Shade selection procedure is one of the critical steps in providing acceptable restoration for patients in restorative aesthetic dentistry, which is dependent largely on knowledge, skill and experience of the operator. Sometimes knowledge of protocols for a procedure does not automatically translate to a good outcome if it is not put into operational feasibility. Assessing the awareness of standard protocols for visual tooth shade selection and evaluation of the actual technique of shade matching is paramount to meeting the aesthetic demands of the patients. This study therefore focused on the assessment of knowledge and techniques of tooth shade selection practiced by the dentists in Nigeria.
More males than female dentists that participated in this study correlated with the study of Ogunbodede[24] who reported that there were more male dentists than female in Nigeria. He attributed this to the break in career of female dentists occasioned by childbirth and rearing. A large number of the dentists (77.9%) practiced in the Teaching hospital which is usually located in the urban or suburban areas of the country where there are modern facilities and schools. In addition, dental practice being known to be capital intensive and demands huge investment which translate to the fact that it can only flourish in the urban area where economy is better together with the logistics involved in its sustainability. Another reason for this may be the pursuit of skills and specialization by majority of the dentists which is mainly offered by the Teaching hospitals. All the aforementioned might probably be the reason for the attraction of the dentists to the urban areas.
Although the practice of tooth shade selection is mostly carried out by restorative dentists, pediatric dentists and general dental practitioners,[2] most dentists would have been involved in tooth shade matching during their standard undergraduate, post graduate training or in their private dental practices. This study found that most of the participants claimed to have seen (98.6%) and used (95.4%) the shade guide in the course of their clinical practice; nonetheless, not many of them used it frequently. This is not unconnected with the fact that not all dentists would end up practicing dentistry or be engaged in a specialty of dentistry that requires tooth shade matching. The finding is further buttressed by the inability of the majority (67.7%) of the participants to recall the type and brand of the shade guide they saw or used.
There are many brands of shade guides that are commercially produced[25] of which the Vita shade guide is the most commonly used.[26][21] This was evidenced by the current study as majority of the participants mentioned Vita shade guide as the brand of shade guide they used.
Patients are increasingly aware of their aesthetics and demanding prosthesis that match their remaining natural teeth in agreement with the study of Habib et al.[1] Picking a shade that mostly matches the adjacent natural teeth is very important in order to meet the expectation of the patient. To achieve this, adherent to standard protocols[1][21][27] for tooth shade selection will go a long way if meticulously followed. Although, a good number of the participants in the present study were aware that these protocols exist, but some of the protocols were not followed by the majority of them. In furtherance to that, majority of the participants do not wet shade guide (81.1%) or tooth (61.4%) and do not position the shade guide above or below the tooth (75.7%) as recommended in the protocols, perhaps this is not seen as an important aspect of the colour matching procedure.
Majority of the dentists never considered selecting shade for different parts of the tooth crown such as incisal, middle and cervical third, while less than half (41.7%) match shade with patient’s input. On the other hand, most of the participants that match shade do so before the start of the procedure as well select shade under natural light. This is because the majority of the participants believed that natural light is the best for correct tooth shade selection as found in the current study and in accordance with the study of Esan et al[2] who reported that 85% of their participant select shade under natural light.
A noteworthy finding from this study is the fact that many (60.9%) of the participants have been involved in the practice of guessing the tooth shade without the use of any shade guide. This possibly could be the outcome of relying on their acquired age long experience. This may sometimes result in wrong shade selection and consequently poor colour match especially in the advent of advanced methods of shade selection such as colorimeter, spectroradiometer and spectrophotometer to mention just but a few.
The outcome of the current study which showed low level of awareness of these digital methods of tooth shade selection with very high proportion (95.7%) of the participants that had never used any of these devices before further corroborate that change is difficult to imbibe or perhaps the cost of procurement of these devices with the consequential additional increase in the cost of treatment might be responsible for its current low level of acceptability.