OBJECTIVE To evaluate methods and clinical performance of crown lengthening surgery for aesthetic restoration improvement of short anterior teeth. Various surgery methods, proper restoration time after surgery, and indications for crown lengthening surgery were discussed. METHODS Crown lengthening surgery and prosthetic treatment were applied to 148 short anterior teeth of 22 cases. Modified Ryge criteria were used to assess the gingival health after treatment. Restoration results before and after treatment were evaluated by use of Kay's altered dental esthetics classification. RESULTS When patients were re-examined after restoration of two weeks, obvious inflammation was found in 7.4% teeth. After providing the treatment and instruction on oral hygiene, 98.6% gingival health was significantly improved during the follow-up period. Two cases were examined during more than 4-year period and no obvious gingival inflammation and change in dental crown ratio were found. After treatment, all of 22 cases met Kay dental esthetics classification Class II-I (cosmetic) or Class II-I criteria. CONCLUSIONS Right selection of indications, accurate restoration design, delicate surgery operation, enough recover period for the gingival after surgery, and proper oral hygiene training method, all contribute to the satisfactory aesthetic restoration of anterior teeth.