## 4 Discussion
In opposition to this, the mockups achieved through the digital workflows were symmetrical, except for the gingival arches between elements 1.2-1.3 and 2.2-2.3 in the 2D digital workflow and the dimensions of dental elements 1.1 and 1.2 in the 3D digital workflow. This alteration could be due to the fact that the software for 3D planning was open-source, which implied having no feasibility to substantially adjust the template of teeth to obtain perfect fitting and proportions. It could be interesting to improve this aspect by using professional software and a manageable template of teeth for 3D planning in order to have a more accurate result to measure. To correct the asymmetry, a gingivectomy would be needed, as shown by the overlapping of white matter on the gingival margin in the digital mock-up. The surgical procedure was not considered by the dental technician, who produced the wax-up without changing the soft tissues' features. The distinct symmetry in the digital reconstruction could be the reason for the high ratings obtained through the 2D digital reconstruction. Considering the working times collected in Table 11, the traditional workflow seemed to be the fastest; however, it must be noted that, in the 3D digital workflow a digital intraoral scanner was not used. If the intraoral scanner had been used, the total working time of 320 min could have been reduced by 50 min, which was the time used to take an alginate impression and produce the plaster model. In this case, the fastest workflow was the 3D digital workflow, despite it having the worst ratings in the survey. These results could be limited by the use of open-source software that had several limitations compared with paid programs, for example, not allowing to place the two dental arches in occlusion or the lack of digital dental elements to use in the digital wax-up. The operative times used to produce the mock-up through the 2D digital workflow were the longest (400 min); however, the aesthetic dental and facial analyses were accurately performed with a consequent more customized previsualization and aesthetic result fitting better with the facial features of the patient. Surely, it would also be possible that a trained operator could execute the same procedure in less time. The authors are well aware that drawing conclusions based on a single case represents a scientific weakness. However, the aesthetic planning of smile restoration is strongly related to the abilities of clinicians and technicians who create wax-ups or digital plans. This aspect is highlighted in our study, where all aspects of the procedures are evaluated, even if they were performed on a single patient. We assumed that knowing the operative times and information about results in terms of symmetry could be an important issue for clinicians and readers, even if they were not drawn from multiple cases. An important aspect the clinician should take into consideration is the cost differences between the three types of workflows. This aspect greatly affects the feasibility to make reliable mock-ups and full digital rehabilitation; because of this, the authors tested the feasibility of using open-source software, also for allowing young and non-specialized clinicians to use digital tools [32]. In conclusion, it can be noted that aesthetic digital planning is a useful tool for clinicians and also for communicating with patients [33]. It is, however, known that, sometimes, it could condition patients into having non-realistic expectations as to what the final result of the rehabilitation could actually be [17]. The production of the mock-up is certainly an important step that can be included in the course of treatment, especially in rehabilitation in the aesthetic area; it is useful for the patient to have concrete feedback on the modifications that will be applied in the restoration and also for the clinician to have visual feedback of the future restorations in the context of the patient's smile and face [34].