CDEN0210

18 I I case report _ gummy smiles _The traditional method for correcting a gummysmilewithtoohighagum-to-teethratio is enormously invasive. It involves cutting and lifting the gum tissue back in order to remove bone, after which the gums have to be sewn back in place. This process requires a six- to eight-week healing process, which is not only painful1 , but also aesthetically displeasing. Another method, whichinvolvesrepositioningthelipaftercutting into the vestibule, is equally invasive and re- quires an excessively long period of healing.2 Today, cosmetic dentists often perform a gingivectomy utilising a scalpel, electrosurge or diode laser in order to correct an overly gummy smile. However, these methods are contingent upon the amount of biological width available in the patient.3 Two to three millimetres of gum tissue must remain over the bone after the tissue has been removed.Thisbiologicalwidthlimitationusually creates one of two options. Either the patient must be subjected 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 (VI; measured from the cemento-enamel junction [CEJ] of tooth #8 or 9 to the CEJ of tooth #24 or 25), the gummy smile condition may not be satisfac- torily corrected when only a gingivectomy is performed. Cosmetic dentists undertake regular training to adjust horizontal smile abnormalities such as overcrowding and large gaps. The idea of chang- ing the vertical dimension of occlusion as part of improving dento-facial aesthetics is not new.4 Whileocclusalphilosophiesmaydiffer,mostwill agree that the occlusion must be given careful considerationwhenchangingitsverticaldimen- sion, both as part of the diagnostic process and to avoid possible iatrogenic results. cosmeticdentistry 2_2010 Bite alteration for reducing gummy smiles: Two case reports Author_ Dr David S. Frey, USA Fig. 1bFig. 1a

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