How many tooth colors are there?

Objectives: This study aimed to estimate the number of distinct tooth colors using a large dataset of in-vivo CIELAB measurements. It further assessed the coverage error (CE) and coverage error percentage (CEP) of commonly used shade guides and determined the number of shades needed for an ideal guide, using the Euclidean distance (ΔEab) and thresholds for clinical perceptibility (PT) and acceptability (AT) as evaluation criteria.

Methods: A total of 8153 untreated maxillary and mandibular anterior teeth were measured in vivo using calibrated dental photography. Cardinality was applied to determine the number of unique natural tooth colors. The CE and CEP were calculated for the Vita Classical and Vita 3D-Master shade guides, while the cardinality method was also used to estimate the number of shades required to adequately cover the estimated gamut of natural tooth colors.

Results: The cardinality analysis revealed 1173 unique natural tooth colors. The CE for the Vita Classical shade guide was 4.1 ΔEab, with a CEP of 75 % beyond AT, while the 3D-Master shade guide had a CE of 3.3 ΔEab and a CEP of 70 % beyond AT. Based on cardinality computation, 92 discrete shades are required to adequately cover the estimated gamut of natural tooth colors with a CE of 1.2 ΔEab and CEP of 0.3 % beyond AT.

Conclusions: Cardinality computations estimated 1173 unique tooth colors while 92 discrete shades are estimated for full coverage. Such a number is impractical for physical shade guides, but new digital tools and 3D printing may offer future solutions. Both, the Vita Classical and 3D-Master shade guides do not fully represent the range of natural tooth colors.

Clinical significance: This study highlights the limitations of existing shade guides and underscores the potential for new developments.