PMC9508994_01
Pretreatment, exaggerated smile view. Note non-ideal gingival display.
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Al-Elm University, and the patient agreed and signed a consent form to publish her case details and accompanying clinical photographs. A 46-year-old woman with a noncontributory medical history presented to the Department of Prosthodontics with the chief complaint of unsatisfactory esthetics of the maxillary anterior teeth (ie, "short teeth", defective restorations and excessive non-ideal gingival display at rest position/in an exaggerated smile) (Figure 1).
Pretreatment, retracted intraoral frontal view.
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I, overjet of 1 mm, overbite of 3 mm, and mutually protected occlusion during mandibular movements (Figure 2). Clinical and radiographic examinations revealed multiple extractions, root canal treatments (RCTs), composite veneers, metal-ceramic crowns and fixed dental prostheses (FDPs). In the anterior region, the problems identified during intraoral examination were marginal gingival inflammation with a probing depth of 4 mm due to inadequate direct and indirect restorations of the anterior maxillary teeth.
2D proposed smile design.
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Smile analysis revealed short anterior maxillary teeth with a 90% width to length ratio (for central incisors) and a high lip line/gingival display of 2 mm at rest and 4 mm in an exaggerated smile, with improper gingival architecture and thick gingival/periodontal biotype (Figure 3).   
(A) Software view of superimposition of the virtual diagnostic cast, wax-up cast design, and CBCT image. CBCT, cone beam computed tomography. (B) Software view of the initial design of the surgical guide. (C) Software view of the definitive design of the surgical guide.
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The digital workflow described by Passos et al was followed to 3D-design and fabricate a crown lengthening surgical guide (Figure 4A-C).
Surgical guide in place.
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Subsequently, this surgical guide allowed for accurate execution of surgical esthetic crown lengthening according to the 3D digital planned design (Figure 5).
Standard tessellation language (STL) file of diagnostic wax-up.
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Furthermore, a stereolithographic prototype of smile wax-up of the upper and lower teeth was then 3D printed using a light-polymerizing 3D resin (Jamghe Pro Model Resin, Jamghe) (Figure 6).
Primary flap design after initial incision using the surgical guide.
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Surgical crown lengthening was performed using the fabricated surgical guide (Figure 7).
Inserted definitive prostheses with occlusal appliance in place.
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At the 1-week follow-up evaluation, the patient was happy and comfortable with her new prostheses, and a maxillary occlusal device (night guard) (Figure 8) was delivered at that time; the patient was instructed to wear it at night to protect the prostheses.
Smile after treatment.
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After 1.5 years, she was still pleased and comfortable with her smile (Figure 9).