Conservative Dentistry And Endodontics
EGYPTIANDENTAL JOURNALVol. 66, 2705:2714, October, 2020Print ISSN 0070-9484 Online ISSN 2090-2360Conservative Dentistry and Endodonticswww.eda-egypt.org Codex : 39/2010 DOI : 10.21608/edj.2020.36507.1178ASSESSMENT OF TOOTH SHADE AFTER DE-ANDRE-HYDRATION DURING CLINICAL RESTORATIVEPROCEDURES: A RANDOMIZED CLINICAL TRIALShereen Hafez* and Sameh Abou-Steit**ABSTRACTObjectives: this study was aimed to assess any tooth colour change resulting from dehydrationdue to rubber dam application and the required time for any change to recover to baseline.Furthermore, to evaluate the quality of change and the affected areas of the teeth.Materials and methods: Ten Participants with intact maxillary central incisors were recruitedfrom the clinic of conservative dentistry. The age was ranging from 20 to 55 years with a meanage of 30.5 years. The inclusion criteria were unrestored intact maxillary central incisors withouttooth bleaching performed over the past year. Exclusion criteria were the existence of any fixedorthodontic appliance or retainers or restorations on central incisors. Patients were randomizedafter performing polishing of their teeth. The VITA Easyshade spectrophotometer was used forevaluating tooth shade in this study. A baseline measurement was taken of the test tooth and then at10 min and 30 min. Further spectrophotometric measurements of the test tooth were done at,40 minand 60 min during rehydration. Data was collected from the Easyshade as CIE L*a*b* coordinates,chroma (C), hue (H) and ΔE. For statistical analysis, ANOVA was used to study the changes due tode- and re-hydration processes at the significance level P 0.05.Results: Color change (ΔE): there was a statistically significant change in mean (ΔE) values(P-value 0.001, Effect size 0.602). Pair-wise comparisons revealed that there was no statisticallysignificant change in mean (ΔE) values from 10 to 30 minutes. From 30 to 40 minutes, therewas a statistically significant decrease in mean (ΔE) value followed by non-statistically significantchange from 40 to 60 minutes (A statistically significant decrease after rehydration).Conclusions: It is necessary to develop standardized, reproducible imaging modalities andobjective image analysis methods. It should be highlighted that a systematic consideration of thedynamic light interaction within the coronal structures is essential for selecting proper value andchromaticity for restorative materials that is mandatory to obtain the successful esthetic restorations.Within the limitations of the present clinical trial, there is an obvious change in teeth shade upondehydration that was assessed clinically by spectrophotometer. It is highly recommended by theclinicians to wait more than 60 min in order to properly assess color match, or to carry out the shadematching procedure on another dental visit. Dental shade matching procedures should be performedbefore the teeth exposure to dehydration to avoid shades mismatch that may not be satisfactory andwould require modification or even remake of restorations.KEYWORDS: esthetic, tooth shade, spectrophotometer, tooth dehydration, tooth rehydration,color assessment* Assistant Professor of Conservative Dentistry, Faculty of Dentistry, Cairo University.** Lecturer of Fixed Prosthodontics, Faculty of Dentistry, Ahram Canadian University.
(2706)E.D.J. Vol. 66, No. 4INTRODUCTIONFrom the architectural point of view, the smilerepresents approximately 60% of the weight of theface that may have a visual impact subconsciouslyon people we meet. Statistics performed by theAmerican academy of cosmetic dentistry survey(AACD) in 2017 revealed that a high value isconsidered on a patient smile. Furthermore, thepopulations have an increased awareness of therole teeth play in appearance; hence, patients’expectations of aesthetics in contemporary dentistryare ever increasing. Here comes the importanceof performing esthetic dentistry that is highlightedas reproducing natural looking teeth by generatingperfect esthetic restorations that represents a greatchallenge for long time due to many materials’limitations affecting shade integration or surfacequality, as well as possibly color stability.Patient frustration regarding tooth colour wasthe main aim in a survey concerned with esthetic appearance.(1) Thus precise shade measurement gathered with proper communication of tooth colour isessential to a clinically prosperous aesthetic outcome.(2) It is compulsory that clinicians should havebetter understanding for dynamic light interactionwith tooth structures together with the proper histoanatomic principles for proper material and shadeselection during any restorative procedure whetherdirect or indirect. The structural configurations ofthe tooth formulate a complex optical medium forlight when passing through the enamel tissue to dentin traversing the intervening dentino-enamel complex in terms of opacification which is the completereflection of light as well as gradient between transparency which is the complete light transmission.(3)Furthermore, this behavior is not constant throughtime however it changes over the years, as tissueschange in composition and morphology. A betterunderstanding of active aging of tooth structuresis a crucial for success when selecting the propervalue and chromaticity for any restorative materials.Shereen Hafez and Sameh Abou-SteitHence, clinicians as well as technicians shouldhave enough training sessions for proper selectionof tooth shade. Thus to achieve a clinically acceptedesthetic outcomes, there are four main contributingfactors are: Dynamic Light Interaction, Histo-anatomical Features, Smilography and the 9 Elementsof visual synthesis.(3)(4,5)In dental practice, one of the real challengefacing the clinicians is the accurate reproductionof the optical characteristics of the intact tooth,outstanding to the inherent translucency enamel,dentin and the intervening dentinoenamel complex(DEC). Translucent restorative materials offer asignificant color measurement challenge as theyinteract with light in a complex manner that differthan other materials. The old traditional way ofvisual estimation approaches that solely employthe Munsell color model system based on hue,chroma, and value (H/C/V) dominating the dentalmarket seems to be insufficient when allocatingthe relevant data among the members of the dentalteam (clinician/technician/patient).(6) In 1931 theCommission Internationale de l’Eclairage (CIE)defined a standard light source, developed a standardobserver and enabled the calculation of tri-stimulusx, y, z values, which represent how the humanvisual system responds to a given colour and allowsus to transform spectral energy data into meaningfulcolour data. It should be noted that the DE in theL*a*b* colour space indicates the degree of colourdifference not the direction of the colour difference.It is often deduced in the literature that a ΔE of1 is the 50:50 perceptibility thresholds. Usually,natural teeth hues have a great tendency to be inthe yellow to yellow-orange range which is mainlydetermined by the colour of dentine while enameloccupying only a slight role through light scatteringat the blue range wavelength.(7) Implements usedfor clinical selection or matching of tooth shadeinclude colourimeters, digital imaging systemsand spectrophotometers.(8) It has been previouslyreported that VITA Easyshade has to be the most
ASSESSMENT OF TOOTH SHADE AFTER DE-AND RE-HYDRATION DURING CLINICALreliable instrument in both in-vitro and in-vivoresearches.(2) Moreover, it has been reported thatteeth dehydration can make them appear more whiterby increasing enamel opacity when examined bythe Easyshade as the light cannot be scattered fromhydroxyapatite crystal to crystal.(6,10,11)This loss oftranslucency upon dehydration may therefore causemore light reflection that would mask the underlyingcolor of dentine and thus it appears lighter. Russell etal.(12) , in their research, applied a rubber dam to theanterior teeth of seven participants and allowed theteeth to dehydrate for 15 min., a measurement wastaken using a spectrophotometer and further threemore readings were taken at 10 min intervals afterremoval of rubber dam and tooth rehydration. Theyrevealed that tooth colour had become less saturatedand lighter after dehydration and the colour ofthe teeth reverted to their baseline values 20 minafter removal of the rubber dam. Thus it could beconcluded that most dental procedures cause somedehydration of teeth.(13-16)It is crucially required to record the teeth shadeat the commencement of the dental appointmentbut there is insufficient literature evidence tosupport this.(14) The most commonly reportedpatient complaint is color mismatch betweenrestoration and natural teeth resulting in restorationsreplacement consequently increased expense.(2) Asmost dental procedures can lead to teeth dehydrationwhich in turn can alter their shade resulting inunacceptable results in shade matching. Aimingto elude undesirable mismatch of color betweendental restoration and natural teeth it is essentialthat the procedure of shade selection is carriedout at the beginning of the appointment. Thus thisclinical trial aimed to investigate any color changein tooth resulting from dehydration resulted fromrubber dam application and the required time forcolor change to recover to baseline and to assess thequality of change and the areas the most affected ofthe teeth.(2707)MATERIALS AND METHODSResearch Ethics Committee approvalThis randomized clinical trial was performed atthe Clinic of Conservative Dentistry Department,Faculty of dentistry, Cairo university, Egypt withthe approval of Research Ethics Committee No.CEBD-2020-4-040. In addition to ClinicalTrials.gov ID of NCT04348773Consent statementAn informed consent with an easy Arabiclanguage was signed by the recruited participants.Sample size calculationThis power analysis used color change (ΔE)as the primary outcome. Based upon the resultsof Suliman S et al (2019); the mean and standarddeviation values for (ΔE) after dehydration andrehydration were (5.11 2.39) and (2.73 2.14),respectively. Using alpha (α) level of (5%) and Beta(β) level of (20%) i.e. power (80%); the effectsize (dz) was found to be (1.046) and the minimumestimated sample size was (10) patients. Samplesize calculation was performed using G*PowerVersion 3.1.9.2.Ten Participants with intact maxillary centralincisors were recruited. Patients were enrolled fromthe clinic of Conservative Dentistry Department,Cairo University. An informed consent was signedby the recruited participants. The age range was from20 to 55 years with a mean age of 30.5 years. Theinclusion criteria were unrestored intact maxillarycentral incisors with no tooth bleaching performedduring the previous year. Exclusion criteria werepresence of any restorations or fixed orthodonticappliance or any fixed retainers on central incisors.After teeth polishing of the recruited participants,they were randomized using computer software.The generated list was then sealed in 10 envelopesby a different person other than the operator.
(2708)E.D.J. Vol. 66, No. 4Spectrophotometric analysisThe VITA Easyshade spectrophotometer wasused for evaluating tooth shade in this study. Afterpatient acceptance and approval. The Easyshadewas used with ‘‘Base shade determination” settingto measure colour at middle of the middle third andwas calibrated before each set of measurements.To standardize each measurement, a clear vacuumformed template was applied with custom-madewindow with the same dimension of the VITAEasy-shade probe tip corresponding to the middleof the middle third of the tooth to be assessed.While to ensure infection control, a plastic barrierwas applied to the probe tip of the VITA Easyshade.Spectrophotometer measurements for all participantswere carried out by the same operator by placingShereen Hafez and Sameh Abou-Steitthe probe perpendicular to the tooth surface beingmeasured. A baseline measurement was taken of thetest tooth. Figure (1A). Then isolated with rubberdam (Nic Tone, medium sheet) and KSK clamp#210 and allowed to dehydrate without blowingany air from 3 in 1 syringe. Spectrophotometricmeasurements of the test tooth during dehydrationwere carried out at 10 min and 30 min. Figure(1B, 1C). The rubber dam was then removed andparticipants were then asked to drink a glass ofwater. Further spectrophotometric measurementsof the test tooth were done at,40 min and 60 minduring rehydration. Figure (1D). Data was collectedfrom the Easyshade as CIE L*a*b* coordinates,chroma (C), hue (H) and ΔE.Fig. (1) A: Base line measurement of test tooth, B: Easyshade measurement at 10 min of dehydration, C: Easyshade measurementat 30 min of dehydration, D: Easyshade measurement at 40 min of rehydration
ASSESSMENT OF TOOTH SHADE AFTER DE-AND RE-HYDRATION DURING CLINICALStatistical analysisNumerical data were explored for normality bychecking the distribution of data and using tests ofnormality (Kolmogorov-Smirnov and Shapiro-Wilktests). Color All data showed normal (parametric)distribution except for (a*) values which showednon-normal (non-parametric) distribution. Datawere presented as mean, standard deviation (SD),95% Confidence Interval (95% CI), median andrange values. For parametric data; repeated measuresANOVA was used to study the changes due to deand re-hydration processes. Bonferroni’s post-hoctest was used for pair-wise comparisons. For nonparametric data; Friedman’s test was used to studythe changes due to de- and re-hydration processes.Dunn’s test was used for pair-wise comparisons.The significance level was set at P 0.05. Statisticalanalysis was performed with IBM SPSS Statisticsfor Windows, Version 23.0. Armonk, NY: IBMCorp.RESULTSDemographic dataThe present study was conducted on 10 teeth in10 patients; 6 males (60%) and 4 females (40%).The mean and standard deviation values for agewere 30.5.Descriptive statistics of color parametersDescriptive statistics of color parameters arepresented in Table (1). The mean, standard deviation(SD) values and results of repeated measuresANOVA and Friedman’s tests for comparisonbetween color parameters at different time periods(de- and re-hydration) are presented in table (2). Themean, standard deviation (SD) values and resultsof Friedman’s tests for comparison between colorchange (ΔE) after de- and re-hydration processesare presented in table (3).(2709)Changes in color parameters after de- and rehydration:(L*) value; there was no statistically significantchange in mean (L*) values after de- and rehydration processes (P-value 0.108, Effect size 0.191).(a*) value; there was a statistically significantchange in mean (a*) values after de- and rehydration processes (P-value 0.009, Effect size 0.280). Pair-wise comparisons revealed thatthere was a statistically significant increase inmean (a*) values after 10 minutes followed bynon-statistically significant change from 10 to 30minutes (A statistically significant increase afterdehydration). From 30 to 40 minutes, there was astatistically significant decrease in mean (a*) valuefollowed by non-statistically significant changefrom 40 to 60 minutes (A statistically significantdecrease after rehydration). The mean (a*) valuesafter rehydration (40 and 60 minutes) showed nonstatistically significant difference from base linevalue.(b*) value; there was a statistically significantchange in mean (b*) values after de- and rehydration processes (P-value 0.001, Effect size 0.666). Pair-wise comparisons revealed thatthere was a statistically significant increase inmean (b*) values after 10 minutes followed bynon-statistically significant change from 10 to 30minutes (A statistically significant increase afterdehydration). From 30 to 40 minutes, there was astatistically significant decrease in mean (b*) valuefollowed by non-statistically significant changefrom 40 to 60 minutes (A statistically significantdecrease after rehydration). The mean (b*) valuesafter rehydration (40 and 60 minutes) showed nonstatistically significant difference from base linevalue.Chroma value; there was a statisticallysignificant change in mean chroma values after deand re-hydration processes (P-value 0.001, Effect
(2710)E.D.J. Vol. 66, No. 4Shereen Hafez and Sameh Abou-Steitsize 0.648). Pair-wise comparisons revealedthat there was a statistically significant increase inmean chroma values after 10 minutes followed bynon-statistically significant change from 10 to 30minutes (A statistically significant increase afterdehydration). From 30 to 40 minutes, there wasa statistically significant decrease in mean chromavalue followed by non-statistically significantchange from 40 to 60 minutes (A statisticallysignificant decrease after rehydration). The meanchroma values after rehydration (40 and 60 minutes)showed non-statistically significant difference frombase line value.Table (1). Descriptive statistics of color parametersTime(minutes)ColorparametersL*Base linea*b*ChromaHueL*Dehydration10 min.a*30 Hue22.2MedianRange83.619.4ChromaUpperbound4.4ΔE40 min.80.6-0.08Lower22.2a*60 min.SDb*ΔERehydrationMean95% 3.11.488.11.521.78.7
ASSESSMENT OF TOOTH SHADE AFTER DE-AND RE-HYDRATION DURING CLINICALHue value; there was a statistically significantchange in mean hue values after de- and rehydration processes (P-value 0.001, Effect size 0.712). Pair-wise comparisons revealed thatthere was a statistically significant decrease inmean hue values after 10 minutes followed bynon-statistically significant change from 10 to 30minutes (A statistically significant decrease afterdehydration). From 30 to 40 minutes, there was astatistically significant increase in mean hue valuefollowed by non-statistically significant changefrom 40 to 60 minutes (A statistically significantincrease after rehydration). The mean hue values(2711)after rehydration (40 and 60 minutes) showed nonstatistically significant difference from base linevalue.Color change (ΔE): there was a statisticallysignificant change in mean (ΔE) values (P-value 0.001, Effect size 0.602). Pair-wise comparisonsrevealed that there was no statistically significantchange in mean (ΔE) values from 10 to 30 minutes.From 30 to 40 minutes, there was a statisticallysignificant decrease in mean (ΔE) value followedby non-statistically significant change from 40 to60 minutes (A statistically significant decrease afterrehydration).TABLE (2) The mean, standard deviation (SD) values and results of repeated measures ANOVA andFriedman’s tests for comparison between color parameters at different time periods (de- and rehydration)ColorparametersDehydrationBase line10 min.Rehydration30 min.40 min.60 min.P-valueEffect size(Partial EtaSquared) 2.21.683.61.7832.90.1080.191a*-0.1 B1.50.2 A10.4 A0.9-0.3 B1.2-0.8 Bb*16.83.13.819.3BChroma173.819.3B2.292.7 AHueBB94.6 A22.2A4.423.5A3.322.2A4.423.5A3.990.1 B3.289 B1.30.009*r 0.2803.2 17.5B2.9 0.001*0.6663.1 17.6B2.8 0.001*0.6482.8 0.001*0.7123.495 A*: Significant at P 0.05, †: Except for (a*) value where the effect size is (r),Different superscripts in the same row indicate statistically significant differenceTABLE (3) The mean, standard deviation (SD) values and results of Friedman’s tests for comparison betweencolor change (ΔE) after de- and re-hydration processesDehydrationColor changeΔE10 min.Rehydration30 min.40 min.60 min.MeanSDMeanSDMeanSDMeanSD7.3 A3.98.2 A3.55.5 B3.14.8 B2.2*: Significant at P 0.05, Different superscripts indicate statistically significant differenceP-valueEffect size (r) 0.001*0.602
(2712)E.D.J. Vol. 66, No. 4DISCUSSIONThe dynamic light interaction of enamelhas revealed to be age related, wavelengthspecific, and is greatly affected by its hydrationcondition.(2) Over the last decade, there has beenincreased interest in alternative photographictechniques aiming to increase the objectivity andaccuracy of dental shade evaluation as well aslaboratory communication thus minimizing the userdependent error in the future practice.(3) in order toenhance the sensation of surface topography of themaxillary central incisors Direct illumination wasused. The reason for observing the time required forteeth rehydration in the present clinical trial was tofound whether the resultant color change from dentalprocedure dehydration could be recovered within asuitable time before accurate measurement of toothshade. The present clinical trial also evaluated therelative change in shade not the shade itself so itwas considered to comprise both central incisorsin the same image so that to exclude all concernsthat separate images might be affected by otherconfounders as the environmental lighting, the flashperformance and the distance from camera.In the current study, the results of changein color parameters after de- and re-hydrationrevealed that (L*) value; there was no statisticallysignificant change in mean (L*) values after deand re-hydration processes (P-value 0.108, Effectsize 0.191). However, (a*) value; there was astatistically significant change in mean (a*) valuesafter de- and re-hydration processes (P-value 0.009, Effect size 0.280). Pair-wise comparisonsrevealed that there was a statistically significantincrease in mean (a*) values after 10 minutesfollowed by non-statistically significant changefrom 10 to 30 minutes (A statistically significantincrease after dehydration). From 30 to 40 minutes,there was a statistically significant decrease in mean(a*) value followed by non-statistically significantchange from 40 to 60 minutes (A statisticallyShereen Hafez and Sameh Abou-Steitsignificant decrease after rehydration). The mean(a*) values after rehydration (40 and 60 minutes)showed non-statistically significant difference frombase line value. Furthermore, (b*) value; therewas a statistically significant change in mean (b*)values after de- and re-hydration processes (P-value 0.001, Effect size 0.666). Pair-wise comparisonsrevealed that there was a statistically significantincrease in mean (b*) values after 10 minutesfollowed by non-statistically significant changefrom 10 to 30 minutes (A statistically significantincrease after dehydration). From 30 to 40 minutes,there was a statistically significant decrease in mean(b*) value followed by non-statistically significantchange from 40 to 60 minutes (A statisticallysignificant decrease after rehydration). The mean(b*) values after rehydration (40 and 60 minutes)showed non-statistically significant difference frombase line value.From these results it could be noticed thatthe major change in color coordinates alteredsignificantly between different time intervals atbaseline and 10 min as well as baseline and 30min of dehydration resulted from isolation usingrubber dam. This was in accordance with Burki etal (2) and it might be attributed to the dehydrationeffect that results in an increase in the enamelopacity. Tooth dehydration result in creation ofnew interface in which there was a replacementof the water with air around the enamel prismsresulting in a great alteration in refractive indiceswith superior scattering at a dehydrated enamel–airinterface compared to enamel–water interface. Thusthe dehydrated enamel exhibit lower translucencycausing more reflection so camouflaging theunderlying yellow shade of dentine, that wouldbe interpreted in a lighter appearance. However,this differs from the findings of Russell et al (12) inwhich only L* and a* coordinates were significantlydifferent after dehydration with rubber dam isolationfor 15 min.
ASSESSMENT OF TOOTH SHADE AFTER DE-AND RE-HYDRATION DURING CLINICALIn the present study, regarding the Chroma value;there was a statistically significant change in meanchroma values after de- and re-hydration processes(P-value 0.001, Effect size 0.648). Pair-wisecomparisons revealed that there was a statisticallysignificant increase in mean chroma values after 10minutes followed by non-statistically significantchange from 10 to 30 minutes (A statisticallysignificant increase after dehydration). From 30to 40 minutes, there was a statistically significantdecrease in mean chroma value followed bynon-statistically significant change from 40 to60 minutes (A statistically significant decreaseafter rehydration). The mean chroma values afterrehydration (40 and 60 minutes) showed nonstatistically significant difference from base linevalue.For the Hue value; there was a statisticallysignificant change in mean hue values after deand re-hydration processes (P-value 0.001, Effectsize 0.712). Pair-wise comparisons revealedthat there was a statistically significant decreasein mean hue values after 10 minutes followed bynon-statistically significant change from 10 to 30minutes (A statistically significant decrease afterdehydration). From 30 to 40 minutes, there was astatistically significant increase in mean hue valuefollowed by non-statistically significant changefrom 40 to 60 minutes (A statistically significantincrease after rehydration). The mean hue valuesafter rehydration (40 and 60 minutes) showed nonstatistically significant difference from base linevalue. This might be attributed to the alteration inthe reflectance spectrum of the dehydrated enamel.(3)These findings are in agreement with previousresearch where there is an overall gradation incolor from the cervical region, which is the mostsaturated, to the incisal region.(2)Color change (ΔE) values were calculated toassess the clinical significance of the change incolour measured with spectrophotometer. In thepresent study, the results of the color change (ΔE)(2713)revealed that there was a statistically significantchange in mean (ΔE) values (P-value 0.001,Effect size 0.602). Pair-wise comparisonsrevealed that there was no statistically significantchange in mean (ΔE) values from 10 to 30 minutes.From 30 to 40 minutes, there was a statisticallysignificant decrease in mean (ΔE) value followedby non-statistically significant change from 40 to60 minutes (A statistically significant decrease afterrehydration). This was in accordance with previousstudies (2,15,16) where the decrease in translucencyduring dehydration is described as a consequenceof an increased difference in refractive indicesbetween the enamel prisms and the surroundingmedium when there is replacement of water by air.Opposite to Russel et al(12) where there was muchlower than the present clinical trial, for that reason,there will be high clinical risk to find unacceptablecolor mismatch between restoration and naturaltooth. Thus it could be clinically recommended towait more than 60 min for another assessment colormatch, or much preferably to carry out the colormatching procedure on additional appointment.CONCLUSIONS1) It is necessary to develop standardized,reproducible imaging modalities and objectiveimage analysis methods.2) It should be highlighted that a systematicconsideration of the dynamic light interactionwithin the coronal structures is crucial forselecting proper value and chromaticity forrestorative materials that is mandatory to obtainthe successful esthetic restorations.3) Within the restrictions of the present clinicaltrial, an obvious change in teeth shade wasobserved upon dehydration that was assessedclinically by spectrophotometer. Thus, it ishighly recommended by the clinicians to waitmore than 60 min in order to properly assesscolor match, or to carry out the shade matchingprocedure on another dental visit.
(2714)E.D.J. Vol. 66, No. 44) Dental shade matching procedures shouldbe performed before the teeth exposure todehydration to avoid shades mismatch thatmay not be satisfactory and would requiremodification or even remake of restorations.Shereen Hafez and Sameh Abou-Steitlocal refractive index: an optical coherence tomographystudy. J Dent 2012;40:387–396.6.Joiner A. Tooth colour: a review of the literature. Journalof Dentistry 2004;32:3–12.7.Paul S, Peter A, Pietrobon N, et al. Visual and spectrophotometric shade analysis of human teeth. Journal of DentalResearch 2002;81:578.8.Brewer JD, Wee A, Seghi R. Advances in color matching.Denta l Clinics of North America 2004;48:341.9.Douglas RD, Steinhauer TJ, Wee AG. Intraoral determination of the tolerance of dentists for perceptibility and acceptability of shade mismatch. TheJournal of ProstheticDentistry 2007;97: 200–8.Disclosure of statementThe authors declare that they have no conflictsof interestACKNOWLEDGMENTSpecial thanks to Omar Hesham and MohamedAref (resident in conservative dentistry department,faculty of dentistry, Cairo University) for theirtremendous efforts and the perfect photographingof the clinical cases in this study.REFERENCES10. Stevenson B. Current methods of shade matching in dentistry: a review of the supporting literature. Dental Update2009; 36:270.11. Dozic A, Kleverlaan CJ, El Zohairy A, et al. Performanceof five commercially available tooth color measuring devices. Journal of Prosthodontics 2007;16: 93–100.1.Samorodnitzky-Naveh GR, Geiger SB, Levin L. Patients’satisfaction with dental esthetics. The Journal of theAmerican Dental Association 2007;138:805.2.Burki Z., Watkins S., Wilson R
www.eda-egypt.org Codex : 39/2010 DOI : 10.21608/edj.2020.36507.1178 Print ISSN 0070-9484 Online ISSN 2090-2360 Conservative Dentistry and Endodontics EGYPTIAN DENTAL JOURNAL Vol. 66, 2705:2714, October, 2020 * Assistant Professor of Conservative Dentistry, Faculty of Dentistry, Cairo University.
Kauser, 6Dr. Aman Khan, 1PG Student, Dept. Of Conservative Dentistry & Endodontics, 2Professor and HOD, Dept. Of Conservative Dentistry & Endodontics, 3Reader, Department Of Conservative Dentistry and Endodontics. 4Senior Lecturer, Department Of Conservative Dentistry and Endodontics.
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