DSDapp use for multidisciplinary esthetic planning

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.

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.

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.

The crown lengthening double guide and the digital Perio analysis

OBJECTIVE

This article describes a surgical crown lengthening double guide, which was digitally obtained to improve diagnosis, treatment outcome, and follow-up.

CLINICAL CONSIDERATIONS

The rehabilitation of anterior dental esthetics should involve interdisciplinary and facially driven planning for achieving pleasant long-term outcomes. Surgical crown lengthening is one of the most common periodontal surgery, which can be assisted by digital tools to improve surgical planning and follow-up.

CONCLUSION

The double guide for surgical crown lengthening allows the proper management of hard and soft tissues for achieving a predefined goal based on biological requirements and facially driven planning. In addition, the digital quality control allows the follow-up compared with the pre-operative condition and planned treatment plan.

CLINICAL SIGNIFICANCE

The use of digital tools allow the clinician to develop a facially driven planning with proper communication with the team and patient, leading to a shorter, more predictable, and less invasive surgical technique, reducing postoperative inflammation and increasing patient comfort.