Altered passive eruption

When planning aesthetic cases one of the first thing you must decide is the position of the incisal edge. This has important implications in vertical dimension and soft tissue management. Wear cases often affect this. Altered passive eruption can occur in anteriorly positioned bruxers. It results when attrition results in overeruption of teeth with brings the bone and soft tissue with it. In anterior bruxist cases there will be minimal wear on the posterior teeth and no loss of vertical dimension. They will also generally show a disparity of the gingival margin heights with the maxillary incisor gingival margins being positioned too far incisally. Provided the aesthetics was acceptable before the altered passive eruption, these patients do not usually benefit from opening the VD or lengthening the incisal edges as the maxillary display will usually be too excessive. Instead, they may benefit from procedures such as intrusion of the incisors  to allow restorative space and move the gingival margins higher or crown lengthening or gingivectomy to improve the gingival margin positions.

Full smile photographs and intraoral photographs are essential in planning these cases. Treating any aesthetic case by first considering how the teeth relate to the face adn working out the incisal edge positions is paramount in causing a positive aesthetic change and avoiding a "toothy" finishing position.