Abstract
In this article we review the pharmacodynamics of commercially available preparations of botulinum toxin type A, and discuss the potential uses of the drug in smile modification. A major emphasis is placed on applications relevant to modern dental practice, and to the complications arising from its use. Botulinum toxin A, when applied correctly, is a safe and effective means of achieving aesthetic smile modification, with limited data on any demonstrable long-term adverse effects.
Key points
Provides information regarding a drug that is increasingly used by dental practitioners worldwide.
Provides education on alternative options for correction or camouflage of dentofacial aesthetics of the lower face.
Summarises the available case reports and research articles on use of botulinum toxin for lower facial and smile aesthetics, a major component of modern dental practice.
Access options
Subscribe to Journal
Get full journal access for 1 year
$737.00
only $30.71 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
from$8.99
All prices are NET prices.
References
- 1.
Carruthers J A, Lowe N J, Menter M A et al. A multicentre, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines. J Am Acad Dermatol 2002; 46: 840–849.
- 2.
Gadhia K, Walmsley A D. Facial aesthetics: is botulinum toxin treatment effective and safe? A systematic review of randomised controlled trials. Br Dent J 2009; 207: E9; discussion 216–217.
- 3.
Journal B D. Safeguards introuced for provision of injectable cosmetic treatments. Br Dent J 2010; 208: 279.
- 4.
Blasi J, Chapman E R, Link E et al. Botulinum neurotoxin A selectively cleaves the synaptic protein SNAP-25. Nature 1993; 365: 160–163.
- 5.
Kao I, Drachman D B, Price D L. Botulinum toxin: mechanism of presynaptic blockade. Science 1976; 193: 1256–1258.
- 6.
Dressler D, Saberi F A, Barbosa E R. Botulinum toxin: mechanisms of action. Arq Neuropsiquiatr 2005; 63: 180–185.
- 7.
Klein A. Complications and Adverse Reactions With the Use of Botulinum Toxin. Dis Mon 2002; 48: 336–356.
- 8.
Karsai S, Raulin C. Botox and Dysport: is there a dose conversion ratio in dermatology and aesthetic medicine? J Am Acad Dermatol 2010; 62: 346–347.
- 9.
de Almeida A T, De Boulle K. Diffusion characteristics of botulinum neurotoxin products and their clinical significance in cosmetic applications. J Cosmet Laser Ther 2007; 9 (Suppl 1): 17–22.
- 10.
Trindade de Almeida A R, Marques E, de Almeida J, Cunha T, Boraso R. Pilot study comparing the diffusion of two formulations of botulinum toxin type A in patients with forehead hyperhidrosis. Dermatol Surg 2007; 33: S37–S43.
- 11.
Allergan. Botox Cosmetic-botulinim toxin type A injection powder, lypophilized for solution. 2015.
- 12.
Yogosawa F. Predicting soft tissue profile changes concurrent with orthodontic treatment. Angle Orthod 1990; 60: 199–206.
- 13.
Carruthers J, Carruthers A. Special feature: Botox treatment for expressive facial lines and wrinkles. Curr Opin Otolaryngol Head Neck Surg 2000; 8: 357–361.
- 14.
Gustafsson M, Ahlgren J. Mentalis and orbicularis activity in children with incompetent lips: an electromyographic and cephalometric study. Act Odontologica 1975; 33: 355–363.
- 15.
Cunningham M. Measuring the physical in physical attractiveness: quasi-experiments on the sociobiology of female facial beauty. J Pers Soc Psychol 1986; 50: 925.
- 16.
Guyuron B. MOC-PS(SM) CME article: genioplasty. Plst Reconstr Surg 2008; 121: 1–7.
- 17.
Skinazi G L, Lindauer S J, Isaacson R J. Chin, nose, and lips. Normal ratios in young men and women. Am J Orthod Dentofacial Orthop 1994; 106: 518–523.
- 18.
Cunningham M B, Barbee A P, Pike C L. What do women want? Facialmetric assessment of multiple motives in the perception of male physical attractiveness. J Pers Soc Psychol 1990; 59: 61–72.
- 19.
Rosen H M. Aesthetic refinements in genioplasty: the role of the labiomental fold. Plast Reconstr Surg 1991; 88: 760–767.
- 20.
Zide B M, Boutros S. Chin surgery III: revelations. Plast Reconstr Surg 2003; 111: 1542–1550.
- 21.
Beer K, Yohn M, Closter J. A double-blinded, placebo-controlled study of Botox for the treatment of subjects with chin rhytids. J Drugs Dermatol 2005; 4: 417–422.
- 22.
Carruthers J, Carruthers A. Aesthetic botulinum A toxin in the mid and lower face and neck. Dermatol Surg 2003; 29: 468–476.
- 23.
Lowe N J, Yamauchi P. Cosmetic uses of botulinum toxins for lower aspects of the face and neck. Clin Dermatol 2004; 22: 18–22.
- 24.
Frush J F, Fisher R D. The dynesthetic interpretation of the dentogenic concept. J Prosth Dent 1958; 8: 558–581.
- 25.
Sarver D M. The importance of incisor positioning in the esthetic smile: the smile arc. Am J Orthod Dentofacial Orthop 2001; 120: 98–111.
- 26.
Garber D A, Salama M A. The aesthetic smile: diagnosis and treatment. Periodontol 2000 1996; 11: 18–28.
- 27.
Tjan A H, Miller G D, The J G. Some esthetic factors in a smile. J Prosthet Dent 1984; 51: 24–28.
- 28.
Robbins J W. Differential diagnosis and treatment of excess gingival display. Pract Periodontics Aesthet Dent 1999; 11: 265–272.
- 29.
Garcia A, Fulton J E, Jr. Cosmetic denervation of the muscles of facial expression with botulinum toxin. A dose-response study. Dermatol Surg 1996; 22: 39–43.
- 30.
Kane M A. The effect of botulinum toxin injections on the nasolabial fold. Plast Reconstr Surg 2003; 112(5 Suppl): 66S–72S; discussion 3S–4S.
- 31.
Mazzuco R, Hexsel D. Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. J Am Acad Dermatol 2010; 63: 1042–1051.
- 32.
Indra A S, Biswas P P, Vineet V T, Yeshaswini T. Botox as an adjunct to orthognathic surgery for a case of severe vertical maxillary excess. J Maxillofac Oral Surg 2011; 10: 266–270.
- 33.
Polo M. Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofacial Orthop 2008; 133: 195–203.
- 34.
Dickens SS, D. Proffit W. The dynamics of the maxillary incisor and the upper lip: a cross-sectional study of resting and smile hard tissue characteristics. World J Orthod 2002; 3: 313–320.
- 35.
Emer J, Waldorf H. Injectable neurotoxins and fillers: There is no free lunch. Clin Dermatol 2011; 29: 678–690.
- 36.
Cohen J, Slessinger J. Cox S E, Lin X, Reloxin Investigational Group. An Analysis of the Long-Term Safety Data of Repeat Administrations of Botulinum Neurotoxin Type A-ABO for th Treatment of Glabellar Lines. Aesthet Surg J 2009; 29: 43–49.
Author information
Affiliations
Lead Registrar, Oral and Maxillofacial Surgery The Royal Dental Hospital of Melbourne 720 Swanston St, Carlton Australia, 3,053 E
- S. N. Delpachitra
Oral and Maxillofacial Surgery Resident The Royal Dental Hospital of Melbourne 720 Swanston St, Carlton Australia, 3,053 E
- A. W. Sklavos
Consultant Oral and Maxillofacial Surgeon, The Royal Melbourne Hospital 300 Grattan Street, Parkville Australia 3050
- M. Dastaran
Authors
Search for S. N. Delpachitra in:
Search for A. W. Sklavos in:
Search for M. Dastaran in:
Corresponding author
Correspondence to S. N. Delpachitra.
Rights and permissions
To obtain permission to re-use content from this article visit RightsLink.