Enhancing Smiles and Rejuvenating Appearance: The Power of Botox and Veneers

David Fuller

Last Updated On: March 27, 2024

The orofacial complex is a dynamic system where even the slightest change can result in a noticeable difference. In pursuing a radiant smile and a youthful appearance, many turn to cosmetic procedures such as Botox and veneers. 

Although veneers are an elective and almost exclusively aesthetic procedure, their success is significantly dependent on the stable balance of harmony between the masticatory system and orofacial soft tissues. 

Veneers and Botox offer a comprehensive solution for those seeking a flawless smile and a youthful look.

The Use of Botox in Dentistry¹

With time, the utility of Botox has extended beyond cosmetic needs. A neurotoxic protein, Botox, is derived from Clostridium botulinum, an anaerobic bacteria. It inhibits the neuromuscular transmission of acetylcholine⁹, a neurotransmitter that sends signals to muscle cells. 

By blocking these signals, Botox reduces muscle action or lack of muscle contraction, which can help treat various medical conditions. The applications of Botox include both cosmetic and therapeutic aspects. The cosmetic applications are explored in a later section.

Therapeutic Applications of Dental Botox:

• Temporomandibular joint disorders (TMDs);
• Oromandibular dystonia (OMD);
• Palsy of the facial nerve;
• Migraine;
• Trigeminal neuralgia;
• Bruxism and parafunctional habits;
• Sialorrhea (salivary gland secretory disorders);
• Maxillofacial trauma and fractures;
• Orthodontic relapse;
• As an adjunctive measure.

Botox is typically available in 7 serotypes (A to G)², but only types A and B are FDA-approved for therapeutic use. It takes around 2 weeks for Botox to show its clinical effects. 

Understanding Dental Veneers

When replicating the natural tooth appearance, dental veneers are the go-to option for their excellent aesthetics. The need for minimal tooth preparation and color stability attracts patients to rejuvenate their smiles. In the hands of a trained cosmetic dentist, well-planned and placed veneers can effectively reduce a person’s age by almost 10 years. The results are quick and provide an instant boost to the patient’s confidence. 

Like thin shells, a dental veneer, usually made from porcelain or composite resin, is bonded to a tooth’s front (labial/buccal) surface to cover generalized and localized defects³, including:

• Intrinsic and extrinsic discoloration;
• Fractured, chipped, or attrition;
• Abnormalities in the external dental structure;
• Minor corrections in tooth alignment; 
• Chipped off dental crowns and FPD facings. 

Veneers are long-lasting and have a survival probability of 91%⁴. Moreover, they are resistant to stains, which is a significant advantage over natural enamel. They can be customized to match the individual’s facial features and preferences, making them a good choice for aesthetic enhancement while preserving the integrity of the dental hard tissue. 

Patients seeking esthetic dental treatments prioritize the appearance of the “social six” anterior teeth over functional concerns. Research by Wazani et al. found that 59% sought treatment due to dissatisfaction with looks rather than functional issues.

Therefore, evaluating and correcting posterior occlusion before addressing cosmetic concerns in the front teeth is crucial to achieving lasting positive outcomes. 

Achieving the ‘Botox Smile’ – The Complementary Roles of Botox and Dental Veneers

The perfect smile is incomplete without the harmony of the hard and soft tissues. One thing that dentists across the world unanimously experience is trepidation regarding the stability and longevity of aesthetic procedures like veneers. Factors such as temporomandibular disorders (TMDs), parafunctional habits, irregular muscle activity, and unforeseen healing patterns can lead to undesired outcomes.

Mitigating these issues can result in the need for more invasive treatments, which can be psychologically and financially draining for the patient. This is where Botox and dermal fillers can provide drastic benefits without going beyond a few millimeters of soft tissue. 

The therapeutic effects of Botox help address the following cosmetic concerns¹:

• Asymmetric Smile:

This is often a result of hyperkinetic lip depressor or elevator muscles, resulting in an imbalance in lip positioning.  

• Gummy Smile:

Excessive maxillary gingival display^1,5 (>2mm), or a gummy smile result from multiple etiologies. It can be hard to treat this condition because some muscles in the lip and cheek are overactive. These muscles include the levator anguli oris, levator labii superioris, levator labii superioris alaeque nasii, zygomaticus, and the depressor septi. 

• Black Triangles⁸:

Many people in dentistry fear “black triangles,” which are the result of interdental spaces that allow food particles to accumulate. Injecting Botox or dermal fillers into the interdental papilla closes these gaps. The results of such treatments typically last for about eight months or longer, necessitating periodic reapplications. 

• Botox After Dental Implants⁶:

Interestingly, a dose of Botox to the masticatory muscles can mitigate abnormal forces generated in bruxers. Evidence⁶ suggests that dental implants are more prone to micro-fractures at the bone-implant junction owing to excessive functional force. Administering Botox (Type A) injections into these muscles can relax and weaken muscle activity for approximately three to four months, giving a much-needed window for promoting osseointegration.

• Marionette lines (sad/reverse smile):

The appearance of drooping mouth corners and Marionette lines is caused by age-related changes in the skin and hyperactivity of the depressor anguli oris (triangularis muscle) muscles. 

• Smoker lines (perioral rhytides):

Age, exposure to the sun, smoking, and strawing make vertical lip lines worse because they result from repetitive orbicularis oris muscle contractions. 

• Masseteric hypertrophy:

Masseteric hypertrophy is a condition where the masseter muscles in the jaw become enlarged due to various reasons, such as genetics, chronic clenching habits, and TMJ dysfunction. This can impart a squarish appearance to the face. 

Botox effectively addresses perioral wrinkles, gummy smiles^6,10,11, marionette lines, smoker’s lines, and masseteric hypertrophy by relaxing targeted muscles, diminishing wrinkles, and enhancing overall facial appearance.

While planning Botox after veneers, the latter should fully settle before injecting Botox. This usually takes a few weeks, allowing the gingiva and teeth to adjust to the new veneers. The waiting ensures that the Botox treatment does not interfere with the bonding of the veneers or cause any complications.

Treatment Considerations

Establishing the proper function of the masticatory system is critical to ensuring optimal outcomes and patient satisfaction while planning veneers. 

It involves a comprehensive examination and diagnosis to restore the worn dentition while prioritizing functional aspects. A thorough treatment plan includes reviewing the patient’s history, overall health, oro-facial structures, and functional examinations. 

The ‘5P’ approach⁷ can help tackle complex cases through various phases, including,

• The assessment of prosthodontic and restorative needs, 
• Necessary auxiliary preparations, 
• Delivering definitive prosthodontic treatment 
• and implementing a maintenance plan. 

Overall, evaluating these factors meticulously is vital to ensuring patient comfort and optimal aesthetic results.

Effective Combination Treatment

The combination of Botox and dentistry offers safe and effective cosmetic enhancement and delivers quick results. Coupled with veneers or fillers, it rejuvenates smiles by addressing issues like black triangles, gummy smiles, and high lip lines. 

Although costly and repetitive, Botox’s popularity lies in its non-invasive, fast results, especially among patients apprehensive of invasive procedures. Dentists, with their expertise in the orofacial region, can administer Botox. However, proper training and expertise are vital for minimizing risks and ensuring optimal outcomes.

References:

1. Mostafa D. Botulinum toxin in dentistry. Botulinum Toxin; 2018. DOI: 10.5772/intechopen.78950
2. Gomes Souza F. C., Resende da Silva S., Sant Ana Neto A. L., Shitsuka C. and Gregnanin Pedron I.. Gingivoplasty and botulinum toxin application to improve gummy smile: Case report. SVOA Dentistry 2:3 2021. Pages 109-114.
3. Suresh M., Mitthra S., Balasubramaniam A., Changankary J., Arunajatesan S. A detailed overview on veneers – Diagnostic and clinical considerations. Challenges in Disease and Health Research (pp.20-34). 2020.  DOI: 10.9734/bpi/cdhr/v3
4. Alothman Y., Bamasoud MS. The success of dental veneers according to preparation design and material type. Open Access Maced J Med Sci. 2018 Dec 14;6(12):2402-2408. doi: 10.3889/oamjms.2018.353. PMID: 30607201; PMCID: PMC6311473.
5. Agarwal A, Aeran H, S., Tuli A, Bhatnagar N, BOTOX– An innovative treatment modality in dentistry: A review. Int J Oral Health Dent 2018;4(1):17-21
6. Reddy M.S., Shetty S.R., Shetty R.M., et al. Botox in periodontics – exploring new avenues. SADJ March 2021, Vol. 76 No. 2 p78 – p83. Doi: 10.17159/2519-0105/2021/v76no2a3 
7. Trushkowsky R.D. (Editor). Esthetic oral rehabilitation with veneers. 1st ed. Springer Nature Switzerland AG; 2020. doi.org/10.1007/978-3-030-41091-9 
8. Malcmacher L., Treating the dreaded black triangle. DDS, MAGD. Dentaltown.;2011. 
9. Srivastava S, Kharbanda S, Pal U.S., Shah V. Applications of botulinum toxin in dentistry: A comprehensive review. Natl J Maxillofac Surg. 2015 Jul-Dec; 6(2): 152–159. doi: 10.4103/0975-5950.183860 
10. Sinha A, Hurakadli M, Yadav P. Botox and dermal fillers: the twin face of cosmetic dentistry. International Journal of Contemporary Dental and Medical Reviews (2015), Article ID 131214. vol.2015, Article ID 131214, 2015. doi: 10.15713/ins.ijcdmr.27 
11. Özay Uslu M., Ömer A. K., The treatment of a gummy smile patient with laminate veneers by reverse vestibuloplasty: a case study. JOJ Case Stud. 2018; 8(3): 555737. DOI: 10.19080/JOJCS.2018.08.555737.

FAQ

• Can you get Botox after veneers? 

Yes, one can get Botox after veneers. However, waiting at least two weeks to 15 days post-veneer cementation is essential to evaluating the need for additional changes. 

• Are dentists allowed to inject Botox?

Dentists are well-known for their expertise in dealing with problems concerning the head and neck region. Their dexterity in complex dental and oro-facial procedures makes them the perfect candidate to administer Botox. However, the scope of this particular service may vary in different places. Therefore, it is best to have a licensed professional perform the procedure. 

• What cannot be done after Botox?

After administering Botox, it is crucial not to allow its spread to other areas of the face, as it can lead to potential side effects. Avoiding the following can help improve the benefits of treatment: 

• Rubbing or massaging the injection site
• Exercising strenuously
• Consuming alcohol or caffeine