Case #10 By Jacobo Somoza

Written on 11/18/2017
Masoud Abu Zant

DSD 2D vs Smile Design 2D/3D vs Smile Design 3D - Jacobo Somoza Institute

Many colleagues ask me why do we make two types of smile designs and when do we utilize them? And why don't I make 2D? Basically there are 3 types of digital smile designs: - 2D: the DSD of Christian Coachman or the Photoshop Smile Design by Edward A. McLaren, - 2D/3D: like the NemoDSD3D or Dental System with its 3Shape RealView function and - 3D alone: like the 3D Smile Design by Jacobo Somoza Institute. We started doing the 2D DSD 4 years ago, after we were trained Christian Coachman’s course. I am the one who thinks that Christian is a genius and has revolutionized our profession, because now many colleagues plan their cases and before they did not. But right away, we'd detected some limitations with only using the 2D: 1-the camera slightly distorts the reality, depending on the lens that we use (DSLR 60mm vs 105mm, Smartphones, etc). As an example, a photo of an arch taken with a 105mm lens tends to widen the image more than a lens of 60mm. 2-the measurements depend on the position, angle of projection, rotation and distance between the camera and the object to be photographed (person). 3-unable to correct occlusal planes, because it is necessary to introduce photos in profile to 45º. 4-the measurements taken in the 12 o’clock photo are not real. 5-insufficient information to make changes to the vertical dimension of the patient 6-unable to visualize the final result, in real time, of the patient's mouth, because they are simple 2D teeth silhouettes on a computer screen that the technician has to manually reproduce on a real and 3D model not deformed by the lens. So, at the beginning of 2015, we were trained in the operation of the Dental System at 3Dental’s facilities so that we could implement the RealView function and solve the problems we had identified. Our main problem was not being able to correct the occlusal planes in a correct way, so we introduced our first, I think great input, which were the facial photos to 45º. This enabled us to correct individually both the left and right occlusal plane and have a better relationship between the incisal edge and the lip. Today, many colleagues employ this perspective. We were the first to introduce it and publish it (on social media). We realized that the most useful prospects for the design of the smile, in addition to the frontal views, are the ones that take the position of the patient's head on two planes, like the 12 o’clock prospective,introduced by Christian Coachman, and of the 45º perspective, which we introduced. So with this type of 2D/3D Smile Design (3Shape RealView) we get: - avoid the errors of the photographic deformation because the software adjusts the scan to the photo. - we could visualize the waxup diagnosis, in real-time, and the increase in the vertical dimension. - use a large variety of dental anatomies, which were updated with the help of top dental laboratory technicians and real teeth anatomies of the patient. - use virtual articulator and many other tools. - much faster because we could have the finished design and create the printed model in the same day or the next day. Even with all of this, we continued to have problems with many cases such as with patients with large facial asymmetries, cases where teeth are very buccally positioned, cases with fixed orthodontics and complex multidisciplinary cases. So we began to develop our own Jacobo Somoza Institute 3D Smile Design Protocol based upon NemoScan, from Nemotec, among other softwares. I knew very well the NemoScan software because I participated in its development and creation. We made the Protocol public last year and presented it for the first time at the 1st Dental Campus and, internationally, at New York University, invited by Christian Coachman at his DSD Residency. So for those of you who do not only treat magazine models, as is my case, and you to treat mainly adult patients. These are the patients who have major asymmetries, because, over the years, they have acquired facial asymmetries in movement (something that no one talks about and I don't understand why), and many other problems. 2D/3D Smile Designs don't help us enough, for these patients. Below we show you a video summarizing of all this, an attached table and another post where the three systems are compared. PS: I’d like to thank to Dr Fernando Rey for his studio that helped me perform and analyze the photos so that I can verify the problems of the 2D Photo, and that we did this over a year ago.