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14 September 2023

Digital smile design workflow

By Lorenzo Breschi and Diego D’Urso


Digital technology is increasingly being adopted in the dental clinical practice, making treatments more predictable and improving the level of communication with patients. However, the clinician must possess adequate knowledge to intervene in the event of program errors and avoid that these are reflected in defects of the restoration. 

Nevertheless, before effectively implementing digital smile design, it is crucial to have a solid understanding of the proper application of traditional analog smile design techniques. Recently, Bassett and Kois have described a hybrid smile design workflow to demonstrate the incorporation of the analog methods into digital smile design programs.

Material and methods

In their paper, two clinical cases, one simple and one complex, were presented. First, an analog and digital dento-facial plan was performed to determine the maxillary incisal edge position. 

Next, a direct composite mockup was positioned on the maxillary left central incisal edge to determine the desired length. A digital program (EXOCAD) was used to design the provisional restoration based on patient’s characteristics and esthetic willingness. 

The use of the STL files made it possible to avoid the analog facebow step. The only application of these rules, however, may be too limiting. The clinician must determine the appropriate sizes of the teeth in each individual patient taking into consideration the unique arch form, lip dynamics and facial proportions. Digital technology allows a preview of each proportion choice by superimposing the protype over the existing dentition. 


With their work, the authors offered a comprehensive breakdown of the essential stages involved in managing a case, starting from the initial data collection and culminating in the design phase, utilizing in-house CAD software. 

According to the cases presentations, it's vital for dentists to not overly depend on the software algorithm when incorporating digital technology into the treatment planning process. When used appropriately, digital tools serve as a complement, enriching, streamlining and expediting the creation and execution of aesthetically pleasing, minimally invasive treatment plans.

With digital design at hand, clinicians can thoroughly assess the restorative treatment plan, ensuring it adheres to the principles of minimally invasive procedures. This assessment becomes possible due to the advantages of digital tools, allowing for meticulous evaluation and optimization of the proposed treatment approach.

Bassett J, Kois JC. "Creating a hybrid smile design workflow: The analog brain drives the digital technology." J Esthet Restor Dent. 2023 Jul;35(5):773-786. doi: 10.1111/jerd.13101. PMID: 37462144.

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