ArticleClinical, cosmetic and investigational dentistry2026
Use of a Customized Milled Metal Surgical Guide for Esthetic Crown Lengthening: A Case Report.
Article in Clinical, cosmetic and investigational dentistry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Excessive gingival display (EGD) resulting from altered passive eruption (APE) is a clinical condition that is commonly managed by esthetic crown lengthening to achieve stable and symmetrical gingival margins. Determining the appropriate gingival and osseous resection levels remains a key step in achieving predictable surgical outcomes. Although digitally printed resin guides have been widely discussed, clinical data regarding milled metal dual-purpose guides remain limited. Patients and Methods: This single case report (n=1) describes the digital workflow for designing and fabricating a dual-purpose cobalt-chromium surgical guide to assist both gingivectomy and osteoectomy. The guide dimensions were determined by superimposing cone-beam computed tomography (CBCT) data with intraoral scan files to identify the cementoenamel junction (CEJ). The guide was fabricated using a subtractive milling process and used during esthetic crown lengthening in a patient diagnosed with altered passive eruption type I. Results: The milled metal guide appeared to provide stable positioning during surgery and helped guide both soft- and hard-tissue resection. At 6-month follow-up, gingival margins remained stable, symmetrical contouring was achieved, patient satisfaction was high, and no immediate postoperative complications were observed. Conclusion: This report presents a CBCT-integrated workflow for dual-purpose surgical guidance. The rigidity of the milled metal framework may assist intraoperative stability and support favorable short-term clinical outcomes in this case.
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