"Armchair" diagnosis and cosmetic dentistry treatment plan.

• History: The letter that accompanied this picture stated that this person was not interested in pursuing extensive orthodontic treatment (braces) as a solution for correcting the irregularities associated with their smile.
  
  
• Cosmetic dentistry treatment plan: It's hard to tell for certain from this picture but it seems likely that the second upper tooth left of center (the upper left lateral incisor) is in crossbite. When this person closes their teeth all of the way together this tooth lies behind its corresponding lower teeth rather than in front of them. If this interpretation is accurate then there really won't be any way to rebuild this tooth so to give it the appearance we've illustrated in our "after" picture. Some orthodontic treatment, although possibly just for this single tooth, will be needed.
  
  
• Cosmetic dentistry treatment plan: The overall cosmetic treatment plan we've illustrated here is to improve the apparent alignment of the upper front teeth by way of placing porcelain veneers. All of the teeth, except the upper left lateral incisor that we've already discussed, are in position well enough that it could be expected that the placement of veneers would provide the results we've illustrated.
  
  The lateral incisor in crossbite will need to be more favorably positioned using orthodontic treatment before a porcelain veneer can be placed on it. But because just this one tooth needs to be repositioned (and because of some other reasons not so easily explained in this forum) the difficulty in performing this orthodontic treatment should be significantly less than if all of the front upper teeth were to be realigned.