Esthetic Management of Altered Passive Eruption With Gingivectomy and Gingivoplasty During Orthodontic Treatment: A Case Report

Altered passive eruption (APE) is a condition in which the gingival margin remains positioned coronally over the anatomical crown after tooth eruption, resulting in excessive gingival coverage and reduced visible clinical crown height.This condition can compromise smile esthetics by producing unfavorable tooth to gingiva proportions.This case report describes the multidisciplinary management of a 25-year-old female patient who presented seeking improvement in the appearance of her smile.The patient was classified as American Society of Anesthesiologists (ASA) physical status I and reported no known allergies.Clinical examination revealed excessive gingival coverage of the anterior clinical crowns, reduced apparent clinical crown height, and irregular gingival margins, with findings considered consistent with APE in association with dental malalignment.A treatment plan combining fixed orthodontic therapy with gingivectomy and gingivoplasty was developed to improve dental alignment and gingival architecture.Orthodontic treatment was performed for approximately 18 months.During the final stage of orthodontic therapy, approximately two months before the removal of the fixed appliances, gingivectomy and gingivoplasty were performed under local anesthesia to remove excess gingival tissue and establish a more harmonious gingival contour.Healing was monitored clinically, and at the one-month postoperative evaluation, favorable soft tissue healing, increased clinical crown exposure, and improved gingival symmetry were observed.Orthodontic treatment was subsequently completed.The final clinical appearance demonstrated improved dental alignment, clinical crown proportions, and gingival architecture, resulting in an esthetic outcome that was satisfactory to the patient.This case illustrates the clinical integration of orthodontic treatment with gingivectomy and gingivoplasty for the esthetic management of findings consistent with APE in a young adult patient.