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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 4  |  Page : 251-255

The prevalence of natural tooth colors in the people of North India


1 Department of Prosthodontics, BJSDC, Ludhiana, Punjab, India
2 Consultant The Tooth Place, Ludhiana, Punjab, India

Date of Web Publication1-Dec-2017

Correspondence Address:
Harinder Kuckreja
Department of Prosthodontics, BJSDC, 19-G, Sarabha Nagar, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_86_17

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  Abstract 

Aims and Objectives: Tooth color is a major factor with regard to dental esthetics. Restorative dentistry has evolved from its previous dentist driven to patient driven service and patient opinion plays an important role in selecting the treatment plan. Whitening teeth and smile designing for esthetic purpose is currently fashionable. Selection of appropriate tooth shade for edentulous patients is an important part of teeth replacement. Most patients prefer having lighter shades. However ultimate objective of esthetic dentistry is to create a beautiful smile, with teeth of pleasing inherent proportions to one another and color in harmony with gingiva, lips and face of the patient. Proper shade selection has a positive impact on the patient's acceptance of the treatment. The present study was designed to measure the tooth colors in a particular age group of North Indian population. There is enough data to support the use of objective methods of measuring shade and dentists are shifting to these newer technologies but subjective methods of shade selection are still popular as the digital devices are expensive. Materials and Methods: In the present study, shade of cervical, middle and incisal third of the facial surface of natural maxillary central incisor was measured with digital colorimeter, VITA Easyshade® Advance 4.0. It is an optical reading device that can assess the wavelengths reflected back to its sensors. Lighting in operatory does not affect the shade measurement. It is extremely accurate. The limitation of study was its small sample size. Conclusion: It was concluded that the most prevalent shade in cervical third was 1M2, middle third was 1M1 and incisal third was 2M1.

Keywords: Digital colorimeter, shade matching, tooth color


How to cite this article:
Kuckreja H, S. Kuckreja K B, Bhullar D, Nahar S, Singh A, Jain A. The prevalence of natural tooth colors in the people of North India. Indian J Dent Sci 2017;9:251-5

How to cite this URL:
Kuckreja H, S. Kuckreja K B, Bhullar D, Nahar S, Singh A, Jain A. The prevalence of natural tooth colors in the people of North India. Indian J Dent Sci [serial online] 2017 [cited 2018 Jul 15];9:251-5. Available from: http://www.ijds.in/text.asp?2017/9/4/251/219633


  Introduction Top


The ultimate objective of esthetic rehabilitation is to design a pleasant smile in harmony with adjacent gingival tissues and face.[1],[2] Balancing illusion with reality allows the clinician to design and sculpt a smile which patient perceives as natural and attractive.[3] Tooth shape, size, form, and color are the fundamental requirements for any restoration to look esthetically pleasing.[4] However, color is the most dominant requirement.[5]

Studies have reported age- and gender-related changes in tooth colors.[6],[7],[8] Teeth generally become darker with age. Women generally have lighter teeth.[9],[10],[11]

The past few years have seen an increased interest of people in cosmetic dental treatments such as smile designing and tooth whitening.[12] Knowledge of distribution of shades in a particular age group, gender, area, and within the tooth itself can be helpful in proper shade selection and instituting dental treatment for a more predictable and realistic outcome.

The oldest color system was created by Albert H. Munsell in 1905. It brought clarity to color communication by establishing an orderly system for accurately identifying every color that exists. According to this, color has three dimensions – hue (H), value or lightness (V), and chroma (C). Hue is the dominant wavelength and helps to differentiate one color from another. Chroma is the saturation of color. Value is the darkness/lightness and is determined by the amount of black and white on a given scale.[13] This was the first system to separate hue, chroma, and value into perceptually uniform and independent dimensions, systematically illustrating the colors in a three-dimensional space.

As defined in 2001 by the Commission Internationale de l'Éclairage (CIE), color is: “The characteristic of visual perception that can be described through the attributes of Hue, Value, and Chroma.”[13]

There are two ways of measuring tooth color – subjective, through the use of shade guides, and objective, mainly through the use of electronic devices such as spectrophotometers, colorimeters, and imaging systems.[14],[15],[16],[17]

Measuring the color of teeth with the subjective method is affected by many factors such as human eye and brain, influencing the overall perception of tooth color, the illumination in operatory, and patient's clothing.[18]

Before 1998, the most popular shade guide was Vita Classical Shade Guide. It is based on hue and represents only 16 shades, too few to represent the color variability of natural dentitions. In 1998, Vita 3D Master was introduced.[19] The Toothguide 3D Master shade guide consists of 29 tabs and represents an application of the lightness–chroma–hue concept of shade matching. The tabs are identified with a sequence of Number-letter-number. The first number represents the lightness, the letter represents the hue, and the second number represents the chroma. There are six main groups based on value (lightness), from 0 (lightest) to 6 (darkest). Within each of the six groups, the tabs are arranged into three chroma levels (except for group 1 which has only two levels), from 1 (least chromatic) to 3 (most chromatic). The levels within the groups are represented by letters, with L (left) being yellowish, M (middle) being of middle hue, and R (Right) being reddish.

The objective methods expresses the color results in CIE L* a* b*, color system, as well as Vita Classic and 3D Master. According to the CIE L* a* b* system, all perceived colors have three dimensions, L for lightness (L* = 0 yields black and L* =100 indicates diffuse white), a for green–red (a*, negative values indicate green, while positive values indicate red), and b for the color opposites blue–yellow (b*, negative values indicate blue and positive values indicate yellow).[20]

Presently, the most popular method of shade matching in dentistry is very subjective though dentists are shifting to more objective methods. Some authors have suggested that there is a correlation between the human eye and the spectrophotometer.[21],[22],[23] Others have failed to find any such relationship.[24],[25],[26],[27] Digital imaging for color matching and communication have been received with increased interest.[28],[29]

The present study was designed to find the most prevalent shades in the North Indian population using VITA Easyshade ® Advance 4.0.[30],[31]

VITA Easyshade ® Advance 4.0 is reliable enough for daily clinical work to assess tooth color during the fabrication of esthetic appliances because it is not dependent on light conditions and light sources.[31]


  Materials and Methods Top


The present study was based on measuring the shade of right maxillary central incisor of 117 volunteers from different areas of North India. As age affects the tooth color, only a particular age group, 18–24 years of age, was selected.

Shade was measured using a digital colorimeter, VITA Easyshade ® Advance 4.0. Healthy maxillary central incisors were included in the study. Discolored teeth, due to intrinsic or extrinsic stains, were not included. Intrinsic stains are those affecting the internal calcified tissues of the teeth, while extrinsic stains result from the deposition of a film, pigment, or calculus on the surface of enamel, exposed dentin, or cementum.

Teeth with restorations do not represent the natural tooth surfaces and were not included. Caries result in decalcification and discoloration, so carious central incisors were excluded.

To have consistency in the procedure, a single operator carried out all the measurements under the same lighting conditions and specifications. Before recording the shade, the central incisor was cleaned properly. To prevent cross-contamination, the probe of easy shade was covered with a disposable shield and calibration of the probe was done along with the shield. The probe tip was placed in contact with and at rig ht angles to the facial surface first at cervical, then middle, and the incisal regions [Figure 1]. The digital shade guide was set at a mode for taking reading at three points [Figure 2]. Shade was measured at cervical middle and incisal regions on the facial surface [Figure 3].
Figure 1: VITA Easyshade® Advance 4.0 covered with protective shield and held perpendicular to tooth

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Figure 2: Screen of VITA Easyshade® Advance 4.0 showing the color measurement in Vita classical as well in 3D Master shades

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Figure 3: Measurement at three different places on the labial surface of central incisor

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  Results Top


According to the analysis of data, the most prevalent shade in cervical region was 1M2. It accounted for 31.62%. This was followed by 1M1 which was 15.8%.

Dominant hue was M with lighter value. Only 3% of specimens were found to be of higher value.

However, teeth with higher values were of different hues and accounted for 0.85% of each L, M, and R where, L is more yellow and R is more red than M within a particular group [Table 1] and [Graph 1].
Table 1: Shade in cervical third

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In the middle third, the most prevalent shade was 1M1 (33.33%). This was followed by 2M1 (19.6%). Two teeth (1.71%) had the lightest value, but chromatic saturation was 3 [Table 2] and [Graph 2].
Table 2: Shade in middle third

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In the incisal third, the dominant hue was M. However, the value increased to 2. Maximum number of teeth (42) had shade in the range of 2M1. This was followed by 1M1. None of the teeth had a value darker than 2. Just one tooth was lighter with 0M3 shade [Table 3] and [Graph 3].
Table 3: Shade in incisal third

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  Discussion Top


Natural dentitions are highly characterized, and for a clinician to develop a restoration that looks natural and pleasing, color is a very important. In cases where dentist has full control of altering shade as in cases of completely edentulous patients, excessively worn out dentitions, and tooth whitening, the color of restoration should merge with the age gender and facial complexion so as to have a more natural appearance.[32-35] Smile has been said to be one of the most important interactive communication skills of a person and color of teeth probably constitutes one of the most important parts of first impression of someone. However, there are authors who believe that when the overall dental appearance is considered, several factors are of significance, including tooth color, shape, and position; restoration quality; and the general arrangement of the dentition.[35] Matching the hue and chroma is fifth or sixth in importance on the list of things to match when constructing a prosthetic replacement.

The present study was designed to measure tooth colors of North Indian population so that it can help in customizing dental treatment for them. VITA Easyshade® Advance 4.0 was used for measuring the shade as it is reliable and easy to use. The mode selected was 3D Master because it is simple and easy to interpret and has enough variability of shades to represent the natural tooth colors

The shade obtained in the cervical third of tooth is 1M2 (31.62%), in the middle 1M1 (33.33%), and in the incisal third 2M1 (35.9%). Value 1 indicates lighter tooth color and color saturation is up to 2. However, the sample size was small and represented only a limited age group. The results of the study need to be evaluated further with larger and different age groups.


  Conclusion Top


The conclusion drawn is that the most prevalent shade in the North Indian population in the age group of 18–24 is 1M2 in cervical, 1M1 in middle, and 2M1 in incisal. Out of the five value groups (1, lightest and 5, darkest), teeth are closer to the lighter value. The value increases from cervical to incisal. Within the yellow red range of natural tooth hues that is L (yellow) and R (red), the most frequent hue is M. Chroma is within 2 and decreases from cervical to incisal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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