Generally speaking, with the advent of digital cameras and imaging software, we can now simulate final treatment outcomes at a pretreatment stage. Patients’ "before" images are graphically manipulated, visualizing the dentists’ recommended treatment plans. The "before and after" images then are displayed on a computer screen and/or printed for the patients to take home and share with a friend or a family member.
This service can be utilized by every discipline in dentistry: general dentistry, periodontics, prosthodontics and orthodontics, and especially by those having an interest in esthetic dentistry (crown lengthening, laminates, crowns and bleaching, to name a few), regardless of case complexity.
As a prosthodontist myself and a user of digital imaging since the early 1990s, I find this service serves primarily as a common diagnostic denominator, qualifying the treatment desires for the patient and dentist alike. Secondarily, this service serves as a powerful marketing tool that appears to increase case acceptance during case presentations in the dental office, and facilitates communications with other clinicians and dental laboratories. For example, from my own experience, this is an excellent communication tool between the restoring dentist and the periodontist when it comes to anterior crown lengthening. The patient, restoring dentist and periodontist can all agree on the desired extent of the procedure, establishing an "azimuth" or a treatment goal.
As far as what kind of dental procedures can be simulated with digital imaging, the following is a list of the most common procedures used with this service:
- – placing anterior laminate veneers or bonded composites;
- – placing crowns and bridges (including implant-supported prostheses);
- – replacing posterior inlays and onlays;
- – removing stains or discolored restorations;
- – bleaching;
- – closing spaces (such as bonded composites, bridges, orthodontics and implants);
- – straightening and/or recontouring teeth;
- – crown lengthening and recontouring gingival margins.
Once a practitioner becomes proficient with the service, simulations become more and more realistic, conveying the clinician’s capacity to reproduce (mimic) the simulation. Additionally, and as indicated in our article, in a recent prospective clinical study, computer imaging simulation scored higher patient satisfaction marks than did conventional methods.1
Other authors also suggest that, in more complex treatment plans, the dentist can convey a treatment concept to the patient more easily and realistically when using computer imaging simulation.2–4 Nevertheless, to the extent that a patient could conceive an "implied warranty in projections of treatment," as suggested by Dr. Anderson, especially with more complex esthetically driven treatment procedures, I recommend the following:
- – discussing this notion with the patient;
- – stamping the simulated photo with a disclaimer like "actual treatment results may vary."
Additionally, in the more complex treatment procedures, I strongly advocate supplementing the consultation with model wax-ups, preferably articulated. It allows a dentist to carry information from a two-dimensional computer simulation into a three-dimensional functional replica (a mock-up).
As far as Dr. Anderson’s second suggestion for the further studies, I share his opinion. In our article, we concluded that for better understanding of the correlation between consultation methodology, case acceptance, treatment outcome and patient satisfaction, we strongly encourage conducting more comprehensive investigations with larger study populations.
With respect to Dr. Anderson’s point regarding orthognathic imaging, these applications use cephalometric data points and very sophisticated algorithms that predict posttreatment photographic facial outcomes, taking into consideration things such as growth of the patient, as well as surgical intervention and orthodontic tooth movements. This specific application was not part of our study.
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