CDEN0210

I 19 case report _ gummy smiles I cosmeticdentistry 2_2010 When the patient presents with a significant difference between the mandibular position at habitual occlusion relative to an optimised occlusal position, increasing vertical dimension by increasing the crown-to-gum ratio and ef- fectively decreasing the gummy smile can have a dramatic cosmetic effect on a patient. The cases presented here illustrate that vertical abnormalities such as gummy smiles may some- times be further enhanced and the need for surgical intervention minimised if the vertical dimension of the bite is altered. In adjusting the vertical dimension, care must be taken to ensure a functional occlusion in the finished case. Jankelson described the method for muscle relaxation in order to determine mandibular position at true physiological rest.5 Application of transcutaneous electrical nerve stimulation (J5 Myomonitor TENS, Myotronics) for a period of 30 to 40 minutes allows the mus- cles of mastication innervated by cranial nerves #5 and 7 to relax. While there is no universal agreement amongst dentists on occlusal philosophy, I have found the Jankelson method of establishing a true mandibular physiological rest position (PRP) to be highly effective. Physiological rest position is objectively verified with surface elec- tromyography and computerised jaw tracking (K7 Evaluation System, Myotronics). The K7 System provides calculations that in- dicatewhenthepatientisatphysiologicalrestas compared with habitual rest. These calculations indicate the extent to which VI can be increased or the extent to which freeway space can be decreased without interrupting the patient’s true PRP. Concerns about changing the entire arch to effect anterior defects are unfounded for two reasons.Firstly,thenewlydiagnosedmandibular position is verified as correct by using an or- thotic before anything is done to the natural teeth. Secondly, this technique of treating a Fig. 3Fig. 2 Fig. 5Fig. 4

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