Figures 1a–1c: Arthur presented with a misaligned tooth #9, a dens invaginatus anomaly on tooth #10, and abfractions caused by his clenching and grinding parafunctional habits.

Figures 2a, 2b: Here’s a closer look at the anomaly. Dens invaginatus, also known as a tooth within a tooth, presents a greater risk for developing caries.¹ Management of the condition can include sealing the fissure, performing a root canal, or surgery. In this case, removing the carious lesion was sufficient, since the anomaly was not located close to the nerve.

Figures 3a, 3b: A gingivectomy and closed-flap crown lengthening were performed on teeth #6–8 to create symmetry and match tooth #9. The procedures were done using a Waterlase iPlus^® tissue laser (BIOLASE, Inc.; Foothill Ranch, Calif.).

Figures 5a–5c: I ordered a diagnostic wax-up from the lab as part of the treatment plan. Satisfied with the wax-up, I used a putty matrix to create the bis-acryl temporaries shown here. The patient was impressed by the esthetic look and was able to test drive his future smile.

Figures 8a, 8b: I bonded the BruxZir Esthetic veneers using NX3 Nexus^™ Third Generation Light-Cure cement (Kerr Corporation; Brea, Calif.) I was happy to see that the gingivectomy on #6–8 and crown lengthening resulted in gingival symmetry.

Figures 10a, 10b: The before-and-after photographs show a dramatic change in the patient’s esthetic appearance.