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A comparison between visual, digital photography and polarizing filter

photography for shade selection

Article  in  Indian journal of dental research: official publication of Indian Society for Dental Research · September 2020
DOI: 10.4103/ijdr.IJDR_286_19

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Kasturi Kelkar Chethan Hegde

Mahsa University College A.B. Shetty Memorial Institute of Dental Science
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Original Research

A Comparison Between Visual, Digital Photography and Polarizing Filter

Photography for Shade Selection

Abstract Kasturi C Kelkar,

Aim: There is an increased awareness for aesthetically pleasing restorations among patients in Easha Singh Dogra,
current practice. Due to variability in the natural tooth colour, shade selection becomes an intricate Vinaya Bhat,
procedure. The aim of this study is to determine which of the three named methods is more accurate
for shade selection in aesthetic dentistry. Materials and Methods: Two VITAPAN classical shade Krishna Prasad D,
guides were used for this study. Nine shades were selected from the first shade guide (A1, A2, A3.5, Chethan Hegde
B1, B2, B3, C1, C2, C3) and the number was concealed. Ten selected participants were asked to Department of Prosthodontics,
identify each concealed shade with the second shade guide. Canon 5D camera with ISO 200, shutter A B Shetty Memorial
speed 1/100  sec, F22 was used for capturing images of the second shade guide. Photoshop CS3 Institute of Dental Sciences,
NITTE (Deemed to be
Software was used for developing the digital shade guide. The participants were asked to match the
University), Deralakatte,
shades from the first shade guide with the prepared digital shade guide. The third photographic shade Mangalore, Karnataka, India
guide was prepared using a polarised filter on the Canon 5D camera with the same settings. The
participants were asked to match shades with the prepared photographic shade guide. Results: Total
observations made during the study were 270. Cross table statistical analysis  (Chi‑square test)
done using SPSS 20.0 showed statistically significant difference between conventional and digital
photography (P = 0.049). Analysis between digital photography and polarizing filter photography did
not reveal a significant association (P = 0.181). Conclusion: Digital photographic method was most
accurate among the three shade selection methods. It can be used to obtain aesthetic results.

Keywords: Digital photography, polarizing filter, shade selection

Introduction vary from each manufacturer company.[4,5]

There has been an increased awareness
for aesthetically pleasing restorations
among patients. Hence it is a practitioner’s
responsibility to provide restorations which
can merge well with the surrounding natural
dentition. Selection of appropriate shade
for the prosthesis can be a challenging
process. Factors such as shade matching
conditions  (lighting),[1] education and
training, various shade matching tools and
knowledge of colour science influence the
final dental prosthesis.[2]
Visual shade selection method is one of the
most frequently used procedure however
it is highly subjective and inconsistent.[1,3]
Fatigue, ageing, colour defective vision,
medications and experience may influence
the colour perception of an individual.[3]
Variation seen during natural daylight can
influence the shade matching.[1] The various
shade guides used for visual shade selection
This is an open access journal, and articles are
distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creations are
licensed under the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
Also, each generation of tabs are dissimilar
within a given shade guide company.
Instrumental methods of shade selection
include the use of spectrophotometer,
colourimeter and photography.[1] The use
of these devices involves huge investments
resulting in fewer dentists opting for
them.[1,4] Address for correspondence:
Dr. Vinaya Bhat,
Digital photographs provide an array Department of Prosthodontics,
of colours to choose from. They help A B Shetty Memorial Institute
of Dental Sciences, Deralakatte,
in visualizing the morphology, colour Mangalore ‑ 575 018,
and texture of the teeth thus improving Karnataka, India.
the communication between a dentist E‑mail: drvinayabhat@gmail.
com
and a technician.[1,3,4,6] Images produced
via photography can be analysed using
appropriate software. This provides the value Received : 29-03-2019
of colours from the whole or part of such Revised : 29-04-2019
Accepted : 25-09-2020
images. The tooth shade can be analysed Published : 08-01-2021
objectively and transmitted via internet to
the technician thus giving more information Access this article online
about the restoration to be fabricated.[5] Website: www.ijdr.in
Polarising filter eliminates glare and DOI: 10.4103/ijdr.IJDR_286_19
reflection seen in an image while increasing Quick Response Code:
How to cite this article: Kelkar KC, Dogra ES,
Bhat V, Prasad DK, Hegde C. A comparison between
visual, digital photography and polarizing filter
photography for shade selection. Indian J Dent Res
2020;5:712-7.

712 © 2021 Indian Journal of Dental Research | Published by Wolters Kluwer - Medknow
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Kelkar, et al.: Shade selection methods in aesthetic dentistry
colour saturation.[2] It enhances the translucency and allows
us to better visualize the real polychromatic nature of
teeth.[1,2]
The purpose of the present study was to determine which
among the three named methods i.e., visual shade selection,
digital photography and polarising filter photography
is better for shade selection in aesthetic dentistry and
whether experience influences the ability for accurate shade
selection. The null hypothesis for this study considered that
there was no significant difference in the shade selection
methods under study.
Materials and Methodology
A total of ten observers  (five males, five females) were
selected based on their work experience comprising of four
postgraduate students, three dental technicians and three
professors. Each of the observer was asked to perform
shade selection according to the following methods:
1. Visual shade selection
2. Digital photographic shade selection
3. Polarizing filter photographic shade selection
For visual shade selection
Two VITAPAN classical shade guides were used for this
study. Nine shades were selected from the first shade
guide  (A1, A2, A3.5, B1, B2, B3, C1, C2, C3) and the
shade number was concealed. The selected tabs depicted
the most common shades used in a clinical setup. For the
control shade guide, same shade tabs were selected from
the second VITAPAN classical shade guide.
Each observer was given one concealed shade tab in a
random sequence and was asked to identify the shade from
the control shade guide (in natural daylight). No time limit
was imposed for the matching. Each observer made nine
observations giving a total of 90 observations from this
method.
For digital photographic shade selection
Digital photographs of each selected shade tab from the
control group were captured individually to prepare a
digital photographic shade guide. A  Canon 5D camera
was mounted on a tripod stand at a height of two feet
and the shade tabs were kept at 30 cms from the camera.
A  standardised camera setting of ISO 200, shutter speed
1/100 seconds, F22 were used for capturing all photographic
images. The lighting conditions while capturing these
images comprised of a mixture of daylight and overhead
light tubes and camera inbuilt flash. Using Photoshop CS3
software, a digital photographic control shade guide was
prepared. For capturing images of the concealed shade
tabs, each tab was placed at right central incisor position
in a typhodont with adjacent central incisor missing. Thus,
nine images of typhodont with concealed shade tab in the
right central incisor position were captured and transferred
to Photoshop Cs3 software. The prepared digital control
Indian Journal of Dental Research | Volume 31 | Issue 5 | September-October 2020 
shade guide was layered above each captured photograph
of the concealed shade tab. Thus nine photoshop document
files (PSD) were developed for matching.
For polarizing filter photographic shade selection
A circular polarizing filter was attached to the Canon 5D
camera. Photographs of control shade tab were captured
using polarising filter to prepare polarised shade guide.
Images of typhodont with concealed shade tab at right
central incisor position and missing adjacent central incisor
were taken. The photographs were captured with the
same camera settings and lighting conditions standardised
for digital photographic shade selection. These nine
images were transferred to photoshop Cs3 software and
the prepared polarised shade guide was layered on each
photograph. Thus nine PSD files were developed for
matching for the polarising method.
Verbal instructions with a demonstration for computerised
shade matching was given to educate the ten observers
and introduce them to Photoshop Cs3 software. The 18
PSD files  (nine digital photographs, nine polarizing filter
photographs) were coded as per concealment of the shade
tabs. Each observer was presented with a PSD file and
asked to match the missing central incisor with the adjacent
right central incisor from the shade guide provided above.
The observer could move around the control shades and
even overlap two shades for selection. Once the shade
was matched, the observation was noted, and the next file
was presented for shade selection. Each observer made
nine digital photographic observations and nine polarized
filter photographic observations giving a total of 180
observations.
The cross table statistical analysis was done using
Chi‑square test in SPSS 20.0 software.
Results
A total of 270 observations were made during this study.
In visual shade selection method, 50% of the observations
were correct. In the digital photographic method of shade
selection, the correct percentage of shade matching was
63.3% whereas for polarizing filter photographic shade
selection the correct percentage was 55.6%  [Table  1].
The cross table statistical analysis showed a significant
difference between the visual and the digital photographic
shade selection method  (p  =  0.049). In comparison with
the visual method, an increase of 5.5% was observed in
polarizing filter photography (p = 0.275). Analysis between
digital photography and polarizing filter photography
did not reveal a significant association  (p  =  0.181). In
the analysis, level of significance is taken as 5% and
level of confidence is taken as 95%. For comparison of
observations among different group of shade selection
Chi  square test is used with 5% level of significance.
Overall confidence interval is 50.42% to 62%. For visual
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Kelkar, et al.: Shade selection methods in aesthetic dentistry

group the 95% confidence interval lies between 39.67% to
60.33%. For digital group the 95% confidence interval lies
between 53.3% to 73.3% and for polarized filter group it
lies between 45.2% to 65.8%.
In the study Reliability Index for the ten observers was
calculated to be 0.5. The individual matching ability of
each observer is given in Table  2. Observer one  (66.6%)
and five  (66.6%) had the most correct observations in
visual method. The least accurate shade matching was
done by observer four  (11.1%). In digital photographic
method, observer six was most accurate with all correct
observations. Most of the observers achieved an accuracy
of more than 50% in this method. With the use of
polarising filter photographic method, observer ten had the
most accurate observations (100%).
The professors and postgraduate students had an increase
in the correct number of observations in digital shade
selection methods as opposed to visual method whereas the
dental technicians showed a better shade matching ability
in the visual shade selection method. As the sample size is
very small no statistical test for the significant increase is
carried out and only the observations are noted down.
Discussion
The study of colour is an integral part of esthetic dentistry.
The colour of an object is determined by the nature of the
light source illuminating an object, its spectral reflectance[1]
properties and nature of human colour perception.[4] Ideal
colour temperatures for shade matching ranges from
5000 k to 7500 k.[7] However, these conditions vary in
natural daylight. Various shade selection methods are being
practised by dental professionals worldwide although
the most frequently used is visual shade matching. It
depends on an individual’s perception of shade selection
and is influenced by the light source, ageing, eye fatigue,
medication, colour vision deficiencies and dehydration
of the tooth. In this study, 50% of the observers matched
the shades correctly for visual shade selection method.
In a study done by Jared et al., 43% of the shades were
matched accurately by the observers. Schropp et al.

Figure 1: VITAPAN classical shade tab randomisation done Figure 2: Visual shade selection

Table 1: Number of correct and incorrect observations in three methods (original)

Method Visual Shade selection Digital Photographic shade selection Polarising Filter Photographic shade selection
Correct Observations 45 (50%) 57 (63%) 50 (55.5%)
Incorrect Observations 45 (50%) 33 (37%) 40 (44.4%)
Total Observations 90 (100%) 90 (100%) 90 (100%)

Table 2: Individual Matching Ability of each Observer (Original)

Method Visual Shade selection Digital Photographic shade selection Polarising Filter Photographic shade selection
Observer 1 6 (66.6%) 2 (22.2%) 1 (11.1%)
Observer 2 5 (55.5%) 7 (77.7%) 5 (55.5%)
Observer 3 3 (33.3%) 4 (44.4%) 2 (22.2%)
Observer 4 1 (11.1%) 6 (66.6%) 5 (55.5%)
Observer 5 6 (66.6%) 5 (55.5%) 5 (55.5%)
Observer 6 5 (55.5%) 9 (100%) 7 (77.7%)
Observer 7 5 (55.5%) 5 (55.5%) 4 (44.4%)
Observer 8 4 (44.4%) 5 (55.5%) 5 (55.5%)
Observer 9 4 (44.4%) 6 (66.6%) 7 (77.7%)
Observer 10 4 (44.4%) 7 (77.7%) 9 (100%)

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Kelkar, et al.: Shade selection methods in aesthetic dentistry
Figure 3: Digital photographic shade selection
Figure 5: Observer performing shade matching
evaluated the efficacy of digital photographs and graphic
computer software for colour matching with conventional
visual matching in a simulated clinic. They observed 32%
correct visual shade matches.
In the present study, nine shade tabs were selected from
the VITAPAN classical shade guide according to the
most frequently used shades in a clinical setup. Use of a
limited number of shade tabs from the same manufacturer
could have resulted in an increased number of correct
observations. Several studies have concluded that the use
of human extracted teeth[5] or human subjects[4] influences
the visual shade selection.
Instrumental methods for shade matching include the
use of a spectrophotometer, colourimeter and digital
photography. Spectrophotometers and colourimeters are
complex, expensive and not necessarily associated with
higher accuracy. Hence fewer dentists opt for these options.
The use of digital photography in shade selection helps
in analysing the morphology, colour and texture of the
adjacent structures to fabricate an accurate prosthesis. It
bridges the lack of communication between the dentist
and the technician. Digital photographic shade selection
procedure showed an increase of 13% as compared to visual
shade selection. Our results are in confluence with Jared
et al.  (61.1%) and Schropp et al.  (66%). The observers in
Indian Journal of Dental Research | Volume 31 | Issue 5 | September-October 2020 
Figure 4: Polarizing filter photography shade selection
Figure 6: Overlapping of shade tabs during digital shade matching
this study preferred the computerized methods as it allowed
them to see the shade guide and the dentition adjacent to
the missing tooth on the same screen. The shade tabs could
be moved around the computer screen and even overlapped
to obtain optimum results.
The use of a polarizing filter enhances the optical properties
of a shade tab by eliminating the reflected light. Thus, it gives
a matte effect to the captured images.[1,2] In this study 55.5%
of the observations were matched correctly by the observers.
There was an increase of 5.5% as opposed to visual shade
selection and a decrease of 7.5% in correct observations as
compared to the digital photographic method.
There was a variability in shade selection between each
observer in visual shade matching. Dental technicians
showed a better shade matching ability in this method. This
may be due to the experience of an individual. Our results
are in accordance with a study done by McMaugh et al.
where the mean score values observed by technicians was
higher in comparison to the students and practitioners.[8]
Çapa et al. evaluated the factors affecting shade matching
in dentists, dental staff members and laypeople and
observed a higher success rate in dental technicians due
to their experience in routinely performing porcelain
shade matching.[9] The highest percentage of accuracy by
observers one and five was 66.6% in visual shade selection
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Kelkar, et al.: Shade selection methods in aesthetic dentistry

Table 3: Number of times shade were matched correctly in the three methods (original)
Visual shade selection Digital Photographic Shade selection Polarised Filter photographic shade selection
A1 3 times 6 times 4 times
A2 6 times 6 times 3 times
A3.5 6 times 5 times 9 times
B1 4 times 8 times 5 times
B2 3 times 5 times 2 times
B3 9 times 7 times 8 times
C1 3 times 6 times 1 time
C2 5 times 5 times 6 times
C3 4 times 8 times 7 times

whereas in digital and polarizing filter photographic shade Acknowledgement

selection 100% accuracy was shown by observer six and
ten respectively.
Previous studies have stated the influence of gender on shade
perception with females having a superior shade matching
ability than males.[10,11] In this study, shade matching was
not influenced by the gender of an observer. Similar findings
were seen by Clary et al. Darker shades are better perceived
by the human eye.[3] In this study, most accurately perceived
shade by the observers was B3 [Table 3].
Education and experience aids in improved shade matching
skills.[7] The professors and technicians in this study showed
better shade matching ability than the postgraduate students
in visual shade matching technique. Adequate knowledge
about colour science and training for shade matching will
help in increasing the shade selection skills.[12]
One of the limitations of this study was matching few
shade tabs of the same company with each other which
may have resulted in higher accuracy.[5] The observers had
no time limitation for each of the shade selection methods
which could have resulted in eye fatigue. Also, increasing
the number of observations in each shade selection
method could have improved the matching skills of each
observer.
Conclusion
Digital photographic shade selection method was most
accurate among the three‑shade selection methods. It
provides better communication between a clinician and
technician and can be used to obtain optimum aesthetic
results.
Within the parameters of this study, a new polarizing filter
shade guide was prepared. However, the use of polarising
filter did not significantly influence the shade selection as
compared to digital photographic shade selection and visual
shade selection methods.
Shade matching when regularly practised can enhance
a clinician’s shade selection skills. Thus, education and
training may improve an individual’s shade matching
abilities.
This manuscript has been read and approved by all the
authors, requirements for authorship have been met, and
each author believes that the manuscript represents honest
work.
Key Messages
The study aims to identify which shade selection method
provides more accurate results. It was observed that
education and experience aids in accurate shade selection.
The use of a polarising filter during photography enhances
the optical properties of the shade tabs used.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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