DTUS0710

3CCOSMETIC TRIBUNE | March 2010 Interview smile revitalization. Because this procedure is very complex and detailed, these books have been very successful for my practice because they’re easy to read and contain sev- eral before and after pictures. Patients show them to other potential patients, so they’ve been very strong internal marketing tools. It’s also easy for me to share these books with other dentists. I allow them to co-write my books by adding their own before and after pictures so that they can enjoy the market- ing success that I’ve had. I call this the Instant Author Program [www. instantauthorprogram]. Your office is in Beverly Hills, where many people are known to get frequent cosmetic procedures. Do you find that injections in the face and lips — such as Botox, restylane and collagen — cause problems with a patient’s smile? Yes. Women often enlarge the size of their lips to the point of sacrific- ing their smiles. So when they smile, they no longer show much of their teeth. In that case, these injections can create a vertical abnormality. If they want to show more teeth, they need to open the vertical dimension in their bites. We must open the bite up so that when they close their mouth, the top and bottom teeth touch sooner. That allows more of the teeth to show and gives the dentist room to make a larger central that peers through the lips and gives the patient a more youthful smile. Not showing enough teeth is the opposite problem of what you call a gummy smile, correct? Yes, a gummy smile is the opposite vertical abnormality. With a gummy smile, the patient shows too much of the teeth and gums. These patients often have a very small vertical dimension, 13 to 14 millimeters. By opening them up to their nat- ural physiological vertical length, which might be closer to 17 millime- ters, they show more teeth and less gum as the ratio between the gums and teeth is reversed. By opening the bite, you can also reduce gummy smiles, as my article [in this edition] illustrates. What kind of patient would you consider a good candidate for what you call full-mouth revital- ization? People who have had lots of den- tistry in the past or worn their teeth down, as well as people who don’t like their smile and want veneers on the top and bottom teeth. If you’re going to veneer 20 teeth, the only remaining teeth are molars. Many of these patients already have amalgam fillings or crowns on these teeth. So it only makes sense to do the full-mouth with a corrected bite on these patients. If you fail to correct the bite, you also fail to address the core problem of why so much dentistry is already in the patient’s mouth. By leaving the patient in his or her habitual bite, that patient is going to continue to have the same problems he or she has had for the past 30 years or more. However, by creating a harmoni- ous environment between the tem- poral mandibular joint, the teeth and the muscles of mastication, you can achieve beautiful and long-lasting restorations. Are there patients who aren’t good candidates for full-mouth revital- ization? Yes. There are times when it makes sense to be a tooth or smile doc- tor. Someone who has all virgin teeth without any cavities or some- one with a vertical dimension of 17 to 21 millimeters with no history of neuromuscular symptoms wouldn’t require full-mouth revitalization. The same can be said for some- one who is very young and open to the idea of orthodontics. If some- one’s natural teeth are in the proper shape, size and contour without any contortions, they don’t require a full- mouth approach. Do your patients often ask you to fix a tooth and then end up going for the full-mouth approach? Yes, sometimes it’s important for a patient to understand why his or her teeth are fracturing and decay- ing. Teeth restored back into the patient’s habitual bite may be very limiting. Again, it’s always the patients’ choice, but I want them to make a AD very informed choice. I have a patient now who is dis- satisfied with his previous dentist. He struggled with three teeth on the bottom right where he was given three porcelain-fused-to-metal crowns. His bite is so tough and so limited in the back molars that after his bite was adjusted many times, he can now see the metal on his crowns. So I explained to him that I could redo the crowns, but he will have the same problem because his teeth are very flat and worn down with a lot of old dentistry. I showed him how full-mouth revitalization will open his bite and allow the necessary room to restore his teeth. Without this, he will con- tinue to wear down his teeth. CT