Can dental treatments inadvertently worsen facial asymmetry if not carefully planned?

Okay, so I’ve been noticing some subtle differences in my face lately, especially around my jawline. I think one side might be slightly more defined than the other, and maybe my smile is a little crooked? It’s not super obvious, but I’m definitely more aware of it.

I actually just had a couple of fillings done on my lower left molars a few weeks ago. And I’m considering getting Invisalign to straighten my teeth because I have a slight overbite. I’m just really worried that if these procedures aren’t done perfectly, they could potentially make my facial asymmetry even more noticeable, or even worse, cause asymmetry where there wasn’t really any before.

Specifically, I’m concerned about things like:

• Uneven bite adjustment after the fillings. Could that somehow shift my jaw alignment?
• If Invisalign moves my teeth in a way that isn’t perfectly balanced, could it affect the underlying bone structure or muscle tension and contribute to asymmetry?
• Should I be looking for a dentist or orthodontist who specifically specializes in facial aesthetics in addition to just general dental work?
• Are there any specific questions I should be asking my dentist and orthodontist about this before I start any treatment?
• Are there any imaging techniques, like 3D scans, that can help to ensure a symmetrical outcome?

I’m just trying to be proactive and prevent any future problems. I want to improve my dental health, but not at the expense of my facial appearance.

Answer

Yes, dental treatments can inadvertently worsen facial asymmetry if not carefully planned. Facial asymmetry is a common condition, but noticeable asymmetry can be a concern for patients seeking cosmetic or functional improvements. Dental interventions, while primarily focused on oral health, can influence the surrounding facial structures and musculature, potentially exacerbating existing asymmetries or even creating new ones. Here’s a detailed breakdown of how this can occur:

1. Extractions and Tooth Loss:

• Bone Resorption: Following tooth extraction, the alveolar bone that once supported the tooth begins to resorb. This bone loss is not uniform and can vary depending on factors like the extraction technique, the patient’s bone density, and the presence of infection. Uneven bone resorption, especially in the posterior regions, can alter the facial support and create asymmetry in the cheeks or jawline.
• Loss of Vertical Dimension: Tooth loss, particularly in the posterior teeth, can lead to a collapse of the vertical dimension of occlusion (the distance between the upper and lower jaws when the teeth are in contact). This collapse can cause the mandible to rotate upwards and forwards, altering the facial profile and potentially exacerbating asymmetry.
• Shifting of Teeth: When a tooth is extracted, adjacent teeth tend to drift into the empty space. This drifting can be uneven, leading to a misalignment of the dental midline and affecting the symmetry of the smile and facial appearance.
• Muscle Imbalance: Loss of teeth and subsequent changes in the bite can lead to imbalances in the muscles of mastication (chewing muscles). Uneven muscle activity can contribute to asymmetry in the lower face and jaw.

2. Orthodontic Treatment:

• Asymmetric Tooth Movement: If orthodontic treatment is not carefully planned and executed, it can result in uneven tooth movement. For example, if one side of the arch is expanded more than the other, it can create asymmetry in the smile and facial appearance.
• Extraction Patterns: Orthodontic treatment sometimes involves extracting teeth to create space for alignment. If extractions are performed asymmetrically (e.g., extracting one premolar on one side and two on the other), it can lead to asymmetry in the dental arches and potentially affect facial balance.
• Jaw Growth Modification: In growing patients, orthodontic appliances can be used to influence jaw growth. If this growth modification is not carefully monitored and adjusted, it can lead to asymmetric jaw development, resulting in facial asymmetry.
• Temporomandibular Joint (TMJ) Issues: Orthodontic treatment can sometimes affect the TMJ. If the treatment causes or exacerbates TMJ dysfunction, it can lead to muscle imbalances and asymmetry in the jaw and face.

3. Restorative Dentistry (Crowns, Bridges, Veneers):

• Occlusal Imbalance: Incorrectly designed or placed restorations can create occlusal imbalances (uneven bite forces). These imbalances can lead to muscle imbalances, TMJ problems, and asymmetry in the way the jaw functions.
• Changes in Tooth Contours: Altering the shape and size of teeth with restorations can affect the support for the lips and cheeks. If these changes are not carefully planned, they can create asymmetry in the facial appearance.
• Uneven Incisal Edge Position: The incisal edge position (the biting edge of the front teeth) is important for smile esthetics. If the incisal edges of the upper front teeth are not symmetrical, it can create an unbalanced smile and affect the overall facial appearance.

4. Dental Implants:

• Improper Placement: Incorrectly placed dental implants can affect the position and angulation of the replacement teeth. This can lead to occlusal imbalances, muscle imbalances, and asymmetry in the smile and facial appearance.
• Bone Grafting: In cases of significant bone loss, bone grafting may be necessary before implant placement. Uneven bone grafting can create asymmetry in the underlying bone structure, affecting the support for the overlying soft tissues.

5. Maxillofacial Surgery:

• Uneven Bone Cuts or Positioning: While maxillofacial surgery aims to correct skeletal asymmetries, improper planning or execution can lead to further asymmetry. Bone cuts that are not precise or fixation that is not stable can result in unfavorable outcomes.
• Soft Tissue Management: Soft tissue response to surgery is unpredictable. Uneven healing or scarring can contribute to facial asymmetry.
• Condylar Resorption: Following orthognathic surgery, some patients experience condylar resorption (breakdown of the TMJ condyle). This can lead to changes in the jaw position and potentially exacerbate facial asymmetry.

Mitigation Strategies:

To minimize the risk of dental treatments worsening facial asymmetry, dentists should:

• Thorough Examination and Diagnosis: Conduct a comprehensive examination, including a detailed medical and dental history, clinical examination, radiographic analysis (including panoramic radiographs, cephalometric radiographs, and cone-beam computed tomography), and photographic documentation.
• Careful Treatment Planning: Develop a detailed treatment plan that considers the patient’s overall facial esthetics and function. This plan should address any existing asymmetries and aim to improve or at least not worsen them.
• Interdisciplinary Approach: Collaborate with other specialists, such as orthodontists, oral surgeons, and prosthodontists, to ensure a coordinated and comprehensive approach to treatment.
• Precise Execution: Use meticulous techniques and high-quality materials to ensure accurate and predictable results.
• Patient Communication: Clearly communicate the potential risks and benefits of treatment to the patient and involve them in the decision-making process.
• Long-Term Maintenance: Emphasize the importance of long-term maintenance and follow-up care to prevent relapse and ensure the stability of the treatment results.

In summary, dental treatments, while intended to improve oral health, can inadvertently worsen facial asymmetry if not carefully planned and executed. A thorough understanding of facial anatomy, biomechanics, and treatment principles is essential to minimize this risk and achieve optimal outcomes.