p < 0.01), and
fabricated by different laboratory technicians at different fabri- shades (p <0.01) (Table 1). Multiple comparisons of ࢞E of the
cation times. metal ceramic crowns for each technician at different times are
presented in Figure 1. Technician 1 demonstrated good color
Materials and methods reproduction in T1 . He had the lowest ࢞E (1.50) early in the
morning, and the highest ࢞E (2.78) at noon (T2 ). There was
Standard metal ceramic preparation was done on a maxillary significant difference in color reproduction difference (࢞E)
right central incisor in a typodont jaw model (Melamine tooth; among all shades at different times (p < 0.05), except between
Columbia Dentoform Corporation, Long Island, NY). Nine sec- T1 and T3 for shades 2L1.5 (p = 0.599) and 3M2 (p = 0.965)
ondary impressions (poly[vinyl siloxane], Master Dent; Den- and also between T1 and T2 for shade 4R2.5 (p = 0.877).
tonics Inc, Monroe, NC) were made and poured using extra Similarly, technician 2 worked better in T1 for shades 3M2
hard stone (Hardrock; Whip Mix, Dortmund, Germany) to pro- and 4R2.5, but the lighter shade (2L1.5) was better in T2 and
duce nine working casts and dies. Fifteen nickel-chromium T3 . There was significant difference in ࢞E among all shades
ceramometal alloy copings (Wiron 99; Bego, Bremen, Ger- at different times (p < 0.001), except between T2 and T3 for
many) were fabricated for each die. One hundred thirty five shades 2L1.5 (p = 0.087). Technician 3 had better results at T3
metal copings for metal ceramic restorations were made by with the darker shades (3M2 and 4R2.5). There was significant
one technician for standardization. The casts with their copings difference in ࢞E among all shades at different times (p < 0.01),
were numbered and randomly distributed among three den- except between T1 and both times T2 and T3 for shade 2L1.5
tal laboratory technicians (n = 45). The authors of the current (p = 0.151 and 0.319, respectively), and between T2 and T3 for
study were blinded to the identity of the technicians. They were shade 3M2 (p = 0.975).

228 Journal of Prosthodontics 27 (2018) 227–231 


C 2016 by the American College of Prosthodontists
Bahannan and Awad Porcelain Shade, Application Time, and Shade Reproduction

Table 1 One-way ANOVA for ࢞E values by technician, time, and shade

Significant comparisons
Mean SD 95% CI for mean F p by Scheffe test

Overall 2.11 0.84 2.06 2.16


Technician 1 2.17 0.84 2.08 2.25 29.12 <0.01∗ 1 vs. 3
2 2.30 0.89 2.21 2.38 2 vs. 3
3 1.87 0.72 1.80 1.94
Time 1 2.16 0.80 2.08 2.24 18.01 <0.01∗ 1 vs. 3
2 2.25 0.96 2.16 2.35 2 vs. 3
3 1.92 0.70 1.85 1.98
Shade 2L1.5 1.99 0.84 1.91 2.07 6.95 <0.01∗ 2L1.5 vs. 3M2
3M2 2.20 0.79 2.13 2.28
4R2.5 2.13 0.88 2.05 2.22

*Statistical significance.

Figure 1 Mean color difference (E) by technician, shade, and applica-


tion time.
Figure 2 Mean color difference (E) by shades, technicians, and
application time.
With lighter shade 1, 2L1.5 (Fig 2), there was significant
difference in color difference (࢞E) among all technicians at
different times (p < 0.001), except between technicians 2 and
3 at T2 (p = 0.467) and technicians 1 and 2 at T3 (p = 0.819). with technician 3, and highest mean with technician 2, with
In shade 2 (3M2), there was no significant difference in ࢞E a significant difference between technician 3 and each of the
among technicians at T1 (p = 0.09, 0.80, and 0.30, respectively), other technicians (p < 0.001). T2 was associated with signifi-
while there was significant difference among them at T2 and T3 cantly higher ࢞E values in contrast to the other two times for
(p < 0.001), except between technicians 1 and 2 at T3 technicians 1 and 2. T3 was associated with significantly lower
(p = 0.155). Regarding shade 3 (4R2.5), there was signifi- ࢞E values in contrast to the other two times for technicians 2
cant difference in ࢞E among all technicians at different times and 3.
(p < 0.001), except between technician 1 and 3 at T2
(p = 0.878). Discussion
Figure 3 represents the two-way interaction of color repro-
duction by technicians and time. In T1 , there was significant The current study was conducted to assess the ability to re-
difference between technician 1 on one side and technicians 2 produce different acceptable shades at different times. The
and 3 on the other side (p < 0.001), in favor of technician null hypothesis of the study was rejected since the applica-
1, while for times T2 and T3 there were significant differ- tion of porcelain at different times did affect the accuracy of
ences between technician 3 and each of technicians 1 and 2 shade reproduction. All technicians were affected by time of
(p < 0.001) in favor of technician 3. Regarding technician 2, application, although they used the same porcelain system (Vita
there was significant difference between T3 and each of times Zahnfabrik), same illuminator (KaVo Dental GmbH), and stan-
T1 and T2 (p < 0.001). The lowest mean of ࢞E values was dardized metal substructure (Wiron 99).

Journal of Prosthodontics 27 (2018) 227–231 


C 2016 by the American College of Prosthodontists 229
Porcelain Shade, Application Time, and Shade Reproduction Bahannan and Awad

should be considered during shade matching and reproduction.


Several papers indicate that shade matching can be improved
through education and training.25,26 However, no studies have
been found similar to our study. No one has yet related time
of shade production to quality of the color reproduction. The
results of our study indicate that regardless of the technicians’
skills, the application time did affect the final result of the
shade. In the current study, we found that the worst time for
color reproduction for technicians 1 and 2 was in the middle
of the day (T2 ), while the best time was early in the morning
(T1 ). In contrast, technician 3 worked better in the afternoon
(T3 ), but not early in the morning (T1 ). This might be related
to the time of color reproduction, which could be a factor, and
Figure 3 Two-way interaction of color reproduction by technicians and it depends on each technician.
time. Johnston and Kao claimed that a color difference of
࢞E > 3.7 is considered a poor match.27 In our study, we
considered ࢞E > 3.0 to be poor, according to the Easyshade
Because we used the instrumental method, all restorations
spectrophotometer manufacturer’s instructions. Although there
were measured in the middle third of the labial surface, and
was significant color difference at different times, they were
we considered other factors that could affect the results. It has
within the acceptable range (࢞E < 3.0). Although the number
been reported that the accuracy of shade using instrumental
of technicians is one of the limitations of the study, the techni-
methods is affected by the location of the tip of the instrument.
cians are the only ones who can determine which time is best
The aperture of the spectrophotometer (Easyshade Compact
for them to reproduce shades with more accuracy.
device) is about 3 to 4 mm. The authors felt that there was no
need to make a jig for placing the aperture, since it was small
and could be placed in the center of the restoration accurately. Conclusions
Having a small aperture was considered an advantage because
it measures a specific area of the restoration.20 A wide aperture Within the limitations of this study, the following conclusions
will provide the average area color, which may not represent were drawn:
the color array.20 1. The proper shade reproduction is affected by the time of
The selected shades (2L1.5, 3M2, 4R2.5) were chosen to porcelain application.
investigate the most reproducible shades with greater variability 2. The ability to reproduce the target shade differed among
among them. These shades represented different hues, chroma, laboratory technicians.
and values. We believe that the shade itself has an influence on 3. There is no specific time for all technicians to reproduce
the accuracy of the shade production. Although technicians 1 the correct shades; however, the afternoon time (1 pm)
and 3 mastered all shades, they did better with lighter shades was the worst time for most of them.
(2L1.5, 3M2). On the other hand, technician 2 had better results
with the dark shade (4R2.5).
Acknowledgments
Comparing the work of the technicians, it was noticed that
not all technicians had the same technical skills, although there The authors acknowledge Deanship of Scientific Research
was no significant difference among the samples of each tech- (DSR) at King Abdulaziz University, Jeddah, Saudi Arabia
nician in each specific time. Both technician 1 and 3 had low for the technical and financial support. The authors would like
࢞E (1.3, 1.4). Technician 2 had the highest color difference to express their sincere thanks to Professor Mona Hassan in
(࢞E = 3.4). There was a significant difference among tech- King Abdulaziz University for her assistance in the statistical
nicians (p < 0.001), which is in agreement with Douglas and analysis, and Dr. Lina Bahanan and Dr. Nada Shokair for their
Brewer, who found that the ability of technicians to reproduce assistance in collecting the laboratory data.
the target shades differed among laborateries.21 Several factors,
including porcelain batch, type, shade, and layer thickness, in- References
fluence the technicians’ skills in obtaining correct shades.19,22
Some authors have claimed the difference in ࢞E is due to using 1. Wang P, Wei J, Li Q, et al: Evaluation of an optimized shade
high-fusing porcelain in making the shade tabs with no metal guide made from porcelain powder mixtures. J Prosthet Dent
backing, resulting in unrealistic representation.23 Others found 2014;112:1553-1558
that any changes in thickness of the porcelain layers within 2. Hammad IA: Intrarater repeatability of shade selections with two
the clinically available space affect the overall shade of the shade guides. J Prosthet Dent 2003;89:50-53
3. Vehashinayim RH: Tooth color matching systems and
restoration.20
communication with dental laboratory in indirect restorations.
The human eye is considered an excellent shade detector,20 2011 update. Refuat Hapeh Vehashinayim 2012;29:28-34, 64
although the color of the tooth presents an interaction among 4. Wee AG, Monaghan P, Johnston WM: Variation in color between
polychromatic, multi-layered hard and soft dental tissues.23,24 intended matched shade and fabricated shade of dental porcelain.
Eye fatigue could affect the quality of the work.5 Therefore, it J Prosthet Dent 2002;87:657-666

230 Journal of Prosthodontics 27 (2018) 227–231 


C 2016 by the American College of Prosthodontists
Bahannan and Awad Porcelain Shade, Application Time, and Shade Reproduction

5. Bahannan SA: Shade matching quality among dental students different metal alloys and porcelains in the metal-ceramic
using visual and instrumental methods. J Dent 2014;42:48-52 complex. J Prosthet Dent 2004;92:477-485
6. Chu SJ: Clinical steps to predictable color management in 17. Zhang Y, Griggs JA, Benham AW: Influence of powder/liquid
aesthetic restorative dentistry. Dent Clin N Am 2007;51:473- mixing ratio on porosity and translucency of dental porcelains. J
485 Prosthet Dent 2004;91:128-135
7. Stevenson B: The colour measurement of ceramic samples using 18. Yilmaz B, Ozçelik TB, Wee AG: Effect of repeated firings on the
a commercial colour measuring device and a laboratory color of opaque porcelain applied on different dental alloys. J
spectrophotometer. PhD Thesis, University of Edinburgh, Prosthet Dent 2009;101:395-404
Edinburgh, UK, 2009. 19. Jarad FD, Moss BW, Youngson CC, et al: The effect of enamel
8. Ahmad I, Habib R, Azad A: Scientific and artistic principles of porcelain thickness on color and the ability of a shade guide to
tooth shade selection: a review. Pak Oral Dent J 2011;31:222-226 prescribe chroma. Dent Mater 2007;23:454-460
9. Joiner A: Tooth colour: a review of the literature. J Dent 20. Dozić A, Kleverlaan CJ, Meegdes M, et al: The influence
2004;32:3-12 of porcelain layer thickness on the final shade of
10. Klemetti E, Matela AM, Haag P, et al: Shade selection ceramic restorations. J Prosthet Dent 2003;90:563-570
performed by novice dental professionals and colorimeter. J Oral 21. Douglas RD, Brewer JD: Variability of porcelain color
Rehabil 2006;33:31-35 reproduction by commercial laboratories. J Prosthet Dent
11. Lath DL, Wildgoose DG, Guan H, et al: Visual whiteness 2003;90:339-346
ranking of a Vitapan 3D Master shade guide by untrained 22. Sorensen JA, Torres TJ: Improved color matching of
assessors. J Clin Dent 2006;17:10-13 metal-ceramic restorations. Part III: innovations in porcelain
12. Ghulman MA, Awad MA: Color variation between matched and application. J Prosthet Dent 1988;59:1-7
fabricated shades of different ceramics. J Prosthodont 23. Johnston WM: Color measurement in dentistry. J Dent
2013;22:472-477 2009;37:e2-e6
13. AlSaleh S, Labban M, AlHariri M, et al: Evaluation of self shade 24. Paravina RD, Powers JM: Esthetic Color Training in Dentistry
matching ability of dental students using visual and instrumental (ed 1). St. Louis, Elsevier, 2004
means. J Dent 2012;40s:e82-e87 25. Paravina RD: Dental Color Matcher, an Online Educational and
14. Anitha KV, Dhanraj M, Haribabu R: Comparison of the effect of Training Program for Esthetic Dentistry. 2016. Available online
different ceramic alloys and porcelain systems upon the color of at www.scadent.org/news/free-color-training. Accessed February
metal—ceramic restorations: an in vitro study. J Indian 24, 2016
Prosthodont Soc 2013;13:296-302 26. Chu SJ, Devigus A, Paravina RD, et al: Fundamentals of Color:
15. Omar HI, Atta O, El-Mowafy O: Difference between selected Shade Matching and Communication in Esthetic Dentistry
and obtained shade for metal-ceramic crown systems. Oper Dent (ed 2). Hanover Park, IL, Quintessence, 2011
2008;33:502-507 27. Johnston WM, Kao EC: Assessment of appearance match by
16. Kourtis SG, Tripodakis AP, Doukoudakis AA: visual observation and clinical colorimeter. J Dent Res
Spectrophotometric evaluation of the optical influence of 1989;68:819-822

Journal of Prosthodontics 27 (2018) 227–231 


C 2016 by the American College of Prosthodontists 231