Complex Aesthetic Treatment for Smile Rehabilitation with Supernumerary Tooth, Tooth Fracture, and Dental Shape Anomalies on Upper Anterior Teeth: A Case Report

Background: Facial and dental harmony play a crucial role in psychological well-being and self confidence. Aesthetic discrepancies in the maxillary anterior region, including supernumerary teeth, crown fractures, and unesthetic crown morphology, require rehabilitation while preserving oral functions. Digital Smile Design (DSD) facilitates complex aesthetic treatment by integrating macroesthetic and microesthetic principles in smile design planning. 

Purpose: This case report presents step-by-step of complex aesthetic treatment in a male patient with a supernumerary tooth, crown fractures, and unesthetic crown morphology. 

Case: A 23-year-old male with untreated dental trauma from an accident one year ago. Intraoral examination revealed a supernumerary tooth labeled 22(2) between teeth 21 and 22. Crown fractures in teeth 11, 21, and 22(2) were diagnosed as pulp necrosis and asymptomatic apical periodontitis. Tooth 12 exhibited an incisal taper, while tooth 22(1) had a more rounded mesio-incisal than disto-incisal edge. The patient reported diminished self confidence and sought treatment.

Case Management: Teeth number 11, 21, and 22(2) were managed with root canal treatment, followed by fiber post insertion and lithium disilicate crown. Tooth 12 underwent direct veneer restoration, while tooth 22(1) received an indirect veneer restoration using lithium disilicate. Aesthetic optimization was achieved through two-dimensional photographic analysis and digital impressions, with specialized software simulating the ideal tooth shape and size following macroesthetic and microesthetic principles. 

Conclusion: Complex aesthetic rehabilitation with Digital Smile Design (DSD) and lithium disilicate restorations optimizes aesthetics and function.