Digital Smile Design-An innovative tool in aesthetic dentistry

Fully digital workflow of occlusal reconstruction treatment in a patient with congenital dentition defects

OBJECTIVE

Occlusal reconstruction is a critical intervention for patients with dental hard tissue defects, temporomandibular joint (TMJ) disorders, and jaw position abnormalities. Clinical efficiency and outcomes of these procedures have improved with advances in digital technologies. This case report aims to illustrate a comprehensive digital workflow for occlusal reconstruction in a patient with congenital dentition defects, emphasizing the application of digital technologies to enhance treatment outcomes.

CLINICAL CONSIDERATIONS

A 28-year-old woman with previously installed porcelain-fused-to-metal bridge restorations presented with a fractured prosthesis and TMJ symptoms. A multidisciplinary approach was adopted involving the use of digital facebow, intraoral scanners, digital smile design, and CAD/CAM technologies. The process included the extraction of defective restorations, temporary restorations to refine jaw position, and final permanent restorations. The digital workflow facilitated precise diagnostics and treatment, culminating in the successful installation of permanent restorations. Regular follow-ups at one- and three-months post-treatment confirmed stable occlusal function and high patient satisfaction.

CONCLUSIONS

This case report showcases the potential of multiple digital technologies to streamline complex dental treatments and achieve high-quality results.

CLINICAL SIGNIFICANCE

The integration of digital technologies in occlusal reconstruction treatments offers significant benefits in terms of precision, patient comfort, and esthetic outcomes.

Digital Planning to Enhance Diagnosis and Precision in Correcting Excessive Gingival Display in the Presence of Asymmetrical Maxillary Position: A Case Report

This case report addresses the treatment of excessive gingival display (EGD) in the context of maxillary asymmetry, zenith irregularities, and occlusal plane inclination. Digital planning was pivotal in formulating a precise treatment strategy by incorporating facial photographs, digital models, and cone-beam computed tomography data. Parameters, including occlusal plane inclination, teeth position, and lip-to-gingival margin relationships, were considered to ensure treatment alignment with the patient's facial characteristics. Notably, during the planning phase, it was evident that the conventional approach using the cementoenamel junction as the apical limit for incisions would result in asymmetry. Consequently, the gingival margin position was defined in accordance with facial and lip features. The chosen treatment, flapless crown lengthening, was tailored to the patient's thin phenotype and guided by measurements derived from digital planning. Postsurgery, the patient experienced a swift and painless recovery. A harmonious smile with a stable gingival margin position was achieved at the 1-year follow-up, seamlessly complementing the patient's facial attributes. This case underscores the importance of personalized EGD treatment and the value of digital planning in enhancing diagnostic accuracy and precise treatment planning, ultimately facilitating optimal treatment strategies.

Enamel hypoplasia with nonsyndromic oligodontia: A rare case report

Enamel hypoplasia is an exclusive ectodermal disturbance, related to alterations in the organic enamel matrix which can cause white flecks, narrow horizontal bands, lines of pits, grooves, and discoloration of the teeth. It can result in compromised oral health that causes physiological and psychological disturbances. Management of enamel hypoplasia not only includes esthetic and functional rehabilitation of the patient but also requires a positive rapport building with the patient due to psychosocial issues. The present case reports elucidate step-by-step management of 16-year-old female patient who presented with localized enamel hypoplasia with severely decayed anterior teeth, poor dental esthetics, and oligodontia of the lower teeth.

The Recent Use, Patient Satisfaction, and Advancement in Digital Smile Designing: A Systematic Review

Digital smile designing (DSD) is a concept of dentistry which combines the old and the new and becomes a different world in the world of smile aesthetics and functionality. Dental aesthetics is not just a cosmetic issue but a multidimensional part of oral health that has a great impact on psychological well-being, social life, functional capabilities, and, hence, the quality of life. To put it simply, the recognition of its significance stresses the necessity of complete dental care which is the one that combines beauty and function as well as health. This systematic review aims to analyze the recent use and patient satisfaction of DSD and to show the recent advances in DSD. A thorough literature search was conducted across the online databases for articles about the implementation of digital smile analysis in dentistry. The articles that were published between 2013 and 2023 on DSD were selected which included randomized and non-randomized trials and observational studies covering the effectiveness, advantages, and patients' opinions about the treatment. The National Institutes of Health tool was applied for bias assessment. Ten studies were selected to address the use of DSD in dentistry based on the inclusion criteria. The findings from these studies suggest that DSD is useful in improving communication, reducing working time, minimizing errors, enhancing patient satisfaction, and providing clinical adequacy for final prosthetic pieces, indicating the usefulness of this approach in dental procedures. Smile designing using digital technologies has the potential to improve dental aesthetics and treatment procedures while showcasing their reliability and clinical effectiveness.

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.

Artificial intelligence and smile design: An e-Delphi consensus statement of ethical challenges

PURPOSE

Smile design software increasingly relies on artificial intelligence (AI). However, using AI for smile design raises numerous technical and ethical concerns. This study aimed to evaluate these ethical issues.

METHODS

An international consortium of experts specialized in AI, dentistry, and smile design was engaged to emulate and assess the ethical challenges raised by the use of AI for smile design. An e-Delphi protocol was used to seek the agreement of the ITU-WHO group on well-established ethical principles regarding the use of AI (wellness, respect for autonomy, privacy protection, solidarity, governance, equity, diversity, expertise/prudence, accountability/responsibility, sustainability, and transparency). Each principle included examples of ethical challenges that users might encounter when using AI for smile design.

RESULTS

On the first round of the e-Delphi exercise, participants agreed that seven items should be considered in smile design (diversity, transparency, wellness, privacy protection, prudence, law and governance, and sustainable development), but the remaining four items (equity, accountability and responsibility, solidarity, and respect of autonomy) were rejected and had to be reformulated. After a second round, participants agreed to all items that should be considered while using AI for smile design.

CONCLUSIONS

AI development and deployment for smile design should abide by the ethical principles of wellness, respect for autonomy, privacy protection, solidarity, governance, equity, diversity, expertise/prudence, accountability/responsibility, sustainability, and transparency.

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.

Integrating digital smile design into restorative Dentistry: A narrative review of the applications and benefits

The primary goal of esthetic treatment is to ensure patient satisfaction and meet their expectations of improving their facial esthetics and smile. However, some patients may have doubts regarding the irreversible nature of the treatment. In such cases, the Digital Smile Designing (DSD) technique can be employed to educate and motivate patients. DSD is a technical tool that allows digital designing and modification of a patient's smile, enabling them to visualize the potential outcomes before the actual treatment begins. This technique facilitates visual communication and patient involvement in the smile design process, leading to predictable treatment results and higher acceptance rates. This article provides an overview of DSD in esthetic dental practice and discusses its applications, advantages, limitations, and future possibilities.

Establishment of a 3D esthetic analysis workflow on 3D virtual patient and preliminary evaluation

BACKGROUND

In esthetic dentistry, a thorough esthetic analysis holds significant role in both diagnosing diseases and designing treatment plans. This study established a 3D esthetic analysis workflow based on 3D facial and dental models, and aimed to provide an imperative foundation for the artificial intelligent 3D analysis in future esthetic dentistry.

METHODS

The established 3D esthetic analysis workflow includes the following steps: 1) key point detection, 2) coordinate system redetermination and 3) esthetic parameter calculation. The accuracy and reproducibility of this established workflow were evaluated by a self-controlled experiment (n = 15) in which 2D esthetic analysis and direct measurement were taken as control. Measurement differences between 3D and 2D analysis were evaluated with paired t-tests.

RESULTS

3D esthetic analysis demonstrated high consistency and reliability (0.973 < ICC < 1.000). Compared with 2D measurements, the results from 3D esthetic measurements were closer to direct measurements regarding tooth-related esthetic parameters (P<0.05).

CONCLUSIONS

The 3D esthetic analysis workflow established for 3D virtual patients demonstrated a high level of consistency and reliability, better than 2D measurements in the precision of tooth-related parameter analysis. These findings indicate a highly promising outlook for achieving an objective, precise, and efficient esthetic analysis in the future, which is expected to result in a more streamlined and user-friendly digital design process. This study was registered with the Ethics Committee of Peking University School of Stomatology in September 2021 with the registration number PKUSSIRB-202168136.

Aesthetic treatment planning simplified using digital smile design: A case report

Digital smile design (DSD) plays an essential role in the planning of aesthetic treatments. However, most digital smile designing software programmes are expensive and require specialised training and skill for effective implementation. This paper illustrates the use of Adobe Photoshop and Microsoft PowerPoint, which are economical and user friendly for planning aesthetics in a clinical case.

Improving the Communication of Dental Findings in Pediatric Dentistry by Using Intraoral Scans as a Visual Aid: A Randomized Clinical Trial

The aim of this first randomized clinical trial (RCT) was to determine whether intraoral scans (IOS) can be used as a visual aid to improve the communication of dental findings in pediatric dentistry. Therefore, 60 children (mean age 10.1 ± 3.3 years) and their accompanying parents/primary caregivers were examined between July 2022 and February 2023. Patients were randomly allocated to two groups: half of the participants were informed of the children's dental findings including treatment plans by verbal explanation alone (control group, n = 30), while the other half were informed using IOS (Trios 4, 3Shape) as a visual aid to support the verbal explanation (study group, n = 30). Both groups then completed a questionnaire regarding their children's diagnosis, treatment needs, planned therapy, and oral hygiene. Statistical analysis was performed using a t-test (p < 0.05). Overall, there was a significant difference between the two groups (p < 0.001) in terms of understanding the current oral situation of their children. While 85.5 ± 17.3% (mean ± standard deviation) of the answers were correct in the study group, only 57.2 ± 17.8% of the participants in the control group were capable of answering the questions correctly. In particular, the control group had difficulties answering the questions about treatment needs and therapy correctly. Within the limitations of this first pilot study, IOS can be clearly recommended as a visual aid to improve the communication of dental findings with PGs in pediatric dentistry.

Accuracy of computer-aided design trial restorations fabricated with different digital workflows

STATEMENT OF PROBLEM

Trial restorations are a versatile tool for visualizing the esthetic treatment plan and should be an accurate replica of the planned smile design. The accuracy of conventionally fabricated trial restorations has been investigated; however, studies on the accuracy of different digital workflows for trial restoration fabrication are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the accuracy of computer-aided design (CAD) trial restorations fabricated with different digital workflows.

MATERIAL AND METHODS

A patient in need of additive esthetic treatment was examined, and intraoral and extraoral photographs and intraoral digital scans were made, followed by 3D digital smile design using the exocad software program. The reference virtual design was converted into trial restorations (N=40) by using different digital workflows: subtractive manufacturing, additive manufacturing, additive manufacturing of 3D designed index, and silicone index on an additively manufactured cast. Fabricated trial restorations of all groups were scanned with a desktop scanner, providing a standard tessellation language (STL) file serving as the test data for each trial restoration. All the STL files of the test and reference data were imported into a reverse engineering software program to evaluate the 3D trueness of each workflow. Also, analog and digital 2D linear measurements (maxillary left central incisor height, maxillary left central incisor width, and intercanine width) were made to assess any dimensional alterations between the fabricated trial restorations and the reference digital smile design. A 1-way analysis of variance (ANOVA) was used to analyze the data followed by the Tukey post hoc test (α=.05).

RESULTS

For 3D trueness measurements, root mean square (RMS) values representing the deviations between the fabricated trial restorations and the reference digital smile design varied significantly among the different groups (P<.001), with the highest mean deviation found in the group of additive manufacturing of 3D designed index (0.21 ±0.01 mm), while the lowest mean value of deviation was found in the group of subtractive manufacturing (0.11 ±0.02 mm). For both the digital and analog 2D linear measurements, post hoc pairwise comparisons showed the group of additive manufacturing of 3D designed index to have significantly higher values of deviation than the other groups in all assigned measurements (P<.001).

CONCLUSIONS

The accuracy of CAD trial restorations was affected by the fabrication technique, and implementing conventional steps in the digital workflows of trial restoration fabrication may result in discrepancies that affect accuracy when compared with the reference design.

Printed Digital Wax-up Model as a Blueprint for Layered Pressed-ceramic Laminate Veneers: Technique Description and Case Report

This article presents a clinical technique for transferring Digital Smile Design (DSD) information and a digital wax-up to fabricate highly personalized ceramic laminate veneers. The hybrid workflow of digitally designed wax-up and conventional hand-crafted veneers is showcased in a female adult who sought to improve her smile due to maxillary anterior incisal wear. The ceramic veneers, layered by feldspathic porcelain, followed the contours and shade blueprint planned with the digital wax-up. The DSD improved the harmony of the facial-and-smile relationship, and the ceramic restorations fulfilled the patient's esthetic and functional demands. Guides based on the printed model with the digitally designed wax-up can provide a reference for pressed lithium disilicate veneers layered with feldspathic porcelain.

Comparison of maxillary anterior mathematical proportions among 3 dental arch forms

STATEMENT OF PROBLEM

Race and sex differences in the mathematical proportions of maxillary anterior teeth have been evaluated. However, studies exploring the relationship between the mathematical proportion of maxillary anterior teeth and maxillary dental arch form are lacking.

PURPOSE

The purpose of this clinical study was to determine if a correlation exists between the mathematical proportions of maxillary anterior teeth and 3 dental arch forms.

MATERIAL AND METHODS

Three hundred young participants were recruited according to predefined criteria, and images and maxillary casts were obtained. The perceived width and length of the maxillary anterior teeth were measured on the images by using a software program, and mathematical proportions, including width ratios and width-to-length ratios, were calculated for each. The casts were used to categorize each specimen into tapered, ovoid, or square groups by using a specific classification method, and the width ratios and width-to-height ratios of the 3 dental arch forms were compared. Statistical analysis was performed by using analysis of variance (ANOVA) or the Kruskal-Wallis H test to compare the mathematical proportions of maxillary anterior teeth among the 3 dental arch forms (α=.05). The intraclass correlation coefficient (ICC) was used to test the reliability of the investigators.

RESULTS

Except for the width-to-length ratios of the central incisor, mathematical proportions were affected by the dental arch form. The perceived width ratios of the maxillary lateral incisor-to-central incisor gradually increased from the tapered arch to the ovoid arch and from the ovoid arch to the square arch, with mean ±standard deviation values of 0.71 ±0.04, 0.73 ±0.05, and 0.79 ±0.06, respectively. For the maxillary perceived width ratios of canine-to-lateral incisor, the ovoid arch had the maximum perceived width ratios (0.86 ±0.10), followed by the tapered (0.82 ±0.10) and square arches (0.77 ±0.11). The width-to-length ratios of the central incisor were not affected by the arch form (P=.075), and the width-to-length ratios of the lateral incisor increased as the arch form became flat, with respective values of 0.70 ±0.10, 0.74 ±0.10, and 0.76 ±0.10. For the width-to-length ratios of the canine, the ovoid arch had the maximum perceived width ratios (0.58 ±0.10), followed by the tapered (0.53 ±0.10) and square arches (0.52 ±0.10).

CONCLUSIONS

The mathematical proportions varied among the 3 dental arch forms, and the dental arch form should be considered during the prosthodontic design of maxillary anterior teeth.

All-on-Four Case Rehabilitated with Fully Digitally Fabricated Prosthesis Milled from Graphene-Reinforced Poly Methyl Methacrylate Puck Using Indigenously Developed Intraoral and Extraoral Scanning Methods

Digital dentistry is disruptive to conventional methods for performing prosthetic rehabilitation. Fabrication of prosthesis for all-on-four implants involves multiple steps when done conventionally and is prone to error. The use of digital technologies such as intraoral scanners (IOS) and extraoral scanners can marginalize these errors and also reduce the chairside time. This clinical report outlined a method which used a conjunction of extraoral and IOS to collect data for implant position, soft tissue profile, and vertical and centric relations. These data were then combined and used to fabricate a hybrid denture for the patient. The hybrid denture was milled from graphene-reinforced poly methyl methacrylate puck which provided the advantages of monobloc prosthesis and the material advantages of graphene. The entire prosthetic rehabilitation was completed within three appointments.

Surgical Precision Analysis of Orthognathic Surgery Combined With Invisible Orthodontic

BACKGROUND

This study aimed to explore the changes in hard tissue after applying invisible orthodontic-orthognathic treatment and the digital design, and to explore the accuracy of the treatment effect of maxillofacial tissue after invisible orthodontic treatment and orthognathic treatment.

METHODS

From September 2020 to January 2022, 25 patients with class III skeletal malocclusion and 7 patients with class II skeletal malocclusion, were treated with invisible orthodontic treatment and orthognathic combined treatment. Orthodontic treatment with preoperative invisible orthodontic treatment followed by orthodontic surgery. All patients had cephalometric lateral films after surgery to analyze orthognathic surgery's goals and surgical effects of orthognathic surgery and the digital design. Measure the angle of the sella-nasion-A point angle, angle of sella-nasion-B point, ANB angle, maxillary convex angle, mandibular plane (MP) angle, 1-SN angle, 1-MP angle, etc, and compare surgery outcome with digital design.

RESULT

All patients were satisfied with the effect and no complications occurred. Angle of sella-nasion-A point, angle of sella-nasion-B point, ANB angle, maxillary convex angle, MP angle, 1-SN angle, and 1-MP angle had no significant difference between the postoperative effect and the purpose of digital design ( P >0.05), there was no apparent deviation between the upper and lower jaw and the chin ( P >0.05).

CONCLUSION

The combined invisible orthodontic treatment and orthognathic treatment are accurate and effective, and are worthy of promotion. It supplements traditional orthognathic therapy and is suitable for corresponding patients.

Clinical considerations in the application of direct composite for tooth wear

Various techniques are available for the application of composite to restore worn teeth. Different techniques may be chosen based on the clinical presentation or clinician preference. However, for composite to be successful, there are numerous factors which must be considered in order to optimise the outcome. Pre-treatment steps, such as isolation for optimal moisture control and adequate surface preparation of the tooth, as well as the post build-up objectives of achieving a stable occlusion, good marginal adaptation and final aesthetics, are discussed in the paper.

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.

A comprehensive technique using digital workflow to improve an unpleasant smile: A clinical report

By utilising open-source digital software, clinicians can create an integrative digital workflow composed of various technological systems. This report presents a clinical case that follows a comprehensive digital workflow to improve the smile of a 42-year-old female patient. The patient presented with minor attrition of maxillary anterior teeth and discoloured, asymmetrical composite restorations on central maxillary incisors. Her smile was rehabilitated by restoring her maxillary anterior teeth with lithium disilicate ceramic veneers. A smile design system was used to create a virtual simulation of the patient's desired treatment outcome. Utilising a 3D tooth library generated by the smile design system, extra-oral photographs, and intra-oral scans of the patient's maxillary and mandibular arches, a 3D model of the proposed smile design was created in an advanced 3D sculpting software. The resin casts that were fabricated with a 3D printer were used to fabricate a mockup and sent to the laboratory as reference for the final restoration. The specific shade recipe for the ceramic veneers was obtained using a special polar eye filter and digital shade matching software. There is no doubt that advancements in digital technology are providing clinicians with limitless treatment modalities. From intra-oral scanners and smile design systems to 3D sculpting software and even digital shade matching systems, continuous technological developments are paving the way for the complete digitalisation of dentistry. This case report presents an example of this digital revolution.

Where Is the Artificial Intelligence Applied in Dentistry? Systematic Review and Literature Analysis

This literature research had two main objectives. The first objective was to quantify how frequently artificial intelligence (AI) was utilized in dental literature from 2011 until 2021. The second objective was to distinguish the focus of such publications; in particular, dental field and topic. The main inclusion criterium was an original article or review in English focused on dental utilization of AI. All other types of publications or non-dental or non-AI-focused were excluded. The information sources were Web of Science, PubMed, Scopus, and Google Scholar, queried on 19 April 2022. The search string was “artificial intelligence” AND (dental OR dentistry OR tooth OR teeth OR dentofacial OR maxillofacial OR orofacial OR orthodontics OR endodontics OR periodontics OR prosthodontics). Following the removal of duplicates, all remaining publications were returned by searches and were screened by three independent operators to minimize the risk of bias. The analysis of 2011–2021 publications identified 4413 records, from which 1497 were finally selected and calculated according to the year of publication. The results confirmed a historically unprecedented boom in AI dental publications, with an average increase of 21.6% per year over the last decade and a 34.9% increase per year over the last 5 years. In the achievement of the second objective, qualitative assessment of dental AI publications since 2021 identified 1717 records, with 497 papers finally selected. The results of this assessment indicated the relative proportions of focal topics, as follows: radiology 26.36%, orthodontics 18.31%, general scope 17.10%, restorative 12.09%, surgery 11.87% and education 5.63%. The review confirms that the current use of artificial intelligence in dentistry is concentrated mainly around the evaluation of digital diagnostic methods, especially radiology; however, its implementation is expected to gradually penetrate all parts of the profession.

Full Digital Workflow in the Esthetic Dental Restoration

This case report presented a fully digital workflow in esthetic dental restoration. A 51-year-old female patient was referred to BDMS Wellness Clinic due to a fracture of the maxillary left central incisor. An immediate dental implant was planned to restore tooth 21 with esthetic crown lengthening of upper front teeth and new zirconia crowns for teeth 11, 12, 13, 21, 22, and 23. Digital impression was made using a digital scanner (PRIMESCAN®, Dentsply Sirona, Bensheim, Germany); surgical guide (Cerec Guide 3, Dentsply Sirona, Bensheim, Germany) was designed by using a designing software (Galileos Software, Dentsply Sirona, Bensheim, Germany) and was milled by using a milling machine (MCXL milling machine, Dentsply Sirona, Bensheim, Germany) to create a precise surgical guide. 3D smile design was done by using the Digital Smile Design (DSD) program, the crown lengthening guide was designed according to DSD designed by using a designing software (Inlab 19 Software, Dentsply Sirona, Bensheim, Germany), and the guide was fabricated by a 3D printer (FormLabs Form 2, Formlab, MA, USA). Provisional crowns (splinted) for teeth 11, 12, 13, 21, 22, and 23 were milled by using polymer (VIPI BLOCK TRILUX®, VIPI Industria, Pirassununga, SP, Brazil) using a milling machine (MCX5, Dentsply Sirona, Bensheim, Germany). The zirconia crowns were designed by using software (Inlab19 Software, Dentsply Sirona, Bensheim, Germany) and milled using the same milling machine. At the implant position, Ti-base is cemented by using an abutment (Multilink Hybrid Abutment, Ivoclar Vivadent, Schaan, Lichtenstein, Germany) with zirconia coping (Cercon base white shade, Dentsply Sirona, Bensheim, Germany) utilized as the abutment. The zirconia crowns (Cercon Xt, Dentsply Sirona, Bensheim, Germany) were sintered and characterized and then cemented. The patient was satisfied with the esthetic outcome of the treatment.

Proposal for Introducing a Digital Aesthetic Dentistry Course in Undergraduate Program: Contents and Ways of Administration

Background: Nowadays, digital dentistry is a fundamental skill that dentists need to acquire at this time. The digital workflow has gained acceptance and is widely used in most disciplines of dentistry. For this reason, it might be advisable to include this content in the undergraduate curriculum. The aim of this work was to create a course in digital aesthetic dentistry and evaluate its effectiveness. Methods: Dental students at the University of Verona (from third to sixth year) participated in a 2-h course on photography, digital aesthetic analysis, and digitally planned rehabilitations. Students were randomly divided into two groups, the first group attending the course with video tutorials and the second group attending the traditional class with slides. The students’ ability to perform digital aesthetic analysis and rehabilitation was tested. In addition, a questionnaire was completed to determine student satisfaction with the course and method of delivery. Statistical analysis was performed. Results: The course was highly appreciated, especially by the students who received the video tutorials. Good results were obtained in the performance of digital analysis and rehabilitation, which were better in the first group. Conclusions: Digital aesthetic dentistry was a success in terms of newly acquired skills. From this point of view, the proposal of a course on this subject in the undergraduate curriculum deserves a close evaluation. The video tutorial method seems to be a good way to teach operative digital procedures.

The Application of Artificial Intelligence Technology in Art Teaching Taking Architectural Painting as an Example

In the current era of technology, artificial intelligence has grown rapidly in such a way that it has established its presence in all fields. The purpose of artificial intelligence is to reduce human intervention and complete tasks with an enhanced result. In this research, we are going to study the application of artificial intelligence technology in art teaching, taking architectural painting as an example. Architectural painting is a type of painting that focuses only on architecture, including indoor and outdoor views of the buildings. In earlier stages, architecture was shown only in the background of paintings that had different objects as the main subject. Later, architecture itself became a mainstream genre in the field of painting. As has been shown by other researchers, the latest technologies such as Internet technology, wireless sensor networks (WSNs), and artificial intelligence like deep learning technologies are deployed in art teaching. Artificial intelligence has made teaching easier. This proposed system makes use of Internet technology, WSNs, artificial intelligence, and lightweight deep learning models in the field of art teaching. The teaching method is enhanced by adapting to this new technology. For performing the analysis of the proposed system, the Limited Broyden–Fletcher–Goldfarb–Shanno (L-BFGS) art algorithm is implemented. This L-BFGS algorithm focuses on finding the local minima in any given application. In this art teaching of architectural painting, the proposed algorithm will aid in explaining the minute works to be noted while doing the artwork. The proposed algorithm is then compared with the traditional Gradient Descent, Adam, and Adadelta algorithms. From the results, it can be observed that the proposed algorithm has achieved accuracy of 97% and 98% in the training and testing phases, respectively.

The Impact of Social Media Posts Concerning Esthetic Dentistry on Self-Esteem and Satisfaction Among Adults in Saudi Arabia

Background:

Social media platforms have become credible tools for spreading awareness of dental care as well as advertisements for esthetic dentistry, which may negatively affect users by leading to dissatisfaction and low self-esteem when they compare themselves with others.

Objective:

To measure self-esteem and satisfaction related to esthetic dentistry by administering a validated questionnaire to adults in Saudi Arabia, which investigates how they are affected by seeing the topic addressed on social media.

Methods:

This study investigated 515 participants living in Saudi Arabia. A self-administered validated questionnaire was electronically developed using Google Forms 2020. A link to the questionnaire was distributed through multiple social media platforms, such as WhatsApp, Twitter, and Instagram, to assess self-esteem and satisfaction resulting from the presentation of esthetic dentistry on social media platforms among adults. A pilot study was conducted to assess the validity and reliability of the questionnaire, which was modified based on feedback, as well as the results of the reliability testing.

Results:

The analysis showed that the social media platforms on which information about or advertisements for esthetic dentistry are most commonly found were Snapchat (45.8%) and Instagram (44.5%). A statistically significant association was found between the sociodemographic data, including age (P=0.00), gender (P=0.000), occupation (P=0.001), monthly income (P=0.000), and the effect of the appearance of one’s smile on willingness to post personal photos on social media.

Conclusion:

The findings suggest that seeing esthetic dentistry addressed on social media sites influences social media users’ self-esteem and satisfaction. Social media platforms should be encouraged to properly discuss common concerns and available dental treatments.

Gingival Depigmentation Using Diode 980 nm and Erbium-YAG 2940 nm Lasers: A Split-Mouth Clinical Comparative Study

Background

Gingival hyperpigmentation, “black gum,” refers to black discrete single or multiple pigments on the gingiva. Several factors may play a role in gingival hyperpigmentation ranging from physiologic pigmentation to manifestations of systemic diseases. Several techniques have been used for gingival depigmentation to lighten its color.

Methods

Fifteen patients exhibiting nonsmoking melanin hyperpigmentation, with the mean age of 28.6 ± 7.8 years, were recruited. The facial gingiva of the anterior teeth and premolars of each jaw was divided into two halves. The right or left side of each jaw quadrant randomly received either diode laser operating at 980 nm wavelength or erbium-YAG laser at 2940 nm. Parameters such as degree of gingival depigmentation, bleeding, pain, patient satisfaction, and wound healing were assessed and compared between the two techniques. The subjects were followed up to six months for melanin pigmentation recurrence.

Results

Both techniques were efficient for gingival depigmentation. Nevertheless, bleeding during surgery was statistically higher for Er:YAG laser technique as compared to diode laser. Wound healing showed statistically nonsignificant differences between the two lasers, although Er:YAG seems to give better outcomes than the diode. The patients were satisfied with both laser techniques during and after gingival depigmentation. However, the pain score was higher for Er:YAG laser than for diode laser.

Conclusion

This study demonstrated that both lasers' techniques are efficient for gingival depigmentation. However, diode laser seems to show less painful experience and relatively better bleeding control.

Accuracy of Dental Photography: Professional vs. Smartphone's Camera

There is a scant literature on the accuracy of dental photographs captured by Digital Single-Lens Reflex (DSLR) and smartphone cameras. The aim was to compare linear measurements of plaster models photographed with DSLR and smartphone's camera with digital models. Thirty maxillary casts were prepared. Vertical and horizontal reference lines were marked on each tooth, with exception to molars. Then, models were scanned with the TRIOS 3 Basic intraoral dental scanner (control). Six photographs were captured for each model: one using DSLR camera (Canon EOS 700D) and five with smartphone (iPhone X) (distance range 16-32 cm). Teeth heights and widths were measured on scans and photographs. The following conclusions could be drawn: (1) the measurements of teeth by means of DSLR and smartphone cameras (at distances of at least 24 cm) and scan did not differ. (2) The measurements of anterior teeth by means of DSLR and smartphone cameras (at all distances tested) and scan exhibited no difference. For documentational purposes, the distortion is negligeable, and both camera devices can be applied. Dentists can rely on DSLR and smartphone cameras (at distances of at least 24 cm) for smile designs providing comparable and reliable linear measurements.

Accuracy of trial restorations from virtual planning: A comparison of two fabrication techniques

STATEMENT OF PROBLEM

Different technologies have been used to fabricate trial restorations. However, studies investigating the accuracy of trial restorations fabricated with different techniques in comparison with the initial 3-dimensional virtual design are lacking.

PURPOSE

The purpose of this clinical study was to evaluate completely digital workflows for managing the esthetic outcome through the production of trial restorations with 2 different technologies: stereolithography apparatus (SLA 3D) and computer-aided design and computer-aided manufacturing (CAD-CAM). The aim was to determine which of them provided trial restorations more similar to those of the 3D virtual design.

MATERIAL AND METHODS

Thirty participants who did not meet ideal esthetic proportions for the anterior maxillary teeth were enrolled. For each, 2 intraoral and extraoral frontal photographs and intraoral digital scans were made. The digital images were processed by using the Digital Smile System (DSS) software program to have a smile preview after the treatment. Virtual designs were matched with the surface tessellation language (STL) files from the intraoral scans and edited by exocad DentalCAD to create custom trial restorations using SLA 3D and CAD-CAM technologies. Two independent examiners measured the virtual restorations by using virtual calipers in the software program and then the trial restorations by using digital calipers. The measurements were carried out from the incisal edge to the gingival margin, mesial-distal widths of the central incisors, and the distance from the distal margins of maxillary right and left canines. The trial restorations were evaluated intraorally for fit. The participants approved the definitive treatment outcome after the evaluation. The normality of data was verified with the Shapiro-Wilk test, and the Friedman test for matched groups with the Bonferroni and Dunn tests for multiple comparisons were used (α=.05).

RESULTS

Comparing the 3D designs with the printed trial restorations, a significant increase was only found in the mesial-distal width of central incisors (P<.05), while the milled trial restorations showed a significant increase (P<.05) of all measurements except for the maxillary right and left canines. Comparing printed trial restorations with the milled ones, the only significant difference was found in height measures of maxillary right central incisor, with the milled trial restorations exhibiting higher values than the printed ones (P<.05). The printed trial restorations showed good clinical fit, and the milled restorations had poor clinical adaptation.

CONCLUSIONS

The accuracy of printed trial restorations was higher than that of milled trial restorations, except for the canine to canine width of maxillary anterior teeth. However, this difference did not compromise the fit of the printed trial restorations. The milled trial restorations had increased dimensions in comparison with the measurements made in 3D designs, and consequently, their clinical fit was compromised. SLA 3D- printing technology provided the best fit.

Dentogingival Smile Analysis of Young Adults of Al Qassim Province, Saudi Arabia: A Cross-Sectional Study

Objectives. The present study aims to analyse the smiling components among young adults within Al Qassim region by evaluating typical smile parameters. Methodology. A cross-sectional study was conducted among 324 female and male participants between 18 and 35 years, within Al Qassim Province of Saudi Arabia. The dentogingival macro-aesthetic elements of the smile, the parallelism between the incisal curve and lower lip line, midline, and buccal corridors were determined by using Canon Rebel t7i (Canon, Melville, NY, USA) and evaluated by photo editing software Adobe Photoshop CC2019. The data were analysed using a chi-square test and Spearman’s correlation test for nonparametric data. Results. 62.5% of young adults had no buccal corridors. The nonparallel smile was found in 53.2% of young adults. A high smile line was observed in 33% of participants. 59.3% of young adults lacked a coinciding dental and facial midline. There was a statistically significant difference in the parallelism of the incisal curve and lower lip line as well as in the position of the upper lip line across genders ( $P<0.05$ ). Conclusion. Understanding macro-aesthetic elements of teeth and their interrelation with the surrounding oral structures can be a guide in creating natural and aesthetically pleasing restorative treatment.

Aesthetic Dentistry, How You Say and How You See: A 500-People Survey on Digital Preview and Color Perception

Purpose

Digital technologies have improved ways to perform aesthetic dentistry in the last few years. The aims of this survey were to investigate the most preferred way to preview the result of an aesthetic dental rehabilitation among a population of dental professionals and laypeople and to compare aesthetic standards of the general population and dentists in terms of the color of teeth for aesthetic dental rehabilitations.

Patients and Methods

A questionnaire was sent to the subjects (dentists and laypeople) during a 1-year period and, together with their demographic data, different ways to preview the result of an aesthetic rehabilitation were submitted, such as digital smile design, dental wax-up and oral explanation. Furthermore, an additional section of the questionnaire investigated the most suitable color for an aesthetic rehabilitation based on the colors of the VITA Scale. Results were statistically analyzed (with Chi-square of independence and Mann–Whitney U-test) highlighting differences of answers based on age groups, educational attainment, gender, and belonging or not to the dental field.

Results

Findings showed that digital smile design (digital preview) is a high-appreciated method for previewing and communicating with patients both by dental professionals and laypeople. Furthermore, lighter colors were found to be more valued by laypeople and significant differences were highlighted between the two populations assessed.

Conclusion

It seems to be viable to use digital preview for dentists and laypeople to improve previewing and communicating ways. It might be advisable to better motivate patients in recognizing aesthetical features and to raise their awareness in preferring more mimetic aesthetic results. Great opportunities are opened up by digital smile design in teaching, learning, and routine practice.

DSDapp use for multidisciplinary esthetic planning

OBJECTIVES

Digital smile design (DSD) is useful in planning multidisciplinary esthetic treatments. However, DSD requires clinician training and skill to ensure its effective use. The Digital smile design application (DSDapp) was recently developed, to facilitate such planning. The objective of this study was to illustrate the use of the DSDapp for esthetic planning in a clinical case that included periodontal plastic surgery and ceramic laminate veneers.

CLINICAL CONSIDERATIONS

An intraoral digital scan was performed, and a photograph was obtained using an iPad (frontal facial full smile). The images were analyzed using the DSDapp. All reference lines were inserted, and dental shapes predetermined by the app were superimposed on the photographs. A digital diagnostic wax-up was performed considering the plan created in the DSDapp. After 3D printing the wax-up, a mock-up transferred the planning to the oral cavity. Following this, the patient was referred to a periodontist for the periodontal plastic surgery. After the healing period, the teeth were prepared for computer-aided design/computer-aided modeling lithium disilicate ceramic laminate veneers.

CONCLUSIONS

DSDapp use accelerated the initial planning steps. Smile planning can be performed during the clinical session with the patient's active participation. In addition, the DSDapp facilitated better communication within the multidisciplinary team.

CLINICAL SIGNIFICANCE

The DSDapp relies more on intuition than on skill and training to execute the treatment plan. The DSDapp provides immediate feedback to the patient, offering greater predictability and helps monitor the planning through all the clinical stages.