DTUS0710

COSMETIC TRIBUNE The World’s Cosmetic Dentistry Newspaper · U.S. Edition AD You were the first dentist to use and exploit the term, “full-mouth revitalization,” and you common- ly refer to yourself as a “mouth doctor.” What does all this mean? I did a Google search of the term, “full-mouth revitalization,” when I was writing my book, “Revitalize Your Mouth,” in 2004, and noth- ing showed up. Thus, I am now the proud owner of that trademark for my signature procedure. What I mean by “mouth doctor” is that I can be one of three types of dentists for my patients: a tooth doc- tor, a smile doctor or a mouth doc- tor. Some dentists are tooth doctors, some are both tooth and smile doc- tors and others, like me, enjoy being a mouth doctor. A mouth doctor is comprehen- sive: correcting the teeth, the smile and the bite. Correcting the bite can enhance so much more for the patient than merely restoring the teeth in the patient’s current habitual position. Patients can look healthier and more attractive if you proportionalize the lower one-third of the face. Correcting the bite can also miraculously alleviate headaches, ear pain, jaw pain and muscle pain in the neck. It can even improve pos- ture. In my experience, most patients with unattractive smiles got that way because of their malocclusion. The bite is the engineering, back- g CT page 2C g CT page 4C By Robin Goodman, Group Editor Comprehensive dentistry: becoming a full-mouth doctor By David S. Frey, DDS Bite alteration to reduce gummy smiles The traditional method for cor- recting a gummy smile with too high a gum-to-teeth ratio has been enormously invasive. It has involved cutting and lifting the gum tissue back in order to remove bone, after which the gums must be sewn back in place. This process requires a six to eight-week healing process, which is not only painful1 , but esthetically dis- pleasing during that period. Another method, which involves reposition- ing the lip after cutting into the vestibule, is equally invasive with an excessively long period of healing.2 Today, cosmetic dentists often perform a gingivectomy utilizing a scalpel, electrosurge or diode laser in order to correct an overly gummy smile. However, these methods are contingent upon the amount of bio- logical width available in each indi- vidual patient.3 Two to three mil- limeters of gum tissue must remain over the bone after the tissue has been removed. This biological width limitation usually creates one of two options. Either the patient must be sub- jected to invasive surgical gum flaps accompanied by bone removal or the patient must be satisfied with very little change in the gum-to-teeth ratio. If the patient presents with a significantly short vertical index (measured from the CEJ of tooth No. 8 or No. 9 to the CEJ of tooth No. 24 or No. 25), the gummy smile condition may not be satisfactorily corrected when only a gingivectomy is performed. Cosmetic dentists train regularly to adjust horizontal smile abnor- malities such as over-crowding and large gaps. The idea of changing the vertical dimension of occlusion as part of improving dentofacial esthet- ics is not new.4 While occlusal phi- losophies may differ, most will agree that the occlusion must be given careful consideration when chang- ing its vertical dimension, both as part of the diagnostic process and to avoid possible iatrogenic results. When the patient presents with a significant difference between the mandibular position at habitual occlusion relative to an optimized occlusal position, increasing vertical March 2010 www.dental-tribune.com Vol. 3, No. 3 Fig. 1a: Before An interview with Dr. David Frey Fig. 1b: After

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