altered passive eruption

1. Postgraduate Case Scenario:
Gummy Smile Management
Diagnosis, Etiology, and Treatment
Options

2. Case Summary
• • Age/Sex: 27-year-old female
• • Chief Complaint: "My smile shows too much
of my gums"
• • History: No systemic diseases or medication
use
• • Clinical Findings:
• - Gingival display: 5 mm
• - Short clinical crowns of maxillary anteriors
• - Normal lip length and eruption pattern

3. Learning Objectives
• • Identify and differentiate causes of excessive
gingival display
• • Discuss various surgical and non-surgical
options for managing a gummy smile
• • Select treatment modalities based on
etiological diagnosis

4. Diagnostic & Etiological
Classification
• • Diagnostic Work-up:
• - Lip length, Lip mobility
• - Tooth length vs crown width
• - Radiographic CEJ and bone level
• • Etiological Types:
• - Altered Passive Eruption
• - Vertical Maxillary Excess
• - Hypermobile Upper Lip

5. Treatment Modalities Overview
• • Altered Passive Eruption: Crown lengthening
with flap & bone recontouring
• • Hypermobile Lip: Lip repositioning surgery
or Botox
• • Vertical Maxillary Excess: Orthognathic (Le
Fort I impaction)
• • Dentoalveolar Extrusion: Orthodontic
intrusion or restorative options

6. Scientific References
• 1. Garber DA, Salama MA. Periodontol 2000.
1996.
• 2. Silberberg N, Goldstein M, Smidt A.
Quintessence Int. 2009.
• 3. Humayun N, et al. J Contemp Dent Pract.
2010.