Surgical crown lengthening (SCL) is indicated to reestablish the biologic width and to increase the extent of supragingival tooth structure for restorative or esthetic purposes. The present study aimed to evaluate the postrestorative conditions and positional changes of the periodontal tissues following SCL 15 years or more after surgery. Moreover, an early postsurgical physiologically oriented crevicular tooth repreparation (POCR) approach for surgical and restorative phases of the SCL procedure is described. Eighteen patients who needed SCL to gain retention necessary for prosthetic treatment, or previous prosthetic margins, were included. During surgery, the bone level was reduced based on the future prosthetic margin and predetermined biologic width; flaps were placed at the bony crest. Relined temporary acrylic resin crowns were delivered 7 to 10 days postsurgery, and definitive crowns were delivered 9 months postsurgery. Patients were examined at baseline (BSL); at 3, 6, and 9 months postoperatively; and at each yearly recall visit. The following parameters were evaluated: Plaque and Gingival Indices, free gingival margin, width and thickness of the keratinized gingiva, probing depth, attachment level, bone level, direct bone level, and biologic width. Sixteen patients completed the study. No significant change in the position of the free gingival margin and periodontal parameters were seen from 9 months to > 15 years. Biologic width at 9 months was smaller compared to BSL (-0.06 ± 0.02 mm) and gradually increased during the follow-up period, almost reaching the initial levels at the examinations > 15 years later. The described SCL technique obtained a consistent 3-mm gain of coronal tooth structure and was successful in maintaining stable periodontal tissue conditions, reestablishing the biologic width to its original vertical dimension after 15 years.