Smile Design Research Articles

Smile Characteristics in Orthodontics: A Concept Review

It is important for orthodontists to make every effort to develop a harmonious balance that will produce the most attractive smile possible for each patient treated. A smile usually translates a common man emotional intelligence and expresses his feeling in a unique fashion Thus, he seeks the orthodontist to improve the esthetics and especially the smile. The success of smile design is determined by the patient’s profile and the orthodontist’s esthetic goals and skill so as to re-establish patients’ expectations. This article enlights the overview few characteristics for a balanced smile.

Anterior maxillary teeth crown lenghtening and indirect veneer for esthetics rehabilitation: A case report

Background: Crown Lengthening is a surgical procedure performed to create a symmetrical gingival line and is carried out to expose necessary additional tooth structure. A short clinical crown occurs as a result of dental malformations, eruption disharmony, and genetic variation. Purpose: The purpose of this case report is to explain the treatment management of Crown Lengthening over the case of diastema closure by indirect veneer restoration. Case: 32 years old female presented with a chief complaint over a space between her anterior maxillary teeth. She wants to rectify her smile. Case Management: The management in this case are preparation of Digital Smile Design (DSD), Crown Lengthening on 11 and 21, and Indirect Veneer on 11, 21, 22. Conclusion: Aesthetical rehabilitation could be attained by an indirect veneer treatment followed by a gingival management which is Crown Lengthening.

Diagnostic Wax-Up - an extremely important method of communication between the dental office and the dental laboratory

Communication between the clinical department (dental office) and the technical department (dental laboratory) is one of the topics that often comes to the mind of every dental technician or dentist. This communication can be done by different methods as a type of inter-compartment communication, but diagnostic wax-up, along with Digital Smile Design and mock-up, is not only one of the most effective, but also one of the clearest and precise ways of transmitting information from the dental technician to the dentist, and implicitly to the patient, but also vice versa.

Digital Smile Design: Case Series

Aesthetic treatment is done to improve one's appearance. Digital Smile Design, Computer-aided design and Computer-aided manufacturing (CADCAM) dentistry have revolutionized aesthetic dentistry. First, involving patients in treatment planning increases patient confidence and a happier outcome. Secondly, decreased appointments and decreased overall treatment time also facilitate patients in today's busy lifestyle. However, this treatment method is uncommon in Pakistan due to a lack of knowledge and expensive equipment. This article aims to create awareness among the dentists so newer advanced treatment modality is adopted in Pakistan, bringing us at par with other countries.

Esthetic Rehabilitation of Patient with Multiple Diastema following Orthodontic Treatment and Maxillofacial Surgery: a Case Report

To perform esthetic rehabilitation with diastema closure of a patient after ortho-surgical treatment using lithium disilicate veneers. A 22-year-old male patient with multiple diastema in the maxillary arch following orthodontic treatment and maxillofacial surgery applied for prosthodontic treatment. Digital planning was done on preoperative photographs in 3Shape Smile Design software. The width/length ratio of the central incisors had key importance when choosing a triangle tooth form with a Proportional Smile Design. Study casts were mounted by facebow and bite records for analog wax-up (KaVo Protar evo 5B Articulator). Wax-up was guided by the contour line of smile design. A silicone block was prepared for the functional mock-up which was found esthetic and comfortable for the patient. A 0.4 mm width butt joint preparation was used for IPS e-max CAD lithium-disilicate veneers. Two phases one-time A-silicone impression was taken with double-cord technique. Veneers were delivered by superimposing the abutment teeth and the wax-up STL files in CAD software (Ceramill Mind). Restorations were manufactured from IPS e-max CAD lithium-disilicate MT A2 blocks and were individually characterized. The final restoration was cemented with LC adhesive resin cement (Variolink Esthetic LC) in rubber dam isolation. The patient was satisfied with the esthetic and functional outcome of the final restorations. Analog/digital workflow following treatment planning with 3Smile Design software makes treatment predictable. Proportional Smile Design is an effective method for designing a smile balanced with the face. High-quality CAD/CAM materials offer superior esthetics for patient satisfaction in the case of minimal invasive preparation.

Full-mouth rehabilitation of a young adult with Type-II dentinogenesis imperfecta

Dentinogenesis imperfecta is a hereditary autosomal dominant disorder. Type-II symptoms are discoloration, tooth/root dysmorphia, and chipping of enamel. Coverage of all teeth is recommended. To restore esthetics and masticatory function of the patient with dentinogenesis imperfecta. A 24-year-old male patient had multiple caries but no occlusion on the right side. The examination revealed DMF-T 31, tulip-shaped and short/rounded radixes, shell-like chipping of enamel, which led to the diagnosis of type-II dentinogenesis imperfecta. After elimination of all decays an intraoral scanner (Trios 3, 3Shape, Copenhagen, Denmark) was used to capture the initial surface information on both arches. The 3D-mirroring technique was performed: the tooth shapes were copied from the less-damaged surfaces on the left side to the right side, and smile design (3Shape Smile Design) was performed to reconstruct the esthetics of the fronts. Reconstructed 3D tooth surfaces were generated. All teeth were prepared and digitalized. Sectioned bite registration and digital bite acquisitions were performed. Reconstructed 3D tooth surfaces were copied onto the prepared teeth data and temporaries were 3D printed (NextDent 5100, NextDent B.V., Soesterberg, Netherlands) out from resin (NextDent C&B MFH) and cemented. After 3 months of wearing, the temporaries were rescanned intraorally, master casts were printed. Metal frameworks were sintered based on the prepared teeth scans, then porcelain layering is done on printed master casts in an adjustable articulator (PROTAREvo3, KaVo, Biberach, Germany). The tooth shapes and masticatory function were restored. The digital mirroring technique, smile design, and sectional bite registration can improve the quality of complex rehabilitation.

Facially driven esthetic rehabilitation and bite elevation for a patient with worn front teeth: a case report

A facially driven rehabilitation, increasing occlusal vertical dimension (OVD) for a patient with deep bite and severely worn front teeth. Forty- year-old woman presented whose main concern was having worn maxillary and mandibular incisors, and canines. Digital smile design was applied (3Shape TRIOS Smile Design) and the upper central incisor's width-length ratio was set to 81% (initial: 100%, width: 9 mm, length: 9 mm). Following gothic arch tracing and face bow registration, OVD was increased by 3.0 mm and diagnostic wax-up (upper front- and premolar teeth; lower front-, premolar- and molar teeth) was made on casts mounted on articulator programmed to individual patient parameters. A motivational mock-up was made, followed by preparation with a minimal invasive approach. Silicone keys were used to copy the bite during optical impression taking (TRIOS 3, 3Shape) for functional digital wax-up and PMMA temporaries. After 2 months of wearing, temporaries were scanned and overlapped on a virtual model of prepared teeth using gingival, dental reference points (3Shape Dental System). Facially driven backward planning and bite elevation was performed. Monolithic final restorations (crowns, overlays, veneers) were milled (IPS e.max CAD, Ivoclar Vivadent) based on functional digital wax-up and PMMA temporaries. To reach the satisfied esthetic in the front region the presented treatment describes a conventional protocol for increasing OVD, creating a mock-up and then a digital workflow to copy the temporaries for a predictable result.

Esthetic rehabilitation of anterior teeth with “copy-paste” concept: a case report

The aim of this fully digital workflow was to create harmonic smile correction with esthetic veneers applying orthodontic treatment and the “copy-paste” concept. A 29-years-old male patient presented with the main complaints of the teeth angulation and color discrepancies. Our treatment plan was four IPS e.max CAD MT lithium-disilicate ceramic veneers (12,11,21,22). The initial situation was scanned with 3Shape Trios 3 wireless Pod. The next step was the orthodontic treatment planned with Clear Aligner Studio (3Shape). The 2D smile design was planned with TRIOS Smile Design (3shape) after the orthodontic retention phase. The 3D design was made with 3Shape RealView Engine. Digital wax-up was printed with NextDent 5100 and transferred into the patient mouth without preparation. After 24 hours, the patient came back to the dental office where some esthetic corrections were made. This situation was scanned as a pre-preparation scan. Minimal invasive preparation was made through the mock-up, and the precision situational impression was taken digitally with Trios 3. Based on the pre-preparation scan the veneers were planned with TRIOS Design Studio (3shape). The delivery was made in absolute isolation, cemented with Maxcem Elite Clear (Kerr). The aesthetic outcome of the lithium-disilicate veneers was natural-looking and conservative while providing high optical properties. Digital workflow could provide a more predictable outcome compared with the analog way. The dentist can present the expected result for the patient before the preparation phase. With digital workflow, we can achieve the concept of “copy-paste” dentistry by transferring the digital wax-up to the final restoration entirely.

Guided Perio-Prosthodontic Rehabilitation of Heavy Bruxists

To investigate the opportunities and limits in predefining new gingival and alveolar bone contour in combined surgical-restorative treatments with the aid of superimposition of DICOM, intraoral scan (IOS) and pre-operative digital prosthodontic wax-up; to fuel discussions to define scientific research protocols; to formulate needs for software and hardware innovation to improve existing protocols. Milled bite-planes establish physiological vertical dimension after severe wear; the vertical dimension dictates in smile design the amount of acceptable lengthening on the incisal-occlusal aspect of the teeth; golden proportions define the position of the cervical tooth margin and thus the gingival contour; considering biological width and phenotype new alveolar profile is determined; templates are produced to guide osteoplasty; temporary crowns are rebased and cemented with open flap; flaps are sutured after cleaning cement; during healing, if necessary, temporaries are adjusted for function or papilla fill; final IOS of the temporaries is captured; CAD/CAM final restorations are delivered. Satisfying clinical results are obtained with simultaneous periodontal recontouring surgery and restorative temporization. Mainstream CAD and planning software does not provide segmentation tools that allow for accurate design on both teeth, soft tissue, and bone surface. As a consequence templates will not physically adapt to the bone. Premilled temporaries need to be rebased. Perfect prediction of free-hands tooth preparation is impossible. There is a need for innovation to improve the segmentation of superimposed files that represent different anatomical layers and structures.

Augmented reality application in prosthodontics

Augmented reality refers to: “a technology that superimposes a computer-generated image on a user’s view of the real world, thus providing a composite view”. It has become resourceful in many fields including dentistry and medicine. Currently augmented reality is restricted to education, maxillofacial surgeries and implantology but further research and development can expand its uses to many other critical areas. In prosthodontics, visualization of a smile design or a prosthesis outcome becomes difficult to the patient. Augmented reality will make it easier for all the persons involved to establish a proper communication and desired treatment outcome for the patient as it will superimpose the desired outcome on the current patient situation. As augmented reality is becoming more common, its applications will become wider. This article presents a brief history of the development of augmented reality and its current applications in the field of prosthodontics.

Digital Workflow in Implant Treatment Planning For Terminal Dentition Patients.

Treatment planning for the transition of patients from terminal dentition to full-arch implant rehabilitation poses challenges. Such challenges pertain to achieving the new orientation of the occlusal and esthetic plane as well as the change of vertical dimension of occlusion (VDO), while the fixed provisionalization using a digital workflow still tends to be considered complex and hard to perform. This article illustrates step-by-step the utilization of a digital workflow protocol in the treatment planning for rehabilitation of terminal dentition patients, simplifying the smile design and ensuring that fixed provisionalization serves both functional and esthetic requirements. This protocol includes facially driven, three-dimensional (3D) digital smile design and chairside mock-up restoration workflows that enable prosthetically driven assessment prior to implant treatment planning and 3D printing of surgical templates and prefabricated interim prostheses, which can predictably reduce chairside time and adjustments at the surgical and fixed provisionalization appointment.

Size, shape, alignment, and arrangement—4 steps to optimize dentofacial composition in smile design by using the patient-centered concept: A dental technique

A technique derived from patient-based outcomes is described for planning and determination of dental morphology in esthetic rehabilitation by direct evaluation in the mouth, with the help of the patient, and based on the definitive simulation results. The technique is focused on identification of a tooth arrangement to provide the most harmonious dentofacial composition based on size, shape, alignment, and arrangement, with input from the patient. A clinical treatment is presented to illustrate the use of the technique. Dental selection before smile design provided a comprehensive approach to the complex art of giving each patient’s smile individuality and personality.

2D modeling of smile design for orthopedic rehabilitation of patients

BACKGROUND: Accurate digital modeling of smile designs enables the creation of prosthetic restorations that are aesthetically and functionally reliable.
 AIM: To examine modern digital programs used for 2D planning of future smile designs.
 MATERIAL AND METHODS: This study used a self-designed questionnaire to evaluate the convenience of use and functionality of Digital Smile Design (DSD, Brazil) and SmileCloud (SmileCloud, USA), the two most popular technologies used for 2D fabrication of smile designs by dentists adopting digital treatment protocols.
 RESULTS: The survey was conducted among 12 dentists who used similar programs and had no prior experience of working with SmileCloud or DSD. The study group was asked to carry out 2D modeling of smile designs for the same patient using the programs mentioned above, and then complete the questionnaire using monosyllabic answer.
 CONCLUSION: The majority of respondents found SmileCloud to be more convenient in terms of usability and functionality when carrying out 2D modeling of smile designs.

Crown lengthening procedure based on cone beam computed tomography measurements

This case report describes about a patient's desire and visualization of a pleasant smile for whom esthetic crown lengthening is indicated due to excessive gingival display. The Cone Beam Computed Tomography (CBCT) scan was used as a measurement using smile design principle which provided a reference for flap surgery and osteotomy procedure. A 6 months post-surgery follow up was obtained.

Digital planning of composite customized veneers using Digital Smile Design: Evaluation of its accuracy and manufacturing.

ObjectivesThis study aimed to evaluate the production of customized composite veneers starting from a two‐dimensional (2D) digital preview using the Digital Smile System (DSS).Material and MethodsA photographic examination of 30 patients was performed by taking two digital pictures of the face and a digital preview through the DSS. Moreover, optical scans of the dental arches were obtained and the data were entered into a three‐dimensional (3D) software to prepare a virtual preview. The standard tessellation language files were sent for production using CAD‐CAM technology. The Friedman test, Bonferroni, and Dunn post hoc tests were used, comparing the linear measurements of the 2D and 3D plans and the final veneers (α = .05).ResultsSignificant differences emerged between the pictures and digital scans on the mesial–distal widths of the lateral incisors and canine. Linear measurements in the 2D plan were significantly different from those of the 3D plan, except for the height measures of incisors. No significant changes were found on comparing the parameters of the 2D and 3D plans with those of the final pieces.ConclusionsThe customized veneers were clinically adequate and similar to 2D and 3D plans, although significant differences emerged between the picture and digital scans as well as between the 2D and 3D plans.

Correlative evaluation of temperaments and proportions in smile for invocation of customized smile in young individuals using photography

A prosthesis can be said to be successful only if it fulfils all the components of replacement including Esthetic. Esthetics play a prime role in the success of the prosthesis. The knowledge of concept and proportions used in dental Esthetic can be used to enhance esthetics of the prosthesis. For improving the communication, confirming the diagnosis and thereby enhancing the certainty of the treatment, a conceptual tool that can be used is Esthetic smile design. Since smile analysis is an vital part of the complete facial examination carried out by dental domains. Evaluating the patient’s smile benefits the dentist in many ways.it allows the clinician to see what needs to be done, what can be done, and what should be accepted. This study aims to evaluate and correlate the temperaments and various proportions in smile of young individuals for invocation of customized smile using digital photography. Study comprising of 140 participants. All the participants will be given a self-reporting type of questionnaire. Their temperament will be identified after the analysis of the questionnaire. Dental proportions (Golden proportions, RED, Golden percentage) will be evaluated by taking the photograph of the patient. A digital camera will be used for capturing the photographs.

The aesthetic management of a midline diastema with direct composite using digital smile design, putty index and button shade technique: A case report

Background: A diastema is the distance or space between two or more adjacent teeth. This abnormality can interfere with the aesthetics of a patient, and 97% of diastemas occur in the maxilla. Various treatments can be performed for diastema closure in patients, one of which is composite resin restoration. Purpose: To explain the aesthetic procedure for diastema closure. Case: A 20-year-old female patient presented with complaints of the distance between her anterior teeth (Class I Angle occlusion with normal overjet and overbite). The labial frenum associated with the diastema was normal in size and position. The patient was not amenable to invasive procedures. Case Management: Management of midline diastema closure using the direct composite technique with DSD, the putty index method and button shade technique. Conclusion: The closure of a midline diastema with direct composite using DSD, the putty index method and button shade technique provides aesthetic results with less cost and time due to the absence of laboratory procedures.

A Fully Digital Workflow to Achieve Predictable Esthetic and Functional Outcomes: A Case Series.

Various types of digital dental technologies have been successfully implemented as a part of dental treatment to improve predictability and efficiency of dental procedures. Virtual smile design can be used to enhance predictability from an esthetic perspective, and the virtual articulator can be a useful tool to create a desired occlusal scheme. This case series describes a fully digital workflow that can predictably achieve desired esthetic and functional outcomes. The proposed protocol also includes other currently available digital technologies, such as intraoral scanning, computer-aided design, milling, and 3D printing. Three clinical cases are presented to describe the workflow in detail.

Interdisciplinary 3D digital treatment simulation before complex esthetic rehabilitation of orthodontic, orthognathic and prosthetic treatment: workflow establishment and primary evaluation

BackgroundAn interdisciplinary treatment simulation and smile design before a complex esthetic rehabilitation is important for clinicians’ decision-making and patient motivation. Meanwhile, intervention and interaction are necessary for dental specialists in these complex rehabilitations. However, it is difficult to visualize an interdisciplinary treatment plan by using the conventional method, especially when orthognathic surgery is involved, thus hindering communication between dental specialists. This research aims to establish a 3D digital workflow of interdisciplinary treatment simulation to solve this problem.MethodsAn interdisciplinary 3D digital workflow of simulated treatment plan for complex esthetic rehabilitation was established. Eleven patients were enrolled and illustrated with their treatment plans using 3D treatment simulation, as well as 2D digital smile design (DSD) plus wax-up. Visual analogue scales (VAS) were used to rate the intuitiveness, understanding, and satisfaction or help between the two methods by patients and dental specialists.ResultsAccording to the ratings from the patients, 3D treatment simulation showed obvious advantages in the aspects of intuitiveness (9.7 ± 0.5 vs 6.4 ± 1.4) and treatment understanding (9.1 ± 0.8 vs 6.6 ± 1.5), and the satisfaction rates were also higher (9.0 ± 0.6 vs 7.1 ± 1.8). Dental specialists regarded the 3D digital plans as more intuitive (8.9 ± 0.8 vs 5.9 ± 1.0) and useful to understand the plans from the other specialists (8.9 ± 0.7 vs 6.1 ± 1.0) and helpful to their own treatment plans (8.7 ± 0.9 vs 5.9 ± 1.4).ConclusionsThe interdisciplinary 3D digital treatment simulation helps both patients and dental specialists to improve treatment understanding, and facilitates dental specialists for decision-making before complex esthetic rehabilitation.Trial registrationThis study was registered in the National Clinical Trials Registry under the identification number MR-11-20-002862. This is an observational study in which we did not assign the intervention.

Evaluating the Precision of Automatic Segmentation of Teeth, Gingiva and Facial Landmarks for 2D Digital Smile Design Using Real-Time Instance Segmentation Network.

Digital smile design (DSD) technology, which takes pictures of patients’ faces together with anterior dentition and uses them for prosthesis design, has been recently introduced. However, the limitation of DSD is that it evaluates a patient with only one photograph taken in a still state, and the patient’s profile cannot be observed from various viewpoints. Therefore, this study aims to segment the patient’s anterior teeth, gingiva and facial landmarks using YOLACT++. We trained YOLACT++ on the annotated data of the teeth, lips and gingiva from the Flickr-Faces-HQ (FFHQ) data. We evaluated that the model trained by 2D candid facial images for the detection and segmentation of smile characteristics. The results show the possibility of an automated smile characteristic identification system for the automatic and accurate quantitative assessment of a patient’s smile.