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Botulinum toxin A in dentistry and orofacial surgery: an evidence-based review - part 2: cosmetic applications

Evidence-Based Dentistry (2022)Cite this article

Abstract

Objective An evidence-based review on the role of botulinum toxin type A (BoNTA) on diverse cosmetic applications of interest to dental practitioners and allied specialities. In this context, to identify the cosmetic treatments that have an evidence-based rationale against areas requiring further research, with a view to assess the safety and efficacy of BoNTA.

Data source and selection A comprehensive search was conducted using Cochrane Library of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PubMed (Medline) electronic databases. Thirty-nine studies of variable quality were included. The Best Evidence Topics (BETs) Critical Appraisal Tool was used to facilitate the quality assessment of relevant studies.

Data extraction Based on current level II evidence, BoNTA was safe and effective to improve facial contour, reduce volume and thickness of bilateral hypertrophic masseter. Conservative doses using a combined approach of BoNTA and hyaluronic acid was recommended as a safe and effective treatment for perioral enhancement supported by level II evidence. There was limited evidence, not higher than level III, to support BoNTA effectiveness for gummy smile associated to perioral musculature hyperactivity, while jawline sculpting targeting the platysma muscle had lower level IV evidence up to this date.

Conclusion BoNTA has been widely used off-label for the investigated cosmetic orofacial conditions, with reports of 'good patient and practitioner satisfaction'. However, there is limited high-quality evidence to support the long-term safety and effectiveness of repetitive BoNTA injections. Additionally, no studies were found that provided a cost-effectiveness evaluation of BoNTA formulations against other current cosmetic interventions. Well-designed clinical trials, including long-term follow-up, would help to provide robust evidence-based recommendations for clinical practice, supporting BoNTA popularity, independently or in a combined approach.

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Acknowledgements

The authors wish to acknowledge the help and assistance of the editors and reviewers of the Evidence-Based Dentistry journal for their support and review of the research that was undertaken. Thanks to Miss R. Al-Barazanchi for proofreading.

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  1. Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK

    Ines Novo Pereira & Haidar Hassan

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INP is a dental practitioner working for the National Health Service primary care and currently a PhD resident at the University of Porto, Faculty of Dental Medicine. This study was based on INP master's degree dissertation in Aesthetic Medicine at the Queen Mary University of London. Both authors had full access to all the data in the work and the decision to submit for publication rested with the correspondent author. HH is a clinical senior lecturer at the Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London.

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Correspondence to Haidar Hassan.

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Pereira, I., Hassan, H. Botulinum toxin A in dentistry and orofacial surgery: an evidence-based review - part 2: cosmetic applications. Evid Based Dent (2022). https://doi.org/10.1038/s41432-022-0277-4

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