Introduction: Esthetics is becoming more important to completely edentulous patients than ever before, and more of them are asking for the smile of movie stars. The purpose of this study was to adopt the Digital Smile Design (DSD) software as a new method for complete dentures smile evaluation, that is more reliable than the subjective judgement of the dentist, the patient, or the patients’ relatives. Material and Methods: Sixty patients, 22 females and 38 males, already having their dentures, ranging 40 to 70 years old agreed to participate in this study, where they were photographed in a smiling and a lip retracted position. The photographs were evaluated by one examiner who used a DSD software called Digital Smile System (DSS). Evaluation included coincidence of the dentures midline with that of the face, parallelism of the incisal maxillary plane to the inter pupillary line (IPL), and equality of the width of the maxillary 6 anterior teeth with the inter alar width (IAW) of the nose. Patients were also asked about their acceptance of the dentures teeth forms and color. Results of this study were statistically analyzed using the package for social science (SPSS version 20 for windows) where the data were displayed in the form of frequencies and percentages, and comparisons between the study groups were carried out using Chi Square test at significance level p<0.05. Results: The midline of the maxillary dentures was coincident with the midline of the face in 48 patients, and had a statistically significant relationship with the maxillary incisal plane (p≤.001), which was parallel to the IPL in 41 patients, whether it followed the lower lip line or not. These centrally aligned midline of the dentures also had a significant relationship with the combined width of the maxillary incisors and canines (p=.001) when it was equal to the IAW in 50 of the patients. Teeth forms were accepted by 47 patients with no gender significant difference (p=.879), and 42 patients preferred a whiter shade with a significant difference for the females (p ≤.035). Conclusions: The midline of the face and width of the nose helped correct selection of the width of maxillary incisors, and the inter pupillary line helped to properly orient their plane. Patients opinion regarding their teeth form and color must be taken into consideration carefully. The DSD software presented a simple and a reliable method to evaluate and create the complete denture smile. Complete denture smile conforms to the principles of DSD as it originated from the same biometric references.
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