The aim of restoring teeth in dentistry is to restore their functionality in the oral cavity and to restore optimal aesthetics. The demand for an optimal aesthetic outcome in dentistry has grown significantly over the past few years. The aim of this study was to investigate UK dentists' working practices on shade taking and to assess whether these clinical practices are in accordance with evidence based guidelines.
Methods:A cross-sectional survey was carried out using a questionnaire designed to elicit both quantitative and qualitative data. This included two clinical scenarios (vignettes), which required respondents to describe the steps they would take during shade taking and the prescription they would sent to the dental technician. It was calculated that a minimal sample size of 165 responses was required for this study based on the estimate that 70% of dentists would comply with good practice guidelines with a 95% Confidence Interval of +/-7%. 200 questionnaires were distributed to General Dental Practitioners (GDPs), specialists within a university department and postgraduate students studying for a Master's degree in Restorative Dental Practice (RDP) which formed the cohort of respondents.
Results:170 (85%) completed questionnaires were collected and analysed. 167 respondents (98.9%) used a manual method for shade taking. 98 (57.6%; 95%CI:50%,65%) respondents followed the guidelines on the first vignette, 73 (42.9%; 95%CI:35%,51%) followed the guidelines on the second and 41 (26.5%; 95%CI:20%,33%) followed the guidelines for both. Specialist Professional status (χ 2 4=10.76;p=0.03) and more frequent use of daylight (χ 2 lin=6.09;p=0.01)were both predictive of good practice. However, the number of years qualified of the respondents was not associated with good shade taking practice.Qualitative data analyses revealed several themes about the quality of clinical shade taking: a) the time shade was taken, b) light source used, c) shades for different aspects of the tooth, d) dental care professional (DCP) opinion, and e) photographic support.
Discussion:Within the limitations of this study, it was demonstrated that dentists needed to improve their shade taking techniques in clinical dentistry. The results showed that only 25% of respondents in this study successfully followed evidence-based good practice guidelines. It also showed that, the many respondents undertook shade taking with a degree of chance and guesswork without consistently following protocols or techniques, which could potentially introduce recording errors and errors in communication with the dental laboratories, resulting in suboptimal clinical outcomes. These findings highlighted the need to incorporate appropriate training on shade taking into the relevant dental curricula. This study also highlighted the importance of compiling accurate and detailed laboratory prescriptions in relation to the shade of the restorations to be fabricated.
