Aesthetic rehabilitation of maxillary anterior teeth with high caries risk and poor oral hygiene: A case report

Introduction: Anterior teeth are key to smile aesthetics, requiring careful restorative planning. Success depends on dentist-patient-lab collaboration and precise case selection. Smile harmony involves tooth color, shape, texture, gingival contour, and facial alignment. Caries, caused by bacterial acid demineralization, often prompts esthetic treatment. Tools like Digital Smile Design (DSD) enhance predictability and teamwork, addressing high-caries-risk cases with poor oral hygiene. 

Description of Case: A 28-year-old female patient presented with multiple carious lesions and esthetic concerns in the maxillary anterior region. She reported poor oral hygiene habits, a high-frequency snacking routine, and an upcoming wedding as motivation for treatment. Clinical and radiographic evaluations revealed extensive caries, a non-vital tooth and esthetic discrepancies including discoloration, misalignment, and gingival asymmetry. A comprehensive treatment plan was implemented, involving periodontal therapy, root canal treatment, and full-coverage lithium disilicate crowns guided by digital smile design. 

Discussion: Managing complex anterior esthetic cases with high caries risk and poor hygiene requires a multidisciplinary approach. Behavioral factors worsened the condition, necessitating restorative, endodontic, and periodontal treatment. The use of digital smile design helped in planning and achieving optimal esthetic outcomes. Lithium disilicate crowns were selected for their superior esthetics and strength, providing long-term functional and cosmetic benefits. 

Conclusion: This case highlights that successful esthetic rehabilitation depends on accurate diagnosis, motivated patient involvement, and coordinated multidisciplinary treatment. The approach effectively restored both dental function and appearance, greatly improving the patient's smile and self-confidence.