A Comprehensive Digital Workflow for the Treatment of Excessive Gingival Display Caused by Altered Passive Eruption: A Prospective Case Series

OBJECTIVES: This study evaluated the clinical outcomes, surgical accuracy, and patient satisfaction in treating excessive gingival display caused by altered passive eruption (APE) using a comprehensive digital workflow and double surgical guide. MATERIALS AND METHODS: A prospective case series study was conducted enrolling 30 patients diagnosed with APE Type 1B. Cone-beam computed tomography (CBCT), intraoral scanning, and digital smile design were used to design and fabricate a 3D-printed double surgical guide for both gingivectomy and osteotomy. The primary outcome was surgical accuracy, assessed by the gingival margin relapse at 6 months. Secondary outcomes included gingival display (GD), clinical crown length (CCL), periodontal and papillary parameters, and patient satisfaction. Statistical analyses were performed with significance set at p < 0.05. RESULTS: Thirty participants were treated successfully. The digital workflow demonstrated high accuracy with a median gingival margin relapse of 0.69 [0.58-0.87] mm at 6 months. Regarding clinical efficacy, a statistically significant reduction in GD was observed (from 3.13 [2.90-3.85] to 1.06 [0.56-1.99] mm; p < 0.001) alongside a statistically significant increase in CCL (from 7.64 [7.25-8.16] to 10.00 [9.56-10.46] mm; p < 0.001). Patient-reported outcomes indicated 100.0% satisfaction with the esthetic result. CONCLUSIONS: Within the limitations of this case series, the described comprehensive digital workflow using a double surgical guide is a predictable and effective method for treating excessive gingival display. The technique achieves significant esthetic improvements and results in a high level of patient satisfaction. CLINICAL SIGNIFICANCE: This study presents a comprehensive digital workflow for the treatment of gummy smile caused by altered passive eruption. By integrating digital planning with a double surgical guide, clinicians can achieve precise soft and hard tissue management, leading to predictable esthetic outcomes and high patient satisfaction.