CLINICAL RESEARCH

Determining color for the

direct restorative approach

Romain Ceinos, PhD, DDS

Lecturer, Côte d’Azur University, UFR of Dentistry, Nice, France
Aix-Marseille University, Marseille, France
Member of the international Bio-Emulation Group

Panaghiotis Bazos, DDS, MClinDent, MOrth

Specialist Orthodontist, Private Practice, Aigion, Greece
Founding member of the international Bio-Emulation Group

Javier Tapia, DDS

Private Practice, Madrid, Spain
Founding member of the international Bio-Emulation Group

Correspondence to: Dr Romain Ceinos

Université Côte d’Azur, UFR d’Odontologie, 24 Avenue Diables Bleus, 06357 Cedex 04 Nice, France;
Tel: +33 679 559 742; Email: romain.ceinos@unice.fr

494 | The International Journal of Esthetic Dentistry | Volume 16 | Number 4 | Winter 2021

Abstract
When implementing a direct composite resin (CR) res-
toration, the determination of color can be a challeng-
ing step. The reproduction of tooth shade is often a
source of frustration for the practitioner. Dental color
can be complex, and its accurate reproduction re-
quires not only a good understanding of color by the
The International Journal of Esthetic Dentistry | Volume 16 | Number 4 | Winter 2021
CEINOS ET AL
practitioner but also the use of appropriate methods
to achieve it. It is important to remember what tooth
color parameters one is able to mimic with CRs. The
purpose of this article is to demystify the errors attrib-
utable to standard tools, ie, shade guides, and above
all to suggest a number of measures to avoid such
errors.
(Int J Esthet Dent 2021;16:2–21)
| 495
CLINICAL RESEARCH

Tooth color parameters and

incremental correlation

Achieving seamless optical integration for

direct restorations remains an arduous
daily challenge. Patients notice even the
slightest color difference, resulting in their
Dentin body discontent and the need for repeating the
Incisal edge effects treatment.1,2
In order to select the right tooth color
Enamel layer
and then reproduce it with the help of com-
posite resins (CRs), two areas of knowledge
Fig 1 A direct restoration layered with composite resins (CRs) mimics the hard are essential for practitioners:
tissue to be replaced by incremental spacialization according to the natural ■ Understanding the parameters govern-
histo-anatomic model. ing natural tooth color.
■ Knowing how to simulate natural tooth
color using the different types of CRs
contained in CR kits.

Although several methods of layering CRs

have been proposed, the most frequent-
ly adopted technique to date is natural
3D layering.3 This method is based on an
incremental distribution of resin, similar to
the histo-anatomic model,4,5 ie, an external
shell of enamel resin replacing the enamel,
and, at its internal core, the addition of den-
Fig 2 Step-by-step anatomical layering with CR. tin masses with a progressive desaturation
from the cervical area toward the incisal
edge, replacing the dentin (Fig 1).6,7
Based on Munsell’s hue (basic color),
chroma (color intensity), and value (light-
ness) model, the parameters governing
tooth color can be linked to the resins that
Characterization Translucency are supposed to imitate them.8
■ Hue does not play a role in the practi-
tioner’s choice of incremental masses.
Texture Opalescence In fact, all industrial manufacturers are
developing CR systems with an almost
Brightness Chroma identical dentin chromatic base, restrict-
ed to the yellow–orange hue range, just
like the natural tooth.
■ Chroma (saturation) or pigment quantity is
mainly dictated by the dentin. It will there-
Fig 3 Synthesis of the major colorimetric parameters in direct restorative fore be logically simulated by the choice
dentistry. of CR dentinal incremental mass(es).

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 CEINOS ET AL

■ Value (amount of gray within the color)

is due to the enamel tissue: its degree
of lightness will be reproduced by the
CR enamel mass. Choosing the correct
degree of lightness is of utmost impor-
tance and will greatly influence colori-
metric success.9 Relative light reflection
will also be influenced according to
the textured appearance of the surface
topology of the superficial layer during
the finishing and polishing stages of the
CR restoration.

In order to fine-tune the color choice, the

practitioner must add secondary colori- Fig 4 Natural tooth imitation (center); under ultraviolet (UV) light by a
metric dimensions to Munsell’s model fluorescence-calibrated CR system (left), and the colorimetric mismatch of
(Figs 2 and 3). a CR system that does not take into account the fluorescence properties
of dental tissue (right).
Studies unequivocally show the lack of
standardization in fluorescent properties
between different CR brands. As soon as
several combinations of incremental CR
masses are applied, the optical aspect of the
fluorescence is influenced in a somewhat
unpredictable way. The consequences of
the different colorimetric perceptions from
the metameric (color perceived according
to various types of lighting) and esthetic
points of view within multilayer restorations
are not yet fully understood and remain con-
troversial. However, it is generally assumed
that an esthetic restorative material only ex-
hibits optimal properties when it reflects or
scatters light in a similar way to the natural
tooth (Fig 4). It is therefore recommended
to use contemporary CR materials, the
fluorescence of which has been calibrated Fig 5 The five patterns of opalescence according to Dr Lorenzo Vanini.

to be similar to enamel-dentin tissue.10,11

Opalescence is particularly visible in
areas where enamel is not combined with
dentin. Its visual impression is influenced
by the shape of the dentin tapered-edged
samples as well as the thickness and trans- masses (Fig 5). The visual appearance of the
lucency of the enamel layer. Opalescence is tooth can be imitated using flowable com-
based on five patterns, described by Vanini posite staining agents that reproduce the
and Mangani,12 the visibility of which can be various stains, streaks, and cracks in the res-
enhanced by using bluish or amber effect toration to varying degrees of depth.13

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CLINICAL RESEARCH
Fig 6 ‘Daylight’
portable devices
(from left to right):
Rite-Lite 2 (AdDent),
Smile Lite and Smile
Lite MDP (Smile Line),
Optilume TrueShade
(Optident), Coco Lux
(Hass).
Methods for direct colorimetric
determination
Despite the shade guides available for each
CR system, the practitioner is often con-
fronted with the difficulty of accurately re-
producing tooth color through the direct
method. This clinical reality raises sever-
al questions: What are the sources of the
errors attributable to the different types of
shade guides in the process of selecting
tooth color? What are the alternatives avail-
able for achieving the most accurate color
selection possible using the direct restora-
tive method?
Creating the right light environment
The ability to interpret a color is optimized
with the use of a ‘daylight’-type light source.
In the absence of a ceiling light that can
provide this ideal lighting environment, port-
able devices are a reliable aid to assist in the
practitioner’s choice (Fig 6).14,15 These port-
able lamps have open rectangular or round
shapes, creating an observation area that is
illuminated by a set of light-emitting diodes
498 | The International Journal of Esthetic Dentistry | Volume 16 | Number 4 | Winter 2021
(LEDs). This provides the optimal 5500 K
light temperature, with the possibility of
adding cross-polarizing filters that eliminate
reflections from shiny surfaces and improve
the visualization of details and dental trans-
lucency areas for better visual interpretation
reliability.16,17 Many manufacturers offer simi-
lar devices that can be coupled with smart-
phones or digital single-lens reflex (DSLR)
cameras, offering the possibility of taking
photographs.
Gaining a better understanding of
shade guides and their flaws
When targeting the CR systems used in
conjunction with the histo-anatomic layer-
ing technique, shade guides are classified
according to a variety of categories: some
that abide by the Vita standard, others that
do not, and some that individually separate
the enamel and dentin masses, allowing for
a multitude of possible combinations of the
samples.
In fact, commercially available shade
guides used for direct restorations are
biased in many ways:

■ Most CRs show a significant color
change after light curing and may or may
not match the sample from the com-
mercial shade guide with sufficient visual
acuity.18,19 Particular caution should be
exercised with the higher value, bright-
est, and less saturated CRs, which gene-
rally undergo greater color changes after
photopolymerization than those with
lower-value, highly pigmented resins.20
■ The vast majority of samples from shade
guides are not made from CRs but from
methacrylic resins. This type of plastic
material is incapable of accurately mim-
icking the restorative true color of CRs.21
As a result, color differences between
restorative materials and their reference
shade guides are generally contingent
on our ability to distinguish color, where
the color ‘shift’ is tangible.22
Shade guides with individual shade tabs
made solely with dentin materials meant to
facilitate in the selection of chroma and satu-
ration, and individual shade tabs made sole-
ly with enamel materials meant to objectify
degree value, might often be misleading.
CEINOS ET AL
Fig 7 Shade guide
samples are framed
by a transparent
plastic margin that
interferes with the
choice of color. In
addition, the nature
of the material used
is not identical to the
CR system to which
it is dedicated, and
thicknesses are
dissimilar to those
used in dental
practices.
Despite the laudable advantage of high-
lighting the primary dimension, namely
value (lightness), they remain the most er-
ror-prone of shade guides. The thickness of
the enamel tab samples from this type of
shade guide is overestimated and complete-
ly irrelevant to the actual thickness of the
restoration. As the degree of translucency or
opacity of the CR enamel is correlated to its
thickness, a random sample size (> 0.7 mm)
will interfere with the practitioner’s incre-
mental choice (Fig 7). The most serious flaw
of shade guides with individual tabs is the
practitioner’s inability to immediately pre-
dict the color rendering emanating from the
combination of enamel-dentin layers. Their
use is therefore particularly unpredictable in
terms of the final result obtained. To over-
come this problem, a very small number of
commercial manufacturers have developed
shade guides in which enamel and dentin
materials can be combined or have been
pre-combined.
An exception is the Miris 2 (Coltene
Whaledent) and, more recently, Inspiro
(Edelweiss) dual laminate shade guides,
where the dentin sample (body) is inserted
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CLINICAL RESEARCH

Fig 8 The Inspiro shade guide provides a combination Fig 9 For an optimal preview of the dentin-enamel
approach: The dentin cores for selecting the saturation combination, a glycerin film is interposed between the
fit into the enamel shells, determining the degree of two samples.
lightness.

Fig 10 Image
showing the dentin
and enamel samples
alone, and then
combined.

inside the enamel sample (skin) for a realistic

preview of all possible combinations. Better
optical results are obtained by interposing a
glycerin film between the skin and the body
in order to neutralize the refractive index of
the air between samples and to provide an
optical connection (Figs 8 to 10). Dual lami-
nate shade guides perform well in many re-
Fig 11 (a) Enamel
CR tapered-edged spects (possibility of gauging lightness and
samples of the saturation separately; precision of the final
Enamel Plus HRi outcome preview resulting from the select-
shade guide. The ed enamel-dentin combination; enamel
black-and-white calibrated in thickness), but are nevertheless
image highlights the
limited to the use of the CR for which they
different degrees of
lightness. (b) Dentin were designed.23
CR tapered-edged a Enamel Plus HFO and, more recently,
samples of the Enamel Plus HRi (both Micerium, Bisico)
Enamel Plus HRi shade guides also offer a possible combi-
shade guide showing nation of the enamel tapered-edged sam-
increasing saturation.
ples (Fig 11a) with the dentin ones (Fig 11b)
to preview the result (Fig 12), although they
are not literally combinable (the samples
do not interlock with each other). As they
are rendered in a triangular shape, the ta-
pered-edged samples in this shade guide
b
offer several thicknesses in order to assess

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 CEINOS ET AL

Enamel
and
dentin

Enamel Dentin

Fig 12 Combining the tapered-edged samples in the Enamel Plus HRi shade Fig 13 The CR tapered-edged samples of the Enamel
guide enables the practitioner to preview the colorimetric rendering obtained as Plus HRi shade guide have a triangular shape to permit
a function of the CR thickness. the gradual increase in sample thickness.

the various possible combinations (Fig 13). Fig 14 The dentin

It should be noted that the shade guides of- samples in the
fered by Micerium are the only ones on the Mosaic shade guide
have two ends: one
market that are made in CR.
where only dentin is
Finally, the Mosaic (Ultradent) shade present (pure
guide offers an improved approach to the saturation), and one
mere individual separation between the in the shape of an
enamel and dentin masses. Each dentin incisor added to a
specimen has two sides: a pure dentin side neutral enamel mass.

to see the saturation on its own, and a sec-

ond side that combines the dentin with a
neutral enamel mass to assess the expected
final rendering (Fig 14). This option is inter-
esting but limits the enamel-dentin preview
to only one of the six enamel masses of-
fered by this CR system.
For marketing reasons, some manufac-
turers recommend that clinicians repro-
duce a color using a direct technique with Fig 15 Filtek
reference to the Vita Classical shade guide Supreme XTE
(Fig 15). As this shade guide is widely used (3M ESPE) wheel
shade guide showing
in dental practice, the objective is to make
the correspondence
it appealing to practitioners by reinforcing
of the CR increments
their habits. However, despite the use of to be selected from a
the recommended incremental masses Vitapan Classical
combinations, the resulting color does benchmark.

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CLINICAL RESEARCH

a b c

Fig 16 Attempts by manufacturers to create shade guides with samples of varying thicknesses. (a) Gradia Direct (GC). (b) Tetric EvoCeram
(Ivoclar Vivadent). (c) Vitapan Classical referential frame.

Fig 17 For an identical Vita Classical referential frame (here A3.5), the colorimetric study of three brands of shade
guides – Esthet.X HD (Dentsply Sirona), Gradia Direct, and Tetric EvoCeram – unequivocally demonstrates the
differences in color through the numerical values L*a*b*.

not actually correspond precisely to the
assumed corresponding shade guides.24,25
This difference can be explained by various
parameters. In the CRs dedicated to layer-
ing methods, manufacturers do not neces-
sarily describe the optimal thickness of the
final enamel layer required to produce a
given color. Bear in mind that the thickness
of the enamel layer can critically affect the
overall CR color, and in a different way from
one brand to another. On the other hand,
for the same Vita color designation (eg, A1,
A2, etc), colorimetric inconsistencies exist
for the same given proclaimed shade from
one CR manufacturer to another (Figs 16
and 17).26,27

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The try-in button technique method
To overcome this lack of correlation between
CR and shade guides, many authors recom-
mend using an in situ colorimetric verifica-
tion of a small quantity of photopolymerized
CR on tooth surfaces.28,29 This so-called try-
in button technique is a simple method that
allows the assessment of the dentin mass
in the high saturation zone of the cervical
area, and the enamel mass at the incisal
margin where there is more natural enamel.
However, this is not a defect-free approach.
CR buttons are visually assessed with the
association of an underlying substrate that
interferes with the practitioner’s choice.
The biggest concern, however, lies in hard
tissue dehydration: One by one, CR buttons
must be placed at the coronal target sta-
ges, then be light cured before the result is
judged. During this implementation period,
the enamel may become opaque and total-
ly distort the color determination. In the ab-
sence of salivary fluid, it only takes a minute
or two for an optical modification of the
natural tooth to occur due to dehydration.30
Therefore, this method should ideally be
performed as quickly as possible.
Finally, the contribution of photography
is of great help in selecting the best possible
CR types. A black-and-white photograph
greatly assists in the correct selection of the
enamel mass. The evaluation of the chro-
matic base, the determination of the dentin
cut-out at the free margin, and the high-
lighting of the various characterizations are
significantly facilitated by cross-polarized
light photography (Fig 18).31
The custom shade guide
A recurring intention exists in the literature
to improve the color standardization of the
various CR materials made available to prac-
titioners.32 In anticipation of this hypothet-
ical color standardization within available
CEINOS ET AL
Fig 18 Images showing the try-in button method: the choice of the enamel
mass is facilitated by a black-and-white photograph of the CR buttons in the
incisal position. The choice of the dentin mass is guided by a polarized light
photograph of the CR buttons positioned at the first coronal third or at the
cervical margin. The opalescence and the various characterizations of the tooth
to be reproduced are highlighted using the polarized light image.
restorative materials, and because of the
modifications in post-photopolymerization
CR color and translucency, many authors
advise using a custom shade guide made
from the CR material intended to be used
so as to obtain rigorous and accurate color
selections.33
This idea of resorting to a custom shade
guide in the direct restorative field is not
new. The concept was first introduced in
the 1980s through originator articles.34-38
However, it was not until the 1990s that the
first milestones were achieved with prefab-
ricated molds dedicated to the production
of such shade guides (T-Tabs).39 Indeed, the
‘freehand’ production of a CR shade guide
is technically possible,40 but it is tedious
and does not allow resin thicknesses to be
calibrated accurately during sample manu-
facture. Paolone et al41 have drawn up
specifications for the various parameters
governing the ideal custom shade guide, as
follows:
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CLINICAL RESEARCH

Fig 19 LM-Misura (anterior). Fig 20 Calibra In-Out spatula.

a b

Fig 21 (a) Shade Guide Kit (GC). (b) Step-by-step process of the kit. This tool is not suitable for previewing the
association of enamel and dentin increments; it only permits the creation of a sample of a single CR mass. For this
reason, its use is not recommended to determine the color of a tooth to be restored through the layered method.

■ Samples in the shade guide must be restoration in terms of lightness, saturation,

made of the same material as that used
in the mouth, ie, exclusively in CR.
■ Each sample must allow a color pre-
view once the different CR layers have
been stratified (association of light-cured
enamel and dentin layers).
■ The enamel–resin layer thickness should
be similar to the one that will be applied
clinically in the restoration, depending
on which coronal stages are to be repro-
duced (0.3 to 0.7 mm).
■ The sample must reproduce the morphol-
ogy of an incisor with predetermined and
reproducible incremental thicknesses.
The thickness of the incremental masses
used has an impact on the final color of the
and translucency.42 To obtain reproducible
results, it is therefore essential to first cali-
brate CR layer thicknesses in the colorimet-
ric sample. Also, the practitioner should use
appropriate tools to accurately reproduce,
in the mouth, thicknesses similar to those
of the custom shade guide.43 The restora-
tion of an enamel resin film similar to that
of the sample from the custom shade guide
on the buccal surface of the restoration
can be facilitated in several ways. Incre-
mental thicknesses can be controlled using
silicone keys or special carving spatulas.
Indeed, in recent years, some instruments
have emerged to assist the CR layering pro-
cess. Since the refractive index of enamel
composites is generally higher than that

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 CEINOS ET AL

Fig 22 Step-by-step
production of the
Estelite Asteria
Custom Shade Guide
(Tokuyama Dental).
CR thicknesses are
calibrated and
realistic in relation to
those used in clinics;
however, the
samples are not
combinable, which
hinders the preview
of the tooth color to
be reproduced.

Fig 23 Step-by-step
process of the 3M
Custom Shade Guide
(3M ESPE). The case
is in one single piece
and is made of rigid
plastic. A (mobile)
male part first
enables the enamel
shell to be impacted
into the female part.
In a second stage,
the CR dentin is
invaginated within
the enamel shell and
is embedded in the
support of the shade
guide sample.

Fig 24 Step-by-step
process of the My
Shade Guide (Smile
Line) custom shade
guide. The mold is
divided into two parts:
a female one made of
rigid silicone and
a male one made of
flexible transparent
silicone, allowing the
passage of light
exposure with the
light-curing lamp.

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CLINICAL RESEARCH

Fig 25 (a) custom_eyes 2.0; Emulation differs from its former version (marketed by GC with the Essentia kit) in
two respects: 1) a new mold has been added to the preexisting one that permits the addition of a gingival context
to the samples; and 2) the silicone used is transparent, which allows light curing on all its faces. (b) Step-by-step
demonstration of how to use the customized custom_eyes 2.0; Emulation shade guide: The dentin sample can be
obtained with a reduced number of steps. Light curing on both sides of the mold ensures complete and rapid
hardening of the material. The dentin sample is secondarily combined with an enamel mass.

506 | The International Journal of Esthetic Dentistry | Volume 16 | Number 4 | Winter 2021
 CEINOS ET AL

Fig 25 cont (c) The practitioner can finish the resulting sample with a pink CR collar (here: Ena Tender Pink;
Micerium, Bisico). This last step has the advantage of being able to contextualize the color in its periodontal
environment, and, if necessary, proceed to determine it in order to carry out direct or indirect gingival restorations.

a b c

Fig 26 (a) Dentin samples from custom_eyes 2.0: Light Dentin, Medium Dentin, and Dark Dentin (Essentia). (b) Dentin+enamel samples
from custom_eyes 2.0: Light Dentin/Light Enamel, Medium Dentin/Light Enamel, Medium Dentin/Dark Enamel, and Dark Dentin/Dark
Enamel. (c) Enhanced samples with three distinct areas of colorimetric reading, a coronal area offering a dentin preview combined with
enamel, a gingival area, and a root zone made of pure dentin mass.

of natural enamel, the final enamel layer
tends to be thinner than the natural tissue
would otherwise be.43 LM-Arte has devel-
oped the LM-Misura (anterior) instrument,
which allows a 0.5-mm–thick material to be
placed within the buccal dentin layer to en-
sure uniform placement of the final enamel
layer (Fig 19).44 The Calibra In-Out spatu-
la (developed by WeRestor.it, marketed by
Hu-Friedy) is based on the same principle of
enamel thickness calibration, while provid-
ing a significant improvement in morpho-
logy due to its curved profile (Fig 20).
In order for practitioners to create their
own shade guides, several brands pro-
vide different prefabricated molds (Figs 21
to 26). These molds all have a number of
points in common: they enable CR thick-
ness calibration thanks to an interlocking
play between the male and female parts;
and the samples obtained have contours
similar to those of an incisor. The various
molds on the market differ in design and
material (rigid plastic or hard silicone in
mold form; in one single part or in several
parts). Manufacturing is somewhat difficult

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CLINICAL RESEARCH

Fig 27 This image (plus the following Fig 28 Aid to selection thanks to a Fig 29 Placement of a Nic Tone-type
images to Fig 53) showsthe application of a polarized filter (polar_eyes). (MDC Dental) rubber dam operating field.
customized shade guide through a clinical
case (Dr Javia Tapia): color determination
with a customized shade guide.

Fig 30 Removal of the defective Fig 31 Tissue conditioning using an Fig 32 Implementing the enamel shell in
restoration, preparation, and polishing of adhesive system requiring total acid etching CR Dark Enamel (Essentia) guided by a
the cavity line. of dental substrates. silicone key.

Fig 33 The enamel shell is completed at Fig 34 Making the dentinal lobes in CR Fig 35 The medial crest of the lobes are
the proximal edges. (Medium Dentin). completed by a Dark Dentin CR.

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 CEINOS ET AL

Fig 36 Placement of an opalescent Fig 37 Characterization by addition of Fig 38 Incremental layering ends with the
effect mass in the incisor terminal part slight white spots (White Modifier). buccal ‘closure’ of the restoration by a type
(Opalescent Modifier). of enamel CR identical to the one used for
the palatal shell.

a b

Fig 39 Contouring and primary finishing of Fig 40a and b Polishing with fine- and extra-fine grain KompoLine (Komet Dental) spiral
the transition lines with a Sof-Lex (3M) disc. wheels.

Fig 41 Surface condition before texturing. Fig 42 Reproduction of the horizontal Fig 43 Characterization of a buccal crack
streaks of the perikymata with a coarse by the passage of a No. 12 scalpel blade.
diamond bur.

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CLINICAL RESEARCH
Fig 44 Surface microgeography softened Fig 45 Glossing.
with the KompoLine spiral wheel.
Fig 47 Restoration of tooth 11 finalized Fig 48 Incisor group in fluorescent flash
under rubber dam: tissue dehydration photographs (fluor_eyes; Emulation).
leaves a slight color demarcation between
the CR and the natural hard tissue.
as regards implementation, and it should
be noted that some systems opt for a mod-
ular number of stages (custom_eyes 2.0;
Emulation). All custom shade guides offer
a sample with associated CR enamel-den-
tin masses except for the Asteria (Tokuy-
ama) shade guide: the enamel and dentin
masses from this manufacturer are dichot-
omized into two distinct non-combinable
samples.
While the creation of a custom color
guide is time consuming, using it for color
matching in direct restorative dentistry is
510 | The International Journal of Esthetic Dentistry | Volume 16 | Number 4 | Winter 2021
Fig 46 Passing the fine-grain polishing strip
through the interdental spaces.
Fig 49 Incisor group in internal transmitted
light.
fast and reliable. A custom color guide can
be all the more powerful when coupled
with an analysis of the L*a*b* data of the
CIE-Lab colorimetric area. A cross-polarized
light photograph (polar_eyes; Emulation)
at the colorimetric area, calibrated thanks
to a neutral gray shade guide, makes it
possible to extract several digital data – L*
(luminosity), a* (amount of red), b* (amount
of yellow) – according to the tooth color to
be reproduced.45 Thereby, by having prior
knowledge of the various L*a*b* values
concerning the possible combinations of
 CEINOS ET AL

Fig 50a and b

Before and after
polarized light views.

a b

Fig 51a and b

Before and after
a b
intraoral views.

Fig 52a and b

Before and after
a b
patient smile.

Fig 53 Final result after complete tissue rehydration.

the CR being used, it is then possible to Color and universal resin

select the CR combination that is closest
to the digital data obtained on the tooth to
be restored. The images in Figures 27 to 53
show the application of a customized shade
guide through a clinical case (Dr Javier
Tapia).46
Many practitioners are looking for ways to
simplify their protocols and save chair time.
For those whose motto is: “Simplicity is the
ultimate sophistication” (Leonardo da Vin-
ci), the contribution of the new Universal

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CLINICAL RESEARCH

technology CRs points the way forward. Conclusion

This type of CR has a chameleon-like prop-
erty: once light cured, the resin will return
a color close to the surrounding dental
substrates.47 This type of restorative kit of-
fers a limited number of syringes (such as
Filtek Univeral; 3M or Clearfil Majesty ES-2
Universal; Kuraray or SimpliShade; Kerr) or
even a single syringe (Omnichroma; Tokuy-
ama or G-ænial Universal; GC) to cover all
dental colors. While there is no denying that
these new universal CRs are attractive, it is
necessary to be aware of their limitations.
The ‘chameleon’ effect of CR means it will
adjust to its substrate color without com-
pletely copying its optical appearance,48
and using it obscures most of the second-
ary colorimetric dimensions that restore the
‘vitality’ of a layered restoration. Therefore,
these new CRs will undoubtedly prove ef-
fective in the posterior area and to some ex-
tent for small-volume anterior restorations,
but they will not be satisfactory in all clinical
situations, particularly those requiring a high
degree of mimicry and esthetic demand.
As practitioners, we blindly follow com-
mercially available shade guides. However,
studies have conclusively shown that CR
systems do not accurately match either
their dedicated shade guides or those re-
sorting to the Vitapan Classical reference.49
The best two alternatives for enhancing
color in restorative procedures are the try-
in button method or the use of a custom
shade guide. Custom shade guides are de-
signed to be as close as possible to clinical
reality and are made from the same bioma-
terial as the restorative material, with repro-
ducible calibrated incremental thicknesses.
Although it is time consuming and expen-
sive to produce a custom shade guide be-
cause each sample uses a fair amount of
CR, these disadvantages are largely offset
by the chair time saved as well as the re-
duction in the number of restorations that
have to be repeated due to colorimetric
failures.50

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