workflow Standardising visual tooth shade determination and precise shade reproduction are some of the everyday challenges faced in dental practices, explains Dr José Gabriel Martínez.

Vita Easyshade

The perception of colour is based on subjective, visual sensory impressions and is influenced by a number of factors. For example, lighting conditions have a significant impact on the shade chosen during tooth shade determination.

The basic shade of the tooth is mainly defined by the dentine. The layers of enamel on top produce a variety of optical effects, depending on the thickness and translucency.

In the following case, dentist Dr José Gabriel Martínez demonstrates how easy and reliable tooth shade determination and material selection is. He uses the Vita Easyshade V digital spectrophotometer.

Clinical situation

Figure 1: The insufficient, fractured composite filling on tooth UL1 was to be restored using a CAD/CAM-supported feldspar ceramic crown
Figure 2: As a quick solution, a temporary composite crown was fabricated using CAD/CAM-based Vita CAD-Temp Multicolor

A patient’s upper middle incisor was reconstructed using a direct composite restoration, which fractured.

In addition to the material deficiency, the patient was also not satisfied with the tooth shade and aesthetic appearance. For that reason, the decision was made to reconstruct the tooth using an efficient, digital workflow. One with a monolithic, tooth-coloured feldspar ceramic crown.

In order to treat the ­patient in a single session, a full-crown ­restoration was performed. The composite structure was almost entirely removed.

Figure 3: During the preparation of tooth UL1, the composite filling was almost completely removed

Following, a temporary crown was made from the CAD/CAM Vita CAD-Temp Multicolor composite material using the 2M2 shade, in order to stabilise the tooth and soft tissue.

Figure 4: During the preparation, the minimum layer thicknesses of the restoration was observed

Tooth shade determination

The shade was digitally determined using Vita Easyshade V, achieving a perfect colour match between the new restoration and the neighbouring left incisor tooth.

A spectrophotometer was used to transmit defined light into the dentine core. The reflected light spectrum was recorded by a measuring probe.

Then the spectral data was analysed independently from the ambient conditions and the tooth shade was determined. This procedure was used to determine the 2M2 tooth shade for the patient. Also, to select the system-recommended ­Vitablocs Reallife blank (Vita Zahnfabrik, Bad Säckingen, Germany).

In order to provide the dental technician with detailed information on the results, additional digital photos were created in raw format. The photographs were taken using the shade guide and a polarising filter in order to reduce reflections.

Figure 5: The basic shade 2M2 was determined using Vita Easyshade V
Figure 6: The shade of the adjacent tooth was integrated into a digital photo and sent to the laboratory

CAD/CAM workflow

Figure 7: Since the shade of the prepared tooth affects the shade of the restoration, a three-point measurement was conducted

After an analogue method was used for the impression and model fabrication. The situation was scanned using the Ineos X5.

The crown was constructed using the Inlab-CAD- Software (both Dentsply Sirona, Bensheim, Germany).

The applied Vitablocs Reallife replicated the tooth’s natural arched shade gradient between the dentine and anterior, thanks to 3D layered structure.

In order to reproduce the shade and translucency of the neighbouring anterior teeth with a natural appearance, the virtual restoration was positioned individually within this three-dimensional layer structure. The monolithic restoration was then fabricated using the Inlab MC XL milling unit (Denstply Sirona). Finally, the restoration was finished with fine diamond and polishing tools.

Figure 8: A digital photograph with polarising filter and corresponding shade tabs provided the dental technician with individualised information

Treatment result

Figure 9: The highly aesthetic monolithic crown naturally integrated into the dental arch

During the clinical try-in, the patient and technician were both highly satisfied with the results, as the feldspar ceramic crown was very well-integrated into the natural tooth structure.

After conditioning the lumen with hydrofluoric acid and silane, the crown was fixed with ­adhesive. Precise digital tooth-shade determination, the correct blank choice based on the Vita Easyshade V block mode and the additional information provided by digital photo­graphy were the success factors in the efficient production of an aesthetic, monolithic restoration with natural shade effects and light­ dynamics.

Figure 10: Final result in the upper dentition