Benefits of Digital Smile Design (DSD) in the conception of a complex orthodontic treatment plan: A case report-proof of concept

Abstract

Digital Smile Design (DSD) is a systematic protocol based on specific photographs and software analysis that is used worldwide. DSD aims to assist the practitioner in creating and planning a course of treatment, especially in a multidisciplinary approach, and provides a virtual simulation of the final result. Additionally, it is a tool that enables communication and discussion between all the dental team, including the dental laboratory, and also with the patient. Although widely described and used in prosthetic rehabilitation, this tool remains only anecdotally used in the world of orthodontics. The objective of this proof of concept was to describe the application of the Digital Smile Design protocol in the diagnosis of orthodontic treatment. A teenage patient was referred to our university clinic by a private orthodontic practitioner for a second opinion on the treatment at that time. The patient had a self-ligating orthodontic appliance. According to the history of the case and the oral situation at that moment, the patient required an accurately calculated plan for orthodontic tooth movement that would permit the achievement of future rehabilitation. Therefore, the decision was taken to use a DSD protocol to potentially complete the classic orthodontic examination. From the classic orthodontic examination, the patient presented a molar class I, midline deviations, the #21 and #23 were missing, #12 was conoid (microdontic) and, finally, #22 was in the position of #21. From the DSD results, three different views simulated the final results and therefore provided additional and relevant information, such as the correct position of the upper midline and the correct position of #12, #13, #22 and #23. This proof of concept showed the clinical relevance of the Digital Smile Design protocol as a new tool for complex orthodontic treatment planning, especially in a multidisciplinary approach. Further publications will be necessary in order to define a specific DSD protocol for orthodontic treatment.