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Facial Collapse and How to Fix It

Facial Collapse and How to Fix It

After your teeth are all extracted, the jaws begin to shrink. Your body now considers the bone in the jaws to be useless, and it takes those minerals for use elsewhere. Over a period of ten or twenty years, you will end up with a condition called Facial Collapse.

Degenerative dental disease is the most important factor in causing the the look of aging – the convex, sunken face caused by the grinding and wearing down of teeth and loss of jaw bone after loss of teeth.

As you may or may not know, your mouth, gums, teeth and jaw bones affect many of the body’s systems, including the immune system, nutrition, and circulatory system.  Gum disease is particularly damaging and is linked to heart disease, immune deficiency, dangerous inflammation, low birth weights, and a symbiotic relationship with diabetes.   Improper occlusion – the way your upper and lower teeth meet in biting and chewing – can impede nutrition by limiting diet or cause incomplete chewing which is the vital first step in digestion.  Poor occlusion can also cause sleep apnea and TMJ, or jaw joint, pain.

Photos on this page are courtesy of Dr. Carl E. Misch and are from his textbook, Dental Implant Prosthetics, which is the most widely read dental implant textbook in the world.

If You’re Missing All Your Teeth

When you’re missing all your teeth, the only way to restore most of your mouth function is with dental implants. In the past, removable full dentures were considered an adequate solution, because it’s the best we could do. The problems with removable dentures are:

  • They can’t restore even 25 percent of your eating efficiency.
  • They move around in your mouth, often creating sore spots and difficulty eating and speaking.
  • When your teeth are missing, your body senses that and begins to absorb the minerals in the bone for use elsewhere in the body. This results in a condition called facial collapse.
  • Loss of confidence.

Here is an illustration of facial collapse. Notice how the entire lower face, from the nose to the chin, is shorter. Notice also how the lips are sunken in, and how facial lines are accentuated.

After a number of years, people who have lost all their teeth will become dental cripples – unable to eat, self-conscious, unable to retain a conventional denture because their jaws have shrunk and there is nothing for the denture to rest on.

The good news is that there are a number of options for restoring your mouth. We have a page where we list the dental implant options – you may want to consult that page. Here is a brief list of those options for people who have lost all of their teeth:

  • Teeth in an day
  • Snap-on denture
  • Fixed implant/denture hybrid
  • Removable bridge
  • Fully fixed implant restoration

Facial collapse causeHere are a series of models of the lower jaw, showing the progression of bone loss that will occur over the years. The top model shows all the teeth present. Each succeeding model shows more and more bone loss.

Many patients who have had no teeth for maybe twenty years have a jawbone that looks like the lowest model, and find themselves totally uncomfortable and unable to function, because there is no bone left to support a conventional denture.

Consider this. Many of you who are reading this will live well into your 80s or beyond. Do you want to be able to eat normally at that age? Or do you want to be like many of those at that age who keep their teeth in a drawer, who are limited to soft foods, and who have gastric or other health problems because of that? Do you want your long-term quality of life issues to be decided by an insurance company whose primary concern is cutting costs? We will help you no matter how you decide these issues, but we have seen too much misery not to want to bring these long-term consequences to your attention.

Dental Implant Surgery

If you are presently in a situation where you have little or no bone left, we can still help you. Comfort and function can be restored with implant surgery. View photographs of our implant success stories to see for yourself.

Facial collapse bone resorptionOn the right is a photograph of two actual lower jawbones, one with all the teeth present, and another that has had the teeth missing for an extended period. A false tooth is propped up on a wire to illustrate how much bone the body has reabsorbed.

A person with a lower jaw similar to the photograph above on the left would be a dental cripple, unable to wear a conventional denture. This is the sad reality faced by too many patients.

Facial Collapse diagram A periodontis, however, restores many of these cases to complete functionality.

Unfortunately, the wearing of dentures unsupported by dental implants accelerates the bone loss. On the left is a diagram of the facial changes that occur after wearing conventional dentures for years.

Solutions for cases of facial collapse

  • Bone grafting – We can build up the lost bony structure to restore jaw function.
  • Denture/Implant Hybrid restoration – This replaces lost bone and gum tissue with dental restorative materials.
  • Precise computerized placement of implants – When the bony foundation is lacking, the prospects of getting a solid, long-lasting result are enhanced by carefully placing the implants in whatever solid areas of bone are remaining. These solid areas are identified with careful radiographic diagnosis, and using advanced implant placement techniques. Similar techniques are used in the teeth-in-an-hour protocol, and with the NobelGuide™ system.

When dental implants are present, they stimulate the bone and keep it from atrophy. This is called the piezoelectric effect, and you may read more about it by clicking this link. The greater the number of dental implants that are placed, the greater the piezoelectric effect, and the better the protection against facial collapse.

Below are two photographs of patients with facial collapse. Notice the sunken-in upper lip, the shriveled face, and the shortened nose-to-chin distance. Not only would these people look younger, they would feel better and eat better if their mouths were properly restored.

Facial Collapse - male
Facial Collapse – male
Facial Collapse - female
Facial Collapse – female

The Piezoelectric effect

When teeth or dental implants are present in the jaw, a stimulus is sent to the bone that keeps it from dissolving away. This is called the piezoelectric effect, and it is one of the most important reasons for restoring missing teeth with dental implants rather than some other method. It is especially important with people who are missing all their teeth, because they will eventually suffer facial collapse if implants are not placed.

If you’re missing all your teeth, placing eight dental implants in each jaw is enough to preserve your bone nicely. If that doesn’t fit your budget, then the more dental implants you can have placed, the better.

The x-ray below illustrates this effect dramatically. The patient here, a 68-year-old female, has no teeth left. Fifteen years ago, dental implants were placed in her lower front. Now, after fifteen years, there is practically no bone left in her upper arch, or in most of her lower arch. But there is a lot of bone present in the lower front, where implants have kept the bone stimulated and kept it from atrophy.

piezoelectric effect illustrated

We don’t want to minimize the seriousness of the bone she has lost in the rest of her mouth, because she is at risk of jaw fracture and other problems, but we only want to point out that where the implants are located the bone atrophy has been prevented. She would have been best off to have had four more implants in her lower posterior and then eight also in her upper jaw.