# Getting started

Start here if you are new ;)

## A word of thanks

Thank you for choosing Matisse software solutions. For many years, dental technicians have struggled to solve the problem of shade matching in dentistry. With the advent of data based engineering, the time has arrived to employ artificial intelligence to help you in tackling this challenge more effectively. Matisse is the perfect tool for that purpose.

We hereby would like to welcome you the Matisse family!

Yours sincerely,

Marat Awdaljan.

## Video tutorials: Getting familiar with the Matisse workflow

Introductory video tutorials for new starting users.

# Features and functionalities

An overview of all supported features and functionalities.

## Compatibility of restoration manufacturing techniques

The Matisse software is compatible with the following veneering techniques in dental restoration:

• One Bake technique
• Envelope technique
• Skeleton technique
• Internal Staining technique
• Labial cutback technique
• Labial Micro Layering
• 3D staining technique

## Compatibility of shade taking systems

The Matisse software is compatible with the following shade taking systems in dental industry:

• Digital shade taking with gray card Whibal L*76
• Digital shade taking with gray card L*79
• Digital shade taking with gray card L*80

## Supported indications

Matisse gives solutions for the following indications:

• Veneers on refractory (platinum foil). This solution will only contain ceramic recipes on a refractory die. When the preparation is discoloured, a masking recipe will be provided.
• Veneers on lithium disilicate or Celtra Press. This solution contains, in addition to ceramic repices, also a substructure advice.
• Crowns ( lithium disilicate, celtra, zirkonia). This solution contains, in addition to ceramic repices, also a substructure and staining advice.
• Implant crowns ( lithium disilicate, celtra, zirkonia). This solution contains a substructure and staining guideline.
• Crowns and implant crowns ( metal). For a PFM crown this solution contains an opaquer recipe, ceramic recipe and skin enamels.
• Maryland bridge (lithium disilicate/celtra). This solution contains a substructure and staining guideline.
• Full monolithic crowns ( lithium disilicate, celtra and zirkonia). This solution contains advise for a substructure in exact thickness and a staining recipe.

# Hardware/software requirements

What you need to use Matisse succesfully.

## Required equipment

To successfully make use of the Matisse software, the following equipment are required:

• DSLR camera (full frame or APS-C)
• Macro lens (80 to 105 mm)
• Ring flash or lateral flashes
• Crossed polarization filter
• Mac or PC with the latest version of Chrome, Safari, Firefox installed.
• High bandwidth internet connection

In addition to this, the following tools may also apply:

• Gray card L* 76 Whibal
• Gray card L79 or L80
• VITA 3D master shade guide
• Smile line portioners or a universal portioner
• Empty ceramic bottle to mix the recipes

# Background on shade taking systems

Background information on supported shade taking systems

Matisse supports digital color system that make use of various white balance cards and the CIELAB color space. The CIELAB color space (from here onward abbreviated to "LAB" color space) is a color space defined by the International Commission on Illumination (CIE) in 1976. It expresses color uniquely as a triplet $$(L^*,a^*,b^*)$$ of three values, where:

• $$L^*$$ describes the lightness from black (0) to white (100),
• $$a^*$$ describes the amount of green (-) to red (+),
• $$b^*$$ describes the amount of (-) to yellow (+).

CIELAB was designed so that the same amount of numerical change in these values corresponds to roughly the same amount of visually perceived change. This perceptual difference is characterized by the so-called $$\Delta E^*$$-value which measures the "distance" between two colors. Given two colors $$c_1 = (L^*,a^*,b^*)$$ and $$c_2 = (L^*,a^*,b^*)$$, the $$\Delta E^*$$-value is a non-negative number computed by taking the Euclidean distance of the points in 3-dimensional space:

\begin{equation*} \Delta E^*(c_1, c_2) = \sqrt{(L^*_1-L^*_2)^2 + (a^*_1-a^*_2)^2 + (b^*_1-b^*_2)^2 }. \end{equation*}

Currently, Matisse supports digital shade taking systems with $$L^*79$$-gray card and $$L^*80$$-gray card.

##### Natural tooth vs VITA 3D Master

Matisse also supports the following two most commonly used analog methods.

Matisse has an extra feature for users who still work the analogue way. Depending on the case, with VITA-3D a color match can be achieved with a total color difference of $$\Delta E^*=2.5$$. VITA-3D Master is based on the philosophy of Munsell color system, where the value is the most important factor, followed with the hue and chroma of the tooth. It has 26 shades that represents very closely the natural tooth, it starts with very bright shades with less chroma, to middle aged teeth that has middle brightness and higher chroma, to very dark tooth that represents old teeth. As an example, a comparison is made between the average natural teeth color and the corresponding VITA-3D master shade guide.

#### Whibal

This gray card works together with VITA-3D Master shade guide. Gray cards are produced to consistently reproduce the exposure of a picture and to correct the white balance. Because the tolerance of each individual Whibal card can be bigger than $$\Delta E^*>3$$, we recommend to use this card only to correct the exposure and White balance. Thus, use it in combination with VITA-3D master shade guide. When choosing this approach, calibrate the picture on $$L^*76$$ setting and select the target dentin color VITA-3D master.

# The Matisse workflow

A detailed step-by-step workflow on how to use Matisse in your restoration projects.

## Phase I: Preparing your dental images

Depending on which protocol/shade taking system being followed, the user has to take a photo with a crossed polarization filter and a gray card and upload the photo in the software. There are three kind of scenarios to get Matisse solutions.

1. Picture of the teeth with gray card L79 or L80,
2. Picture of the teeth gray card L*76 and vita 3D master,
3. Only a picture with vita 3D master,

#### Step 1: Camera settings

• Shutter speed 1/125
• Aperture F22
• ISO 100 - 200
• Only RAW format pictures are accepted ( CR2. NEF etc)

#### Step 2: First picture

In all the color measuring systems, the first picture is always with the crossed polarization filter. The distance from camera lens to target tooth has to be 20-30 cm. Do not take the picture to close or too far. The right distance is that the first premolars are visible. Use these settings also when measuring the crown on the model. The flash setting has to be on manual mode and the power flash setting on $1/1$ or $1/2$, depending on the type of flashlight.

#### Tip

Keep the gray card perpendicular to the target tooth and focus with the camera lens on the incisal edge of the tooth.

#### Step 3: second picture

The second picture is without the crossed polarization filter, but with a gray card. This picture is taken to analyze the external appearance of the tooth, the skin enamel, the translucency and transparency of the lustres and the surface gloss, smoothes and texture.

#### Step 4: Third picture

Take a picture with gray card and polarization filter from the preparation, this information is very important to achieve an accurate shade match. Matisse takes the preparation color into consideration before giving the complete solution. Upload this pictures into the software.

## Phase II: Analyzing and generating recipes

Upload your images into the gallery. The maximum amount of uploads in one session is 10 pictures. JPEG images are not accepted, only RAW files. Compatible RAW file types are:

• universeel .DNG
• Canon .CRW or .CR2
• Nikon .NEF

#### Step 2: Calibrate the image(s).

Matisse processes the photos automatically. After uploading the picture(s), the next step is to choose the gray card setting. Select your gray card setting by clicking on the gray card classification $$L^*76$$ (Whibal) , $$L^*79$$ or $$L^*80$$. Click on calibrate photo to calibrate the photo. You will be requested to select a reference point on the "white area" of the gray card in the image. The photo will be calibrated automatically. This includes the white-balancing of the image as well as setting the luminosity the appropriate $$L^*$$-value of the gray card. There is also an option for Vita 3D Master, in this case there is no need to calibrate the image.

#### Step 3: Select your ceramic brand.

Select the ceramic brand with which the case is going to be made. At this moment these are the ceramic brands that can be selected:

#### Step 4: Select indication.

Depending on what technique you want to follow, choose the appropriate indication for your restoration. The following table describes what can be chosen for each technique:

#### Step 5: Select substructure.

According to the indication of the case and the ceramic brand that is chosen, the substructure type to be selected will be active. The substructure types that are going to be used are:

• Celtra Press.
• GC Initial LiSi Press
• IPS e.max Press
• KATANA zirconia

#### Step 6: Select available space.

Select the total available space for the substructure and the ceramic build up. Before selecting it, the total available space is measured from the preparation to the final thickness of the labial surface. The easiest way to measure the total available space is when designing the substructure in the CAD/CAM software. The options are: 0.5, 0.8, 1.0, 1.2 and 1.5 mm. These are general guidelines, select the closest number of available space. When having more than 1.5 mm select 1.5 mm. When having 0.5 mm space with a heavy discoloration

#### Warning

Choosing 0.5 mm space with a heavily discolored preparation, the preparation has to be corrected until minimal 1.0mm labialy/bucally. Choosing 0.8 mm space with a heavily discolored preparation, the preparation has to be corrected until minimal 1.0mm.

#### Warning

Do not use white cement for fixating the crown, use clear clear or A2 cement, or composite cement of the same color of the target tooth.

#### Step 7: Measure preparation color.

Click on the color picker and click on the middle area of the preparation and the $(L^,a^,b^*)$-numbers will be automatically measured. When not having a preparation color do one of these three things.

• When the color of the preparation is vital choose the target dentin color
• Choose Natural Die material.
• Choose VITA-3D Master

#### Step 8: Measure dentin colors.

Click on the color picker and then click on the spot of the middle area (1/3 of the tooth), with the highest $$L^*$$ number and the lowest $$a^*$$ and b^* numbers. The $$(L^*,a^*,b^*)$$-numbers of that area will appear automatically in the boxes.

• Dentin middle area: Click on the color picker and click with the cursor on the spot of the middle area (1/3 of the tooth, see figure above), with the highest $$L^*$$ number and the a^* and b^* numbers. The color will be automatically measured.
• Dentin incisal area: Click on the color picker and click with the cursor on the spot of the incisal area (2/3 of the tooth, see again figure above), with the highest $$L^*$$, $$a^*$$ and $$b^*$$ numbers. The color will be automatically measured
• Internal characterizations: Click on the color picker and click on the area with the one following attributes that is desired to replicate: incisal discoloration, white spot, opake mamelons, or to get an extra ceramic recipe for the incisal or cervical area.

#### Step 9: Choose skin enamel.

Depending on the type of restoration and case, one of the following 3 options must be chosen:

• Milky: Whitish enamel or opal.
• Translucent: Semi-transparent, skin enamel that defuses the light.
• Transparent: glass like skin enamel. Internal Characterizations clearly visible

#### Step 10: Generate recipes and saving your results.

Click on generate result to receive the shade matching solution. Click on save result to receive a PDF with the generated output.

## Phase III: Correct interpretation and practical application of the ceramic advice

Matisse will provide an exact solution to each case. What proceeds next is a detailed explanation of how to correctly interpret and apply the given solution.

In the figure above, a typical ceramic advice of Matisse is shown in the case for crowns.

#### Step 1 (crowns): Practical application of the substructure and staining recipe

This step applies only to crowns and veneers on lithium-disilicate. Given the available space and selected brand, Matisse will find a suitable substructure of appropriate thickness for your crown/veneer on lithium disilicate. In some cases, particularly for situations with high discoloration of the preparation, the circumstances do not allow for a substructure of the specified brand. If that occurs, Matisse will automatically look for a substructure of e.max Press, to find a suitable candidate that can mask the heavy discoloration. In situations where absolutely nothing is possible, the user will be prompted about it. If such a situation occurs, it is recommended to create more labial space by preparing the tooth.

Depending on the indication, the amount of space available and color of the preparation Matisse will sometimes give the user a staining recipe for the middle area and for the incisal area of the substructure. Matisse knows exactly how much the substructures needed to be stained, and also when it is necessary. However, Matisse will always strive to give you a substructure advice that does not require staining.

What to do when Matisse generates a staining recipe ? When receiving a staining recipe, it means that the color of the substructure needs to be adjusted using stains. Matisse generates a substructure which aims to push the $$L^*$$-value of the substructure+preparation combination 2 points higher than the desired target $$L^*$$-value (for the middle area). Simultaneously, it tries to bring the chroma (i.e.$$a^*$$ and $$b^*$$) to a fraction of the desired chroma. The result panel in Matisse displays how much the LAB values should increase after performing the staining during the wash firing process. For example, if the panel displays: $$L^*=-2.31$$, $$a^*=+1.53$$ and $$b^*=+5.03$$, this means that substructure is 2.31 points higher in luminosity compared to the target, and that the $$a^*$$ and $$b^*$$ should increase by 1.53 and 5.03 after staining.

What to do with this LAB numbers? You have to measure the substructure on the gypsum model and write the $$(L^*,a^*,b^*)$$-numbers of the substructure on paper, then calculate this with the staining recipe. Write down the $$(L^*,a^*,b^*)$$-values after calculation to use as a guide. For example, if the $$(L^*,a^*,b^*)$$-values of the substructure on the model is $$(L^*85.55, a^*0.46, b^*1.10)$$ and for the staining recipe $$(L^*-2.31, a^*+1.53, b^*+5.03)$$, then after staining process it will become: $$(L^*83.24, a^*3.58, b^*6.03)$$. That is, the result after calculating, is the color that the substructure must have on the model after staining. (Use the staining set of your ceramic brand and use the Matisse staining charts to choose the best fit for the case) When the stains are applied, measure the substructure on the model to see if the target color is achieved, do this before firing the crown. Another way is to stain in a thinner layer and do a fixation firing of 600C without vacuum. If the staining recipe gives an insignificant difference (the numbers are very small), you can choose to not stain because that means that the substructure + the preparation combination already comes very close to the target values.

#### Step 1 (veneers): Practical application of the masking recipe

This step only applies to veneers on refractory. When a preparation is discolored you will receive a masking recipe in a precise thickness until 0.5 mm, (measure this thickness with a sondes paro-instrument). Layer this recipe only on the place where the discoloration is visible. For layering advice please look at section practical application of ceramic recipes.

#### Step 2: Planning and Workflow

Before mixing the recipes and starting with layering, it is highly recommended to plan the case. Here are a couple of pointers:

• Make a gypsum model that is representing the color of the preparation as close as possible, use also wax to replicate the gum color. This is important to be able to control the final color.
• When uploading the case into Matisse software, Recognize how many dentins are needed to replicate the same histo-anatomy of the dentin. De-haze the polarization picture in (soon in Matisse software) and analyze the histo-anatomy of the tooth. Draw the histo-anatomy of the dentin on paper. When dehazing the picture, you will understand where the transition area from opacious dentin to translucent dentin will be. The same holds true for the transition area from dentin to enamel, and from enamel to opalescence.
• Drag the photo's of the case in Keynote to make a ceramic map of the internal effects, you do this by comparing the tooth with the photographed ceramic samples. Do the same thing with the skin enamel (you may send us an info@matisse.ai, and we will send you the keynote with various samples of ceramic brands)
• The most predictable way of working is to layer the crown with all the internal effects, but without the covering it with the skin enamel. After firing, calibrate & save the picture in Matisse and drag the picture into keynote where you can use the ceramic samples (enamel and opals) to compare it with the target tooth. In this phase, make two pictures of the crown on the model: one with polarization filter to compare the Lab* values, and one without the filters to visually make the comparison with the target tooth.
• Do the same steps in keynote after firing the skin enamels and skin opals.
• After glaze firing do the last comparison with the target tooth. The most efficient and fast way is to do the try in in the patient mouth after the first bake.

#### Step 3: Practical application of the ceramic recipes.

Use this guidelines when layering the crown. Focus on creating the correct form (histo-anatomy) of dentin, with the dentin recipe for the middle and incisal area.

#### Tip

Use a small portioner to take the amount of scopes given in the recipe. Put them in a empty ceramic bottle, mix it 5 to 10 seconds and the recipe is ready to be used.

#### Note

In some situations, Matisse gives a two-layer recipe for each section. Divide the dentin layer into equal parts and apply the layers consecutively. For example, if the total dentin layer is 0.8 mm, than the first 0.4mm must be applied with the corresponding recipe of the first layer, and the the remaining available space must be made with recipe corresponding to the second layer.

Histo-anatomy of dentin : 1st Layer. When using the ceramic recipes to create the dentin, it is important to control the correct volume or thickness. This will give you the correct color and appearance.

#### Tip

When layering use a silicone index to control the volume of dentin.

• Cervical area: The dentin volume on the cervical area is 50% of the total thickness and the completion is made with cervical translucent masses or modifiers.
• Middle area: The middle area of a natural tooth is the brightest and the most opaque, to replicate this area we have to create a volume of 90% of the total thickness.
• Incisal area: The volume of the incisal area is depending on the type of tooth. When there is opacity incisaly keep the volume on 70%, When replicating sclerotic (translucent) dentin keep the volume on 50%. of the total thickness.
• Incisal Canvas: Choose the enamel to create the canvas according to the L* value of the target tooth.

Internal characterizations : 2nd Layer. This step is important to achieve an identical match. Use the internal effects planning which is done in Keynote .

• Cervical area: Use cervical translucent masses to complete the right color and appearance
• Middle area: Use bright enamels or opal effects to complete this area, most of the time a very thin layer (0.3mm)
• Incisal area: To create a natural looking incisal third, it is important to create the DEC layer, do this only on the incisal 1/3
1. Seal the dentin lobes with waterthin layer of a transparent ceramic mass (opal effect)
2. Place mamelons effects on top of this layer
3. Seal it again with opal effects or yellowish/ orange transparent mases

Skin enamel and Skin opal: 3rd Layer. With this layer the same depth , light reflection and appearance is created as the target tooth. Analyze and plan this step carefully in keynote. During analyzing the skin enamel and opal of a case. It will be more evident that a natural tooth has different types of external transparency, translucency and white areas. For each case to succeed there is another combination. Matisse chooses only the best skin enamel that is compatible with the color of the dentin middle area and incisal area. The user has to to do the ceramic mapping.

• Cervical area: In the previous step a translucent layer was added. Analyze it again and when needed repeat it with the same layer of cervical translucent mass. With very glass like tooth use a transparent powder.
• Middle area: use In the middle area enamel or opal effect.
• Incisal area: If the incisal area is transparent use transparent opal effects, if it is discoloured use chromatic transparent masses. If it is translucent use enamels. During this step also the Halo effect is applied on the incisal edge.
• Lustre: Lustre is the most outer layer of the tooth, also known as the Skin opal. In some cases the most outer layer is transparent, in cases like that add on top the skin enamel a very thin layer of transparent opal effect. In cases when the lustre is more translucent/whitish, add brighter opal effects.

# Case reports

Illustrative examples of how to use Matisse.

# Showcases

A showcase of succesful projects completed with Matisse.

# Webinars

Simple video tutorials walking you through the restoration process step-by-step.

# Published articles

## Lisi

Published in GC Getconnected app.

## Practical usage of Matisse

##### How to check the final color of the crown or veneer refractory on the model?

When working on refractory, it is not possible to check the color on the refractory die. Create a model with gingiva and the preparation color, so that after removing the veneer from the refractory material, you can check the final color on that model. The solutions that matisse gives are including the preparation color, that means that if you want to check the accuracy of the color on the model, you need to replicate the preparation color, with Natural Die color from Ivoclar Vivadent or the SP die material from Dentsply. Other possibilities are to use wax/ acrylic or a die space by Harvest dental.

##### Which gypsum model to use?

Use light gray model or a creme/yellow model, do not use white or very dark model such as brown or dark gray.

##### What are the steps after receiving the complete solution by matisse?

The steps are:

• you will receive different ceramic recipes, scope the amount of ceramic according to the blue figure and pour it in a empty ceramic bottle, mix 5 to 10 sec and the recipe is ready.
• follow the exact advice of substructure and thickness to have predictable results. stain the substructure and measure it according to the staining recipe
• plan your case, make the ceramic mapping, draw the histo-anatomy of dentin, internal effects and which and where the skin enamel is going to be placed.

##### When do I know if staining the substructure is needed or not?

Matisse is trying to give the best possible outcome in any situation, the best possible outcome is to not stain at all. In situations where staining is not needed Matisse will give L0 a0 b*0 as recipe, When you do need to stain the substructure you will see these numbers L-1 a+2 b+10. These numbers represent the color that is needed on top of the substructure. For a more detailed explanation, click here..

##### Which portioners are compatible for use in Matisse?

Use a small sized universal portioner, brand does not matter.

##### How many times is it acceptable to fire the crown and still have a predictable result?

The ideal situation is to do it in two steps, first to fire the crown with all the layers (incisal canvas/dentin middle/dentin incisal/internal effects) but without the skin enamel/lustres. After firing, make a picture and measure the lab colors of the crown to compare with the target colors. In this step you can also use internal staining technique and do a fixation firing. Then use fire the skin enamels/opals and finish the crown.

##### How to measure/control the thickness of my ceramic build up?

The best way to measure the thickness of the layers is by a probe, or by a silicone index. The probe can be used to measure the accurate thickness when layering the masking recipe, the silicon index can be used to control the volume of the middle and incisal area.

See here.