CLINICAL RESEARCH

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Karl Martin Lehmann, DMD
Assistant Professor, Department of Prosthetic Dentistry,
University Medical Center, Mainz, Germany

Alessandro Devigus, DMD

Private Practice, Bülach, Switzerland

Christopher Igiel, DMD

Assistant Professor, Department of Prosthetic Dentistry,
University Medical Center, Mainz, Germany

Michael Weyhrauch,
Assistant Professor, Department of Prosthetic Dentistry,
University Medical Center, Mainz, Germany

Irene Schmidtmann,
Statistician, Institute for Medical Biostatistics, Epidemiology, and Informatics,
University Medical Center, Mainz, Germany

Stefan Wentaschek, DMD MSc

Assistant Professor, Department of Prosthetic Dentistry,
University Medical Center, Mainz, Germany

Herbert Scheller, DMD, PhD

Medical Director, Department of Prosthetic Dentistry,
University Medical Center, Mainz, Germany

Corresponding author: Karl Martin Lehmann

Assistant Professor, Department of Prosthetic Dentistry, University Medical Center, Augustusplatz 2, 55131 Mainz, Germany.

Tel: +49-6131-17-2871, Fax: +49-6131-17-5517. E-mail: karl.lehmann@unimedizin-mainz.de

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Abstract
Objectives: This in vitro study evaluated
the accordance of dental color meas-
urement devices with a Commission In-
ternationale de l’Eclairage (CIE)-compli-
ant reference system, by comparing the
CIE lightness, chroma, and hue (L*C*h°)
color coordinates of ceramic samples.
Methods: Four color measurement de-
vices: Vita Easyshade® Advance (A);
DeguDent Shadepilot™ (B); X-Rite®
Shadevision™ (C); and Crystaleye Olym-
pus (D), were compared with a CIE-com-
pliant reference system by recording
the L*C*h° color coordinates of ceramic
samples matching the tooth colors of
the Vita Linearguide 3D-Master®, under
standardized test conditions. Differenc-
es between regression lines for the den-
tal color measurement device data and
regression lines for the CIE-compliant
reference system data were evaluated.
Results: All devices offered high intra-
class correlation coefficients (0.9771–
LEHMANN ET AL
0.9999) for the L*C*h° color coordinates.
The regression lines of the L* and C*
coordinates for device A were steeper
than those of the CIE-compliant refer-
ence system; the regression lines for
devices B, C, and D were nearly paral-
lel to those of the reference system, but
with an offset. The regression lines of
the h° coordinates for all devices were
almost parallel to those of the reference
system, with slopes near 1. Excluding
the L* and h° coordinate measure-
ments of device A, the measurements
with the devices exhibited deviations
from the reference system that were
greater than those expected by chance
(P < 0.0002).
Conclusions: The dental color measure-
ment devices assessed here offered
excellent reproducibility, but showed
significant deviations from the CIE-com-
pliant reference system regarding the
L*C*h° color coordinates.
(Eur J Esthet Dent 2012;7:324–333)
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 CLINICAL RESEARCH
Introduction
The reproducibility and accuracy of the
detection of color information and its
reproduction represent a challenge for
both clinicians and technicians in re-
storative dentistry.1-7 Traditionally, tooth
color was visually defined with shade
guides that were used for tooth color
determination and to aid communica-
tion between clinicians and technicians.
However, shade selection is a subjective
procedure and is affected by many fac-
tors, including lighting conditions and
human perception.1,8-10 Although visual
shade matching has improved through
the use of shade tabs that are matched
with teeth or restorations in the order
of lightness, chroma, and hue,11 visual
shade selection still results in frequent
errors in appearance and matching res-
torations to natural teeth. Furthermore,
communication with a laboratory tech-
nician through the use of inadequate
shade guides adds a further source of
error, owing to the lack of shade guide
standardization by manufacturers.3
Color measurement devices of dif-
ferent types, including spectrophotom-
eters, colorimeters, and digital imaging
instruments, have been used clinically
for many years.12-17 These devices al-
low more reproducible and accurate
determinations of color coordinates and
the quantification of color differences
between natural teeth and dental resto-
rations. Thus, dental shade matching in-
struments have the potential to increase
the success of color matching, commu-
nication, and reproduction.3 These elec-
tronic color measurement devices have
the ability to determine color information
in concordance with the majority of color
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order systems (eg, L*a*b* and L*C*h°)
established by the Commission Interna-
tionale de l’Eclairage (CIE).18 Although
their reproducibility has been frequently
investigated, the dental color measuring
devices have rarely been compared with
a CIE-compliant reference system.13
The purpose of this study was to
compare the L*C*h° color coordinates
obtained using dental color measure-
ment devices with those obtained using
a CIE-compliant reference system. The
null hypothesis was that the L*, C*, and
h° color coordinates of the tested color
measurement devices are in accord-
ance with those of a CIE-compliant ref-
erence system.
Materials and methods
Test conditions
Illumination lighting conditions (Just
Normlicht, Weilheim an der Teck, Ger-
many) were set at 6500 K and 2000 Lux.
Daylight was excluded. A single trained
operator recorded the L*C*h° color co-
ordinates of each ceramic sample five
times, with each of the color measure-
ment devices and with the CIE-compli-
ant reference system.
Color measurement devices
The devices tested were Vita Easy-
shade® Advance (A), DeguDent Shade-
pilot™ (B), X-Rite® Shadevision™ (C), and
Olympus Crystaleye (D). The devices
were used according to the manufactur-
ers’ instructions. The data obtained with
these devices are shown in Table 1.
 LEHMANN ET AL
Data obtained with the color measurement devices: A: Easyshade Advance (Vita); B: Shadepilot (DeguDent); C: Shadevision

CIE-compliant reference system

Launch
date

2003

2011

2006

2001

2007
The CIE-compliant reference system was
a UV-Vis spectrophotometer equipped
with an integrated sphere (Evolution
resolution
Spectral

600®; Thermo Scientific, Madison, WI,

USA). The spectral resolution was set at
(nm)

N/A

N/A
2.0 nm over the entire range of wave-
2.0

25

10

lengths, from 380 nm to 780 nm. The

ment region

scanning speed was set at 60 nm/min.

measurement

measurement
Measure-

The room temperature was held constant

Complete

Complete

Complete at 25°C. Prior to the measurements, the

tooth

tooth

tooth
Spot

Spot

spectrophotometer was prepared for

30 mins to allow thermal equilibration.
The calibration was executed using a
ment range

diffuse 99% reflectance white standard

Measure-

380–780

400–700

400–720

(Labsphere, North Sutton, NH, USA).

(nm)

The recorded spectra were the basis for

N/A

N/A

calculating the CIE L*C*h° coordinates,

and OptLab-SPX 2.5 software (Ascanis,
Searchlight
White LED

illuminator

Überlingen, Germany) was used. Rec-

Tungsten
source

alibration was performed after each

Light

lamp

LED

LED
D65

measurement.
Two reflection
Calibration

Ceramic samples
standards
Reflection

Reflection

Reflection
standard

standard

standard

standard
Ceramic

Ceramic samples matching the tooth

colors of the Vita Linearguide 3D Mas-
ter® (feldspathic ceramic VM13 by VITA
Zahnfabrik; H. Rauter & Co, Bad Säck-
Operation

photometer

photometer

photometer

photometer
colorimeter

ingen, Germany) were used to per-

Imaging,
Spectro-

Spectro-

Spectro-

Spectro-
(X-Rite); and D: Crystaleye (Olympus).

mode

form successive measurements, with

repositioning. The samples were disc
shaped (diameter: 12 ± 0.5 mm; thick-
Evolution 600

ness: 2 ± 0.5 mm) and were stored in

Shadevision
Easyshade

DeguDent,
Shadepilot

Crystaleye

a light-tight box at 25°C. A specimen

Olympus,
Advance
Thermo,

X-Rite,

holder covered with a diffuse 99% re-

Vita,

flectance white standard reflectance

coating was used to fix the ceramic
Reference

samples.
Device
Table 1

D
A

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 CLINICAL RESEARCH
Statistical analysis
Data were imported into Statistical Pack-
age for the Social Sciences (SPSS) 17.0
(Munich, Germany) and Statistical Ana-
lysis System (SAS) 9.2 (SAS Institute,
2002–2008, Cary, NC, USA). Variance
components attributable to differences
in the color of the ceramic samples and
to measurement errors for each type of
measurement were calculated fitting lin-
ear mixed models with SAS PROC MIXED
(SAS Institute). The mean differences
between the measurements obtained by
the electronic color measurement devic-
es and those obtained by the CIE-com-
pliant reference system were calculated.
We also determined 95% confidence in-
tervals (CI) for these differences taking
into account repeated measurements.
To assess the equality of the electronic
color measurements and the spectro-
photometric reference measurements,
t tests were used. The CIE L*C*h° color
coordinates were used for further regres-
sion analysis. The association between
the color measurement devices tested
and the CIE-compliant reference system
was calculated through linear regres-
sion using SAS PROC REG. As repeated
measurements on the same specimen
by the same device differed very little,
we fitted the regression line to the means
of the repeated measurements.
Results
The L*C*h° color coordinates deter-
mined with the dental color measurement
devices (y-axis) were plotted relative to
those obtained with the CIE-compliant
spectrophotometric reference system
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(x-axis), together with the corresponding
regression lines. The marked bisecting
line indicates complete accordance of
the color measurement device and the
CIE-compliant reference system. The
intraclass correlation coefficients and
values for the slopes and intercepts of
the regression lines and corresponding
95% confidence intervals are shown in
Table 2. The mean deviations between
the color measurement devices and the
CIE-compliant reference system and
the corresponding 95% confidence in-
tervals are shown in Table 3. Only the
mean values are shown, as all of the
tested measurement devices exhibited
high intraclass correlation coefficients
of 0.9771 to 0.9999 for the L*C*h° color
coordinates.
Lightness
The regression lines of the lightness (L*)
coordinates for the color measuring de-
vices B to D were nearly parallel to that
of the CIE-compliant reference system,
with mean slopes of 1.02 to 1.14 (Fig 1).
The slope of the linear regression line for
device A (slope = 1.80; 95% CI; 1.59–
2.01) was steeper than the slopes for the
CIE-compliant reference system and the
other three devices. Nevertheless, de-
vice A showed the smallest mean devia-
tion (-0.04; 95% CI; -2.10–2.01), because
device A underestimated low L* values
and overestimated high L* values. This
deviation was within a random variation
(P = 0.9669). The B and C devices gave
regression lines almost parallel to that
of the CIE-compliant reference system
(B: slope = 1.14; 95% CI; 1.11–1.17; C:
slope = 1.02; 95% CI; 0.98–1.07), al-
though each had a different offset from
 LEHMANN ET AL

Table 2 Regression lines and regression coefficients of the color measurement devices compared with
the CIE-compliant reference system

Interval Intercept,

Interval Intercept,
Color coordinate

95% Confidence

95% Confidence

95% Confidence

95% Confidence
Interval slope,

Interval slope,
Measurement

upper bound

upper bound
lower bound

lower bound
correlation
coefficient
Intraclass

Intercept
device

Slope
L* A 0.9997 -54.09 -68.23 -39.94 1.80 1.59 2.01

L* B 0.9999 -6.91 -9.05 -4.77 1.14 1.11 1.17

L* C 0.9989 4.39 -9.52 7.26 1.02 0.98 1.07

L* D 0.9973 -9.54 1.52 -3.79 1.09 1.00 1.17

C* A 0.9998 7.07 1.71 17.00 1.67 1.27 2.07

C* B 0.9998 5.77 0.83 2.06 1.11 1.08 114.00

C* C 0.9986 1.49 -0.75 1.79 1.06 0.99 1.12

C* D 0.9951 0.52 1.56 9.60 0.81 0.60 1.02

h° A 0.9999 7.21 -13.11 27.53 0.91 0.64 1.18

h° B 0.9975 8.14 0.12 16.16 0.94 0.83 1.04

h° C 0.9886 8.50 -2.46 19.45 0.87 0.73 1.02

h° D 0.9771 28.94 11.01 46.87 0.66 0.42 0.89

Table 3 Mean deviations of the color measurement devices from the CIE-compliant reference system.
Color coordinate

95% Confidence

95% Confidence
Mean deviation

limit for mean

limit for mean

Measurement

upper bound
lower bound
deviation,

deviation,

t value
device

Pr > |t|

L* A -0.04 -2.10 2.01 -0.04 0.9669

L* B 2.40 2.06 2.75 13.96 <0.0001

L* C 6.02 5.79 6.26 50.77 <0.0001

L* D -3.52 -4.02 -3.02 -14.00 <0.0001

C* A 21.78 19.39 24.18 18.01 <0.0001

C* B 3.44 3.18 3.71 25.52 <0.0001

C* C 1.54 1.19 1.89 8.77 <0.0001

C* D 2.12 1.01 3.23 3.79 0.0002

h° A 0.27 -0.72 1.27 0.55 0.5859

h° B 3.24 2.84 3.64 16.04 <0.0001

h° C -1.17 -1.73 -0.61 -4.13 0.0001

h° D 2.91 1.91 3.91 5.75 <0.0001

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 CLINICAL RESEARCH

95 55
(A) (A)
(B) (B)
90 50
(C)
(C)
(D)
(D) 45
85

mean of C* coordinates
mean of L* coordinates

40
80
35
75
30
70
25
65
20
60
15

55
10

50 5

45 0
55 60 65 70 75 80 85 0 5 10 15 20 25 30

mean of L* coordinates of CIE mean of C* coordinates of CIE

compliant reference system compliant reference system

Fig 1 CIE L* coordinates of the color measure- Fig 2 CIE C* coordinates of the color measure-
ment devices A to D compared with the CIE-com- ment devices A to D compared with the CIE-com-
pliant reference system. pliant reference system.

a line of complete accordance with the for the CIE-compliant reference sys-
reference system. Devices B and C tem, and their slopes were similar to
showed positive mean deviations (B: the respective slopes of the L* coor-
2.40; 95% CI; 2.06−2.75 and C: 6.02; dinate lines (A: slope = 1.67; 95% CI;
95% CI; -5.79–6.26). The regression line 1.27–2.07; B: slope = 1.11; 95% CI;
of device D was also nearly parallel to, 1.08–1.14; C: slope = 1.06; 95% CI;
and offset below, that of the reference 0.99–1.12; D: slope = 0.81; 95% CI;
system (D: mean deviation = -3.52; 95% 0.60–1.02). Color measuring device C
CI; -4.02 to -3.02). With the exception showed the smallest mean deviation:
of device A (P = 0.9669), the deviations (1.54; 95% CI; 1.19–1.89) compared
of the devices with regard to lightness with the other tested devices. The de-
were greater than those expected by viations of the chroma measurements
chance (P < 0.0001). for all devices were greater than those
expected by chance (P < 0.0001).
Chroma
Hue
The regression lines of the chroma (C*)
coordinates for all of the tested devic- Compared with the slope of the regres-
es (Fig 2) were located above the line sion line of the hue (h°) coordinates for

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90
(A)
(B)
(C)
(D)
85
mean of h° coordinates
80
75
70
65
65 70
mean of h° coordinates of CIE
compliant reference system
Fig 3 CIE h° coordinates of the color measure-
ment devices A to D compared with the CIE-com-
pliant reference system.
the CIE-compliant reference system
(slope = 1), the slopes of the h° linear
regression lines for all of the devices
(Fig 3) were lower (A: slope = 0.91;
95% CI; 0.64–1.18; B: slope = 0.94;
95% CI; 0.83–1.04; C: slope = 0.87;
95% CI; 0.73–1.02; D: slope = 0.66;
95% CI; 0.42–0.89). Device A exhibited
the highest intraclass correlation coef-
ficient (ICC = 0.9999) (Table 2) and
the lowest mean deviation (0.27; 95%
CI; −0.72 to 1.27) with respect to the
CIE-compliant reference system (Table
3). The deviation for device A was
within random variation (P = 0.5859),
whereas the deviations for devices B
(P < 0.0001), C (P = 0.0001), and D
(P < 0.0001) were higher than those
expected by chance.
LEHMANN ET AL
Discussion
Electronic devices present new per-
spectives in color matching.19 In partic-
ular, the strength of these systems lies in
their ability to quantify color information
by recording color coordinates (ie, CIE
coordinates), which define color space.
Across the CIE L*a*b* color space, dif-
ferences approximately represent the
same scope as humans’ color percep-
tion, thereby improving the interpreta-
tion of color measurements. In addition,
75 80 85
color measurement systems have the
ability to define even small color differ-
ences between two objects, ie dental
restorations and natural teeth. At this
level of color measurement, instruments
can be judged based on their repeata-
bility and accuracy. In the present inves-
tigation, the color measurement devices
displayed excellent repeatability for the
L*C*h° color coordinates (ICC > 0.9771)
and thus offer clinically acceptable re-
peatability.
Based on the nature of color science,
the true colors of the ceramic speci-
mens used here are unknown. However,
comparisons between the color meas-
urement devices and a CIE-compliant
reference system, which presents the
nearest approach to the true values,
may allow an estimation regarding their
accuracy.13 This is an important consid-
eration, because for color coordinates
to be useful for both defining colors and
quantifying color differences, the meas-
urement system must be highly repro-
ducible and accurate. Beyond this, ac-
curately determined color coordinates
allow comparisons among the results of
different color measurement systems.
This is advantageous given that different
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 CLINICAL RESEARCH

color measurement systems are increas- devices to match CIE-compliant refer-

ingly used in both color matching and
reproduction processes; thus, accurate
measurements allowing comparisons
could improve communication between
clinicians and technicians.1,13,19-21 How-
ever, all of the measuring devices in the
present study differed to various degrees
from the CIE-compliant reference system
with regard to the L*C*h° color coordi-
nates. No devices in this study exhibited
regression lines for the L*, C*, and h° co-
ordinates that corresponded with those
for the CIE-compliant reference system
with respect to slope and intercept.
In summary, dental color measure-
ment devices should exhibit both high
reproducibility and accuracy, to allow
recorded color coordinates to be com-
pared among different color measur-
ing systems and to provide an accurate
evaluation of color differences between
two objects. It is suggested that manu-
facturers adjust their color measurement
ence systems, perhaps by modification
of the calibration process or transforma-
tion of the recorded data.
The null hypothesis that the L*C*h°
color coordinates determined with the
color measurement devices are in ac-
cordance with those obtained with a
CIE-compliant spectrophotometric ref-
erence system was rejected.
Conclusion
Within the limitations of this in vitro study,
the results indicate that the color meas-
urement devices under investigation
have excellent reproducibility, but the re-
corded L*, C*, and h° color coordinates
clearly deviated from those obtained
with the CIE-compliant reference sys-
tem. The color coordinates recorded by
different devices are currently not com-
parable.

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