Modern Interdisciplinary Restorative Dentistry should start from a Smile Design project in harmony with the face and lip dynamics. Treatment planning should be a brainstorm process to try to find the best procedures to make this project possible. This means that in Facially Driven Dentistry, Smile Design should come before Treatment Planning.
Digital tools can be used to facilitate this process. Digital drawings can be made over facial photos of the patient to develop what we call the Smile Frame. A visual guide that will suggest the best 3D position of the Teeth and Gingiva according to lips and face. This 2D smile frame can be calibrated to STL files and CBCT’s. This process allows us to perform a facially driven diagnostic wax-up before even planning the case. One of the new concepts the we have been using is the utilize the cephalometric analysis to improve the digital wax-up. The cephalometric lines are very useful to suggest the best position of the incisal edge and inclination of the central incisor and also the occlusal plan.
On implant full mouth rehabilitation cases, this digital tooth setup can be overlapped to the CBCT to plan the implant position, grafting procedures and/or bone reduction. The digital setup will also be used to digitally design and fabricate the surgical guides, bone reduction guides and immediate loading prosthesis, maintaining a predictable relationship between the initial design and the final prosthetic outcome.
By Christian Coachman