Effect of digital smile simulation on patients’ decision to accept combined orthodontic restorative treatment planning for smile makeover

Patients seeking a smile makeover to improve the aesthetics of anterior teeth crowding often decline to undergo orthodontic treatment beforehand because it can prolong the process or because of an incomplete understanding of the procedure. However, performing only restorations does not achieve optimal results and may require more extensive tooth preparation. Providing patients with a preview of their expected aesthetic outcomes using digital smile simulation (DSS), both with and without orthodontic treatment, can increase their willingness to accept treatment. To examine the impact of DSS on patients' understanding, perception, confidence, and willingness to undergo orthodontic treatment. Sixty patients were randomly assigned to two groups: a control group receiving conventional consultation and a DSS-assisted consultation group. Five domains have been evaluated using a 1-7 scale questionnaire (15 Likert). Statistical analysis included independent t-tests comparing group, sex, and age. A significant statistical difference in patients' understanding, perception of the outcome, confidence, and willingness was observed between the DSS and control groups, with higher scores in the DSS group than in the control group (p < 0.0001). Subgroup analysis showed no significant differences between males and females or between patients under 30 and those over 30. DSS consultations can enhance patients' short-term decision-making and increase their willingness to pursue orthodontics prior to restorative procedures. However, since these results are based on immediate, post-consultation subjective perceptions, the clinical significance of these interactive visual tools should be viewed with caution. The study was listed on ISRCTN, the UK's clinical trials registry, under the study registration number ISRCTN44916096 (registered on August 4, 2025).