One of the most important decisions that a cosmetic dentist and patient will make together is selecting the best color for the patient’s new porcelain veneers or porcelain crowns (caps). Cosmetic dentists often hear from patients “I want my teeth whiter, but not too white.” or “I want them to look natural, but I still want them really white.”
Below is the typical cosmetic dentistry shade guide. You’ll note that there are twenty different shades.
The sixteen shades on the right are the common shades that most patients have. About a decade ago when teeth bleaching made its entry into dentistry we found that patients teeth could be bleached whiter than the whitest natural shade. And, PATIENTS LOVED THE NEW WHITER SHADES! Thus, dentists, patients and ceramists demanded new whiter shades be made available, and the four shades on the left were created.
So, now having twenty shades (there are actually many more than 20) to choose from, what color is right for you? The answer to this questio depends on whether or not the dentist matching the new porcelain crowns and/or porcelain veneers to other existing teeth (or veneers or crowns). If so, then the dentist and patient choose one of the shades that best matches.
However, more often than not when doing complete smile makeovers by placing 8-10 or even more porcelain veneers and/or porcelain crowns, the issue of matching is no longer as relivant. The cosmetic dentist is now creating a new smile and can choose any color available. Today, we’re finding that most of our smile makeover patients are wanting one of the four bleaching shades on the left!
It may still seem like “guess work” choosing from one of the shades on the shade guide, as “how will it look in your mouth” is really the important question? Today much of that guess work can be eliminated by the “trial smile” test drive of the porcelain veneers or porcelain crowns. After preparing the teeth for porcelain veneers or porcelain crowns, the dentist fabricates temporary porcelain veneers or porcelain crowns at the desired color (or a very close alternate shade), and the patient can then wear the temporary veneers for a few days before making the final decision. The patient comes back for the final decision, and based on how they like the color of the temporary veneers or crowns, the patient can then decide to have the final porcelain veneers or porcelain crowns made the same shade, lighter or darker. This is a much more practical approach than merely choosing a shade from the shade guide!
Another point is that over the past two decades that even the average patients are wanting teeth whiter. For example, back when I started practicing cosmetic dentistry in 1980 the most popular shade was A2. Five years later it was A1, which was whiter. Then in the 1990s the most popular was B1, whiter still. At the turn of the century the most popular was 040 (again, much whiter), one of the bleaching shades. In 2004 it was 030 and 2007 it was 020. The past year we’ve seen that 90% of our smile makeover patients choose to have their teeth either 010 or 020, the two whitest bleaching shades on the left of the shade guide above!
Regardless of what colors are available, it is the patient’s choice what color the porcelain veneers or porcelain crowns are made. The cosmetic dentist and assistant will make suggestions, but the patient is the one who has to approve of the final shade. After all, it is their teeth and smile, right?
Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA