A comparative study of the use of digital technology in the anterior smile experience.

OBJECTIVES: this study aims to compare the clinical outcomes of traditional and digital crown extension guides in the aesthetic restoration of anterior teeth. Additionally, the study will analyze the differences in the results of various digital crown extension guides in anterior aesthetic restorations. METHODS: Sixty-two patients who required aesthetic restoration of their anterior teeth were selected for this study. The patients had a total of 230 anterior teeth and were randomly divided into three groups: a control group of 22 cases who received diagnostic wax-up with pressure film, an experimental group 1 of 20 cases who received 3D printed digital models with pressure film, and an experimental group 2 of 20 patients who received digital dual-positioning guides. The control group had a total of 84 anterior teeth, experimental group 1 had 72 anterior teeth, and experimental group 2 had 74 anterior teeth. The study compared three methods for fabricating crown extension guides: the control group used the diagnostic wax-up plus compression film method, while experimental group 1 used compression film on 3D printed models and experimental group 2 used 3D printed digital dual-positioning crown extension guides. After the crown lengthening surgery, the control group patients wore DMG resin temporary crown material for gingival contouring, while the experimental group patients wore 3D printed resin temporary crowns for the same purpose. The patients were followed up in the outpatient clinic after wearing temporary crowns for 1 month, 3 months, and 6 months, respectively. The clinical results were evaluated in terms of marginal fit, red aesthetic index, and white aesthetic index. RESULTS: Based on the statistical analysis, the experimental group required significantly fewer follow-up visits and less time for guide design and fabrication compared to the control group. Additionally, the surgical time for the experimental group was significantly shorter than that of the control group. During the postoperative period between the 1st and 3rd month, the PES index scores for the marginal gingival level, proximal, and distal mesiodistal gingival papillae of the experimental group showed a trend of superiority over those of the control group. By the 6th month, the marginal gingival level exhibited a significant difference between the experimental and control groups. The experimental group demonstrated superior results to the control group in terms of shape, contour, and volume of the teeth, color, surface texture, and transparency of the restorations, and features during the 1st and 3rd postoperative months. In the 6th month, the comparative results indicated that the experimental group continued to exhibit superior outcomes to the control group in terms of the shape, color, surface texture, and transparency of the restorations, as well as the characteristics of the teeth. Additionally, the experimental group demonstrated significantly fewer gingival alterations than the control group at 1 month, 3 months, and 6 months post-procedure, with this difference being statistically significant. Furthermore, the combination of 3D printing technology and restorative techniques was utilized, resulting in consistent patient satisfaction. CONCLUSION: Digitalisation plays an important role in anterior aesthetic restorations. The use of digital technology to manage the entire process of anterior cosmetic restorations can improve restorative results, reduce the number of follow-up appointments, shorten consultation time, and achieve better patient satisfaction.

Perceptions in Digital Smile Design: Assessing Laypeople and Dental Professionals' Preferences Using an Artificial-Intelligence-Based Application.

Digital Smile Design (DSD) is used in many fields of dentistry. This prospective observational study assessed laypeople's and dental professionals' perceptions of a DSD application. SmileCloud, an online DSD platform, was used to create two different designs for three patients; after that, the participants, in a 30-question online illustrated survey, were asked about the most attractive design and other features of the smile. Dentists' and laypeople's perceptions about specific DSD features were assessed. The Kolmogorov-Smirnov normality test was used. Descriptive and crosstab analyses compared the respondents' opinions for each statement. Chi-square tests were used to determine the relationship between the questions and any association with age, gender, and profession. The test results were rated as significant at a p-value < 0.05. A total of 520 participants (dental professionals, students, dental technicians, and laypeople) were enrolled. The statistically significant features were self-esteem related to appearance (p = 0.05), facial and smile symmetry (p = 0.42, p < 0.0001), tooth color (p = 0.012), and symmetry of gums (p < 0.001). For each patient, the design with dominant round upper incisors and perfect symmetry was preferred (p < 0.001). Digital pre-visualization benefits diagnosis and enriches treatment planning. The dentist-dental technician-patient team should be involved in the decision-making process of pre-visualization.

Assessment of Patient Satisfaction and Treatment Outcomes in Digital Smile Design vs. Conventional Smile Design: A Randomized Controlled Trial.

Background: The esthetics of a smile holds significant importance in an individual's self-esteem and overall quality of life. In the realm of cosmetic dentistry, smile design has traditionally relied on conventional methods, but recent advances in technology have introduced digital smile design (DSD) as a promising alternative. Materials and Methods: In this randomized controlled trial, 150 adult patients seeking smile enhancement procedures were enrolled and randomly assigned to one of two groups: the DSD group or the conventional smile design group. The DSD group underwent smile design using digital technology, including intraoral scans, computer-aided design, and 3D simulations. Meanwhile, the conventional smile design group received smile design through traditional methods, involving manual impressions, stone models, and manual wax-ups. Patient satisfaction was measured using a visual analog scale (VAS) ranging from 0 to 100 immediately after the procedure, while treatment outcomes were assessed three months post-procedure by dental professionals using a standardized assessment scale. Results: In terms of patient satisfaction, the DSD group demonstrated a mean score of 85.4 (SD ± 6.2), while the conventional smile design group had a mean score of 79.8 (SD ± 7.1). This suggests that patients in the DSD group reported higher levels of satisfaction with their smile enhancements. Regarding treatment outcomes, 92% of patients in the DSD group exhibited excellent restoration fit, occlusion, and esthetics, whereas 78% of patients in the conventional smile design group achieved the same level of excellence. These findings collectively indicate that digital smile design (DSD) may yield superior patient satisfaction and improved treatment outcomes when compared to conventional smile design methods, particularly with regard to esthetic results and overall patient contentment. Conclusion: In conclusion, the results of this randomized controlled trial emphasize the potential advantages of integrating digital technology into smile design procedures.

Evaluation metric of smile classification by peri-oral tissue segmentation for the automation of digital smile design.

OBJECTIVES: This study aimed to develop and validate evaluation metric for an automated smile classification model termed the "smile index." This innovative model uses computational methods to numerically classify and analyze conventional smile types. METHODS: The datasets used in this study consisted of 300 images to verify, 150 images to validate, and 9 images to test the evaluation metric. Images were annotated using Labelme. Computational techniques were used to calculate smile index values for the study datasets, and the resulting values were evaluated in three stages. RESULTS: The smile index successfully classified smile types using cutoff values of 0.0285 and 0.193. High accuracy (0.933) was achieved, along with an F1 score greater than 0.09. The smile index successfully reclassified smiles into six types (low, low-to-medium, medium, medium-to-high, high, and extremely high smiles), thereby providing a clear distinction among different smile characteristics. CONCLUSION: The smile index is a novel dimensionless parameter for classifying smile types. The index acts as a robust evaluation tool for artificial intelligence models that automatically classify smile types, thereby providing a scientific basis for largely subjective aesthetic elements. CLINICAL SIGNIFICANCE: The computational approach employed by the smile index enables quantitative numerical classification of smile types. This fosters the application of computerized methods in quantifying and analyzing real smile characteristics observed in clinical practice, paving the way for a more objective evidence-based approach to aesthetic dentistry.

Mapping the Landscape of the Digital Workflow of Esthetic Veneers from Design to Cementation: A Systematic Review.

The purpose of this systematic review was to map all the existing literature on digitally designed and fabricated esthetic veneers. We aimed to compare the accuracy of digitally designed preparation and cementation guides for esthetic indirect veneers with the conventional workflow. We evaluated studies comparing the accuracy and predictability of workflows between digitally fabricated indirect-esthetic veneers and conventional indirect veneers. Searches were performed in August 2023 across three databases, specifically Google Scholar, Cochrane, and PubMed, and were restricted to English-language publications. The search strategy was based on the PICO criteria. Reference lists of identified articles were manually checked to find further pertinent studies that were not discovered during the electronic search. The titles and abstracts were reviewed in the first stage, and then the full article texts were reviewed and cross-matched against the predetermined inclusion criteria. Following the search, 169 articles were identified: 41 from Google Scholar, 44 from Cochrane, and 71 from PubMed, with 13 added manually. Of these, 20 were chosen for a detailed quality assessment of the digital veneer workflow and the accuracy of digital preparations and cementation guides for laminate veneers. Based on our findings, the digitally fabricated laminate-veneer workflow demonstrated superior predictability and accuracy compared to the conventional workflow.

The influence of different tooth proportions obtained using digital smile design on the perception of smile esthetics.

OBJECTIVE: The aim of this study is to examine the effect of designs using different esthetic dental proportions made with a digital smile design program on the esthetic perception of individuals of different ages, genders and educational statuses. MATERIALS AND METHODS: Different smile designs were made on facial photos taken of a female and male model using a smile design program. Four different dental proportions (golden proportion [GPR], golden percentage [GPE]), Preston proportion [P] and recurring esthetic dental proportion [RED]) and two different tooth shapes (oval and square) were used. Images with 16 different smile designs were presented to 4th and 5th-year students of a faculty of dentistry, dentists, specialist dentists and laypersons for scoring. RESULTS: The gender of the participants did not affect the scores given (p > 0.05), and participants over the age of 30 and lay people had higher scores (p < 0.05). The GPR design was scored lower than RED when all designs were subdivided by tooth shape and gender (p < 0.001). CONCLUSIONS: The esthetic perceptions of people of different ages and dentistry education levels may differ from each other. Using the GPR when designing a digital smile may not be suitable for both genders. CLINICAL SIGNIFICANCE: If esthetic dental proportions are to be utilized when designing a smile, it may be more appropriate to use the P and RED proportions instead of the GPR. In addition, if the patients whose smiles will be designed are young and have received dental education, it should be considered that their esthetic expectations may be high. Trial registration ClinicalTrials.gov Identifier: NCT0567043.

Creating a hybrid smile design workflow: The analog brain drives the digital technology.

OBJECTIVE: This article will explain and demonstrate the application of analog smile design techniques and concepts as a precursor for digital smile design implementation. The application of these techniques will be described with two case presentations that will demonstrate the incorporation of these analog methods into digital smile design programs. CLINICAL CONSIDERATIONS: Digital smile design workflows can be more efficient and require less chair time but must be based on an understanding and application of basic smile design principles to apply the digital techniques successfully. CONCLUSIONS: The application of basic smile design techniques to digital workflows resulted in excellent clinical outcomes for both a localized treatment plan and a full mouth restorative rehabilitation. CLINICAL SIGNIFICANCE: Digital smile design is quickly being adopted into dental practices. However, the digital design must be created by the clinician and be based on a thorough understanding of basic esthetic and restorative principles to achieve predictable successful clinical outcomes.

Full-Arch Guided Restoration and Bone Regeneration: A Complete Digital Workflow Case Report.

OBJECTIVE: complex rehabilitations present multiple difficulties, regarding both the planification of the surgery and the design of the prothesis. A digital approach can support the workflow, as well as the degree of intraoperative precision, and improve the long-term prognosis. METHODS: A surgical guide was designed for implant placement. An extensive regeneration of the upper jaw was performed with contextual implant insertion, and a delayed load rehabilitation was chosen. After four months, a second surgery and a simultaneous soft tissue augmentation was performed, and a 3D-printed temporary restoration was placed. After another two months, new dental and facial scans, smile design, and facial bite registrations were obtained. Upper and lower dentures were built using an exclusively digital workflow. Both metal substructures were passivated and cemented in one session; in the following appointment, the aesthetic and occlusal checks were carried out. During the third visit, both prostheses were delivered. RESULTS: Careful case planning and the surgical guide made it possible to achieve primary stability and acceptable emergence profiles in an extremely reabsorbed upper jaw. Leukocyte-Platelet Rich Fibrin (L-PRF) made the extensive bone regeneration more approachable and lowered the post-operative pain and swelling, while speeding up the soft tissue healing process. During the re-entry surgery, the volumes of soft tissues were increased to improve aesthetics, and the amount of keratinized gingiva around the six implants was also increased. Smile design and facial scans have provided the means to create acceptable aesthetics and function in a few sessions with minimal patient discomfort. CONCLUSIONS: Computer-assisted implantology is a safe and precise method of performing dental implant surgery. Preliminary studies have a high degree of accuracy, but further studies are needed to arrive at a fully digital clinical protocol at all stages.

Managing the transition to a complex full mouth rehabilitation utilizing injectable composite.

OBJECTIVE: This article describes the use of flowable injectable composite resins to facilitate transitional treatment of a complex complete mouth rehabilitation. CLINICAL CONSIDERATIONS: Some patients require urgent and complex complete mouth rehabilitations that are time and cost intensive. Financial considerations can prevent some patients from pursuing treatment. This can result in the oral conditions worsening over time and compromising the long-term prognosis of the teeth. CONCLUSIONS: Injectable composite resins can be used as a transitional bonding material for complex cases using an injection molding technique utilizing clear indices obtained from a diagnostic waxing. This allows for a full mouth rehabilitation to be performed in a single appointment, producing instant results. CLINICAL SIGNIFICANCE: Transitioning with injectable composite as demonstrated in this case will immediately stabilize an otherwise deteriorating situation in a cost-effective way and allows patients to address the realities of financial or time constraints when transitioning to more durable porcelain restorations over a period of years.

Integration of Digital and Analog Workflow to Achieve Predictable Esthetics: A Novel Approach.

The use of digital smile designing simplifies the restoration of esthetics. In this article, a case of diastema and incisal notching in anterior teeth was rehabilitated with porcelain laminate veneers using combination of digital and analog workflow.

Enhanced Lip-Contour During Facial Scan for 3D DSD and Implant Planning: A Blue Screen Approach.

When obtaining 3-dimensional (3D) facial images for digital smile design (DSD) and dental implant planning, inaccuracies may frequently be introduced by distortion in the region between the lips' vermilion border and the teeth. The present clinical technique aimed to reduce such deformation during face scanning, thereby facilitating 3D DSD. This is also essential to plan bone reduction with precision for implant reconstructions. A custom-made silicone matrix acting as a blue screen provided reliable support for 3D visualization of facial images in a patient requiring a new maxillary screw-retained implant-supported fixed complete denture. Imperceptible volumetric changes were registered in the facial tissues when the silicone matrix was added. The usual deformation of the lip vermilion border originating in face scans was overcome by applying blue-screen technology with a silicone matrix. Reproducing the vermilion border of the lip contour accurately may offer improved communication and visualization for 3D DSD. The silicone matrix was a practical approach that acted as a blue screen to display the transition from lips to teeth with satisfactory precision. Implementing blue-screen technology in reconstructive dentistry might increase predictability by reducing errors when scanning objects with challenging-to-capture surfaces.

Digital Smile Design.

One of the important ways of social interaction is through verbal and nonverbal communication. The human face is capable of eliciting multi-response according to the situation; amongst them, a smile plays a significant effect in relaying a positive communication that can immensely influence societal outcomes. An important part of dental treatment is to restore the tooth to functionality and to esthetically rehabilitate it, which forms the core of esthetic dentistry. Modern advancements have led us to various esthetic treatment options. Recently, due to the boom of information technology, we are progressing into the digital age where everything has almost been made through computers and the internet. In the dental field, advanced software is being used to modify and create smiles, thereby completely revolutionizing esthetic dentistry. Digital smile design is a recently introduced concept and software which analyzes the smile of an individual through various input scanners and photographs. They provide a plethora of solutions and predictions as to how the smile can be designed, to the point it can pinpoint minor corrections. Here, we discuss the importance of smiles and the analysis using digital smile design.

Smile Analysis: Diagnosis and Treatment Planning.

Smile design is defined as the process of creating an esthetic smile based on scientific and artistic guidelines established through studies, perception, and cultural and racial standards that have been recognized over time. Smile design is a dynamic field with evolving trends that take into consideration: facial esthetics, lip dynamics, pink and white esthetics, and personality. Traditional smile design focused on the orodental complex. Modern smile designers must have a global understanding of the entire patient to design the perfect smile.

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.

Conventional and Digital Workflow Planning for Maxillary Teeth Restoration with Porcelain Laminate Veneers: A Clinical Report.

Nowadays, media-influenced patients have the desire to "extremely rapidly" alter their teeth to "ideal" and "too bright" ones. Although some esthetically demanding cases need to be thoroughly planned and treated through prolonged phases, other cases can be handled quickly. In such cases, we can witness the impact of many computer software programs for digital smile design that have penetrated clinical practice. This clinical report describes a conventional and digital step-by-step treatment workflow for restoring anterior maxillary teeth with porcelain laminate veneers. Two digital smile design software (GPS and Nemo DSD 3D) were utilized and compared with the conventional workflow. Feldspathic veneers were chosen for their superior optical properties. Case complexity and operator's experience played a significant role in the selection between the conventional and digital workflow. The advanced digital programs, while having many advantages, are not necessarily superior to the traditional technique. The digital smile design programs used in this case demonstrated an effective and predictable workflow. They can achieve comprehensive digital smile design with a satisfactory esthetic outcome, yet the conventional workflow gave conservative and esthetically pleasing results.

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.

Predictable digital restorative workflow for minimally invasive esthetic rehabilitation utilizing a virtual patient model with global diagnosis principle.

OBJECTIVE: The conventional anterior esthetic treatment protocol is limited as it's time consuming and unreliable. A predictable digital workflow for minimally invasive anterior esthetic tooth rehabilitation with global diagnosis principle has been introduced in this report. CLINICAL CONSIDERATIONS: A 23-year-old female patient with the chief complaint of unsatisfied shape and color of her anterior teeth visited our hospital for restorative consultation. Three-dimensional Digital Smile Design was used to integrate into a virtual patient model to provide rehabilitative esthetic planning with global diagnostic principle. 3D printer was used for communication and guidance preparation. Digital impression and computer-aided design/computer-aided manufacturing technologies were adopted for making the morphology of designed restorations that can precisely transfer to definitive prostheses. The esthetics, functional occlusion, and gingival tissues remained stable for over a follow-up period of 3 years. No signs of fractures within the restorations were observed. CONCLUSIONS: Minimally invasive anterior esthetic tooth rehabilitation can be readily achieved using a predictable digital workflow with global diagnosis principle. CLINICAL SIGNIFICANCE: This digital approach might promote diagnosis, enhance communication, reduce processing time, and increase the predictability of final outcomes with high comfort and esthetic effect.

Multidisciplinary design: Creating a common perspective in complex cases.

OBJECTIVE: This clinical report describes and illustrates digital treatment planning and interdisciplinary orthodontic, surgical, and prosthetic treatment in a highly complex clinical case. CLINICAL CONSIDERATIONS: Analogue design protocols through wax ups are highly variable, technique sensitive, and operator dependent. Digital smile design and treatment planning tools facilitate simplified processes through the use of natural tooth libraries, based on the specific esthetic and functional needs of the individual patient. The vast information compiled in the virtual patient and the treatment plan consolidated in the initial digital design facilitate true interdisciplinary treatment planning and execution, with all dental specialties involved, from orthodontic to surgical and prosthetic treatment. CONCLUSIONS: Digital protocols and design tools provide clear clinical roadmaps for increased efficiency, precision, and predictability, vastly improving the quality of interdisciplinary patient care. CLINICAL SIGNIFICANCE: While analogue protocols are technique sensitive and largely dependent on the operator, digital smile design, and treatment planning tools offer opportunities for truly patient-centered individualized care and interdisciplinary treatment.

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.