F1000Research F1000Research 2046-1402 F1000 Research Limited London, UK 10.12688/f1000research.146428.2 Research Article Articles Prevalence, satisfaction and preference of tooth shades and their correlation with age, gender and skin shade: A cross sectional study

[version 2; peer review: 1 approved, 2 approved with reservations]

 Bajantri Prashanth Data Curation Methodology Resources Visualization https://orcid.org/0000-0003-2470-9383 1 Chawda Tanay Conceptualization Data Curation Methodology Resources Visualization 1 Natarajan Srikant Investigation Supervision Validation https://orcid.org/0000-0002-2686-0397 2 Ono Alisha Investigation Validation Writing – Original Draft Preparation Writing – Review & Editing 1 Shetty Thilak Conceptualization Resources Supervision 1 Rodrigues Shobha Data Curation Investigation Project Administration Supervision a 1 Pai Umesh Conceptualization Resources Visualization https://orcid.org/0000-0003-2401-7467 1 M Mahesh Data Curation Formal Analysis 1 Saldanha Sharon Project Administration Visualization Writing – Original Draft Preparation https://orcid.org/0000-0003-0296-8085 1 Hegde Puneeth Funding Acquisition Project Administration Visualization Writing – Review & Editing 1 Mukherjee Sandipan Software Supervision 1 Sales Ann Project Administration Supervision Visualization https://orcid.org/0009-0007-8056-906X 1 Kamath Vignesh Conceptualization Project Administration Resources https://orcid.org/0000-0002-4996-448X 1 Prosthodontics Crown and Bridge, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India Oral pathology, Oral pathology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, Karnataka, 576104, India shobha.j@manipal.edu

No competing interests were disclosed.

 5 3 2025 2024 13 1076 21 2 2025 Copyright: © 2025 Bajantri P et al. 2025 This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Shade selection is one of the most important factors that determines the satisfaction of the patient with the dental prosthesis and thus the overall success of the treatment. Conventional methods of shade selection require the presence of existing teeth or past dental/photographic records. Despite the presence of these records, shade selection continues to be challenging, subjective and arbitrarily based on the patient’s age and gender especially if the visual method is employed. This study aims to assess the prevalence, satisfaction, and preference of tooth shades in a cross section of the local Indian population, investigating their correlation with age, gender, and skin color in a diverse sample of 120 participants visiting the outpatient department of this Institution.

Methods

A total of 120 participants, 60 males and 60 females, categorized into four age (n=15): groups 20-30, 30-40, 40-50, & 50-60 yrs were recruited randomly and evaluated visually using the VITA 3D Master in the study. Participants were also asked about their satisfaction with existing tooth shades and their preferences.

 Results

The most common existing tooth shade was Value 2 (52.5%).

Statistical analysis using Chi-square tests revealed that Value 2 was the most desired shade among males and females alike, particularly in the age group of 41 to 50 years (p < 0.001).

Shade 2L1.5 was the most prevalent (n=26), with Value 2 (59.16%) being the most sought-after shade, followed by Shade 2L1.5 (n=21), Shade 2M1 (n=18), Shade 1M1 (n=15), and Shade 2R1.5 (n=14).

Existing tooth shades of Value 0 were the least common.

The highest satisfaction with existing shades was observed in males aged 41 to 50 (n=15), followed by males aged 51 to 60 (n=14) and females aged 31 to 40 (n=12) and 41 to 50 (n=12). Significant differences in satisfaction were noted among males (p < 0.001).

 Conclusions

This study reveals a consistent and strong preference among both males and females for tooth shades classified as Value 2, following the VITA Tooth-Guide 3D Master shade guide. This universal preference suggests the relevance and acceptance of this shade category across diverse patient groups.

 Shade selection VITA Tooth-Guide 3D Master esthetics The author(s) declared that no grants were involved in supporting this work. Amendments from Version 1

The manuscript has been updated based on constructive feedback from reviewers. It has been edited for improved language, grammar, and typographical errors. Suggestions from the reviewers, including standardizing spelling (e.g., "esthetics", “color”), have been implemented. The introduction and discussion sections were revised to incorporate current literature and clarify the results. The materials and methods section were expanded to provide more details on the shade study and the shade selection process. Three additional references were included. Additionally, the authorship has been revised with consent from all authors, designating Dr. Prashant Bajantri as the first author and Dr. Shobha J. Rodrigues as the corresponding author.

 Introduction

Facial esthetics have become important in modern society as they seem to define one’s character. Dental appearance is one of the main features that determines the attractiveness of our face and plays a key role in our social interactions. 1 It has been found that the most important factors that influence the perception of beautiful teeth are age, gender, and skin color. 2 , 3

Shade selection is an important procedure for providing patients with an esthetic restoration that harmoniously blends with the patient’s existing dentition. 4 The selection of teeth with proper shade positively influences the patient’s aesthetic perception and improves prosthesis acceptance. 5 Shade selection is a compound phenomena and requires knowledge of the physics, physiology and psychology of colour and is both an art and a science requiring in depth knowledge, accurate clinical judgement and perception on the part of the dentist.

The selection of artificial teeth to replace missing natural teeth is a relatively straightforward procedure when natural anterior teeth remain. Technology advances have made available a wide variety of shade guides for use in patients with natural teeth. However, the choice of tooth shade is problematic for edentulous individuals with no preextraction records. 6

Various factors such as age, sex, and skin color have been proposed as aids for artificial tooth shade selection. 7 Some dentists have even suggested the color of hair and eye color, but most authors favor the use of facial skin tone as a guide for tooth shade selection. 8

There is limited scientific information on the relationship between facial skin complexion and tooth color in the Indian population. This lack of knowledge may impact the ability of prosthodontists to provide better esthetics to the patient.

The perception among dentists is that individuals with darker skin color have lighter shades of teeth. This perception is commonly explained by the illusion of a greater contrast between skin color and tooth shade. 3

The age of the patient was found to have a definite relationship with the tooth shade value, which has been corroborated by many studies that have shown darker tooth shade values with an increase in age and vice versa. 3 , 6

Gender is another factor significantly associated with tooth shade values. Men are more likely to have darker tooth shade values, whereas women of the same age group are more likely to have lighter tooth shade values. 9

Various studies have been conducted to establish a relationship between age, sex, and skin color in individuals with tooth shades, but contrasting results have been reported. One reason for the varying results can be attributed to the ethnic origin of the study samples. 8 , 9

Individual studies conducted by Ajayi et al. (2011), Albashaireh et al., Hamamci et al. (2009), and Afshar MK et al. (2019) had reported satisfaction with dental appearance of 79.4% in Nigeria, 10 67.6% in Jordan, 11 71.1% in Turkey, 12 and 47.2% in Malaysia. 13

A study conducted by Maghaireh et al. (2016) found that most people were not satisfied with their tooth color, and the sought-after treatment was tooth whitening. They also reported that women are significantly more likely to seek cosmetic and orthodontic restorations. 14

In a study by Tin-Oo (2011), satisfaction with tooth color was significantly lower in women, and tooth whitening was the most preferred treatment. 15

Research in the field of esthetics and shade matching has predominantly been conducted in Western populations. However, with increasing dental awareness and demand for esthetics in developing countries, such as the Indian subcontinent, research in the field of esthetics based on the local population has become the need of the hour.

This study aimed to determine the prevalence, satisfaction, and preference of tooth shades and their correlation with sex, age, and skin color.

The null hypothesis was that there would be no difference in the prevalence, preference, and satisfaction of tooth shades between the age class, gender, and skin color patterns.

 Methods Study setting

A cross section of about 120 subjects visiting the outpatient Department of Prosthodontics and Crown and Bridge, of this Institution were randomly recruited for the study Informed consent was obtained under a protocol reviewed and approved by the Institutional board.

 Pilot study and sample size calculation

A pilot study was conducted which showed a prevalence of satisfaction of 56.52% with an alpha of 5 % the corresponding z value was Z=-1.96.

Using the formula n=(Z(α/2)/d) 2^ “p(1-p)” the minimum percentage difference to be deemed clinically significant at 10%, the minimum sample size required would be 95 for the study. A method of matched quota sampling was employed to recruit an equal number of participants in each age group and sex. For the easy divisibility of the groups, a sample size of 120 was selected.

 Eligibility criteria

120 participants were recruited in this study using the following inclusion criteria:

All six maxillary anterior teeth (canine-to-canine) (13, 12, 11, 21, 22, 23) should be present.

Teeth should have no external discoloration or staining

All the 6 maxillary anterior teeth should have similar shades

Grouping

The 120 randomly recruited participants were divided into eight groups based on their age and gender, as follows:

Group 1: Males & females in the age group 20-30 yrs
Group 2: Males & females in the age group 30-40 yrs
Group 3: Males & females in the age group 40-50 yrs
Group 4: Males & females in the age group 50-60 yrs

The color of their teeth was visually evaluated using the 3D Master shade Guide.

 Procedure

Questionnaire

The participants were then asked to complete a questionnaire on their age, gender, and ethnic origin. They were then shown a face mirror and asked if they were satisfied with the color of their upper front teeth.

Shade selection

The Investigator underwent the Ishihara test to check for negative color blindness

Shade selection was done under natural lighting from the northern sky

Bright colour surroundings were avoided and female patients were asked to remove lipstick before commencing the shade selection

A light blue colour screen was used as a background during shade selection

A thorough oral prophylaxis was performed and shade selection was done under moist conditions at the operators eye level at an arms length

A squint test was performed and the least conspicuous color was designated as the most appropriate shade of the tooth

The investigators thus selected the tooth shade that best matched the participants shade using a shade guide (3D Master, VITA Zahnfabrik H. Rauter GmbH & Co. KG Postfach 1338 D-79704 Bad Säckingen), as per manufacturer instructions ( Figure 1A).

A - VITA Tooth-Guide 3D Master. B - L'Oreal skin shade guide.

If the test subjects were not satisfied with their existing tooth shade, they were guided to find the preferred tooth shade using the “VITA Tooth-Guide 3D Master” shade guide.

The participants’ skin color was recorded using the L’Oreal skin shade guide ( Figure 1B).

 Data management and statistical analysis

After collecting the data from all 120 participants, statistical analysis was done using χ 2 test to correlate tooth shade, skin color, age and gender. Odds ratios were calculated using a logistic regression. Statistical significance was considered at 95% confidence interval, and p values less than 0.05 were considered significant. IBM SPSS Statistics version 20.0 was used for these statistical calculations.

 Results

A total of 120 participants were grouped based on their age and sex to evaluate the prevalence, satisfaction, and preference of tooth shade and their correlation with age, sex, and skin shade using questionnaires along with the VITA Tooth-Guide 3D Master shade guide and L’Oreal skin shade guide.

Existing tooth shades

As can be seen in Table 1, the most common existing among the participants was Value 2 (52.5%) of VITA Tooth-Guide 3D Master shade. Shade 2L1.5 (n=26) was the most common, followed by 3L1.5 (n=14), 2M1 (n=12), 2R1.5 (n=10), and 2M2 (n=9).

Percentages of existing value of tooth shade and the wanted value of tooth shade by the participants.
Percentage of participants who had the value of shade Percentage of participants who wanted the value of shade
Value 0 0% 3.33%
Value 1 8.33% 20%
Value 2 52.5% 58.33%
Value 3 36.66% 17.5%
Value 4 2.5% 0.83%

The least common existing tooth shades were of value 0, with no participants showing any existing shade.

 Desired tooth shades

The most commonly desired tooth shade was of value 2 (58.33%). Shade 2L1.5, the most commonly preferred tooth shade (n=21), followed by 2M1 (n=18), 1M1 (n=15), 2R1.5 (n=14), and 1M2 (n=9).

Chi-square tests revealed that value 2 was the most preferred shade among males and females equally in the age group of 41–50 years. The value 2 was statistically significant in the higher age group (p<0.001) ( Table 2).

Comparison of shade wanted by males and females of different age groups and their chi-square analysis.
Chi-Square Tests
Age Group Value df P value (<0.05 is significant)
20-30 Pearson Chi-Square 4.419 4 .352
N of Valid Cases 30
31-40 Pearson Chi-Square 5.559 3 .135
N of Valid Cases 30
41-50 Pearson Chi-Square <0.001 2 1 <0.001
N of Valid Cases 30
51-60 Pearson Chi-Square 2.274 2 .321
N of Valid Cases 30
Satisfaction

Among the shades present, highest satisfaction was observed with people having shades of value 1 (90%), followed by values 2 (82.25%), value 3 (44.44%), and value 4 (33.33%).

As shown in Figure 2, the highest satisfaction with existing shade was seen in males aged 41–50 years (n=15), followed by males aged 51–60 years (n=14), and females aged 31–40(n=12) and 41–50 (n=12). The lowest satisfaction was observed in males aged 20-30 (n=12), followed by males aged 31–40 years (n=10), and females aged 20-30 (n=5).

Bar graph of Satisfaction of tooth shade among participants of different age groups.

A) Males. B) Females.

The differences in satisfaction with tooth shades among the males were statistically significant (p<0.001) ( Table 3).

Comparison of satisfaction with existing shades of teeth among males and females of different age groups and their chi-square analysis.
Chi-Square Tests
Sex Value df P value (<0.05 is significant)
Female Pearson Chi-Square 1.364 3 .714
N of Valid Cases 60
Male Pearson Chi-Square 31.798 3 <0.001
N of Valid Cases 60
Sex Age Group Total
20-30 31-40 41-50 51-60
Female Satisfaction No 5 3 3 5 16
Yes 10 12 12 10 44
Total 15 15 15 15 60
Male Satisfaction No 12 10 0 1 23
Yes 3 5 15 14 37
Total 15 15 15 15 60
Skin colour

No statistically significant correlations or differences were found between participants with different skin colour concerning shade present, shade wanted, and satisfaction with existing shades.

 Discussion

Color is a visual perception that results from light interacting with objects and the eye's photoreceptors. The perceived colour is also influenced by psychological precondition of an individual. Most people associate lighter and brighter teeth with beauty, however it is essential that the colour has to be in harmony with the face especially when a single esthetic indirect restoration is planned. To ensure good esthetics,the attributes of colour namely, hue, chroma and value must be correctly chosen. Amongst these attributes Value is most important since a small variation in chroma and hue will not be noticeable if value blends. 16

Methods of dental shade selection can be broadly categorized into visual and digital methods. Visual methods, popularly used include the use of stocks and custom shade guides. Digital methods include digital cameras, color-measuring software, colorimeters, spectrophotometers, and intraoral scanners. Despite developments in dental shade selection methods, shade selection remains a challenge that affects esthetic outcomes. 17

This challenge is augmented when patients are edentulous and lack any prior photographic or dental records of the shade of their original teeth, and conventional dental shade selection tools cannot be used.

According to protocol, the age, sex, and complexion of the patient should be taken into consideration while choosing the dental shade for completely edentulous patients. There are several recommendations for selecting the shape and size of artificial teeth, which are supported by rationale and empirical data. 18 – 21

However, shade selection for completely edentulous patients follows vague and broad criteria and is therefore more subjective and arbitrary. These add complexities to complete dentures and full-mouth rehabilitation. 18 – 23

This study aimed to explore the prevalence , satisfaction and preference of tooth shade values and their correlation with age, gender, and skin color. A diverse, but convenient sample of 120 was s randomly recruited to represent a cross section of the local population.

The current study demonstrated that the age and gender of the patient affect their satisfaction with existing dental shades and their shade preferences. No correlation was observed between skin shade and existing or desired shade in the observed test subjects. These observations are similar to previous studies by Esan TA et al. and Al Dwairi et al. 24 , 25

However the results are in contrast to a similar study performed. 26

The difference in the results may be extrapolated to the difference in the population studied as well as the methodology employed.

The results of this study showed that people become more satisfied with their shade as age advances. As age advances,people tend to become more involved in solving daily issues and are more concerned with greater challenges in life rather than their tooth colour.

In addition, shades of value 2 were the most prevalent and the most prefered shade by males and females as compared to shades of other values. The study found a significant relationship between the shade of teeth and age groups. 80% of the participants in age group of 30 – 40 & 40 – 50 years were satisfied with their shades, however in the younger age group only 67% were satisfied with their existing shade. As people age, their teeth tend to become darker, which is likely due to the formation of secondary dentin. The study also revealed that most patients irrespective of their age preferred teeth with Value 2, which is consistent with the value of the general population in the Indian subcontinent. This may be because shades of lower value are in harmony with their skin texture and appear most naturalised. As against this approximately 10% of the participants preferred brighter teeth. The perspective of what beauty entails differs from person to person. Some percentage of people presume brighter teeth, though not confluent with its surroundings to be more aesthetic. In contrast to the above result about 11.2% of patients preferred shades of lower value confirming that the perception of aesthetics varies between individuals.

Extrapolating the above results to clinical settings, patients desirous of brighter teeth are candidates who may consider tooth whitening, laminate veneers or crowns.

The most wanted/liked shades by the test subjects were 2L1.5 (17.5%), 2M1 (15%), 1M1 (12.5%), 2R1.5 (11.67%), 1M2 (7.5%), 2M2 (6.67%), and 2L2.5 (5.83%).

In the age group of 20 to 30 years, 53.3% of the female participants had shades of value 2, while 40% had shades of value 3. 66.7% were satisfied with their existing shade. 46.7% liked shades of value 2 and 26.7% liked value 3.

53.3% of the male participants had shades of value 2, while 33.3% had shades of value 3. 20% were satisfied with their existing shade. 46.7% liked value 2 and 33.3% liked value 1.

In the age group of 30 to 40 years, 46.7% of the female participants had shades of value 3, while 40% had shades of value 2. Eighty% were satisfied with their existing shade. 53.3% liked value 2, and 26.7% liked value 3.

46.7% of the male participants had shades of value 2, while 46.7% had shades of value 3. 33.3% were satisfied with their existing shade. Sixty% liked value 2, and 33.3% liked value 1.

In the age group of 40 to 50 years, 53.3% of the female participants had shades of value 2, while 40% had shades of value 3. Eighty% were satisfied with their existing shade. 73.3 % liked value 2, and 20% wanted to liked value 3.

66.7% of the male participants had shades of value 2, while 20% had shades of value 3. 80% were satisfied with their existing shade.

In age group 50 to 60, 40% of the female participants had shades of value 3, while 40% had shades of value 4. 66.7% were satisfied with their existing shade. 53.3% liked value 2, and 26.7% liked value 1.

66.7% Of the male participants had shades of value 2, while 26.7% had shades of value 3. 93.3% were satisfied with their existing shade. 73% liked value 2 and 20% liked value 3.

Males in the higher age groups were more satisfied with their teeth than younger age groups and females. This was also observed in studies conducted by Tin-Oo et al. and Maghaireh et al. 14 , 15

Conclusions

Within the limitations of this study, the following conclusions can be drawn:

Satisfaction with existing shade increases in males, especially in the age group of 41–50 years.

The most desired tooth shades by both males and females were of value 2, as per the VITA Tooth-Guide 3D Master shade guide.

Limitations of the study

In this study, participants with different skin shades were not selected. Light shade (n=5), fair shade (n=14), medium shade (n=45), Medium Dark shade (n=37), or dark shade (n=19). This can influence the results with respect to the relationship between skin shade and the satisfaction of existing tooth shades, along with tooth shades preferred by the participants of different skin shades.

A larger sample size may reveal further correlations between the hue, value, and chroma of existing and preferred tooth shades.

Key points

In the case of the unavailability of dental photographic records in edentulous patients, age and sex can act as a guide for shade selection.

If the patient or dentist is unsure about the shade of complete dentures and full-mouth rehabilitations, shades of value 2 can be selected, as they are the most liked shades according to the present study.

Older men may prefer darker shades of teeth, whereas women of all ages may prefer lighter shades.

Ethical considerations

All observations were performed in conformity with the ethical standards of the Institutional Ethics Committee, Manipal College of Dental Sciences Mangalore, after receiving approval from the committee (ref:22007 dated:12/02/2022). Each individual assigned to participate in the study gave written informed consent to participate in the study.

 Data availability Underlying data

Figshare: prevalence, satisfaction and preference of tooth shades and their correlation with age, gender and skin shade: a cross sectional study, DOI: https://doi.org/10.6084/m9.figshare.24903114.v3. 27

This project contains the following:

Raw data

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

 Extended data

Figshare: prevalence, satisfaction and preference of tooth shades and their correlation with age, gender and skin shade: a cross sectional study, DOI: https://doi.org/10.6084/m9.figshare.24903114.v3. 27

This project contains the following:

Questionnaire

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

 Reporting guidelines

Figshare: prevalence, satisfaction and preference of tooth shades and their correlation with age, gender and skin shade: a cross sectional study, DOI: https://doi.org/10.6084/m9.figshare.24903114.v3. 27

This project contains the following:

STROBE CHECK

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

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Competing interests: No competing interests were disclosed.

 26 6 2025 Copyright: © 2025 Szalewski L 2025 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

The manuscript titled  "Prevalence, satisfaction and preference of tooth shades and their correlation with age, gender and skin shade: A cross-sectional study" addresses an important topic in contemporary prosthodontics: the subjective and multifactorial nature of tooth shade selection and its relationship with demographic variables. The study is relevant and timely, particularly within the context of increasing esthetic awareness in the Indian population.

The abstract provides a comprehensive summary of the research; however, it includes a somewhat misleading statement suggesting that difficulties in shade selection persist “despite the presence of dental records or photographs.” In fact, such difficulties primarily arise from the inherent subjectivity of visual shade selection methods. It would be more precise to attribute this challenge to the method used rather than the availability of historical data.

The introduction is well-structured and touches on key background concepts, but it would benefit from greater linguistic consistency—particularly with regard to the spelling of "esthetic" versus "aesthetic" and "color" versus "colour." Several short paragraphs could be merged to improve flow and coherence. Some of the cited references are dated and could be supplemented with more recent literature to enhance the scientific rigor.

The methods section provides a general overview of the sampling and procedures used, including the use of the VITA Tooth-Guide 3D Master and the L’Oréal skin shade guide. However, several methodological concerns merit attention. The choice of a matched quota sampling technique introduces potential bias, despite its utility in ensuring equal gender and age group representation. The study lacks a clear justification for the selected age brackets, and the protocol for tooth shade and skin shade evaluation could be described in more detail—particularly regarding lighting conditions, calibration of observers, and steps to minimize intra- and inter-observer variability.

The statistical analysis is broadly appropriate, employing Chi-square tests and logistic regression. Nonetheless, key details—such as confidence intervals or odds ratios—are not provided, and Table 2 lacks clarity in explaining what was statistically significant. Some aspects of the presentation would benefit from clearer explanations and more consistent terminology (e.g., “desired” tooth shade rather than “wanted”).

The discussion section is underdeveloped. Rather than offering an interpretive analysis of the findings in the context of existing literature, it reads as a list of factual observations. The authors miss the opportunity to explore the clinical implications of their results more deeply. For instance, while the preference for shade Value 2 is clearly demonstrated, the discussion lacks a thorough exploration of how this might inform clinical protocols, especially in edentulous patients.

The limitations section is appropriate, though brief. It would be helpful to elaborate on the potential effects of selection bias, the relatively small sample size, and the lack of blinding or randomization.

Is the work clearly and accurately presented and does it cite the current literature?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Partly

Are all the source data underlying the results available to ensure full reproducibility?

Partly

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

prosthetics, dental photography, dental education,

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Bajantri Dr Prashanth Prosthodontics crown and bridg, Manipal University, Mangalore, Karnataka, India

Competing interests: No competing interests were disclosed.

 1 7 2025

Dear Reviewer,

We thank you for the time and effort invested in evaluating our manuscript .  We believe these revisions have strengthened the clarity and clinical relevance of our work. We are happy to work on any further suggestions made by you.

We have addressed the changes point by point.

Abstract: The sentence implies that difficulties persist “despite records”; subjectivity stems from visual methods.

All the revised changes recommended are tracked in the new document

2

Title: Prefer “skin color” over “skin shade.”

Title has been amended

3

Introduction—Consistency (esthetic/aesthetic; color/colour). Merge short paragraphs; update dated references.

We have standardized to “esthetic” and “color” throughout and merged related paragraphs for improved flow..

4

Methods—Sampling bias, age‑bracket rationale, procedural detail (lighting, calibration, intra/inter‑observer variability, skin‑shade site).

Changes made are highlighted in red

5

 Statistical Analysis—Provide CIs/Odds Ratios.

95% confidence intervals and odds ratios are now reported for logistic regression. Table 2 was reformatted and the caption rewritten to explain significance indicators clearly.

6

Terminology—Use “preferred” instead of “wanted.”

Replaced all occurrences of “wanted” with “preferred.”

7

Discussion—Too descriptive; expand interpretation, link to literature, emphasize clinical implications.

Clinical implications added. All repeat in results has been removed

8

 Limitations—Elaborate on selection bias, sample size, absence of blinding/randomization.

Expanded the limitations to include these points and their potential impact on generalizability.

9

 Minor language issues & typographical errors have been addressed

 10.5256/f1000research.176521.r369658 Reviewer response for version 2 Westland Stephen 1 Referee https://orcid.org/0000-0003-3480-4755 School of Design, University of Leeds, Leeds, UK

Competing interests: No competing interests were disclosed.

 27 3 2025 Copyright: © 2025 Westland S 2025 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve

Many thanks. I just read the revised manuscript and I have seen the response to the comment. On this basis I am happy to recommend the manuscript be accepted.

Is the work clearly and accurately presented and does it cite the current literature?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

NA

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

 10.5256/f1000research.160517.r339854 Reviewer response for version 1 Adebayo Gbenga Emmanuel 1 Referee https://orcid.org/0000-0001-9299-0627 Department of Dental Services, Federal Medical Centre, Ebute-metta, Nigeria

Competing interests: No competing interests were disclosed.

 12 12 2024 Copyright: © 2024 Adebayo GE 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

This article focused on the prevalence, satisfaction of patients and their preference for tooth shade and how it correlate with their age gender and skin color. This is a very good research topic as it addresses the aesthetic need and satisfaction of patient.  The demand of patient for dental prosthesis that meet their aesthetic quest is on the rise, and tooth shade matching is a significant factor in meeting this demand. However, having read through the article thoroughly, there are things I observed and these are pointed out under the different sections of the article as follows:

Title

The title of the research is clear and objectives well captured, although “skin color” would have been more appropriate than “skin shade”

Abstract

The author made mention in the abstract that in the absence of teeth and dental photograph, tooth shade selection becomes challenging and subjective. But I want to say that whether teeth and dental photograph are available or not, tooth shade matching is still challenging and subjective if conventional visual method of tooth shade selection is used. Subjectivity of shade selection primarily has to do with the method of shade matching used, whether it is visual or machine aided such as spectrophotometer. I feel the sentence can be rephrased for better understanding.

Introduction

Introduction seems good and past studies were referenced. However, the author is not consistent with the use of “esthetic and ‘aesthetic”, he should have stuck to one. Also, the introduction has too many small paragraphs that can be combined.

Method

- Sampling technique used for this study not appropriate in my own opinion as it might have introduced bias, although it has the advantage of making grouping into equal male and female easy.

- Procedure for the study is not detailed. For example, the tooth shade matching steps was not stated clearly, were the investigators screened for eye anomaly or not, was it done under natural light or not, were the teeth wet or dry etc. For the skin shade matching, which part of the body skin was used, how was the matching done etc.

- Age bracket of the participants and the reason should have been included in the selection criteria not just showing it in the grouping.

- The description of the shade value should have been presented for better understanding of the results.

Result

Result well presented in my own view and breaking it into sections made it clearer

Discussion

Discussion is not adequate, nearly repetition of the result earlier presented, not much reference was made to other studies to corroborate the findings. I feel the discussion can be worked on to make it more robust.

Conclusion

Well concluded

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

Aesthetic Restorative Dentistry, Endodontics and Dental implantology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Bajantri Dr Prashanth Prosthodontics crown and bridg, Manipal University, Mangalore, Karnataka, India

Competing interests: No competing interests were disclosed.

 31 12 2024

We thank both the reviewers and the Editorial for the time and effort invested in our manuscript and we are most happy to make the changes suggested by the reviewers.

All the recommendations made by the reviewers have been humbly accepted and the necessary rectifications have been  made in the document.

However, if the reviewers  feel the need for any more corrections we are happy to do so

kind regards,

Shobha Rodrigues

shobha.j@manipal.edu

corresponding Author

 10.5256/f1000research.160517.r339847 Reviewer response for version 1 Westland Stephen 1 Referee https://orcid.org/0000-0003-3480-4755 School of Design, University of Leeds, Leeds, UK

Competing interests: No competing interests were disclosed.

 28 11 2024 Copyright: © 2024 Westland S 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

This is an interesting manuscript that explores the relationship between prevalence, satisfaction and preference for shades and age, gender and skin shade. 

I believe that the work was carried out with Indian participants. With that in mind I think it would be sensible to specify this in the abstract.

In the Methods section a Z value of Z=-1.95996398454005 is reported. I don't think this number of decimal places is justified. I suggest this be changed to 1.96.

In terms of the pilot study conclusions, are the authors satisfied that 120 participants in total should be recruited rather than 120 in each of the age age/gender categories?

Under Eligibility Criteria point 2 should be changed from 

"Teeth should be no external discoloration or staining" to

"Teeth should have no external discoloration or staining."

In the Grouping section, shouldn't the table have a title, e.g. Table 1: blah blah.

Under Procedure the authors write:

"The investigators then selected the most common tooth shade among the maxillary anterior teeth" Is this really what the mean? In which case, what was the most common tooth shade. I think they might mean to write that they selected the tooth shade that best matched the participant's teeth.

Under Wanted tooth shades, I think this would be better expressed as Desired tooth shades. 

Under wanted shade section, I do find it confusing. For example, in Table 1 it is evident that Value 2 is most prevalent and most preferred. Later, in the statistical analysis in Table 2 it is reported that there is significance for the the 41-50 age group. But what is significant? It is not clear.

The way the Discussion is presented is not very engaging. It is simply a list of observations with very little discussion involved. 

Ultimately, although satisfaction and preference is interesting, I think prevalence is most important. The finding is that most people have teeth of Value 2. Is there any correlation of tooth shade prevalence with age or gender? 

I think a clearer Discussion is needed. Factual observations should be moved to the Results section. The list of observations in the Discussion is too long. A proper discussion of what the results mean clinically is needed.

Is the work clearly and accurately presented and does it cite the current literature?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

Specialist in colour and appearance of teeth

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.