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CAD/CAM - international magazine of digital dentistry, Italian Edition, No. 3, 2015

133_2015 special _ digital technologies It is most important to get the patient ex- pectations in alignment with the dentist before starting detailed treatment planning. We need to know what the patient wants in order to deliv- er it to the patient. To be able to communicate effectively with the patient, we need to know ourselves and we need to know our clinical abil- ities and limitations before applying our work. In my opinion, the patient experience is essential in case presentation. Clinical photos both extraoral- ly and intraorally are the first step in the treat- ment planning process. We recommend that you start with the protocol from AACD (American Academy of Cosmetic Dentistry) or DSD (Digital Smile Design by Christian Coachman). These are well documented protocols and con- tain all the basic photos needed. The photos will be used following the DSD protocol to visualise the end result to the patient and in communica- tions with specialists and the dental lab (if need- ed). The DSD protocol enables a multidiscipli- nary treatment planning process without seeing the patient in the practice. Every step is done through a free cloud-based service. It is inexpensive, flexible and easy to do. The data from the DSD is trans- ferred to a model of the patient (Figs. 1a-d). This can be done on a stone model or a digital model. With the models aligned, it is possible to make an additive wax-up with the exact proportions of the DSD. With a stone model, we make a silicone stent that is careful- ly trimmed. We fill it with a bis-acrylic material and position it in the mouth of the patient. With a digital wax-up we need to make a composite shell that is either milled or printed on a 3-D printer. The shell can be glued into position with bis-acrylics or flowable composite. With the try- in smile we take a series of photos. The photos will be used to verify with the patient that we are on the right track. If needed, the try-in smile can be adjusted until the wanted result is achieved. If we make any corrections, a new impression is taken for our final treatment plan. Fig. 1c Fig. 1d

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