CDEN0210

20 I I case report _ gummy smiles gummy smile is based upon opening the bite. Therefore, when porcelain is added to the full arch to increase vertical dimension, it involves little to no destruction of the natural dentition because the restorations are placed over the occlusal surface. In my experience and as illustrated in these cases, once the PRP of the mandible has been established, the increased gum-to-teeth ratio is significant prior to the removal of any gum tissue. It is prudent to mention here that if the patient’s PRP does not differ significantly from habitual rest after TENS relaxation, very little change in vertical dimension would be available for this procedure. Use of the Golden Proportion to establish a pleasing aesthetic effect has been seen in art, architecture and various scientific fields for centuries and used in dentistry for at least 25 years.6 Like occlusal philosophy, some question its validity.7,8 However, it is used by many today in plastic surgery, orthodontics and aesthetic dentistry as an aspect of treatment planning for facial aesthetics and, in my ex- perience, patients are highly pleased with the outcome. Calculations utilising the Golden Proportion equation can also be applied to tooth shape and will indicate whether the ‘golden’ VI can be reached through a combination of bite correc- tion and gingivectomy. These simple calcula- tions indicate whether the vertical length of the patient’s smile will be more aesthetically pleasing after the corrections have been made: _Widthofcentralincisor÷1.618=goldenlength of central incisor _Length of central incisor x 1.618 = golden VI Based on these two calculations, an orthotic in the optimal bite position for both aesthetics and function can be fitted for the patient’s upper teeth.Theorthoticiswornforapproximatelyone month in order to be certain that no headaches, neck pain, grinding or chewing issues ensue. This period also provides the patient with time to become psychologically accustomed to the additional tooth length that shows prior to the gingivectomy and application of veneers. If the patient is dissatisfied with the length- to-width ratio of the teeth in the orthotic, ad- justments can be made to the orthotic before beginning the procedure. Correcting the bite before performing a gin- givectomy can offer a greater aesthetic result, significantly reducing the amount of gum tissue that shows before a gingivectomy is performed. cosmeticdentistry 2_2010 Fig. 6 Fig. 7bFig. 7a