Before and After 2026: Bridging the Gap – Redefining the Temporary Stage in Aesthetic Dentistry: AI-Assisted Visualisation to Enhance Patient–Clinician–Ceramist Communication
Introduction:
In aesthetic dentistry, considerable attention is given to the beginning and end of treatment: the initial smile design and the final restorations. Between these two points lies the temporary stage—an essential but often underutilised phase that is commonly treated as little more than a functional transition.
Temporary restorations are typically used to evaluate broad parameters such as tooth shape, proportion, length and phonetics. Yet many of the qualities that ultimately determine whether a smile appears natural—or whether it genuinely reflects the patient’s preferences—are still deferred until the final ceramic restorations are produced. These may include brightness, enamel translucency, incisal effects and the subtle characteristics that give teeth their individual appearance.
This creates a significant gap in the decision-making process. Patients are often asked to describe what they want using subjective terms such as natural, bright or characterised, even though those words can carry very different meanings for the patient, clinician and ceramist. When these preferences remain abstract, the final restorations may become the first occasion on which the patient can properly see what those decisions mean.
But the temporary stage offers something that photographs, digital simulations and verbal explanations cannot fully reproduce: the opportunity for the patient to experience the proposed smile in their own mouth, within the context of their face, expressions and daily life. When used deliberately, this stage can become more than a provisional preview. It can serve as a structured visual and experiential communication medium through which aesthetic preferences are explored, compared and progressively refined before the final restorations are made.
This article introduces an expanded approach to the temporary stage—one that brings selected qualities traditionally reserved for the final ceramic restorations into the provisional phase of treatment. Through a clinical case, it will explore how variations in incisal translucency and characterisation can be visualised and assessed while the outcome remains adjustable, helping to transform subjective preferences into more tangible and communicable decisions.
Rather than treating temporaries as an approximation of the final result, this approach repositions them as an active stage of aesthetic discovery: a bridge between professional interpretation and the patient’s evolving understanding of their ideal outcome.
Pre-op Stage and Initial Smile Design Consultation:
The initial smile design consultation identified several aesthetic characteristics that the patient wished to modify. The existing smile demonstrated a relatively flat smile line, with comparatively dominant canines and tooth proportions that contributed to a stronger, more masculine appearance (Figs 1–6). Additional concerns included exposed root surfaces and visible discolouration at the margins of the existing restorations.
Following discussion of these features, a softer and more feminine aesthetic direction was established. The proposed design involved increasing the apparent length of the central incisors with a subtle increase in labial volume, while reducing the visual prominence of the canines. Rounder anterior tooth forms and more open incisal embrasures were also preferred to create a softer transition between the teeth.
As the patient displayed a naturally broad and expressive smile, smile width was another important consideration. Although the posterior dentition already presented with reasonably favourable aesthetics, a 10-unit treatment design extending from 15–25 was selected to provide greater control of the buccal corridors and create a fuller, more harmonious relationship between the proposed restorations, lips and overall smile.
Colour was briefly discussed at this early stage, with BL4 selected as an initial reference for the intended brightness and communicated to the treating clinician for fabrication of the provisional restorations. Rather than regarding this as a definitive shade selection, the plan was to reassess brightness during the provisional stage after whitening of the lower dentition. This would allow the colour decision to be evaluated within the context of the proposed new tooth forms before fabrication of the definitive restorations.
Diagnostic Wax-up and Temporisation:
Following the initial smile design consultation, a diagnostic wax-up was produced for 15–25 to translate the proposed aesthetic changes into a three-dimensional form (Fig 7). This design was subsequently transferred clinically with a high degree of accuracy into the provisional restorations (Fig 8). The quality of this transfer was particularly important, as the provisionals closely replicated the diagnostic wax-up and therefore provided a reliable foundation from which the proposed design could be assessed in the mouth rather than reconsidered from an inaccurate approximation.
At the temporary review, the overall design was considered successful, particularly the increased smile width and management of the buccal corridors, confirming the decision to extend treatment across 10 units rather than eight. However, once the patient had experienced the new smile in everyday life, several opportunities for refinement became apparent. The overall tooth length was considered slightly excessive and a reduction of approximately 0.5 mm was preferred. The patient was also receptive to introducing a degree of controlled imperfection through subtle asymmetry between the lateral incisors, more open incisal embrasures and slight variation of the incisal edges—features intended to move the design away from uniformity while remaining faithful to the established provisional form.
More significantly, the provisional stage changed the nature of the colour discussion. Although the overall brightness of the temporaries—approximately A1—was considered appropriate, the patient perceived them as flat and overly uniform. Rather than simply selecting a different shade, this prompted a more detailed discussion of how brightness, translucency and characterisation interact. A slightly higher value was proposed for the central incisors (approximately BL4), transitioning through the lateral incisors toward A1 at the canines. Increased incisal translucency and subtle cervical warmth were also identified as desirable. At this point, the provisional restorations had fulfilled their conventional role in establishing form, function and overall brightness; the next question was whether they could also be used to communicate the more subtle optical characteristics traditionally left until the definitive ceramic stage.
AI-Assisted Visualisation of Incisal Translucency and Characteristics at Provisional:
Although the provisional restorations provided an excellent representation of the proposed tooth form, their relatively uniform appearance made it more difficult for the patient to visualise some of the optical characteristics that could be incorporated into the definitive ceramic restorations. In particular, the concept of incisal translucency can be difficult to communicate verbally. Terms such as mild, natural or highly translucent remain subjective until the patient is able to associate them with a visual reference.
To facilitate this discussion, artificial intelligence was used to digitally modify an image of the provisional restorations while maintaining the established tooth forms and overall aesthetic direction. Figure 9 represents the provisional restorations as they appeared clinically, while Figure 10 provides a visual interpretation with a more apparent degree of incisal translucency. The purpose of the digitally modified image was not to predict the definitive ceramic result, but to provide a visual reference from which the patient, clinician and ceramist could discuss the desired optical direction more precisely.
Importantly, the patient did not prefer the degree of translucency represented in Figure 10, although this level of incisal effect is often appreciated among dental professionals. While she recognised that some translucency would reduce the relatively uniform appearance of the provisionals, her preference remained closer to Figure 9. Following comparison and discussion, an aesthetic direction between the two visual references, with a more moderate increase in incisal translucency, was agreed upon for the definitive restorations.
This illustrates a potentially valuable role for AI within aesthetic dentistry. Rather than using digital enhancement simply to present an idealised result, it can be used to make otherwise abstract aesthetic variables more tangible while the treatment outcome remains adjustable. Equally importantly, the patient’s rejection of the more pronounced effect provides useful information. The objective is therefore not for the patient to approve the digitally generated image itself, but for the image to stimulate a more precise conversation about what should—and should not—be transferred to the definitive restoration.
Post-op Outcome:
The definitive restorations were fabricated in accordance with the aesthetic direction established during the provisional review. The overall tooth length was reduced slightly, while subtle variations in the incisal edges, lateral incisors and embrasures were incorporated to soften the design and reduce the sense of uniformity. The increased smile width and management of the buccal corridors were maintained, preserving the broader harmony established through the 10-unit diagnostic wax-up (Figs 11-17).
Optically, the final restorations retained the level of brightness preferred by the patient while introducing greater depth through controlled incisal translucency, subtle cervical warmth and variation across the anterior segment. The central incisors remained relatively bright, with a gradual transition toward the lateral incisors and canines. Importantly, the degree of translucency was more restrained than that represented in the AI-modified image, reflecting the direction established through comparison rather than reproducing either visual reference literally.
The postoperative outcome therefore represents a balance between the patient’s preferences and the optical qualities required to avoid an excessively flat or uniform appearance. The AI-assisted image did not determine the final result; instead, it helped clarify the boundaries of the patient’s preference while the outcome remained adjustable. This information could then be interpreted through the ceramist’s material selection, layering and surface characterisation to produce a definitive result that remained faithful to the design the patient had already experienced in the provisional stage.
Conclusion:
The provisional stage has traditionally been used to evaluate parameters such as tooth form, proportion, phonetics and function. However, its potential extends beyond confirming whether an established design is acceptable. When combined with structured visual comparison, it can also help determine the more subtle aesthetic direction of the definitive restorations while the outcome remains adjustable.
In this case, AI-assisted visualisation made the concept of incisal translucency more tangible by allowing the patient to compare different optical interpretations of her own provisional restorations. Her rejection of the more pronounced effect was as informative as an approval would have been: it established an upper boundary to her preference and enabled a more moderate direction to be communicated before fabrication of the definitive ceramics.
AI did not replace clinical judgement, ceramic artistry or communication. Its value was in supporting them—transforming an abstract discussion into a visible comparison and allowing the temporary stage to function as an active part of aesthetic decision-making. In this way, the provisionals became more than a preview of the intended result; they became the bridge through which that result was progressively defined.
Patient Perspective:
Response from Yugo/Smile Virtuoso:
When Jeanette first visited my studio for the initial smile design consultation, my aim was to gather as much information as possible from her. Smile design is not simply about creating something that looks attractive—it is about carefully understanding the patient’s expectations, lifestyle and aesthetic preferences so that the final result feels natural and genuinely “theirs”.
The proposed design was first developed through a diagnostic wax-up, followed by a set of temporary restorations placed in the mouth. This stage is critical, as what we see digitally on a screen can be very different from how a smile appears in the mouth and how it feels to live with from day to day. The temporaries allowed us to test the design in real life and make subtle refinements before committing to the final restorations.
During this stage, we discussed several adjustments, particularly around the colour and overall balance of the smile. Shade selection is highly subjective. While I always approach cases with my own aesthetic philosophy, the goal is to find the right balance between professional judgement and what the patient truly wants.
The final outcome is something we are all very pleased with—Jeanette, Dr Duncan Copp and myself. Thank you again, Jeanette, for your kind words and for trusting us throughout the process, and for allowing us to present your case in publication.:)
Lastly, I would like to acknowledge the clinical excellence of Dr Duncan Copp from the Paddington Dental Surgery. Without his ongoing collaboration and our shared commitment to exceeding patients’ expectations, this article—and the clinical journey behind it—would not have been possible.
