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CADCAM international magazine of digital dentistry

08 I I special _ digital smile design spontaneous smile, which was captured during dynamic recording. In this particular clinical case, hadwebasedourtreatmentplanonthesocialsmile photograph, we would have failed to visualise the display of the mandibular incisors, which showed unpleasant stains. Thenextstepwastoanalysethepatientfromthe facial perspective based on the details of her teeth. The digital smile design (DSD) concept diagnoses aesthetic problems from a facial perspective and, based on a simplified digital analysis of a few pho- tographs, proposes treatment options and assists with communication between the various special- ists in the team. Thefirststepistodrawahorizontalandavertical line. The photograph is centred, moved and rotated until the bi-pupillary line is horizontal. The facial midline is subsequently ascertained. Then the same lines are superimposed on to a similar photograph, which has also been centred, but this time taken with lip retractors in place (Figs. 5a–c). The same photographs are then magnified and analysed (Figs. 6 & 7). The upper lip line is re- created and then superimposed on to the photograph taken with lip retrac- torsinplaceasreferenceofitsposition (Figs.8&9).Thenthetoothproportions are measured and their ideal contours are drawn (Figs. 9 & 10a). The isolated situation can be seen in Figure 10b. Aphotographtakenfromthe12o’clock position is used for the analysis of the labio-palatal position of the teeth and superimposed on to the analysis done previously (Fig. 11). Once the clinician is clear about the treatment possibilities and limita- tions, a digitally designed mock-up can be created. This procedure reduces chair time dramatically and increases patient acceptance. Owing to easily accessible software such as Microsoft PowerPoint and Keynote, these effects are easily and quickly created by anyone with minimal training. Recently, new software has been released that simplifies the procedure even more, DSD software for iPads (www.digitalsmiledesign.com). The procedure is based on overlapping certain areas of the teeth in the manner previously described. The result can be seen in detail in Figure 12 and the display in Figure 13. A comparison from the facial perspective be- tween the preoperative situation, the traditional mock-up and the digital mock-up can be seen in Figure 14. Traditional indirect mock-ups are made from a previously created wax-up from the labora- tory. First, an impression is taken and a stone cast isthenfabricated.Afterwards,thetechnicianwaxes the necessary teeth depending on the instructions given by the clinician. The next step is taking an impression from that wax-up. The excess is removed and a flowable self- or dual-curing composite material (usuallybis-acrylicbased)isappliedto the silicone guide and then placed in the patient’s mouth. After a few min- utes, the excess is removed and the patient is able to see the changes and the clinician is able to evaluate the proposaldirectlyinthemouth.Gener- ally, photographs are taken of the new situation and analysed. The option of a digital mock-up is much simpler. Once the final forms have been cre- ated, a photograph is superimposed on to them, and the texture of the new teeth is created. As seen in Figure 14, the results of the traditional and the digital methods are similar and it is difficulttodifferentiatebetweenthem. CAD/CAM 4_2014 Fig. 15 Fig. 14 CAD0414_06-10_Mahn 14.11.14 13:34 Seite 3 CAD0414_06-10_Mahn 14.11.1413:34 Seite 3

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