Current Oral Health Reports

, Volume 5, Issue 2, pp 116–120 | Cite as

Virtual Dental Patient: How Long Until It’s Here?

  • Tim JodaEmail author
  • Stefan Wolfart
  • Sven Reich
  • Nicola U. Zitzmann
Digital and Esthetic Dentistry (E Anadioti and P Stathopoulou, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Digital and Esthetic Dentistry


Purpose of Review

Recent developments in digital technology to be generated by superimposing different 3D imaging datasets. The aim of this literature review was to provide an update on the current status of knowledge, to report on the progress in virtual patient science, and to identify further research needed to facilitate the translation to clinical practice.

Recent Findings

Case reports were identified describing different dental patient simulation techniques. Publications focused mainly on methodological feasibility of combining skeletal, facial, and dental imaging to produce virtual simulations. Clinical randomized controlled trials were scarce.


Superimposition of 3D medical data files is a feasible technique to create a virtual patient under static conditions. 3D image fusion is of interest and importance in all fields of dental medicine including diagnostics, treatment, science, and education. Future research should focus on simplifying the technology, to enable virtual patient simulation to be generated in a single-step approach.


Computer-assisted image processing Three-dimensional imaging Patient simulation Digital dental medicine Superimposition technique Image fusion 


Compliance with Ethics Standards

Conflict of Interest

Stefan Wolfart reports grants, personal fees, and non-financial support from Camlog Foundation, personal fees and non-financial support from Camlog, grants, personal fees, and non-financial support from Straumann, personal fees and non-financial support from ITI (International Team for Implantology), grants and non-financial support from Ivoclar Vivadent, grants from 3M Espe, outside the submitted work. Sven Reich reports grants, personal fees, and non-financial support from 3M Oral Care, Dentsply Sirona, and Ivoclar Vivadent, and personal fees and non-financial from Camlog, Camlog foundation, Digital Dental Academy, pluradent, Straumann and public scientific organizations (e.g.: DGCZ, DGI). The other authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Andresen V. Three contributions to orthodontilogical diagnosis. Int J Orthod Oral Surg Radiogr. 1926;12:235–51.CrossRefGoogle Scholar
  2. 2.
    Joda T, Ferrari M, Gallucci GO, Wittneben JG, Brägger U. Digital technology in fixed implant prosthodontics. Periodontol. 2017;73(1):178–92.CrossRefGoogle Scholar
  3. 3.
    Kapos T, Evans C. CAD/CAM technology for implant abutments, crowns, and superstructures. Int J Oral Maxillofac Implants. 2014;29(Suppl):117–36.CrossRefPubMedGoogle Scholar
  4. 4.
    Fasbinder DJ. Digital dentistry: innovation for restorative treatment. Compend Contin Educ Dent. 2010;31(4):2–11. quiz 12PubMedGoogle Scholar
  5. 5.
    Eaton KA, Reynolds PA, Grayden SK, Wilson NHF. A vision of dental education in the third millennium. Br Dent J. 2008;205(5):261–71.CrossRefPubMedGoogle Scholar
  6. 6.
    Marinello C. The digital revolution in prosthodontics: can it benefit older people? Gerodontology. 2016;33(2):145–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Lee CY, et al. Use of cone beam computed tomography and a laser intraoral scanner in virtual dental implant surgery: part 1. Implant Dent. 2012;21(4):265–71.CrossRefPubMedGoogle Scholar
  8. 8.
    Lin HH, Chiang WC, Lo LJ, Sheng-Pin Hsu S, Wang CH, Wan SY. Artifact-resistant superimposition of digital dental models and cone-beam computed tomography images. J Oral Maxillofac Surg. 2013;71(11):1933–47.CrossRefPubMedGoogle Scholar
  9. 9.
    •• Plooij JM, Maal TJJ, Haers P, Borstlap WA, Kuijpers-Jagtman AM, Bergé SJ. Digital three-dimensional image fusion processes for planning and evaluating orthodontics and orthognathic surgery. A systematic review. Int J Oral Maxillofac Surg. 2011;40(4):341–52. Systematic review focusing on 3D radiographic imaging and fusion technology in orthodontics. CrossRefPubMedGoogle Scholar
  10. 10.
    Joda T, Zarone F, Ferrari M. The complete digital workflow in fixed prosthodontics: a systematic review. BMC Oral Health. 2017;17(1):124.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Ayoub AF, Xiao Y, Khambay B, Siebert JP, Hadley D. Towards building a photo-realistic virtual human face for craniomaxillofacial diagnosis and treatment planning. Int J Oral Maxillofac Surg. 2007;36(5):423–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Jayaratne YS, McGrath CP, Zwahlen RA. How accurate are the fusion of cone-beam CT and 3D stereophotographic images? PLoS One. 2012;7(11):e49585.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kau CH. Creation of the virtual patient for the study of facial morphology. Facial Plast Surg Clin North Am. 2011;19(4):615–22.CrossRefPubMedGoogle Scholar
  14. 14.
    Hatcher DC, Dial C. Three-dimensional surface imaging of the face. J Calif Dent Assoc. 2009;37(3):193–7.PubMedGoogle Scholar
  15. 15.
    Xin P, Yu H, Cheng H, Shen S, Shen SGF. Image fusion in craniofacial virtual reality modeling based on CT and 3dMD photogrammetry. J Craniofac Surg. 2013;24(5):1573–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Abramovitch K, Rice DD. Basic principles of cone beam computed tomography. Dent Clin N Am. 2014;58(3):463–84.CrossRefPubMedGoogle Scholar
  17. 17.
    Christensen GJ. Impressions are changing: deciding on conventional, digital or digital plus in-office milling. J Am Dent Assoc. 2009;140(10):1301–4.CrossRefPubMedGoogle Scholar
  18. 18.
    van Noort R. The future of dental devices is digital. Dent Mater. 2012;28(1):3–12.CrossRefPubMedGoogle Scholar
  19. 19.
    •• Joda T, Bragger U, Gallucci GO. Systematic literature review of digital three-dimensional superimposition techniques to create virtual dental patients. Int J Oral Maxillofac Implants. 2015;30(2):330–7. Systematic review of the literature summarizing the current status of knowledge and technical progess in virtual dental patient simulation. CrossRefPubMedGoogle Scholar
  20. 20.
    Maal TJ, et al. The accuracy of matching three-dimensional photographs with skin surfaces derived from cone-beam computed tomography. Int J Oral Maxillofac Surg. 2008;37(7):641–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Oliveira-Santos T, Baumberger C, Constantinescu M, Olariu R, Nolte LP, Alaraibi S, et al. 3D face reconstruction from 2D pictures: first results of a web-based computer aided system for aesthetic procedures. Ann Biomed Eng. 2013;41(5):952–66.CrossRefPubMedGoogle Scholar
  22. 22.
    Rangel FA, Maal TJJ, Bergé SJ, van Vlijmen OJC, Plooij JM, Schutyser F, et al. Integration of digital dental casts in 3-dimensional facial photographs. Am J Orthod Dentofac Orthop. 2008;134(6):820–6.CrossRefGoogle Scholar
  23. 23.
    Swennen GR, Mollemans W, Schutyser F. Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging. J Oral Maxillofac Surg. 2009;67(10):2080–92.CrossRefPubMedGoogle Scholar
  24. 24.
    van der Zande MM, Gorter RC, Wismeijer D. Dental practitioners and a digital future: an initial exploration of barriers and incentives to adopting digital technologies. Br Dent J. 2013;215(11):E21.CrossRefPubMedGoogle Scholar
  25. 25.
    Gkantidis N, Schauseil M, Pazera P, Zorkun B, Katsaros C, Ludwig B. Evaluation of 3-dimensional superimposition techniques on various skeletal structures of the head using surface models. PLoS One. 2015;10(2):e0118810.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Fluegge T, et al. A registration of cone beam computed tomography data and intraoral surface scans: a prerequisite for guided implant surgery with CAD/CAM drilling guides. Clin Oral Implants Res. 2017;28(9):1113–8.CrossRefGoogle Scholar
  27. 27.
    •• Joda T, Gallucci GO. The virtual patient in dental medicine. Clin Oral Implants Res. 2015;26(6):725–6. First technical report demonstrating feasibility of triple superimposition of DICOM + ST + OBJ for replication of a virtual dental patient . CrossRefPubMedGoogle Scholar
  28. 28.
    Schoenbaum TR. Dentistry in the digital age: an update. Dent Today. 2012;31(2):108–13.PubMedGoogle Scholar
  29. 29.
    Kim BR, Oh KM, Cevidanes LHS, Park JE, Sim HS, Seo SK, et al. Analysis of 3D soft tissue changes after 1- and 2-jaw orthognathic surgery in mandibular prognathism patients. J Oral Maxillofac Surg. 2013;71(1):151–61.CrossRefPubMedGoogle Scholar
  30. 30.
    Mori Y, Shimizu H, Minami K, Kwon TG, Mano T. Development of a simulation system in mandibular orthognathic surgery based on integrated three-dimensional data. Oral Maxillofac Surg. 2011;15(3):131–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Schendel SA, Jacobson R, Khalessi S. Three-dimensional facial simulation in orthognathic surgery: is it accurate? J Oral Maxillofac Surg. 2013;71(8):1406–14.CrossRefPubMedGoogle Scholar
  32. 32.
    Harris BT, Montero D, Grant GT, Morton D, Llop DR, Lin WS. Creation of a 3-dimensional virtual dental patient for computer-guided surgery and CAD-CAM interim complete removable and fixed dental prostheses: a clinical report. J Prosthet Dent. 2017;117(2):197–204.CrossRefPubMedGoogle Scholar
  33. 33.
    Hassan B, Gimenez Gonzalez B, Tahmaseb A, Greven M, Wismeijer D. A digital approach integrating facial scanning in a CAD-CAM workflow for complete-mouth implant-supported rehabilitation of patients with edentulism: a pilot clinical study. J Prosthet Dent. 2017;117(4):486–92.CrossRefPubMedGoogle Scholar
  34. 34.
    Liebregts J, Xi T, Timmermans M, de Koning M, Bergé S, Hoppenreijs T, et al. Accuracy of three-dimensional soft tissue simulation in bimaxillary osteotomies. J Craniomaxillofac Surg. 2015;43(3):329–35.CrossRefPubMedGoogle Scholar
  35. 35.
    Ullah R, Turner PJ, Khambay BS. Accuracy of three-dimensional soft tissue predictions in orthognathic surgery after Le Fort I advancement osteotomies. Br J Oral Maxillofac Surg. 2015;53(2):153–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Coachman C, Calamita MA, Sesma N. Dynamic documentation of the smile and the 2D/3D digital smile design process. Int J Periodontics Restorative Dent. 2017;37(2):183–93.CrossRefPubMedGoogle Scholar
  37. 37.
    Galantucci LM, Percoco G, Lavecchia F, di Gioia E. Noninvasive computerized scanning method for the correlation between the facial soft and hard tissues for an integrated three-dimensional anthropometry and cephalometry. J Craniofac Surg. 2013;24(3):797–804.CrossRefPubMedGoogle Scholar
  38. 38.
    Katase H, Kanazawa M, Inokoshi M, Minakuchi S. Face simulation system for complete dentures by applying rapid prototyping. J Prosthet Dent. 2013;109(6):353–60.CrossRefPubMedGoogle Scholar
  39. 39.
    Lin WS, Harris BT, Phasuk K, Llop DR, Morton D. Integrating a facial scan, virtual smile design, and 3D virtual patient for treatment with CAD-CAM ceramic veneers: a clinical report. J Prosthet Dent. 2017;119:200–5. Scholar
  40. 40.
    Naudi KB, Benramadan R, Brocklebank L, Ju X, Khambay B, Ayoub A. The virtual human face: superimposing the simultaneously captured 3D photorealistic skin surface of the face on the untextured skin image of the CBCT scan. Int J Oral Maxillofac Surg. 2013;42(3):393–400.CrossRefPubMedGoogle Scholar
  41. 41.
    Roy E, Bakr MM, George R. The need for virtual reality simulators in dental education: a review. Saudi Dent J. 2017;29(2):41–7.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Marei HF, al-Eraky MM, Almasoud NN, Donkers J, van Merrienboer JJG. The use of virtual patient scenarios as a vehicle for teaching professionalism. Eur J Dent Educ. 2017;22:e253–60. Scholar
  43. 43.
    Thomas R, Hopper E. Simulations: an opportunity we are missing. J Res Comput Educ. 1991;23:497–513.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Tim Joda
    • 1
    • 2
    Email author
  • Stefan Wolfart
    • 3
  • Sven Reich
    • 3
  • Nicola U. Zitzmann
    • 2
  1. 1.Department of Reconstructive Dentistry & Gerodontology, School of Dental MedicineUniversity of BernBernSwitzerland
  2. 2.Department of Reconstructive Dentistry, University Center for Dental Medicine BaselUniversity of BaselBaselSwitzerland
  3. 3.Department of Prosthodontics & Biomaterials, Center for Implantology, Medical FacultyRWTH Aachen UniversityAachenGermany

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