Use of a Customized Milled Metal Surgical Guide for Esthetic Crown Lengthening: A Case Report

Excessive gingival display (EGD) resulting from altered passive eruption (APE) is a clinical condition that is commonly managed by esthetic crown lengthening to achieve stable and symmetrical gingival margins. Determining the appropriate gingival and osseous resection levels remains a key step in achieving predictable surgical outcomes. Although digitally printed resin guides have been widely discussed, clinical data regarding milled metal dual-purpose guides remain limited.

This single case report (n=1) describes the digital workflow for designing and fabricating a dual-purpose cobalt-chromium surgical guide to assist both gingivectomy and osteoectomy. The guide dimensions were determined by superimposing cone-beam computed tomography (CBCT) data with intraoral scan files to identify the cementoenamel junction (CEJ). The guide was fabricated using a subtractive milling process and used during esthetic crown lengthening in a patient diagnosed with altered passive eruption type I.

The milled metal guide appeared to provide stable positioning during surgery and helped guide both soft- and hard-tissue resection. At 6-month follow-up, gingival margins remained stable, symmetrical contouring was achieved, patient satisfaction was high, and no immediate postoperative complications were observed.

This report presents a CBCT-integrated workflow for dual-purpose surgical guidance. The rigidity of the milled metal framework may assist intraoperative stability and support favorable short-term clinical outcomes in this case.