Diş Hekimliğinde Botulinum Toksin Uygulamaları
Synopsis
Botulinum toksini (BTX), asetilkolin salınımını bloke ederek çalışan ve diş hekimliğinde hem estetik hem de fonksiyonel tedavilerde giderek daha fazla tercih edilen güçlü bir nörotoksindir. Klinik kullanımda en yaygın serotipler FDA onaylı olan BoNT-A ve BoNT-B'dir. Estetik alanda, LLSAN gibi dudak kaldırıcı kasların hiperaktivitesinden kaynaklanan "gummy smile" (diş eti gülümsemesi) vakalarında kasları zayıflatmak amacıyla stratejik noktalara enjeksiyonlar yapılır. Fonksiyonel olarak ise masseter ve temporal kas hipertrofilerinde, kare yüz görünümünü azaltmak ve bruksizmin olumsuz etkilerini hafifletmek için güvenli bölgeler belirlenerek derin kas içi uygulamalar gerçekleştirilir. Bunların yanı sıra sialore (aşırı tükürük salgısı) ve submandibuler bez hipertrofilerinde hacim azaltma amacıyla parotis ve submandibuler bezlere ultrason kılavuzluğunda enjeksiyonlar uygulanmaktadır. BTX ayrıca oral ülserler, skar revizyonu, miyofasiyal ağrı sendromu ve trigeminal nevralji gibi kronik ağrı durumlarında da klinik faydalar sunar. Dental implant tedavilerinde parafonksiyonel lateral kuvvetlerin azaltılmasında ve maksillofasiyal cerrahi sonrasında relapsların veya kırık komplikasyonlarının önlenmesinde çiğneme kaslarının manipülasyonu için güncel bir yaklaşım olarak popülerlik kazanmıştır. Ancak, gebelik, emzirme, nöromüsküler kavşak hastalıkları ve bazı ilaç etkileşimleri durumlarında kontrendikedir. Uygulama sonrasında asimetri, ptosis ve disfaji gibi enjeksiyon tekniğine veya toksine bağlı çeşitli komplikasyonlar gelişebileceğinden, klinisyenlerin bu süreçleri doğru yönetmesi kritik önem taşır.
Botulinum toxin (BTX) is a potent neurotoxin that works by blocking acetylcholine release and is increasingly preferred in dentistry for both aesthetic and functional treatments. The most common serotypes in clinical use are the FDA-approved BoNT-A and BoNT-B. Aesthetically, injections are performed at strategic points to weaken muscles in "gummy smile" cases caused by the hyperactivity of lip elevator muscles such as LLSAN. Functionally, in masseter and temporal muscle hypertrophies, deep intramuscular applications are carried out by defining safe zones to reduce square face appearance and alleviate the negative effects of bruxism. In addition, ultrasound-guided injections are administered into the parotid and submandibular glands for volume reduction in sialorrhea and submandibular gland hypertrophies. BTX also offers clinical benefits in chronic pain conditions such as oral ulcers, scar revision, myofascial pain syndrome, and trigeminal neuralgia. It has gained popularity as a contemporary approach for manipulating masticatory muscles to reduce parafunctional lateral forces in dental implant treatments and to prevent relapses or fracture complications after maxillofacial surgery. However, it is contraindicated in cases of pregnancy, lactation, neuromuscular junction disorders, and certain drug interactions. Since various complications, such as asymmetry, ptosis, and dysphagia, can develop after application depending on the injection technique or the toxin, it is of critical importance for clinicians to manage these processes accurately.
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