###### Abstract  
This study aimed to compare conventional, digital 2D and digital 3D workflows as possible aesthetic rehabilitation processes for the maxillary anterior area using \"open-source\" software. For the conventional workflow, a diagnostic wax-up was produced by a dental technician. For the 2D digital workflow, Keynote software (version 11.1) was used to perform digital aesthetic analysis and smile planning. Measurements were taken and used by the technician to obtain a dental wax-up. For the 3D session, a plaster model was scanned and used to perform 3D analysis and the guide for the mock-up was digitally printed. Symmetry and aesthetic parameters were assessed for each mock-up, and the opinion of dental professionals and laypeople about the aesthetic outcome of three mockups was assessed by an anonymous questionnaire. The 2D mock-up received the highest score, and this mock-up was found to be the most symmetrical, even though it had the longest operating times. There was a statistically significant difference (\(p=0.000\)) between the scores given to this picture: experts in the dental field gave lower scores compared with non-professionals. Digital planning of aesthetic rehabilitation represents a technologically innovative procedure in dental practice, making it possible to achieve excellent aesthetic results, even when using open-source software. digital workflow; mock-up; aesthetic rehabilitation; open-source software +
Footnote †: journal: Medicalstandard to represent a preview of dental rehabilitations, even though the quality of the outcome is strongly impacted by the manual skills and knowledge of dental anatomy of the technician [12]. New digital technologies, diffused in recent years into routine clinical dentistry, are drastically changing the workflow. The introduction of photography in 1839 led medical professionals to document clinical procedures more and more and paved the way for the development of new digital treatment approaches. In 2002, [PERSON] and [PERSON] introduced what was going to become the aesthetical analysis of a patient's arches performed on patients' photographs and would, six years later, led to the first Digital Smile Design (DSD) protocol fully based on intraoral and extraoral images [13,14]. Given this, it is also important that young clinicians, undergraduates and non-specialized dentists have the opportunities and possibilities to provide their patients with more than one aesthetic analysis and method to create digital and clinical mock-ups [15,16,17]. The Digital Smile Design protocol can be performed on various software, such as Microsoft PowerPoint (version 17, Microsoft Corporation, Redmont, WA, USA), Keynote (Apple Inc., Cupertino, CA, USA) and Photoshop (version 21.x, Adobe Inc., San Jose, CA, USA), or specific apps, such as DSD App (Digital Smile Design, Madrid, Spain), Smile Design Pro (Tasty Tech Ltd., Toronto, ON, Canada) and Planmeca Romexis Smile Design (Planmeca OY, Helsinki, Finland). Every software package allows the drawing of reference lines and shapes on extra- and intraoral digital photographs. Facial, demotinggival and dental analyses are carried out to determine the new measurements of the dental elements that are then modified through standard templates or by drawing the elements ex novo [17,18,19]. All of the precise measurements of the modified dental elements obtained from the protocol are then used by a dental technician to produce an accurate wax-up. The protocol depends on photographic documentation of the case that, if not correctly achieved, could negatively impact the diagnosis and planning of the restorations. Therefore, a learning curve is to be expected for the clinician to be able to use the software [1]. A digital alternative to 2D digital smile planning is 3D digital smile planning performed on a three-dimensional scan of the patient's dental arches. This technique allows the clinician to design a digital wax-up of the elements using digital libraries of different three-dimensional shapes and sizes of dental elements [20].