I would like to thank Dr. Hartwig for his commentary. The goal of this article, as indicated, was to present the potential role of periodontal treatment in the management of gingival esthetics. Within that limitation, the important roles of oral and maxillofacial orthognathic surgery, orthodontics and prosthodontics in esthetics were not discussed, and cases that relied heavily on those disciplines were not presented. The patients presented in the article were given comprehensive and thoughtfully presented treatment options.
The patient presented in Figures 1 through 6 did have a significant degree of maxillary vertical excess, and the ideal treatment plan presented to the patient was for a combination of orthodontics and orthognathic surgery, including maxillary impaction with a LeFort I osteotomy and mandibular advancement. The patient chose the alternative plan that was presented.
The patient in Figures 7 through 9 definitely did not have maxillary excess, and presented with ideal facial proportion. To decrease her lower face height would not only disrupt her stunning facial appearance, but also leave her teeth with an inappropriate aspect ratio, wider than they are tall, which was her chief complaint.
It is an underestimation of the intelligence and education of dentists to believe they see orthognathic surgery as extreme or impractical. I am disappointed that Dr. Hartwig considers the results from esthetic crown lengthening to be poor.
