The perception of aesthetic appearance is a significant determinant of psychological and social well-being, with societal biases often favoring individuals perceived as attractive, correlating with greater observed success (1, 2). Concurrently, the field of aesthetic dentistry has experienced substantial growth, a trend increasingly propelled by the pervasive influence of social media platforms and digital applications (3). Achieving optimal outcomes for ceramic restoration in the aesthetic zone requires precise planning and execution. Digital Smile Design (DSD) has revolutionized restorative dentistry by providing a comprehensive digital approach. Utilizing specialized software and imaging, DSD enables clinicians to analyze facial and dental proportions and digitally design a harmonious, patient-specific smile before treatment (4, 5). Integrating DSD into the workflow permits clinicians to overcome limitations of subjective assessment, enhances dentist-patient communication by enabling patients to visualize proposed outcomes, fosters collaboration within interdisciplinary teams and increases patient satisfaction and involvement in decision-making (6, 7). Furthermore, DSD serves as a powerful tool that ensures appropriate communication between clinicians and dental laboratories for accurate restoration fabrication (8).

Diagnostic wax-up constitutes a fundamental diagnostic and treatment planning tool for patients being considered for prosthetic restorations. It enables the critical assessment of discrepancies between the existing dentition and the proposed ideal morphology, including evaluations of tooth size discrepancies, available restorative space, the planned occlusal scheme and potential treatment requirements within the opposing arch (9). Furthermore, this allows for clinical evaluation of the provisional restorations and provides an opportunity for the patient to request modifications at an early stage of treatment planning. In terms of diagnostic role, it provides the basis for fabricating both diagnostic guides and preparation reduction guides (10). The definitive tooth preparation can be precisely executed using an interim prosthesis stabilized intraorally via a putty silicone index and a silicone reduction guide derived from the wax-up. Specifically, reduction guides fabricated from the diagnostic wax-up utilizing either clear or putty matrices permit the clinician to quantitatively assess the adequacy of interproximal, incisal and facial reduction for each tooth during preparation, which minimizes enamel removal (11). The pursuit of minimally invasive aesthetic restorations has driven the widespread adoption of ceramic laminate veneers as a primary solution in modern dentistry (12). Among available ceramic materials, lithium disilicate (LDS) has emerged as the preferred choice due to its superior mechanical strength, exceptional optical properties and proven long-term clinical reliability (13). Its high flexural strength, ranging between 350 and 400 Megapascal (MPa), allows its use in monolithic restorations, providing a balance between aesthetics and function (14). Compared to traditional feldspathic ceramics, LDS offer an optimal balance of high fracture resistance and natural translucency, making them particularly suitable for aesthetic rehabilitation of anterior teeth as well as adoptable in minimally invasive prosthodontic procedures, such as veneers, inlays and onlays (15). Clinical studies consistently demonstrate high survival rates and minimal complication rates for LDS restoration (16–18). Besides, achieving long-term success with these restorations necessitates careful case selection, conservative preparation protocols and precise adhesive cementation techniques (19, 20). Crucially, enamel preservation optimizes bonding outcomes; LDS veneers exhibit superior adhesion to enamel, conferring enhanced longevity and significantly greater survival rates relative to dentin-bonded restorations (21).

On the other hand, the successful rehabilitation of aesthetically disharmonious anterior dentition, particularly in cases presenting with complex biomechanical and periodontal challenges such as altered passive eruption (APE) and Angle Class II division 2 malocclusion which require a meticulously planned, minimally invasive approach. In such clinical scenarios, conventional treatment planning may fall short in addressing the intricate interplay between aesthetic ideals, functional demands and biological preservation. When combined with the high strength, excellent aesthetics, and conservative preparation protocols afforded by the LDS laminate veneers, this digital workflow ensures an optimal balance between maximal tissue preservation and long-term restorative success (22).

This case report illustrates the application of this integrated protocol in a patient with anterior aesthetic disharmony, highlighting how DSD-driven planning and LDS veneers can effectively address both aesthetic deficiencies and underlying structural challenges through a minimally invasive intervention.

This six-year recall case report demonstrated a 100% survival rate for the LDS veneers. The clinical acceptability of the restorations was longitudinally assessed using a modified USPHS Ryge criteria system. This method involves the direct evaluation of specific qualitative characteristics—including color match, marginal integrity (adaptation and discoloration), anatomical contour, surface texture and evidence of secondary caries. Each criterion is assigned a qualitative score (typically Alpha for ideal, Bravo for clinically acceptable and Charlie for unacceptable) to facilitate standardized monitoring of restoration performance over time (25). In the present case report, the retention, color match, secondary caries, anatomic form and surface texture were evaluated at 0 grade – Alpha; while the marginal adaptation was evaluated at 1 grade - Bravo with a slight deviation from the ideal performance, which possible correction without damage after six years. Several observed slight marginal defects and slight marginal discolorations were not considered definitive failures, as they could be easily repolished or repaired. The results herein, which indicate superior performance of LDS veneers, are corroborated by prior long-term clinical studies reporting high estimated 10-year survival rates of around 95.5% (26–28).

Accurate diagnosis and treatment planning are paramount in aesthetic dentistry, and DSD facilitates this through virtual aesthetic analysis and treatment simulation based on edited photographs or digital patient models (29). This study utilized a dataset comprising standardized extraoral and intraoral photographs of patients. While multiple software solutions exist for digital smile design treatment planning, this study utilizes Adobe Photoshop. This software was prioritized over other available options due to its advanced editing toolkit, which facilitates a non-linear workflow through the use of discrete, editable layers for each design element. This feature, combined with its capacity to export high-resolution images in multiple formats while maintaining exceptional color calibration and sharpness, makes it an optimal tool for precise and reproducible digital wax-ups (30, 31). The reference lines and shapes, as described by Coachman, were applied by using layered analysis to diagnose existing discrepancies and digitally design the proposed prosthetic morphology. A precise superimposition of the patient's frontal facial and intraoral photographs is a critical prerequisite for the accurate transfer of digital design data from the facial to the intraoral context in the Digital Smile Design (DSD) workflow (32). To standardize patient positioning, a pose-fixation headrest and camera viewfinder-integrated alignment guides were employed during image acquisition as previously reported (7). Furthermore, to ensure the stability of the established occlusal plane following the DSD-guided diagnostic mock-up, its orientation was meticulously transferred and verified at each sequential stage of the definitive ceramic restoration fabrication.

The selection of an appropriate preparation design is a critical determinant in the clinical success and longevity of ceramic laminate veneers. Common preparation designs include the featheredge, incisal overlap and window preparations (33). The featheredge design is considered the most conservative, maximizing the preservation of sound tooth structure. However, it may compromise veneer fit and fracture resistance due to minimal incisal reduction and the resulting thin ceramic margin (34). In contrast, the incisal overlap design, which extends the preparation over the incisal edge, enhances restoration stability, improves seating accuracy and provides superior aesthetic outcomes by masking the tooth-veneer interface (35). The window preparation, while also conservative, may offer less mechanical support and resistance form compared to the incisal overlap, particularly under functional loading conditions (36). On the other hand, a well-adapted veneer properly designed with proximal “wings” may contribute to periodontal health. Indeed, finite element analysis (FEA) and in-vitro studies on extracted teeth have demonstrated that a modified window preparation with convex (“S”-shaped) proximal contours helps preserve the interproximal contact area, minimizes micro-gaps and enhances the aesthetic emergence profile at the gingival papilla. (35, 37, 38) Therefore, all the veneers were decided to prepare with an S-shape proximal contour. Of note, the 6 anterior teeth in this report were prepared following a modified window design, while veneers on the first and second premolars were prepared with partial occlusal coverage to enhance load-bearing capacity and ensure optimal aesthetic integration.

The biomechanics of Angle's Class II Division 2 malocclusion are characterized by anterior protrusive and lateral excursive movements. This occlusal pattern results in the application of substantial functional loads primarily onto the incisal edges of the central incisors and the palatal transitional ridges of the maxillary canines (39, 40). In this study, compensate for the pronounced lingual inclination of the anterior teeth and to provide adequate lip support, the proposed veneers on the four maxillary incisors required a significant thickness of 1.2–2.5 mm at the incisal edge.

Superior clinical outcomes, specifically regarding marginal integrity and bond durability, have been consistently reported with the use of etch-and-rinse adhesive systems (41, 42). In this study, preparation depth was guided by a silicone index to achieve a minimal tooth reduction of 0.3–0.5 mm, ensuring that the preparation margins were located almost within enamel, a paramount factor for achieving a durable and long-lasting bond. Regarding the maxillary central incisors, which presented with rotation and a palatal inclination of the long axis, a heightened risk of dentin exposure following preparation was anticipated. Consequently, following a standardized preparation with an average reduction of 0.3 mm and 0.5–0.8 mm in areas of tooth rotation, iatrogenic dentin exposure was identified at specific sites. An immediate dentin sealing (IDS) protocol was subsequently implemented to prevent postoperative hypersensitivity and to enhance the bond strength of the definitive laminate veneer restorations (43).

Mastering the cementation is another crucial factor for ensuring best performance of LDS veneers. The appropriate luting agent should be chosen following a comprehensive evaluation of factors such as ceramic thickness, adhesive characteristics, precision of marginal fit and the mechanical properties of the cement (44). Dual-cure cements are advantageous in cases where the ceramic material is too thick or too opaque to allow sufficient light transmission for polymerization. However, they have a shorter working time and may lead to failure if not properly cured (45). Previous study has reported that a higher degree of conversion in low viscosity light-cure resin cement materials enhances the mechanical properties, reducing the risk of microleakage and increasing the color stability and durability of the final ceramic veneers (46). In this study, a light-cured luting resin was utilized and the oxygen inhibition layer was further blocked with the glycerine gel application as previously recommended (47). A final high-intensity polymerization cycle was meticulously performed with an LED light source, strictly following the manufacturer's instructions regarding exposure time and working distance.

This report has limitations inherent to a single case study. While clinical and photographic documentation is comprehensive, the absence of systematic periapical radiographs at the 6-year recall (as the patient was asymptomatic) is a limitation for evaluating potential subclinical changes. The long-term performance of the veneers in this specific malocclusion warrants further observation.

This case report has underscored that the long-term aesthetic and functional success of LDS veneers is contingent upon a comprehensive diagnostic evaluation utilizing the DSD concept, meticulous material selection, appropriate preparation design and precise adhesive cementation protocols.