Esthetic Crown Lengthening: A Case Report and Literature Review

Excessive gingival display is a common esthetic concern among patients seeking smile enhancement. Altered passive eruption (APE) is a frequent etiologic factor and is characterized by incomplete apical migration of the gingival margin following tooth eruption. Accurate diagnosis and adherence to periodontal biologic principles are essential for achieving stable and predictable outcomes in esthetic crown lengthening (ECL). This article reviews the biologic and surgical principles of ECL, with particular emphasis on APE, and illustrates its management through a clinical case. A 28-year-old systemically healthy woman presented with short clinical crowns and excessive gingival display in the maxillary anterior region. Clinical and radiographic examination revealed the alveolar crest at or near the cemento-enamel junction (CEJ), consistent with APE Type I, Subgroup B (Type I-B) according to Coslet's classification. ECL was performed using a full-thickness flap with osseous recontouring to re-establish the supracrestal tissue attachment and achieve harmonious dentogingival proportions. Healing was uneventful, and stable gingival margins were maintained at the six-month follow-up, with marked improvement in smile esthetics. ECL is a predictable and effective treatment for APE when appropriate diagnosis, meticulous surgical planning, and preservation of the supracrestal tissue attachment are respected. In Type I-B cases, osseous resection is necessary to ensure long-term periodontal stability and optimal esthetic outcomes.