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02 April 2023

A digital workflow for perio analysis and crown lengthening: a case report

By Lorenzo Breschi and Diego D’Urso


A “gummy smile,” known as excessive gingival display, is a multifactorial condition that requires accurate diagnosis and treatment planning for achieving long-term esthetic outcomes. Coachman et al. (2022) have presented a case report of surgical crown lengthening in an esthetic region to describe how a digital workflow can improve diagnosis, treatment outcome and follow-up, achieving effective and predictable results.

Materials and methods

After data collection, a digital application (DSDApp, LLC) was utilized to create a 2D facially driven smile frame which showed the need for surgical crown lengthening to improve the esthetics. Clinicians conducted a cone-beam computed tomography (CBCT) exam and a 3D digital diagnostic wax-up were required for the perio analysis and surgical planning. 

The digital procedure allowed the team to create a virtual model of the patient collecting all the anatomical and periodontal information and plan using NemoStudio software (Nemotec, Madrid, Spain), a double guide based on aesthetic and biological requirements. The use of the guide during surgical procedures allowed the team to perform gingivectomy and osteotomy as planned. The inner edge of the guide indicated the new gingival margin, while the outer edge pointed out the height of the bone crest.


This case report presented a novel double guide for surgical crown lengthening allowing excellent management of hard and soft tissue based on individual patient’s needs. The application of digital technology allowed easy quality control of the achieved results.  

Coachman C, Valavanis K, Silveira FC, Kahn S, Tavares AD, Mahn E, Parize H, Saliba FMP. “The crown lengthening double guide and the digital Perio analysis.” J Esthet Restor Dent. 2023 Jan;35(1):215-221. doi: 10.1111/jerd.12920

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