Using Digital Design Software to Guide Esthetic Treatment
Practicing digital dentistry with imaging, design software, and in-house 3D printing has brought many tangible benefits to my practice. In addition to enhancing the predictability of my cases, it has greatly increased my case acceptance rate by allowing the patient to see what their new smile could look like. In 2019, when I still relied heavily on a traditional lab workflow, I spent $40,000 on wax models, and less than 50% of those cases moved forward. In 2021, after adopting a digital workflow that includes exocad’s open-architecture CAD software platform, I spent almost nothing on waxups and my case acceptance was 95%. This digital workflow increased productivity and communication between myself and my ceramist. The patient was no longer debating whether to move forward, but how far they’d like to go with their treatment.
With exocad’s DentalCAD software, I’m able to show patients their smile design and gain their approval at their first visit, as opposed to ordering a lab-generated stone cast that does not help the patient decide on their treatment. The ability to show a 3D digital design of the desired esthetic outcome and explain how to achieve it through the least invasive means has also resulted in many referrals from specialists who want the patient to be able to view their options and decide how to proceed.
Case in Point
Recently, an orthodontist referred a patient who was unhappy with her front teeth, which she described as crooked. She had undergone clear aligner treatment and was not interested in further orthodontic intervention. She felt that her bite had improved but was still not ideal. She had older veneers on Nos. 7–9 that needed to be replaced, and a crown on the endodontically treated No. 10. She had a midline cant in need of uprighting, a midline shift of 3 mm, and a size discrepancy between Nos. 8 and 9. The question was whether to proceed restoratively with new veneers or take a more conservative approach by aligning the teeth orthodontically before adding veneers without removal of tooth structure.
After taking a full-face photo and an intraoral scan of both arches, I developed a facially driven treatment plan in exocad for review during the patient’s initial appointment. Being able to evaluate the esthetic relationship between the proposed smile and the face within the software is especially important when adjusting the midline. The digital design also allows us to determine how much tooth structure would be removed, helping us decide on the course of treatment.
Creating the New Smile
My treatment plan called for moving the midline 1 mm—any more than that would cause unwanted damage to the tooth—and uprighting the cant to help harmonize the smile. The 4 existing restorations would be removed and replaced with temporaries that mimic the new midline and shape. At that point, the patient could evaluate the result and decide whether to proceed with the restorative plan, bypassing further orthodontic treatment. Otherwise, she would go back to the orthodontist with temporary veneers.
Because the patient was, in fact, thrilled with her new appearance after wearing the temporaries for several weeks, we moved forward and expanded the restorative plan to include preps of Nos. 5, 6, 11, and 12. Ultimately, the patient received porcelain veneers on all 8 teeth during her final visit.
In the end, the patient received the complete smile that she wanted, thanks to our ability to diagnose and treatment plan predictably using digital design software and following a workflow absent of the risks and inconvenience of the traditional approach.
EXOCAD DENTALCAD
exocad DentalCAD is the leading OEM-branded dental CAD software—great for beginners and even more powerful in the hands of an expert. The software is known for its speedy operation and ease of use, helping to minimize training costs and maximize productivity. It is reliable and robust, even for solving complex cases on a daily basis. DentalCAD’s core version supports the design of various esthetic and functional dental restorations and appliances based on individual anatomies and requirements. Service offerings are easily extended with one or more of exocad‘s fully integrated add-on modules.
Dr. Tadros is an accredited member of the American Academy of Cosmetic Dentistry (AACD), and a fellow in the Academy of General Dentistry and the International Congress of Oral Implantologists. She has been listed among America’s Top Dentists in 2015- 2018, honored as one of America’s Top 40 Under 40 Dentists in 2020, and is a Kois Advanced Center Trained Dentist who practices minimally invasive dentistry and thorough risk assessment for each case. She practices in Fort Lauderdale, FL, and is currently the boardcertifi ed dentist of the Academy of Cosmetic Dentistry in Fort Lauderdale.
