Improved Gingival Margin Stability with a Digital Workflow in Esthetic Crown Lengthening: A Single-Center, Interventional, Non-Randomized, Open-Label Comparative Clinical Study on 622 Teeth

Background/Objectives: The stability of the gingival margin after crown lengthening is a key determinant of esthetic success in anterior rehabilitation. Digital workflows have been proposed to improve surgical precision, but their long-term impact on marginal stability remains insufficiently substantiated. Methods: A total of 87 patients (622 maxillary anterior and premolar teeth) who underwent esthetic crown lengthening were retrospectively evaluated. Patients were allocated to either a digitally guided workflow (G1, n = 62) or a freehand approach (G2, n = 25). Gingival margin stability was assessed using standardized intraoral photography and calibrated digital measurements at baseline, 1–2 months, and 12 months. Recurrence, periodontal parameters, complications, and patient satisfaction (VAS) were recorded. Mixed-effects models accounted for the clustering of teeth within patients. Results: Both workflows achieved predictable crown lengthening outcomes. At 12 months, median gingival margin recurrence was significantly lower in the guided group (G1: 0.14 mm [IQR 0.10–0.19]) compared with the freehand group (G2: 0.27 mm [IQR 0.20–0.34]) (p < 0.001). Secondary surgical revision was required in 1.6% of G1 patients versus 16.0% of G2 patients (p < 0.001). Patient satisfaction was high overall but greater in G1 (mean VAS 9.65 ± 0.52) than in G2 (8.96 ± 0.73). No major biological complications occurred. Conclusions: Digitally guided crown lengthening resulted in improved gingival margin stability and reduced the need for secondary correction compared with the freehand approach. Precise control of the bone crest position relative to the planned gingival margin is critical for long-term esthetic success.