Long-Term Outcome of Guided Crown Lengthening and Lip Repositioning in the Treatment of Excessive Gingival Display

Managing excessive gingival display (EGD) is challenging and requires precise diagnosis and etiology-driven treatment for long-term stability. This report describes a digitally guided, staged approach combining esthetic crown lengthening (ECL) and lip repositioning (LR) for multifactorial EGD.

A 28-year-old female presented with 7 mm of gingival display on dynamic smile, upper lip length of 19 mm, and lip mobility of 6 mm. The etiologic diagnosis was vertical maxillary excess (VME) Class II, hyperactive upper lip (HUL), and altered passive eruption (APE) (Coslet Type 1 B). Digital planning was performed using 3Shape intraoral scanning integrated with digital smile design (DSD) to establish target gingival zeniths and smile line. A dual-purpose three-dimensional (3D)-printed surgical guide (Form 3, Formlabs) was designed to (1) control the apical extent of crown lengthening and (2) visualize the anticipated dynamic lip line, targeting a residual gingival display of 2-3 mm.

Phase 1 involved ECL with gingivectomy and osseous recontouring to reestablish biologic width and create ideal crown proportions. After 6 weeks of healing, LR was performed following Bhola's technique with a partial-thickness mucosal excision, selective myectomy, and deep horizontal mattress sutures for stabilization. Gingival display reduced from 7 mm at baseline to 0 mm at 3 months, and measured ~2-3 mm after 5 years of follow-up, maintaining a pleasing smile arc and high patient satisfaction.

A digitally guided staged approach integrating ECL and LR effectively managed combined EGD etiology. The 3D-printed guide enhanced surgical precision and predictability, with sustained esthetic improvement at 5 years and minor recurrence (2-3 mm).