Botulinum toxin (BTX), a neurotoxin, is widely used to treat muscle spasms, facial twitching, salivation, and myofascial pain because of its muscle-relaxing and antinociceptive effect. BTX reduces pain through inhibition of activation of the synaptic nerve by blocking the release of acetylcholine from the presynaptic membrane and preventing release of substance P by targeting SNAP-25 to block the release of calcium ions. Researchers hoped that BTX would reduce occlusal force in temporomandibular disorder (TMD) patients. Different studies evaluated how BTX injections in masticatory muscles influenced occlusion in TMD patients. Unfortunately, there are only animal studies which consider how the masticatory system modifies after BTX injection. Papers which studied with electromyography TMD patients highlighted the high number of alterations in the strength of masticatory muscles.  BTX in TMD patients showed a significant improvement in both biting time and maximum occlusal force. However, there was no improvement in the asymmetrical distribution of occlusal force. The maximum occlusal force of the masseter muscle in the intercuspid position was reduced after BTX injection, reached its lowest value three months after treatment, and remained lower than the pretreatment value. However, the difference six months after treatment was insignificant. This result is consistent with the pharmacokinetics of BTX and indicates that the masseter muscle plays a crucial role in biting.

It is important to consider changes in dental occlusion in our clinical practice, especially when performing full-arch rehabilitation on natural teeth or dental implants, and even with immediate loading dental implants. Before starting a complex prosthodontic rehabilitation, patients should be thoroughly evaluated to determine if they have any form of bruxism that may cause an overload of dental structure. The use of BTX can help dental practitioners reduce maximum occlusal forces. The goal of this lecture is to review existing literature and attempt to understand if BTX could improve occlusal strength.

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