In the age of digital dentistry, virtual treatment planning is becoming an increasingly important element of dental practice. Thanks to new technological advances in the computer- assisted design and computer-assisted manufacturing (CAD/CAM) of dental restorations, predictable interdisciplinary treatment using the backward planning approach appears useful and feasible. Today, a virtual smile design can be used as the basis for creating an esthetic virtual setup of the desired final result. The virtual setup, in turn, is used to plan further treatment steps in an interdisciplinary team approach, and communicate the results to the patient. The smile design concept and the esthetic analyses required for it are described in this article. We include not only a step-by-step description of the virtual smile design workflow, but also describe and compare the several available smile design options and systems. Subsequently, a brief discussion of the advantages and limitations of virtual smile design is followed by a section on different ways to integrate a two-dimensional (2D) smile design into the digital three-dimensional (3D) workflow. New technological developments are also described, such as the integration of smile designs in digital face scans, and 3D diagnostic follow-up using intraoral scanners.