Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : ZE01 - ZE05 Full Version

Digital Smile Design- An Overview of 3D Digital Workflow

Published: January 1, 2023 | DOI:
Pooja Mohan Chitlange, Priyanka Paul Madhu, Amit Reche

1. Intern, Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India. 2. Assistant Professor, Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India. 3. Associate Professor and Head, Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India.

Correspondence Address :
Pooja Mohan Chitlange,
Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha 442001, Maharashtra, India.


Smile designing is a branch of cosmetic dental procedure that corrects imperfections of the teeth and restores dental health and appearance of the person. Today Digital Smile Design (DSD) is changing the future of dental practice worldwide. It’s a unique approach to modern dentistry is revolutionising smile designing clinics worldwide. DSD is a software which used worldwide, is based on specific photographs and software analysis. DSD is a tool (software) that helps in easy communication and discussion between all the smile designers, dental laboratory technician as well as with patients. DSD especially can be used in a multidisciplinary approach and hence not only used in prosthetic rehabilitation but also used in other branches of dentistry like Orthodontic, Periodontics, etc., The concept of smile designing is not new. The need of aesthetic can be traced from the earliest civilisations of both the Phoenicians (about 800 BC) and Etruscians (about 900 BC). They used to carve animal tusks to simulate the shape, form and hue of natural teeth. Pierre Fauchard (1678-1761) from of France, together with several colleagues modernised and promoted dentistry and also started aesthetic practices. There are many parameters such as dentofacial parameter, gingival parameter, ease of use, documentation ability, cost, time required, systematic digital workflow and organisation, and compatibility of the program with Computer-aided design/Computer-aided Manufacturing (CAD/CAM) or other parameters that may affect the user’s decision. DSD helps both clinician and patient to improve treatment planning and stimulate the final results of the treatment. There are many software available, and the clinicians can use any of the software according to their needs. Some software can be used easily as a mobile app. This article reviews the basic principles of smile design, various parameters of smile design, comparison of various software, uses, advantages and limitations of DSD.


Aesthetic dentistry, Computer-aided design and computer-aided manufacturing, Cosmetic dentistry, Intraoral scanner, Smile

Cosmetic dentistry has the ability to not only change but also enhance once appearance. Smile designing is a branch of cosmetic dentistry that corrects disturbances of the teeth and restores dental problems and aesthetics of the person. Having a smile you love increases your confidence as well as your self-esteem. Smile is the first to be noticed by someone when they look at you. Now, it is possible to achieve your dream smile with smile designing. Today DSD is changing the future of dental practice worldwide. It’s a unique approach to modern dentistry is revolutionising smile designing clinics worldwide. Teeth have always been considered the most important factor for beauty (smile) (1). The main objective of a smile designing is to fulfil patient’s requirements and the results of the procedure should enhance patient’s facial aesthetics and smile. Smile designing is an irreversible procedure so it is difficult to convince and educate through conventional smile design technique but with DSD it is very easy to motivate and educate patient by developing and showing the smile digitally and it helps them to visualise it prior to the treatment by creating and presenting a virtual simulation of their new smile design.

DSD is a software which used worldwide, is based on particular photographs and software analysis (2),(3). DSD is a tool (software) that helps in easy communication and discussion between all the smile designers, laboratory technician as well as with patients. DSD especially is a multidisciplinary approach and hence, it is not only used in prosthetic rehabilitation but also used in other branches of dentistry like Orthodontic, Periodontics etc., (4). DSD workflow needs an intraoral scanner and software programs, photographs and videos. Intraoral scanners are dynamic instruments that allow for instant evaluation of impression quality and the ability to submit models to the laboratory via e-mail, minimising money and time (1).


The concept of designing a smile is evolving continuously. The demand for aesthetics can be traced back to the Phoenicians (around 800 BC) and Etruscians (around 900 BC). They used to carve animal tusks to mimic the form, shape and colour of real teeth (2). Pierre Fauchard (1678-1761) from France, together with several colleagues modernised and promoted dentistry and also started aesthetic practices (3). The concept of smile designing developed rapidly during 18th century. During 18th century the oral health was affected due to the wide spread of caries, because of high intake of sweets, poisoning due to heavy metals and some systemic diseases. Therefore, over the time, the demand for Aesthetics increased more among the high Socio-economic groups before spreading among the population. Modern dentistry attempted to satisfy the aesthetic and functional needs by developing a variety of novel treatment alternatives (4). In recent years, smile design has advanced from traditional (manual) smile design to DSD, which has now improved from 2 Dimensional (2D) to 3 Dimensional (3D). Previously, manual drawings on printed photographs of the patient were used for the demonstration of the end results of therapy; however, this has since been replaced with absolute automated drawing using DSD software on a computer. This is simple to operate, edit, and explain to patients (5). In the year 2017, Christian Coachman has proposed the evolution of Digital Smile Design Software (DSDS) as six generations described in (Table/Fig 1) (6).

Components of Smile Aesthetics

The components of smile aesthetics are divided into four main components which are facial aesthetics, gingival aesthetics, macro-aesthetics and micro-aesthetics (7). The components of smile aesthetics contain various parameters of analysis which are listed in (Table/Fig 2).

Digital Smile Designing Procedure

The cosmetic aspects in different DSD software vary, but the core method of constructing a smile stays the similar. All of the programmes allow you to build your own smile by drawing reference lines and structures on intraoral and extraoral images. The front image of the face is created using reference lines of facial analysis. The horizontal guiding lines are intercommissural lines and interpupillary lines which offer a perfect balance on the horizontal parts of an aesthetically attractive face, while the vertical guiding lines are the glabella, nose, chin, dental midline, and mandible (8),(9). DSD allows a relative analysis of the teeth and face after determining horizontal and vertical proportion. Dentogingival analysis is performed after face analysis. The gingiva shown is determined by the measurement of height of the top lip at rest and during smiling. The smile curve is obtained by connecting the curvature of the incisal margins of the upper front teeth. The proportions of the lower lip and the anterior-posterior curve of the teeth establish the dental contour. This face image’s intraoral view is then cropped. On the teeth, three reference lines are drawn: a horizontal straight line from tip of one canine to the tip of another canine, a vertical line crossing the midline (passing from the interdental papillae) and a horizontal line on the incisal margins of central incisors. This helps to reproduce the cross, i.e., the reference facial midline on the face and interpupillary line, onto the intraoral view. A few other lines are drawn for a full dental study, such as the connecting lines of the gingival and incisal battlements and the gingival zenith (5).

Some theories are used for the selection of ideal dimensions of teeth for ideal size of dental length to width ratio, Golden proportion (10), Pound’s theory (11), Visagism (12), Dentogenic theory (13),(14) or Recurring aesthetic dental proportion (15). After all of the preliminary work has been completed a digital ruler is used to make the necessary modifications. The alterations can be customised to the patient’s aesthetic preferences and unique demands (16). A fresh smile is displayed to a patient once all of the modifications have been completed. This digital smile may be used to prepare a final model that can be visually assessed in the patient’s oral cavity. The model not only permits visualisation of gingival architecture, lips, and facial shape, but also speech during the try-in phase before any permanent alterations occur (17). The complete workflow of DSD is shown in (Table/Fig 3) (5),(18).

Workflow of Digital Smile Design (DSD)

The following are the proportions used in smile designing;

Golden proportion: The golden proportion was initially stated by Lombardi in dentistry, and Levin subsequently developed it. When a line is divided into two sections in the golden proportion, the ratio of the small segment to the large segment is equal to the ratio of large section to overall line. The golden proportion or divine proportion, ratio of following terms is about 1:1.618 (19).

Facial proportion: The rule of thirds separates the face vertically into about 3 equal portions in facial proportion. The lower 3rd of the face is then divided into three parts, with the incisal plane ideally situated at the intersection of the top and middle third (19).

Dental proportion: The height of the ideal central incisor should be one-sixteenth of the height of the face from the ideal hairline to the chin, and the width should be one-sixteenth of the interzygomatic width (19).

Golden percentage: Snow analysed the individual apparent tooth width as a proportion of the overall apparent width of the six anterior teeth bilaterally. In order to generate an aesthetically attractive grin, he established the golden percentage, which states that the proportionate width of individual tooth should be 25% central incisor, 15% lateral incisor, and 10% canine of the overall width of the anterior section (19).

There are many DSD software developed by different companies. The clinician can use any of the programmes according to the needs. (Table/Fig 4) shows the list of the DSD software available.

Many aspects, including dentofacial parameter, gingival parameter, documentation capability, cost, ease of use, systematic digital workflow and organisation, time required and application compatibility with CAD/CAM, may impact the user’s choice. Many aesthetic criteria, including the facial midline, dentofacial midline, gingival height and contour, facial profile, height, and smile curve, as well as intra and interdental proportions, influence smile evaluation and design (20),(21),(22).


In year 2017, Omar D and Duarte C conducted a study comparing eight DSD softwares (Photoshop CS6, Keynote, Planmeca Romexis Smile Design, Cerec SW 4.2, Aesthetic Digital Smile Design (ÀDSD), Smile Designer Pro, DSD App and VisagiSMile) (22). With over 25 parameters but the scoring was done based on 20 parameters. (Table/Fig 5) shows the 12 face analysis parameters, three Dentogingival analysis parameters, five parameters of dental analysis, and five additional parameters that were chosen from the examined literature [10-12,23-30]. Despite the fact that the application was not designed particularly for dental use, it was found that Keynote and Photoshop CS6 provide a more comprehensive smile design than other professional DSD programmes (23).

According to Omar D and Duarte C out of 20, photoshop scored 20, followed by Keynote which scored 19 out of 20 (22). Photoshop has capability to fulfil all the parameters of the facial, Dentogingival, dental analysis (31),(32),(33). Similar to photoshop, Keynote can analyse every parameter but was not able to change and create detailed ideal changes on the tooth structure (34),(35). Both keynote and photoshop are photo editing software hence, cannot be specific for dental use. It cannot be operated by mobile phone and cannot be used with CAD/CAM. The software is not developed for patient documentation and dental use therefore, required special training to operate this software. Similarly, ADSD program scored 18 out of 20, but it contains limited facial analysis parameters (36),(37). The software is specifically developed for DSD and the workflow has been designed for dental use. This software is also not used with CAD/CAM. It requires fewer operative skills to operate software effectively. However, the functionalities are confined to those currently present in the software (32).

Planmeca Romexis Smile Design is a DSD software that may be used to simulate smiles, plan treatments, and communicate effectively. It is compatible with both Mac and Windows. It doesn’t need any additional software to work. It’s quick and easy to use. Designing a smile with a 2D face shot and accurate teeth selection takes only a few minutes. The programme enables the operator to carefully alter the location, shape and size of each tooth in order to obtain perfect proportion and aesthetics (33),(35).

Cerec SW 4.2, scored 13 out of 20 (38),(39). This software is not efficient as above-mentioned software in facial and Dentogingival parameter analysis. There are very few frontal facial parameters and facial profile parameters incorporated in this software. This software can be used with CAD/CAM but cannot be operated as mobile app. Additionally, DSD App, SDP, and VisagiSMile programs had similar scores, 10 out of 20 (34),(40),(41),(42). The most significant disadvantages of these programmes were discovered in the analysis of facial component, which is typically employed for picture calibration in these systems. These programmes did not contain frontal face parameters or facial profile parameters. Some of these programmes however, unable to change delicate natural aspects, which can result in a less convincing digital replica of the smile. Later in 2017, the DSD app intended to encompass every area of frontal and facial profile analysis, as well as an orofacial surgical simulation extension (22),(42).

Photoshop, Keynote and ADSD has a greater number of aesthetic analysis parameters. Other DSD softwares has a smaller number of aesthetic analysis parameters but incorporated comprehensive Dentogingival and dental aesthetic functions. The PRSD, Cerec SW 4.2 and DSD App all supported 3D processing moreover, Cerec SW 4.2 and PRSD can be used in conjunction with CAD/CAM. Both the smile designer pro and DSD app can be operated as mobile phone software (22),(23).

In the year 2017, Santos FR et al., performed a periodontal surgery for gummy smile with the help of DSD. The results of the surgery were excellent and patient was happy with the end results. He concluded that by the help of DSD it is very easy to demonstrate the end results of the treatment to the patients (43). Garcia PP et al., published a study report of a maxillary anterior rehabilitation using the DSD system and a direct model technique in 2018. He found that the use of DSD in association with mock-up for diagnostic and treatment planning yielded good results in the cosmetic rehabilitation of the front teeth (44). Stanley M et al., conducted a case study in 2018. In this scenario, DSD software and CAD/CAM (monolithic lithium disilicate) ceramic veneers and crowns, were used to alleviate vertical dimension loss, aesthetics, and Temporomandibular joint diseases (following a minimal tooth preparation technique) (14).

Advantages of Digital Smile Design (DSD)

• DSD assists patients in visualising the predicted outcomes prior to beginning treatment. This enhances the treatment’s predictability (45).
• Operator can motivate and educate the patient by showing the final outcome digitally before doing any irreversible procedure this can also serve in crucial medicolegal purposes (5).
• Clinicians and patients can both digitally visualise and analyse gingival, dental and facial characteristics that will decide the final smile and facial aesthetics (46).
• DSD contributes to the personalisation of smile design by exceeding patient’s involvement in their own smile designing, results in a more cosmetically motivated, emotive, and confident smile (46).
• Before the treatment begins, comparison between before and after treatment images using a digital scale, horizontal and vertical reference lines can be done (46).
• DSD not only helps in better communication between patients and clinician but also helps in better communication between other team members, lab technician, etc.,

Limitation of DSD

• The evaluation and further planning depend only on photos and videos, any variation in documentation may result in distortion of reference image and results in improper diagnosis and treatment planning.
• The treatment with DSD is economically expensive as for complete 3D digital work updated 3D software, CAD/CAM software, intraoral scanner and 3D printer are necessary (5).
• Some software requires specific training to operate software which makes it more costly and time consuming. Although the complete procedure is time consuming, the results of the software are very good. As the technology is developing the limitations of the system can be overcome.


From the above discussion, it can be concluded that as in this new era cosmetics and aesthetics are of more concern, everyone loves to have perfect smile and aesthetics. DSD has made the smile designing very easy. There are many advantages of DSD with limitations. DSD especially is a multidisciplinary 3D approach and can be used in various different branches of dentistry. There are many softwares available. clinician can use any of the software according to their needs. Some softwares can also be used easily as a mobile app. Thus, being user friendly and convenient to use and helping both the clinician and the patient to improve the treatment planning and stimulate the final results.


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DOI and Others

DOI: 10.7860/JCDR/2023/61467.17386

Date of Submission: Nov 14, 2022
Date of Peer Review: Dec 05, 2022
Date of Acceptance: Dec 12, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

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