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Episode #452: The Power In Learning About Gingival Architecture, with Dr. Betsy Bakeman

the best practices show podcast Jul 29, 2022

 Do your patients care about gingival architecture? Chances are, yes! They just don't know what it is, or that it can be corrected. And sometimes, neither do dentists. So, to help you optimize the results of your dentistry, Kirk Behrendt brings back Dr. Betsy Bakeman, adjunct faculty member at the Kois Center, to share what she’s learned about gingival architecture, why you should learn more, and how to get started. To help patients achieve their ideal smiles, listen to Episode 452 of The Best Practices Show!

Main Takeaways:

  • You can alter gingival architecture for esthetic reasons.
  • Learn gingival architecture to optimize outcomes.
  • This knowledge will give you added expertise.
  • Learning this will improve communication.
  • Gingival architecture is simple to learn.


  • “You hear about the gingival architecture being the framework for the teeth, and it’s something that I never used to consider at all, until I started going through the accreditation process in the American Academy of Cosmetic Dentistry. And they started talking about how this was really important for esthetics, and I knew what I wanted to do. I learned where the architecture should be, the symmetry, the harmony. But I didn't know how to manage it, and I struggled getting my patients to go to the periodontist, to go to a specialist. I struggled with communication with my patients, with the specialist, and I didn't know how to achieve optimal results.” (3:28—4:17)
  • “[Gingival architecture is] really simple. It’s very manageable. Any general dentist can learn these techniques, and it helps you in so many ways.” (4:40—4:49)
  • “[What most dentists get wrong is] how simple and predictable [gingival architecture] is. It’s just so simple and predictable. Once you know what to do, it’s amazing how simple and predictable it is.” (5:49—6:05)
  • “Even if you decide, ‘I don't like blood. I don't like working with a scalpel. I don't want to do that,’ you become better at communicating what you want with your periodontist. So, it’s helpful to know what the ceramicist is doing, to know what the specialist is doing. We become better communicators and we’re more likely to get what we need when we work with our specialists.” (6:43—7:08)
  • “You can't unsee it. Once you see asymmetry in the gingival architecture and the patient is asking you about this chipped tooth, this dark tooth, whatever it is that they're focused on, and then you say, ‘Can I point out some other things that I see that may or may not be important to you? If you're going to restore these teeth, you may notice afterwards that these gum heights aren't even on these two middle teeth. And there are opportunities to correct that before we do your two restorations so that it looks perfectly symmetrical.’ And patients often say, ‘Oh, I didn't notice that.’ Or they might say, ‘I didn't know you could correct that.’” (7:41—8:28)
  • “Especially in people that have short teeth and gummy smiles where there's actually more tooth structure under the gum tissue, people are amazed. I mean, they didn't even know that that could be corrected. And so, they're so excited. It’s added expertise in the eyes of the patient that you're the first person that mentioned that this could actually be corrected for them. They didn't even know it. And honestly, a lot of dentists don't know it either.” (8:30—8:59)
  • “In dental school, we’re taught a lot about single-tooth dentistry, and we really focus on teeth. I mean, dental school — dental anatomy, teeth, teeth, teeth, teeth, teeth. And I didn't know that you could alter gingival architecture for esthetic reasons until I was like 15 years out of dental school.” (9:09—9:32)
  • “The AACD says if you're going to say you're a cosmetic dentist, you need to manage gingival architecture. Whether you do it yourself or you refer to the periodontist to have them do it, you're ultimately driving the bus and you ultimately have to make the decisions. So, you need to be able to have those skills or communicate what you need to create an optimal result.” (13:35—14:03)
  • “It’s really funny. Patients, when I'm pointing out, ‘We have this asymmetry,’ and I just fold it into the treatment plan — and they can always tell me they don't want it. But it’s interesting because patients will say, ‘You know, if I'm going to do these restorations, if I'm going to invest this money, I'm going to do it right.’ And it’s not necessarily right or wrong, it’s esthetic. And I will even say that to the patient. I'll say, ‘It’s not necessarily right or wrong. It’s just more optimal to correct this and make it more ideal.’ But in the patient’s mind, they're thinking, ‘That's the right way to do it.’ And people really appreciate that you've pointed that out.” (20:40—21:31)
  • “If you have an asymmetry in gingival architecture, say you have the right central with the tissue here, and the left central here, and the patient is noticing the chipping and the wear on the biting edge, or the discoloration. And now, you make everything about those teeth beautiful. But now, they're going to be different sizes when you're finished. Now, what's the patient going to notice? They're going to say, ‘Why is this one tooth shorter than the other?’ And when you finish the treatment is not the time you want the patient to be asking those kinds of questions.” (21:32—22:04)
  • “Dr. John Kois has been teaching this subject matter for more than 25 years. And out of all the courses he teaches, this one has been about the same content. Most of the literature that comes out just reinforces what we already know and teach, so there have not been a lot of changes. So, once you master the knowledge, you'll have it, which is a really beautiful thing.” (29:08—29:36)
  • “We’re dentists. We like control. And to be able to have that control and place the tissue where you want it, bone where you want it, to know where it is when you go to prep the teeth, it helps people so much. And it’s so simple to learn. So, I encourage everyone to learn how to do that. You'll use it every day in your practice.” (30:48—31:15)


  • 0:00 Introduction.
  • 2:37 Dr. Bakeman’s background.
  • 3:13 Why this is an important topic.
  • 5:28 What most dentists get wrong about gingival architecture.
  • 7:08 Gingival architecture is added expertise.
  • 9:00 You can alter gingival anatomy.
  • 11:27 The challenging AACD accreditation process.  
  • 14:13 The importance of still photography.
  • 17:26 Dr. Bakeman’s philosophy for working with specialists.
  • 20:24 Talking to patients about gingival architecture.
  • 23:29 Changes in overall patient health.
  • 25:53 The team’s role in the gingival architecture process.
  • 28:44 The future of gingival architecture.
  • 30:29 Last thoughts about gingival architecture.
  • 31:17 More about the Kois Center and how to get started.
  • 37:25 Advice for dentists.

Reach Out to Dr. Bakeman:

Dr. Bakeman’s email: [email protected] 

Dr. Bakeman’s website: http://www.micosmeticdentist.com/

Dr. Bakeman’s Facebook: https://www.facebook.com/cosmeticdentistry.MI

Dr. Bakeman’s social media: @betsybakemandds


Kois Center: https://www.koiscenter.com/

Kois Center course list: https://www.koiscenter.com/courses/  

Dr. Betsy Bakeman Bio:

Dr. Betsy Bakeman teaches as an adjunct faculty member at the Kois Center in Seattle, Washington. She is a member of the American Academy of Restorative Dentistry and the American Academy of Esthetic Dentistry, and an Accredited Fellow of the American Academy of Cosmetic Dentistry (AACD). Dr. Bakeman is immediate past-president for the AACD. She also serves as both accreditation and fellowship examiner for the AACD. She was the recipient of the AACD’s 2013 Award for Excellence in Cosmetic Dentistry Education. She maintains a full-time private practice in Grand Rapids, Michigan⁠⁠.


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