Study On The Clinical Application Of Digital Smile Design In Esthetics Veneer Restoration Of Anterior Teeth

Purpose:1.Applying Digital smile design to guide the aesthetic porcelain veneer of the anterior teeth;2.To evaluate the patient satisfaction of Digital smile design in anterior teeth which were repaired with aesthetic restorations;3.To illustrate the repair effects of the combination of Digital smile design and porcelain veneers that used in anterior teeth aesthetic restoration by analyzing clinical performance.Methods:A total of 91 anterior teeth of 32 patients who admitted to the department of prosthodontics of Jilin university Dental Hospital from October 2016 to November 2017,of which clinical diagnosis conformed to the indications of porcelain veneers and needed aesthetic restoration were selected as the research objects.At the start of treatment,dental images for smile design were collected with SLR camera and then the full-face images which showed the patient’s natural smile and the intraoral full-arch images were imported into the DSD design software for preoperative evaluation.The design of the new dental profile was guided by the fundamental esthetic criteria and combined with the patient’s actual personality situation.And the virtual effect of restorations could be previewed by setting teeth morphology designed on both intraoral and full-face photographs,then the clinicians used the virtual effect design pictures to communicate with the patients to introduce the treatment planning and the digital previsualization.After adjusting the design based on the patient’s opinions,the obtained digital design was used to guide the dental technicians to make the wax-up,then the doctors communicated with the patient through the wax-up again to modify it until the results could meet the patient satisfaction.The next step was to convert the digital project into an intraoral mock-up by injecting the self-curing composite resin into the silicone index obtained from the wax-up which was positioned on the teeth.The mock-up could provide a direct clinical preview of the final restoration and could evaluate the final volume of the restoration according to analyze the esthetics effect and functions.At this moment the clinicians could adjust the design finally based on patient direct feedback.If the final results could obtain the patient’s approval,the step of teeth preparation driven by the silicone index would begin.The preparation of the tooth under the guidance of the design results was finished.The IPS e-max porcelain veneers were prepared by sending the master model and design to the denture factory after the conventional impression preparation and provisional restoration were finished.In order to evaluate the marginal adaption and color,the veneers should be tried in firstly to select the correct type of adhesives.After the adhesive program was completed,the satisfaction of the patients in the shape of restorations,the degree of coordination with the adjacent teeth,color,pronunciation,smile effect and doctor-patient communication effect were evaluated by the questionnaires.At the end of the questionnaire,the visual analogue scale(VAS)was used to score the overall satisfaction of the treatment from pre-operative communication to the final restoration luting adhesive step completed,so that patients would give the overall satisfaction of this treatment.And the patients were required to regularly return after one month,three months,six months and twelve months to observe the clinical effect of restorations with reference to the modified American Public Health Service(USPHS)standard.Results:1.Satisfaction evaluation:the satisfaction rate of the communication effect and aesthetics effect of the restorations,such as the contour of the veneers,the degree of coordination with the adjacent teeth,color,the effect of pronunciation as well as smile effect and were all over 90%.Among them,the satisfaction rate of the smile effect and the doctor patient communication was as high as possible 100%.At the same time,the average satisfaction score for this treatment process averaged 8.59±1.19,all patients’ scores were qualified above(more than 6 points),and seven patients of them(about 20%)had a satisfactory score of full mark(10 points)for the total treatment process,the satisfaction score was higher.2.Clinical evaluation:after the treatment was finished,the patients were required to regular return after one month,three months,six months and twelve months to observe the clinical effect of restorations.The clinical performances of the rehabilitations in each period were as follows:one month after treatment,there were four teeth occurred mild gingivitis situation and three teeth appeared postoperative sensitivity symptoms;three months after treatment,there were one tooth showed a minor fracture in the restoration without affecting the appearance and function and three teeth had mildly congestive gums reaction,at the same time one tooth showed slight discoloration of the restoration;six months after treatment,one tooth showed ceramics fracture of restoration and four teeth developed mild gingivitis;twelve months after treatment,two teeth showed ceramics fracture,the edge of three restorations had slightly crack and one tooth appeared gingivitis.The periodontal conditions of the patients with gingival inflammation after treatment were improved significantly after receiving the correct oral hygiene guidance.And the above defects didn’t affect the aesthetics effect and functions of the restorations,and the restorations could be used normally after intraoral adjustments.Both the doctors and the patients were satisfied with the clinical effect of the restorations.Conclusion:1.The application of Digital smile design in aesthetic veneer restoration of anternor teeth can achieve a higher aesthetic effect in the shape of the prosthesis,coordination with the adjacent teeth,tooth color,pronunciation and smiling effect.2.Applying Digital smile design to the veneer of anterior aesthetics restoration is a treatment plan which can greatly improve the communication efficiency between the doctors-patients and enhance patient satisfaction.3.Applying Digital smile design to the aesthetics veneer restoration of anterior teeth is an ideal pattern to obtain good clinical effect which could satisfied both the patients and doctors.Above all,the combination of DSD design and veneer of the aesthetic anterior teeth restoration is an ideal clinical treatment plan.