The 4D virtual patient in digital dentistry: can multimodal data integration and specialty-specific applications pave the road toward dental digital twins?
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20262342Keywords:
Digital dentistry, Virtual patient, Facial scanning, Intraoral scanning, CBCT, Virtual articulationAbstract
The virtual patient in dentistry represents an integrated digital model rather than a single imaging modality or isolated digital workflow. This structured narrative review examined the principal components, clinical applications, and translational limitations of virtual-patient approaches in dentistry, including intraoral scanning, cone-beam computed tomography, facial scanning, digital photography, jaw-motion tracking, virtual articulation, occlusal analysis, and emerging digital-twin concepts. A literature search of PubMed, Scopus, and Web of Science was conducted, and the evidence was analyzed comparatively according to data source, integration method, specialty-specific application, clinical purpose, and current evidence maturity across periodontics, implant dentistry, prosthodontics, orthodontics, endodontics, pediatric dentistry, and oral and maxillofacial surgery. Overall, the findings suggest that the virtual patient does not represent a uniform level of clinical maturity across dental disciplines. Prosthodontics, implant dentistry, orthodontics, and oral and maxillofacial surgery currently show the strongest clinically anchored applications, particularly for facially driven treatment planning, prosthetically guided implant placement, digital setups, orthognathic simulation, and surgical transfer. By contrast, applications in periodontics, endodontics, and pediatric dentistry remain more focused on diagnosis, monitoring, guided precision, and longitudinal documentation rather than fully predictive digital modelling. Current limitations include registration error, scanner-dependent accuracy, soft-tissue distortion, CBCT artifacts, incomplete dynamic occlusal simulation, software interoperability barriers, and limited evidence linking virtual-patient workflows to long-term clinical outcomes. Future progress will depend on standardized validation studies that assess accuracy, transfer reliability, clinical efficiency, patient communication, and patient-relevant outcomes, while clearly distinguishing virtual-patient modelling from the more ambitious concept of a true dental digital twin.
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References
Fontenele RC, Gaêta-Araujo H, Jacobs R. Cone beam computed tomography in dentistry: Clinical recommendations and indication-specific features. J Dent. 2025;159:105781. DOI: https://doi.org/10.1016/j.jdent.2025.105781
Alrehaili RS, Almuzaini S, Alrajhi J, Dashti A, Alsuroor O, Alzahrani F, et al. Teledentistry in the Era of Digital Dentistry: Clinical Applications, Patient Experience, and Equity-Oriented Policy Implications. Cureus. 2025;17:e100137. DOI: https://doi.org/10.7759/cureus.100137
Caussin E, Moussally C, Le Goff S, Fasham T, Troizier-Cheyne M, Tapie L, et al. Vat Photopolymerization 3D Printing in Dentistry: A Comprehensive Review of Actual Popular Technologies. Materials (Basel). 2024;17(4):950. DOI: https://doi.org/10.3390/ma17040950
Khalil AS, Alrehaili RS, Alenazi S, Alfawzan F, Alobaidi R, Alshami A, et al. How Accurate is the Fit of Additive 3D-Printed Implant-Supported Restorations and Partial Coverage Posterior Restorations? A Systematic Review. J Pioneering Med Sci. 2025;14(9):12-22. DOI: https://doi.org/10.47310/jpms2025140903
Lawand G, Tohme H, Azevedo L, Martin W, Gonzaga L, Nassif M, et al. Techniques and accuracy for aligning facial and intraoral digital scans to integrate a 3-dimensional virtual patient: A systematic review. J Prosthet Dent. 2026;135(3):484-504. DOI: https://doi.org/10.1016/j.prosdent.2025.04.017
Jindanil T, Burlacu-Vatamanu OE, Baldini B, Meyns J, Meewis J, Fontenele RC, et al. Automated orofacial virtual patient creation using two cohorts of MSCT vs. CBCT scans. Head Face Med. 2025;21:21. DOI: https://doi.org/10.1186/s13005-025-00500-1
Shuto T, Mine Y, Tani A, Taji T, Murayama T. Facial Scans in Clinical Dentistry and Related Research: A Scoping Review. Cureus. 2025;17(4):e81662. DOI: https://doi.org/10.7759/cureus.81662
Haku-Mizuhara K, Tanabe G, Kadempour A, Mirafzali S, Yotsuya M, Yamaguchi S. Development of a 4-dimensional virtual patient in motion: A digital concept. J Prosthet Dent. 2026;135(1):47-53. DOI: https://doi.org/10.1016/j.prosdent.2025.02.064
Katsoulakis E, Wang Q, Wu H, Shah J, Ranjbar K, Noguchi T, et al. Digital twins for health: a scoping review. NPJ Digit Med. 2024;7:77. DOI: https://doi.org/10.1038/s41746-024-01073-0
Drummond D, Gonsard A. Definitions and Characteristics of Patient Digital Twins Being Developed for Clinical Use: Scoping Review. J Med Internet Res. 2024;26:e58504. DOI: https://doi.org/10.2196/58504
Lee JD, Nguyen O, Lin YC, Poon CY, Huang YF, Chen CC, et al. Facial scanners in dentistry: An overview. Prosthesis. 2022;4(4):664-78. DOI: https://doi.org/10.3390/prosthesis4040053
Yuan Y, Liu Q, Yang S, Li H, Wang Y, Zhang L, et al. Four-dimensional superimposition techniques to compose dental dynamic virtual patients: A systematic review. J Funct Biomater. 2023;14(1):33. DOI: https://doi.org/10.3390/jfb14010033
Joda T, Gallucci GO. The virtual patient in dental medicine. Clin Oral Implants Res. 2015;26:725-6. DOI: https://doi.org/10.1111/clr.12379
Granata S, Giberti L, Vigolo P, Stellini E, Di Fiore A. Incorporating a facial scanner into the digital workflow: A dental technique. J Prosthet Dent. 2020;123(6):781-5. DOI: https://doi.org/10.1016/j.prosdent.2019.05.021
Rangel FA, Maal TJJ, Bronkhorst EM, Breuning KH, Schols JGJH, Berge SJ, et al. Accuracy and reliability of a novel method for fusion of digital dental casts and cone beam computed tomography scans. PLoS One. 2013;8(3):e59130. DOI: https://doi.org/10.1371/journal.pone.0059130
Zou B, Kim JH, Kim SH, Lee C, Kim YJ, Kim HJ, et al. Accuracy of a surface-based fusion method when integrating digital models and the cone beam computed tomography scans with metal artifacts. Sci Rep. 2022;12:8034. DOI: https://doi.org/10.1038/s41598-022-11677-9
Pérez-Giugovaz MG, Park SH, Revilla-León M. Three-dimensional virtual representation by superimposing facial and intraoral digital scans with an additively manufactured intraoral scan body. J Prosthet Dent. 2021;126(4):459-63. DOI: https://doi.org/10.1016/j.prosdent.2020.07.012
Ntovas P, Revilla-León M, Barmak AB, Att W, Özcan M, Kois JC, et al. Accuracy of 3-dimensional virtual patient representation using different digital integration techniques and four facial scanners: A clinical validation study. J Prosthet Dent. 2026;135(4):561.e1-10. DOI: https://doi.org/10.1016/j.prosdent.2025.10.029
Amezua X, Iturrate M, Garikano X, Pradíes G, Solaberrieta E. Analysis of the influence of the facial scanning method on the transfer accuracy of a maxillary digital scan to a 3D face scan for a virtual facebow technique: An in vitro study. J Prosthet Dent. 2022;128(5):1024-31. DOI: https://doi.org/10.1016/j.prosdent.2021.02.007
Jain M, Abduo J. Accuracy of static and dynamic occlusion simulation of virtual articulation compared with a conventional articulator: A systematic review. J Prosthet Dent. 2026. DOI: https://doi.org/10.1016/j.prosdent.2026.01.028
Zambrana N, Sesma N, Fomenko I, Revilla-León M, Kois JC, Att W, et al. Jaw tracking integration to the virtual patient: A 4D dynamic approach. J Prosthet Dent. 2024;131(3):370-4. DOI: https://doi.org/10.1016/j.prosdent.2022.02.011
Kim JE, Park JH, Moon HS, Shim JS, Lee JY. Complete assessment of occlusal dynamics and establishment of a digital workflow by using target tracking with a three-dimensional facial scanner. J Prosthodont Res. 2019;63(1):120-4. DOI: https://doi.org/10.1016/j.jpor.2018.10.003
Wong King C, Chuy V, Laran A, Fages M, Bertholon A, Ducret M, et al. In vitro comparison of digital occlusal analyzers and articulating paper in static and dynamic occlusion. J Dent. 2026;164:106215. DOI: https://doi.org/10.1016/j.jdent.2025.106215
Lepidi L, Kim BC, Giberti L, Chen Z, Li J, Revilla-León M, et al. The 4D virtual patient: A proof of concept in digital dentistry. J Prosthet Dent. 2025;134(6):1442-5. DOI: https://doi.org/10.1016/j.prosdent.2024.02.029
Caron T, Decup F, Grosgogeat B, Chacun D. The relevance of intraoral scanner (IOS) for periodontal diagnosis: A scoping review. J Dent. 2025;160:105824. DOI: https://doi.org/10.1016/j.jdent.2025.105824
Dritsas K, Halazonetis D, Ghamri M, Antonarakis GS, Christou P. Accurate gingival recession quantification using 3D digital dental models. Clin Oral Investig. 2023;27(4):1697-705. DOI: https://doi.org/10.1007/s00784-022-04795-1
Kuralt M, Gašperšič R, Fidler A. The precision of gingival recession measurements is increased by an automated curvature analysis method. BMC Oral Health. 2021;21:505. DOI: https://doi.org/10.1186/s12903-021-01858-9
Mendoza-Azpur G, Cornejo H, Villanueva M, Paredes C, Rios K, Mayta-Tovalino F, et al. Periodontal plastic surgery for esthetic crown lengthening by using data merging and a CAD-CAM surgical guide. J Prosthet Dent. 2022;127(4):556-9. DOI: https://doi.org/10.1016/j.prosdent.2020.09.041
Gonçalves V, De Almeida Malzoni CM, Santos JC dos, Rios D, De Souza Batista VE, De Lima Lucas BL. Predictability of periodontal surgical guides manufactured by digital flow in clinical crown lengthening: A randomized trial. J Esthet Restor Dent. 2025;37:2125. DOI: https://doi.org/10.1111/jerd.13487
Azhari A. Accuracy of artificial intelligence applications in periodontics: a thematic narrative review. Front Dent Med. 2026;7:1729825. DOI: https://doi.org/10.3389/fdmed.2026.1729825
Pozzi A, Arcuri L, Moy PK. The smiling scan technique: Facially driven guided surgery and prosthetics. J Prosthodont Res. 2018;62:514-7. DOI: https://doi.org/10.1016/j.jpor.2018.03.004
Pérez-Giugovaz MG, Sadeghpour M, Revilla-León M. Virtual 3-dimensional representation of a completely edentulous patient for computer-aided static implant planning. J Prosthet Dent. 2023;129:384-90. DOI: https://doi.org/10.1016/j.prosdent.2021.06.038
Abad-Coronel C, Vandeweghe S, Vela Cervantes MD, Cobo-Vázquez C, Álvarez-Novoa C, Agustín-Panadero R, et al. Accuracy of implant placement using digital prosthetically-derived surgical guides: A systematic review. Appl Sci (Basel). 2024;14(17):7422. DOI: https://doi.org/10.3390/app14167422
Khaohoen A, Powcharoen W, Sornsuwan T, Wongsirichat N, Sirintawat N, Chaisuparat R, et al. Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials. BMC Oral Health. 2024;24:359. DOI: https://doi.org/10.1186/s12903-024-04033-y
Pradíes G, García-Naranjo AM, Martínez-Rus F, Martínez de Fuentes R, Romeo-Rubio M. EPA Consensus Project Paper: Shifting from the ‘Analogic Virtual Patient’ to the ‘Digital Virtual Patient’ in Prosthodontics. A Scoping Review. Eur J Prosthodont Restor Dent. 2023. DOI: https://doi.org/10.1922/EJPRD_2485Pradies17
Lin WS, Harris BT, Phasuk K, Liao YJ, 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. 2018;119(2):200-5. DOI: https://doi.org/10.1016/j.prosdent.2017.03.007
Luniyal C, Shukla AK, Priyadarshi M, Singh S, Gupta A, Kumar A, et al. Assessment of patient satisfaction and treatment outcomes in digital smile design vs. conventional smile design: A randomized controlled trial. J Pharm Bioallied Sci. 2024;16(1):S669. DOI: https://doi.org/10.4103/jpbs.jpbs_928_23
Lo Giudice A, Ortensi L, Farronato M, Lucchese A, Lo Giudice R, Pantaleo G, et al. The step further smile virtual planning: milled versus prototyped mock-ups for the evaluation of the designed smile characteristics. BMC Oral Health. 2020;20:165. DOI: https://doi.org/10.1186/s12903-020-01145-z
Kaitatzidou A, Chalazoniti A, Faggion CM, Tsintsadze N, Kourtis S. Digital scans versus conventional impressions in fixed prosthodontics: An overview of systematic reviews. J Prosthet Dent. 2025;134(6):2156-64. DOI: https://doi.org/10.1016/j.prosdent.2024.11.002
Marradi F, Staderini E, Zimbalatti MA, Spagnuolo G, Galli M, Gracco A, et al. How to obtain an orthodontic virtual patient through superimposition of three-dimensional data: A systematic review. Appl Sci (Basel). 2020;10(15):5354. DOI: https://doi.org/10.3390/app10155354
Sereewisai B, Chintavalakorn R, Santiwong P, Ratanaporncharoen C, Thiradilok S. The accuracy of virtual setup in simulating treatment outcomes in orthodontic practice: a systematic review. BDJ Open. 2023;9:41. DOI: https://doi.org/10.1038/s41405-023-00169-1
Stucki S, Gkantidis N. Assessment of techniques used for superimposition of maxillary and mandibular 3D surface models to evaluate tooth movement: a systematic review. Eur J Orthod. 2020;42:559-70. DOI: https://doi.org/10.1093/ejo/cjz075
Muthuswamy Pandian S, Subramanian AK, Vaiid N. Comparison of efficacy and accuracy of tooth movements in optimized and conventional attachments of clear aligners - A systematic review and meta-analysis. J Oral Biol Craniofac Res. 2025;15:1123-33. DOI: https://doi.org/10.1016/j.jobcr.2025.07.019
Sangalli L, Alessandri-Bonetti A, Dalessandri D. Effectiveness of dental monitoring system in orthodontics: A systematic review. J Orthod. 2023. DOI: https://doi.org/10.1177/14653125231178040
Rosen E, Goldberger T, Beitlitum I, Tsesis I, Taschieri S, Rosenberg E, et al. Diagnosis efficacy of cone-beam computed tomography in endodontics—A systematic review of high-level-evidence studies. Appl Sci (Basel). 2022;12(2):938. DOI: https://doi.org/10.3390/app12030938
Zubizarreta-Macho Á, Castaño SV, María Montiel-Company J, Mena-Álvarez J, Cabanillas-Balsera D, Martín-González J, et al. Effect of computer-aided navigation techniques on the accuracy of endodontic access cavities: A systematic review and meta-analysis. Biology (Basel). 2021;10(3):212. DOI: https://doi.org/10.3390/biology10030212
Jonaityte EM, Bilvinaite G, Drukteinis S, Peciuliene V, Skliutas E, Zaleckas L, et al. Accuracy of dynamic navigation for non-surgical endodontic treatment: A systematic review. J Clin Med. 2022;11(12):3441. DOI: https://doi.org/10.3390/jcm11123441
Langaliya A, Kritika S, Shah A, Jain S, Patel S, Patel N, et al. Does dynamic navigation system preserve more dentine? – A systematic review. BMC Oral Health. 2024;24:678. DOI: https://doi.org/10.1186/s12903-024-04450-z
Pul U, Schwendicke F. Artificial intelligence for detecting periapical radiolucencies: A systematic review and meta-analysis. J Dent. 2024;147:105104. DOI: https://doi.org/10.1016/j.jdent.2024.105104
Setzer FC, Li J, Khan AA. The Use of Artificial Intelligence in Endodontics. J Dent Res 2024;103:853–862. DOI: https://doi.org/10.1177/00220345241255593
Liczmanski K, Stamm T, Sauerland C, Rüther J, Wiechmann D, Lübberink G, et al. Accuracy of intraoral scans in the mixed dentition: A prospective non-randomized comparative clinical trial. Head Face Med. 2020;16:11. DOI: https://doi.org/10.1186/s13005-020-00222-6
Okamoto A, Karibe H, Tanaka S, Kawakami T, Fujita Y. Reliability of mixed dentition space analysis using a digital model obtained from an optical impression: A preliminary study. BMC Res Notes. 2024;17:12. DOI: https://doi.org/10.1186/s13104-023-06678-4
Van Gorp G, Maes A, Lambrechts M, Politis C, Jacobs R, Willems G, et al. Is use of CBCT without proper training justified in paediatric dental traumatology? An exploratory study. BMC Oral Health. 2023;23:270. DOI: https://doi.org/10.1186/s12903-023-03013-y
Karamüftüoğlu N, Üçpunar BY, Birben İ, Aksoy S, Korkmaz Y. Artificial intelligence in pediatric dentistry: A systematic review and meta-analysis. Children (Basel). 2026;13(2):152. DOI: https://doi.org/10.3390/children13010152
Assiry AA, Alrehaili RS, Mahnashi A, Alharthi A, Alotaibi S, Alshammari F, et al. How is artificial intelligence transforming the intersection of pediatric and special care dentistry? A scoping review of current applications and ethical considerations. Prosthesis. 2025;7(4):119. DOI: https://doi.org/10.3390/prosthesis7050119
Alkhayer A, Piffkó J, Lippold C, Danesh G. Accuracy of virtual planning in orthognathic surgery: A systematic review. Head Face Med. 2020;16:34. DOI: https://doi.org/10.1186/s13005-020-00250-2
Lee YJ, Oh JH, Kim SG. Virtual surgical plan with custom surgical guide for orthognathic surgery: Systematic review and meta-analysis. Maxillofac Plast Reconstr Surg. 2024;46:39. DOI: https://doi.org/10.1186/s40902-024-00449-2
Olejnik A, Verstraete L, Croonenborghs TM, Verhelst PJ, Politis C. The accuracy of three-dimensional soft tissue simulation in orthognathic surgery—A systematic review. J Imaging. 2024;10(5):119. DOI: https://doi.org/10.3390/jimaging10050119
Kotecha S, Ferro A, Harrison P, Patel M, Praveen P. Orbital reconstruction: A systematic review and meta-analysis evaluating the role of patient-specific implants. Oral Maxillofac Surg. 2023;27(2):213-26. DOI: https://doi.org/10.1007/s10006-022-01074-x
Yousif E, Abdalla M, Jumaa H, Al-Saadi S, Al-Mutairi K, Alharthi A, et al. 3D-printed patient-specific implants in maxillofacial reconstruction: A systematic review and meta-analysis of clinical outcomes and workflow efficiency. Cureus. 2025;17:e98224. DOI: https://doi.org/10.7759/cureus.98224
Sun T, He X, Li Z. Digital twin in healthcare: Recent updates and challenges. Digit Health. 2023;9:20552076221149651. DOI: https://doi.org/10.1177/20552076221149651
Elsayed EI, Galadari R, Alharmoodi R. Digital twin technologies in endodontics: Current evidence, challenges, and future perspectives. Digit Dent J. 2026;3:100051. DOI: https://doi.org/10.1016/j.ddj.2025.100051
Salvi S, Vu G, Gurupur V, Li X, Wang H, Zhang Y, et al. Digital convergence in dental informatics: A structured narrative review of artificial intelligence, Internet of Things, digital twins, and large language models with security, privacy, and ethical considerations. J Dent Inform. 2025. DOI: https://doi.org/10.3390/electronics14163278
Alang TAIT, Lee YY, Tan TS. Medical Digital Twin Technology for Interoperability: Challenges and Opportunities. Biomed Eng Comput Biol. 2026;17:11795972261431928. DOI: https://doi.org/10.1177/11795972261431928
Burr CD, Qian S, Winter P, Chico T, Rangel Smith C, Wagg D, et al. Realising the digital twin: a thematic review and analysis of the ethical, legal, and social issues for digital twins in healthcare. AI Soc. 2026;41(5):5243-67. DOI: https://doi.org/10.1007/s00146-025-02833-6