Esthetic crown lengthening in the treatment of gummy smile

The aim of this article was to evaluate 1 year after surgery a surgical protocol that included gingivectomy and an apically positioned flap plus osseous resective surgery to correct excessive gingival display (EGD) in patients with altered passive eruption (APE) of the maxillary anterior teeth. Six female patients aged 18 to 22 years were diagnosed with APE type 1B. Surgical crown lengthening with flap surgery and bone recontouring was performed to achieve the biologic width. Photographic images were analyzed to evaluate the stable improvement of crown length before the procedure (baseline), immediately after surgery (immediate postoperative), and at 3 and 12 months postsurgery. Moreover, a lip repositioning procedure was also performed in one case to complement the periodontal therapy. Compared with baseline, an increase of 1.6 mm in the mean tooth crown height was observed in the photographic analysis at 12 months. A minimal difference was observed between the mean tooth crown height immediate postoperative and at 12 months, which indicates stability of the gingival margin. In conclusion, the surgical protocol outlined in this article describing esthetic crown lengthening for the treatment of APE/gummy smile resulted in predictable outcomes and stability of the gingival margin 1 year after surgery.