The correlation between gingival recession in the edentulous area and facial aging accompanied by buccal indentation and sagging of the mandibular line in patients with dentition defect clinical research
牙列缺损患者缺牙区牙龈萎缩与面部衰老伴颊凹下颌线松弛相关性临床研究

摘要

牙列缺失和牙龈萎缩是口腔常见问题，这两个情况不仅会影响日常生活咀嚼的功能，还可能影响人的面部软组织塌陷轮廓松弛衰老。本研究通过实际病例观察和统计数据整理，主要研究了这两种口腔问题与面颊凹陷松弛衰老、下颌线条模糊之间的关系。研究团队选取了85名存在不同严重程度牙龈萎缩和牙列缺损的患者作为观察对象，用测量仪器记录了他们面颊凹陷的深度、下颌边缘的弧度等指标，同时结合口腔内部检查结果进行综合判断。从统计结果来看，牙龈萎缩越严重的人，面颊部位的皮肤松弛现象就越严重，这个现象可能与牙根周围骨头吸收有关。而缺牙数量超过3颗以上的患者中，有超过60%出现下颌线条模糊的情况，这可能是因为缺少牙齿支撑导致骨头萎缩。值得注意的是，年龄增长会加快这种变化速度，比如40岁以上患者的面部下垂程度比年轻患者平均高出35%左右。性别差异方面，女性患者下颌骨吸收速度比男性快约20%，这可能与女性更年期后骨质变化有关。造成这些现象的主要原因，是牙龈萎缩会损害牙根周围的骨头支撑力，就像房子失去地基会倾斜一样，面部软组织失去支撑就会下垂衰老。而缺牙会影响咬合力的不均衡，导致骨头发生不均匀吸收，在临床治疗方面，及时修复缺损牙齿（比如使用种植牙或活动假牙）能有效改善这种情况。对于牙龈问题，定期洁牙和使用软毛牙刷可以减缓萎缩速度。目前研究还存在一些局限，比如样本数量不够多，观察时间也较短。后续需要跟踪观察患者5年以上的面部变化，同时要研究不同修复方式对面部轮廓的影响差异。这些发现提醒我们，维护口腔健康不仅能保护牙齿，对保持面部年轻化也有重要意。

Abstract

Among oral health problems, gum recession and teeth loss are common phenomena. These conditions not only affect people's ability to eat, but also may change their facial contours. According to case records and examination reports in the hospital, we found that when gums become thinner and atrophy or teeth fall, many people will experience sagging cheeks and blurred chin lines. In recent observations, we followed and investigated 85 patients with different severity gingival problems and dental missing problems, and used measurement tools to record the depth of their cheek depression and the arc of the mandible edge, while comparing them with the internal examination results of the oral cavity [1,6]. According to statistical results, the more severe the patient's gingival recession, the more severe the skin sagging on the cheeks. For example, a patient caused alveolar bone to be absorbed due to long-term gingival inflammation, and the depression area below the entire cheekbones is about 3 mm deeper than that of normal people [3]. In addition, the number of teeth missing is also related to the blurred jawline. Especially when more than 3 teeth are missing, the arc-shaped contour of the mandibular angle often becomes unclear, which is more obvious in female patients [5,9]. The possible reason is that after the teeth are missing, the bone tissue that originally supported the face gradually loses, just like if the house loses the load-bearing wall, the skin and muscles on the surface will sag [7]. It is worth noting that people of different ages are affected differently. If young patients experience teeth loss, due to the high content of collagen on their face, they may not experience significant sagging in the short term. However, among patients over 40 years old, the number of missing teeth shows a significant positive correlation with the degree of facial relaxation, which may be related to the natural aging process of human beings [13,20]. A 52-year-old female patient not only had difficulty chewing because of multiple front teeth, but even the corners of her mouth sag unconsciously when she spoke. After half a year of dental implant repair, the facial lines gradually returned to nature [10,27]. In terms of treatment, timely repairing missing teeth or performing gingival regeneration treatment is helpful for maintaining facial shape. For example, restoring the alveolar bone height through bone increment surgery, or increasing the thickness of the gums with connective tissue transplantation can effectively improve facial relaxation problems [16,34]. However, these treatment methods require the formulation of plans based on the specific situation of the patient. For example, a patient suffered from mandible defects due to trauma, the doctor used digital guide technology for precise implantation, and the postoperative occlusal function and facial appearance were well restored [12,28].There are also some shortcomings in this study, such as the insufficient number of samples and the observation time is short. In the future, more information on patients in different regions and living habits needs to be collected, especially long-term tracking of changes in the effect after treatment. If an early warning model of gum health and facial aging can be established, it will be of great help to preventive treatment [8][18]. In addition, new advances have been made in research on gingival self-repair materials, which may provide more options for clinical treatment [36,40].