Impact of Presentation Sequence on Patient Tooth Shade Selection

N/AActive Not RecruitingNCT07370545

University of Jordan300 enrolled

Overview

This study is a clinical trial designed to understand how the way a dentist presents tooth color options affects a patient's final choice for their dental treatment. The insvestigators know that patients often prefer lighter, "bleached" shades, but the process of choosing can be influenced by the order in which the shades are shown. The insvestigators will randomly dividing participants into three groups. One group will see natural shades first, followed by bleached shades. A second group will see bleached shades first, followed by natural shades. The third group will see all shades at once. The main goal is to measure how often patients change their mind (switch their choice) and by how much (the "jump" in lightness) depending on the order of presentation. The insvestigators will also use a questionnaire to see if a patient's self-consciousness about their smile affects how light of a shade they choose. The results will help dentists improve communication and ensure patients are truly satisfied with their final aesthetic decision.

This is a prospective, single-center, three-arm parallel-group Randomized Controlled Trial (RCT) designed to rigorously investigate the cognitive bias known as the "order effect" in patient-driven tooth shade selection. The study aims to quantify the influence of sequential versus simultaneous shade guide presentation on final aesthetic preference and to correlate this choice with the patient's underlying psychosocial perception of their dental aesthetics. Methodology: Participants seeking aesthetic dental treatment will be randomized (1:1:1) into three intervention groups: 1. Group A (Natural -\> Bleached): Sequential presentation of natural shades followed by the introduction of bleached shades. 2. Group B (Bleached -\> Natural): Sequential presentation of bleached shades followed by the introduction of natural shades. 3. Group C (Simultaneous): Single presentation of the full VITA 3D-Master shade guide (natural and bleached tabs combined). Outcome Measures: The primary outcomes are the switching frequency and the magnitude of change (Delta L\*) between initial and final selections in the sequential groups (A and B), and the comparison of the final proportion of bleached shade selections across all three groups. Secondary outcomes include the correlation between the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) total score and the final selected shade's L\* value, and the quantification of the Patient-Clinician Discrepancy using CIE Delta E00 between the patient's choice and an independent clinician's recommendation. Significance: This study will provide evidence-based guidelines for clinical practice, moving beyond anecdotal preference recording to a structured, bias-mitigating approach to shared aesthetic decision-making. The integration of the PIDAQ and objective colorimetric analysis (Lab\*) and Delta E00 will provide a novel, high-impact explanation for the observed preference for lighter shades.

Interventions

Sequential Shade Presentation (Natural to Bleached)BEHAVIORAL

Participants are first presented with the natural range of the VITA 3D-Master shade guide (1M1-5M3) to select an initial preference. Following this, the bleached shade tabs (0M1-0M3) are introduced, and participants are invited to finalize their choice. This procedure measures the "pull" toward lighter shades when introduced as a secondary option.

Sequential Shade Presentation (Bleached to Natural)BEHAVIORAL

Participants are first presented with the bleached range of the VITA 3D-Master shade guide (0M1-0M3) to select an initial preference. Following this, the full natural range (1M1-5M3) is introduced, and participants are invited to finalize their choice. This procedure measures the stability of the bleached shade preference when natural alternatives are subsequently provided.

Simultaneous Shade Presentation (Full Range)BEHAVIORAL

Participants are presented with the complete VITA 3D-Master shade guide, including both natural (1M1-5M3) and bleached (0M1-0M3) tabs, in a single session. Participants select their preferred shade from the entire range simultaneously. This serves as the control method to establish baseline preference without sequential bias.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients aged 18 years or older. * Seeking aesthetic dental treatment (e.g., anterior restorations, veneers, or tooth bleaching). * Possessing at least one sound, non-restored maxillary central incisor (tooth #8 or #9) to serve as a reference for objective shade measurement. * Ability to understand the study procedures and provide written informed consent. * Fluent in the language of the study (Arabic/English) to complete the psychosocial questionnaire (PIDAQ). Exclusion Criteria: * Congenital or acquired color vision deficiencies (screened using the Ishihara test). * Cognitive impairments or psychological conditions that may affect decision-making or the ability to complete questionnaires. * Extensive existing restorations, crowns, or severe intrinsic staining (e.g., tetracycline staining) on the maxillary anterior teeth. * Active periodontal disease or poor oral hygiene that may interfere with accurate shade assessment. * Previous history of professional tooth bleaching within the last 6 months.

Outcomes

Primary Outcomes

Final Shade Selection (L* Value)

The lightness (L\*) value of the final tooth shade selected by the patient using the VITA 3D-Master guide. The VITA 3D-Master tabs will be converted to CIE Lab\* coordinates based on established conversion tables. This measure assesses the final aesthetic preference across the three randomized groups.