Clinical and esthetic outcomes of DSD-assisted esthetic crown lengthening with a dual surgical guide for re-restoration of periodontally compromised maxillary anterior teeth: A prospective case series

Objective To evaluate the clinical and esthetic outcomes of DSD-assisted esthetic crown lengthening with a dual surgical guide for the re-restoration of periodontally compromised maxillary anterior teeth. Methods Fourteen patients (70 affected teeth) were included. After root canal treatment and initial periodontal therapy, all patients underwent esthetic crown lengthening under DSD guidance with a 3D-printed dual surgical guide, followed by definitive all-ceramic restoration 6 months later. Probing depth (PD), bleeding on probing (BOP), papilla index (PI), and cervical margin adaptation were recorded at baseline, preoperatively, postoperatively, and after restoration. Patient satisfaction was assessed using a visual analog scale, and esthetic outcomes were evaluated using the pink esthetic score/white esthetic score (PES/WES). Results PD and BOP improved significantly after initial therapy. PD decreased further after surgery and remained low after restoration, whereas BOP remained at a low level overall during follow-up, with slight fluctuations across time points. PI increased significantly at all postoperative and post-restoration time points compared with preoperative values. Cervical marginal adaptation improved and remained stable. Most patients were satisfied with gingival margin position, smile esthetics, and the overall treatment process. PES, WES, and the combined PES/WES score all increased significantly. PES improved early after restoration and remained stable, whereas WES and the combined score further improved at 1 year. Conclusions DSD-assisted esthetic crown lengthening with a dual surgical guide appears to be a feasible and predictable approach for the re-restoration of periodontally compromised maxillary anterior teeth and was associated with improved periodontal parameters, stable soft tissue harmony, favorable esthetic outcomes, and high patient satisfaction.