A Fully Digital Workflow for Smile Design Using Intraoral Scanning and 3D Virtual articulation

Considerable changes in the field of esthetic dentistry, allowing clinicians to perform smile design procedures with intraoral scanners and three-dimensional virtual articulation systems. These technologies are increasingly being used in clinical practice, but there is limited evidence on the accuracy, efficiency, and satisfaction with the outcomes of these technologies. The aim of this study was to investigate the smile design outcomes of a completely digital workflow that included intraoral scanning and 3D virtual articulation in comparison with the results obtained with a traditional analog approach. Sixty-two patients who needed esthetic anterior restorations were included and split into a digital workflow group (n = 31) and a conventional workflow group (n = 31). The images in the digital group were captured with the Primescan AC system and were scanned into the software 3Shape Dental System for virtual smile design and 3D-articulation simulation. The traditional group received traditional impressions, facebow transfer and plaster model articulation. Primary measures were dimensional accuracy of planned and final restorations, total workflow time, clinical appointments and patient satisfaction score at 6 months using a validated VAS. For the digitally assisted group, the mean dimensional deviation of the virtually designed model from the actual ceramic restoration was found to be 0.19 mm compared to 0.34 mm for the conventional method (p<0.01). There was a 38% reduction in workflow time, and a decrease in average clinical hours from 6.8 to 4.2. Patients treated in the digital workflow were more satisfied with a good esthetic visualization and clarity of communication (8.7 vs. 7.1 on a 0-10 scale, p = 0.03). There were no significant differences in the final restoration fit. The results suggest that the accuracy, efficiency and patient satisfaction achieved by fully digital smile design workflows are better than that of conventional analog methods.