I am writing regarding "Achieving Gingival Esthetics" by Dr. Michael S. Reddy (March JADA). While this article nicely illustrated the available advances in periodontal care, it also omitted several critical diagnostic and treatment considerations relevant to gingival esthetics.
Dr. Reddy rightly pointed out the importance of not focusing exclusively on the teeth, but rather on the overall appearance of the smile. Unfortunately, the approach he presented overlooked evaluating the facial skeleton. I am particularly disturbed that Dr. Reddy did not discuss vertical maxillary excess as a diagnosis in the article.
The patients illustrated in Figures 1 through 9 clearly have vertical maxillary excess as their primary diagnosis. Excessive gingival display is a symptom of vertical maxillary hyperplasia, and very often the most appropriate treatment for such patients is a LeFort I osteotomy. Doing esthetic crown lengthening and osseous recontouring only masks the underlying disorder, and to my eyes, it does so poorly in many cases.
I know some dentists view orthognathic surgery as extreme or impractical. Fortunately, however, with an oral surgeon who is confident and experienced in discussing the diagnosis, treatment and recovery considerations associated with orthognathic surgery, most patients will choose this option readily.
I hope the patients undergoing extensive periodontal surgery in this article were given comprehensive and thoughtfully presented treatment options.
