Aim: This retrospective study aims to reveal the clinical outcome at 48 months of a minimally invasive crown lengthening technique performing an intrasurcular flapless osteotomy, using a piezoelectric tip designed for this purpose.

Material and Methods: All subjects in the current case series required esthetic crown lengthening procedures in the anterior esthetic zone of the maxilla. Prosthetic planning was carried out, which included a digital waxup of the ideal tooth morphology, which allowed constructing a surgical guide to transfer the proposed gingival margins to the patient. Gingivectomy was performed by using an electrosurgery system Perfect TCS IITM (Coltene Whaledent) and osteotomy by using a piezoelectric insert PiezoSmileTM (BROK) until achieving a bone crestgingival margin distance similar to the presurgical.

Results: 57 patients were followed postoperatively for 48 months. During the post-operative period, healing, complications, periodontal and aesthetic health parameters including the position of the gingival margin were observed. WES, PES and RES indexes showed an optimal integration with the restorative materials and a good aesthetic result.

Conclusion: Minimally invasive crown lengthening technique with electrosurgery and a piezoelectric insert is effective in repositioning the gingival margin in a stable and predictable manner within a 48 months follow-up.