At last year’s Dental Showcase Nick Mohindra, from Added Dimension Dentistry, hosted a series of mini lectures entitled ‘The missing link in the facial ageing puzzle’. He began by describing how he first discovered the effects Oralift appliances can have on facial aesthetics.
Dentists tend to just look at teeth, gums and mouths. When Nick first got started in dentistry he was the same, but for the last 20 years he has been more interested in faces generally, because he began to realise that what he was doing in the mouth was having a profound effect on the face too. This led him to develop the Oralift appliance, which evolved over several years and is designed to slow down and even reverse the signs of the ageing process (crow’s feet, sagging jowls and so on). It also has the ability to slow down parafunction, which also reduces the ageing effect, and alters the resting vertical dimension by manipulating the free way space.
Oralift appliances are thermoplastic mandibulary mouthguard-type appliances incorporating 3, 5 or 7mm bite blocks which, when moulded to the teeth, only contact in the molar region. Oralift appliances only take two minutes to fit. They are only worn during the day, never at night, and because they are only worn for a maximum of two hours per day (two sessions of one hour each), every third day, there is no risk of changes to the occlusal scheme.
Oralift appliances are worn in a cycle of two months worn, four months not worn, two months worn, four months not worn. However, even when they are not being worn they still seem to be having an effect on the ageing process because of the long-term results Nick has observed. It’s like having a personal trainer for the face.
Simple facial exercises can help fight the ageing process too, but the Oralift differs in two ways. Firstly, the muscles being affected by Oralift seem to be all the head and neck muscles, including the muscles involved in breathing and swallowing. The second difference is that the muscles are having to adapt to the new mandibular position, and the increased volume in the mouth. This process of adaptation is not necessarily the same as exercise.
There are a number of theories as to how Oralift works. The most plausible one seems to be that, when it is in the mouth, the muscles of the head and neck are activated to create an increased free way space and this activity generates new chemistry and adjustments within the musculature.
Results
As part of the ageing process there is a downward migration of the soft tissues of the face, so the ageing triangle changes from a youthful inverted triangle, pointing towards the chin, to an elderly triangle with the base at the chin. This creates a classic ‘grumpy old face’. The Oralift appliance is designed to have an effect on these soft tissues and to reverse the ageing triangle to a youthful one.
The biggest changes occur in the skin, which becomes thinner and loses its elasticity during the ageing process. In young skin the fibroblasts are kept stretched by collagen, but as people age the collagen breaks down, the fibroblasts start to collapse, become dormant and begin to die, and the skin loses its elasticity.
At the same time, all the facial muscles gradually decrease in mass. By the age of 60 they retain only about 60 per cent of their volume. Meanwhile, the muscles of facial expression increase in tone so that wrinkles and crow’s feet start to develop. However, if the facial muscles become activated and stretched, by wearing an Oralift appliance, the above processes may be reversed.
As people age the facial skeleton changes. The impact of this on facial appearance has not been well understood until recently. Research is now showing that these changes, especially in the midface, contribute to the southward migration of the soft tissues. The maxilla moves inwards, so that the skin and muscles are no longer supported and cause the nasolabial folds to become deeper. These changes could partly be attributed to changes in facial muscle function. As the muscles on the face deteriorate, the strain they put on the facial skeleton changes. This could lead to the remodelling of the facial skeleton. However, if the muscle function is improved, as a result of wearing an Oralift appliance, these changes may be reversed again contributing to a more youthful appearance. These changes can be demonstrated using a series of before, during and after treatment photographs, but in order to demonstrate these properly the photographs need to be standardised, so that the clinician and patient can evaluate directly comparable images (same angulation, distance and so on).
Using Oralift you can manipulate the free way space to create a three dimensional change to the face, which will help to restore the golden proportion. In many cases, both class II and III patients can be altered into class I when the mandible is at rest, although when in maximum intercuspation the face will revert back to its original form. This can be achieved without the need for orthodontics or surgery, just by manipulating the free way space.
Smile design
As a result of the ageing effect on the face there is a change in the ‘smile window’, so the amount of tooth displayed becomes less because the ‘mask’ is coming down. Observers start to notice more of the lower teeth and less of the upper teeth. There are lots of smile design courses involving orthodontics and veneers relating to this topic. However, simply increasing the length of the upper teeth would be the wrong thing to do.
As the ageing triangle migrates downwards it also affects the patient’s smile profile. If you reverse this migration, using Oralift, the ‘facial mask’ moves upwards too, without the need for any tooth adjustment.
As people age their whole face tends to become asymmetrical. Wearing an Oralift appliance helps correct this asymmetry. Asymmetry can be the result of bony or muscular changes. Bony changes would obviously be slower to correct than muscular changes.
Conclusion
Nowadays, people often want instant results, but you can’t hurry nature. Instantaneous results can be achieved with Botox, fillers and surgery, but they do wear off and can be disastrous sometimes. Oralift can provide a long-lasting, natural and non-invasive solution, but it does take longer so the patient needs to be patient too. It is becoming more accepted that the key to delaying the ageing process is to maintain the normal facial muscle strength. The loss of muscle strength with ageing is a primary cause for cranio-facial skeletal changes. Nick believes that the Oralift can help to restore the muscles to a more youthful state, and that it is the missing link in the facial ageing puzzle.