19 June 2019

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DSD for a more predictable smile analysis: are software on the market comparable?

Lorenzo Breschi

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Today there is an increasing number of patients demanding for highly aesthetic treatments and cosmetic dentistry is increasingly becoming an issue of concern to people who desire to improve their smile. Cosmetic dentistry integrates all the areas of dentistry; therefore, a comprehensive aesthetic evaluation in every clinical case is necessary in order to choose the best treatment approach.
The fundamental criteria for aesthetic analysis should include facial, dentogingival and dental esthetics. A detailed analysis of patients' smiles and faces, can be performed through a traditional wax-up or using a more modern image software to obtain the so called Digital Smile Design (DSD). DSD is a new tool that allows aesthetic analysis, virtual treatment planning and pre-visualization of the final therapy through photo editing and/or 3D scanning of patients’ mouth. Furthermore, digital smile design improves the communication between the dentist, the dental technician and the patient, thus, ensuring a more predictable outcome for each individual patient.

Different software can be employed for DSD and some of them have been properly created for dentistry purposes and sold as specific digital smile design software to be used in the dental field. Among them, the most famous are:

• Smile Designer Pro,
• Aesthetic Digital Smile Design,
• Cerec SW 4.2,
• Planmeca,
• Romexis Smile Design,
• VisagiSMile,
• DSD App by Coachman.

However, also non-specific programs, like Photoshop or Keynote, could be adapted by dentists and dental professionals as DSD programs.   An article written by Doya Omar and Carolina Duarte in the late 2017, compared some of the most commonly used DSD programs and analysed their ability to assess and digitally modify facial, dento-gingival and dental smile aesthetic parameters. In the present literature review seventeen article, published from 2007 to 2017 were selected after an electronic search with several database. In order to compare the competency in aesthetic analysis of each program, 12 facial, 3 dento-gingival and 5 dental analysis parameters were considered.

According to these parameters, the number of aesthetic features assessed by each of the studied programs was counted as a score out of 20. The highest scores were observed for Photoshop and Keynote which showed that a more comprehensive aesthetic analysis can be achieved using these programs even though they are not specifically designed for dental practice. These programs could be used for analysis of complex cases that require treatment beyond single restorations and where orthodontic or surgical interventions are to be considered. Yet, their most important drawback is that a moderate to advanced degree of training is required by the dentist in order to use all the software functions needed in the process of smile design.
 On the other hand, most of the programs specific designed for dental practice seem to overlook facial aesthetic parameters and, instead, concentrate on dentogingival and dental aesthetic features. Until now, the only dental designed program that includes a more comprehensive facial analysis as a complement to the dento-gingival and dental analysis is Aesthetic Digital Smile Design software. However, the positive side of the dental software is the presence of key features that improve clinical applications and facilitate the dentists and the dental technicians and offer a less time-consuming digital workflow and a shorter learning curve. Additionally, some of them can be connected to a milling machine to complete the CAD/CAM process (Cerec SW 4.2; ADSD). Others include the concept of Visagism and design the smile based on personality traits (VisagiSMile; DSD App).
DSD programs incorporate digital technology to the smile design process and can be used as tools for diagnosis, treatment plan visualization and communication with the patient and technician. The digital process, if well employed is able to increase treatment outcome, predictability and final acceptance by the patient. However, not all the DSD programs available today provide the same competency for comprehensive analysis of the dentofacial esthetic parameters. Although this is one of the most important elements to be considered when choosing a DSD program, other factors such as ease of use, case documentation ability, cost, time efficiency, systematic digital workflow and organization and compatibility with CAD/CAM workflow or other digital systems should also be taken into consideration.