Integration of Digital Smile Design Into Aesthetic and Functional Crown Lengthening: A Clinical Case Report

Altered passive eruption is characterized by the position of gingival margins coronal to the cementoenamel junction, resulting in short clinical crowns and excessive gingival display, which is confirmed by clinical and radiographic examination. The present case report describes a 42-year-old systemically healthy female patient who reported with a dislodged prosthesis in the maxillary anterior region and dissatisfaction with her smile aesthetics. A periapical lesion on tooth 13 and altered passive eruption were confirmed by clinical and radiographic examination. Treatment was planned according to the etiology, and a digital mock-up was prepared using computer-aided design/computer-aided manufacturing (CAD/CAM) software, followed by surgical crown lengthening with a 3D-printed guided stent. For a precise initial gingival incision, electrosurgery was used under controlled settings, and a full-thickness flap was elevated for osseous recontouring. Temporary prostheses were delivered immediately postoperatively, and later lithium disilicate restorations were placed on teeth 13-23. Patient satisfaction was achieved, crown height-to-width proportions of the restorations were improved, and the gingival display was successfully reduced by 2 mm while maintaining probing depth within 2 mm. This case demonstrates how collaborative care and digital planning can help patients with altered passive eruption achieve precise aesthetic results.