The last step in our series of posts that began with a diagnosis of altered passive eruption is correction of the excess gingival tissue. The correct position for the gingival margins was determined using tooth proportion beginning at the reference of a correct incisal edge location. The information was transferred to a model and a snap on trial smile was created out of Venus Diamond Composite. The corrective procedure begins by trying in the snap on trial smile and letting the patient see what the final result will look like. Today I also took some photographs of the composite in place for the patient to evaluate.
Friday’s post discussed the common diagnosis of altered passive eruption. We looked at the process and how to identify patients whose dental esthetics has been negatively impacted by this process. When we think that part of a treatment plan will include altering the gingival esthetics, one of the things we are tasked with is determining where we want the tissue to be. The first step as always is making a determination about incisal edge position in the face. Using a lips at rest photograph and full face image for my patient with altered passive eruption, we determined that her incisal edges are correctly positioned.
I had the pleasure today of seeing a young woman whose chief concern was short square teeth. Orthodontic treatment was recently completed and she is routinely wearing her retainers. The clinical exam revealed no wear on the maxillary incisor teeth. The sulcus depths on the facial range from 4mm to 6mm and the CEJ can not be found with an explorer in the sulcus. Radiographs of the anterior teeth show bone levels are in the correct position relative to the CEJ. The periodontal exam revealed very little plaque and no bleeding on probing. My diagnosis after reviewing all of these exam findings is altered passive eruption. In my practice, altered passive eruption, is a very common diagnosis.
It is common for patients to present with what dental professionals would call a “gummy” smile. This appearance of excessive gingiva above the cervical of the maxillary anterior teeth in a full smile can have multiple causes, one of which is the diagnosis hypermobile lip. When we think about excessive gingival display, the first thing to remember is that not everyone finds this unattractive. Many of my patients show a significant amount of gingiva at a full smile and find it very pleasing esthetically. Commonly when there is more than 3-4mm of gingival display we and our patients will find this as an esthetic issue, but I remember to bring this conversation up gently so as not to offend someone who isn’t bothered by it.