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DigitalSmileDesign-Aninnovativetool
inaestheticdentistry
ZebaJafria,NafisAhmadetal
JournalofOralBiologyandCraniofacialResearch10(2020)194–19
Presented By
M.Swathi
Contents
 Introduction
 Evolution of digital smile designing
 Review of literature
 Requirements for DSD
 Procedure of carrying DSD
 Advantages, Limitations
 Conclusion
 References
Introduction
 A beautiful confident smile is desired by all.
 When a patient wishes to attain that smile but is skeptical to
undertake the treatment procedure, for not being able to visualize
his or her treatment outcome, is when, a clinician can use the
Digital smile designing (DSD) tool.
 DSD concept aims to help clinician by improving the aesthetic
visualization of the patient's concern, giving understanding of the
possible solution therefore educating and motivating them about the
benefits of the treatment and increasing the case acceptance.
 Digital smile design is a digital mode that help us to create and
project the new smile design by attaining a simulation and pre
visualization of the ultimate result of the proposed treatment.
 A design created digitally involves participation of the patients on
the designing process of their self-smile design, leading to
customization of smile design as per individual needs and desires.
 It complements with the morpho psychological characteristics of
the patient, relating patient to an emotional level, increasing their
confidence in the process and better acceptance of the anticipated
treatment.
Evolution of
DSD
 Generation 1: Analogue drawings over photos and no connection to the
analogue model .
 Generation 2: Digital 2D drawings and visual connection to the analogue
model.
 Generation 3:Digital 2D drawings and analogue connection to the model.
Generation .
 Generation 4: Digital 2D drawings and digital connection to the 3D
model. Generation.
 Generation 5: Complete 3D workflow.
 Generation 6: The 4D concept. Adding motion to the smile design
process.
Requirements
 DSD software
 Digital SLR camera or smart phone
 Digital intraoral scanner
 3D printer and CAD/CAM
Photography
protocol
1. Three frontal views:
• Full face with a wide smile and the teeth apart
• Full face at rest.
• Retracted view of the full maxillary and mandibular arch with teeth
apart.
2. Two profile views:
• Side Profile at Rest
• Side Profile with a full Smile
3. A 12 O, clock view with a wide smile and incisal edge of maxillary
teeth visible and resting on lower lip
4. An intra occlusal view of maxillary arch from second premolar to
second premolar.
Videography
protocol
 A facial frontal video with retractor and without retractor smiling.
 A facial profile video with lips at rest and wide-E smile.
 A 12 O'clock video above the head at the most coronal angle that
still allows visualization of the incisal edge.
 An anterior occlusal video to record maxillary teeth from second
premolar to second premolar with the palatine raphe as a straight
line.
 Four complementary videos should also be taken for facial,
phonetic, functional and structural analysis.
 Static photographs
Types of DSD
software
 Photoshop CS6 (Adobe Systems Incorporated)
 Microsoft PowerPoint (Microsoft Office, Microsoft, Redmond,
Washington, USA)
 Smile Designer Pro (SDP) (Tasty Tech Ltd)
 Aesthetic Digital Smile Design (ADSD - Dr. Valerio Bini)
 Cerec SW 4.2 (Sirona Dental Systems Inc.)
 Planmeca Romexis Smile Design (PRSD) (Planmeca Romexis®)
 VisagiSMile (Web Motion LTD)
 DSD App by Coachman (DSDApp LLC)
 Keynote (iWork, Apple, Cupertino, California, USA)
 Guided Positioning System (GPS)
 DSS (EGSolution)
 NemoDSD (3D)
 Exocad DentalCAD 2.3
Procedure
 Facial analysis is done using reference lines from which uniform
parameters are developed for frontal view of the face.
 The horizontal reference lines consist of the inter-pupillary and
inter-commissural lines that deliver a complete sense of balance and
horizontal over view in the aesthetically pleasing face.
 While the vertical reference line includes the facial midline,
passing the glabella, nose, and the chin .
 The horizontal and vertical lines are crossed against each other to
measure symmetry .
 The facial photograph with a wide smile and the teeth apart is
moved behind this cross to determine the ideal horizontal plane and
vertical midline which permits a comparative analysis of the teeth
and face.
 After facial analysis, dento gingival analysis is done.
 The length of the upper lip at rest and in a smile is checked to
determine the gingival display.
 Smile curve is established by correlating the curvature of the incisal
edges of the maxillary anterior teeth.
 The dental contour is made according to the lower lip proportions
and the anterior-posterior curvature of the teeth.
 This facial photograph is then cropped to show only the intraoral
view.
 Three reference lines are marked on the teeth, a straight horizontal
line drawn from canine tip to canine tip, one more horizontal line on
the incisal edges of central incisors and another vertical line passing
through the dental midline (passing through theinterdental papillae).
 This supports in reproducing the cross, that is, the reference inter-
pupillary and facial midline on the face onto the intraoral view.
 Few additional lines are drawn such as the gingival zenith,joining
lines of the gingival and incisal battlements for complete dental
analysis.
 For adequate teeth dimension the ideal size of dental width to length
ratio can be incorporated by any one of the published theories
which includes Golden proportion,Pound's theory,Recurring
aesthetic dental proportion, or Visagism
 Required changes are carried out with the help of a digital ruler
which can be calibrated on the photograph by measuring the width
of the central incisors in the study model.
 Changes can be modified, decreased or adapted to different
situations, depending on the aesthetic requirement and individual
needs of the patient.
 After the new smile design is attained it can be digitally presented
to the patient to seek out appreciation and feedback.
 This digitally approved smile design at this stage can be used to
create physical mockup which can be tested aesthetically in the
patient's mouth.
 The mock-up allows for not only visualization of the shape
integrated to the gingiva,lips, face, but also to phonetics during the
evaluation period.
Digital Smile Design-An innovative tool in aesthetic dentistry.pptx
Advantages
 Digital analysis visualization.
 Diagnosis and treatment planning.
 Customization.
 Communication.
 Medico-legal functions.
Limitations
 Economically expensive.
 Indequency in photographic and video documentation.
 Learning curve.
Future
prospects
 With the improvements in the software over the next few years, it
will be possible to address facial aesthetics in advanced cases where
implants need to be placed by superimposing the files coming from
a CT scan or a Cone Beam, along with 3D files of an oral
impression or a facial scan and a photo.
 There also is a possibility of incorporating 4D concept in which
motion can be added to the smile design concept.
 With ever evolving fast paced technology a time, not so far, may
come, when digitally designed smile can be projected to virtual
reality glasses to foresee the desired smile in actual reality.
Review of
Literature
 Chetan et al in 2023, had conducted a study on assessment
of Patient Satisfaction and Treatment Outcomes in Digital
Smile Design vs. Conventional Smile Design
 He had concluded that patients in the DSD group exhibited
excellent restoration fit, occlusion, and esthetics
emphasizing potential advantages of integrating digital
technology into smile design procedures.
Conclusion
 Helpful tool in aesthetic visualization.
 Improves clinician's diagnosis and treatment planning.
References
 Luniyal C, Shukla AK, Priyadarshi M, Ahmed F, Kumari N,
Bankoti P, Makkad RS. Assessment of Patient Satisfaction and
Treatment Outcomes in Digital Smile Design vs. Conventional
Smile Design: A Randomized Controlled Trial. Journal of Pharmacy
and Bioallied Sciences. 2024 Feb 1;16(Suppl 1):S672-4.
 Davis NC. Smile design. Dent Clin North Am. 2007;51(2):299–318.
 Dias NS, Tsingene F. SAEF–Smile's aesthetic evaluation form: a
useful tool to improve communication between clinicians and
patients during multidisciplinary treatment. Eur J Esthetic Dent.
2011;6(2):160–176.
 Paolucci B, Calamita M, Coachman C, Gurel G, Shayder A,
Hallawell P. Visagism: The Art of Dental Composition.
Quintessence of Dental Technology; 2012:1–14.
 Chiche G, Pinault A. Diagnosis and treatment planning of aesthetic
problems. Aesthetics of Anterior Prosthodontics. Quintessence.
2004; 2004:13–25.

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Digital Smile Design-An innovative tool in aesthetic dentistry.pptx

  • 2. Contents  Introduction  Evolution of digital smile designing  Review of literature  Requirements for DSD  Procedure of carrying DSD  Advantages, Limitations  Conclusion  References
  • 3. Introduction  A beautiful confident smile is desired by all.  When a patient wishes to attain that smile but is skeptical to undertake the treatment procedure, for not being able to visualize his or her treatment outcome, is when, a clinician can use the Digital smile designing (DSD) tool.  DSD concept aims to help clinician by improving the aesthetic visualization of the patient's concern, giving understanding of the possible solution therefore educating and motivating them about the benefits of the treatment and increasing the case acceptance.
  • 4.  Digital smile design is a digital mode that help us to create and project the new smile design by attaining a simulation and pre visualization of the ultimate result of the proposed treatment.  A design created digitally involves participation of the patients on the designing process of their self-smile design, leading to customization of smile design as per individual needs and desires.  It complements with the morpho psychological characteristics of the patient, relating patient to an emotional level, increasing their confidence in the process and better acceptance of the anticipated treatment.
  • 5. Evolution of DSD  Generation 1: Analogue drawings over photos and no connection to the analogue model .  Generation 2: Digital 2D drawings and visual connection to the analogue model.  Generation 3:Digital 2D drawings and analogue connection to the model. Generation .  Generation 4: Digital 2D drawings and digital connection to the 3D model. Generation.  Generation 5: Complete 3D workflow.  Generation 6: The 4D concept. Adding motion to the smile design process.
  • 6. Requirements  DSD software  Digital SLR camera or smart phone  Digital intraoral scanner  3D printer and CAD/CAM
  • 7. Photography protocol 1. Three frontal views: • Full face with a wide smile and the teeth apart • Full face at rest. • Retracted view of the full maxillary and mandibular arch with teeth apart.
  • 8. 2. Two profile views: • Side Profile at Rest • Side Profile with a full Smile
  • 9. 3. A 12 O, clock view with a wide smile and incisal edge of maxillary teeth visible and resting on lower lip
  • 10. 4. An intra occlusal view of maxillary arch from second premolar to second premolar.
  • 11. Videography protocol  A facial frontal video with retractor and without retractor smiling.  A facial profile video with lips at rest and wide-E smile.
  • 12.  A 12 O'clock video above the head at the most coronal angle that still allows visualization of the incisal edge.  An anterior occlusal video to record maxillary teeth from second premolar to second premolar with the palatine raphe as a straight line.
  • 13.  Four complementary videos should also be taken for facial, phonetic, functional and structural analysis.  Static photographs
  • 14. Types of DSD software  Photoshop CS6 (Adobe Systems Incorporated)  Microsoft PowerPoint (Microsoft Office, Microsoft, Redmond, Washington, USA)  Smile Designer Pro (SDP) (Tasty Tech Ltd)  Aesthetic Digital Smile Design (ADSD - Dr. Valerio Bini)  Cerec SW 4.2 (Sirona Dental Systems Inc.)  Planmeca Romexis Smile Design (PRSD) (Planmeca Romexis®)
  • 15.  VisagiSMile (Web Motion LTD)  DSD App by Coachman (DSDApp LLC)  Keynote (iWork, Apple, Cupertino, California, USA)  Guided Positioning System (GPS)  DSS (EGSolution)  NemoDSD (3D)  Exocad DentalCAD 2.3
  • 16. Procedure  Facial analysis is done using reference lines from which uniform parameters are developed for frontal view of the face.  The horizontal reference lines consist of the inter-pupillary and inter-commissural lines that deliver a complete sense of balance and horizontal over view in the aesthetically pleasing face.  While the vertical reference line includes the facial midline, passing the glabella, nose, and the chin .
  • 17.  The horizontal and vertical lines are crossed against each other to measure symmetry .  The facial photograph with a wide smile and the teeth apart is moved behind this cross to determine the ideal horizontal plane and vertical midline which permits a comparative analysis of the teeth and face.
  • 18.  After facial analysis, dento gingival analysis is done.  The length of the upper lip at rest and in a smile is checked to determine the gingival display.  Smile curve is established by correlating the curvature of the incisal edges of the maxillary anterior teeth.  The dental contour is made according to the lower lip proportions and the anterior-posterior curvature of the teeth.  This facial photograph is then cropped to show only the intraoral view.  Three reference lines are marked on the teeth, a straight horizontal line drawn from canine tip to canine tip, one more horizontal line on the incisal edges of central incisors and another vertical line passing through the dental midline (passing through theinterdental papillae).
  • 19.  This supports in reproducing the cross, that is, the reference inter- pupillary and facial midline on the face onto the intraoral view.  Few additional lines are drawn such as the gingival zenith,joining lines of the gingival and incisal battlements for complete dental analysis.  For adequate teeth dimension the ideal size of dental width to length ratio can be incorporated by any one of the published theories which includes Golden proportion,Pound's theory,Recurring aesthetic dental proportion, or Visagism
  • 20.  Required changes are carried out with the help of a digital ruler which can be calibrated on the photograph by measuring the width of the central incisors in the study model.  Changes can be modified, decreased or adapted to different situations, depending on the aesthetic requirement and individual needs of the patient.
  • 21.  After the new smile design is attained it can be digitally presented to the patient to seek out appreciation and feedback.  This digitally approved smile design at this stage can be used to create physical mockup which can be tested aesthetically in the patient's mouth.  The mock-up allows for not only visualization of the shape integrated to the gingiva,lips, face, but also to phonetics during the evaluation period.
  • 23. Advantages  Digital analysis visualization.  Diagnosis and treatment planning.  Customization.  Communication.  Medico-legal functions.
  • 24. Limitations  Economically expensive.  Indequency in photographic and video documentation.  Learning curve.
  • 25. Future prospects  With the improvements in the software over the next few years, it will be possible to address facial aesthetics in advanced cases where implants need to be placed by superimposing the files coming from a CT scan or a Cone Beam, along with 3D files of an oral impression or a facial scan and a photo.  There also is a possibility of incorporating 4D concept in which motion can be added to the smile design concept.
  • 26.  With ever evolving fast paced technology a time, not so far, may come, when digitally designed smile can be projected to virtual reality glasses to foresee the desired smile in actual reality.
  • 27. Review of Literature  Chetan et al in 2023, had conducted a study on assessment of Patient Satisfaction and Treatment Outcomes in Digital Smile Design vs. Conventional Smile Design  He had concluded that patients in the DSD group exhibited excellent restoration fit, occlusion, and esthetics emphasizing potential advantages of integrating digital technology into smile design procedures.
  • 28. Conclusion  Helpful tool in aesthetic visualization.  Improves clinician's diagnosis and treatment planning.
  • 29. References  Luniyal C, Shukla AK, Priyadarshi M, Ahmed F, Kumari N, Bankoti P, Makkad RS. Assessment of Patient Satisfaction and Treatment Outcomes in Digital Smile Design vs. Conventional Smile Design: A Randomized Controlled Trial. Journal of Pharmacy and Bioallied Sciences. 2024 Feb 1;16(Suppl 1):S672-4.  Davis NC. Smile design. Dent Clin North Am. 2007;51(2):299–318.  Dias NS, Tsingene F. SAEF–Smile's aesthetic evaluation form: a useful tool to improve communication between clinicians and patients during multidisciplinary treatment. Eur J Esthetic Dent. 2011;6(2):160–176.
  • 30.  Paolucci B, Calamita M, Coachman C, Gurel G, Shayder A, Hallawell P. Visagism: The Art of Dental Composition. Quintessence of Dental Technology; 2012:1–14.  Chiche G, Pinault A. Diagnosis and treatment planning of aesthetic problems. Aesthetics of Anterior Prosthodontics. Quintessence. 2004; 2004:13–25.

Editor's Notes

  1. Coachman and Calamita described DSD as a multi-use conceptual tool that can support diagnostic vision, improve communication, and enhance treatment predictability, by permitting careful analysis of the patient's facial and dental characteristics that may have gone unnoticedby clinical, photographic or diagnostic cast based evaluation procedures.
  2. In the last two decades smile designing has progressively evolved from physical analogue to digital designing which has advanced from 2D to 3D Christian Coachman in 2017 has proposed this evolution in generations as:
  3. DSD technique is carried out by digital equipment already prevailing in current dental practice like a computer with one of the DSD Software. An accurate photographic documentation is essential as complete facial and dental analysis rests on preliminary photographs on which changes and designing is formulated, a video documentation required for dynamic analysis of teeth, gingiva, lips and face during smiling, laughing andtalking in order to integrate facially guided principles to the smile design
  4. To proceed with a correct digital planning it is crucial to follow a photography protocol. Photographs taken should be of utmost quality and precision, with correct posture and standardized techniques, as facial reference lines like the commissural lines, lip line and inter-pupillary line which forms the basis of smile designing are established on them. Poor photography misrepresents the reference image and may lead to an improper diagnosis and plannin
  5. According to Coachman during videography best framing and zoom should be adjusted with suitable exposure and focus adjusted to mouth. For ideal development of the facially guided smile frame, four videos from specific angles should be taken:
  6. Factors such as dentofacial aesthetic parameters, ease of use, case documentation ability, cost, time efficiency, systematic digital workflow and organization, and compatibility of the program with CAD/ CAM or other digital systems may influence the user's decision
  7. Although the inclusion of aesthetic parameters in different DSD software varies, basic procedure of smile designing remains the same. All the DSD software allows for aesthetic designing through the drawing of reference lines and shapes on extra- and intraoral digital photographs
  8. Patients can view their rehabilitations even before they start, and this can also have important medico-legal functions.
  9. 2.As the diagnosis and treatment plan depends on photographic and video documentation, inadequacy in them may distort the reference image and may result in an incorrect diagnosis and planning 2.For complete 3D digital work flow, 3.Training and handling for certain software are necessary which
  10. Complete 3D digital workflow is still not extensively used which in future may come into practice far and wide when more and more clinician will adopt digital scanner, 3D printers, CAD/CAM, then the need for time-consuming impressions, plaster and wax will become far less necessary.
  11. It not only helps patients to envision their treatment outcome but also improves clinician's diagnosis and treatment planning