Diagnosis and inter-disciplinary treatment of altered passive eruption, the digital evolution

Altered passive eruption (APE) is a condition better known as ‘gummy smile’, patients affected by APE display short and square clinical crowns and an excessive display of gingiva when smiling.

APE was classified as type 1 or 2 depending on its features, in type 1 the gingival margin is coronal to the CEJ, the teeth look short and squared, in type 2 the gingival margin seems to be at the right position, it is the bone crest that is not. The position of the bone crest is defined by sub types A and B. In subtype A the bone crest is located 1.5 to 2 mm apical to the CEJ while in subtype B the alveolar bone crest is located near the CEJ and in some cases even above the CEJ.

Nowadays a case of APE can be studied and 3D planned with a full support of digital dentistry. Once the process of planning is completed, the surgical stent is produced by a 3D printer, the patient is recalled for fitting the surgical stent and final check -up and the surgical procedure is performed.

A case where Vertical Maxillary Excess (VME) and APE were present together is showed and the diagnosis and interdisciplinary treatment demonstrated.