initial
treatment
the CLINICAL CASE OF SQUELETTED FACE
BY INCREASING THE VERTICAL DIMENSION OF OCCLUSION - DVO
CLINICAL CASE OF FACE REJUVENATION THROUGH HARMONIZATION OF THE SKELETAL SMILE :
POSITION OF THE MANDIBLE AND RESTRUCTURING OF THE TEETH
Medical history of Corinne
The patient arrived partially edentulous with a removable appliance on her upper jaw.
The vertical dimension of occlusion (DVO) is greatly diminished due to the partial absence of teeth and also due to the wear or destruction of teeth still on the arch.
The consequence of these defects is the sagging of the lower part of the face and therefore of the soft tissues of the face.
The therapeutic choice
The patient’s choice, after several treatment plan alternatives were proposed, was to use classical aesthetic restructuring techniques with the placement of two full ceramic bridges, top and bottom.
Implant surgery was rejected by the patient.
During the design and fabrication of the two full ceramic bridges, the height of the esthetic ceramic crowns was studied to correct and increase the vertical dimension of occlusion or DVO. A partial reconstruction of the gums on the upper bridge with pink ceramic to compensate for the loss of gum tissue is to be noted.
Note that this case was performed without any plastic surgery or cosmetic medicine on the soft tissues of the face but only by Smile design techniques.
RESTRUCTURING THE AESTHETICS OF THE TEETH of the smile :
FITTING OF TWO COMPLETE TOP AND BOTTOM BRIDGES WITH A CERAMIC COSMETIC
Initial clinical situation before the DVO is raised
The following series of photos shows the patient upon her arrival at the office. She is partially edentulous. She wears a removable appliance to replace the upper front teeth and a second removable appliance to replace the lower back teeth.
Clinical outcome after prosthetic treatment and DVO enhancement
The following series of photos shows the patient during treatment and when she leaves the office. The vertical dimension of the occlusion was raised correctly. Two full ceramic bridges replaced missing teeth, restructured the smile and rejuvenated the appearance of the face.
SMILE DESIGN DENTAL TECHNIQUES FOR FACIAL AESTHETICS:
REJUVENATION OF FACIAL EXPRESSION AND SMILE
To demonstrate the results of this clinical case of restructuring the Vertical Bite Dimension, two series of before and after photographs were perfectly calibrated to be totally symmetrical and homothetic.
The first set of before and after photographs shows a huge difference between the two facial expressions: the photograph on the right was taken after the treatment was completed and two full bridges were placed on the two dental arches (upper and lower). The photo on the left is the patient’s expression upon arrival at the office.
Two photographs before and after treatment were perfectly calibrated to be totally symmetrical and homothetic.
Left: The patient’s face BEFORE the placement of ceramic dentures.
Right: The patient’s face AFTER the placement of ceramic dentures They show a huge difference between the two expressions of the same face while the photograph on the right was taken well after the photo on the left, but after the placement of the two full bridges.
The top three yellow lines demonstrate the perfect symmetry and calibration of the photographs by aligning the middle of the eyes, the tip of the nose and the upper lip.
The fourth yellow line at the bottom of the right-hand post-treatment photo shows the new chin position after the two full ceramic bridges were placed.
Right: The patient’s face, AFTER the placement of ceramic dentures, is longer after the restructuring (lengthening) of the Vertical Bite Dimension.
This The new position is illustrated by the lowest yellow line. The other three yellow lines are used to demonstrate the perfect calibration and symmetry of the two before and after photographs.
The red line shows the former position of the chin on the left photo before treatment.
The lowest yellow line marks the new position of the chin and therefore of the entire lower jaw, AFTER treatment.
The difference between the position of the red line and the lowest yellow line is the measure of the increase of the Vertical Bite Dimension.
Left: The red line shows the former position of the chin BEFORE treatment.
Right: The fourth yellow line below shows the new chin position AFTER the two full ceramic bridges have been placed.
analysis of the vertical dimension corrections
Detailed analysis of the correction of the Vertical Dimension by ceramic dental prosthesis for the restoration of the aesthetic harmony of the teeth, smile and face
Front view before the fitting of prostheses: in red
Note the recovery of the oval shape of the face visualized by the yellow line vs the red line, the nasolabial folds are less marked (Naso labial fold), the freed lips have regained their normal expression and the bitterness wrinkles have almost disappeared, the jowls have almost disappeared with the restructuring of the general subsidence. The expression of the face is a rejuvenation without the use of techniques other than dental restructuring of the vertical dimension of occlusion (DVO).
Front view after the fitting of prostheses: in yellow
We note the recovery of the oval of the face (oval shape) visualized by the yellow line vs. the red line, the nasolabial folds are less marked, the freed lips have regained their normal expression and the bitterness wrinkles have almost disappeared, the jowls have almost disappeared with the restructuring of the general sagging. The facial expression is a rejuvenation without the contribution of techniques other than dental restructuring of the vertical dimension of occlusion (DVO).
Profile view before the fitting of prostheses: in red
We note that the gonia angle seems more open (rear angle formed by the meeting of the horizontal and vertical branch of the lower jaw), the lower and horizontal part of the lower jaw(visualized by the red dotted line) as well as the chin (chin) goes up and forward to give a prognathic expression to the patient (even though she is not naturally in Angle Class III), the nasolabial folds are marked (Naso labial fold) and jowls (cheek) are formed in a general sagging of the facial expression, the lips are crushed one against the other in a sad expression with wrinkles of marked bitterness.
Profile view after the fitting of prostheses: in yellow
We note that the goniac angle seems to have closed, giving a more “square” expression to the face, the lower and horizontal part of the lower jaw as well as the chin have moved lower and further back (this movement is visualized by the red dotted line vs. the yellow line) (chin) to erase the prognathic expression, The nasolabial folds are less marked (Naso labial fold) and the jowls have almost disappeared with the restructuring of the general sagging, the freed lips have regained their normal expression and the bitterness lines have almost disappeared.
