Tooth show enhancement in the esthetic zone: a review and proposal a decision-making framework

This article aims to comprehensively review the clinical indications for esthetic crown lengthening (CL) and to propose a decision-making framework that incorporates key yet often overlooked factors influencing treatment planning. To gain a deeper understanding of the various clinical scenarios in which esthetic CL may be indicated, individual conditions are examined in detail, each accompanied by an appropriate treatment approach. Based on this analysis, we introduce a decision-making framework designed to guide clinicians in selecting the optimal treatment modality by accurately identifying the underlying esthetic concerns. The majority of published clinical guidelines for esthetic CL focus predominantly on cases with excessive gingival display. However, patients presenting without gingival display who may still benefit from esthetic CL are frequently neglected in the literature. Additionally, the influence of the smile arc and its relationship to incisal edge positioning remains underrepresented in current discussions. Our proposed decision-making framework integrates these critical factors to support more individualized and comprehensive treatment planning. Clinicians must possess a thorough understanding of all relevant esthetic and functional parameters when evaluating candidates for esthetic CL. Moreover, early and coordinated consultation with the prosthodontist is essential to define the appropriate balance between surgical and restorative interventions prior to surgical execution.