Esthetic crown lengthening is a critical surgical procedure aimed at improving dental esthetics by lengthening the clinical crown for enhanced smile harmony and functional restoration. Despite its routine application, significant gaps remain in the comprehensive understanding of biological and anatomical variables: such as the diverse periodontal phenotypes, the dynamics of supracrestal tissue attachment (formerly biological width), and individual soft tissue responses that influence surgical outcomes and long-term stability. Current knowledge recognizes the need for individualized surgical approaches based on precise assessment of these parameters, yet variations in technique selection, healing patterns, and esthetic predictability pose ongoing challenges. This presentation will delineate what is currently known about esthetic crown lengthening. Furthermore, it will highlight unresolved questions regarding optimizing surgical protocols, managing patient-specific factors, and integrating emerging technologies for improved esthetic and functional results. By bridging these knowledge gaps, clinicians can better tailor treatments to enhance patient satisfaction and clinical success in esthetic crown lengthening procedures.

Aim:
To provide a comprehensive overview of esthetic crown lengthening by examining current knowledge on biological and anatomical variables, and to identify unresolved challenges and opportunities for optimizing surgical protocols and patient-specific treatment approaches.
Objectives:
To review the impact of periodontal phenotypes, supracrestal tissue attachment dynamics, and individual soft tissue responses on esthetic crown lengthening outcomes.
To evaluate variations in surgical techniques, suturing techniques and it’s effect on healing and their influence on esthetic predictability and long-term stability.
To discuss unresolved questions and challenges in optimizing protocols tailored to individual patients.
To explore the potential role of emerging technologies in enhancing esthetic and functional results in esthetic crown lengthening procedures.