2 International Journal of Dentistry Figure 1 physically and socially active and sees his physician on regular basis. His periodontal condition was fair but stable. He had few localized areas of gingival bleeding and supragingival plaque with mild calculus. He had some missing teeth: multiple posterior teeth: nu- mber 1, 4, 13, 14, 16, 17, 19, 28, 29, and 32. He had new and recurrent carious lesions detected in teeth number 2, 6, 8, 9, 10, 11, and 21. He had implant-retained porcelain crowns on teeth nu- mber 13, 14, root canal therapy with post, core buildup and porcelain fused to metal crown on number 7 and ceramo- metal crown and ﬁxed partial denture work in the following areas: number 3, 4, 5, 7, 10, 12, 18, 20, 27, 30, and 31. 4. Diagnosis and Planning The patient’s chief complaint and his desire for a more aes- thetic smile was the driving force in formulation of this treatment plan. A thorough aesthetic examination was done, the patient’s concerns were discussed, study models and preliminary photographs were taken, and radiographs were examined. The diagnosis was based on the patient’s medical history, clinical and radiologic examination. Upon further evaluation, it was concluded that before any restorative or prosthodontic procedures were planned, a periodontal consultation was necessary to correct the un- aesthetic gingival margin in the maxillary anterior region. During the periodontal consultation, it was determined that the patient would require a crown lengthening proce- dure as well as a gingivectomy prior to any other treatment in order to respect the biological width and if ideal aesthetics were to be achieved. The patient would then receive porcelain crowns on his six anterior teeth. It was noted that the patient had many interproximal carious lesions. He received a caries risk assessment, extensive oral hygiene instructions, and a prescription for Prevident 5000 toothpaste. Following an adult prophylaxis and some selective hand scaling, a shade of his teeth was taken. The shade of his teeth ranged from A3 to A4 using the Vita Lumin (Vident, Germany) shade guide. The patient desired to have a lighter shade, and shade A2 was agreed upon. Figure 2 Figure 3 He also had poorly matched composite and porcelain res- torations, uneven gingival margins, black interproximal triangles, and severe occlusal wear, with many chipped incisal edges (Figure 1). Treatment options were explored and in order to address all of the patient’s requests, as well as to satisfy all clinical re- quirements, the following treatment plan/sequence was dev- eloped for and accepted by the patient: (i) performing surgical crown lengthening and gingivec- tomy in area number 6 through number 11, (ii) Postoperatory followup: suture removal in 10–14 days, and 8 weeks of healing, were allowed, (iii) performing all operative restorations on teeth: num- ber 2 MOD, number 20 B, number 21 MOD and direct composites restorations, (iv) Preparing teeth number 6, 7, 8, 9, 10, and 11 and pro- visionalizing (Luxatemp, Zenith/DMG; Englewood, NJ), (v) reﬁning prepared teeth [1] and taking impressions for Procera-AllCeram crowns (Nobel Biocare Sweden), (vi) inserting crowns with FujiCem, a resin-modiﬁed glass ionomer [2], (vii) follow-up treatment with hygiene and home care for optimal gingival health and high caries risk.