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Porcelain Veneers using DSDApp as a tool for a transformative natural-looking smile makeover: A Case Report

Case Report by: 
Dr. Imad Ghandour

A 22-year-old female came to Ghandour Dental Office located in Cannes, France for a dental emergency. While going for a swim she was accidentally hit in the mouth by her friend’s foot when jumping in the pool. 

DSDApp Smile Simulation

Upon her arrival pulp vitality test exams and X-rays were taken on the fractured elements and were temporarily restored with composite resin. After two months of observation, the dental elements did not show any endodontic symptoms and the overall oral health, as well as the patient’s lips and gums, were healthy. 

The patient had been complaining about the appearance of her existing smile for some years, but due to her young age, Dr. Ghandour tried to praise the natural beauty of her smile. A few months after the accident, the patient came back into the office to express the dissatisfaction with her smile and that she was ready to start a smile makeover.

In order for the doctor to begin explaining to her the treatment options, clinical and complementary analyses were performed. Dr. Ghandour aimed to create a harmonious and youthful smile design guided by her facial structure using the 3D module in the DSDApp software.

To begin a 3D Smile Design project, the doctor took a frontal-facial smiling photo of the patient (fig.1)  to understand the patient’s facial structures, symmetry, and facial midline with the assistance of the app’s Artificial Intelligence (AI) (fig. 2). Please note: In this particular case, a motivational smile simulation was bypassed as the patient sought the dentist for a smile makeover. Dr. Ghandour created an Advanced Smile Design using the patient’s upper intraoral scan (.stl file) which was superimposed onto the picture to create the facially-driven 2D design with more accuracy (fig. 3).

Initial Smile

Fig. 2

Fig. 3

Since the purpose of the treatment was to create harmony in the patient’s esthetic smile and close the existing diastemas, to determine the arch form, an occlusal curve line was placed on the edge of the buccal cusps of the posterior teeth and incisal edge of the incisors with the goal of following the existing occlusal arch form of the maxilla. (fig.4).

Fig. 4: 

The smile frame was placed by using the recurring esthetic dental (RED) proportion (width and length ratio proportion), arch curve, and patient’s tooth proportions (fig. 5). A mix of Jan Hajto natural tooth shapes in the app were selected to create a unique smile for the patient (Jan Hajto F02, F08, F10, M08) . It was assessed that there was a need for a small gingivoplasty on the upper right quadrant elements to give an illusion of elevation of the occlusal plane and an overall smile and facial harmony. (fig.6).

Fig. 5

Fig. 6

The patient was shown the smile simulation with the app’s before and after slider and she was immediately impressed with the great difference in the appearance of her smile. She excitedly approved the case. (fig.7A,7B,7C).

Fig. 7A

Fig. 7B

Fig. 7C

3D Smile Design

The smile design was then converted to a 3D design for digital teeth mounting  (fig.8A, 8B, 8C,8D,8E,8F). To fine-tune the project, digital waxing was applied using the sculpt tool feature to further refine the model. (9A,9B)  The 3D case was then exported from the app as an .STL file and imported to a CAD/CAM software to prepare the model for 3D printing. 

Fig.8A

Fig. 8B

Fig. 8C

Fig. 8D

Fig.8E

Fig. 8F

Fig. 9A

Fig.9B

Final Results

An impression of the mock-up was done using addition silicone. The mold was then filled with bis acryl resin and placed onto the patient’s teeth for a smile test-drive. When shown to the patient, she was filled with emotion as it was what she envisioned her perfect smile to look like. (10A,10B). Minor adjustments were made with the mock-up in the mouth. (One of the many reasons a smile test-drive adds immense value is because it allows the dentist to make the necessary adjustments to perfect the smile).

Fig. 10A

Fig. 10B

After making the final adjustments of the occlusion and anterior guidances, the patient was scanned with the mockup to copy the ideal design in mouth. The scanned mockup was sent to a cad software. The test drive was then removed from the patient’s mouth and ten teeth were minimally prepped to receive the facially driven restorations.

The patient’s mouth was scanned once again and the new scan in conjunction with the DSDApp 3D design mockup project was replicated in the CAD software to perform the porcelain veneers.

Ten minimally invasive porcelain veneers were placed going from the upper left second premolar to the upper right second premolar harmonizing the patient’s facial esthetics ultimately resulting in the patient’s satisfaction. (Fig. 11A, 11B).

Fig. 11A

Fig. 11B

This entire procedure was done during one visit to the dentist’s office. Dr. Ghandour leverages his hybrid dental practice with his in-house lab to expedite the turnaround time for cases such as these.  In addition, by using DSDApp Dr. Ghandour is able to have full control of the cases originated  by him from start to finish.

Dr Imad Ghandour
Dental surgeon and master dental technician .
Digital Smile Designer Certified – DSDAPP
Mechanical engineer (Geneva)
Specialist in Dental Material .
Specialization in Aesthetic Dentistry ,Oral Rehabilitation and Occlusion.
KOL , Pilot and trainer for dentist and laboratories
International lecturer and publisher .
Dental Clinic and lab in France city Cannes

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Case Report Review: Porcelain Veneers from facially-driven Smile Design to Final-Restorations

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