Communicating Shade to Labs

I used to just wrtie “A2” in a box on a lab sheet and hope that the lab would figure it out.  That was pretty dumb.

Unfortunately (or fortunately) our teeth are not identical to the VITA shade guide tabs.  There is far more complexity that exists in our dentin and enamel, so if we are to hope to acheive a higer level of replication we must put in some more effort than just writing a letter and a number on a lab script.

The good news is that you don’t need a masters degree in the fine arts to be able to take a good shade.  Here are some simple steps I use:

(1) Buy a damn digital SLR camera with flash and macro lens

I promise you that getting a professional camera will bring you to another level of dentistry.  There are a number of reasons, which our friend, Dr. Albert Yoo, is writing about in this month’s issue of Dental Economics.  But for now let’s be concerned with the fact that shade communication is far better with a proper camera set up than with your smart phone.  Two popular palces to get the whole package are Lester Dine and PhotoMed.

(2) Pick a few shades that look good

Don’t just pick one shade for your photo; pick a few.  Chances are that there’s more than one shade tab that will offer insight into the teeth of interest.  Giving more than one tab will also give the lab technician some variety and the ability to compare elements of color between photographs.  Don’t forget to give the lab a stump shade (shade of the prepared tooth) if you are using all-ceramic restorations.

(3) Take a proper photograph with the shade tab

Make sure the tab identifier is visable (e.g. A2, C4, etc).  Make sure the tab is held at a similar orientation as the teeth of interest so that the light plays off of it similarly.  Take a few photographs under different lights and not just your treatment room.

The orientation of the shade tab is a bit off, thus giving us a reflection that is not present on the teeth of interest.  This photo isn't terrible, but we lose an opportunity communicate some information to the lab.

The orientation of the shade tab is a bit off, thus giving us a reflection that is not present on the teeth of interest. This photo isn’t terrible, but we lose an opportunity communicate some information to the lab.

These photos are more accurate.  We have good orientation of the tabs, we can see the tab identifiers, and the lab has two photos for comparison.

These photos are more accurate. We have good orientation of the tabs, we can see the tab identifiers, and the lab has two photos for comparison.

(4) There’s more than just shade to communicate

But of course we’re not ONLY interested in communicating shade, are we?  There is also characterization and texture; what are the nuances of how the shade is distributed on the surfaces and what tiny lumps and bumps are to be found?  For these bits I like to take an extreme close-up photo, which can really only be done with a camera with a proper macro lens.  This can be separate from your shade tab photos so you’ll have a free hand to use a cool toy like a contrastor.

The left lateral incisior will receive a veneer.  Note all of the "personality" on the adjacent incisors.  We have craze lines, small incisal chips, and other details that the lab technician can emulate.  Bonus points for using a contrastor to black out the background and help show translucency.

The left lateral incisior will receive a veneer. Note all of the “personality” on the adjacent incisors. We have craze lines, small incisal chips, and other details that the lab technician can emulate. Bonus points for using a contrastor to black out the background and help show translucency.

 

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