A Custom Shade Guide System for Composite Resins Steven Wieder, D .M .D .*
Shade guides that are included in most composite kits are not made of the actual resin material. Therefore the true shade, translucency, or opacity of the composite resin is not readily apparent with stock shade guides. Due to this fact, it has become evident that the best solution to the shade guide problem is to construct a custom shade guide from the actual resin. Until recently, fabrication of custom shade guides has been a time-consuming, inefficient task. Now, a simple and efficient method of forming accurate shade guides for composites is available. With its unique handlehemplate design, T-TABS” enable a dentist to create a precise, labeled shade guide within minutes. There are many advantages to both dentist and patient when T-TABS are employed in the construction of custom shade guides.
vents, and consistency in fabrication and appearance are still questionable at best.3 Because of the labor involved and the often inconsistent results obtained, many dentists have decided they can manage without custom shade guides, or they concoct other shade selection techniques. One such technique is referred to as the “dab on” technique. A small amount of resin is placed on the tooth to be restored and is then polymerized. The shade of this dab is compared to the shade of the tooth to be restored. Two pitfalls are evident with this method. First, material and time are wasted with each dab placed. Second, most light-cured composites change their shade when they undergo curing. Since the curing of a composite takes over 24 hours to complete, only during subsequent appointments can the final shade of these restorations be accurately determined.2 A simple and efficient method of forming accurate shade guides for composite materials is now available. Due to its unique handle/template design, T-TABS enable a dentist or assistant to create a precise, labeled shade guide within minutes.
ith the increased interest in esthetic restorations, the challenge of the clinician todav is to achieve the best possible shade match between the patient’s tooth being restored and the composite resin. Most composite resin kits provide a shade tab that is designed to match the shade of the composite being polymerized. Unfortunately, the majority of these stock shade guides are manufactured from unfilled methacrylates and do not accurately depict the true shade, translucency, or opacity of the composite resin after polymerization. Due to these inherent shortcomings in almost all stock shade guides, clinicians have often recommended the fabrication of custom shade guides. Jordan states that a practical solution to this problem is to make shade guides from the material itself.’ Albers concurs in that custom shade guides made of composite are considerably more accurate.2 A University of Florida study that evaluated composite shade selection with the use of stock shade guides versus custom shade guides yielded the following conclusion: The use of a custom tab for shade matching leads to a higher proportion of excellent color matching of the final restoration.3 The answer to the problems associated with inferior stock shade guides is to construct your own custom shade guide from the actual resin. Dentists who perform this task however are few in number. The main reason for this inconsistency is that until now, fabricating custom shade guides has been an inefficient, laborious task It takes considerable time and effort to make up these guides using whatever technique the doctor in-
FABRICATION METHOD With each shade or combination shade, place the resin material in the tooth form, slotted handle, and retention holes (Fig. 1). The resin material should at least be flush with the slotted handle. Take care to avoid bubbles or voids. To create a flush, mirror finish on the backside of the tab, place a mylar strip over the open side of the handle and tooth form. Polymerize the resin on both sides of the tab according to the manufacturer’s time requirements. Adjust the position of the light so that all sections of the resin are fully cured, Hold the handle and, using the finger tab provided, snap off the tooth 10
Shade Guide System for Composite Resins
Figure 1. Placement of composite resin in tooth form, slotted handle, and retention holes.
form in one continuous motion toward the handle (Fig. 2). Remove flash using normal finishing techniques. To obtain a high gloss finish, buff lightly on the slow speed of a polishing wheel. Place the appropriate label in the slot and repeat the steps for the remainder of your shades (Fig. 3). You now possess an accurate shade guide for your composite resins (Fig. 4). There are many advantages obtained when utilizing a custom shade guide for composites. The major advantage is that the precise shade, translucency, or opacity of the resin in its completely cured state is visibly evident.
Figure 3. Custom shade tab finished, polished, and labeled.
Figure 4. Finished custom shade tabs on storage ring.
The dab-on technique described eaflier does not allow the dentist to observe the true shade in its completely polymerized form. Fabrication of combination shade tabs are now possible by mixing measured portions of different shades. Dentists’ time is saved by not having to guess at shade selection or employ other less than
Figure 2. Snapping off tooth form from the handle and polymerized resin using finger tab. 11
Journal of Esthetic Dentistry/Volume 2, Number 1]unxurylFebrua+y 1990
characterize tabs with stains and color modifiers, etc. prior to actual placement. The label is large enough to accommodate information on the tab and is highly visible. The tabs are easily handled and stored and present to the patient as a clean, professional dental product. T-TABS were developed due to inherent shortcomings found in stock shade guides. This product will significantly reduce the frustration and stress incurred in shade selection for composite restorations.
satisfactory techniques. The percentage of composite restorations completed in the first appointment due to proper shade selection is greatly increased. Patients rarely have to come back to have finishing touches on shading performed. Composite material is not wasted due to the same reasons mentioned above. Accurate and efficient shade selection will lead to greater patient satisfaction, which can in turn produce more referrals. Last but certainly not least, the stress involved in choosing the correct shade the first time is eliminated.
T-TABS encompass all the advantages of using a custom shade guide plus many advantages unique unto itself. The tabs have been designed so that fabrication of custom shade guides are simple. The task can easily be delegated to staff members. The tabs more closely approximate the thickness of resin used in anterior restorations and labial veneering. At the gingival third of the tab, the thickness is 1.0 mm, the middle third is 1.3 mm, and the incisal edge is 0.5 mm. Dentists can
1. Feigenbaum NL, Mopper KW. Coloring with resins. In:
Jordan RE, ed. Esthetic composite bonding. Toronto: BC Decker, 1988:143-156. 2. Albers HF. Tooth colored restoratives. Santa Rosa: Alto Books, 1985. 3. Pink FE, Frazier KB. An evaluation of a custom composite shade guide for shade determination. Department of Operative Dentistry, University of Florida, 1988: Submitted for publication AGD.