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Use of DSDApp as a treatment planning tool for Invisalign Aligners and Porcelain Veneers

Case Report by:

DR. Alysson Resende, DDS
DR. Felipe Saliba, DDS
DR. Diogo Alves, DDS

A 30 year-old female patient sought dental treatment at AR Odontologia, a DSD Clinic located in Belo Horizonte, Brazil complaining about her dissatisfaction with the harmony of her smile and posterior crossbite. (Fig. 1).

An examination and full mouth radiographs revealed no cavities and no evidence of any endodontic or periodontal pathology. There were no signs or symptoms of temporomandibular joint disorder. On the posterior left side a cross-bite was observed and the dental midline slightly shifted to her left side  (Fig. 2A, 2B).

Figure 1

Initial photo (note posterior left crossbite + disharmony of smile)

Figure 2A

Retracted lateral picture showing posterior crossbite

Figure 2B

Retracted frontal  showing dental midline slightly shifted to the patient’s left side

A correct oral hygiene instruction was performed followed by digitalization of the upper and lower arch of the patient (Fig. 3). After scanning, one frontal facial smiling photo was taken of the patient to simulate the smile with DSDApp (Fig. 4). 

Figure 3

Upper and lower arch
Intraoral scan .STL file

Figure 4

Frontal Facial Smile Picture

DSDApp Smile Simulation

The app calibrated the patient’s picture following the facial flow concept (Fig. 5)  and a smile (selected from one of the natural smile donator libraries [Jan Hajto F07] by the doctor) was then superimposed on the patient’s picture. The patient was shown the smile simulation case presentation with before and after photos using DSDApp. Once shown the transformation, she was immediately appreciative and instantly approved the case (Fig. 6A, 6B).

Figure 6A

2D Smile Simulation Before and After

Figure 5

Auto Calibration + Facial Flow concept applied

Figure 6B

2D Smile Simulation Before and After Slider

DSDApp 3D Smile Design

To create a 3D Smile Design, the upper intra-oral scan (.STL file) was calibrated into the App (Fig. 7) and a frontal facial smiling photo and a digital impression (.STL file) of the patient were reconciled (Fig. 8). The facial guided smile frame was created by using the recurring aesthetic dental (RED) proportion, (width and length ratio proportion), arch curve, teeth proportion, and design and the same smile donator [Jan Hajto F07] was used for 3D Smile Design (Fig. 9) which was then converted to a 3D project for digital teeth mounting (Fig. 10A, 10B). To fine-tune the project, digital waxing was applied to get better accuracy of the future smile (Fig. 11A, 11B).

Results

The 3D Smile Design was then presented to the patient, with the goal of involving her to be a co-designer of her own smile (Fig.12A, 12B) and then exported from the app (as 3D project which is a STL file) and imported to a CAM software to create and 3D print a mock-up. An impression of the mock-up was done using addition silicone. The mold was then filled with bysacryl resin and place onto the patient’s teeth. When shown to the patient, it created an emotional attachment to the design as well as a wow factor. ( Fig. 13).

The documentation of the 3D design project was sent to Invisalign along with the Invisalign protocol to create the trays for the orthodontic treatment bases on the reserved treatment planning. Twenty-eight trays of Invisalign aligners were used with the purpose of correcting the position of her posterior cross-bite and dental midline. At the conclusion of the Invisalign treatment, the patient’s mouth was rescanned and the new scan in conjunction with the DSDApp 3D project was sent to the DSD Planning Center where an Ideal digital wax-up was created to replicate the final smile.

Ten minimally invasive porcelain veneers were placed going from upper left second premolar to upper right second premolar harmonizing the patient’s facial esthetics ultimately resulting in the patient’s satisfaction.( Fig. 14A, 14B, 14C, 14D) The combination of DSDApp, Invisalign Aligners and the DSD Planning Center are useful tools and resources used to achieve satisfactory esthetic and predictable results.

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