DSD is a technical tool which is used to design and modify the smile of patients (photo 1)digitally and help them to visualize it before hand by creating and presenting a digital mockup (photo 2) of their new smile design before the treatment physically starts. We can then do the physical mockup in the patient without touching the tooth.

After the motivational mockup, we can proceed the treatment for the patient smile.

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Case

A 32-year-old man presented with concerns about esthetics associ- ated with missing lateral incisors (圖1)He had received orth- odontic treatment as a teenager, which had relapsed. His chief con- cern was his unpleasing smile. He desired a treatment plan that did not involve more orthodontics and that could be completed in a short period of time and would preserve as much tooth structure as possible.

Close-up view with the interdental ruler in place showing the position of tooth No. 8 in the facial midline(Fig 2).The existing tooth positions could be accommodated with minimally invasive preparations if the dental midline was shifted 2 mm to the left (as indicated by green line)(Fig 3).The digital treatment plan allowed the patient to visual- ize and understand the compromises that a restorative-only approach would induce. He could see that the midline of the final restoration would be positioned about 2 mm offset from the facial midline, and he agreed to the placement of the midline slightly to the left of the facial midline in order to avoid orthodontic treatment. We planned to use addictive approach (1.5mm) with the reference of the lower lip position (fig 4)

With the use of Kois Dental facial analyzer,(Fig 5)，we transfer the facial midline and interpapillary line to the articulator (Fig 6), the laboratory technician fabricate the diagnostic waxup (Fig 7，8) for the mock up.

We then proceed to the mockup(Fig 1). The patient satisfied the mock up, we can start the minimally invasive treatment. With the use of waterlase to correct the gingival margin of the central incisors.(Fig 2)，then prepare the tooth minimally (Fig 3)，0.3mm reduction of the tooth, and then cemented the veneer( Fig 5 &6) Digital Smile Design Meets the Dento-Facial Analyzer: Optimizing Esthetics While

Tse Tak On Ryan, John Kois Compend Contin Educ Dent. 2016 Jan;37(1):46-50.

Porcelain veneers are a type of medical-grade ceramic shell that covers the front surface of the natural teeth. Dental veneers offer an immediate transformation for a patient’s smile. Porcelain veneers are made specifically for each patient to ensure a perfect fit. The advanced materials look very much like the natural dental enamel. 

Dentists can use dental veneers for numerous cosmetic corrections, from orthodontic adjustments to teeth whitening. Due to their lifelike and natural appearance, and their multitude of uses, porcelain veneers are among the most popular and reputable cosmetic dentistry procedures.

Indication:

• Cracks or chips
• Minor misalignment
• Gaps between the teeth
• Discoloration

Advantage: 

• Minimally invasive
• Good result
• Long life span around 10-12 years

Disadvantage: 

• Can only use in minor misalignment
• Recommended to have orthodontic treatment first for crowding case.

Porcelain Veneers Cost:

Depend on

1. Type of the veneers : Material , monolithic or layering
2. Fabrication : CAD CAM , Laboratory, factory made or by ceramist
3. Dentist experience:  It is important for patients to receive porcelain veneers from an experienced dentist. It is recommended that patients look for the dentists that will have a smile design before. Patients can look at photos of the dentist ’s clinical case and suit their desire.

Patient interaction

Smile Design is an personalized treatment, so it is essential to have the patient involving in the treatment planning. Our clinic will have the digital smile design to plan the smile of every client in facial driven approach.

Porcelain crowns are used to solve problems such as grossly broken teeth, cracked teeth, root canal tooth or replacement of the old crowns. It can be full ceramic or metal ceramic, depend on the location in the mouth. Full ceramic crowns are commonly used because of the esthetic.

Indication: 

• Root canal treated tooth
• Grossly broken tooth
• Cracked Tooth
• Replacement of old crown

Advantage:

Rigid, Esthetic pleasant, long longevity, and can change the alignment

Disadvantage:

aggressive, remove too much enamel and so it is not indicated on intact tooth

Porcelain Veneers Cost:

Depend on:

1. The material : metal ceramic / full ceramic ; if full ceramic, it also depend on the type of porcelain, layering or non-layering
2. Fabrication : CAD/ AM , Laboratory ,factory made or by ceramist

Single Crown in esthetic area
It is a common clinical situation, in our clinic, Dr.Ryan Tse will used special photographic technique, i.e. cross polarised filter and elab card, for the shade matching.

Microabrasion

The superficial brown stain in the tooth surface, can be removed by Opalustre( Ultradent Products)( photo 1)，which is 6.6% hydrochloric acid slurry contains silicon carbide microparticles. This combination provides chemical stain removal along with gentle mechanical abrasion. OpalCups latch-type bristle polishing cups are used with the Opalustre slurry for micropolishing the newly treated enamel surface.

Case:

Yellowish teeth with brown stain (photo2)。
Teeth whitening,
2 weeks home bleaching first (photo 3)，
Microabrasion by Opalustre(photo 4)。

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ICON infiltation (DMG Germany)

The enamel white spots are caused by air and water entrepments in the tooth which have a lower refractive index than intact tooth structure, which leads to unesthetic discolorations. Icon(Photo 5) balances out this difference and the appearance blends in with the healthy enamel, and is helpful for treating a variety of white spot lesion types.

Case:

The brown and white spot in the tooth surface which jeopardise the smile. (photo 6)。
The teeth was isolated by rubber dam, and Microabrasion was used to remove the brown spot first,
and then apply the ICON to remove the whitee spot (photo7)，
Treatment is minimally invasive and no need to have anaesthesia.

NIP Pini,Enamel microabrasion: An overview of clinical and scientific considerations.World J Clin Cases. 2015 Jan 16; 3(1): 34–41.

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The tooth will be discolored after root canal treatment or by traumatic extravastion of blood products.This internal discoloration can be treated by the application of an oxidant paste, a mixture of sodium perborate and 3% to 30% hydrogen peroxide placed in the pulp chamber. 

Procedure:

The endodontic material is removed and dental material is applied to isolate the chamber as a barrier. The bleaching gel is placed inside the chamber and then sealed with dental material.

The bleaching gel is replaced every week till the desired result is reached. The tooth chamber is replaced with composite resin.
The result may relapse after 3-4 years, retreatment may be indicated after.