A female patient in her 20s came in for a consultation as she lacked the confidence to smile because she was unhappy with the unaesthetic appearance of her anterior teeth (Figure 1). Figure 1 The examination revealed discolouration and wear of the upper central incisors. The upper left lateral incisor also had both distal and mesial secondary caries. The canines were prominent and rotated bucco-distally (Figures 2, 3 and 4). Figure 2 Figure 3 Figure 4 Radiographs revealed satisfactory root canal treatments on the upper right lateral incisor and the upper left central incisor. There was a periapical radiolucency associated with the upper right central incisor as well as evidence of calculus present interdentally (Figures 5, 6 and 7). Figure 5 Figure 6 Figure 7 In order to resolve the periapical pathology and the periodontal health, I advised root canal treatment of the upper right central incisor and subgingival debridement to restore the periodontal health. Following the endodontic treatment, the root canals of the central incisors and the upper right lateral incisor were sealed with glass ionomer cement.
Once the first phase of the treatment was completed and the periodontal health was restored, several options for addressing the appearance of the anterior teeth were discussed with the patient. Orthodontics could be used to align the upper canines in the arch and an inside/outside bleaching technique would whiten the discoloured teeth. The patient had the choice of two different methods for restoration of the upper anterior teeth. The first option was to use composite, the second was to have ceramic crowns or veneers, with or without aesthetic posts. The patient was very nervous and apprehensive about having any extensive dental treatment. She decided to go for bleaching and the restoration of the teeth with composite due to its minimally invasive approach. If there is a relapse of colour in the future due to the tooth whitening, the composite can be resurfaced or repaired with a more opaque colour.