Dentures and lip support: what to assess

The lip is supported from the inside. The front teeth, the alveolar bone and, when present, dentures, veneers, crowns, and implants hold up the thickness, projection, and position of the lip. Changing the support changes the lip, and many complaints of a thin, drooping, or "turned in" lip start there. A facial harmonization professional who assesses the mouth with this in mind avoids filling what is really a support problem.

This page lists what to assess when the patient has or is about to get a denture, and how to work together with the dentist. It connects with tooth loss and the face, teeth and facial harmonization: which comes first, and veneers and smile planning in orofacial harmonization (HOF).

How does a denture affect the lip?

The upper lip rests on the incisors and the alveolar bone. The lower lip rests on the lower incisors and part of the mandible. Some dental parameters have a visible effect on the lip:

• Incisor position. More projected teeth push the lip forward. More upright or retruded teeth leave it without support.
• Tooth length. Long or short teeth change the incisor display at rest and when smiling.
• Vertical dimension. The height of the lower third with the teeth in occlusion changes the proportions of the face and the look of the lip.
• Occlusal plane. Its tilt influences the smile design and how the lip reads. See occlusal plane.
• Denture thickness. Removable dentures and their flanges can fill out the lip or fall short of supporting it.

When any of these variables is off, the lip can look thin, drooping, overly projected, or lined with vertical wrinkles, and trying to correct it with hyaluronic acid tends to be frustrating.

What to assess before filling

Assessing lip support is part of the exam for anyone about to fill. A few questions make a difference:

If any of these variables is in transition, the best move is to wait. Filling the lip of a patient who is about to change veneers or dentures usually leads to adjustments, excess, or asymmetry later. See dental veneers and harmonization, braces and lip filler, and HOF plan with veneers.

Working with dentistry

Integrated work has practical benefits. The dentist knows the occlusal plane, the vertical dimension, and the position of the teeth. The facial harmonization professional knows the soft tissue, the lip, and the profile. Sharing information makes it possible to:

• Define the order: rehabilitation, provisional, final, and only then HOF.
• Adjust the denture with the lip in mind, and the lip with the denture in mind.
• Avoid duplicating effort or fixing the same problem twice.
• Document the plan so that both understand the goal.

Each professional respects the other's scope, according to the rules of their professional council. If there is doubt about who handles what, the advice is to talk and refer, without taking on what is outside your competence. See referring patients in HOF and smile analysis in HOF.

When lip filler helps

Not everything is dentistry. Even with adequate support, the lip can benefit from volume and contour, within a plan. At the discretion of the licensed professional, lip filler may be considered once the dental base is stable. At that point the lip is assessed again, because the change in support often alters the concern. See lip filler, dentist after lip filler, and thin lips: what to do.

The opposite also holds: in patients with a well-fitted denture, the lip may look fuller and make the procedure unnecessary. Reassessing before filling saves the patient money and avoids excess.

How to talk to the patient

Many patients do not connect the lip with the teeth. It helps to explain that the lip is supported from the inside, with a simple example: "It's like a curtain hung on a rod. If the rod changes, the curtain hangs differently." That makes it natural to recommend sorting out the dentistry first. Avoid criticizing other professionals' work. Talk about what will be best for the whole.

What Harmy shows

The simulation shows the effect of adding volume to the lip in a front view. It does not take into account the denture, the teeth, or the support, and it does not indicate whether the lip needs volume or a base adjustment. That is why it is a support tool once the base is settled.

In short

Lip support depends on the teeth, the bone, and the denture. Assessing the base before filling, agreeing on the order with the dentist, and reassessing the lip after dental changes avoids overdone lips and rework. Results vary from person to person and depend on individual factors. The decision belongs to the licensed professional, according to the rules of their professional council.