Performance in Gingival Shade Selection Among Undergraduate Dental Students According to Gender: A Pilot Study

Color perception is a subjective process that can vary considerably among individuals. However, limited research has examined gingival shade selection according to observer gender.

According to observer gender and gingival site, the objectives of this study were: (1) to compare subjective visual gingival shade selections; (2) to evaluate the accuracy of these visual selections by determining the degree of agreement between subjective and instrumental shade matching (subjective versus objective shade matches); and (3) to analyze the clinical performance of visual gingival shade selection.

A gingival color assessment was conducted in 34 participants across five gingival sites. Objective color measurements were obtained using the SpectroShade Micro spectrophotometer, and subjective shade selections were made using 15 ceramic gingival shade tabs. Eight male and eight female final-year undergraduate dental students visually selected the shade tab that best matched each gingival site. A single trained operator recorded the CIELAB color coordinates of each gingival site using the spectrophotometer and identified the objectively determined shade tab for each participant and site (i.e., the shade tab yielding the smallest color difference). Agreement between subjective selections and the objectively optimal shade tabs was evaluated and compared between groups using the χ² test. Visual gingival shade-matching performance was further assessed by calculating color difference (ΔE00), defined as the CIEDE2000 color difference between the observer-selected shade tab and the measured gingival CIELAB coordinates. Based on perceptibility (PT = 1.1) and acceptability (AT = 2.8) thresholds, visual matches were classified as excellent, acceptable, moderately unacceptable, clearly unacceptable, or extremely unacceptable.

Statistically significant differences (p < 0.05) were observed between male and female observers in all gingival sites except the attached gingiva. Shade tables 10 and 11 were most frequently selected in all sites except the mucogingival junction, where tables 6 and 5 predominated. Agreement rates between subjective selections and objectively optimal shade tabs ranged from 4.4% (mucogingival junction) to 18.4% (mesial papilla). ΔE00 values ranged from 1.38 to 20.27 in the mesial papilla, 0.37 to 19.54 in the distal papilla, 0.49 to 16.54 in the free gingival margin, 0.37 to 17.58 in the attached gingiva, and 0.56 to 23.61 in the mucogingival junction. Mean ΔE00 values (4.74-6.60) exceeded the clinically acceptable threshold for gingival color in all sites and for both genders. The percentage of moderately, clearly, or extremely unacceptable visual selections ranged from 76.7% (mesial papilla) to 93.4% (mucogingival junction). Significant gender differences were observed only in the mesial papilla (p < 0.001), where male observers showed a higher percentage of acceptable matches than female observers (27.9% vs. 18.8%).

Both male and female undergraduate observers experienced difficulty selecting the gingival shade tab that most accurately represented the gingival color determined instrumentally when relying solely on visual perception. Visual gingival shade selection performed by inexperienced undergraduate observers demonstrated limited accuracy under the conditions of this study, as chromatic mismatches frequently exceeded clinically acceptable thresholds.

In this pilot study involving inexperienced undergraduate observers, subjective visual shade matching demonstrated limited accuracy across all gingival sites and in both genders. Objective color measurement devices may provide a valuable complement to visual assessment by facilitating clinically valid gingival color records and supporting esthetic outcomes in restorative and prosthetic treatments.