Altered Passive Eruption: The Undiagnosed Entity

Evian, Cyril I.; Cutler, S A; Rosenberg, Edwin S.; Shah, Raj Kishor

doi:10.14219/jada.archive.1993.0208

Cited by 36 publications

(36 citation statements)

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“…A number of factors have been proposed, such as interocclusal interference on the part of soft tissues during the eruptive phase, the presence of thick and fibrotic gums that tend to migrate more slowly during the passive phase than fine gingival tissue, and even a certain hereditary tendency in families with individuals presenting APE. According to some authors, a bone crest close to the cementoenamel junction (Coslet subtype B) could impede gingival migration during the passive phase of eruption (16), thus establishing a distinction between altered passive eruption and altered active eruption. Based on this consideration, the hypothesis has been proposed that two mechanisms intervene in APE, giving rise to two different morphological patterns at DGJ level ( Fig.…”

Section: Pathogenesis Of Apementioning

confidence: 99%

“…Based on a series of 1025 patients with a mean age of 24.2 ± 6.2 years, Volchansky and CleatonJones (3) recorded a 12.1% incidence of APE. The literature discusses whether APE is a genuine risk to periodontal health, and points to difficulties in oral hygiene and a narrow connective tissue attachment as possible causes (15,16). Coslet indicated that APE 2A, 1B and especially 2B are risk situations for health, particularly before dental treatment -identifying a narrow band of gum and the absence of connective insertion to the root as risk factors.…”

Section: Clinical Relevance Of Apementioning

confidence: 99%

“…In the literature, the definition of APE is not very precise: "location of the gingival margin on the anatomical crown excessively occlusal and far from the cementoenamel junction in the adult individual" (15,16). In order to establish a precise diagnosis, three factors should be evaluated: a) quantitative estimation of the gum overlap; b) clinical signs of EPA; and c) specification of the age from which we could affirm that there has been a failure to conclude eruption.…”

Section: Reflections On Apementioning

confidence: 99%

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Altered passive eruption (APE):A little-known clinical situation

Alpiste-Illueca¹

2011

Med Oral

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Gummy smile constitutes a relatively frequent aesthetic alteration characterized by excessive exhibition of the gums during smiling movements of the upper lip. It is the result of an inadequate relation between the lower edge of the upper lip, the positioning of the anterosuperior teeth, the location of the upper jaw, and the gingival margin position with respect to the dental crown. Altered Passive Eruption (APE) is a clinical situation produced by excessive gum overlapping over the enamel limits, resulting in a short clinical crown appearance, that gives the sensation of hidden teeth. The term itself suggests the causal mechanism, i.e., failure in the passive phase of dental eruption, though there is no scientific evidence to support this. While there are some authors who consider APE to be a risk situation for periodontal health, its clearest clinical implication refers to oral esthetics. APE is a factor that frequently contributes to the presence of a gummy or gingival smile, and it can easily be corrected by periodontal surgery. Nevertheless, it is essential to establish a correct differential diagnosis and good treatment plan. A literature review is presented of the dental eruption process, etiological hypotheses of APE, its morphologic classification, and its clinical relevance.

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Section: Pathogenesis Of Apementioning

confidence: 99%

Section: Clinical Relevance Of Apementioning

confidence: 99%

Section: Reflections On Apementioning

confidence: 99%

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Altered passive eruption (APE):A little-known clinical situation

Alpiste-Illueca¹

2011

Med Oral

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“…La erupción pasiva alterada (EPA) se desarrolla cuando el margen gingival se encuentra colocado incisal u oclusalmente sobre la corona anató-mica en la edad adulta y no migra apicalmente a una situación próxima al límite amelocementario 2,3 pudiendo ser la causa de la existencia de sonrisa gingival en gran número de pacientes.…”

Section: Introductionunclassified

“…Se asocia frecuentemente a biotipos periodontales gruesos y fibrosos aunque su etiología es desconocida 3 . Existe controversia sobre la edad a la que se puede realizar el diagnóstico y posterior tratamiento de esta entidad.…”

Section: Introductionunclassified

Erupción pasiva alterada: Implicaciones estéticas y alternativas terapéuticas

García

Ureña²,

López³

et al. 2006

RCOE

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Resumen: la causa del exceso de encía al sonreír depende de múltiples factores, como el exceso de dimensión vertical del maxilar superior, las malposiciones dentarias debidas a una gran sobremordida o la presencia de una erupción pasiva alterada. Esta última entidad clínica, que a menudo pasa inadvertida a pesar de su alta prevalencia, puede condicionar de forma importante la estéti-ca de la sonrisa.En este artículo se analiza la forma de realizar un diagnóstico correcto de esta alteración, lo cual será esencial para elegir la mejor corrección de cada caso en concreto, generalmente mediante técnicas de cirugía periodontal. Se describen dichas opciones terapéuticas y finalmente se incluyen unos casos clíni-cos a modo de ejemplo de tratamiento de dicho proceso en el que, aparte de existir implicaciones patológicas, la estética juega un papel determinante.Palabras clave: Sonrisa gingival, Erupción pasiva alterada, Cirugía periodontal. Abstract:Gum overexposure when smiling is caused by multiple factors. Factors range from excessive superior jaw vertical dimension, poorly positioned teeth due to overbite or due to the presence of delayed passive eruption. This last clinical term, which often goes unnoticed even though it is highly common, can seriously determine the aesthetics on the smile.This article analyses the ways of correctly diagnosing this alteration. It is essential to choose the most appropriate procedure for each case, usually being periodontal surgery. A number of therapeutic options are described and some clinical cases are included as treatment examples. Apart from the existence of pathological implications, aesthetics plays an important role.

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Experimental gingivitis in patients with and without altered passive eruption

Aghazada

Marini

Zeza

et al. 2019

Journal of Periodontology

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BackgroundIndividuals with altered passive eruption (APE) are assumed to be more susceptible to periodontal diseases. To date, this hypothesis has not been sufficiently supported by scientific evidence. The aim of this study, using an experimental gingivitis model, was to examine the development and resolution of gingival inflammation in patients with APE when compared to patients with normal gingival anatomy.MethodsA localized experimental gingivitis was induced in 9 patients with APE (test group) and 9 patients without APE (control group) in the maxillary right quadrant. After 21 days, patients were instructed to resume proper home oral hygiene procedures. At baseline (day 0) and at days 7, 14, 21, 28, 35, and 42, plaque index (PlI), gingival index (GI), and gingival crevicular fluid volume (GCF) were evaluated for teeth 6 (canine), 7 (lateral incisor) and 8 (central incisor) of test and control groups.ResultsDuring the experimental gingivitis phase (days 0 to 21), the rate of change in gingival inflammation (GI) was dramatically different between the APE test group and the control group. On day 21, at the time of maximum plaque accumulation, the GI of the APE test group was a 109% greater than the GI of the test group (P ≤ 0.001) despite similar plaque levels (P = 0.436). During the resolution of inflammation phase (days 22 to 42), the APE test group continued to exhibit statistically higher GI scores than the control group (P = 0.029).ConclusionIn the presence of similar amounts of plaque deposits and plaque accumulation rates, APE patients exhibited differences in the development and resolution of plaque‐induced gingival inflammation when compared to controls.

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Altered Passive Eruption: The Undiagnosed Entity

Cited by 36 publications

References 4 publications

Altered passive eruption (APE):A little-known clinical situation

Altered passive eruption (APE):A little-known clinical situation

Erupción pasiva alterada: Implicaciones estéticas y alternativas terapéuticas

Experimental gingivitis in patients with and without altered passive eruption

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