Dental Facelift

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Can losing teeth make me look older?
What is the relationship between teeth and facial bone?
What are the Consequences of Not Replacing my Missing Teeth on the way I look?
How can I tell if my jaw is overclosed? If my bite is collapsing?
What can be done then to achieve a younger look?
Where does dentistry fit in the realm of facial aesthetics?

Can losing teeth make me look older?

Tooth loss definitely causes your face to age prematurely. Facial ageing is a biological phenomenon and, unfortunately, an inevitable fact of life. From the time we are born, our genes lead our body through a series of changes ranging from growth to maturation and ageing. This process is also influenced by lifestyle and environment. Our obsession with attractiveness and youthfulness is to some extend due to this ageing process in that beauty has long been considered a driving force in social interactions. The effects of ageing on the face are basically due to changes in the facial skin, the facial muscles and the bony infrastructure

In the fully dentate patient, facial ageing is believed to be totally due to soft tissue changes. Ageing of the skin is associated with progressive atrophy of the dermis. This leads to thinning, wrinkling, sagging and laxity of the facial skin. The muscles involved in facial expression loose their tonicity. In the peri-oral area, gravity-assisted sagging of the soft tissues induces naso-labial folds to develop and cheeks to flatten. There is diminished tooth display of the upper anterior teeth and increased display of lower anterior teeth. Ageing also causes an increase in the vertical length of the nose.

Those facial changes that naturally occur in relation to the aging process are dramatically accelerated by the loss of teeth and the resulting facial bone loss. Jawbones and dental arches constitute a framework draped by muscles, and any change to this framework reflects through skin onto your face. An athlete for example can have nicely-shaped muscles only if there is a strong bone structure underneath to hold on to. A well-shaped, symmetrical face with healthy looking facial skin needs an intact and healthy underlying bone structure. This is demonstrated well in young adults with intact bony structures. The same is observed in middle-aged or even old individuals who have been able to maintain their facial structure. It might be called graceful aging but it is not an accidental phenomenon or due to luck. It is directly related to the state of their oral and dental health. An older individual who has been able to maintain all his or her teeth looks much younger than the same age individual who has lost teeth and wears dentures.

Tooth loss causes remodeling and shrinkage of the supporting jawbone, and eventually leads to atrophic facial bone and consequential collapse of the overlying muscles and skin. Since these changes occur gradually over a period of years, patients usually are unaware that they are from the loss of teeth. Patients often learn to tolerate and adapt. Historically this relationship between teeth and supporting facial bone has been grossly ignored by professionals in the field. However, it is the dentist’s responsibility to explain these consequences to patients before extracting teeth and providing all other options at this time.

What is the relationship between teeth and facial bone?

Growth of the jawbone starts in the fetus stage and is primarily initiated by presence and development of tooth buds, which eventually develop into teeth. The jawbone does not develop in the absence of teeth, very much in the same way the skull would not develop if there is no brain growth. A tooth that is growing brings along a big amount of investing bone with its overlying gum. The erupting dental arch literally pulls up a big portion of facial bone from the basal jawbone. This U-shaped bony column that runs the entire length of both the maxillary and mandibular dental arches, and in which tooth roots are embedded, is called the alveolar ridge. It is very unique in that it only exists for the sake of the teeth that it retains. Its development leads to a significant increase in facial height.

This close relationship between teeth and facial bone continues throughout life. The maintenance of the volume and density of facial bone is highly dependent upon stimulating forces transmitted to the bone through functioning teeth: throughout the day, teeth make hundreds of fleeting contacts with each other, constituting small stresses transmitted through the periodontal ligament that suspends each tooth in its socket, causing the bone to remodel and rebuild continually. When chewing and swallowing, teeth transmit compressive and tensile forces to the surrounding bone. Every time these forces are modified, a definite change occurs in the internal architecture and external configuration: when you loose a tooth, the lack of stimulation to its supporting bone causes a decrease in both volume and density. In the first year after it has been taken out, there is already 25% shrinkage in bone volume, and this process continues into the years to come. This loss of bone occurs both in height and in width. What initially began as a sort of tall, broad, bell curve-shaped ridge eventually becomes a short, narrow, stumpy sort of what doesn’t even appear to be a ridge.

And it might not stop there. Once the alveolar ridge is lost, the basal bone beneath it also begins to melt away.

Teeth give volume to your face

Tooth-transmitted chewing forces play a meaningful role in the morphogenesis of the mid-facial skeleton. During mastication, there are high levels of bone strains in parts of the maxilla and cheekbone. That helps organize the structure of the face. Bone gets more robust and flares laterally, and bony prominences at sites of muscle attachment increase in size. That’s what a full look is mostly about.

With the loss of back teeth though, chewing efficiency diminishes. Only lower levels of chewing forces are acceptable. If not, the remaining teeth would be overworked to bear the load normally designated for the missing teeth, and they would eventually fail through over usage. This situation leads to a decrease in muscle mass and compactness which in turn leads to reduced mechanical strain on the facial bony structures. Muscle atrophy results in bone loss, which is earliest and most extreme at sites of muscle insertions such as the cheekbone area. Lost bone is replaced by a structureless material: fat. Muscle mass loss leads to a down-sizing of your mid-face.

Dentures speed up facial aging

If you are a denture wearer, you eventually will get to the same unflattering situation because your chewing efficiency is severely compromised: In the back teeth area of an individual with natural teeth, the average biting force has been measured to be 15 to a 100 times higher than that of a denture patient. The longer a person wears a denture, the less force she is able to generate.

What are the Consequences of Not Replacing my Missing Teeth on the way I look?

In addition to its ill-effect on facial bone, the loss of teeth exacerbates further the ageing process of your face through a mechanism you are likely not aware of.

If there are missing teeth and gaps within the arch, there are a number of potential future complications that could occur. Generally, nature abhors a vacuum. Therefore, if there is a tooth missing, your other teeth could migrate in an attempt to fill that gap. The existing teeth on either side of the missing space would drift into the void. This would not be a bodily movement, but rather a tipping movement. The result would be teeth that are in a slanted position, and a tooth that is “leaning over” is not as tall as one that is standing up straight. When molars (back teeth) are not as tall as they should be, then the lower jaw has to close down further to get the teeth to come together in order to get enough chewing abilities. What happens then is that the anterior teeth begin to bear a greater amount of load for which they were not designated. Thus, loss of molars will cause the overworked, single-rooted anterior teeth to splay. They get more inclined and, at that point, patients may complain of spaces appearing between their front teeth.

This position, describing how far the lower jaw is allowed to close before the upper and lower teeth make contact and prevent further closure of jaws is referred to as the vertical dimension of occlusion (VDO). It could be thought of as the chin-to-nose distance when the teeth make contact. When people have a full set of teeth, this distance is a stable measurement over time. However, with the loss of multi-rooted back teeth, there is a decrease in the VDO, as the mouth is allowed to overclose when there are only front teeth present to block further upward movement of the mandible towards the maxilla. As stated before, the front teeth are not structurally designed to support the VDO. You cannot think of them as a “door stop”! Instead, they are squashed or pushed forward. The nose and chin get closer together.

That distance from the base of the nose to the base of the chin defines the lower facial height. It is one of the most important aspects in facial aesthetics. In a normally proportioned face, this measurement is equal to the middle facial third (eyebrow to the base of the nose). People with overclosure of the jaw consecutive to a loss in the VDO usually present with decreasing aesthetics because of a collapsing of the lower third of their face.

Mettre: moche sans dents, chewing capabilities, psychology…  canted smile

How can I tell if my jaw is overclosed? If my bite is collapsing?

Because facial height has a profound effect on attractiveness, the loss of it leads to diminished facial contour, with signs of premature ageing showing. If you notice any of the things mentioned below, then the odds are extreme that you could benefit from a more ideal, restored posterior bite.

*The chin tends to rotate forward and upward, and the cheeks, having lost back tooth support, can sink-in slightly, because there is “too much cheek” than is needed to extend from the maxilla to the mandible when in an over-closed position. That’s why people with no teeth get the typical witch profile!

*The lower lip sort of rolls forward, leaving a deep crease between it and your chin. The corners of your mouth tend to droop downwards and join up with the marionette fold when your teeth are closed all the way together and your lips are sealed.

*The lips get thinner. Upper and lower lips loose their fullness. Women often use one of two techniques to hide this cosmetically undesirable appearance:  either no lipstick or minimum make-up, so that little attention is brought to this area of face or application of lipstick over the vermilion border to give the appearance of fuller lip. The nose may appear larger.

*The loss of muscle tone by having the bite closed down causes wrinkles and the nasio-labial fold to get more prominent.

*The jaw line appears irregular due to the presence of jowls and the chin also tends to droop.

*When looking at your whole face, the lower one third of it seems too short relative            the other two thirds (base of nose to the hairline).

*When you bite down, at least half of your lower teeth disappear up and behind your upper front teeth

*When your mouth is at rest, you may appear “unhappy” because your lips have sagged.

What can be done then to achieve a younger look?

The good news is that there is usually no good reason why the jaws can’t be developed to their ideal size and position. Once your lower face is restored to its proper height, you will enjoy a fuller, more aesthetically pleasing and younger appearance.

Basically, your treatment will aim at increasing the vertical dimension of occlusion (VDO). As stated above, the VDO is some sort of proxy for the chin-to-nose distance. Most of the time, that treatment requires work on ALL your remaining teeth, which can involve not only prosthetic rehabilitation but also any combination of other therapy: periodontal and/or implant surgery, orthodontia… When contemplating that kind of treatment, you have to understand the chronological, financial, and sometimes emotional investment required for achieving the best results. Attempting to limit treatment to selected teeth would result in premature occlusal contacts, which could be harmful during mastication. 

The improvement you will get in your facial aesthetics is a truly anti-ageing process. In that, it opens new avenues for collaboration between aesthetic dentistry, cosmetic dermatology, and plastic surgery.

*The immediate and most prominent change you’ll notice take place around the peri-oral tissues. The vermilion border of your lips will show more and your smile window will improve considerably. Increasing the VDO increases the upward curvature of lips when smiling and reduces the width of the smile at the same time.

*Because of improved mechanics, jaw muscles get more efficient and are being worked harder. They get bigger. The chewing forces and the activity of the facial muscles increase. This in turn causes the skin to stretch and get thicker. 

*The jaw line has improved due to the tightening of the facial skin and to the chin being positioned lower.

*Heightened and fuller cheeks are related not only to the presence of restored back teeth, but also to an increase in muscle mass and tone, causing in turn bigger strain on the bones. Resulting changes in bone density and architecture also contribute to enhanced facial features. 

*The nose looks smaller. Restoration of the lower facial height enhances the proportions of the nose in relation to the whole face.

*The eyes may appear bigger and more youthful.

In today’s modern dentistry, the best way for replacing your missing teeth and restoring your face to its proper height is through the use of Dental Implants. They offer the healthiest, most comfortable and pleasing solution.

Where does dentistry fit in the realm of facial aesthetics?

Physical aesthetics and beauty has long been considered a driving force in social interactions. Even children are taught the importance of developing an aesthetic awareness with the understanding that what is beautiful is good. Today, people become increasingly concerned about the effects of ageing on their face because it is the central feature taken into account in making overall aesthetic judgments of others.

We certainly can do a magnificent job at making your teeth look great and giving you a healthy and beautiful smile: Cosmetic dentistry has been an absolute boom over the last 30 years when it comes to such innovative procedures as teeth whitening, minimally invasive veneers, tooth-colored fillings, and bracket-free orthodontics. But now that you can have your teeth looking much better, it is time to consider that dentistry does not begin or end inside the lips. If your teeth look perfect but we ignore the rest of the face, then we have really limited what we can accomplish with aesthetic dentistry. Teeth need to fit into the entire framework of your face. This is especially true of the immediate areas which surround and outline your mouth. Even though your expectations in terms of tooth colour, shape, and alignment are fulfilled, there always will be something missing from the aesthetic result you could get if unsightly nasolabial folds, marionette lines, dropping lip commisures still frame your nice teeth.

Today, cosmetic dermatology techniques have been widely accepted worldwide as a correction of this ageing process because of their immediate effects, reasonable cost, and ease of delivery. Dermal filler therapy certainly can restore the lost volume in the soft tissues of your face but only so if the underlying bony framework has not been diminished by tooth loss. If those signs of premature ageing showing up on your face are consequential to -or accelerated by- tooth loss, you should first consider the alternative of having your lower facial height increased before embarking on cosmetic dermatology and surgical corrective procedures such as facelift.

You always will achieve a more dramatic and pleasing result with a combination of increase in lower facial height in addition to cosmetic dermatology and/or plastic surgery.

The field of facial aesthetics is complex and multifaceted. We have built a relationship with leading plastic surgeons and cosmetic dermatologists so that all your needs in terms of facial ageing can be addressed.

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