Clinical Application of Botulinum Toxin and Dermal Fillers in a Comprehensive Dental Treatment Approach-A Case Report

Clinical Application of Botulinum Toxin and Dermal Fillers in a Comprehensive Dental Treatment Approach-A Case Report Purpose ❖ The aim of this case report was to demonstrate dental treatment in conjunction with injectables can provide improved facial symmetry, proportions and volume desired for a more harmonized appearance and higher patient satisfaction. Case report ❖A 38-year-old female attended BU-GSDM Periodontology clinic reporting dissatisfaction with her smile due to the gingival display upon smiling, generalized gingival recession, a missing maxillary premolar, and desired a more youthful appearance. Case report continued Botox® was the neuromuscular agent used to treat the patient’s asymmetric eyebrows by decreasing the tone of the temporalis muscle, hypermobility of the upper lip by targeting the levator labii superioris and soften the static lines induced by muscles of facial expression1. Belotero Balance® was the hyaluronic acid-based dermal filler of choice for lip augmentation and restoration of perioral volume loss. Facial harmonization treatment was completed using 64 units of Botox® first, and 2 mL of Belotero Balance® at two sessions thereafter. ❖A comprehensive rehabilitation approach was designed, which included periodontal surgical intervention to improve the gingival recession and thin gingival phenotype, placement of a dental implant in a previously grafted site #4, immediate provisionalization using 3D printed PMMA provisional, and the use of injectables to improve facial balance. Figure 1. (a-b) Photographs of the initial treatment rendered: a. Root coverage procedure using acellular dermal matrix via tunneling technique done for upper left and right quadrants. B. Photograph showing guided implant placement in previously grafted site #4 and immediate provisionalization using 3D printed PMMA provisional. Conclusion Improved facial symmetry and proportions were achieved by judicious administration of Botox® and Belotero Balance® dermal filler to correct volume loss, hypermobility of the upper lip at exaggerated smile, asymmetric eyebrows and soften facial lines. It is imperative to provide dental treatment and restore loss of teeth, as this sets the bony infrastructure and support for the soft tissues in the middle and lower thirds of the face. Dental treatment in conjunction with injectables can provide improved facial symmetry, proportions and volume support desired for a more attractive and harmonized appearance.