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Welcome back! This month, I would like to address another unpleasant situation that often confronts practitioners — the restoring of a natural uniform shade throughout the mouth when dealing with patients who present with varying shades due to existing mismatched restorations and/or prostheses, or natural teeth of varying shades. Cases such as these can be some of the most challenging for the practitioner as well as the technician in obtaining a uniform compatible shade throughout the visible smile line.
For example, cases which involve matching a patient’s existing dentition (whether it be natural teeth, prosthetic restorations, or a combination with a detachable prosthesis) with processed prosthetic teeth can be extremely difficult unless we can communicate with our patients the expected outcome and obtain their informed acceptance. The solutions could be:
- Have your patient live with varying shades on different teeth.
- Crown all of the dentition to match the shade with the porcelain veneers or full crowns.
- A combination of bleaching some teeth, crowning others, and the fabrication of porcelain veneers on the detachable prosthesis to accomplish a compatible shade match.
- Shade prosthetic denture teeth with a composite color tinting system to closely approximate these combination cases.
- When dealing with a full maxillary removable prosthesis, some patients will accept a lighter shade on the maxillary teeth and will not be as concerned with the variable shades on the mandibular teeth. It must be explained to the patient in detail that the lighter upper teeth may significantly be noticed by others when compared to the lower dentition. Generally, those patients with reasonable expectations will be much easier to satisfy. However, even the nicest of patients sometimes insist on a very natural look and uniform shade throughout at least the visible smile line.
My recommendation is to first have a reliable method of determining shade. I have discarded all shade guides I had in various cabinets throughout my office in order to eliminate confusion. I am now using a scientific method of shade matching as a means to eliminate the subjective techniques used in the past.
From a scientific point of view, an apparatus with its own internal light source eliminates other not-as-reliable external sources which may compete with other lighting in the operatory. Shade is comprised of value, chroma, and hue, which can be digitally scanned for a highly predictable outcome.
This technology incorporates multiple color spectrophotometers, scanning multiple angles of the tooth to provide digital shade measurements without any external light source.
The accuracy is unparalleled in today’s dentistry and can be easily transferred to your computer as well as transmitted to your technician. The device to which I refer with confidence is the second-generation VITA Easyshade® Compact.
With this instrument, I can effectively verify and communicate with my prosthetic patients the outcome outlining the overall shade results of any case, including the most challenging combination of removable and fixed anterior prosthetics.
It now becomes the patient’s decision to accept some natural variance in shade, consider custom porcelain veneers, or choose composite shading for him- or herself with an adjacent fixed and removable combination situation.
In closing, we may want to consider measuring scientifically the various shades in patients’ dentitions and allow them to make the final treatment decisions to give them the outcomes they desire.
Certainly, we need to plot the proper design for the patient’s desires and then allow the patient to decide on the final shade, whether it be all the same or customized with some shade differences which, in most cases, can look extremely natural.
Letting the patient become a partner in the decision decreases the stress on both the dentist and the patient and opens the dialogue to what is realistic, while eliminating an unpleasant surprise at try-in and delivery.
Good dentistry requires good communication. I am presently using the VITA Easyshade® Compact and have markedly improved communications with my patients as well as my laboratory technicians.
I sincerely hope the tips I have shared with you today will help you enjoy your patients more each day. See you next month ... Joe Massad