Same-day case acceptance with Cympha DSD
The hardest moment in esthetic dentistry isn't the prep. It's the conversation when the patient asks "but what will it look like?" and you have to answer in words. Cympha's Digital Smile Design workspace turns that conversation into an image — on the patient's own face — in the same appointment.
The whole module runs in the browser, on the photo you just took with your phone. No upload, no CAD seat, and no waiting on a wax-up before the patient can see anything. This cookbook walks one real case from photo to download, and shows where DSD pays off on both sides of the workflow: the chair, and the lab.
Why it works
A 2D single-photo Digital Smile Design isn't trying to be a CAD wax-up. It's the communication tool that comes before one. The clinical realities behind that:
- Patients accept treatment they can see. Verbal description of a smile redesign is the leakiest part of esthetic case presentation. A before/after on their own face closes the gap.
- The lab needs your intent, not your guesswork. A downloaded DSD image, attached to the case, tells the ceramist what aesthetic you're after far better than "make them a little more square."
- The right altitude. No 3D, no occlusion, no mm tolerances — and that's the point. You make the smile decision; the lab makes the manufacturing decision.
Cympha Studio's DSD workspace is built on that framing. Everything below assumes it.
The photo
Step 1 of the wizard is Photo. Best input is a frontal, lip-retracted intraoral shot — the cheeks pulled back, teeth dry, the lower arch visible enough for context. A full-face smile selfie works too: Studio automatically crops to the mouth region and clips the morph to the lip outline so lips and skin are never deformed.
Three inline tools handle anything the photo needs before detection:
- Brightness / contrast for under- or over-exposed phones.
- Rotate for the tilted head everybody takes.
- Crop for the framing that's too wide.
Auto-level (face) does most of this in one click. When the picture looks like a clinical photo, click forward.
Detection — AI in your tab
Step 2 is Detect. Studio finds every tooth and traces its outline in one in-browser AI pass. The patient image stays in the tab the entire time.
What comes back per tooth:
- Bounding box, centre, area
- The incisal point and the zenith
- A 64-point contour
Then analysis runs automatically:
- Arch split (upper / lower) via an occlusal-curve fit (so tilted views don't misclassify posterior teeth)
- Per-tooth labels:
central-R,lateral-L,canine-R,premolar-L#1,molar-R#2, ... - Midline
- Smile arc (anterior-weighted)
- A report card: central width / height, incisal cant, midline offset, lateral-to-central ratio
The report card is the data behind the design — when you start reshaping, those numbers move with you.
When detection isn't quite right:
- A tooth missed → click Add tooth to place it, then Done with addition to fit them all at once.
- A tooth mis-numbered → pick from the Tooth number dropdown; the rest of the arch re-sequences from that anchor.
- A tooth in the wrong jaw → Move to upper jaw / Move to lower jaw.
Manual overrides survive a re-detect, so you don't lose work.
The Frame — golden proportions, your hands
Step 3 is Frame: the structural design surface. Four handle kinds shape the new smile:
- Midline (vertical reference)
- Contacts (vertical lines between anterior teeth — moving them changes tooth widths)
- Incisal curve (the smile-line)
- Gingival curve (the gum-margin shape)
Each upper-anterior tooth occupies a cell [leftContact, rightContact] × [gingivalCurve(x), incisalCurve(x)]. As you drag, the tooth contours re-map into the new cells — width, crown length, leveling and arch shape all flow from the frame.
Two automatic proposals to anchor the conversation:
- Auto-propose curves — smooth, symmetric, with the canines pinned as the arc corners. A blend slider lets you take 30%, 60%, 100% of the proposal.
- Golden widths — rebuilds the anterior contacts to central : lateral : canine = 1 : 0.618 : 0.382. The same blend slider applies.
Then the hand work:
- Grab a whole upper tooth to move or rotate it (the dial handle).
- Use the vertical-shift sliders to intrude or extrude a whole jaw (live preview during drag; the curves bake on release).
- Watch the report card update — the same numbers that read out from the detected smile now read out from the designed one.
Whole-tooth editing in Frame is upper-anterior only by design. The lower arch is contextual: it provides bite reference and follows the upper at the bite via a "shortening-only" coupling (a leader incisal moving away from the bite pulls the antagonist to keep contact; lengthening doesn't — overlap is handled by z-order).
Refine — the final polish
Step 4 is Refine: per-tooth touch-ups that don't cascade. This is the difference between the Frame and Refine layers — same gestures, different semantics:
| Layer | Step | Cascades? | Use | |---|---|---|---| | Structural | Frame | Yes — neighbours re-flow, golden rebalance, metrics re-analyse | Set the design intent | | Cosmetic | Refine | No — local only | Final polish |
In Refine you can drag a boundary point (neighbour points follow with smooth falloff), move the whole crown locally, or rotate it. 32 sparse handles surface on the 64-point contour — enough to control the silhouette without making it fiddly.
The order matters: Frame first, Refine last. If you do per-tooth polish in Refine then go back to Frame, the Frame re-flow will move the foundations under your polish. The wizard order isn't a suggestion.
Generate — the before/after that closes the case
Step 5 is Generate: the render. Two texture modes:
- Template (AI crown) — stamp ideal-smile crowns into the new shape. The workspace ships with a curated template library, and you can upload your own templates — clinicians who want a consistent house aesthetic, or a specific ceramist's signature look, drop in their own crown images and the workspace treats them the same as the built-in set.
- Preserve (own texture) — warp the patient's own enamel into the new shape, so the result looks like the patient's actual teeth, just realigned.
Then live sliders:
- Shade moves along a clinical shade ramp.
- Whitening brightens the tooth mask only — gums and skin stay where they are.
Both are post-passes on the already-morphed image, so the sliders update in real time without re-running the morph.
The before / after compare slider is the case-acceptance tool. Drag it left and right across the image while you walk the patient through what you'd do: "this is where you are now — this is what the lab is going to make." It's the most effective visual aid in esthetic dentistry, and it's now part of the same browser tab you use for everything else.
What rides to the lab
A DSD image is the doctor's intent, captured — the Intent dimension of a living case, in one picture. Download PNG saves the before/after, and you attach it to the Cympha case before submitting to the lab. The ceramist opens the case and sees:
- The intraoral scans (your case's actual files)
- The patient photo
- The DSD before/after you generated — the smile you decided on
That last attachment is where the leverage is. The ceramist doesn't have to interpret "make them a little more square" into a wax-up. They have the picture you and the patient agreed on. Revisions drop, because the design conversation already happened with the patient in the chair.
Privacy and where the work lives
Detection, analysis, and rendering all run in the browser, on the loaded photo:
- The patient photo never leaves the tab unless you explicitly save the result to a Cympha case.
- A second clinician on the same case opens Cympha Studio in their own browser, runs DSD on the same photo, and gets the same machinery — no install, no licence transfer.
This matches Cympha's posture across the rest of the stack: the work and the patient data live where they belong (in the case file), not in a third-party DSD service that has its own login and its own privacy story. That is one fewer place to have to account for when a patient asks where their photograph went.
What feels fast
- Detection + analysis: one pass, run on your own machine. The result caches, so re-opening the same photo picks up where you left it.
- Frame interaction: dragging the smile curve re-maps every tooth contour and re-runs the metrics live as you move.
- Vertical-shift sliders + rotation: real-time preview during drag.
- Shade / whitening: instant — the sliders update as you move them, no waiting on a render.
The final photo-realistic render fires once when you reach Step 5 (Generate) and again if you go back to change the Frame. Day-to-day editing never blocks on it.
Where it doesn't try to compete
It's worth saying again because the marketing won't:
- No lab CAD. No STL export. No mm-accurate manufacturing tolerances.
- No occlusion analysis. No 3D. No articulation.
- Upper-anterior focused. Posterior teeth are contextual.
The benefit is that the workspace can stay simple, run in a browser, and finish the case-acceptance conversation inside the appointment you already have. Lab manufacturing happens in the GuideMia OrthoPlus / Implant Master desktop apps — same Cympha ecosystem, different altitude.
Closing the loop
A doctor's day with DSD looks like:
- Patient asks about veneers in the new-patient consult. You take a retracted shot with the phone camera.
- Open Cympha Studio → Digital Smile Design → Perform DSD on the photo from the gallery.
- Five wizard steps, chairside. The before/after is on the screen.
- Patient sees the result on their own face. They sign the treatment plan.
- Download → attach to the Cympha case → submit to the lab. The ceramist opens the case and starts with your intent in hand.
The single most common reason esthetic cases fall through is the patient couldn't visualise the outcome. Cympha DSD removes that reason from your workflow — and it changes how the case feels on both sides of it. The doctor stops selling a description and starts showing a result. The ceramist stops interpreting adjectives and builds to a smile the patient already agreed to. That is work both of them can put their name to.