Altered Active and Passive Eruption: A Modified Classification

Abstract

Focused Clinical Question: How should cases of altered passive and active eruption be diagnosed, classified, and treated?Summary: Frequently, a “gummy smile” contributes to esthetic problems and is caused by several factors such as vertical maxillary growth, dentoalveolar extrusion, short upper lip, upper lip hyperactivity, altered passive eruption (APE), or a combination of these factors. APE is a genetic or developmental condition characterized by coronal positioning of the gingival margin over enamel, resulting in short clinical crowns. Active eruption is defined as tooth movement in the occlusal direction as the tooth erupts from its osseous crypt. Altered active eruption (AAE) occurs when teeth achieve the opposite relationship to the occlusal plane prematurely and the osseous crest is on or very close to the cemento‐enamel junction. Thus, correct understanding of biologic events related to APE and AAE should be considered in the classification of a gummy smile. This article proposes a modification of a previous clinical classification and provides a surgical guide for treatment planning of cases involving APE and/or AAE. Periodontal biotypes are also taken into consideration.Conclusions: This article proposes modification of a previous classification dealing with two eruptive processes known as AAE and APE. Clinical cases and schemes enable understanding and treatment planning of different conditions.

Desenvolvimento de guia cirúrgico para auxiliar na técnica de gengivectomia em bisel interno com osteotomia: relato de caso

“…Em alguns casos, a quantidade de osso removido está relacionada com a distância da junção cemento esmalte para da crista óssea que é de cerca de 2 mm (Pires et al, 2010;Fernandes et al, 2014). O paciente desse caso apresentava um tipo de osso alveolar mais espesso, que necessitou de se fazer uma plastia, para assim remover o excesso e proporcionar um melhor contorno, como atestado por Ragghianti et al (2017). Na síntese da ferida optou-se por suturas feitas de forma individual no qual o retalho foi reposicionado e estabilizado nas margens gengivais próximos a JCE, como relatados por Silva, Soumaille, Marson, Progiante & Tatakis, (2015).…”

Complications and treatment errors in peri‐implant soft tissue management

“…Undiagnosed altered passive eruption can result in an implant placement error (Figure 11). In fact, considering a coronally displaced margin as a reference point can lead to excessive coronal implant positioning, especially in cases of an immediate postextraction flapless implant 52–54 …”

Pre-endodontic restoration of structurally compromised teeth: current concepts

“…52 A suitable example would be a case of altered passive eruption, where gingival margin is coronally placed over enamel. 53 Techniques to perform gingivectomy include scalpel, electrosurgery and lasers (Nd:YAG, CO 2 , diode). Scalpel is considered as the 'standard treatment' , and although more cost-effective, it is often associated with peri-operative haemorrhage; 51 thus, it may complicate isolation for the endodontic treatment to be performed at the same visit.…”

“…52 This approach may be necessary in altered active eruption cases, where cementoenamel junction coincides with crestal level. 53 Nevertheless, significant tissue rebound is expected, especially within 3-6 months post-surgery, 58,59 and appears to be associated with several factors, such as thick gingival phenotype, amount of bone removal and flap positioning at crestal level. 58 The extended healing time could delay the provision of definitive restoration, jeopardising the outcome of endodontic treatment.…”