Q: Dr. Eppley, I had extractions and braces before as a child and it left me with a very flat face. I am now having the teeth brought back forward and the spaces re-opened. However even with the lips looking normal I’m thinking my midface my still be a bit concave and am wondering if bone grafts for the missing upper bicuspids would fill in the midface paranasal area or would I be better off just getting something like paranasal implants?
A: Any adjustment at the tooth or alveolar bone level, orthodontic or otherwise, is only going to affect the lip that sits in front of it not the facial profile. The base of the nose and the rest of the face sits above the level of the upper tooth roots. Therefore, bone grafting into the bicuspid space would not be helpful even if it could be done. Bone grafts on the paranasal area, while in the right place, are associated with almost complete resorption due to a lack of stimulation through masticatory forces. The predictable solution would be paranasal implants which are structurally stable and can be carved or shaped into any thickness that matches the needs of the patient’s paranasal augmentation.
Dr. Barry Eppley