International Journal of Esthetic Dentistry (EN), 01/2021

Every human smile is unique and special, reflecting the different shapes, textures, and colors of the teeth as well as their combinations. This uniqueness conveys a direct and specific message when it comes to creating a new smile design. Dentists need to consider the ‘unity of the whole’ concept in this task, which involves bringing together biology, structure, function, and esthetics to create the fifth dimension of the smile. This approach is quite different from the traditional one. A smile reflects the personality and emotional state of the patient, and the translation of this into a new smile design occurs in various ways. This can be performed either through analog methods or digitally; however, the use of visual language will assist the dentist and dental technician in the creation of a personalized smile design. Nowadays, with the significant digital advances that have occurred in dentistry, there are systems on the market that help the dental team to create a personalized new smile design for each specific patient. The Rebel system is one example of such a system. It is actually a virtual laboratory that creates individualized smile designs in three dimensions. The system, with its very sophisticated artificial intelligence (AI)-based software, immediately creates a digital wax-up (STL file). It is therefore simple to use for dentists and dental technicians at all skill levels because the direct mock-up and wax-up stages are eliminated.

New digital tools facilitating data acquisition, team communication, computer-assisted diagnostics, and treatment planning as well as the design and fabrication of restorations, guides, stents and devices in general have fundamentally altered key clinical and laboratory steps. The number of new technologies and the amount of new equipment used today to acquire patient data, the software to manipulate this data, and the machines to manufacture devices from it drastically increases all the time, as do the challenges of integrating these systems into a feasible, realistic, and practical workflow. Creating a simple complete digital workflow is key to taking advantage of these digital opportunities and offering their benefits to all patients. Making digital workflows the routine rather than the exception is fundamentally important in order to grow a dental practice in this new environment. This article presents a new complete digital workflow that changes and improves the process of treating a comprehensive case from diagnostics to execution and maintenance.

Excessively worn dentition is a clinical condition that mainly impacts the esthetic appearance of patients. In many cases, this may even extend to affect their psychologic condition and social interaction, and consequently reduce their quality of life. The treatment steps of such cases involve comprehensive evaluation and diagnosis, a rigid rehabilitation plan, and a careful and well-structured treatment execution. To facilitate long-term success, patient compliance and a strict recall program should be implemented. The case report presented in this article provides a step-by-step description of the treatment of an excessively worn dentition with the aid of the digital workflow.

Many clinicians are unsure of how to develop a comprehensive plan of treatment for patients who present with multiple problems and pathologies. In order to efficiently plan appropriate treatment for such complex patient cases, the clinician needs to either have or develop the necessary knowledge of evidence-based information on the predictability of available clinical procedures. The clinician also needs to understand the correct sequence in which such treatment is applied, and perfect the skills required for carrying out that treatment. Since most clinicians have not acquired all the knowledge and skills necessary for this task, an interdisciplinary approach to treatment is typically required. This article provides a practical step-by-step approach to planning comprehensive interdisciplinary treatment focused primarily on the teeth as they relate to each other and to the structures that surround them. The approach is based on the answers to six questions that are grouped into three steps: 1) evaluation of the teeth relative to the face and lips; 2) assessment of anterior tooth dimensions; and 3) analysis of the anteroposterior and maxillomandibular relationships. The information obtained must then be related to the patient’s skeletal framework, periodontal status, caries susceptibility, and biomechanical risk assessment in order to formulate a clear and complete plan of treatment.