INTRODUCTION Esthetic outcome can be achieved even in challenging clinical situations. Severely fluorosed teeth in a high caries risk patient with a compromised medical and psychological background would be an example of such a challenge. CLINICAL REPORT A 28 years old Saudi female with uncontrolled diabetes came to the dental clinics at King Abdul Aziz University Hospital, with a chief complaint of severe pain related to tooth #11, also dark discolorations of all her teeth, which was diagnosed as severe fluorosis. The discolored teeth were found to be the reason behind unhappy masked facial expressions on her face. Multiple decayed teeth and oral hygiene neglect were evident. A comprehensive treatment plan was implemented including extraction of badly decayed teeth, multiple root canal treatments, gingival recontouring, implants, multiple restorations, and combination of bleaching and porcelain laminates and ceramic crowns. TREATMENT OUTCOME: The patient appreciated the result and she is happy with her new smile. The long-term prognosis of the treatment outcome required controlled blood sugar and meticulous maintenance of oral hygiene. CONCLUSION With proper strategic planning, an outstanding esthetic outcome can be achieved. The patient has to be treated as a whole, taking into account mental and social factors, rather than just the physical symptoms.