The dentist can also treat the lower third of the face aesthetically, perhaps even more easily than other specialists, being more familiar with pain control in these areas.
When performing a full prosthetic rehabilitation, restoring the aesthetics of the smile, it is certainly appropriate to consider the face as a whole, its component tissues and the aging of the latter. Not doing so may result in only partial success of the treatment, compromising the harmonization of our work with the face as a whole.
Over the years, the face undergoes considerable changes that affect not only the skin, but also the deeper structures. The facial skin may show a decrease in subcutaneous fat tissue accompanied by changes in the mimic musculature, while the underlying structures (the bone skeleton and cartilage) may undergo resorption or remodeling.
It is precisely because of this involvement of all the structures present that it is important to carry out a three-dimensional assessment of the face before performing any kind of treatment: a careful visual examination helps us to understand which areas of the face capture our attention the most, and also to understand why.
The examination of the oral region is carried out by assessing the shape, size, volume, tone and symmetry of the upper lip with the lower lip, paying close attention to vermilion, also known as “Cupid’s bow“, and the existence of skin imperfections, such as the barcode on the upper lip edge and the naso-labial folds.
In the past, many materials have been used to increase the volume of the soft tissues of the face and to treat the most superficial wrinkles, achieving different results over time.
The search for the ideal product has always been aimed at finding a material that is biocompatible, long-lasting, natural in result and feel, easily injectable and free of complications.
The safest materials are those based on natural hyaluronic acid, a substance that has the function of giving tissues elasticity and hydration, acting as a fluid-retentive element.
If hyaluronic acid is used in its cross-linked, and therefore heavier, form (the so-called filler), a filling and volume-restoring effect is achieved, but the implanted material acts as a volumiser without exerting any stimulation at the biological level. The result will begin to diminish after about 3-4 months, and after about 6 months a new treatment will be necessary.
If hyaluronic acid in its pure form is used instead, a bio-revititalisation effect is obtained: the material introduced draws liquids and stimulates the production of new endogenous hyaluronic acid, restoring that which is physiologically lost through aging, exposure to ultraviolet rays, smoking and atmospheric pollution. The initial effect is less striking and evident than with fillers, but improves over time precisely because of its action of drawing fluid from the surrounding tissues. Implantation of the material should be repeated after about three to four months.
The aim of these treatments is to make facial volumes more harmonious, reshape asymmetries, smooth out any expression lines, eliminate soft tissue imperfections, and prevent age-related damage.
But also, no less important, to be considered following major prosthetic rehabilitation.
In fact, it happens very often that a patient with full dentures decides to undergo implant-prosthetic rehabilitation by switching to a fixed prosthesis. At the end of the treatment, however, the patient will have the advantage of better chewing and greater comfort, but will often complain of unsightly perioral tissue. This is because the total denture, thanks to the presence of the resin flange, was able to provide good soft tissue support.
Lacking this “prosthetic support”, the patient will perceive a drooping lip or a mouth that is not ‘full’. At this point, a few injections of hyaluronic acid will be the natural and physiological completion of the treatment plan just completed.
