Does the background and the illuminant interfere with the color selection of natural teeth? An integrative review of clinical studies

Resumo

Background: Visual shade selection is subjective and influenced by exterior factors. Different auxiliary devices, such as specific background, illuminant and polarization filter have been developed aiding at the achievement of better esthetic results. This integrative review aimed to determine whether these devices interfere in shade match of natural teeth.  Materials and methods: Electronic searches were performed with no language or date restrictions, based on the research question “Does the background and the illuminant interfere with the color selection of natural teeth?” In vivo studies that compared visual selection on natural teeth under different background and illuminants were included. Quality assessment and bias control were carried out according to Fowkes and Fulton guidelines and Quadas 2. Study screening, appraisal and data extraction were performed in duplicate, independent and blind fashion. Data were analyzed and presented descriptively. Protocol registration no. CRD42019124437. Results: Screening of studies led to 8 final studies out of 1932 references. Observers for shade match were dental students, dentists, lay people, post-graduate students, research assistants and dental professors. Two studies involved tab-to-tab shade match, while the others assessed shade in human volunteers. No study assessed the effect of background color. Varying alternatives of light were tested, including room lights and hand-held correcting lights. The results were expressed as proportion of visual-instrumental agreement, ∆E* and weighted kappa, and were conflicting as to the effect of lighting on shade match. Risk of bias was identified mainly due to lack of blinding. Conclusions: Illumination influenced differently the shade matching performances. The effect of background color is still to be determined. Therefore, additional well-designed studies are required to further elucidate the role of illuminant and background color on shade matching performance. Clinical significance: This study may guide further required studies on dental shade matching. Moreover, it can help clinicians to improve their daily dental practice to achieve greater predictability and longevity of restorative and aesthetic dental treatments.