A comparison of human raters and an intra-oral spectrophotometer

Consistently choosing an accurate shade match is far more difficult than it appears. Recently, several electronic shade-matching devices have been marketed. One device is an intraoral spectrophotometer, Easyshade. The current study compared the accuracy and consistency of the Easyshade (ES) device to three clinicians experienced in tooth whitening trials and trained in the use of the Vitapan 3D Master shade. The maxillary anteriors of 16 participants were matched on three separate occasions one month apart. At each appointment, the three clinicians (R1, R2 & R3) and ES independently chose a single 3D Master tab. A trained research assistant used the Easyshade device to record CIE L*, C* and H* and a shade tab. In addition, color differences between shade tabs were calculated using the Delta E 2000 (delta e 00) formula. The CIE L*C*H* data were also used to establish standards for the five lightness groups of the 3D Master. An intrarater agreement was evaluated using an intraclass correlation statistic, and an inter-rater agreement was evaluated using a weighted Kappa statistic. The percentages of exact matches were: ES = 41%; R1 = 27%; R2 = 22% and R3 = 17%. Matches within a half-shade were also calculated. This represents a mismatch that is perceptible but acceptable. The percentages of matches within a half-tab were: ES = 91%; R1 = 69%; R2 = 85% and R3 = 79%. In terms of lightness, the intra-rater agreement was considered to be very good for ES and R2 and good for R1 and R3. For chroma, agreement for ES was considered good, and for the three clinicians, it was considered moderate. The mean color difference for the L*, C*, H* data recorded at each evaluation was 1.5, or only slightly greater than the color difference between the same tab on different guides (1.2). The delta e 00 data were the most accurate data collected, and they were used to establish a standard to which the tab choices of the four raters were compared. A weighted Kappa statistic was performed and, in terms of lightness, agreement was found to be good for all raters. For chroma, agreement was very good for ES and it was good for the clinicians. In terms of the number of exact matches and matches within a half-shade, the performance of ES was at least comparable to, if not better than, the dentists. Statistically, the same was true in terms of consistency and accuracy when making repeated matches of lightness and chroma using the 3D Master shade guide.