Botox is often used in conjunction with dermal filler therapy as a non-surgical alternative to high lip line cases. The treatment that most dentists have been trained to deliver to these patients would be some kind of periodontal flap surgery with significant osseous reduction through a crown lengthening procedure in order to be able to raise the gingival height to meet the lip line. The patient would then require crown and bridge therapy to better establish the dental esthetics. Every dentist knows how aggressive that treatment would be. I would venture to say that few dentists themselves would, if they were the patients, want to proceed with that kind of aggressive treatment, yet this is what we offer to our patients. With some Botox therapy and lip augmentation with dermal fillers, the muscles surrounding the lip are weakened so they cannot raise the lip as high as before. This has to be done carefully so that the patient maintains full lip competency allowing them to go about their normal activities such as speaking, smiling, puckering, and eating. When done correctly, the patient is not able to raise her lip as high as before to show the gingiva on the left side, but still has the full ability to speak, chew and kiss.
It is important to be able to offer all of the alternatives to the patient for high lip line cases. The advantages of the aggressive treatment option of crown lengthening, possible orthodontics, and crown and bridge therapy, the results will be long lasting and can be esthetic. The disadvantages are the treatment will take a number of appointments, high cost immediately, possible complications of said treatment including sensitivity, possibly requiring endodontic therapy later on, and necessary re-treatment in 10-15 years as gingival recession occurs. The advantages of treating cases like the one above with Botox and dermal fillers are close to immediate results in one appointment and no removal of tooth structure. The disadvantages are needed re-treatment 2-3 times a year and the cost associated with that treatment. It makes no difference to me as the clinician which the patient chooses but it significantly expands the treatment choices we now have in dentistry.
A Beautiful Smile, Not Just Beautiful Teeth
The above case demonstrates how much Botox and dermal fillers are as essential to esthetic dentistrycases as are porcelain veneers and composite resins. The soft tissues around the mouth are as important as the color and position of the teeth in determining the patient’s smile. We, as dentists, have become so teeth-centric that we forget that we also need the perioral areas around the mouth to look as good as the teeth for complete smile analysis and esthetic treatment. How many times have you seen a beautiful esthetic dental case only involving teeth that are surrounded by wrinkled and thin lips and deep nasolabial folds? I would submit that you may have given the patient beautiful teeth but you have not given them a beautiful smile.