Australasian Dentist Issue 92

CATEGORY 82 AUSTRALASIAN DENTIST Dr Giulia D’Anna Taking a global approach to cosmetic dentistry By Dr Giulia D’Anna, BDSc, MRACDS, Grad. Dip. Derm. Th Cert IV TAE, Grad. Cert laser C osmetic dentistry is no longer just about improving the teeth. We need to think globally to produce a harmonious improvement for our patients. Today providing dermal filler and cosmetic neurotoxin injections is within the scope of a dental practitioner. Dental training and skills make dentists exceedingly well qualified to provide safe and aesthetically pleasing results using cosmetic injections. What’s more, it adds to the results that dentists are able to achieve intraorally through traditional cosmetic procedures and orthodontic treatments. Like most dental procedures, providing cosmetic injections requires a combination of technical and artistic skill. This needs to be combined with a comprehensive knowledge of head and neck anatomy, current techniques and treatment options. So let’s look at facial rejuvenation to enhance our approach to cosmetic dentistry. Facial rejuvenation The termfacial rejuvenation refers to several different categories of treatment designed to improve the appearance of the face. Over the years, the number of traditional surgical procedures has declined as patients prefer a non-surgical approach. On the other hand, the number of neurotoxin and dermal filler procedures has increased by more than 244% since 2006. Some of the reasons for this trend are: u The effect is seen in days, u The procedure takes less than one hour, and u There is little to no downtime. u Additionally the enhancements are subtle and discreet, so that patients can have treatment ‘under the radar’ which is very appealing. The concept behind facial rejuvenation is not to make a person look younger, but rather to look radiant and the best that they can for their age. The teeth should match the smile, and the smile should match the face. This is truly a global approach. The importance of the lips The lip region is an extremely important area when it comes to facial aesthetic proportion and balance. As such, many people, young and old, opt to have lip enhancement. The lips have always been highlighted along with the eyes, as the two most beautiful regions of a woman’s or a man’s face. This is apparent by many artists over time, especially where light and shade are highlighted to pronounce the curves of the lips. The lips are the centre of communication, sensuality and function. With the passage of time, photo- damage, hereditary factors, and smoking contribute to loss of lip volume, perioral rhytides or wrinkles, and prominence of mentolabial folds. Genetically thin lips and cosmetic asymmetries of the lips are also issues that can be dealt with similarly, that is, by soft tissue augmentations using fillers. Successful rejuvenation of the perioral region requires knowledge in using a combination of rejuvenation technologies and injectable treatments. Various fillers, temporary and permanent, have been tried in shaping the lips, with beautiful results. Hyaluronic acid (HA) is the main filler widely available and used for non-surgical enhancement. Worldwide usage of HA and published reports clearly confirm the efficacy and safety of HA fillers. They are one of the key components of successful combination treatments of the ageing face and lips. Facial assessment When a patient comes in to see us, there is usually a concern related to a particular line or fold. However as practitioners, we should take a global approach to our assessment. Traditionally, we look at a patient as just a smile with teeth when we are first making our way in dentistry. We soon learn that this narrow view is not enough. We need to look at the whole patient. Although the patient may specifically complain of lip deflation or asymmetry, we should also take into consideration the surrounding areas. Lips are not in isolation, so treatment of the lips should be done with consideration to the surrounding facial area. Consider the photos of the traditional dentist view versus the global view. When we focus on the mouth alone, it appears that lip filler is all that is required to restore LINICAL a better shape to the mouth. However, as we pan out and look at the whole face, and the different facial expressions, it becomes apparent that a global approach to assessment and treatment is required. Now imagine if this patient was another decade or two older, there would potentially be more treatment required and a simple goal of lip enhancement may not achieve a harmonious result if we do not look at the surrounding and supporting tissues. When a patient smiles, their face is animated with full movement of the muscles, skin around their eyes and cheek movement. When a patient is sad, their face will pull downwards. This can highlight the chin and jowl area. Face at rest Examining lip function at rest and during animation is critical, in particular when treatment planning for lip enhancement. Hyper-active (tight) or hypo-active (loose) lips will change the way the face looks in animation. And the activity of the lips can affect the choice of dermal fillers and whether we incorporate muscle relaxants into the treatment. In cases of underlying deformity (dento-skeletal), it would be preferable to refer the patient for correction that allows normal lip function. This may Traditional view Global view