Introduction: Previously, botulinum toxin type A (BTX-A) (Botox; Allergan, Irvine, Calif) was shown
to be effective in reducing excessive gingival display in 5 patients with gummy smiles.
This study was conducted to determine whether the doses and the primary injection
sites used in the pilot study for the correction of gummy smiles provide consistent,
statistically significant, and esthetically pleasing results. Methods: Thirty patients received BTX-A injections to reduce excessive gingival display. Gingival
display was defined as the difference between the lower margin of the upper lip and
the superior margin of the right incisor. Patients were followed at 2, 4, 8, 12, 16,
20, and 24 weeks postinjection, with changes documented by photographs and videos.
At week 2, the patients rated the effects of BTX-A. A group of specialty clinicians
also evaluated the effects of BTX-A. Results: Preinjection gingival display averaged 5.2 ± 1.4 mm in the 30 patients. At 2 weeks
postinjection, mean gingival display had declined to 0.09 mm (± 1.06 mm) in 30 patients
(t = 26.01, P <.00001). The average lip-drop at 2 weeks was 5.1 mm for 30 patients. Gingival display
gradually increased from 2 weeks postinjection through 24 weeks, but, at 24 weeks,
average gingival display had not returned to baseline values. Based on predictions
from a third-order polynomial equation, the baseline average of 5.2 mm would not be
reached until 30 to 32 weeks postinjection. Patients and specialty evaluators rated
the effects of BTX-A as highly favorable. Conclusions: BTX-A injections for the neuromuscular correction of gummy smiles caused by hyperfunctional
upper lip elevator muscles was effective and statistically superior to baseline smiles,
although the effect is transitory.
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Article Info
Publication History
Accepted:
April 3,
2007
Received in revised form:
April 3,
2007
Received:
December 12,
2006
Identification
Copyright
© 2008 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.
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- Botox injections for gummy smilesAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 133Issue 6
