Comparison of Botulinum Toxin and Orthognathic Surgery for Gummy Smile Correction

Objective: This study aimed to compare the changes in the gummy smile in cases treated with botulinum toxin (BTX) application or orthognathic surgery. Methods: The retrospective sample comprised 61 subjects with gummy smile divided into 2 groups according to treatment received for gummy smile correction: 1-38 patients (6 male; 32 female), at a mean age of 28.60 years (s.d.=6.09), treated with BTX application; 223 patients (7 males and 16 females) at a mean age of 29.59 years (s.d.=5.72) treated with orthognathic surgery. Patients from the BTX group refused to undergo orthognathic surgery. The measurement of the gingival exposure was performed in extraoral photographs of the posed smile, before and after treatment, and it was defined as the difference between the stomion of the upper lip and the incisal edge of the maxillary central incisor minus the height of maxillary central incisor obtained in the patient's dental casts. The data were obtained before (T1) and after treatment (T2) and change of gingival exposure with treatment (T2-T1). Intergroup comparison of gummy smile was performed with independent t-tests. Results: The surgical group presented significantly greater correction of the gummy smile with treatment than the BTX group. Conclusion: Gummy smile presented a greater improvement in patients treated with orthognathic surgery than with botulinum toxin application.

[1]  A. Diaspro,et al.  Gummy Smile Treatment: Proposal for a Novel Corrective Technique and a Review of the Literature , 2018, Aesthetic surgery journal.

[2]  A. Magro,et al.  Tratamento do sorriso gengival com toxina botulínica tipo A: relato de caso Treatment of gummy smile using botulinum toxin type A: case report , 2015 .

[3]  Sachin Gupta,et al.  Lip repositioning: An alternative cosmetic treatment for gummy smile , 2014, Journal of Indian Society of Periodontology.

[4]  U. Parajuli,et al.  Combined orthodontic and surgical correction of an adolescent patient with thin palatal cortex and vertical maxillary excess. , 2013, Kathmandu University medical journal.

[5]  S. Saigal,et al.  Progeria: pathogenesis and oral manifestation--a review. , 2012, Kathmandu University medical journal.

[6]  E. Sucupira,et al.  A Simplified Method for Smile Enhancement: Botulinum Toxin Injection for Gummy Smile , 2012, Plastic and reconstructive surgery.

[7]  T. Araújo,et al.  Checklist dos aspectos estéticos a serem considerados no diagnóstico e tratamento do sorriso gengival , 2011 .

[8]  A. S. Indra,et al.  Botox as an Adjunct to Orthognathic Surgery For A Case of Severe Vertical Maxillary Excess , 2011, Journal of maxillofacial and oral surgery.

[9]  D. Hexsel,et al.  Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. , 2010, Journal of the American Academy of Dermatology.

[10]  Stephen G Tracey,et al.  Botox and the gummy smile. , 2010, Progress in orthodontics.

[11]  Carlos Alexandre Câmara.  Estética em Ortodontia: seis linhas horizontais do sorriso , 2010 .

[12]  L. Wolford,et al.  Postsurgical stability of counterclockwise maxillomandibular advancement surgery: affect of articular disc repositioning. , 2008, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[13]  Mario Junior Alves Polo.  Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). , 2008, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[14]  Mario Junior Alves Polo.  Botulinum toxin type A in the treatment of excessive gingival display. , 2005, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[15]  H. Kiyak,et al.  Comparing the perception of dentists and lay people to altered dental esthetics. , 1999, Journal of esthetic dentistry.

[16]  E. Kechichian,et al.  Botulinum Toxin for the Treatment of Excessive Gingival Display: A Systematic Review. , 2016, Aesthetic surgery journal.

[17]  I. Pedron.  UTILIZAÇÃO DA TOXINA BOTULÍNIcA TIPO A ASSOcIADA À cIRURgIA gENgIVAL RESSEcTIVA: RELATO DE cASO Utilization of botulinum toxin type A associated to the resective gingival surgery: case report , 2014 .

[18]  S. Bali,et al.  TREATMENT OF GUMMY SMILE USING BOTULINUM TOXIN TYPE-A (CASE REPORT) , 2014 .

[19]  T. Shimo,et al.  Severe gummy smile with class II malocclusion treated with LeFort I osteotomy combined with horseshoe osteotomy and intraoral vertical ramus osteotomy. , 2013, Acta medica Okayama.

[20]  C. Câmara.  Aesthetics in Orthodontics : Six horizontal smile lines , 2010 .

[21]  S. Uckan,et al.  Bimaxillary orthognathic surgery in a patient with long face: a case report. , 1999, The International journal of adult orthodontics and orthognathic surgery.