HOF Integrated with Restorative and Orthodontic Dentistry
The lower third of the face is supported, in large part, by the teeth and the jaw bones. The position of the incisors defines the support of the upper lip; the height of the teeth and the occlusion influence the length of the lower third; the mandible and the chin define the profile. That is why orofacial harmonization planned without looking at the mouth risks treating with volume what is, at its source, a dental or skeletal problem.
This guide shows how to integrate HOF into the restorative and orthodontic plan: what to assess, what injectables compensate for and what they do not, and how to sequence the stages. It does not state what each professional is allowed to do. The regulatory status of the specialty in Brazil is covered in HOF as a dental specialty and in the legal dispute over HOF.
Why do teeth and face need the same plan?
A few examples show how the mouth changes the way the face reads:
- Upper incisors tilted backward reduce upper lip support, so the lip looks thin and "tucked in," even when its own volume is adequate.
- Loss of back teeth and of tooth height can shorten the lower third, deepen folds and pull down the corners of the mouth.
- A retruded mandible makes the chin look small and the neck look short.
- Excessive incisor projection leaves the lips protruding, and any extra volume worsens the profile.
- Bruxism and a bulky masseter widen the lower third and wear down the teeth, reducing the height of the smile.
In all of these cases, injectables can play a role, but as a complement to a diagnosis that starts in the mouth.
What should you assess in the mouth before planning the face?
| Item | What to look for | Why it matters for HOF |
|---|---|---|
| Incisor display at rest and when smiling | How much tooth shows with the lips relaxed and smiling | Guides decisions about upper lip length, gummy smile and lip volume |
| Incisor tilt and position | Forward or backward projection | Defines upper lip support and lip proportion |
| Smile line and gum display | How much gum shows when smiling | Toxin may play a role; see gummy smile |
| Dental and facial midline | Whether the line of the teeth matches that of the face | Lip asymmetries can start here |
| Occlusion and relationship between arches | Bite, class of relationship between maxilla and mandible | Influences the chin, profile and lower third |
| Vertical dimension | Height of the lower third with the teeth in contact | Loss of height deepens folds and mouth corners |
| Tooth wear | Short, flat teeth | Suggests bruxism; see botulinum toxin for bruxism |
| Periodontal health and lesions | Inflammation, infection, mucosal lesions | Active sources need treatment before injecting near the mouth |
The profile completes the reading: Ricketts line, Steiner S line, nasolabial angle and chin position. The premaxilla and the facial pattern help clarify whether the concern is soft tissue, tooth or bone.
What do injectables compensate for, and what do they not?
| Patient concern | Possible source in the mouth | Role of the injectable | When it is not enough |
|---|---|---|---|
| "My lip is thin" | Incisors tilted back, loss of support | Can complement volume and outline | When the lack of support is dental, the volume can end up out of proportion |
| "I show too much gum" | Muscle hyperactivity, vertical maxillary excess, short clinical crown | Toxin can reduce lip elevation in selected cases | Bony excess or short teeth call for a different approach |
| "My chin is small" | Retruded mandible, malocclusion | Chin filler can improve the profile in mild cases | Significant retrusion may call for orthodontics or surgery; see retrognathic profile |
| "I have deep smile lines" | Loss of support from the maxilla and teeth | Filler can soften them | Significant loss of support calls for rehabilitation |
| "Downturned mouth corners" | Loss of vertical dimension | Filler and toxin can help | A prosthesis or rehabilitation may be the first step |
| "Wide lower face" | Masseter hypertrophy from clenching | Toxin can reduce volume and strength | Bruxism calls for dental assessment and management |
What is the order of the plan?
There is no single sequence, but the most commonly cited logic is to treat first what changes the foundation and then what refines.
- Oral health and control of infection sources. Infections, periodontal inflammation and lesions treated before injecting near the mouth.
- Tooth position and occlusion. Orthodontics and, when indicated, orthognathic surgery change lip support and the profile.
- Rehabilitation and dental esthetics. Restorations, veneers and prostheses define tooth length, display and vertical dimension.
- Facial refinement. Lip volume, chin, folds and contour are adjusted on top of the new foundation.
Reversible, short-lasting procedures, such as toxin for bruxism or a conservative volume, can be added during treatment when they make sense, agreed among the professionals. The intervals between dental treatment and filler, including the risk of biofilm, are covered in dental treatment and filler.
And botulinum toxin in the integrated plan?
Botulinum toxin usually shows up in the dental plan in three situations: in clenching and bruxism, as a complement to dental management; in a bulky masseter that widens the lower third; and in a gummy smile of muscular origin. In all of them, diagnosing the cause comes first. Toxin does not replace a splint, an occlusal adjustment or joint treatment when those are indicated, and its effect is temporary. See botulinum toxin for the masseter.
How do you organize the conversation between professionals?
When the plan involves more than one professional, integration depends on communication, not just technique:
- A shared diagnosis in writing, with photos, so that no one treats without knowing what the other is planning.
- An agreed order, recorded in each professional's patient record.
- A single esthetic goal, decided with the patient, to prevent orthodontics from "opening" the profile and filler from "closing" it again.
- Clear responsibility for each stage and for managing complications.
The business model for bringing HOF into the dental office is in HOF in the dental clinic, and partnerships are in partnerships between professionals in HOF.
How do you explain it to the patient?
The patient arrives asking for a "prettier mouth" and does not separate tooth from lip. Showing the relationship helps them accept a staged plan.
The script for presenting the plan in phases is in staged plan.
And in Harmy?
Checklist for HOF integrated with dentistry
- Mouth examination done: periodontal health, infection sources, wear, occlusion.
- Incisor display, smile line and midline recorded.
- Profile assessed: lips, chin and relationship between arches.
- Source of each concern classified: soft tissue, tooth or bone.
- Plan order defined and recorded with all professionals.
- Intervals between dental treatment and injectables agreed.
- Facial and intraoral photos in the same standard.
- Patient informed about what each stage changes and what it does not.
Frequently asked questions
What is HOF in dentistry?
HOF stands for orofacial harmonization, recognized by Brazil's Federal Council of Dentistry (CFO) as a dental specialty in 2019. In the dental office, it can be planned together with the smile, the teeth and the occlusion. The regulation is under legal dispute; check with the CFO and your CRO.
Can a dentist perform orofacial harmonization?
The CFO regulates orofacial harmonization as a dental specialty, but CFO Resolution 198/2019 was declared unlawful by the TRF1 (a federal appeals court) in August 2026, with no final ruling yet. Follow the official guidance from the CFO and your CRO before any decision.
Does lip filler fix teeth that sit too far back?
It does not fix the cause. Filler can compensate for part of the lack of lip support, but when the incisors tilt backward or teeth are missing, the volume in the lip can end up out of proportion. The dental assessment comes first.
What should come first, orthodontics or harmonization?
In general, changes in tooth position and occlusion come first, because they alter lip support and the profile. Reversible, short-lasting procedures can be done during treatment when they make sense, at the discretion of the professionals involved.
Harmy images are illustrative simulations generated by AI from the patient's photo to support the conversation between practitioner and patient. They are not a promise of results. Indication, technique, product and volume are solely the decision of the licensed practitioner. This content is for information only and does not replace a clinical assessment.