Facial asymmetry can be corrected without plastic surgery

Correct bite - what is it?

Normal, or physiological occlusion, is characterized by the absence of disturbances in the arrangement of the dentition relative to each other with the jaws fully closed. He can be:

• regular, or orthognathic - in this case, the upper teeth overlap the lower teeth by a third of their height and there are no pronounced gaps between the dentition;
• straight - both jaws clearly close;
• biprognathic - both the upper and lower dentition are slightly tilted forward;
• progenic - only the lower jaw is pushed forward a little, but this does not prevent the cutting edges of the teeth from completely closing.

Correct bite is the absence of pronounced gaps between the teeth when the upper teeth are in contact with the lower ones opposite them. Orthodontists determine a bite without pathologies based on the following characteristics.

1. The upper front teeth overlap the lower ones by 1/3 of their height.
2. The incisors and canines are arranged in an even, arched line without distortions or crevices.
3. The upper teeth protrude slightly outward, the lower teeth “look” slightly inward.
4. All teeth are clearly below each other.
5. The center of the jaws vertically coincides with the midline of the face, there are no protruding parts of the cheekbones or chin.

It is important to remember that in order to form a correct bite, you need to be careful about teething and caring for them.

General information

Jaw asymmetry is a pathology expressed in visually visible asymmetry of the lower third of the face. Displacement away from the midline of the entire upper or lower jaw, their segments or individual areas of the face - lips, chin, branches of the upper and lower jaw.

In addition to the above features, pathology can manifest itself as drooping corners of the lips, disruption of the oval of the face, widening or narrowing of the eyes, smoothed lip folds, and some specific features, for example, a pained expression.

To see whether there are deviations or not, you need to imaginarily draw the central line of the face - a vertical straight line passing strictly along the space between the central incisors of the upper and lower jaw. A wide smile makes asymmetry more pronounced.

Strictly speaking, there is no complete correspondence between the left and right parts of the face (ideal symmetry). A certain disproportion of them is present in all people.

The physiological norm is considered to be a position in which the asymmetry in the linear value does not exceed 2-3 mm, in the angular value - 3-5°. If these values ​​are exceeded, they talk about pathology and look for the reasons for its occurrence.

To a greater extent, asymmetry is characteristic of the lower jaw. This is explained by the fact that it is located movably relative to the skull, and has more factors influencing its position than the upper jaw. This is the type of bite, the condition of the TMJ, habitual postures, manner of chewing food, etc.

Dental problems solved with mandibuloplasty and the results achieved.

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According to this address https://orto-info.ru/zubocheliustnye-anomalii/chelyustey/smeshheniya-sredney-linii.html we will discuss how to correct the displacement of the midline of the teeth.

Causes of malocclusion

Malocclusion (malocclusion) is due to various reasons: congenital or acquired. An important role is played by genetic factors, as well as insufficient intake of calcium into the mother’s body when carrying a child. Hereditary problems with bite require certain nuances in treatment. Therefore, before carrying out any orthodontic manipulations, the doctor talks with the parents and learns about all the possible factors in the occurrence of pathology.

Acquired malocclusion develops gradually. It appears at different ages due to its own reasons.

In childhood

• Bad habits (finger sucking, pacifiers, chewing on objects).
• Being on artificial feeding.
• Pathological bone formation.
• Teeth grinding (bruxism).
• Lack of sufficient solid food in the child's diet.
• Mouth breathing (formed as a habit or due to respiratory diseases).
• The replacement of baby teeth occurs too sooner or later.
• Pathologies associated with metabolism.
• Calcium and fluoride deficiency.
• Pronounced carious lesion.
• Injuries of the maxillofacial apparatus

In adults

• Installation of unsuitable dentures.
• Diastemas that form as a result of tooth extraction.
• Various types of injuries.
• Lack of space for eights (wisdom teeth).
• Unusual localization of the language.
• Diseases of the musculoskeletal system.

Reasons for the formation of anomalies in children

Often, an orthopedic doctor immediately after birth notes asymmetry of the skull in newborns. It is determined by the factors of the child’s development in the womb and the conditions of birth (the position of the fetus in the uterus, its passage through the birth canal).

Usually after 2-3 days the newborn’s skull takes the correct shape. If this does not happen, a thorough examination of the baby is necessary to identify the causes of the deformities.

In addition to the birth anomaly, most children under one year of age have facial disproportion due to infants being in one position for a long time.

Birth and infant asymmetry are natural types, and in most cases do not require medical intervention, except perhaps massage.

The pathological anomaly is more often observed in preschool children. It can be congenital or acquired, right-sided or left-sided.

Congenital asymmetry is a consequence of genetic factors and abnormalities in fetal development caused by the condition of the mother and embryo during pregnancy (intrauterine infections, abnormal position of the fetus, asphyxia, lack of nutrients, etc.).

These factors lead to disruption of the formation of soft tissues, cartilage and bones of the skull, uneven healing of sutures, etc.

The specific, most common congenital causes include the following:

• Hypertonicity of the masticatory muscles.
• Muscular dystonia (involuntary muscle contractions leading to impaired development of the TMJ and, often, crossbite).
• Crossbite (due to muscular dystonia or accelerated/slow development of one of the jaws).
• Cleft lip. An anomaly manifested by the presence of 1 or 2 clefts in the upper lip, leading to disruption of the shape of the nose and a depression in the middle area of ​​the face.
• Stigmas of embryogenesis. Various etiological malformations of the fetus. They disrupt the symmetry of the dentofacial apparatus, nose, and skull.

• In addition to pathological factors associated with pathologies of the dentofacial apparatus, there are many other congenital diseases that lead to disruption of facial symmetry.
• These are torticollis, Sturge-Weber syndrome, craniofacial microsomia, etc. The dentist’s task is to differentiate them from pathologies of the dentofacial apparatus, and refer the patient to a doctor of appropriate specialization.

Acquired jaw asymmetry develops in the postnatal period under the influence of various external and internal factors:

• Malocclusion. The most common cause is crossbite, which develops due to bad habits and incorrect positioning of the child in the crib, stroller and at the table. A crossbite can result from slower or faster development of the upper or lower jaw.
• TMJ pathologies.
• Odontogenic and non-odontogenic tumors in the jaws (hard and soft odontoma, osteoma, salivary stones, etc.)
• Impacted teeth.
• Injuries to bone (fracture of jaw bones, skull and face) or muscle tissue.
• Birth injury.
• Periostitis.
• Periodontal inflammation.

Among the non-dental acquired disorders that can lead to an anomaly, the following should be mentioned: diseases of the ENT organs, eye pathologies, curvature of the spine, paresis of the facial nerve, stones in the salivary glands, tumors in the nasal cavity and paranasal sinuses.

Types of malocclusion in adults and children

Dentists usually divide anomalous occlusions into planes.

• Sagittal - characterized by elongated/shortened rows of teeth.
• Transversal - narrowed/expanded dentition is visible.
• Vertical - the presence of shortened/elongated certain areas in the dentition.

In addition, in dental practice it is customary to use the following classification of occlusion.

1. Distal.
   Sagittal occlusion with the upper jaw pushed forward.
2. Mesial.
   Also a sagittal variety, but with the lower jaw moving forward.
3. Cross.
   Transversal pathology with displacement of the jaws, which can only be partially formed, in one direction or another.
4. Open.
   Vertical occlusion occurs with both partial and complete non-occlusion of teeth.
5. Deep.
   The so-called traumatic, contributing to damage to the enamel. Characteristic is almost maximum overlap of the lower rows with the upper ones.
6. Vertical occlusal anomaly.
   In addition to the above listed occlusion disorders, some experts identify 2 more types of anomalies:

• dystopic bite - displacement of one or more teeth;
• reducing - formed due to damaged and (or) lost teeth.

How to correct a child's malocclusion

• Children under 7 years of age
  are shown a set of gymnastic exercises and massage that will help solve the problem.
• Children under 10 years of age
  are already prescribed trainers, with the help of which they can set the desired direction for their teeth. They must be worn for a certain number of hours during the day. But, if the pathologies are more advanced, removable plates and mouthguards are used. Correction of the anomaly takes approximately 2 years.
• For children aged 10-12
  years, braces are used to correct their bite - special orthodontic structures consisting of a power arch and clasps that set an individual direction for each tooth. They cannot be placed at an earlier age; it is necessary that all milk teeth be replaced by permanent ones. How long to wear braces for malocclusion is determined by the treating orthodontist.

How to correct malocclusion in an adult

A very common treatment method for adults is wearing braces. Transparent aligners (aligners) are also very popular now. They are made of transparent plastic material. Aligners are effective in correcting impaired occlusion, are easy to use and look very aesthetically pleasing. All details about this technique can be found here.

In cases where the patient is not in the mood for long-term bite correction with aligners or braces, there is another solution - microprosthetics. In this case, special overlays are installed on the teeth - veneers, with the help of which you can correct uneven teeth and gaps between them. But if there are serious malocclusions, this technique is not used.

There are bite defects for which only surgical treatment is indicated. Examples include: severe malocclusion, facial asymmetry due to trauma or hereditary causes, and chin dysplasia.

Each method of orthodontic treatment has both indications and contraindications. Only an orthodontist can determine the method of treatment after a thorough examination and full diagnosis.

Treatment methods

The variety of causes and nature of the disease determines a wide range of possible treatment methods - from cosmetic to surgical.

Depending on the root cause, cosmetic, conservative, orthodontic and surgical treatment can be used. As well as massage and therapeutic exercises.

Massage

Massage has multiple therapeutic effects:

• Relaxes and tones muscles, relieves hypertension.
• Activates blood and lymph circulation in the affected area, relieves swelling and inflammation.
• Stimulates nerve fibers.
• Reduces pain.

Manual therapy in children is more effective than in adults due to the plasticity of children's muscles. The earlier the anomaly is diagnosed, the more effective manual therapy is.

Cosmetology procedures

Cosmetic treatment consists of getting rid of hypertonicity of the masticatory muscles, which causes facial asymmetry. Technologically, the procedure involves injections of Botox into the masticatory muscles.

The drug relaxes overstrained muscle fibers, straightens the face, returns it to harmonious proportions, and gives a calm and confident expression.

Conservative therapy

Conservative therapy is determined by the nature of the pathology and provides for the treatment of pulpitis, caries, periodontitis, periodontitis and other diseases of the teeth and periodontium, which make it possible to do without surgical intervention.

Analgesics (for pain), antibiotics (for infections), antiseptics (for local inflammation and wounds on the mucous membranes), NSAIDs (for severe inflammation) may be prescribed.

Orthodontic correction

Orthodontic treatment is used for crossbites, narrowing of the jaws, and other dental anomalies. Treatment is carried out with the help of splints, mouthguards, extra- and intraoral devices, braces and other fixed and removable orthodontic appliances.

Surgical intervention

The type of surgical intervention is determined by the nature of the disease and is divided into:

• for dental (removal of tumors and cysts, removal of teeth, opening of abscesses);
• maxillofacial (lavage, arthroscopy, phlegmonectomy, TMJ endoprosthetics, rhinocheilognatoplasty);
• eliminating the consequences of injuries (splinting and regeneration of jaw bones, tying with a ligature);
• otolaryngological (ectomy of paranasal sinus cysts, etc.).

If asymmetry is caused by damage to the brain and meninges, according to indications, ectomy of tumors and abscesses, transcranial or endoscopic removal of hematomas, areas of the brain crushed by TBI, and other surgical protocols are performed.

Consequences of malocclusion

It is a mistake to think that a pathological bite concerns only appearance and only leads to an unattractive smile. This is where the problems arise that are more serious. For example, in 90% of people with abnormal occlusion, incorrect posture is also detected. There is a logical explanation for this: with a broken bite, the center of gravity of the head shifts. This in turn affects the compensation mechanisms of the musculo-ligamentous apparatus of the maxillofacial system. The result of all this is an increase in the pathology of teeth closure.

Aesthetically, occlusion abnormalities lead to facial asymmetry. A weak-willed chin becomes pronounced, and lips protrude unattractively.

Symptoms of facial asymmetry

The severity of facial asymmetry and the reasons that led to the appearance of defects are the two main factors on which the clinical picture of the pathology depends. Minor violations that occur due to age-related changes are considered to be only an aesthetic problem. Gross disproportion of the facial part of the body is usually observed after severe injuries or serious illnesses. Symptoms of changes on the side of the injury are easy to notice externally:

• facial muscles are not involved in movements;
• the corner of the mouth drops;
• articulation is impaired;
• natural folds on the forehead and in the area of ​​the nasolabial triangle are smoothed out;
• the patient cannot completely close one eye;
• while eating, the work of the lacrimal glands increases;
• there is no facial expression on one side of the face.

What is the danger of malocclusion?

In addition to visual problems, more serious dysfunctions often occur, including internal organs.

1. Due to increased and uneven load on the teeth, periodontal disease develops and teeth begin to decay.
2. Inadequate chewing of food leads to disruption of the digestive system.
3. The functioning of the temporomandibular joint is impaired.
4. The respiratory system also begins to malfunction.
5. Slow metabolism.
6. Increased risk of developing caries, especially with cross-closing teeth.
7. Problems with pronunciation of sounds.

In addition, with malocclusions, daily dental care becomes much more difficult, which contributes to the constant accumulation of plaque on them.

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Polovkov Dmitry Anatolievich

Orthodontist

Effect on soft tissues of the oral cavity

Incorrect position leads to microtrauma of the gums and inner surface of the cheeks. Chips leave scratches, closure at a different angle forms non-healing small ulcers at the points of contact, which become foci of inflammation and spread throughout the entire oral cavity. Stomatitis, swelling become more frequent, and complications in the form of ENT diseases are possible.

One of the problems with constant tissue trauma is gum recession, which causes exposed roots to become defenseless against bacterial attacks.

What to do to avoid malocclusion.

The consequences of malocclusion can be avoided by taking measures in time, namely in childhood. Here the responsibility falls largely on parents, who can promptly pay attention to problems and carry out prevention. It is important to take into account the risk of congenital disorders, hereditary predisposition, and also eliminate unfavorable factors:

• prevent the development of rickets and other diseases that impair bone growth;
• bottle feed your baby correctly;
• monitor the position of the child’s body during sleep (posture without tension, head not tilted back, etc.);
• maintain correct posture;
• timely wean your child off the pacifier, thumb sucking habit, toys and other objects;
• treat baby teeth immediately, because their early loss (as well as too late) can negatively affect the bite;
• to prevent nasal breathing disorders, namely to treat diseases of the ENT organs and ARVI.

When anomalies in the development of teeth are identified in childhood, timely assistance from an orthodontist will help solve problems faster than in advanced cases in adults. In children, as a rule, there is no need for surgical intervention yet, and even a complex of therapeutic exercises for the facial muscles can significantly help in correcting the bite.

Publisher: Expert magazine about dentistry Startsmile.ru

Provoking factors in adults

The cause of the anomaly in adults is acute and chronic diseases of the dentofacial apparatus and its injuries:

• Congenital pathologies of the dentofacial apparatus that were not corrected in childhood.
• Arthrosis of the TMJ (dystrophic destructive changes in the joints). They manifest themselves as a displacement of the LF towards the diseased joint, stiffness in the morning, and pain.
• TMJ ankylosis (joint immobility due to cartilage degeneration). The anomaly is noticeable at rest and increases when the mouth is opened, which in case of severe pathology does not exceed 1 cm.
  The line drawn between the lower central incisors shifts towards the damaged joint. Movement of the jaw in the horizontal direction becomes impossible.
• Contracture (restriction of movement) of the LF muscles. The midline is shifted towards the affected muscle.
• Odontogenic benign tumors (odontoma, ameloblastoma, steoma, osteoblastoclastoma). The jaw bones are destroyed by neoplasms, deformation occurs, which usually becomes the first manifestation of the disease.
• Malignant tumors of the upper and lower jaw (sarcomas, carcinomas). The resulting deformation is caused by tumor growth.
• Jaw defects (reduction in the volume of dental tissue) due to osteomyelitis, syphilis, tuberculosis, surgical interventions for oncological diseases. Bone deficiency causes receding of the cheeks and disruption of the oval in the lower jaw area. As the mouth opens, the asymmetry increases.
• Micrognathia – due to underdevelopment of the jaw or damage. Micrognathia HF manifests itself as a reverse overlap, LF - with a slanted chin.
• Diseases of the salivary glands.
• Periostitis. Asymmetry is caused by swelling and/or abscess under the periosteum.
• Periapical (at the root of the tooth) and periaxillary abscess. Facial deformation is caused by swelling that has spread to adjacent tissues. The pathology manifests itself as throbbing pain.
• Crossbite (transversal displacement of the jaws relative to each other). The chin appears to the side, the lip sinks on one side.
• Facial injuries, fracture of the lower or upper jaw. Temporary asymmetry occurs due to soft tissue swelling and/or displacement of the jaw bones.

In addition to the above pathologies, the anomaly can be caused by many other diseases that are not related to the dentofacial apparatus:

• Damage to the brain and meninges (meningitis, encephalitis, stroke).
• Nerve diseases (Bogorad syndrome, facial nerve damage).
• Pathologies of the salivary glands (mucocele, purulent parotitis, adenoma).
• ENT diseases leading to unilateral deformation (sinus cyst, atelectasis (collapse of the paranasal sinus)).

Facial asymmetry can occur due to hydrogen peroxide poisoning, botulism, actinomycosis (infection with actinomycetes fungi).

Treatment methods for small lower jaws in children and adults.

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