The advances that have been made in recent years in the field of dental and facial aesthetics. More and more types of treatments are available to improve the color and appearance of teeth and soft tissues, while enormous progress has been made in tooth reconstruction and cosmetic interventions to enhance the face.
However, as Dr. Ángel Fernández Bustillo points out, “sometimes greater importance is given to purely ornamental aspects, without considering that behind them there is a mechanical and functional aspect that is just as or more primordial ».
In fact, in his practice he often notes that “patients are unaware of the results that tooth loss causes on the appearance of their face, especially when the posterior teeth disappear.”
Doctor Bustillo has been for more than twenty years one of the main references in Spain in the dental implantology and in facial aesthetics, not only for his medical work, but also as a teacher of surgical techniques applied to these fields. He practices in his private clinic in Pamplona, and also collaborates with hospital centers and dental clinics in other parts of Spain.
In this interview we ask you about the most relevant aspects of facial aesthetics from the perspective of dental implantology. At Clínica Bustillo, a comprehensive facial aesthetic service is offered to dental implant patients, since “tooth loss often leads to an aging face and the loss of natural face conditions». Therefore, while people undergo implant treatment to restore full functionality to their mouth, they have the opportunity to regain their facial harmony.
Why is “what is not seen” important in facial aesthetics?
Let’s take an example. If we lose an incisor or a fang, a priori, the aesthetic compromise seems greater than if we lose a tooth. In fact, we look for an immediate solution because we feel that it does not allow us to lead a normal life, since it affects our self-esteem and social and professional life. On the contrary, when losing a tooth, we are not in such a hurry to solve the problem. We chew on the other side and trust it won’t show.
However, do not replace a molar or any other later piece has serious consequences in the mechanical order and, also, although it may not seem like it, in the aesthetic one. The moment we lose a tooth, several processes are triggered.
And what are those processes?
What introduces a radical change and causes premature aging is the loss of teeth. When a piece disappears, the bone mass that supports it begins to atrophy. The maxillary and mandibular alveolar bone that houses the tooth exists to support the loads of chewing and the muscles that surround the mouth. When its function stops, both this and the soft tissues deteriorate rapidly due to the lack of blood supply and the destruction of cells and elastic fibers. Let’s say that the body tends to “disable” the toothless area.
How does deterioration manifest itself?
The situation affects the bony configuration of the face as a whole and leads to changes and deformations of the facial features. As we can see in natural aging, the lip contour is lost and the lips sag.
The distance between the chin and the nose falls and a pseudoprognathism is generated, since the jaw rotates to seek the stability that the teeth previously provided. At the same time, wrinkles appear quickly, especially in the upper part (the ‘barcode effect’) and the soft part of the chin grows due to accumulation of submental fat (the so-called ‘papo’).
On the other hand, the absence of subsequent parts leads to the existing parts supporting a greater overload. With this, more pieces are broken and displacements of the anterior teeth occur, which lack the balance provided by having all the teeth.
Little by little, this evolution caused by bone loss is transferred to all the factions, and we find people who appear much older than they are.
Can the aging process be reversed?
Indeed, it is possible to reverse this process through different techniques that, as I have indicated, go beyond a simple ‘external touch-up’ of the smile. The first measure consists of restoring lost teeth using implant-supported solutions. It is well proven that removable prostheses, which can be a short-term mechanical solution, also contribute to bone loss in the long term, as they do not revitalize the affected area.
On the contrary, dental implant treatments often include a previous process of bone regeneration to restore the bone mass to its functional faculties. And, subsequently, the implant itself, by behaving like a natural piece, allows the structure not to degrade, to become vascularized again and to adequately support both teeth, muscles and soft tissues.
Are there any difficulties in the restoration?
The posterior area is problematic because it leaves little space for subsequent dental restorative intervention. In the upper jaw, because we have the maxillary sinuses, air chambers where it is impossible to place dental implants. And in the jaw, because it is crossed by a sensitive nerve that barely leaves room to insert the implants.
Therefore, when approaching restoration, it will be necessary to carry out bone grafts to recover the necessary volume to allow the artificial teeth to be anchored.
And after implants and prosthetics, can other treatments be applied?
After the return of the parts, we can carry out various facial aesthetic treatments that will help tone and restore firmness. Among them, you can use minimally invasive techniques such as rhinomodeling, facial fillers, lip contouring, facial rejuvenation and other interventions focused on the eyelids or ears.