Altered passive eruption is a common esthetic condition characterized by excessive gingival coverage of the anatomical crowns, resulting in short clinical crowns, excessive gingival display, and compromised smile esthetics. This case report describes the management of altered passive eruption in a 27-year-old male patient who presented with hypersensitivity affecting several maxillary anterior teeth, excessive gingival display, and dissatisfaction with the appearance of his smile. The patient reported that these conditions negatively affected his self-confidence in both social and professional settings. Clinical examination revealed short clinical crowns and unfavorable tooth proportions associated with excessive gingival tissue coverage. A treatment plan consisting of surgical smile design with gingivoplasty and osteoplasty was developed to establish appropriate gingival architecture and supracrestal tissue attachment prior to restorative treatment. Following flap elevation and osseous recontouring, favorable healing, improved gingival symmetry, and increased clinical crown length were achieved. After soft tissue maturation, esthetic veneer rehabilitation was completed to optimize tooth proportions and smile harmony. The combination of periodontal surgery and restorative treatment resulted in improved gingival contours and smile esthetics, while the patient reported resolution of the previously reported dental hypersensitivity and satisfaction with the treatment outcome. This case highlights the importance of a multidisciplinary approach in the management of altered passive eruption and illustrates how coordinated periodontal and restorative treatment can contribute to favorable short-term esthetic and clinical outcomes.

Congenital Insensitivity to Pain with Anhidrosis (CIPA) is a rare, autosomal recessive genetic condition characterized by an inability to sweat, intellectual disability, a lack of pain sensation and self-mutilating behaviours. This report describes the dental management and longitudinal oral findings of a child with CIPA, highlighting a restorative approach and novel findings in the permanent dentition.

Ankylosed primary molars are relatively common during the mixed dentition period; however, ankylosis does not always coincide with infraocclusion. This systematic review assessed the clinical evidence regarding ankylosis of primary molars, including its etiology, diagnosis, and management, and discussed whether infraocclusion is primarily caused by ankylosis or instead reflects a broader disturbance of tooth eruption. A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across three databases (PubMed, Scopus, and Web of Science) on 25 April 2025 and updated on 3 July 2026. The risk of bias and methodological quality of the included studies were assessed using the Joanna Briggs Institute critical appraisal tools. Fourteen studies met the inclusion criteria. The person-level prevalence of infraoccluded primary molars, used as a surrogate for ankylosis, ranged from 1.3% to 24.8%. Histopathological and clinical studies indicated that not all infraoccluded primary molars exhibited evidence of ankylosis. Treatment strategies varied according to the severity of infraocclusion and the presence or absence of permanent successors. The available evidence remains limited and insufficient to determine the temporal and causal relationship between ankylosis and infraocclusion. Further epidemiological, histopathological, and treatment-related studies are needed.

Traumatic dental injuries to primary teeth may result in developmental disturbances in the permanent successors because of the close anatomical relationship between primary tooth apices and developing permanent tooth germs. Injuries occurring during crown formation may interfere with normal odontogenesis and lead to crown dilaceration. A 7-year-old healthy boy presented with abnormal eruption of the permanent maxillary central incisors. At 2.5 years of age, he had sustained avulsion of both primary maxillary central incisors and crown fractures of the primary lateral incisors, followed by extraction of residual root fragments under general anesthesia. Cone-beam computed tomography examination at 6.5 years revealed early abnormal crown morphology of the permanent maxillary central incisors. Follow-up imaging at 7 years confirmed bilateral crown dilaceration, more pronounced on the left side, while root morphology remained normal. Nine months after eruption, the left permanent central incisor developed extensive structural breakdown with pulpal exposure and was considered nonrestorable; therefore, extraction was performed. The contralateral incisor remained asymptomatic and continues under periodic follow-up. The findings were consistent with trauma-related crown dilaceration associated with injury during early crown mineralization. Preservation of Hertwig's epithelial root sheath may explain the normal root development despite severe coronal deformity. Cone-beam computed tomography provided valuable 3-dimensional information for diagnosis, longitudinal monitoring, and treatment planning. Early trauma to primary incisors may result in crown dilaceration of permanent successors. Cone-beam computed tomography contributed useful diagnostic information for evaluating crown morphology and planning clinical management in this case.

Management of an inverted ectopic maxillary central incisor adjacent to an alveolar cleft is challenging because spontaneous eruption into the dental arch is impossible. In a male patient with unilateral cleft lip and alveolus treated between 5 years 4 months and 12 years 5 months, the incisor was replanted with axial correction and mucosal coverage after secondary alveolar bone grafting and confirmation of bony bridging. Surgical exposure and orthodontic traction guided the tooth into the arch without infection, clinically significant root resorption, or clinical ankylosis. This case illustrates replantation followed by surgical exposure and orthodontic traction as a tooth-preservation option.

Delayed tooth eruption is frequently considered a benign developmental variation but may represent an early sign of genetically driven tooth agenesis. We evaluated a 22-month-old female presenting with markedly delayed eruption (only eight primary teeth) and a positive family history of ectodermal features. Given the inconclusive early radiographic findings, whole-exome sequencing (WES) was utilized. WES revealed the proband carried a heterozygous EDARADD variant (NM_080738:c.328G > T; p. Asp110Tyr). Subsequent familial segregation analysis identified an additional heterozygous WNT10A variant (NM_025216:c.637G > A; p. Gly213Ser) within the broader family. The EDARADD variant alone was associated with varying presentations from normal dentition to delayed eruption. Furthermore, the WNT10A variant alone correlated with distinct tooth agenesis, whereas their coexistence exacerbated the phenotype, resulting in severe agenesis and ectodermal features. This case demonstrates WES provides critical diagnostic insight when radiographic evaluation is inconclusive in young patients, facilitating precision dentistry.

Excessive gingival display is a common esthetic concern among patients seeking smile enhancement. Altered passive eruption (APE) is a frequent etiologic factor and is characterized by incomplete apical migration of the gingival margin following tooth eruption. Accurate diagnosis and adherence to periodontal biologic principles are essential for achieving stable and predictable outcomes in esthetic crown lengthening (ECL). This article reviews the biologic and surgical principles of ECL, with particular emphasis on APE, and illustrates its management through a clinical case. A 28-year-old systemically healthy woman presented with short clinical crowns and excessive gingival display in the maxillary anterior region. Clinical and radiographic examination revealed the alveolar crest at or near the cemento-enamel junction (CEJ), consistent with APE Type I, Subgroup B (Type I-B) according to Coslet's classification. ECL was performed using a full-thickness flap with osseous recontouring to re-establish the supracrestal tissue attachment and achieve harmonious dentogingival proportions. Healing was uneventful, and stable gingival margins were maintained at the six-month follow-up, with marked improvement in smile esthetics. ECL is a predictable and effective treatment for APE when appropriate diagnosis, meticulous surgical planning, and preservation of the supracrestal tissue attachment are respected. In Type I-B cases, osseous resection is necessary to ensure long-term periodontal stability and optimal esthetic outcomes.

Tooth and maxillomandibular bone development is a synergistic process precisely and coordinately regulated by genetic programs, molecular signaling networks, and external environmental factors. Recent rapid progress in in situ biomechanical measurement techniques, cellular mechanical imaging, and molecular tracing technologies has greatly promoted research in developmental biomechanics. Accumulating evidence indicates that mechanical stimuli can be converted into biochemical signals via cellular mechanotransduction pathways, thereby modulating key cellular processes, including proliferation, differentiation, and apoptosis, and further regulating tissue morphogenesis and remodeling. In this review, we focus on the role of mechanical control in dental and jaw morphogenesis and remodeling. We first summarize the sources and spatiotemporal distribution features of mechanical stress during dentofacial development. Subsequently, we elaborate on the regulatory roles and underlying molecular mechanisms of mechanical signals in key dentofacial developmental processes, including crown development, root morphogenesis, tooth eruption and replacement, as well as maxillomandibular bone development and remodeling. Finally, we discuss the current research gaps in the field of mechanical stress regulation of dentofacial development and propose potential future research directions.