Virtual try-ins for cosmetic and aesthetic dentistry

Cosmetic Dentistry has been solely based upon the physical aspects of teeth and gums. These physical aspects of aesthetics have been researched but not their underlying basic concepts.

What must be appreciated is that aesthetics is a subliminal phenomenon which has its basis on physical aspects. The physical features must first be perceived and then subjectively interpreted through a complex process before a decision is made upon its aesthetic value.

Dentists perform dental aesthetics assessment based on analyzing only certain physical features such as morphology, size, surface textures and colours, etc. To communicate this, we use:

1. Words e.g. by describing presence or lack of symmetry, balance and harmony;
2. Images e.g. by drawings, photographs and digitally manipulating photographs; and
3. Mathematics e.g. by absolute measurements, angles, proportions and percentages.

Dentists often have difficulty in integrating all this information to create a mental picture for the patient. What transpires is that the dentist and patient decide what type of prosthesis is required, then at the appropriate time measurements and models are taken and sent to the laboratory for the try-in. This is the first time the patient really sees what the dentist has in mind for them, and the discussions can occur in earnest for the next try-in. This method is not a very efficient process.

An ideal solution would be to have the patient visualise their treatment before the try-in.

Imagine your patient observing as you create their treatment on your computer screen while they progressively inform you of their thoughts. They could actually visualise their treatment options in minutes, and you do not require a computer science degree to do it. Wouldn’t it increase your efficiency, productivity and enhance your professional image?

Yaltara Software has developed such a product, by taking advantage of the digital revolution in camera technology and software design. We guide the dentist to use the classical aesthetic measurements to assess their patients which are summarised in the Table. Figure 1 demonstrates a few examples of how these lines are constructed and easily manipulated.

Table 1. Facial parameters

Yaltara’s Oral Cosmetic™ program is designed for the dentist to only take some of these measurements and the computer does the rest. These can then be used as a guide to manipulate the patient’s image to create the prosthesis and how it relates to the face. Upon agreement, print outs are made of the images and the appropriate measurements and models are sent to the laboratory for prosthesis construction.

All this can be accomplished within minutes, as the program is effective and powerful, yet flexible and simple to use.

The manipulation of the patient’s images to create photo-realistic dental treatment predictions are achieved by having a comprehensive dental gallery and customized graphic tools (e.g. Adjustable Digitised Crown Technology) to quickly simulate virtual prostheses and surgical reconstructions (Figure 2).

Our program is flexible enough to allow you to use two approaches, whichever is appropriate:

1. Dental analysis solely

This technique requires a single intra-oral photograph of the patient, which can be used to perform a range of dental treatments. Missing tissue can be digitally reconstructed to represent the results when a prosthetic or surgical approach is undertaken.

2. Facial and dental analysis

This technique demonstrates the full effects of the treatment to the patient, and requires two separate photographs: one of the intra-oral area and the other of the smiling patient.

To ensure reproducibility, the patient and camera must be set in fixed positions. The head is positioned as for cephalometric analysis; the camera is set as the X-ray machine for frontal cephalometric analysis, and a photograph is taken of the patient smiling with their teeth together. With the camera in the same position, an intra-oral photograph is taken with the lips and cheeks retracted, also with the teeth together.

The images are imported into the program and are scaled to size.

A lip aperture is created in the portrait and the intra-oral photograph is positioned underneath and then aligned to reference lines (See Figure 3). The mouth and facial measurements can be integrated and combined.

Photographs of the patient’s pre-treatment status and the projected treatment can be easily viewed on screen, providing a before and after demonstration. These images can also be printed for the patient. Data sheets can be printed outlining measurements and notes for both the clinician and laboratory.

Sound complicated? Not at all, every step is broken into simple stages that you can choose to perform or to pass over. From a simple process, a compelling result is easily achieved. The concepts behind Yaltara’s Oral Cosmetic have numerous advantages, namely:

1) Clinician’s freedom in:

a) Having a systematic approach to assess aesthetics quickly and efficiently;

b) Being far more creative with oral and facial aesthetics;

c) Depicting the aesthetic problems using professional tools;

d) Creating aesthetic solutions which are consentual and recordable; and

e) Far greater control over the construction of the prosthesis.

2) Dental Technicians

a) Receive more specific directions for the construction of the try-in prosthesis; and

b) Once the try-in prosthesis is constructed, an image can be taken to compare it to the proposed prosthesis image.

3) Patient can have:

a) The ability to visualize the clinician’s concepts;

b) Ability to contribute on the aesthetic solution as proposed by the clinician;

c) An input at the virtual try-in, before the prosthesis is inserted;

d) A record of their desires; and

e) Comparison of the prosthesis with the try-in image.

As an additional benefit, Yaltara’s Oral Cosmetic contains the tracking data common to all of Yaltara’s products that creates permanent records of patient consultations.

Conclusion

Yaltara’s Oral Cosmetic program is quick and easy to use. The benefits include the ability to record and create while improving cost efficiency and saving clinical time. It dramatically reduces misunderstandings and improves the communication between clinician, patient and laboratory.