Abstract
BACKGROUND: Shade determination is a critical step for the fabrication of a satisfactory restoration. Visual shade selection with conventional shade guides is subjective and influenced by variables related to light, observer, and object. Shade selection devices have been introduced to provide subjective and quantitative shade values. This systematic review and meta-analysis aimed to compare the color difference for shade selection with visual and instrumental methods. METHODS: An initial search was conducted on databases (MEDLINE via PubMed, Scopus, and Web of Science) in addition to a manual search through references of identified articles. Studies comparing the accuracy of visual and instrumental shade selection based on ΔΕ were included in data synthesis. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated to estimate the effect size for global and subgroup meta-analysis using the inverse variance weighted method and random-effects model (P ˂ 0.05). Results were presented as forest plots. RESULTS: The authors identified 1776 articles from the initial search. Seven in vivo studies were included in the qualitative analysis of which six studies were included in the meta-analysis. For the global meta-analysis, the pooled mean (95% CI) was - 1.10 (- 1.92, - 0.27). Test for overall effect showed that instrumental methods were significantly more accurate than visual methods with significantly less ΔΕ (P = 0.009). Test for subgroup difference showed that the type of instrumental shade selection method used had a significant effect on accuracy (P ˂ 0.001). Instrumental methods including spectrophotometer, digital camera, and smartphone showed significantly better accuracy compared with visual shade selection (P ˂ 0.05). The greatest mean difference was found between the smartphone and visual method with a mean (95% CI) of - 2.98 (- 3.37, - 2.59) with P ˂ 0.001 followed by digital camera and spectrophotometer. There was no significant difference in accuracy between IOS and visual shade selection (P = 1.00). CONCLUSIONS: Instrumental shade selection with a spectrophotometer, digital camera, and smartphone showed significantly better shade matching compared with a conventional shade guide, whereas IOS did not improve the shade matching significantly compared with shade guides. REVIEW REGISTRATION: PROSPERO CRD42022356545.