Journal Article Ahead of print
PubMed: 42922386 DOI: 10.23736/S2724-6329.26.05315-5
Facial esthetic medicine in dentistry: botulinum toxin and hyaluronic acid fillers for smile-face harmonization.
Minerva Dent Oral Sci
Authors: Andrea Ballini, Lorenzo Lo Muzio, Lucia Giuliano, Gaetano Illuzzi, Stefania Cantore, Lorenzo Bartolommei, Ilaria Zollino, Nicola Cortese, Pier M Mandrillo, Eleonora Lo Muzio
Affiliations
- Department of Life Science, Health and Health Professions, Link Campus University, Rome, Italy.
- Master Universitario di II Livello in "Medicina Estetica in Odontoiatria", University of Foggia, Foggia, Italy.
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
- Department of Life Science, Health and Health Professions, Link Campus University, Rome, Italy. Master Universitario di II Livello in "Medicina Estetica in Odontoiatria", University of Foggia, Foggia, Italy.
- Department of Life Science, Health and Health Professions, Link Campus University, Rome, Italy -.
Abstract
Orofacial treatment planning is being redefined by the convergence of minimally invasive facial aesthetic medicine and aesthetic dentistry. Specifically, hyaluronic acid (HA) dermal fillers and botulinum toxin type A (BoNT-A) are being employed more frequently as adjuncts to maximize smile-lip-face harmony. The scope of non-invasive or minimally invasive facial aesthetic medicine for dentists has also been clarified by regulatory changes in Italy, underscoring the importance of competency-based training and organized risk management. The objective is to give a narrative summary of BoNT-A and HA fillers' indications, clinical procedures, integration into dental workflows, and safety concerns in dental practice, with a focus on perioral applications and complication management. In addition to focused searches in Google Scholar and important consensus texts (2000-2025; chosen updates through early 2026), a narrative search was carried out in PubMed/MEDLINE and Scopus. Systematic reviews, clinical trials, and expert consensus statements on face injectables and adverse event management were prioritized. There is evidence to support BoNT-A as a conservative adjunct for gummy smiles caused by hyperfunctional lip elevators, some lower-face dynamic rhytids, and masseter hypertrophy and bruxism-related myofascial pain, providing clinically meaningful reductions in pain, improvements in muscular and joint function, and favorable aesthetic outcomes. HA fillers may be used as a "finishing step" following orthodontic, periodontal, or restorative treatment to enhance lip contour and perioral soft-tissue support. Filler-induced vascular occlusion is the most important safety concern; early detection and prompt hyaluronidase treatment are essential, and ultrasound mapping is becoming more and more recommended for high-risk areas and tailored care. As an orofacial harmonization method, facial aesthetic medicine can be incorporated into modern dentistry as long as indications are conservative, patients are properly chosen and given consent, and clinics are prepared and trained to handle complications. Future studies should establish competency-based training pathways for dental professionals and standardize outcome measurements.
MeSH
Safety, Hyaluronic Acid, Pain, Dentistry, Risk Management, Botulinum Toxins, Therapeutics