Does "Bioesthetic Dentistry" Provide Good Value?
Stephen Barrett, M.D
Robert S. Baratz, M.D., D.D.S., Ph.D.
Bioesthetic dentistry is a marketing term used by dentists who aim to provide "optimum dental health, beauty, and appearance" by correcting what they consider to be defects of the chewing system. It is one of several systems that postulate the existence of an ideal model that provides a blueprint for optimal dental care. According to proponents:
This approach involves a comprehensive evaluation of the entire chewing system. It regards the teeth, jaw joints, bones, nerves, muscles, lips, tongue, mouth and the face as a collective system rather than individual parts. Equilibrium between all these oral structures allows the creation of a natural, youthful looking smile and promotes the maintenance of a healthy chewing system that will provide a lifetime of optimal comfort, function and beauty. Disharmony among the individual components leads to breakdown of the system .
Proponents further claim that their model enables them to observe the earliest stages of pathology—often before symptoms occur—and to direct specialty care (orthodontics, orthognathic surgery, periodontics, prosthodontics, and restorative dentistry) to a common goal .
Bioesthetic dentistry was developed by Robert E. Lee, D.D.S., who had an "occlusion/esthetic oriented private practice" in Grand Terrace, California, taught restorative dentistry at Loma Linda University, and founded Panadent, which markets "innovative" dental products related to bioesthetic practices . According to proponents:
Bioesthetic Dentistry is based on the Ideal Human Dentognathic Model. . . . This Model was discovered by observing and measuring beautiful human dentitions that showed little or no wear, in people over the age of 30. . . . Dr. Lee drew upon his MS in biology to study optimal biologic systems. He observed and recorded nature’s successful, long-lasting, unworn dentitions. Amazingly, the most outstanding dentitions had the SAME features in common. . . . By applying the qualities he observed in the successes of nature to his patients, he found his cases to be very predictable, functional, esthetic, and stable --- superior to any treatment he had previously provided. He termed this very biological approach “Bioesthetic Dentistry” to attract attention .
In 1977, Lee founded Occlusion Seminars, which provided continuing education for dentists and was later renamed The Lee Institute for Orofacial Dentognathic Bioesthetics. In 1994, he helped Charles R. Wold, D.M.D. launch the Ortognathic Bioesthetics International (OBI) to perpetuate his teachings . The OBI Foundation for Bioesthetic Dentistry, which is now a 501(c)(3) nonprofit corporation based in Salem, Oregon, is now the primary source of training in bioesthetic dentistry, In November 2008, its Web site referral directory site listed 239 dentists who had completed at least six days of coursework. Dentists who complete further coursework are eligible to join the Academy of Bioesthetic Dentistry.
The OBI Foundation states that dentists who take its courses are "uniquely trained to accurately diagnose problems with the chewing system and provide the most conservative dental therapies necessary to correct the underlying causes of tooth wear, not just the symptoms." It further claims that bioesthetic dentistry can help "preserve the function and provide lasting natural beauty of your teeth and smile for a lifetime" and can help with an unattractive smile; worn, chipped, cracked or broken teeth and dental work; migraines and other headaches; painful facial or neck muscles; upper back or shoulder pain; jaw joint soreness or pain; difficulty or pain with chewing; grinding or clenching of the teeth; jaw popping or clicking or grating noises; loose teeth or receding gums and bone; shifting bite; ear pain and congestion; and ringing in the ears .
Bioesthetic dentists typically do x-ray examinations of the jaw joints, facial bones, cervical vertebrae, sinuses and airway; take photographs of the teeth, face and smile; and check jaw alignment with special Panadent instruments. These, they say, enable them to determine whether the patient's jaw joints are properly aligned in their sockets and how to correct any "chewing disharmony" that is found. If the teeth are severely crooked, an orthodontist may be consulted. The information is used to create a wax model that serves as a blueprint for corrective work . In most cases, a temporary splint called a maxillary anterior guided orthotic (MAGO) is worn for 2-4 months to get the bite to match the correct jaw position . After stabilization occurs, the jaw position is maintained by reshaping the biting surfaces of teeth and applying crowns, braces, veneers, and bonding as needed. If needed, orthodontic treatment is added and, in extreme cases, jaw repositioning surgery is done. Some cases involve only minor reshaping of teeth and bonding, while more complex cases are said to require full-mouth rejuvenation.
The cost depends on how much is recommended. Various Web sites suggest that MAGO therapy costs from $3,000 to $5,000, minor reshaping and bonding cost from $300 to $500 per tooth, and porcelain crowns run from $900 to $1,500 per tooth. A program that includes only minor reshaping and bonding would cost $5,000 to $7,000, but one in which all the teeth were crowned could cost over $40,000.
Bioesthetic dentists and other dentists use the same restorative procedures. However they differ in about why and when they are used. To prepare for a crown, it is necessary to grind down the tooth to make a stump that the crown will cover. Bioesthetic dentists claim that crowns can greatly enhance mouth function if they cause the teeth mesh perfectly when biting. Most dentists, however, aim to minimize removal of healthy tooth structure, which means that they would not crown healthy teeth for this purpose. Crowning may cause some teeth to need root canal treatments, which, if any fail, will require complete removal of the tooth and replacement with a bridge or implant. Crowns also require patients to exert extra oral hygiene effort to keep the margins where crown borders meet real tooth and gums clean and free of decay.
Bite modification also entails risks. It can lead to bite trauma, tooth death, and/or broken crowns. It can change the chewing surfaces, creating food traps and causing food to be forced into the gums. It can also cause changes in the temporo-mandibular joints (the jaw joints on each side), creating problems with the way the bones meet, trauma to the cartilaginous disc between the bones, and problems with the muscles, tendons, and ligaments that form the joint and allow the jawbone (mandible) to move properly in all directions.
Before-and-after pictures on proponent Web sites indicate that many of their patients improve their appearance. Some patients with a severely dysfunctional mouth may also benefit from this approach. However, we found no published data on the long-term effects of bioesthetic treatment on the jaws, TMJ joints, teeth, and gums or how bioesthetic results compare to those of standard treatment. Nor did we find any discussion of risks or any reports of negative outcomes, which makes us wonder whether they are willing to report negative outcomes.
Two recent lawsuits illustrates what can happen when things go wrong. In 2009, Carey Bertsch, of Scottsdale, Arizona sued two local dentists for negligence, battery, lack of informed consent, and conspiracy to commit fraud in connection with treatment they administered to her. Bertsch's complaint states that in 2004, she sought advice from general dentist Thomas Wais about replacing a recently extracted tooth with a bridge or implant. Wais advised her to undergo treatment that included wearing braces and resurfacing and realigning many of her teeth. Collaborating with Wais, orthodontist Karen Berrigan administered the braces. As treatment progressed, Bertsch developed increasingly severe jaw, head, and neck pain that Wais falsely attributed to mercury poisoning. In 2008, Bertsch consulted a specialist in temporomandubular joint disorders who concluded that her pain was due to a bite dysfunction caused by the inappropriate treatment. The suit also charges that Wais failed to disclose that he was following the principles of bioesthetic dentistry .
In 2010, Carey's husband, Robin Bertsch, filed suit against Wais, the OBI Foundation, and The Wellness Hour, a television show that promotes non-mainstream practices . The complaint states that in 2008, Robin, whom Wais had treated for more than three years, sustained such severe damage to his mouth, jaw, neck, and upper back that he demanded a refund plus additional amounts to cover corrective measures. Robin also demanded that his picture be removed from Wais's Web site, where it implied that Wais had successfully treated Robin for a TMJ problem . Even though no suit was filed, Wais's malpractice insurance company paid Robin $200,000 in response to his letter. Wais removed the picture, but later displayed it and discussed Robin's case several times on The Wellness Hour . After learning about the insurance settlement, the Arizona State Board of Dental Examiners conducted an investigative interview, during which Wais acknowledged that his treatment of Robin had been unsuccessful . Robin's lawsuit, which accuses Wais of negligent misrepresentation and conspiracy to commit fraud, notes that Wais's use of Robin's image during the Wellness Hour broadcast directly contradicted the statements Wais made during the investigative interview.
The Bottom Line
Bioesthetic dentistry offers a very expensive way to improve appearance by extensive application of crowns and other restorations. It is based on an "ideal dental model" that most dentists do not accept. It is claimed to greatly improve function and to provide health benefits as well. Before-and-after pictures indicate that many patients improve their appearance. However, preparation for crowning requires removal of healthy tooth structure; and disturbing healthy, functional teeth may, in the long run, result in complications.
- Orazio T. Bioesthetic dentistry. Web site of Thomas Orazio, DMD, accessed December 6, 2008.
- Dumont TD, The ideal biologic dental model. OBI Foundation for Bioesthetic Dentistry. Undated article, downloaded from OBI Web site, Dec 6, 2008.
- About Panadent. Panadent Web site, accessed Dec 6, 2008.
- About OBI Foundation for Bioesthetic Dentistry. OBI Foundation Web site, accessed Dec 6, 2008.
- Frequent questions. OBI Foundation Web site, accessed Dec 6, 2008.
- McKinney TA, McKinney ACM. MAGO: Maxillary anterior guided orthotic. Drs. Amy and Todd McKinney Web site, accessed Dec 7, 2008.
- Sieweke JC. FAQ. John C. Sieweke, DDS Web site, accessed Dec 7, 2008.
- First amended complaint. Carey P. Bertsch and Robin Bertsch vs. Thomas D. Wais, DDS and Karen L. Berrigan, DMD. Arizona Superior Court Case No. CV2009-050267, filed July 29, 2009.
- Complaint for damages. Robin Bertsch vs. The Wellness Hour, Thomas D. Wais, DDS, and the Foundation for Bioesthetic Dentistry. California Superior Court for the County of Los Angeles. Case No. 37-2010-00051507-CU-FR-NC, filed Feb 23, 2010.
- Bertsch R. Letter to Dr. Thomas Wais, May 10, 2008.
- Interview of Dr. Tom Wais. The Wellness Hour with Randy Alvarez. March 12, 2009.
- Investigative interview of Thomas D. Wais, D.D.S., Oct 16, 2009.
This article was revised on March 4, 2010.