Dental Lab Communication for a Difficult Shade

June 5, 2024 Kelley Brummett DMD

By Kelley Brummett, DMD 

A situation occurred in my office when I was working with a patient who needed a 30-year-old PFM crown replaced on #8. I was struggling with the shade because the adjacent teeth were an in between color. What I did was take a shade photo of the brightest one, which was B1, and then I took a shade photo with A1–because those were the two shades that matched the best. They weren’t what we were looking for. So, I made a provisional out of the A1 shade and a a provisional out of the B1 shade. I took the extra time to place both of them onto the tooth and let the patient look with me and help me decide. The patient chose the A1 shade. 

After I placed the A1 provisional, we sent  photos to my lab. These photos included the first shade photos of B1 and A1 alongside the tooth, photos of the B1 and A1 provisionals, and photos of the provisional I placed on the tooth from various aesthetic views. I then talked to the lab over the phone while we viewed the photos together so they could create the right in-between shade.  

At the end of the process, my patient expressed gratitude for taking the extra steps and meeting her expectations for a beautifully blended smile. 

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Kelley Brummett DMD

Dr. Kelley D. Brummett was born and raised in Missouri. She attended the University of Kansas on a full-ride scholarship in springboard diving and received honors for being the Big Eight Diving Champion on the 1 meter springboard in 1988 and in 1992. Dr. Kelley received her BA in communication at the University of Kansas and went on to receive her Bachelor of Science in Nursing. After practicing nursing, Dr Kelley Brummett went on to earn a degree in Dentistry at the Medical College of Georgia. She has continued her education at the Pankey Institute to further her love of learning and her pursuit to provide quality individual care. Dr. Brummett is a Clinical Instructor at Georgia Regents University and is a member of the American Academy of Cosmetic Dentistry. Dr. Brummett and her husband Darin have two children, Sarah and Sam. They have made Newnan their home for the past 9 years. In her free time, she enjoys traveling, reading and playing with her dogs. Dr. Brummett is an active member of the ADA, GDA, AGDA, and an alumni of the Pankey Institute.

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Choosing Value First

July 1, 2017 Lee Ann Brady DMD

Why You Should Determine Value Before Chroma and Hue When Matching Shades for Composites

The true artistry of the dental profession tends to show itself in many of the more challenging requirements of cosmetic dentistry. One of these areas where we can express our esthetic skills is in shade matching for composites. The struggle arises in understanding the various properties of natural-looking teeth and determining what visual aspects to match first.

 Composites 101: Defining ‘Shades’ and Their Components

Before you can begin to choose which aspects of a natural ‘shade’ to preference, it’s integral to delve into the nature of these complex components.

Reflectiveness and translucence combined determine the appearance of a tooth. Reflective properties are especially important for shade matching because this is the true definition of ‘value.’ Value tends to be defined as the coloring on a range of white to grey, but it’s actually a measure of tooth reflectiveness.

Other esthetic qualities of dentin and enamel include ‘chroma’ and ‘hue.’ A classic numeric scale of 1 (lowest) to 4 (highest) is used to judge chroma, which simply refers to the intensity of a color. Hue, on the other hand, is generally deconstructed into the letters A, B, C, and D. These indicate the names of color.

‘Shade’ is simply the end result when all three parameters of value, intensity, and hue are viewed together. The key lesson here is that these parameters must be matched separately. To achieve the best case outcome, you must rank them according to importance.

Should You Shade Match for Value, Chroma, or Hue First?

This is where things get tricky and we start to juggle multiple considerations at once.

Layering is paramount because dentin shades and light properties differ in composites versus real dentin. This is also true for enamel shades. Added to these differences is the fact that dentin and enamel do not have the same amounts of reflectiveness and translucence. Basically, you have dentin and enamel discrepancies between composites and real teeth in addition to the discrepancies that exist between dentin and enamel.

Precision will impact the final appearance of the tooth, so it’s important that you layer composites to get around these discrepancies. The composite materials selected should match for value before chroma and chroma before hue. Because final value is a blend of the individual values of every composite layer, you must consider that each layer is not going to be representative of your intended value. They build on one another to create life-like reflectiveness and translucency.

A Method You Can Use for Determining Value in Composites

My favorite method for constructing an esthetically superior value is to start the appointment with layering. I plan what composite shades I want to combine ahead of time and work efficiently so that inevitable teeth dehydration doesn’t affect my results.

I layer the materials on the labial of the adjacent tooth in their final thicknesses and photograph the outcome. This allows me to see if my chosen combinations match my esthetic goals and troubleshoot if the composite doesn’t disappear against the tooth. When I’m not happy with the look, I easily pop the composite off the tooth and re-do the process. I only begin to contemplate chroma and hue once I’ve matched the value.

How do you troubleshoot shade matching issues in your esthetic cases? We’d love to hear your perspective in the comments!

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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