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The effect of a novel nano-ceramic coating (TiO 2 ) using an atomic layer deposition (ALD) technique on the surface of polymethyl methacrylate (PMMA) material was investigated. The patients' and clinicians' perception and acceptance of the PMMA color with TiO 2 coating were also examined. In vitro color measurement was performed on thirty specimens (light, original, and dark pink) before and after TiO 2 coating. Patients' and clinicians' perception and acceptance of color changes on PMMA were measured and compared. Descriptive and analytic statistics were analyzed (a = 0.05). TiO 2 films were successfully deposited on the PMMA specimen by the ALD technique. Color changes after TiO 2 coating were observed on all three PMMA shades, significantly higher than the established 50:50% perceptibility threshold, but below the established 50:50% acceptability threshold. The percentage of patients that perceived a color difference after TiO 2 coating were 83.3%, 63.9%, and 77.8% for light, original, and dark pink, respectively. The percentages of clinicians that were satisfied with the color difference were 96.4%, 80%, and 69.2% for light, original, and dark pink, respectively. Color changes after TiO 2 coating were observed, but below the acceptable threshold. The clinical survey demonstrated that a color difference was perceived but was clinically acceptable. In general, laypeople have lower perception and higher acceptance of changes in PMMA color than clinicians.