Gummy Smiles: The Challenge of Gingival Excess: Prevalence and Guidelines for Clinical Management

Orthodontic treatment planning should be a multidisciplinary approach to achieve periodontal health and maximal esthetics. The presence of altered passive eruption may complicate treatment in the presence of inflammation and compromise esthetic outcomes. The prevalence, diagnosis, and treatment of active and arrested passive eruption in the orthodontic patient will be the focus of this article. In a recent landmark study, the prevalence of altered passive eruption in postorthodontic patients, and the same patients 5 years after treatment, were studied for their need for periodontal plastic surgery, esthetic crown lengthening. Less than ideal smile characteristics, namely length-to-width ratios and asymmetry, were found in 65% and 60% of patients, respectively. Enhancing orthodontic results and providing the patient with maximal esthetic results can be achieved through the control of inflammation and esthetic crown lengthening.