Aetiology-driven multidisciplinary management of excessive gingival display following clear aligner therapy: A two-year case report

Introduction: Achieving an Aesthetic smile requires more than orthodontic tooth movement; it depends on harmony among dental, gingival, labial, and facial components. Residual smile disharmony may persist after successful clear aligner therapy when the underlying aetiology is not fully identified.
Case Report: A female patient remained dissatisfied with her smile after successful closure of a maxillary midline diastema using clear aligners. Although the orthodontic outcome was satisfactory, the smile was still perceived as unaesthetic. Comprehensive facial analysis, dynamic smile assessment, upper lip evaluation, and digital smile design were used to determine the contributing factors. Because orthodontic correction alone was insufficient, a multidisciplinary treatment plan was performed, consisting of digitally guided aesthetic crown lengthening with osteotomy and osteoplasty, followed by lip repositioning surgery. Clinical and photographic evaluations were conducted throughout treatment and during a two-year follow-up. 
Discussion: This case demonstrates the value of an aetiology-driven diagnostic approach in managing residual smile disharmony after orthodontic treatment. The integration of facial analysis, digital smile design, and periodontal plastic surgery allowed individualized treatment of both hard- and soft-tissue deficiencies. The combined approach improved smile harmony and maintained clinical stability during follow-up. 
Conclusion: Successful orthodontic treatment does not always produce optimal smile aesthetics. Comprehensive etiologic evaluation and multidisciplinary management may provide predictable, stable, and patient-centered outcomes in patients with residual smile disharmony following clear aligner therapy.