Home

Cases
Community
Events
Shop
Philosophy
Suggestions
Our friends
Contact

SHADEGUIDES
ENDODONTICS
ORTHO AND KIDS
DIGITAL
PERIO

CASES
Restoration of worn teeth with composite resin additions
SHOP
UPCOMING EVENTS
DENTIST COURSE: Inlay/ Onlay restoration of lateral teeth
CASES OF THE WEEK
Jan 18 to Jan 24

Adam Zawadka
Marc Kaloustian
Marino Sutedjo
Ivan Mirovic

LATEST ARTICLES
That Quirky Lateral
TESTIMONIALS
Romain Elie Thank you, you are a real source of inspiration, always pushing me to
do better!
FACEBOOK

Styleitaliano

TWITTER
Tweets por el @styleitaliano.
Founders

Walter Devoto
Dr. Walter Devoto Born in Chiavari on 29/03/1965 graduated in Dentistry in 1991
at Genova University.
Angelo Putignano
M.D. degree and D.D.S. post graduate certificate from University of Ancona-
Italy.

Members

Monaldo Saracinelli
Ive been a student of prof. Fabio Toffenetti and Riccardo Garberoglio.
Jordi Manauta
Was born in Mexico City, where he graduated cum laude. in dentistry from
UNITEC.
 Daniele Rondoni
Born in Savona in 1961 where he lives and has worked in his own laboratory
since...
Vincenzo Musella
Vincenzo Musella graduated in dental technician. Proud friend and student of...
Giuseppe Marchetti
Giuseppe Marchetti was born in Parma (Italy) in October of 1972 and graduated
from...
Simone Grandini
Chair of Endodontics and Restorative Dentistry, University of Siena, Italy.
Giovanna Orsini
Giovanna Orsini is a well known researcher in Italy and internationally.
Paulo Monteiro
My passion for esthetic dentistry began when I attended the last year...
Louis Hardan
Head of Restorative and Esthetic department in Saint-Joseph University in...
Patrizia Lucchi
Patrizia Lucchi Graduated in Dentistry cum Laude in 1995 at the University of
Verona
Anna Salat
Dr Anna Salat graduated with a degree in dentistry from the International
University of Catalonia
Giulio Pavolucci
After graduation magna cum laude in Dentistry, I started focusing my daily work
on...
Marcos Vargas
Dr. Marcos Vargas attended Cayetano Heredia University School of Dentistry in
Lima...
Stefan Koubi
Dr. Koubi graduated from University of Marseille where he...
Engin Taviloglu
Dr. Taviloglu graduated from ?stanbul University School of Dentistry in...
Dimitar Filtchev
Co-founder of the Laser Dental Center and the Implant...
Angie Segatto
My commitment to arts has determined my specialisation.
Gregory Camaleonte
I was born in 1980 in Marseille-France and i have graduated in 2006 from...
Caroline Werkhoven
Caroline Werkhoven graduated in 2002 at ACTA, the dental faculty in Amsterdam..
Ajay Juneja
Ajay Juneja finished his BDS in the year 1995...
Carlos Fernndez Villares
Member of SEPES Spanish Soc...
Sulivan Leite
Sulivan Leite graduated from the Ribeirao...
Giuseppe Chiodera
My name is Giuseppe Chiodera , i was born born in 1979 in Brescia .
Maciej Zarow
Author of book edited by Quintessence: Endo-Prosthodontics: guidelines for
clinical practice ...
Dan Lazar
Dan Lazar, graduated from the Faculty of Dentistry in 2005 in Cluj-Napoca...
Murad Akhundov
Dr. Murad Akhundov graduated from the Faculty of Dentistry in Baku...
Janos Grosz
Graduated summa cum laude in 2006 from the University of Szeged, Faculty of
Dentistry, Hungary...
ARTICLES - BACK - NEXT
Dimitar Filtchev

Indirect Anteriors

Aesthetic Rehabilitation According to the Visagism Concept

14454 Views - Jan 2017

Download PDF

218

0
Favourite
Watch later

Nowadays the peoples demand and level of information has driven the clinicians to
a certain questioning about customization, especially about planning, according to
the individual psychological characteristics, that if ignored, may lead to
dissatisfaction, even though all the classical rules which tend to establish
standards are being used.

In aesthetic dentistry are used concepts, techniques, and materials by which

dentists could establish new smiles with minimally invasive approaches and maximum
natural effect on the restorations and in the same time to restore the mastication
and phonetics, for a better quality of life.

Besides the aesthetic rules established throughout time, the emotional expression
of the treatment, represented by the shapes and lines constituent of a smile,
should also be taken into consideration of creating a customized and personalized
treatment planning.

The concept of visagism may help dentists to do restorations that correspond not
only to the aesthetic but also to the psychological features of the created image
which affects the emotions, identity, behaviour and confidence of the patient. On
the other side these factors affect the way the patients react to the definite
treatment. [3]

These concepts recently have been applied in software such as VisagiSmile which
can help clinicians to change the smile design.

Digital Planning

For achieving an optimal aesthetic result from a dental treatment, we

need to create a suitable smile design that should create a perception which has to
fulfill the aesthetic expectations. [1] [2] It is also important that the teeth
proportions to be correctly diagnosed and designed before an irreversible
restorative dental procedure to be done. [4]

To create a personalised smile design we need to use the visagism concept.[3]

Excellent quality DSD (Digital Smile Design) software products exist on the market,
such as DSD 2D, Smile Designer Pro, Planmeca Romexis Smile Design [5][6][7].
However these solutions do not apply the visagism concept which produces a smile
design in relation to the facial type and personality of the patient which is
perceived as more harmonious.
Visagism applied in aesthetic dentistry is associated with assessment of the facial
type, which involves subjective judgment, time consuming personality test and also
complex calculations of the teeth configuration. The numerical results were then
visualized as a teeth design which served for the patient, for the dentist and for
the dental laboratory.

VisagiSMile is a software that automates the process of creating dental visagism

case. VisagiSMile is a multiplatform web application for aesthetic dentistry which
does not require installation, but only a simple registration process to get
started. All cases and data are stored on a server to allow dentists to work on
different devices and platforms computers, tablets and smartphones. The research
on the Visagism concept is an ongoing process which constantly changes the
requirements for the software

Two main photographs were needed: one full-face with maximal smile and visible
dentition and the other photograph of the upper jaw with retracted lips and black
contrasting tool.

The photograph in full-face with maximal smile and visible dentition uploaded in
Visagismile software were automatically placed behind the facial frame. By
marking the landmark points on the image, the software analyzed the face structure
and classiFied the face as strong, dynamic, sensitive and calm representing in
percentages.

Img. 1 Facial map with landmark points and type classiFication.

Img.2 Personality interview The optimal tooth shape was determined by an interview
(questionnaire in the software). Based on the data from the interview, a software
algorithm automatically calculates the temperament, as perceived by the patient.
The temperament is a combinations of strong, dynamic, delicate and calm.
Combination of tooth shapes conformed to individual characteristics of the patient
respectively are: strong(rectangle), dynamic(triangle),
sensitive(circle),calm(square). The patients preferences about the desired teeth
design which was also included in the calculation of the optimal teeth
configuration. The preferences include characteristics of the teeth related to
their colour, texture and shape.

Img. 3 Final design with detailed text description analysis summery of face
reading, interview and patient choice. According to the face reading the software
calculated the main parameters of the individual smile frame: incisal projetion;
tooth inclination; dominance.[9] The integration was determined by the interview
tooth shapes conformed to the personality of the patient along with the patient
choice, Finished the construction of the new smile design in accordance with the
psycho-dentofacial harmony of the personality.

Img.4 Final design digitally positioned on patients face. Created digital project
easily could be visualised on patients face in order clinician to be able to
analyse the teeth proportions, incisor edge projection and other aesthetic
parameters in relation to the patients face.

Img.5 a Initial view

Img.5 b Initial view

Img.5 c Initial view A 26 years old female patient came with the desire to enhance
the aesthetics. We have already worn out enamel which need to be preserved in order
to improve the durability of the treatment. There was an erosion on the central
incisors and the left lateral incisor. The main challenge in this case was to go
minimally invasive to the teeth structures and also to create a harmonious gingival
contour.

Img. 6 VisagSmile design preview - based on the parameters like shapes, proportions
and arrangement of the front teeth provided by VisagiSMile software digital
proposal, diagnostic wax up was made.

Img.7 Diagnostic wax up front view

Img. 8 First additive composite mock-up was based on the diagnostic wax up. A light
curing composite material was injected into a silicon key and inserted on the
unprepared teeth.

Img.9 First mock up made on the non-prepared teeth served as a powerful

motivational and communicational tool with the patient showing and explaining all
the changes that can be made as the desired final outcome. New full face and intra
oral pictures were made and all the changes were discussed with the patient by
comparing the relevant before and after mock up pictures. After the mock up was
done some parts of the composite covered the gingival margin, but other were in a
distance. This analyse helped us to plan the next step to treat the gingival
recession. After the patient acceptance the treatment and the following steps were
planned - Fixation of Five ceramic veneers, the upper central and lateral incisors
and the left canine.

Img.10 Tooth preparation trough the mock up - by using this technique of

preparation through the mock up allowed us to keep tooth structures and enamel
preservation.

Img.11 Smoothing and polishing the tooth surface was done to ensure less stress
under veneer and also a more uniform film thickness of cement. This also leads to
better adhesion.

Img. 12 a Recession treatment

Img. 12 b Result after the operation.The following stage in the treatment was the
harmonization of the gingival contour by increasing the level of the soft tissue on
the right lateral incisor. For this purpose was used the tunnel technique. By
preparing a partial thickness flap with a micro-blade to the mucogingival junction
and after that a full thickness flap, it was coronal repositioned. After completing
the healing process a final impression was taken using polyether impression
material (Impregum, 3M Espe) and sent to the dental laboratory.

Img. 13 Five ceramic veneers were fabricated by the dental technician Vincenzo
Musella.

Img.14 First try-in of the ceramic veneers - The veneers were tried after removing
the provisionals using try-in paste (Variolink Esthetic Try-in paste Neutral).
The final stage of the treatment was the fixation of the veneers.

Img. 15 Adhesive protocol - the veneers were sandblasted and then treated with
hydrofluoric acid, neutralized in ultrasonic cleaner, rinsed off and dried. After
that silanized and bonded.

Img. 16 Sandblasting the tooth surface - prepared teeth were isolated with rubber-
dam for an adequate control during the fixation process. The first step in
preparing teeth was to sandblast the surface to remove the smear layer for greater
retention.

Img. 17 The following step was to apply etching gel - phosphoric acid and then it
was carefully rinsed off and the teeth were dried.

Img. 18 Primer and adhesive (Opti Bond FL) was applied to the teeth. After multiple
coat application, the solvent in the bonding agent was eliminated blowing the
bonding agent without polymerize.

Img.19 The final fixation was done using light-curing cement (Variolink Aesthetic
Light). The complete curing was done applying air blocking gel to the teeth.
(Oxyguard Panavia)

Img.20 Final view after fixation

Img. 21 The Final result before and after the dental treatment was the creation of
harmonious gingival contour and optimal aesthetic vision.

Img. 22 a

Img. 22 b A photograph was taken 6 months follow up

Img. 23 a Side view

Img. 23 b Side view

Img. 24 Occlusal view

Img. 25 The final result

Conclusions
VisagiSMile is a novel dental software which is an: - Important guideline for the
dentist to do the direct mock up, (or concepts like DSD, SKYN etc.) - Important
guideline for the dental technicians to re-create the design wanted by the
clinicians and the patient. - Planning tool which helps clinicians to do precise,
predictable and adequate smile designs - Used in CAD/CAM technologies. The
generated design can be integrated to the digital planning of dental constructions.
- Used as an education tool to save and share cases worldwide.

Bibliography

Coachman, Ch., M. Calamita. Digital Smile Design: A Tool for Treatment Planning
and Communication in Esthetic Dentistry. Quintessence of Dental Technology,
2012,35,103 111.
Lombard, R., The principles of visua lperception and th? clinical application
to denture aesthetics., J. Prosthet Dent, 1973, 29, 358-382.
Paolucci, B., Calamita, M., Coachman, Ch., Gurel,G., Shaider, A., Hallawell,
Ph. Visagism: The art of dental composition. Quintessence of Dental Technology,
2012,1,187-200
Chu, St. A Biometric Approach To Predictable Treatment Of Clinical Crown
Discrepancies. Pract Proced Aesthet Dent, 2007, 19, 7, 401 409.
DSD Virtual Lab, DSD 2D, http://dsdvirtuallab.com/#2d, 2016
Planmeca, Planmeca Romexis Smile Design, http://www.planmeca.com/
smiledesign/digital-smiledesign/, 2016
Smile Designer Pro, https://www.smiledesignerpro.com/, 2016
Wolfrat S, Menzel H, Kern M. Inability to relate tooth form to face shapes and
gender. Jurnal of Oral Sciences. 2004, 112 ,6 :471-476.
Iliev G, Pavlova J, Filtchev D, Rangelov S, Kocheva B, Dimova M, Nasif-Macci S,
Filchev A. Types of dominance in frontal teeth in natural permanent dentition.
Dental Medicine, 2015(2), 97: 122-132.
Coachman Ch, Calamita MC. Digital Smile Design: A Tool for Treatment Planning
and Communication in Esthetic Dentistry. Quintessence of Dental Technology,
2012,35:103 111.
 Feraru M, Bichacho N, Muzella V. Individualizing a smile makeover. Current
strategies for predictable results. Journal of Cosmetic Dentistry 2016, 32(1): 109-
119.
Gurel, G., Bichacho, N. Permanent diagnostic provisional restorations for
predictable results when redesigning the smile. Pract. Proced. Aesthet Dent.2006,
18(5): 281-286.

ASK THE AUTHOR PRIVATELY

Name

Email

Message

218

0
Favourite
Watch later

SIMILAR ARTICLES

Community
Minimal Invasive Indirect Composite Veneers
Dan Lazar
Precise mock-up
Stefan Koubi
Worn dentition; The Full mock up concept
Maciej Zarow
Full-mouth composite rehabilitation in one day.
Ajay Juneja
No Prep And Minimal Prep Veneers
Maciej Zarow
Contraindicated internal bleaching: What to do?

OTHER POSTS BY THIS AUTHOR

Dimitar Filtchev
Esthetic Rehabilitation with Immediate Implant Loading

Back to top

Home
Cases
Master Courses
Community
Events
Shop
Philosophy
Suggestions
Our friends
Contact

Styleitaliano 2008-2015. All right reserved.

Privacy Policy