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

Background 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. Case Presentation 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. Management and Outcome 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. Conclusion 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).