Vertical maxillary excess associated with altered passive eruption: a case report with an interdisciplinary approach

A smile is a symbol of beauty and wellbeing in our modern society, human facial expression transcending language, culture, race, gender, time, and socioeconomic differences. An esthetic smile consists of three main components: the teeth, the lip framework, and the gingival scaffold. In some patients, the altered relationship between the teeth, the alveolar bone, and the soft tissue may result in the clinical condition known as gummy smile. A single factor or a combination of factors may be present in patients with this clinical condition, including altered passive eruption (APE), vertical maxillary excess, and a short or hyperactive upper lip. The present article reports on a 31-year-old female patient who presented for a consultation. The patient, who was in good general health with no significant medical history, was dissatisfied with her tooth esthetics. She had symmetric facial features with a long face appearance, retruded chin, protruded maxillary incisors, and excessive gingival display that indicated evident APE. In particular, the present case report aims to describe a multidisciplinary treatment involving a phase of orthodontics associated with maxillofacial surgery, and the periodontal surgical sequence of esthetic crown lengthening for the treatment of APE.