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In this chapter:
■ Esthetic parameters to be evaluated: step-by-step checklist
■ Time points for diagnostics, diagnostic tools
■ Conventional procedures
■ Digital procedures
■ Augmented reality in dentistry
■ Diagnostics for fixed implant-supported restorations, surgical stents
Pretreatment diagnostics is essential for predictable treatment outcomes in prosthodontics. Agreeing on the appearance of the final restoration in this early phase of the treatment is key to obtain satisfactory results in comprehensive restorative dentistry1–4.
Patients asking for an esthetic improvement of their dental appearance may approach the restorative team with a desired outcome in mind. Yet, the desired appearance can be difficult to achieve due to anatomical or other limitations. It is a challenge for the restorative team (ie, the dentist and dental technician) to determine the desired, yet realistic outcome for the patient before the initiation of restorative treatment.
Diagnostic wax-ups on the study casts and their transfer into the patient’s mouth using silicone indexes and autopolymerizing provisional resin (mock-up out of, eg, Protemp) are useful tools to clinically communicate and test the planned treatment outcome before the treatment.
The simulation of the final outcome helps with identifying the need for preprosthetic interventions, such as orthodontic tooth movement, or surgical procedures like crown lengthening and hard and/or soft tissue grafting. Furthermore, the diagnostic mock-up can serve as a guide for minimally invasive, defect-oriented tooth preparations.
Until recently, the pretreatment diagnostics encompassed the manual fabrication of a wax-up of the desired outcome on the study casts, and its transfer into clinics by means of a manually made resin mock-up. The major disadvantage of the conventional manually made wax-ups/mock-ups is that their fabrication is time-consuming, and in general only one version of the possible treatment outcome can be tested.
Contemporary digital technologies may provide advantageous features to the increase of efficiency of the pretreatment diagnostics. This Chapter reviews the esthetic parameters to be considered in the diagnostics, and the opportunities digital technologies offer in the diagnostic phase illustrating the procedures by means of one representative clinical example.
1.4.2 Esthetic parameters to be evaluated: step-by-step checklist
At the first examination of the patient, several aspects have to be considered as Part of the pretreatment diagnostics. The evaluation starts from the assessment of the general appearance of the patient, increasingly focusing on the details which are crucial for the restorative treatment. The following all-important aspects to be evaluated are listed next, in chronological order.
Facial aspect to be evaluated
■ Shape of the face – square, ovoid, tapered