Digital Smile Design Research Articles

Molar Incisor Hypomineralization: the use of Digital Smile Design (DSD) in the Esthetic and Functional Recovery of Teeth

Hypomineralized incisor molar syndrome (MIH) results from the action of various etiological factors during the enamel apposition and mineralization stages during dental development. Clinically, it results in changes in the shape, color and contour of the affected teeth, which compromises aesthetics and function. Through a clinical case, this study aimed to report the planning, with the aid of digital smile design (DSD), and the restorative treatment, with ceramic laminate ceramic veneers, of anterior teeth affected by MIH. To provide personalized treatment to the patient's needs and expectations, the use of DSD in case planning to a correct diagnosis, simulation and evaluation of aesthetic rehabilitation. It also favored communication between the patient and the multidisciplinary dental team, and this with the laboratory technician. Keywords: Dental Enamel Hypoplasia. Dental Porcelain. Esthetics, Dental. Resumo A síndrome do molar incisivo hipomineralizado (MIH), é resultante da ação de vários fatores etiológicos durante os estágios de aposição e mineralização do esmalte, durante o desenvolvimento dental. Clinicamente, resulta em alterações na forma, cor e contorno dos dentes afetados, o que compromete a estética e função. Através de um caso clínico, este trabalho teve como objetivo relatar o planejamento, com auxílio do desenho digital do sorriso (DSD), e o tratamento restaurador, com facetas de cerâmicas de dentes anteriores afetados por MIH. Para proporcionar um tratamento personalizado às necessidades e expectativas da paciente, o DSD foi utilizado no planejamento do caso para o correto diagnóstico, simulação e avaliação da reabilitação estética. Também favoreceu a comunicação entre a paciente e a equipe odontológica multidisciplinar, e desta com o técnico de laboratório. Palavras-chave: Hipoplasia do Esmalte Dentário. Porcelana Dentária. Estética Dentária

DSDapp use for multidisciplinary esthetic planning.

Digital smile design (DSD) is useful in planning multidisciplinary esthetic treatments. However, DSD requires clinician training and skill to ensure its effective use. The Digital smile design application (DSDapp) was recently developed, to facilitate such planning. The objective of this study was to illustrate the use of the DSDapp for esthetic planning in a clinical case that included periodontal plastic surgery and ceramic laminate veneers. An intraoral digital scan was performed, and a photograph was obtained using an iPad (frontal facial full smile). The images were analyzed using the DSDapp. All reference lines were inserted, and dental shapes predetermined by the app were superimposed on the photographs. A digital diagnostic wax-up was performed considering the plan created in the DSDapp. After 3D printing the wax-up, a mock-up transferred the planning to the oral cavity. Following this, the patient was referred to a periodontist for the periodontal plastic surgery. After the healing period, the teeth were prepared for computer-aided design/computer-aided modeling lithium disilicate ceramic laminate veneers. DSDapp use accelerated the initial planning steps. Smile planning can be performed during the clinical session with the patient's active participation. In addition, the DSDapp facilitated better communication within the multidisciplinary team. The DSDapp relies more on intuition than on skill and training to execute the treatment plan. The DSDapp provides immediate feedback to the patient, offering greater predictability and helps monitor the planning through all the clinical stages.

A user-friendly method for constructing realistic dental model based on two-dimensional/three-dimensional registration

PurposeThis paper aims to obtain a texture dental model with real images and improve the rendering effect of the dental model.Design/methodology/approachThe paper proposes a semiautomatic method to construct a realistic dental model with real images based on two-dimensional/three-dimensional (2D/3D) registration. First, a 3D digital dental model and three intraoral images are obtained by a 3D scanner and digital single-lens reflex camera. Second, the camera projection poses for every intraoral images are calculated by using the single-objective optimization algorithm. Third, with camera poses, the preliminary projection texture mapping is performed; besides, the seam between two textures is marked. Finally, the marked regions are fused based on the image pyramid to eliminate obvious seams.FindingsThe paper provides a method to construct a realistic dental model. The method can map three intraoral images to the dental model. The experimental results show that the textured dental model without obvious distortion, dislocation and seams is constructed with simple interactions.Originality/valueThe proposed method can be applied to the digital smile design system to improve the communication efficiency between doctors, patients and technicians.

Study on the applications of digital smile design planning technique in complete dentures

One of the most obvious trends in current prosthetic dentistry is the introduction of digital techniques. Of these, the techniques that offer the possibility of aesthetic prefiguration of the final prosthetic result are of particular interest to the dentist. The aim of this paper was to verify the applicability of the Digital Smile Design application, which is the most commonly, used aesthetic prefiguration application, an application designed for the dentate patient, to full edentulism. Two groups of full edentulous patients were formed: the first group, complete denture carriers, dissatisfied with the aesthetic aspects, that they wanted to improve in the new denture, and, the second group, newly bimaxillary full edentulous patients with high aesthetic expectations. Thus, on the first group, the tests were performed on the existing denture, and the second one with the maxillary occlusion template. However, the view of the final result offered the patients the chance to have a realistic picture of their desires regarding the shape, color, size of the teeth, which were inadequate in relation to age and facial typology. The use of this application also improves communication with the dental laboratory. In full edentulism, the current DSD technique can be used with some limitations and the use of it in this field needs more complex studies on larger groups of patients.

Automated integration of facial and intra-oral images of anterior teeth

Background and Objective:Digital smile design is the technique that dentists use to analyze, design, and visualize therapeutic results on a computing workstation prior to actual treatment. Despite it being a crucial step in digital smile design, the process of labeling and integrating the information in facial and intra-oral images is laborious. Therefore, this study aims to develop an automated photo integrating system to facilitate this process. Methods:The teeth in intra-oral images were distinguished by their curvature and finely segmented using an active contour model. The facial keypoints were detected by a sophisticated facial landmark detector algorithm; these keypoints were then overlaid on the corresponding intra-oral image by extracting the contour of the teeth in the facial and intra-oral photographs. With this system, the tooth width-to-height ratios, smile line, and facial midline were automatically marked in the intra-oral image. The accuracy of the proposed segmentation algorithm was evaluated by applying it to 50 images with 274 maxillary anterior teeth. Results:The proposed algorithm recognized 96.0% (263/274) of teeth in our selected image set. The results were then compared to those obtained by applying manual segmentation to the remaining 263 recognized teeth. With a 95% confidence interval, a Jaccard index of 0.928 ± 0.081, average distance of 0.128 ± 0.109 mm, and Hausdorff distance between the results and ground truth of 0.461 ± 0.495 mm were achieved. Conclusions:The results of this study show that the proposed automated system can eliminate the need for dentists to employ a laborious image integration process. It also has the potential for broad applicability in the field of dentistry.

Multidisciplinary approach for anatomical correction and diastema closure with laminates veneers – a clinical report

Objective: multidisciplinary treatment has become increasingly common in dental offices and this treatment strategy is based on the achievement of a healthy, harmonious, and pleasant smile. In addition, the development of new ceramic systems and the possibility of making indirect restorations with a low thickness, such as laminates veneers, allowed combining highly satisfactory aesthetic properties, preserving the dental structure through minimal wear. Case report: this paper describes a multidisciplinary approach involving periodontics and restorative dentistry for the successful, functional, and aesthetic treatment in an adult patient. The digital smile design was performed as a guide to plan the clinical case considering factors such as tooth inclination and position, golden proportion, tooth size and shape. Discussion: based on these concepts, the present work reports, through a clinical case, the restoration of aesthetics and function with ceramic laminates veneers in lithium disilicate, in the case of anatomical correction and diastema closure. Conclusion: overall, the multidisciplinary treatment plan demonstrated to have greater advantages both for the aesthetics and function of the patient, as well as for the work team. During the 24-month follow-up, this case presented great functional and aesthetics results.KEYWORDSCeramic veneers; Aesthetic dentistry; Multidisciplinary treatment.

Full Mouth Rehabilitation of a Patient with Severe Attrition Using Digital Smile Design Concept: Case Report

Prosthetic treatment of patients with severe wear is challenging task. First step is controlling the causative factor that led to teeth wear along with the restoration of lost dentition.

Chairside 3D digital design and trial restoration workflow

Different digital tools have been used in clinical practice to assist in the planning and rehabilitation of patients. Some applications (apps) and software programs used in esthetic planning allow simulation of the smile design, improving communication between patients and professionals. Nonetheless, they are usually difficult to use, time-consuming, unattractive to present to the patient, and complicated to link with the 3D workflow. This article presents a new 3D digital smile design app for esthetic planning, smile simulation, chairside 3D virtual wax pattern, and trial restoration performed with portable devices. In this technique description, a facial frontal photograph, a facial scan standard tessellation language (STL) file, and a maxillary intraoral scan STL file were uploaded to the app. The files were calibrated to each other to allow a 3D facially driven smile design project. The definitive maxillary 3D digital waxing of facial templates was exported to a 3D printer as an STL file. The printed resin templates were directly placed in the mouth with flowable composite resin for an immediate trial restoration without the need for casts, silicone guides, or autopolymerizing resin. The workflow presented in this article linked the 3Dapp project to a printer and allowed straightforward chairside trial restorations.

Laminados Oclusais CAD-CAM e DSD-Natural Restoration para a Reabilitação da Biocorrosão

Modern life increased the incidence of biocorrosion, demanding aesthetic and minimally invasive approach for the rehabilitation of these patients. At the same time, the improvementof adhesive dentistry, restorative materials and Computer Aided Design and Computer Aided Manufacturing (CAD/CAM) systems allowed the improvement on aesthetic with minimized time using effective digital approaches. This manuscript presents an approach with ultra-thin occlusal veneers to augmentation of vertical dimension and sandwich approach (semi-direct composite on palatal and ceramic on labial) to restore biocorrosion. The full mouth CAD-CAM rehabilitation involved posterior occlusal veneers using the software´s anatomic database (biogeneric individual) and natural anterior algorithms obtained by integration between Digital Smile Design (DSD) and CAD-CAM (DSD - Natural Restoration). Therefore, the chairside mode is effective and less time consuming, associated to DSD-Natural Restoration improved anterior esthetic for labial ceramic veneers.

ЦИФРОВОЙ ДИЗАЙН УЛЫБКИ

Nowadays, а lot of people require the reconstruction of teeth due to their loss. Before prosthetics or any other manipulations, the person wants to see the aesthetic appearance of his future teeth as soon as possible. So far, many dentists use the verbal explanation to the patient, how a smile will look like or after the treatment the frontal row of teeth, but the visual representation of the person stays away. But now this can be achieved with the help of «Digital smile design», which shows the person the final result of the dental row. This technology has a number of advantages. Some of them are the quick creation of a prototype model and high accuracy in making the work. Due to these, technologies have facilitated communication between a specialist and a patient. Digital smile design has simplified the doctor’s work process and reduced the patient’s data processing time. From now on, achieving aesthetic results in the reconstruction of teeth for the dentist is not a problem.

Digital Smile Design Applied to Dental Esthetic: A Case Report

The digital smile design (DSD) has been used as a tool for esthetic dentistry that improves predictability of rehabilitation procedures such as direct restorative techniques, which are an effective alternative with low cost to obtain dental esthetics in a short clinical time. This case report aimed to present an integrated planning related to functional, esthetic and emotional requirements from the patient based on digital design parameters. A 23-years-old male patient presented yellowed lateral incisors and canines, with diastema among anterior teeth, and dento-gingival disharmony. The facial harmony, dento-gingival parameters and teeth dimensions were analyzed using DSD. The following clinical procedures were performed: gingivoplasty surgery around the upper right and left lateral incisors (teeth 12 and 22), dental bleaching with 35% hydrogen peroxide combined with 15% carbamide peroxide, and upper anterior direct restorations using resin composite, which resulted in natural aspect and the harmony of the smile.

Elderly Patients' Perception of Previewing the Prosthetic Treatment Outcome.

The demographic statistics indicate that, with the industrial development and the advances in the medical field, the average life of the population has started to increase significantly; consequently, the needs of treatments in geriatric dentistry are becoming more and more significant. The purpose of this study was to evaluate patients’ perception of diverse techniques used to obtain previews for final fixed prosthetic restorations: digital smile design (DSD), wax-up, indirect mock-up, temporary restorations, Computer-Aided Design (CAD). A focus group that included 11 participants, all of them geriatric patients, was formed; patients were invited to respond to a set of seven questions before and after various previsualization methods were applied. The focus-group report indicated that the indirect mock-up and the temporary restorations were considered by the geriatric patients as the best methods for obtaining good prosthetic previews. Comparing to the other tested methods, the use of indirect mock-up increased the acceptance of the prosthetic treatment plan and offered the most influential visual impact for 72.7% of participants. In addition, all tested previews allowed excellent communication with patients, the best results being obtained with the temporary prosthetic restorations (for 54.5% of participants). This approach represented a tool for better decisions regarding final dental restoration and has had a positive influence on patients’ acceptance of the treatment plan as well, making the final restoration more predictable.

Utilização do conceito digital Smile Design na odontologia restauradora

Due to the advancement of digital dentistry, the Digital SmileDesign (DSD) technique has been gaining credibility on the part ofprofessionals and patients. The planning of aesthetic and functionalrestorative treatments becomes more predictable with its use. Thiscase report presents a patient with aesthetic complaint of thesize and shape of her anterior teeth, associated with great gingivalexposure. Photographs were important assistants in the planning ofdental intervention. These were used for facial analysis, drawings ofguidelines and more suitable dental forms. A software called Keynotewas used, capable of managing photos, creating measurements,straight and curved lines, facilitating the planning of a new dentalproportion. At the end of this process, the patient can observe, throughthe help of photographs, the new smile that was built virtually. Thatway, it became easier for her to accept the treatment plan, allowingher to make a test of her new smile with the mock-up.

Dental Digital Photography From Dental Clinical Photography to Digital Smile Design

Dental Digital Photography From Dental Clinical Photography to Digital Smile Design

Predictibility and aesthetics in the anterior sector

Introduction: Today the aesthetic demand in dentistry occupies the first places in terms of consultation needs in the dental office, that is why, as providers of dental health services, we are obliged to offer treatment options that meet standards of quality, functionality, aesthetics, predictability among other things and that are available to different social levels4. There are techniques that supported by elements such as Digital Smile Design (DSD) 9, wax up and mockup5 offer excellent, predictable aesthetic results, with the option of choosing different materials that are available to all our patients from composite resin to better than we find today; the porcelain clinical case: A 25-year-old female patient who goes to a dental office for teeth whitening, when diagnosing the case, the presence of diastema was observed in the upper centers, as well as anomalies regarding aesthetic smile parameters such as pigmentation, proportions , incisal edge line, among other things. Diagnostic waxing, mockup and photographs were performed to evaluate the result. The treatment plan consisted of 6 resin veneers made with the fluid resin injection technique through a transparent silicone matrix (Flow injection technique). RESULTS: The prognosis of the case is considered favorable, taking into account that the treatment with Resins is not definitive, however functional and aesthetic results were achieved properly. Conclusions: There are several treatment alternatives for the solution of aesthetic problems, which adapt to the possibilities of each patient, the mockup is a necessary tool for obtaining predictable treatments. The fluid resin injection technique is a good aesthetic and functional treatment, which sometimes does not require the minimum wear of the teeth to be treated.

Transformação estética de incisivo lateral conóide com resina composta e auxílio de planejamento digital

Objetivo: este trabalho tem como objetivo, baseado em uma revisão de literatura, relatar um caso clínico de transformação estética de incisivos laterais conóides, através da técnica adesiva direta, utilizando resinas compostas e auxílio de planejamento digital. Material e Métodos: foi realizada uma busca bibliográfica nas bases de dados PUBMed e Scielo, com os termos (Microdontia) OU (Dental esthetics) E (Composite Resin OU Composite Resins) E (Anterior teeth) E (Digital Smile Design) (Microdontia) E (Estética Dental) E (Resina Composta OU Resinas Compostas) E (Dentes Anteriores). Foram selecionados 34 artigos, em suas versões completas, considerados de boa qualidade e pertinentes ao tema. Os artigos foram publicados entre 2001 e 2018. Resultados: as restaurações foram consideradas esteticamente satisfatórias pelo paciente, respeitaram princípios biológicos e foram realizadas de acordo com a filosofia minimamente invasiva. Conclusão: foi possível concluir que essa técnica minimamente invasiva preserva estrutura dental sadia, reduz o tempo clínico, é uma opção de baixo custo e apresenta reversibilidade.

Aesthetic restoration of anterior teeth with monolithic self-glazed zirconia crowns via a completely digital workflow: a clinical case report

ABSTRACT This case represents aesthetic restoration by full-contour monolithic zirconia crowns without porcelain veneer via a completely digital workflow. Virtual prostheses were designed following intraoral scanning and digital smile design (DSD) process. Polymethyl methacrylate (PMMA)-based provisional restorations were used and adjusted as guide for aesthetic and occlusal evaluation. Definite self-glazed zirconia crowns were delivered by superimposing the abutment teeth and modified temporary crowns in situ. Such novel zirconia crowns were formed by net-shape manufacturing process following biogeneric copying of the provisional crowns. The restorations represented functionally tailored hierarchical structures exhibiting superior smoothness on the surface without conventional manual work of grinding, polishing and veneering. The application of full-contour monolithic zirconia restorations in the anterior region via a completely digital workflow indicates a reliable treatment option.

Anterior esthetic restoration using DSD (digital smile design) for a patient with congenital missing tooth of maxillary central incisor

Anterior esthetic restoration using DSD (digital smile design) for a patient with congenital missing tooth of maxillary central incisor

A multidisciplinary approach to the functional and esthetic rehabilitation of dentinogenesis imperfecta type II: A clinical report

A 20-year-old woman presented with an unesthetic appearance and severe wear of the anterior teeth. Definitive expected treatment was designed by multidisciplinary combination therapy. Meanwhile, gene sequencing was used diagnostically, and digital smile design (DSD) was used to design the esthetics of the anterior teeth. The 3-month follow-up showed an acceptable outcome. The whole-exon sequencing and direct sequencing of polymerized chain reaction products of dentin sialophosphoprotein were performed, but further sequencing was needed in the repeat region of dentin sialophosphoprotein exon 5 (the data were not shown). DSD assisted and improved the esthetic design of the definitive restoration, communication with the patient, and predictability of the treatment. This treatment demonstrates that the diagnosis and differential diagnosis of patients with dentinogenesis imperfecta (DGI)-II are essential and effective for implementing the definitive treatment plan. Gene screening can be used as an auxiliary method of diagnosing DGI-II. In terms of esthetic design, DSD played an important role in ensuring a satisfactory result. Moreover, a multidisciplinary treatment protocol focusing on prosthodontics, which is different from the traditional treatment of DGI-II and consists solely of prosthodontic rehabilitation, proved highly effective in the esthetic restoration of a patient with DGI-II.

Evaluation of the Impact of Interdisciplinary Case-Based Courses in Dental Education on Smile Evaluation Skills of Undergraduate Students.

The purpose of the present study was to compare the perception of smile aesthetic between 3rd-, 4th-, and 5th-year dental students to identify if interdisciplinary courses have an impact on the attitudes of students. A total of 118 dental students (3rd-, 4th-, and 5th-year; N=43, 43, and 32, respectively) assessed the aesthetic attractiveness of four smile photographs (normal, high, low, and asymmetric smile lines). To enhance the crown, length-to-width ratio and color Digital Smile Design (DSD) were applied to all photographs, and then scoring was performed by using the Visual Analog Scale (VAS). The VAS scores were all <60 regardless of the year of the student. The lowest scores were given for asymmetric smile line. Comparison of the scores of the different years showed statistically insignificant scores between 3rd- and 4th-year dental students (p>0.05), whereas statistical differences between 4th- and 5th-year dental students were found (Cases 1, 2, and 3: p<0.05 and Case 4: p<0.01). All students were critical in the evaluation of smiles. Hence, the motivation for critical thinking based on multidisciplinary courses until 3rd year, the skepticism, and also the perception of the students were increased. The difference between 4th- and 5th-year student aesthetic perceptions showed the impact of interdisciplinary course on enhanced judgment competency of the students.