Dentofacial Rejuvenation: Complete Dentures and Implant-Supported Bridgework
This elegant patient presented for complete dentofacial rejuvenation after years of putting everyone else first and, as often happens with life’s demands, forgetting to look after herself. Complete dentures replace all missing teeth in the upper and/or lower jaws, and the goal is always a pleasing, natural appearance alongside restored ability to eat and speak. But without natural teeth, the jawbones continue to resorb over a lifetime, changing both a person’s appearance and the fit of their prosthesis. Long-time denture wearers often experience loosening as the jaw loses bone mass, which is why we advise relining after two years, or considering an implant-supported prosthesis to improve aesthetics, comfort, chewing and confidence.
The Science of Facial Ageing After Tooth Loss
After tooth loss, the scaffolding that supports the facial musculature diminishes, to a degree that depends on the patient’s genetics (Watt & MacGregor, 1976). No amount of plastic surgery can restore facial tissue once this bony scaffolding, the teeth and their supporting bone, has atrophied. Where sufficient bone volume remains, implant-supported bridgework or overdentures are the best option to restore both soft and hard tissue.
Loss of teeth accelerates facial ageing at any age, a process we refer to as facial atrophy. When anterior teeth are lost, the facial curtain hangs straight down from the lower border of the orbit, and the smooth curve from the upper lip to the cheek is interrupted by an extended nasolabial groove. This shows up as:
- Increased facial folding with loss of lower facial height
- Loss of vertical dimension of occlusion (VDO) and lower facial height
- Loss of upper lip support
- Thinning and retraction of the upper lip
Diagnosis
Accelerated facial ageing and atrophy resulting from long-term tooth loss and bone resorption, with associated loss of facial height, lip support and confidence.
Treatment Approach
Treatment is directed at facial harmony first, not the teeth. We work backwards from the face to the lips, then to the upper arch position, and finally to the teeth themselves, since the diagnostic assessment has to start with the face. A provisional upper denture was fitted alongside the remaining terminal lower teeth, initially restoring the patient’s facial height and upper lip profile as closely as possible. This stage required considerable perseverance from the patient, testing her adaptation and tolerance as the facial height changed, a process grounded in neuroplasticity.
The lower teeth were then removed, and porcelain implant-supported bridgework was constructed and fitted.
Treatment Outcome
Three months later, the patient had fully adapted to her new facial height. Speech and comfort improved dramatically, and her aesthetics and confidence were transformed. Most patients don’t set out wanting implants, they want comfort, the ability to chew their favourite foods, and the confidence to smile. This is what dentofacial rejuvenation ultimately restored for this patient: her wellbeing and confidence, in full.
About the Clinician
Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London
D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth)