What is DSD?
In the simplest term, it is a diagnostic wax-up, but much more superior. A diagnostic pattern has always been the preliminary step to undertake when planning restorative and surgical treatment. For years, impressions were captured and sent to the laboratory. I still remember the days when a stick bite and a photograph were the only assets available to the technician to consider when hand waxing a cast of the patient’s unique situation. I would print the patient’s photo on 8.5”X11” paper. Using a line gauge like a draftsman’s uses a ruler or T square, I would measure the proportions while drawing and annotating the proposed smile. I would even start with a fold down the paper at the mid-line. From here we can transfer the information in front of us, to the cast with a wax knife.
Note the patients maxillary arch is constant between images.
For a full mouth diagnostic pattern, this could take hours. And left so many variables uncontrolled and therefore inaccuracies were not uncommon. With digital technology available today technicians can scrap their pencils and rulers. Consider an intra oral scan, bite scan, patient specific excursive movements scan, multiple smile photos captured on a DSLR, digital face-bow, CT data, and 3D face scans. Now consider all the above seamlessly stitched and aligned together in dental specific software. These assets are not only available to the technician to assist in the design of the diagnostic proposal and aid in constraining to restorative principals.
Facial features used to determine smile attributes.
Each element of the digital media is also used as a standard of comparison to easily identify any discrepancies that could result in a miscalculation and inaccuracies of the final diagnostic situation. Significantly reducing any oversight or unexpected results at the time the diagnostic patterns are transferred to the patient. At the same time all these elements are put into play we must remember the lab is not sending and receiving any physical casts or wax patterns back and forth to the clinician. Instead, photo and video captures together with 3D renditions are exchanged electronically. This allows ample time for the doctor, together with the patient, to assess the proposed diagnostic situation. As well as relay this assessment to the technician rapidly.
Intra Oral Scan Aligned to the patient photography.
Once the patient, doctor, and technician find the proposed smile and diagnostic situation agreeable, we can break ground on the restorative and surgical treatment. Or so we thought. There is another obstacle the technician and the doctor have to overcome. Think back to the last time you sat down with a patient and discussed a very complex treatment plan. You explained the principals and formalities of orthodontic treatment. You educated your patient on the benefits and the caveats of implant surgery. You may have utilized some sample casts or typodonts fixed with implants to sort of, demo, the treatment involved. Finally, you reminded them that success can not be rushed. At this point you have your fingers crossed that your patient is on board, but you can see the perplexing look on your patients face when you tell them the appropriate treatment could take a year, and often longer. Your trying to make a deal, a business deal with your patient. But your presentation is uninspiring.