Shade Selection Techniques with Karen Arieno
Karen Arieno is a leading ceramist specializing in superior all-ceramic restorations and personal in-lab custom shade consultation. She consults with doctors on aesthetic concerns and meets personally with their patients for custom shade selection to achieve the best possible result. Karen leads a small team of talented ceramicists committed to aesthetic excellence. She is also a fine artist. Patients who visit the lab for custom shades enjoy seeing her works on canvas and know that an artist's eye will help make their case a success.
BASIC SHADE SELECTION TECHNIQUES
Take shades before you prep while teeth are still hydrated. This is also a good time for a pre-op photo for help with restoring proper contours and improving esthetics.
Take quick short looks. Look away often to keep your impression fresh. If you look too long your eyes will color correct.
Compare only TWO shade tabs at the same time. Your eyes will see what looks WRONG first. Eliminate the wrong shade, pick another tab and use this process of elimination to narrow down your selection. Eventually you will know which one is right. (Much like an eye exam.)
SQUINT your eyes. This trick will help you to see the value better. The value is the grayness or brightness of the color. When a crown looks wrong in the mouth it is usually the value that is off. Because most vital dentin is yellow in nature, it is the enamel that produces the shade. If the enamel is very translucent we see the C range, and sometimes the B range. When enamel is very opaque and dense we get the lighter tones of A1, B1 and the bleaching shades.
COMMUNICATING SHADES: IN WRITING
Always refer to the shade guide when communicating shades to your lab. The shade guide is your most reliable tool to communicate the colors you see. We rely on this shared visual reference to give you and your patient the results you expect.
Instead of: “It looks like D3, but take out the grey brown and add yellow orange at the gingival and tone down the incisal.”(This vague reference was taken from an actual script; this practice requests shade adjustments on a regular basis, causing more chair time and delay for the patient.)
Try: "The gingival of the crown looks like the incisal one-third of the D3 button and the incisal two-thirds looks like the incisal half of the C3 button." (This may sound complicated, but it is clear and gives the doctor and lab something tangible to compare.)
COMMUNICATING SHADES: WITH IMAGES
Photographs are ALWAYS an effective visual communication tool. Current technology makes it easy to send quality digital images directly to a lab technician. If you are beginning a case, a photo with shade tab held next to the patient’s teeth is especially helpful.(Notice the monitor at my bench in the above photo, I use it all day long.)
ALL CERAMIC CROWNS: When restoring teeth with all-ceramic crowns, it is important to give the lab the color of the stump. If you do not have a stump shade guide, you can use the back of the vital shade guide or send a photo. If you are covering a non-vital (black or dark) stump, it will show through the final restoration. The lab will make correction for this or suggest a different solution.
CUSTOM SHADES: Teeth are like fingerprints, each person’s are unique. When blends and shades are highly characterized and difficult to explain on a lab script, send the patient to the lab to meet with a technician for a custom shade when possible. This is also a good practice for patients with complicated cases and high expectations.
LARGE ANTERIOR CASES: Multiple photos are especially effective for complex cases. Include photos such as lip retraction, natural lip line, full face profile, and full face with shade selection tab. (Doctors will often send more than one shade selection if necessary.)
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