A Multidimensional Analysis of Shade Selection Difficulty for Indirect Restorations Among Dental Students and...

Despite advances in dental materials and digital color registration systems, esthetic matching remains a clinical challenge for both dental students and experienced professionals. A comprehensive narrative review was conducted through bibliographic searches in PubMed, Scopus, Web of Science, and PsycINFO databases from January 2015 to January 2026. The evidence was synthesized using a four-dimensional analytical framework encompassing technological, cognitive-psychological, educational, and clinical-contextual factors. Quantitative synthesis revealed substantial variability in shade matching success rates, with intraoral scanners demonstrating pass rates ranging from 31.3% to 78.2% across devices, while spectrophotometers achieved superior repeatability (ICC > 0.9) but faced interpretive barriers. Cognitive load theory explains the performance deterioration, with novices being particularly susceptible to retinal fatigue and metamerism under non-standardized lighting conditions. The proposed paradigm shift involves redefining shade selection from a purely technical task to a cognitive skill that requires deliberate perceptual calibration, structured educational protocols, and hybrid digital visual workflows. To improve esthetic predictability, educational programs need to integrate longitudinal training in color science with objective feedback mechanisms. Clinical workflows should adopt hybrid calibration-centric protocols that position technology as a verification tool, rather than a replacement for clinical judgment. Understanding the multidimensional nature of shade matching difficulty enables the development of evidence-based educational protocols and clinical workflows, ultimately improving esthetic outcomes.