Altered Passive Eruption
Conditions
Keywords
Gummy Smile, Esthetic Crown Lengthening, Gingivectomy, Osseous Surgery, Periodontal Plastic Surgery, Periodontal Tissue Stability, Intraoral Scanning
Brief summary
This prospective, single-group interventional study will evaluate the stability of periodontal tissues after esthetic periodontal surgery for the correction of altered passive eruption in individuals with excessive gingival display. Ten adult participants with excessive gingival display associated with altered passive eruption and involvement of the alveolar bone will be included. Participants will undergo esthetic crown-lengthening surgery consisting of gingivectomy and osseous recontouring. Periodontal clinical measurements, intraoral digital scans, cone-beam computed tomography, standardized photographs, and patient-reported outcomes will be obtained before surgery and during follow-up. Clinical and three-dimensional tissue changes, esthetic perception, satisfaction, and oral health-related quality of life will be evaluated for up to 12 months after treatment.
Detailed description
Excessive gingival display may be associated with altered passive eruption, a condition characterized by excessive gingival coverage of the anatomical crown and an altered relationship between the gingival margin, cementoenamel junction, and alveolar bone crest. Esthetic crown-lengthening procedures may be indicated to expose the anatomical crown and establish an appropriate periodontal tissue relationship. This prospective, non-randomized, before-and-after clinical study will include 10 adult participants presenting with an esthetic complaint related to excessive gingival display and a diagnosis of altered passive eruption involving the alveolar bone. Before surgery, participants will undergo clinical examination and periodontal preparation. Esthetic periodontal surgery will consist of gingivectomy associated with osseous recontouring. The surgical approach, including flap elevation when required, will be determined according to the periodontal phenotype and local anatomical characteristics. Periodontal clinical measurements will be performed before surgery and during postoperative follow-up. Intraoral digital scanning will be performed before treatment and at 3, 6, and 12 months to evaluate three-dimensional changes and soft-tissue stability. Cone-beam computed tomography will also be used to evaluate periodontal tissue dimensions and remodeling. Standardized intraoral and extraoral photographs will document esthetic changes. Patient-reported outcomes, including postoperative discomfort, esthetic perception, satisfaction, and oral health-related quality of life, will also be assessed. Participants will be followed for 12 months after surgery to determine the stability of the clinical and three-dimensional periodontal outcomes.
Interventions
PROCEDUREEsthetic Crown-Lengthening Surgery
Esthetic periodontal surgery will be performed to correct altered passive eruption. Gingival tissue will be removed by an internal bevel gingivectomy. Osseous recontouring will then be performed to establish an adequate relationship between the cementoenamel junction and the alveolar bone crest. Depending on the periodontal phenotype and anatomical characteristics, osseous recontouring may be performed with or without flap elevation.
Sponsors
University of Sao Paulo
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
All participants will receive the same esthetic periodontal surgical intervention and will be followed longitudinally for 12 months. Outcomes will be compared with each participant's baseline measurements.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults with an esthetic complaint related to excessive gingival display. * Diagnosis of altered passive eruption as one of the etiologic factors associated with excessive gingival display. * Altered passive eruption involving the alveolar bone.
Exclusion criteria
* Current orthodontic treatment. * Active periodontal disease. * Systemic conditions that contraindicate periodontal surgical procedures, including uncontrolled autoimmune diseases. * Use of medications that may interfere with the inflammatory response or wound healing, including corticosteroids or immunosuppressive agents. * Current smokers. * Former smokers who discontinued smoking less than 12 months before enrollment. * Pregnant or breastfeeding individuals. * Excessive gingival display primarily associated with lip hypermobility or vertical maxillary excess without concomitant altered passive eruption.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change From Baseline in Clinical Crown Length | Baseline, 2 weeks, 3 months, 6 months, and 12 months after surgery | Clinical crown length will be recorded in millimeters. The mean change from baseline will be calculated at each postoperative assessment to evaluate the stability of the surgical outcome over time. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change From Baseline in the Distance Between the Cementoenamel Junction and Alveolar Bone Crest | Baseline, 3 months, 6 months, and 12 months after surgery | The distance between the cementoenamel junction and the alveolar bone crest will be measured in millimeters using cone-beam computed tomography to evaluate postoperative periodontal tissue remodeling. |
| Mean Change From Baseline in Gingival Thickness | Baseline, 3 months, 6 months, and 12 months after surgery | Gingival thickness will be measured in millimeters using cone-beam computed tomography to evaluate changes in periodontal soft-tissue dimensions after surgery. |
| Mean Change From Baseline in Alveolar Bone Thickness | Baseline, 3 months, 6 months, and 12 months after surgery | Alveolar bone thickness will be measured in millimeters using cone-beam computed tomography to evaluate bone remodeling after esthetic crown-lengthening surgery. |
| Three-Dimensional Change in Gingival Soft Tissues | Baseline, 3 months, 6 months, and 12 months after surgery | Intraoral digital scans obtained at follow-up visits will be compared with baseline digital models to assess three-dimensional changes in gingival morphology and soft-tissue stability. |
| Change in Oral Health-Related Quality of Life Assessed by OHIP-14 | Baseline, 3 months, 6 months, and 12 months after surgery | Oral health-related quality of life will be assessed using the 14-item Oral Health Impact Profile (OHIP-14). Each item is scored from 0 (never) to 4 (very often), with higher scores indicating a greater negative impact of oral health on quality of life. |
| Postoperative Pain Intensity | 3 months, 6 months, and 12 months after surgery | Postoperative pain will be assessed using a 0-to-100 numerical rating scale, where 0 indicates no pain and 100 indicates unbearable pain. |
Countries
Brazil
Contacts
CONTACTEdgar Daniel Vargas Quiroga, DDS, MSc
CONTACTArthur Belem Novaes Jr, DDS, PhD
Outcome results
None listed