Background: Excessive gingival display “gummy smile” seems to be one of the main esthetic feature of the periodontium that plays an important role on oral health-related quality of life and can have an adverse effect on the patient’s perception of attractiveness and self-confidence.
Altered passive eruption APE is one of the causal factors of Excessive gingival display.
Esthetic crown lengthening surgery could be considered a predictable protocol for APE and achieving more harmonious and symmetrical smiles.

Clinical Implications: Esthetic crown lengthening surgery to manage APE could include gingivectomy and/or apically repositioned full-thickness flap, with/without ostectomy.

The width of keratinized gingiva, the position of the gingival margins, the location of the buccal alveolar crest, the location of the mucogingival junction, and the likelihood of concomitant restorative therapy are all factors that collectively determine the esthetic crown lengthening approach.

Clinical application of lasers in periodontal surgery has continued to expand in the last decade and the concept of minimally invasive dentistry can be achieved by choosing laser treatment.

The ability of erbium lasers to ablate both hard and soft tissues with excellent surgical precision and minimal collateral effects creates the opportunity for a minimally invasive flap and flapless, resulting in decreased tissue damage, minimize the bleeding, causing less inflammation, less post-operative discomfort, and may prevents collateral tissue damage that could occur with conventional methods.

Conclusion: Laser-assisted flapless esthetic crown lengthening is a predictable procedure, less traumatic, faster uneventful wound healing, and overall a positive experience for the patients.

Learning Objectives:

• Understanding of the classification and treatment planning for gummy smile caused by altered passive eruption..
• Discover how to meet the esthetic parameters through crown lengthening.
• Decide which surgical technique to apply in relation to the altered passive eruption diagnosis.
• Utilize the erbium laser in management of crown lengthening.
• Compare the clinical outcomes of erbium laser-assisted open-flap and flapless esthetic crown lengthening.
• Examine the relationship between the alterations in the periodontal tissue levels after crown lengthening with the amount of osseous resection, periodontal phenotype, tooth location, and the surgical technique.