Dental Restorative Digital Workflow: Digital Smile Design from Aesthetic to Function

by Gabriele Cervino , Luca Fiorillo , Alina Vladimirovna Arzukanyan , Gianrico Spagnuolo and Marco Cicciù 

Published: 28 March 2019

Breakthroughs in technology have not been possible without influencing the medical sciences. Dentistry and dental materials have been fully involved in the technological and information technology evolution, so much so that they have revolutionized dental techniques. In this study, we want to create the first collection of articles on the use of digital techniques and software, such as Digital Smile Design. The aim is to collect all of the results regarding the use of this software, and to highlight the fields of use. Twenty-four articles have been included in the review, and the latter describes the use of Digital Smile Design and, in particular, the field of use. The study intends to be present which dental fields use “digitization”. Progress in this field is constant, and will be of increasing interest to dentistry by proposing a speed of treatment planning and a reliability of results. The digital workflow allows for rehabilitations that are reliable both from an aesthetic and functional point of view, as demonstrated in the review. From this study, the current field of use of Digital Smile Design techniques in the various branches of medicine and dentistry have emerged, as well as information about its reliability.

In recent years, prosthetic and implant-prosthetic rehabilitation in the dental field have undergone a strong development in aesthetics and cosmetics, benefiting from both the improvement of some laboratory techniques and the definition of some anatomical criteria useful to the aesthetics of the smile. One of the most noteworthy innovations in the field of prosthetics is undoubtedly represented by the advent of computer-aided design and computer-aided manufacturing (CAD/CAM) technology, which allows professionals to guarantee repeatable and remarkable results from an anatomical–functional point of view. The accessible costs, the small size of the machines, and the relative ease of use make this method passable, even in small-scale outpatient facilities. New processing software, for example, aims to make the entire rehabilitative work-flow digital, simplifying the professional’s work and also facilitating communication with the patient. A quick search on the main informatics engine indicates all of the software available on the market—among them, an important role is undoubtedly played by the Digital Smile Design method. In this work, we will take into consideration all of the articles in the literature regarding the use of this method. This software allows for excellent communication with our patients on the one hand, but on the other, offers the clinician a tool to make the correct therapeutic choice through algorithms. Rehabilitation follows a digital pathway, and the patient can see the result even before starting. These methods allow for accurate planning and guarantee aesthetic, functional, and predictable results. The software in the medical field, 3D technology, and the bioengineering field have been working in synergy in recent years in order to produce excellent therapeutic tools. The possibility of testing three-dimensional structures virtually, before being able to build or test them on patients, is already a huge step forward; this is possible with finite element analyses, for example, with which you can test useful materials for different dental fields, from fixtures to prosthetics, to the simulation of dental movements. Digital Smile Design allows for a thorough workflow simulating the rehabilitation of a patient, simply starting with appropriately calibrated photos. The facial study is usually done using the reference lines, from which the standardized parameters have been developed for the frontal and profile views of the face. The horizontal reference lines used in the frontal view include the interpupillary and intercommissural lines, which provide an overall sense of harmony and horizontal perspective, present in an aesthetically pleasing face. However, the main limitation of this kind of therapeutic method is related to the several anatomical features involved in the rehabilitation. The treatment for giving an “aesthetic smile” to patients is related to the different anatomical areas involved in the treatments, like the teeth, gingiva, mucosa, lip, skin, and so on, which rely on symmetry, shape, and golden proportions. The purpose of this study is to evaluate the effective use of Digital Smile Design techniques in dentistry and other medical fields. These techniques are used in different medical fields, and we have analyzed and categorized all of these fields, and have evaluated the reliability and predictability of these digital techniques.

Digital Smile Design

Digital Smile Design is a method that allows us to digitally design the smile of our patients, by obtaining a simulation and pre-visualization of the therapeutic result. Patients are often found by the dentist and are immediately subjected to dental services or therapies, without the dentist himself having planned well or having shared the therapeutic project of a tailor-made smile for the patient with them. On the one hand, Digital Smile Design allows the patient to have awareness from the beginning of the therapeutic plan and for them be the first interpreter in the aesthetic and functional rehabilitation of their mouth, and on the other hand, it allows the specialist to tune in better to the expectations and needs of the patient, in order to pursue their shared goals. These protocols therefore allow for a previsualization of the clinical case and of the therapeutic result, and for presenting the patient, in a clear way, the usefulness of being able to program the rehabilitation and interface clearly with the help of other professional figures. Being able to provide all of the data to the dental technician, or even being able to evaluate the prosthetic–implant–orthodontic rehabilitation is made simpler, by being able to communicate information about the case in a simple and digital way to colleagues.

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