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Clinical Paper
Preprosthetic Surgery
D. N. Sutton1, B. R. K. Lewis2,
Changes in facial form relative M. Patel3, J. I. Cawood2
1
Department of Maxillofacial Surgery,
University Hospital Aintree, Liverpool, UK;
The surgical and prosthodontic rehabili- there are changes in the facial muscula- form, using recognised anthropometric
tation of the edentulous patient has two ture and consequently a change in facial measurements according to Farkas, and
main goals, firstly, the restoration of oral morphology2. TALLGREN observed that relate these to the extent of jaw atrophy,
function and secondly the restoration of the greatest proportion of the alveolar using the classification of the edentulous
facial form. The relative importance of bone loss occurs in the first year10, how- jaws described by CAWOOD & HOWELL1.
each of these factors will vary from ever this is a chronic process and bone
patient to patient. Satisfactory planning loss continued over the subsequent 25
Methods
of treatment and need or otherwise for years of her study. In addition it is
bone augmentation for these patients known that the rate of this chronic pro- The study sample consisted of 179 Cau-
requires a full understanding of the cess varies not only between individuals, casian patients, mean age 63 years, range
effect of progressive jaw atrophy not but also within the same individual over 18–97 years with varying degrees of jaw
only on the bones of the jaw but also of a period of time. atrophy. The patients were assigned to
the overlying soft tissues. Relatively little has been published groups according to the stage of jaw atro-
Loss of the natural dentition results in regarding the progressive soft tissue phy, which was established by clinical
gradual resorption of the alveolar pro- changes consequent to the loss of the den- examination. Jaw atrophy was assessed
cess and consequently a change in nat- tition. Accordingly the aim of the study using the classification of CAWOOD &
ural jaw relationship, at the same time was to examine the changes in facial HOWELL (Fig. 1).
0901-5027/070676 + 07 $30.00/0 # 2003 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Changes in facial form relative to progressive atrophy of the edentulous jaws 677
Discussion increased interest in medically asso- Obviously, the complex nature of the
ciated anthropometry. It is recognised facial anatomy has required many more
Anthropometry is the biologic science of that standard facial measurements are measurements than are used in classic
the measurement of the human body. essential to the assessment of congenital anthropometry. To this end Farkas has
The use of direct measurements and or acquired defects and to the planning devoted many years of painstaking study
where appropriate ratios or proportions, when constructing or reconstructing nor- and research. He has defined many more
allow clinical comparisons to be made mal facial appearance. Farkas and his facial reference points as well using
between patients in a way not possible associates have concentrated their efforts these points on thousands of subjects to
with subjective measurements. Over the on investigating the anthropometry of record tabulated data of healthy indivi-
past 40 years there has been an the head and face in medicine. duals as well those with asymmetries3,4.