Cosmetic Imaging Systems

Cosmetic imaging allows us to create a new smile for patients without ever touching their mouths. This is all done through the magic of a computer, color monitor, digital or intraoral camera, and mouse using specialized software. You basically take a digital picture and save it in your computer. Then, in some systems, you split the screen to create two identical images of the patient. One image is left untouched while you create simulated procedures on the other.

These simulated procedures include closing spaces, repairing fractured teeth, veneering, crowning, bleaching, recontouring, orthodontics, and tooth lengthening. Even surgical procedures such as a simple gingivoplasty to correct a gummy smile to major orthognathic surgery for total maxillary-mandibular realignment can be done with imaging.

Enhancing Communication with Patients

Imaging has a powerful potential for improved communication, which can lead to increased treatment plan acceptance. Patients who need to "see" what can be accomplished are the main candidates for imaging, while a rushed businessperson who only wants to know the "bottom line": will probably not want to take the time to allow you to perform imaging properly. This person can be identified by the three questions:

(1) What is the solution?

(2) How long will it take?

(3) How much will it cost?

In other words, imaging is useful, but don't think it is a magic bullet. Each person has a "button" which, if found and pushed, will cause him or her to respond favorably. Imaging may or may not be that button for many people. It is just another way of "tangibilizing the intangible".

Although imaging won't automatically increase case acceptance, the enhanced communication with patients by giving them the opportunity to participate in creating their smiles helps to boost their confidence and ultimately reinforces your commitment to excellence. Imaging is not a panacea of success for all — it is another tool for communication, education, and internal marketing. Imaging also says that you have an interest in and are committed to cosmetic dentistry.

External Marketing Possibilities

Imaging can also be a tremendous tool for external marketing. It can be used to demonstrate new advances in dentistry to breakfast clubs, senior citizens groups, hospital staff meetings, civic groups, health fairs, etc. When you show a patient what he or she may look like after your beautiful creation, you appear to be a "state-of-the-art" dentist. Some people would rather see their own image than before and after photographs of someone they don't know.

Should You Charge For Imaging?

Some offices charge for imaging, while others use it as a tool to generate interest in esthetic procedures. Offices that charge for imaging believe it is similar to any other diagnostic service and, therefore, it should be fee-based. One way of lessening the resistance to this fee is by including it in your consultation fee. You can then credit this fee if the patient proceeds with treatment.

Second Opinions

Another effective way of using imaging is during second opinion consultations. It can give you a distinct advantage over the first dentist when the patient can visualize the potential results. The patient is always given a color print of the before and after image to take home. This allows for family and friends to be involved in the decision of whether to pursue treatment.

With the use of imaging to educate, it may be possible to elevate the awareness of each patient's dental needs and desires. This change in perception could lead to much greater demand for your services by each person who undergoes an evaluation in your office.

The Real Results vs. the Imaged One

The once feared legal implication of guaranteeing results through imaging is really a non-issue. As long as prudence is used, imaging can prevent unrealistic expectations of the final results. Actually, the results you are able to achieve with real dentistry usually look better than the created image anyway. Imaging will not make a poor dentist into a good one. Don't even consider buying an imaging system if you can't perform the dentistry you create on the screen.

Lab Communications

Imaging can also be used to improve communication with the lab when you are designing a case. Create the look that you are striving for and email it to the lab even before you present the treatment plan to the patient. The lab may have treatment suggestions or could inform you of limitations you would want to consider. This type of communication could result in fewer remakes, more predictable results, and less post-treatment patient dissatisfaction.

The Imaging Session

Full Face vs. Smile

There are advocates of both approaches, but we have found it is much easier to image a smile view instead of a full face. The smile view gives you better detail and a closer look at the problem. After you finish the image, you can always insert the new smile into a full face. This way, you can have both views. Imaging a full face may be OK if you are demonstrating a rhinoplasty, but it is too small and hard to see the changes when it comes to teeth and the surrounding soft tissues.

On the other hand, with the ability to magnify sections of a view, you can blow up the smile of a full face, cosmetically alter it, and then insert it back into the full face. This equals having the best of all worlds.

Before and After

A before image is captured, usually using a digital SLR camera, and uploaded to the computer. If you or a staff member is very capable with the imaging software, the cosmetic alterations can be done while radiographs and/or impressions for study models are taken. Otherwise, imaging is done between the exam/records appointment and the consultation visit. The patient returns and the new smile is presented, either on a monitor or on a hard copy. This option gives patients a view to what is possible, but does not really give them an understanding of their choices.


Interactive imaging is done with the patient right by your side (or by the side of the staff member in your office assigned to do imaging). This type of service is entirely different from merely showing patients before and after images.

  • Advantages When your patients take part in imaging, they have the opportunity to discuss many different changes with you. They can ask "what if" questions that can follow other "what if" questions. Once one change to a smile is made, a patient may want to see another change. So, in essence, interactive imaging is a form of co-discovery. This type of dialogue is not possible when you merely present before and after images to the patient.
  • Disadvantages There are two main disadvantages to interactive imaging: cost of the time required to do the imaging and staff training. It is more time consuming to image a patient interactively due to the communication that transpires between the patient and the imaging staff member. This varies with each office. But, by far, the most expensive and least predictable disadvantage is staff training and performance.

The success of interactive imaging is directly dependent on the staff member doing it. The imaging staff member must have multiple talents, including good communication skills, computer literacy, and a thorough knowledge of cosmetic dentistry. The learning curve is very steep and, if this staff member leaves your practice, your imaging services will be severely curtailed until you can find a new one. This happened to one of our Editorial Team Members, who trained and lost two imaging staff members within one year. This Editorial Team Member has since gone back to doing cosmetic mockups with composite, since it is too time-consuming for him to do his own imaging.

There are, no doubt, a number of dentists who operate their imaging systems themselves. Many of these dentists do it because it is fun and it breaks the tedium of everyday dentistry. But, in the final analysis, it is usually too expensive for the dentist to do the imaging.


  1. Increased case acceptance.
  2. Increased referrals to and from plastic surgeons and other esthetic/cosmetic professionals.
  3. Increased staff excitement in dentistry.
  4. Improved diagnostic capabilities.
  5. Improved laboratory communications.
  6. Improved patient communications.
  7. Increased "fun" for the dentist.


  1. Cost.
  2. Training time.
  3. Need for additional personnel.
  4. Operating time.
  5. Patient expectations going beyond results that are achievable — resulting in patient dissatisfaction.


Cosmetic imaging software can be a stand-alone program or a module in an entire suite of applications.


Computers, printers, monitors, and cameras are basically commodities today. While there are still software vendors who will be more than happy to sell you brand name hardware at substantially higher prices than you can find online, the typical scenario in most computerized offices is to buy the hardware yourself either directly from the computer manufacturer such as Dell or via an Internet store. Therefore, we have deleted any mention of hardware from the evaluations that follow.

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