The bone needs stimulation to maintain its shape and density. In the mouth, the teeth contribute to such stimulation, since they transmit the necessary compression and traction forces.
When the piece disappears, the density of the bone mass in the area is gradually diluted, first in width and then in height. When a removable prosthesis is placed, the bone cannot be regenerated. In fact, it contributes to further deterioration. The action of the prosthesis is only transferred to the surface, not to the entire bone mass, so that blood flow is reduced and the total loss of bone volume is triggered.
On the other hand, adjacent teeth are also affected by the fall of other pieces, since the holes move them to move. With this, they lose anchoring capacity, to the point that the risk of losing them is also increased.
It is frequent to verify that some specialists do not inform the patient of the anatomical consequences of the loss or extraction of a tooth. It is not considered that not only the removal of the dental piece is important, but also the bone, whose decline accelerates faster if the lost pieces are simply replaced by prostheses supported by soft tissues.
The evidence shows that regardless of the factors that influence a greater or lesser loss of bone (sex, hormonal activity, parafunction and adjustment of the prosthesis), 40% of the prosthetic wearers have worn it poorly adjusted for ten years. This drives bone wear, and when they are worn day and night, which makes more than 80% of people, the process progresses faster. Therefore, it is essential that dental architecture recovery therapies include bone regeneration treatments.
Therefore, the disappearance of bone has very relevant effects in the anatomical plane, which we can point out in two aspects: aesthetics and soft tissues.
Due to the loss of alveolar bone, various aesthetic consequences occur. The decrease in facial height from the collapse of the vertical dimension causes various facial changes. The loss of the Labiodental angle and the deepening of the vertical lines in the area create a harder appearance. The chin rotates forward and causes a prognathic appearance of the face. The patient seems unhappy when the mouth is at rest. The thinning of the lip results in poor lip support provided by the prosthesis and loss of muscle tone.
The reconstructed position of the lip is related to the loss of the anterior part of the upper flange, as well as the loss of tone of the muscles involved in facial expression.
Patients are unaware that these changes in hard and soft tissues come from the loss of teeth. Therefore, we must inform them of the transformations so that they are informed of what type of treatment they need
Consequences on Soft Tissues
The patient’s tongue with toothless ridges is often enlarged in order to accommodate the increased space previously occupied by the teeth. At the same time, it is used to limit the movements of removable prostheses, and acquires a more active role in the masticatory process. As a result, the stability of the removable prosthesis decreases.
In conclusion, it is important to evaluate a facial aesthetic study prior to any implant treatment, since there are many non-invasive techniques to try to recover lost facial harmony.