Digital Smile Design - Oct 14, 2019

Patient 1: Multidisciplinary complex case solved in four appointments

Patient 1 DSD residency 2


Introducing 8 Digital Smile Design cases that you’ll never forget featuring patient cases from the DSD Residency 2 program from August 2019 held in São Paulo, Brazil. Participants from around the world attended this ground-breaking learning experience at the Well Clinic, getting a front row seat on the treatment planning and delivery of world class dentistry to real patients in a Digital Smile Design clinic setting.


We begin our blog post series with this remarkable case. This patient’s main concerns were having missing teeth, gaps between her teeth, broken upper centrals and her tooth colour. 

patient 1 case


Initial clinical diagnosis:

Icon_4 Absence of teeth # 15, 24, 26

Icon_4 Altered occlusal planes

Icon_4 Constricted buccal corridor

Icon_4 Crowded anterior teeth (upper and lower)

Icon_4 Uneven gingival margins

Icon_4 Unesthetic existing prosthetic treatment


With the multidisciplinary expertise of the DSD Planning Center in Madrid, the treatment plan involved several stages, to give this patient a restored smile with improved function and esthetics.


The treatment plan involved the following:  

  • Gingivoplasty/Crown lengthening # 11 and 21 (re-evaluate after ortho outcome)
  • Implant placement
  • Prostho treatment:

· Upper arch: Crowns from # 16 to 26 (# 15, 12, 22, 24 and 26 over implant)
· Lower arch: Veneers/Crowns from # 34 to 46 (# 45 and 46 over implants)


IMPORTANT:  The case was designed to open the OVD 2,5 mm on a digital articulator, to allow the correction of the occlusal planes and ideal tooth proportion.



Treatment timeline

This patient’s treatment spans two DSD Residency 2 courses, however in total, the number of appointments was 4.

At the first appointment, the patient explained that her teeth were making her feel unhappy. She was then digitalized and all scanning and video data was collected. The case was then planned by the interdisciplinary team at the DSD Planning Center using state-of-the-art software. This experienced team is ideally placed to work on multidisciplinary complex cases.

At the next appointment the motivational mockup was presented, outlining the proposed treatment plan which featured crown lengthening, dental implants and veneers. The patient was delighted with the mockup and accepted all proposed treatment.

The following appointments involved implant planning, crown lengthening planning, applying a bite deprogrammer, alongside implant and periodontal surgery with transitional restorations. After that the final restorations were fitted and a night guard was also created. 


Treatment included the following DSD solutions: 

Bullet Point-B Vertical Dimension Increase 

Bullet Point-B DSD Direct

Bullet Point-B Crown Lengthening 

Bullet Point-B Guided Sinus Lift

Bullet Point-B Single Implant

Bullet Point-B Natural Restoration Veneers


Case highlights

Francis coachman  Dr Francis Coachman, Director of DSD Planning Center


“An important aspect of this case is that this was the first time that we created and used a sinus lift guide as part of the dental implant surgery. This is a unique innovation that ensures the highest levels of accuracy in this procedure. As a result, the sinus lift was successful.


Case patient 1 DSD R2



“In addition, this case is an excellent example of DSD’s Copy/Paste Dentistry, thanks to our tried and tested workflow, with the comprehensive digitalisation of the patient and the 3D treatment planning software we are able to design smiles using the database of scanned teeth, for a natural-looking and esthetic result.” 

before and after



“The outcome of this case shows implant restored teeth that were placed by following the face first. It’s common to see cases like this where the main focus is on the position of the implant and then only is the prosthetic design considered. The DSD dental implant protocol is facially guided from the start, which enables the most esthetic and functional outcome possible.”


DSD r2 case 1



“Another notable feature of this case is the use of a double crown lengthening guide which ensures maximum patient comfort, exceptional treatment accuracy and a predictable outcome."


double crown lengthening Guide



“The fact that this multidisciplinary type of treatment was carried out in only 4 appointments to this degree of precision and with this level of esthetic outcome, is a testament to DSD workflows and the value of the DSD Planning Center.”


Patient comments 

The patient was delighted with the results and shared these comments about her experiences, saying that the end result went far beyond an esthetic outcome for her: 


Patient 1 testimonial DSD r2



Watch the full patient interview here:




Find your course here:


DSD residency 2

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