Maxillary and mandibular acrylic stents were prepared in advance to enable accuracy during the gingivectomy procedure. The patient was put on chlorhexidine rinses three times daily for two weeks. Treatment commenced with scaling and root planing a day prior to surgical procedures. Written informed consent was obtained prior to beginning procedures. Initial gingivectomies in both arches to obtain sufficient crown lengths to enable orthodontic appliance placement and improve smile aesthetics.įrenectomy of the thick maxillary labial frenum to enable diastema closure.ĭepigmentation in both arches to improve gingival aesthetics.įixed orthodontic therapy to correct the malocclusion including diastema and crossbite. The case was complicated by the Altered Passive Eruption condition preventing placement of orthodontic brackets in their ideal positions.Ī multidisciplinary approach to management was envisaged and included: Previous history taking revealed no drug usage which could have been a contributing factor. A diagnosis of Altered Passive Eruption Type 1, Sub group A was made after thorough periodontal evaluation. Both arches showed hyper pigmented gingivae with compromised smile aesthetics due to excessive gum show on smiling. The diastema was on account of a thick maxillary labial frenum of the papillary penetrating variety. In most instances, orthodontic therapy is not hindered. It is suggested that orthodontists should be aware of conditions like altered passive eruption and modalities of management. The periodontal surgical procedures were carried out prior to orthodontic therapy and the results obtained were satisfactory. Interdisciplinary treatment protocols including periodontal surgical and orthodontic procedures were used. The periodontal condition was diagnosed as altered passive eruption Type IA. Preadjusted orthodontic brackets have a very precise placement protocol which can affect tooth movement in all 3 planes of space if violated. The inadequate crown lengths made placement of the orthodontic brackets difficult. The patient reported with spacing in the upper arch, moderate crowding in the lower arch, anterior crossbite and excessive gingival tissue on the labial surfaces of teeth in both the arches. An unusual case of altered passive eruption with gingival hyperpigmentation and a Class I malocclusion in a 12-year-old girl having no previous history of medication is presented.
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