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Authors :Dr. Pratibha Katiayr, Dr. Marium Ali.

Abstract

As the world becoming more image conscious people are increasingly on the work out for the ways and means of enhancing their natural beauty. Today, esthetic in any field of dentistry is not just a visual satisfaction but a gratification of all the senses. No longer are people satisfied with just looking good it must be coupled with complete feeling of total well being. Esthetics has evolved to become a multidimensional concept with a longer functional aspect to it.

New technique called DIGITAL SMILE DESIGNE has emerged as multi-use conceptual diagnostic tool to widen the dental team’s diagnostic vision.

Introduction

The Digital Smile Design (DSD) is a multi-use conceptual tool that can strengthen diagnostic vision, improve communication, and enhance predictability throughout treatment. The DSD allows for careful analysis of the patient’s facial and dental characteristics along with any critical factors that may have been overlooked during clinical, photographic, or diagnostic cast–based evaluation procedures. The drawing of reference lines and shapes over extra and intraoral digital photographs in a predetermined sequence can widen diagnostic visualization and help the restorative team evaluate the limitations and risk factors of a given case, including asymmetries, disharmonies, and violations of esthetic principles.

DSD sketches can be performed in presentation software such as Keynote (iWork, Apple, Cupertino, California, USA) or Microsoft PowerPoint (Microsoft Office, Microsoft, Redmond, Washington, USA). This improved visualization makes it easier to select the ideal restorative technique.

Planes and Position used in Esthetics

Postural head position (PHP):- Optimal position to evaluate frontal plane and to see any facial disproportion and any existing disharmony in interpupilary line,incisal line,and facial proportion.
Facial midline:- To define symmetry of face and dental midline. Land marks used to define facial midline are glebella, tip of the nose and menton.
Inter pupillary line:- Best horizontal reference plane to determine incisal plane, gingival plane,and occlusal plane.
Ricketts E plane:- From tip of the nose to chin to determine esthetic lip position plane

Fig 1.

DSD WORK-FLOW

Forming a cross:- By Placing two lines perpendicular to each other at the centre of slide and the Facial photograph with teeth apart should place behind the cross to determine ideal horizontal plane and vertical midline (Fig 1).
Digital facebow:- To determine best horizontal reference plane after analyzing face as a whole (eg. INTERPUPILARY LINE) along with facial mid-line according to facial structure like glebell,.nose and chin ( Fig 1).
Dragging of horizontal line over the mouth to evaluate relationship of the facial line with the smile, dental mid-line ,occlusal plane shifting and to detect canting (Fig 2).
Smile simulation:- Performed by croping of images of teeth and placing them over the smile photograph and correcting gingival level, lenth,and canting of anterior teeth (Fig 3).
Transfer of cross to intra-oral retracted image:- Its performed to analyze its accordance with facial references by drawing three lines over the smile image and to calibre four features over the image (Fig 4).
  • LINE ONE- From tip of the canine to the tip of contra-lateral canine to calibrate size and canting on photograph
  • LINE TWO-From middle of incisal edge of right central to middle edge of left central to calibrate incisal edge position.
  • LINE THREE- Over the dental midline, from the tip of mid-line interdental papilla to the incisal edge embrassure to guide dental midline position.

Fig 2. Fig 3. Fig 4.

Measuring tooth praportion (length and width) and tooth outline:- By placing rectangle over edges of both the central incisor and compare it with ideal proportion of the tooth. The selection of tooth shape depends upon morphopsychological interview and the patient desire, facial fearures and esthetic expectation of the patient (Fig 5).
Digital ruler calibration over intra-oral radiograph:-This can be done by measuring the length of central incisor on the stone cast and then transfer to the computer to calibrate digital ruler and to decide if any measurement needed over anterior area of image (Fig 6).
Transfering cross to the cast:- By placing horizontal line above the gingival margin of the anterior teeth. This distance then measured using digital ruler and transferred to the cast with the help of the caliper (Fig 7).
Transfer vertical line from image to the cast:- By measuring distance between dental midline and facial midline at the incisal edge and transferred to cast with the help of caliper (Fig 8).

After drawing the cross on the cast, now it’s possible to transfer any information regarding gingival margin, root coverage, crown lengthening, incisal edge position, and tooth width.

Fig 5.

Fig 6.

At this stage with all information the technician will need to develop a precise wax-up available on both cast and slides.

The next important step is to evaluate the precision of DSD protocol and diagnostic wax-up to perform a clinical try-in. This can be carried out using a direct mock-up or a provisional restoration depending upon the complexity of the case (Fig 9). After approval from the patient for the provisional, minimal tooth preparation done on the patient and final restoration can be given to the patient (Fig 10).
Fig 5. Intraoral radiograph adjusted to the three reference line and cross used to measure the actual length and width proportion of central incisor.Drawing the tooth outline as guided by cross and by rectanle proportion.

Conclusion

Fig 7. Fig 8. Fig 9.

DSD is a practical multi-use tool with clinically relevant advantages. It can strengthen esthetic diagnostic abilities, improve communication among team members, create a predicable system through-out the treatment phases, enhances patient education and motivation.

The placement of references lines and other shapes over extra- and intraoral digital photographs widens the dental team’s diagnostic vision and helps to evaluate the limitations, risk factors, and esthetic Principles of a given case. These critical data will lead to improved results in all phases of treatment.

Fig 10.

References
  1. Esthetics in Dentistry 2nd Edition RONALD .E. GOLDSTEN.
  2. Virtual Esthetics Smile Design Christian Coachman, Marcelo A. Calamita Winter 2014: Vol 29 No 4; 102-114.
More References are available on request.