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CLINICAL RESEARCH

Composite shade guides


and color matching

Gaetano Paolone, DDS


Private and referral practice, Rome, Italy.
Lecturer, Master of Endodontics and Restorative Dentistry, University of Siena, Italy

Giovanna Orsini, DDS, PhD


Associate Professor, Restorative Dentistry, School of Dentistry,
Polytechnic University of Marche, Ancona, Italy

Jordi Manauta, DDS


Private and referral practice, Chiavari, Italy

Walter Devoto, DDS


Private and referral practice, Sestri Levante, Italy
Lecturer, Master of Endodontics and Restorative Dentistry, University of Siena, Italy
Visiting Professor, University of Marseille, France and International University of Catalonia,
Barcelona, Spain

Angelo Putignano, MD, DDS


Professor, Restorative Dentistry; Head of Department of Endodontics and Operative Dentistry,
School of Dentistry, Polytechnic University of Marche, Ancona, Italy

Correspondence to: Prof Giovanna Orsini


Department of Clinical Sciences and Stomatology, Polytechnic University of Marche, Via Tronto 10, 60126 Ancona, Italy;

Tel: +39 071 220 6224; E-mail: giovorsini@yahoo.com

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Abstract the authors evaluated the reliability of a


system designed to produce self-made
Finding reliable systems that can help standardized “tooth-shaped” shade
the clinician match the color of direct guide specimens. Small changes in com-
composite restorations is often an is- posite enamel thickness may determine
sue. After reviewing several composite huge differences in esthetic outcomes.
shade guides available on the market In conclusion, the results showed that all
and outlining their main characteristics the specimens demonstrated compara-
and limits (unrealistic specimen thick- ble enamel thickness in all the examined
ness, not made with the same material areas (cervical, middle, incisal).
the clinician will use, only a few allow
to overlap enamel tabs on dentin ones), (Int J Esthet Dent 2014;9:162–180)

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Introduction Differences are not just only related


to hue and chroma. Composite’s optical
Composite is probably the most fre- properties19-21 (Fig  1) are in fact strongly
quently used material in daily practice. influenced by several factors: nature and
It is used for direct restorations, indirect size of the filler; the material’s thickness;
restorations, closing diastemas, cemen- fluorescence of the dentins; opacity de-
tation, build-up, etc. Considering that gree of the dentins; degree of translu-
most of the time it is employed in esthet- cency of the enamels; opalescence of
ic regions,1-9 it is very difficult to find reli- the enamels; and refractive index of the
able systems that can help the clinician enamel. All these differences may also
match the color of the restoration. Color arise within the same composite system.
matching in dentistry has always been These facts concur in making the
an issue;10-13 in the world of composites dentist less confident with direct esthet-
we also have several factors that give ic restorations because he/she tends to
rise to confusion. think that esthetic outcomes are not pre-
First of all, there is no unification in dictable when using composites. This
composite shade nomenclature. Every often leads to non-conservative indirect
company creates names for their com- treatments, where shade taking issues
posite shades and most of the time and esthetic outcomes are delegated to
they use the same names of the VITA dental technicians.
shade guide. The market is riddled with Moreover, there are big differences
syringes named A1, A2, A3.5, etc, but between composite systems. Some
most of the time there is no accurate companies propose shades for den-
match between a company color clas- tin with the corresponding shade for
sification and the Vita shade guide.14-17 enamel, using the VITA classification
If we select the same shade (eg, A3) but (eg, Dentin A2 and Enamel A2). Gen-
take them from different composite sys- erally, VITA-based composite shade
tems, we are confronted with a problem: guides do not exactly abide by the
they are completely different from each VITA reference guide.22 Other compa-
other.18 nies propose universal dentins with dif-

Fig 1    Chroma, hue, fluorescence, opacity/translucency of different brands of dentin composite.

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ferent saturations and enamel masses


with different value. Other companies
have dentin, enamel and body masses.
In addition, in some composite systems
there are several “special” composite
masses that have extreme translucen-
cy like transparent and blue shades,
others have a high opacity (eg, they Fig 2    Some of the shade guides we analyzed.
are white), while others provide differ-
ent opalescence values.
Obviously, it is almost impossible to
describe all the characteristics con-
tained in a single mass with a single
name, but sometimes it seems that com- Differences were due to the following
panies prefer to focus on their commer- factors:
cial strategies regarding names, pack- „„Material of the shade guide.
aging and number of syringes. „„Type of support for the shade guide
specimen.
„„Shape of the specimen.
A review of the composite „„Thickness of the specimen.

shade guides
The majority of the shade guides by com-
Prefabricated shade guides posite manufacturers are made of plas-
tic. Few are made of composite. Some
All the concerns exposed concerning systems provide a ceramic shade guide.
the naming of composite masses may Other systems are “paper” shade guides.
be eased using a composite system in Analyzing the shank of the specimens,
which a fine and understandable shade there was metal, plastic and shankless
guide is provided. (for the stick-shaped and paper speci-
For example, if the ‘A2’ dentin of a mens).
composite system does not match at all As for the thickness and the shape of
with the Vita shade guide but the com- the specimens, there was also a vast va-
pany provides a reliable shade guide, riety. Many had the color “painted” on a
color selection should not be an issue. plastic stand (Figs  3 and 4), and this re-
How reliable are shade guides pro- sults in the lack of thickness of the speci-
vided by the companies for their com- men; others have the shape of a com-
posite systems? Unfortunately, they plete crown of a central incisor, although
often are not.23-25 If the shade guides they are exclusively dentin shades.
that exist today on the market are ana- One shade guide had the upper cen-
lyzed, an enormous variety is revealed tral incisor shape and every specimen
(Fig  2). (Fig  5) was the result of a hypothetical
All the shade guides that were ana- stratification of a body, a dentin and an
lyzed were dissimilar from the others. enamel mass, but no information was

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provided concerning the thickness of


the different layers.
Other guides in plastic have sticks
with different thickness for every shade
(Fig  6). Two shade guides had small and
thick specimens for dentin and thinner
and wider ones for enamel and opales-
cent masses (Figs  7 and 8). Only two
of the analyzed shade guides allowed
for the snap-on of enamel and dentin
masses (Fig  9). One of the shade guides
Fig 3    Many shade guides have “painted” speci- made of composite consisted of tapered
mens.
tabs with decreasing thickness (Fig  10).
Tabs can be overlapped for shade
taking, but the thinnest part of the mass-
es of dentin and enamel is in both cases
1  mm. Since enamel thicknesses wider
than 0.7  mm are rarely used clinically,
the overlapping opportunity of this kind
of shade guides seems redundant and
useless. On the contrary, since chroma-
ticity varies when increasing thickness,
dentin specimens with variable thick-
ness could be useful (Fig  11). Howev-
er, enamel and opalescent specimens
(Fig  12) can only offer an approximate
Fig 4    Many shade guides have “painted” speci-
idea and poor clinical benefits.
mens.

Fig 5    This shade guide is a result of a theoretical Fig 6    Plastic specimens with different thickness-
stratification, but there are no indications on thick- es.
ness for each layer.

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Fig 7    Dentin specimens made in ceramic. Fig 8   Enamel and opalescent specimens of the
same shade guide as Fig  7.

Fig 9    This shade guide is in composite and allows Fig 10   Tapered composite tabs both for dentin
the snap-on of enamels on dentins. and enamel.

Fig 11  In this shade guide dentin specimens Fig 12    Enamel and opalescent specimens for the
have variable thickness. same composite system as Fig  11 have the same
dentin thickness.

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If made in composite, a shade guide


can give some indications on the shades’
response depending on different speci-
men thickness when transilluminated
(Fig  13). Additionally, if observed with a
black light, we can check the material’s
fluorescence.
Having analyzed several shade
guides and studied them from the point
of view of clinical needs, the authors for-
mulated several considerations about
Fig 13    Tapered specimens’ behavior, when trans- the composite shade guides currently
illuminated.
available on the market:
„„Only few composite systems have a
shade guide of the same material that
sleeve the clinician will use.
spindle
„„Few shade guides have the possibility
to overlap enamel and dentin shade
specimens.
anvil
thimble „„No shade guides have specimens
with composite enamel cured over a
dentin mass.
„„Default thicknesses of specimens are
often useless, for example, being too
Fig 14    A micrometer.
thick for the enamel shades.
„„“Printed” shade guides are useless
since it is well known that composite
behaves differently with different thick-
zero (closed) position nesses either of dentin and enamel.
„„The shanks of the specimens some-
times divert the clinician’s attention.
This happens especially for the plastic
support surrounding flat specimens.
„„“Paper” shade guides are often print-
ed on glossy paper. This causes dis-
turbing reflections during shade-tak-
ing procedures.

Fig 15    First of all we have to check that the spin-


dle is on the zero position when the micrometer is
closed. It is possible to calibrate the micrometer
with the provided spanner. Adjustment is not man-
datory because the “error” can be added to every
measurement we will make.

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Self-made shade guide


using a micrometer

Because of all these limitations in com-


mercial shade guides, and since a
successful restoration is the result of a
three-dimensional interaction between a
translucent layer placed on an opaque
one, many clinicians have adopted the
practice of producing the shade guides
of the composites that they are going to
use themselves.26-28 “Self-made” shade Fig 16   The micrometer is unscrewed by about
5 to 6  mm. Dentin is placed between the anvil and
guides reflect the need for more reliable
the spindle.
commercial ones.
One method that can be used to pro-
duce your own custom-made shade 3.0  mm
guide is with a micrometer. The microm-
eter (Fig  14) is a cheap device incorpo-
rating a calibrated screw that is widely
used for precise measurements of small
distances in mechanical engineering.
With the help of the micrometer, we
can obtain round specimens with ex-
tremely precise thickness. We can also
Fig 17   The thimble is then closed until we can
overlap two (or more) materials curing read 3  mm on the sleeve. Composite is squeezed
one onto another (eg, enamel and den- and excesses can be easily removed.

tin). A step-by-step procedure on how


to make a shade specimen of a 3  mm
dentin and 0.5 mm enamel is described
in Figs  15 to 22.
Although this method is very precise
and reliable, it has some limitations:
„„It does not provide tooth-shaped
specimens that reproduce natural
convexities of dental surfaces.
„„The enamel layer (when enamel is
layered on dentin) is uniform so you
have to make several specimens to
check different behaviors for different Fig 18    Light curing is then performed all around
enamel thicknesses. the composite’s slot. The specimen’s wall will result
to be smoother if a transparent matrix band is rolled
around the fissure before curing.

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3.5  mm

Fig 19    The micrometer is opened once again and Fig 20    The thimble is twisted once again in order
the enamel composite is placed on one of the sides to close the micrometer until the value of 3.5  mm is
of the dentin disc. In this example an opaque high read.
value mass has been chosen for didactic purposes.

Fig 21  After enamel curing, the micrometer is Fig 22    The specimen is ready, it can be polished
opened in order to remove the specimen. and glued on a stand (eg, on a Microbrush, Micro-
brush International).

Self-made shade guide


with prefabricated molds

A system to create personalized shade


guides (My Shade Guide for compos-
ite, Smile Line) has recently been devel-
oped.
Positive and negative portions of a
matched-mold make up this system
(Fig  23). The negative portion is the one
that reproduces the vestibular enamel; it
Fig 23  Positive and negative portions of My is white and is made of semi-rigid plas-
Shade Guide. tic. The positive portion displays the

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Fig 24    Enamel composite is placed and spread Fig 25    The positive portion is then coupled apply-
on the negative portion. ing a gentle constant pressure in order to make the
enamel excesses flow away through the four vents
created on the negative impression.

Fig 26   Once the two portions are coupled, we Fig 27    The enamel “shell.”
must check that the flask remains closed by itself,
therefore assuring that the material is correctly dis-
tributed. Light curing is then performed through the
transparent portion.

shape of the dentinal body and is made Specimens can be obtained using
of transparent and soft silicon. Making a enamel and dentin masses from the
specimen is quite simple, as described same composite systems or mixing
in Figs  24 to 27. masses from various composite brands.
The enamel layer has different enamel In this way, it is possible to understand
thicknesses: the producer indicates an the response of different materials. More
0.2  mm thickness in the cervical third, an elaborated inverse layering techniques
0.5  mm thickness in the middle and an can be performed, adding a variety of
0.7  mm thickness in the incisal portion colors for special cases.
(Fig  28).

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Figures  29 to 34 show a clinical case


0  mm
in which the shade guide is made of the
same material that will be used for the
restorations. One more element to take
0.2  mm into consideration is that light scattering
and glare often affect shade-taking pro-
cedures.
dentin A polarized view7,29 removes glare
and shows the real color of the teeth and
the shade guide (Figs  35 and 36) con-
tributing to reduce the difference (ΔE)
between the tooth and the restoration
0.5  mm
color.

Aim of the study


enamel
As discussed above, a standardized
custom-made shade guide, with a vari-
0.7  mm
able enamel thickness width and a tooth
shape, can help the clinician to better
Fig 28  The system is designed to provide dif- understand the material’s behavior. The
ferent enamel thicknesses: 0.2  mm in the cervical
clinician can easily reproduce the tooth’s
third, 0.5  mm in the middle third and 0.7  mm in the
incisal portion.
shade, knowing the composition of the
matching specimen.

Fig 29    Initial situation. Fig 30    Shade selection with a shade guide made
of the same composite in which the restoration will
be made. Natural gray background may help color
matching.

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Fig 31    Checking the silicone index. Fig 32    Layering interproximal walls.

Fig 33    Final result right after dental dam removal. Fig 34    Final result after rehydration.

Fig 35    Color matching with polarization. Fig 36    Color matching with flash light.

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For this reason, shade-taking pro-


cedures should rely on a reliable and
reproducible specimen. If the compos-
ite enamel shell is thicker or thinner than
expected, there could be an unpredict-
able esthetic outcome.
Therefore, the objective of this study
was to test the reliability of the system
described above designed to produce
standardized “tooth-shaped” shade
guide specimens.
Fig 37    Composites used in the study. As outlined by several authors, com-
posite enamel thickness plays a primary
role in the esthetic outcome, so the study
was based on composite enamel shells
produced by the analyzed system.
The null hypotheses of the present
study were that:
„„The thickness of the enamel shell is
uniform;
„„The specimen’s thicknesses are not
influenced by the type of material.

Materials and methods


Fig 38    Composites were heated before use. Since every composite has a different
handling (soft, hard, sticky) and in order
to verify whether the specimens’ thick-
ness could be influenced by the type
of material, different composite resin
brands were analyzed in this study. Six-
teen composites (enamel and incisal
ones) of different brands (Table  1) have
been included for the present study
(Fig  37).
My Shade Guide’s mold is made of
two portions: the enamel mold is white,
while the other mold is made of trans-
parent silicone and is characterized by
the dentinal body shape. The two parts
Fig 39    Every specimen was measured in the cer- join together with the enamel composite
vical, middle and incisal areas. in between, and are used to make the

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Table 1  Cervical measurements

Product name Company Shade Mean Std. Dev. Min Max

Ceram-x Dentsply E1 0.32 0.04 0.28 0.35

Clearfil Majesty Kuraray


E 0.31 0.02 0.29 0.33
Esthetic Medical Inc.

ENAMEL plus
GDF GmbH GE1 0.32 0.04 0.28 0.35
HFO

Opallis FGM EA1 0.33 0.01 0.32 0.34

Filtek Supreme
3M ESPE A2 ENAMEL 0.30 0.03 0.28 0.33
XTE

Coltène
Miris 2 NT 0.38 0.02 0.35 0.39*
Whaledent

ENAMEL plus
GDF GmbH UE1 0.32 0.02 0.31 0.34
HRi

IPS Empress Ivoclar


Enamel D3 0.32 0.06 0.28 0.38
Direct Vivadent

Kerr
Herculite Ultra XL 0.29 0.03 0.26 0.32
Corporation

G-aenial GC Corporation AE 0.32 0.02 0.31 0.34

Heraeus Kulzer
Venus Diamond CL 0.30 0.05 0.25 0.35
GmbH

GRADIA DIRECT GC Corporation DT 0.30 0.04 0.26 0.34

Tokuyama
Estelite Σ Quick BW 0.30 0.01 0.29 0.31
Dental Corp.

Artiste Pentron Clinical A Enamel 0.31 0.01 0.3 0.32

Coltène White Opal-


SYNERGY D6 0.33 0.03 0.29 0.35
Whaledent escent

DeltaMed Incisal Me-


Renamel Microfill 0.29 0.01 0.28 0.3
GmbH dium

* t-test P = 0.034

enamel shells that represent the speci- After 30  min, a small amount of ma-
men of this study. terial was taken from the heated syringe
A standardized protocol has been and spread on to the white part of the
used to produce every specimen. Every mold with a rounded obturator in order
composite was placed in a composite to provide a uniform material thickness.
heater conditioner (Fig  38) (CHC, Com- The two parts of the mold were coupled
posite Heating Conditioner, Micerium). and a little pressure was applied for 3  s

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Fig 40    A stable and reliable template was used to measure every specimen in the same point.

in the middle of the transparent portion template was made in composite (M7
following the manufacturer’s instruc- CeramX, Dentsply) layered and cured
tions, while the mold was placed on a on the “buccal” portion of a specimen
laboratory dental vibrator (Vibrax 230V, isolated with Vaseline.
Renfert) running at a low frequency.
The mold was checked to see if the
two parts had been joined perfectly. Results
The procedure was repeated until cou-
pling was considered satisfactory, mak- Table  1 shows the mean changes (plus
ing sure that every side of the mold was standard deviations and minimum and
“closed.” maximum) in cervical measurements,
A curing light was then applied in the showing that no significant differences
middle of the transparent portion of the were observed (all P > 0.05), except
mold for 80  s in order to cure the com- for one composite (Miris 2, P = 0.034).
posite. After this, the mold was opened Table  2 shows no significant differenc-
and the shell was cured for another 40  s. es across the measurements taken at
The enamel shells were carefully re- the middle area. Table  3 shows that no
moved from the white portion of the mold. significant differences were observed
In order to measure the specimens’ when the measurements were taken at
thickness, a point micrometer was used the incisal area (all P > 0.05), except for
(SMPC25, Alpa). Every specimen was two composites (Enamel plus HRi, P =
produced by a single operator, who pro- 0.019; Renamel Microfill, P = 0.020).
duced three specimens (enamel shells)
for every composite.
Every specimen was measured Discussion
(Fig  39) in the cervical, middle and in-
cisal areas in order to evaluate their Both the null hypothesis were accepted,
thickness. As a means to measure every while all the specimens demonstrated
specimen in the same point, a stable and comparable enamel shell measure-
reliable template was used (Fig  40). This ments in all the examined areas.

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Table 2  Middle measurements

Product name Company Shade Mean Std. Dev. Min Max

Ceram-x Dentsply E1 0.52 0.03 0.5 0.55

Clearfil Majesty Kuraray Medical


E 0.53 0.02 0.51 0.55
Esthetic Inc.

ENAMEL plus HFO GDF GmbH GE1 0.52 0.06 0.47 0.58

Opallis FGM EA1 0.52 0.06 0.48 0.59

Filtek Supreme XTE 3M ESPE A2 ENAMEL 0.53 0.08 0.44 0.58

Miris 2 Coltène Whaledent NT 0.49 0.04 0.44 0.52

ENAMEL plus HRi GDF GmbH UE1 0.51 0.02 0.49 0.52

IPS Empress Direct Ivoclar Vivadent Enamel D3 0.48 0.05 0.44 0.54

Herculite Ultra Kerr Corporation XL 0.51 0.03 0.48 0.53

G-aenial GC Corporation AE 0.51 0.05 0.46 0.55

Heraeus Kulzer
Venus Diamond CL 0.55 0.06 0.47 0.59
GmbH

GRADIA DIRECT GC Corporation DT 0.50 0.04 0.46 0.54

Tokuyama Dental
Estelite Σ Quick BW 0.52 0.02 0.5 0.53
Corp.

Artiste Pentron Clinical A Enamel 0.54 0.06 0.49 0.6

White
SYNERGY D6 Coltène Whaledent 0.52 0.06 0.46 0.57
Opalescent

Renamel Microfill DeltaMed GmbH Incisal Medium 0.51 0.02 0.49 0.53

There are significant clinical advan- ence values of a prefabricated anatomic


tages when using the proposed cus- dual-laminate shade guide (Miris 2) are
tom-made shade guide. Classic shade acceptable when compared to Vitapan
guides are composed by layered tabs, Classical and custom guides. They pro-
but the user does not have control on vided a comprehensive understanding
the enamel shell. Magne et al30 have of the color with dentin alone, enamel
recently demonstrated that color differ- alone, or the dentin/enamel combination,

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Table 3  Incisal measurements

Product name Company Shade Mean Std. Dev. Min Max

Ceram-x Dentsply E1 0.70 0.02 0.68 0.72

Clearfil Majesty Kuraray Medical


E 0.73 0.02 0.72 0.75
Esthetic Inc.

ENAMEL plus HFO GDF GmbH GE1 0.69 0.04 0.65 0.73

Opallis FGM EA1 0.74 0.03 0.72 0.77

Filtek Supreme XTE 3M ESPE A2 ENAMEL 0.70 0.05 0.64 0.74

Miris 2 Coltène Whaledent NT 0.71 0.01 0.7 0.71

ENAMEL plus HRi GDF GmbH UE1 0.76 0.02 0.75 0.78*

IPS Empress Direct Ivoclar Vivadent Enamel D3 0.66 0.02 0.65 0.69

Herculite Ultra Kerr Corporation XL 0.71 0.01 0.7 0.72

G-aenial GC Corporation AE 0.71 0.04 0.68 0.75

Heraeus Kulzer
Venus Diamond CL 0.72 0.03 0.69 0.75
GmbH

GRADIA DIRECT GC Corporation DT 0.70 0.08 0.65 0.78

Tokuyama Dental
Estelite Σ Quick BW 0.72 0.05 0.69 0.78
Corp.

Artiste Pentron Clinical A Enamel 0.74 0.05 0.69 0.79

White
SYNERGY D6 Coltène Whaledent 0.74 0.05 0.68 0.78
Opalescent

Incisal
Renamel Microfill DeltaMed GmbH 0.74 0.01 0.73 0.75**
Medium

* t-test P = 0.019; ** t-test P = 0.020

however the described findings evaluat- cause it examined different brands of


ed only one brand of composite resins, composite resins, demonstrating that
pointing out that additional works could matching shades among different sys-
be performed to extend the matching tems could be available with predictable
shades between other systems. There- layer thicknesses. Composite enamel
fore, the present study could represent thickness plays a fundamental role in the
a valid contribution for the clinicians be- esthetic outcome of a restoration and

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this issue has been discussed by sev- Conclusion


eral authors.31-33 Schmeling et al report-
ed that value enamel composite optical As a result of all of these considerations,
properties, such as translucency, for ex- the authors came to the conclusion that,
ample, was influenced by the value and although a “perfect” shade guide is
thickness of the enamel composite.31 In- very difficult to obtain, an effort to im-
deed, the authors suggest that special prove current commercial shade guides
attention should be paid to the thickness should be made.
of the material used to reproduce trans- A barely acceptable shade guide
lucency of natural tooth enamel.31 should have the following requirements:
Friebel et al reported that the total „„Specimens should be made of the
color impression could be shown to be same materials that the clinician will
dependent on the sample thickness use, therefore in composite.
and the transparency/translucency of „„They should offer the capability to
the single layers of enamel and dentin overlap enamel and dentin speci-
materials.32 The authors reported also mens interposing glycerin or, even
that the influence of the cover layer on better, specimens should be already
the total color impression increases cured together.
distinctly with the layer thicknesses. In „„Thickness of the enamel should not
fact, they experienced differences in be unrealistic (0.7 mm maximum).
color impressions in composite enam- „„It should be possible to test the behav-
el layers thinner (0.1  mm) and thicker ior of different enamel thicknesses.
(1.4  mm) than the reference layer thick- „„The shanks utilized for the specimens
ness (0.4  mm).32 should not interfere with shade selec-
Vichi et al reported that layer thick- tion.
ness and the proportion of dentinal thick- „„They should provide for a standard-
nesses and translucent shade greatly ized shape, similar to the incisors, for
influence the final aspect of a multi-layer every specimen with predetermined
composite restoration.33 layer thicknesses.

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