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Rx

 

 

Shade taking with Ivoclar-Williams shade guides

 

I. Determine type of patient

Before starting the shade taking process it’s important to talk to the patient to determine what are his or her expectations (what type of patient are they?) It can be very frustrating to discover a Hollywood after doing an Alfred E. Newman.

Hollywood- white and straight. Is a very concerned and vocal patient.
Alfred E. Newman- "What me worry?" The vast majority of patients are here. They typically go along with what you prescribe and accept, but they obviously can lean more in either of the other 2 directions.
Naturalist- wants teeth to look totally natural and blend in completely with other teeth- may have numerous craze lines, wear facets, diastemas, strange rotations, and particular contours. This is the most demanding patient.
 

II. Prepare the patient for the shade taking task.

  1. Remove or cover influencing colors such as lipstick or bright clothing.
  2. Turn off operatory light or at least have it pointed well away from the patient.
  3. Have the patient seated in an upright or 45 degree position.
  4. Explain to them how you want their mouth and lips opened.

 

III. Take shades (in this example I'm using IPS Classic porcelain tabs)

  1. Use the Vita-Lumin (VL) guide to determine "general" shade. Please note that the vast majority of shades lie in the A, B, or D hues and in the 2 or 3 chroma values.

    2. use only one tab of a couple of ranges at a time, i.e. A2 & B2 from here you can change to higher or lower sets of tabs, i.e. A1 & B1 or A3 & B3

  2. Starting with a shade determined from VL (example B3) check shade tab of IPS classic dentin "D" for match. You may decide to raise or lower choice- say, B2 instead of B3.
  3. Determine marginal area shade (normally is close to or the same as the Dentin)

    4. for porcelain butt margins- use "M" tab

    for non porcelain butt margins- use "OD" tab

  4. Indicate on Rx placement of marginal shade
  5. Indicate on Rx placement of Dentin
  6. Determine primary incisal shades (S1 thru S4) & indicate on Rx placement of
  7. Determine secondary incisal shades & indicate on Rx placement of- often is blue (T/B) at mesial or distal incisal point angles, clear (T/C) areas, yellow spots, or dentin halos.
    8.
  8. Determine characteristics- this basically includes craze lines, mammalons, calcification, amalgams, and carries, but can also be placement of texture and sheen (see #’s 11 & 12)
  9. Determine interproximal shade (OD orange (O), yellow(G), or brown(B))
  10. Determine occlusal or lingual fossa shade (Oc.D orange(O), yellow(G), or brown(B))
  11. Rate surface texture in percentage ( 10% extremely smooth-90% extremely textured)
  12. Rate luster (10% very dull- 90% very shiny)
  13. Choose style:

    14. virginal-young tooth with deep anatomy, mammalons, pointed cusp tips, and no wear

    Average- has some wear, not as intricate anatomy, may or may not have mammalons

    vigorous- very worn, flat occlusals or sharp irregular incisals,

  14. Double check

 

Example of shade prescription

tooth1.bmp (546174 bytes)

 

Points to remember

  1. Only look at shades and teeth for short periods of time.
    2.
  2. Have the patient often lick their teeth to keep them moist.
    3.
  3. The light source will dramatically effect shade. So never have operatory light focused on patient; use color corrected lighting overhead; and don’t be afraid to check shades in different settings outside of the operatory.
  4. Only take the shade prior to prepping, never afterwards or during.
    5.
  5. Background colors effect shades- especially reds, so have patients remove lipsticks and use blue aprons to cover offensive clothing. (this especially includes plaid polyester bell bottoms!)
  6. Reduce, reduce, reduce!!! The amount of reduction is the most important factor in creating esthetic restorations. The difference between 0.5mm and 1.0mm is just as dramatic as the difference between 1.5mm and 2.0mm reduction. Remember that we’re trying to hide a metal substructure that won’t let light pass through as it does in a natural tooth. We can have it refract in ways to mimic nature, but porcelain depth must be there to do so.
    7.
  7. Women are far less likely to be color blind than men, so it’s not a bad idea to have your assistant help in shade taking decisions (assuming of course that your assistant is a woman!)

 

 

A quick understanding of Hue, Chroma, & Value

Hue- is the basic color. "A" shades are orangish-brown, "B" shades are yellow, and "D" shades are yellowish-brown.
Chroma- is the intensity of that color, so that a higher degree of chroma would have a higher concentration of hue.
Value- is typically looked at as the amount of grayness or whiteness. To lower the value means to darken, and to raise the value means to lighten.  The "C" shades can be used to indicate four basic values.