RESEARCH ARTICLE

The Effect of ColorTraining of Dental Students’on

Dental Shades Matching Quality
AFNAN F. ALFOUZAN, BDS, MS*, HUSSAM M. ALQAHTANI, BDS†,
ESAM A. TASHKANDI, BDS, MS, FDS RCS, PhD‡

ABSTRACT
Objective: To assess the effect of color training on the dental shade matching quality of dental students of both gender
and to study the need to include lectures and exercises about shade selection in the undergraduate dental
curriculum.
Materials and Methods: One hundred and twentyjunior dental students from the College of Dentistry at King Saud
University participated in the present study and were distributed randomly into four testing groups.They were asked
to match the color of four target shade tabs from theVITA Linearguide 3D-MASTER.Group1attended a brief lecture
and a training exercise about dental shade matching,Group 2 only attended the lecture, and Group 3 only performed
the training exercise.Group 4 did not participate in the lecture or the training exercise and served as a control.Exact
matching rates were calculated and analyzed to determine the pre- and post-test matching values.Three way
repeated measures analysis of variance, paired ttest, and independent t-test were used to compare shade matching
quality, with a signif|cance level of p < 0.05.
Results: There was a signif|cant difference between the pre- and post-test values for the students’dental shade matching
qualities for all of the test groups.
Conclusion: The effectiveness of the dental shade matching training about color and dental shade matching for improving
the students’shade matching quality was proven for both genders.

CLINICAL SIGNIFICANCE
Training can improve shade matching quality of dental students.
(J Esthet Restor Dent 29:346^351, 2017)

INTRODUCTION (brightness), and chroma (saturation).3,4 No single

The demand for esthetic dentistry in clinical practice is
consistently increasing.1 The esthetic result of dental
treatment is influenced by the shape, form, and color
of the final restoration.2
Color is usually described according to the Munsell
color space system in terms of hue (color), value
tooth is of uniform color; therefore, shade selection is
a crucial step in the success of definitive restoration.
Traditional shade selection under ideal conditions is a
subjective assessment, even among experienced
clinicians.5–7 Culpepper and colleagues found that
dentists disagreed about shade matching for the same
tooth and that individual dentists could not duplicate
their shade selections on different days.5

*Assistant Professor, Department of Prosthodontics, King Saud University, Riyadh, Saudi Arabia

Teaching Assistance, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
`
Associate Professor, Department of Prosthodontics, King Saud University, Riyadh, Saudi Arabia

346 Vol 29  No 5  346^351  2017 Journal of Esthetic and Restorative Dentistry DOI 10.1111/jerd.12284 V
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Recent advances in color matching have been driven
by market demands for high-quality esthetic
restorations. Furthermore, improved shade guides, the
availability of shade-taking devices and research in the
area of human color vision have improved the
potential for achieving excellent color-matched
restorations.8 Because of the subjective nature of
perceptual shade matching, the ability to match shades
is acquired through knowledge of basic color principles
and clinical experience.9,10
A recent survey found that only a few dental schools
teach the fundamentals of color science in their dental
curriculum. Generally, dental students and most
clinicians are not familiar with visual color analysis and
are often unable to adequately describe the perceived
tooth color and appearance to dental laboratory
technicians.11
The purpose of the present study was to assess the
effect of color training on the dental shade matching
quality of dental students of both gender and to study
the need for dental students to participate in lectures
and exercises regarding shade selection. The null
hypotheses tested were first that color training has no
effect on dental students of both gender on their
dental shades matching quality and second that there
is no difference in the effect of training with lectures
and/or exercises on the dental shade matching quality.
MATERIALS AND METHODS
The ethical committee of the College of Dentistry
Research Center (CDRC) at King Saud University,
Riyadh, approved the study, and the study was
conducted in accordance with the principles of the
Helsinki Declaration. One hundred twenty dental
students (60 female and 60 male) participated in this
study. The students were in the third year of a five-
year dental program at the College of Dentistry at
King Saud University, Riyadh, Saudi Arabia. The
average age of the students was 21 years.
All of the subjects were screened for color vision
deficiency using the Isochromatic Color Vision tests.12
C 2017 Wiley Periodicals, Inc.
V DOI 10.1111/jerd.12284
EFFECT OF COLOR TRAINING Al-Fouzan et al
Any subject who presented color vision deficiency was
excluded from the study.
All of the students (n 5 120) were asked to match the
color of four target shade tabs from the VITA
Linearguide 3D-master (3D; Vita Zahnfabrik, Bad
Sackingen, Germany). Four predefined shade tabs
(2M2, 2R2.5, 3M3, 4R1.5) were labeled with a specific
symbol, and their specific shade designations were
concealed with masking tape. These shades were
specifically selected to be distributed evenly within the
shade guide color space.
The students were instructed to first select the group
(value) from the first toothguide holder, which
contained 6 tabs, and to then select (chroma) and
(hue) within the chosen group (1–5) of toothguide
holders, which contained 7 tabs. Shade matching was
performed using a GTI D65 color-corrected, light-
viewing booth (model PDV-2e/M, Newburgh, New
York) with 6,500 k. One subject was allowed in the
test room at a time to prevent influence from the
other subjects. No specific time restriction was given
for the shade matching procedure, and all of the
subjects completed the shade matching procedure in
the same room under the same conditions. If
necessary, the subjects were asked to rest their eyes by
looking at the neutral grey viewing booth walls for a
few seconds.
Upon completion of the pre-test, the subjects were
randomly distributed into the four study groups (the
intervention). The first group attended a brief lecture
about color and dental shade matching and was asked
to perform a dental shade matching exercise every
week for three consecutive weeks (Group 1, n 5 30, 15
males and 15 females). The second group attended the
same lecture as Group 1 but did not perform the
weekly exercises (Group 2, n 5 30, 15 males and 15
females). The third group performed the dental shade
matching exercises once a week for three consecutive
weeks but did not attend the lecture (Group 3, n 5 30,
15 males and 15 females). The fourth group did not
attend the lecture or perform the dental shade
matching exercise (control; Group 4, n 5 30, 15 males
and 15 females). On the fourth week, the original
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 EFFECT OF COLOR TRAINING Al-Fouzan et al

TABLE 1. The effect of dental students training groups (intervention) time (before and after) and gender (male and female) on shade
matching quality value
Source Type III sum Degrees Mean F p
of squares of freedom square
Time 1430.817 1 1430.817 39.340 <0.001

Gender 0.017 1 0.017 0.000 0.987

Intervention 647.900 3 215.967 3.337 0.022

Time * intervention 256.150 3 85.383 2.348 .076

Time * Gender 299.267 1 299.267 8.228 .005

Gender * intervention 131.283 3 43.761 0.866 0.460

Time * intervention * 222.233 3 74.078 2.037 .113

Gender

shade matching experiment was repeated by all of the
subjects. Correct matches were calculated based on the
best-matching shade guide method described by
Paravina, in which the best-matching shade tabs were
ranked from 10 points for the best match to 1 point
for the tenth-best match.13
Statistical Analysis
The data were analyzed using Statistical Package for
the Social Sciences software (SPSS Version 21,
Chicago). Descriptive statistics (mean and standard
deviation) were used to describe the quantitative
outcome variable (shade matching quality). Three-way
analysis of variance of repeated measures was used to
observe the effect of intervention (dental students
groups) and gender on the outcome variable (shade
matching quality). In the model, the intervention
groups and gender were considered as between-
subjects factors whereas time (before and after) as
within-subjects factor. Student’s t-test for paired
samples was used to compare the mean values of
(before and after) outcome variable in male and female
study groups. And Student’s t-test for independent
samples was used to compare mean values between
male and female student groups at before intervention
and after intervention. A p-value of 0.05 also a
Bonferroni correction with a new p-value for multiple
comparison was used. The 95% confidence intervals
were used to report the statistical significance and
precision of results.
RESULTS
Table 1 shows the effect of time, where a highly
statistically significant change in shade matching
quality values was observed at before and after
intervention (F 5 39.340, p < 0.001), significant
difference in the shade matching quality values among
different student training groups (intervention) (F 5
3.337, p 5 0.022) and no significant difference between
male and female subjects in relation to their
assessment of shade matching quality values. There
was statistically significant change in the values of
shade matching quality, which was observed at before
and after intervention and difference due to the type of
intervention and no gender effect there was a
difference in the values of shade matching quality. The
interaction between type of intervention groups and
time was toward statistically significance (F 5 2.348,
p 5 0.076). This was due to interaction between time
and all groups together, which indicated that the
change in shade quality was not statistically significant
across all the four groups. But there was an interaction
between gender and time (F 5 8.228, p 5 0.005). And
there was no interaction between gender and type of
intervention (F 5 0.866, p 5 0.460) also non-
significant interaction in the mean values of shade

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 EFFECT OF COLOR TRAINING Al-Fouzan et al

TABLE 2. Comparison of mean values of shade matching quality between male and female study subjects at before and after
intervention
Time Gender Difference p-value 95% Confidence
interval for
Male Female difference of mean
Before 26.90(7.1) 24.65(7.6) 2.25 0.096* 20.41,4.91

After 29.55(7.2) 31.77(7.3) 22.22 0.097* 24.84,0.41

*> 0.025 (Bonferroni corrected level of signif|cance‘‘a’’)çStatistically not signif|cant.

TABLE 3. Comparison of mean values of shade matching quality between before and after intervention, for male and female study
subjects
Gender Time Difference p-value 95% Confidence
interval for
Before After difference of mean
Male 26.90(7.1) 29.55(7.2) 22.65 0.020* 24.86, 20.44

Female 24.65(7.6) 31.77(7.3) 27.12 <0.001* 29.44, 24.79

*<0.025 (Bonferroni corrected level of signif|cance‘‘a’’)çStatistically signif|cant.

matching quality was observed for the three way of before and after the training process, which indicates a
interaction of time, type of intervention groups and need to include lectures and exercises about shade
gender (F 5 2.037, p 5 0.113). selection in the dental school curriculum.

There is no statistically significant difference between
male and female subjects in the mean values of shade
matching quality scores at each of the time points of
intervention (before and after the training) by ignoring
the type of intervention (Table 2).
Table 3 shows a statistically significant difference in
the mean values of shade matching quality scores
between two time points of intervention, before and
after the training for both male and female study
subjects by ignoring the type of intervention. The
mean scores are significantly higher for both male and
female subjects after the training when compared with
their mean scores at before it.
The present study shows that the lecture and exercises
regarding color shade matching of junior dental
students led to more accurate shade matching. Some
studies have shown that previous training and
experience in shade matching plays an important role
in the accuracy of shade matching;14–16 however, Curd
and colleagues reported that experience did not affect
the shade matching accuracy of dental students.3
The female dental students were better at shade
matching than the male dental students. This finding
agrees with that of Haddad and colleagues;17 however,
other studies found no significant influence of gender
on tooth color selection.18

Junior dental students are an appropriate population to

DISCUSSION
Based on the results of this study, the null hypothesis
was rejected. There was a significant difference
between the dental students’ shade matching quality
test shade matching abilities due to their young,
matched age as well as their lack of experience in
shade selection. Furthermore, these students are likely
to have fewer medical conditions that affect color
perception.3

C 2017 Wiley Periodicals, Inc.

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 EFFECT OF COLOR TRAINING Al-Fouzan et al
Isochromatic color tests were used to exclude students
who might have color vision deficiency. Only three
(5%) male dental students did not pass the test; they
were informed about their result and were advised to
seek the help of their auxiliary staff for shade selection
in their future practice. However, no female dental
students were excluded after taking the isochromatic
color test. In the present study, the rate of color vision
deficiency was lower than that of the general
population, in which 8% of men and 2% of women are
affected.3,19,20
The Linearguide 3D Master (LG) was used in the
present study. It was introduced to the market in 2009
and provides better shade matching and subjective
evaluation results than the 3D-Master (TG) and
Vitapan Classical (VC) toothguides. The modified TG
contains the same tabs (29 tabs), but has a simplified
presentation and a two-step shade matching
procedure.13
The type of illumination can affect shade selection. A
neutral light or northern-exposure daylight is
recommended as the best lighting condition for shade
selection; however, these conditions cannot always be
achieved. Curd and colleagues found that dental
students’ shade selection abilities were better with a
light-correcting source than under natural light.3 All of
the shade matching procedures in this study were
performed under color-corrected light.
Because of the effectiveness of color training on the
dental students’ shade matching quality, the authors
recommend formally including lectures and
exercises about shade selection in the undergraduate
curriculum.
CONCLUSION
Within the limitations of this study, it was concluded
that: The effectiveness of the dental shade matching
training about color and dental shade matching for
improving students’ shade matching quality was
evident.
350 Vol 29  No 5  346^351  2017 Journal of Esthetic and Restorative Dentistry
DISCLOSURE AND ACKNOWLEDGEMENTS
The authors do not have any financial interest in the
companies whose materials are included in this article.
This research project was supported by a grant from
the “Research Center of the Center For Female
Scientific and Medical Colleges,” Deanship of Scientific
Research, King Saud University.
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Reprint requests: Dr Afnan Al-Fouzan,Department of
Prosthodontics,College of Dentistry,King Saud University,P O Box
60169,Riyadh11545, Saudi Arabia; email: afnan477@hotmail.com
Journal of Esthetic and Restorative Dentistry Vol 29  No 5  346^351  2017 351