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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.

Aim This prospective cohort study evaluated late complications (LC) on recipient sites comparing two types of connective tissue grafts (CTG). Materials and Methods Participants (n: 60) were treated with coronally advanced flap (CAF) plus CTG harvested by de‐epithelialized technique (DE) (n:31) or two‐parallel incision (PI) (n:29). Areas were evaluated to identify white discharge associated or not with gingival cul‐de‐sac. Patients were ordered in groups with (DE+and PI+) or without (DE‐ and PI‐) LC. Biopsies for histopathological analysis in LC areas were proposed. Results Six cases exhibited LC, 5 in DE graft (DE+) and 1 in PI graft (PI+) group; 2 were diagnosed at 3 months postoperatively, 3 at 6 months and one at 12 months. The relative risk for LC was 1.7 times greater for DE graft (p: 0.01; CI: 1.10 to 2.72; RR>1). Differences were not observed for clinical outcomes after both types of CTGs (p > 0.05). Biopsies showed deep invagination of the epithelial lining suggesting cyst‐like area/ cavity with keratin content and consolidated in fibrous connective tissue. After 24 months biopsied areas presented no recurrence of LC, in non‐biopsied patients the clinical condition remained unchanged. Conclusions Considering the limitations of this study, LC on recipient sites demonstrated no statistical difference between two types of CTG.

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Purpose To investigate the influence of implant surface decontaminated and uncontaminated on osteoblast-like cell adhesion and proliferation Materials and methods Commercially available implants of different brands and surface characteristics were selected: Biomet 3i® Nanotite (NT) and Osseotite (OT), Straumann® SLActive (SLA), and Neodent® Acqua Drive (ACQ) and Neoporos Drive CM (CM). Physical and chemical properties of the implants were investigated by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and wettability analysis (WETT). Implants were previously contaminated with Aggregatibacter actinomycetemcomitans strains; after that, samples were decontaminated by different chemical methods. Decontaminated (test group; n = 15/type of implant) and uncontaminated (control group; n = 5/type of implant) samples were analyzed according to the number of human osteoblastic osteosarcoma cells (Saos-2) adhered on the implant surface after 24 h and 72 h in SEM images. Results ACQ was found to be highly hydrophilic, and NT was the most hydrophobic implant. Increased variation of Saos-2 cell adhesion and proliferation were observed on all test and control groups. Controversially, at the proliferation analysis in 72 h, CM implant was the only implant that showed no significant difference between test and group (p = 0.2833; Tukey’s multiple comparisons test). NT implants showed the greater value of cell proliferation when compared with all types of implant surface (p = 0.0002; Tukey’s multiple comparisons test). Conclusions These findings suggest that decontaminated surfaces were able to impair the counting of osteoblast-like cell adhesion and proliferation.