“Denture face” describes the premature aging of the lower face that occurs after tooth loss and subsequent jawbone deterioration. This appearance often includes a sunken look, deep wrinkles around the mouth, and an over-projecting chin, making a person look older. Understanding the biological processes that cause these changes is the first step in preserving facial aesthetics. By maintaining the underlying support structure, individuals can prevent or correct the visible signs of this facial collapse.
The Underlying Causes of Facial Changes
The primary biological reason for the change in facial structure is alveolar bone resorption—the natural shrinkage of the jawbone after teeth are removed. Teeth are necessary for jawbone preservation, as the roots transfer chewing forces that stimulate bone renewal. Without this regular mechanical stimulation, the body reabsorbs the bone tissue, causing the jaw ridge to decrease in both height and width.
Bone loss begins quickly, with a reduction in ridge height occurring within the first two months following tooth loss. Resorption continues throughout life, leading to the gradual loss of the foundation supporting the facial muscles and skin. This causes the lips and cheeks to collapse inward, deepening the nasolabial folds and creating a profile associated with aging.
Another significant mechanical cause is the loss of Vertical Dimension of Occlusion (VDO), the measured distance between the upper and lower jaws when the teeth are closed. Ill-fitting or old dentures fail to maintain the correct VDO, causing the jaw to over-close.
This decreased VDO compresses the space between the nose and chin, resulting in a sunken mouth and a prominent chin. The facial muscles shorten, and the skin bunches up, leading to wrinkles at the corners of the mouth and a thin-lipped appearance. Restoring this vertical measurement is important for achieving both functional comfort and aesthetic harmony.
Ensuring Proper Denture Fit and Maintenance
Mitigating facial collapse while wearing traditional removable dentures relies on meticulous maintenance and professional adjustments. The primary way to counteract continuous bone loss is through regular relining of the denture base. A reline involves adding new material to the denture surface that contacts the gum tissue to improve the fit.
Since the jawbone is constantly changing, dentures must be relined to maintain proper fit, typically every one to two years. Ignoring a reline leads to loose dentures that shift, causing discomfort, difficulty chewing, and accelerating VDO loss. Relines can be soft, offering greater comfort for sensitive gums, or hard, using a more durable acrylic material.
For individuals who receive immediate dentures following extractions, frequent adjustments are necessary during the initial healing period. The largest amount of bone resorption occurs rapidly after the initial loss, necessitating several relines or adjustments in the first few months. This proactive care ensures the prosthesis continues to support the facial structure as the underlying anatomy changes.
Vertical Dimension of Occlusion (VDO) Measurement
Accurate measurement of the VDO during denture fabrication is a foundational step in preventing a collapsed appearance. Prosthodontists determine the correct distance, aiming for a finished denture that provides a small, resting interocclusal space (typically 2 to 4 millimeters) when the jaw is relaxed. When the VDO is set correctly, it ensures the muscles of the lower face are properly supported, preventing the bunched-up look of denture face.
Permanent Solutions for Facial Support
The most definitive way to address the root cause of denture face is by choosing a tooth replacement option that actively slows jawbone resorption. Dental implants, which are titanium posts surgically placed into the jawbone, serve as artificial tooth roots. Unlike conventional dentures that accelerate bone loss, implants provide the necessary stimulation to the bone.
This stimulation occurs through osseointegration, where the jawbone tissue fuses directly with the implant surface. When a person bites or chews, the force is transferred through the implant, mimicking a natural tooth root. This mechanical loading encourages the growth of bone-building cells, maintaining density and preventing the deterioration that causes facial collapse.
Implants provide a superior foundation for prosthetics, supporting either a fixed bridge or a removable overdenture. Implant-supported options offer stability and maintain facial contours better than conventional dentures, which offer limited chewing power and do not stimulate the bone. By preserving the jawbone structure, dental implants help maintain the natural height of the lower face and prevent the sunken appearance.
In cases where significant bone loss has already occurred, a bone grafting procedure may be required before implants can be placed. Grafting involves adding bone material (synthetic, animal-derived, or taken from the patient’s body) to the jaw. This process rebuilds the lost volume, creating a stable foundation strong enough to support the implants and restore the lost facial structure.