When it comes to facial ageing, it’s not merely the wrinkles and folds that make us appear older than our years – but also the size and proportion of our ageing teeth. Dr Sam Thandar discusses how anti-ageing dentistry can create a more youthful appearance.
Did you know that ageing teeth can create or enhance the appearance of an ageing face? Did you also know that the size and proportion of your teeth affected by the ageing process can make you look unnecessarily older?
Lastly, are you aware that the advances with anti-ageing dentistry can reverse the ageing process and create a more youthful look? Let me explain how this works by looking at each part independently. Firstly, let’s look at teeth, then the muscles, soft tissue, and facial profile thereafter.
As you age, the thicker outermost enamel surface of the tooth is gradually worn down, while the yellow underline dentin becomes thicker and more yellow – causing an overall darker appearance on the tooth. During this time, the length of each tooth generally becomes shorter and a little narrower due to enamel loss on the edges (as well as between your teeth respectively).
Meanwhile, the distance from the bottom of your nose to the bottom of your chin decreases – as the shorter teeth allow your jaw to close a little more. With your jaw allowed to close in, it also rotates a little more forward in some cases – which will ultimately alter your overall facial symmetry and proportions.
The masseter muscle (muscle you can feel on the side of your face when you clench) then also shortens and becomes more powerful. This creates a more bulgy, square like appearance around the angle of the lower jaw and side of the face (as opposed to a more tapered youthful look).
There are numerous articles, publications and studies available that attempt to mathematically quantify beauty by using golden proportions. These studies look at both the vertical and horizontal components of golden proportions and facial symmetry.
Some are more complicated than others to apply and use – as well as to replicate surgically or non-invasively. In essence (and for simplicity), the horizontal plane of the face is divided into upper, middle and lower thirds – and each should be equal in appearance. It is in this plane that the most obvious and notable changes in facial dimension are evident, as the result of worn down and ageing teeth.
As the teeth become shorter and smaller, one can imagine the lower third of the face (which is defined from the bottom of the nose to the chin) also decreases in size – thereby creating a disproportionate and ageing look to the face.
When one looks at the face from a side profile, there is also a more forward position of the lower jaw, as well as a slightly thicker appearance in the masseter region.
These above changes for simplicity are described for a patient without any para functional movements or habits. Furthermore, patients with a history of teeth grinding – or patients with a less than ideal bite – generally have considerably more changes to these dimensions. This is due to the underlying factors which accelerate the ageing process.
So how do we restore these dimensions by a dental facelift?
We assess the following parameters and correct accordingly:
- Amount of upper incisors visible at rest and during smiling. This is relevant to the patients lip line (lip line can be high, medium or low). In a medium lip line for example, we should always see 1-2 mm of tooth structure at rest, and 1-0 mm gingiva during a smile.
- Amount of gum tissue visible overall shape of the arch. This tends to deteriorate as the teeth become worn, and the arch loses the rounded shape.
- Bucal corridor. When we look at your smile from the front of your face, we want to see 100% of the front two teeth, then 66% of the side two in relation to the front two. This ratio continues towards the back of your mouth, and as we get further back we see less and less of each tooth. This is where we also use golden proportions to determine the amount of tooth shown.
- Embrasures. These are the fine grooves between the tips of your teeth – an ageing worn dentition has almost no embrasure spaces. Tooth size, shape and colour. These are assessed in relation to face shape, while the colour is usually compared to the white of the eye.
Regarding the facial profile, we measure the distance between bottom of the nose to the bottom of your chin – with your teeth in the biting position, as well as with your teeth relaxed.
We then calculate the difference between the two measurements, and by using all the other information above we can then determine where the optimal position of your teeth should be to enhance aesthetics and function.
Once the above is established, we decide what method, material, and procedure we would utilize to restore the worn enamel and ageing dentition. These materials range from resin-ceramic hybrid materials to full ceramic. Depending on the extent of restoration required, teeth are either over-laid or veneered, with these materials bonded onto the remaining tooth surface. This can either be performed by bonding directly to existing enamel with minor preparations, or by having the existing enamel removed and replaced by the new bonded ceramic material.
These materials mimic enamel in texture, translucency and strength – and can either be fabricated in a single appointment using CADCAM dentistry, or conventionally by using a dental laboratory. Once these proportions are addressed and restored, it often imparts an age-defying appearance to the face – as well as a youthful, fresh look.
In closing, it’s important to note that each patient is unique, and therefore each case should be thoroughly assessed for treatment benefits. In some cases, complementary, minor facial aesthetics to plastic surgery may be involved to achieve optimal results.
A2 Magazine prints only four magazines each year – reporting seasonally on everything you need and want to know about aesthetics, anti-ageing and cosmetic surgery in South Africa – where to go, who to see, what to expect, something new and so much more! Never miss an edition – click here for more info about where you can buy the magazine.