Clinical application of Coslet’s classification of altered passive eruption among dental practitioners

Objective. Altered passive eruption (APE) is a periodontal condition marked by excessive gingival display and short clinical crowns due to the coronal positioning of the gingival margin. This study assessed dental practitioners’ knowledge and clinical application of Coslet’s classification for the diagnosis and management of APE. Material and methods. A cross-sectional, vignette-based online survey was conducted among general dental practitioners (GDPs) and periodontists in the Southern Region of Saudi Arabia. The expert-reviewed questionnaire assessed participants’ knowledge, diagnostic accuracy, and management decisions for APE subtypes. Responses from self-identified dental students were excluded, and the primary analysis comprised the eligible practitioners who completed all four case vignettes. Data were analyzed using the Mann-Whitney U and Kruskal-Wallis tests, with significance set at p < 0.05. Results. A total of 77 responses were received (approximate response rate: 15.4%). After exclusion of 25 respondents who self-identified as dental students, 52 eligible dental practitioners remained, of whom 36 completed all four clinical vignettes and constituted the primary analytic sample. Only 3 of 36 participants (8.3%) achieved full diagnostic and management accuracy across all four vignettes, whereas 13 (36.1%) answered none correctly in both domains. Periodontists demonstrated significantly higher diagnostic and management accuracy than GDPs (p < 0.001). Accuracy differed significantly across experience categories (p ≤ 0.008), practitioners with five or fewer years of experience scoring lowest, with no further gradient across the more experienced groups. Self-reported formal training in APE diagnosis and management was associated with higher management scores (p = 0.037) but not with diagnosis or combined accuracy (p > 0.05). Bone sounding was reported as always or usually used by more periodontists (71%) than GDPs (42%). Conclusions. Diagnostic and management discrepancies were observed, particularly among GDPs. Case-based and simulation-driven education and standardized clinical protocols may help improve APE diagnosis and treatment; direct evaluation of such interventions is required.