Botox in periodontics - Exploring new avenues (original) (raw)
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Treatment of Gummy Smile Using Botulinum Toxin Type-A (Case Report)
2014
Extensive exposure of the gingiva during a smile, called excessive gingival display, may be a cause of concern for both patients and clinicians.When an excess of gingiva superior to the maxillary anterior teeth is displayed upon full smile, it is termed a gingival smile or Gummy smile. Treatment modalities for gummy smile change according to its etiology.This article examines a non-surgical treatment option for reducing the excessive gingival display ('gummy smiles'), which can be found in many patients. Botulinum toxin type A (BTX-A) (Botox; Allergan) has been studied since the late 1970s for the treatment of several conditions associated with excessive muscle contraction. If carefully administered, this procedure is a very quick, reliable and predictable treatment option for most appropriate cases and should be considered as a viable modality before embarking on any anterior cosmetic dentistry or indeed facial aesthetic treatment for the lips themselves.
Gummy smile and botulinum toxin: A new approach based on the gingival exposure area
Journal of the American Academy of Dermatology, 2010
Background: Gummy smile (GS) is an aesthetic disorder for some patients, which can be corrected by injection of botulinum toxin. Objective: We sought to classify GS according to the area of gingival exposure and the respective muscles involved in order to perfect the botulinum toxin injection technique for each patient. Methods: Sixteen patients with GS were evaluated before receiving botulinum toxin injections. Based on the area of excessive gum displayed and identification of the muscles involved, 4 different types of GS were identified: anterior, posterior, mixed, and asymmetric. AbobotulinumtoxinA (Dysport, Ipsen Biopharm Limited, Wrexham, UK) was injected using a different injection technique for each type of GS, based on the main muscles involved. With the aid of two computer programs, the area of gum exposed was measured before and after the application of abobotulinumtoxinA, to evaluate the level of improvement. Results: There was a decrease in the degree of gum display in all patients. The general average improvement achieved was 75.09%. Two patients showed slight adverse effects that were easily corrected with additional doses of abobotulinumtoxinA. Limitations: For this study, there was no sample size calculation and no statistical analysis of the cases. Conclusion: The authors conclude that it is important to identify the type of GS and therefore the main muscles involved, so that the correct injection technique can be used. AbobotulinumtoxinA was shown to be effective and safe for use in all types of GS in the present sample.
Gingivoplasty and botulinum toxin application result in improvement of severe gummy smile
2020
Background Currently, the search for esthetic excellence has become the main objective in dental treatment. Gummy smile is among patients’ complaints, since this condition may influence their self-esteem and social relationships. The development of new techniques such as the application of botulinum toxin may offer more conservative therapeutic options for the treatment of gummy smile. Case presentation A patient with dentogingival discrepancy and severe gummy smile was treated with gingivoplasty and application of botulinum toxin in order to optimize the harmony of the smile. The result was satisfactory regarding the harmony of the smile by combination of the treatments. The use of each of these treatments alone could not have achieved the excellence of the result. Initially, the creation of the new gingival zenith after gingivoplasty promoted the new dental architecture, favoring gingival, dental and facial harmony for the patient. Subsequently, the application of botulinum toxin ...
Gummy Smile and Treatment with Botulinum Toxin Type A (Botox)
Botulinum Toxin - Recent Topics and Applications [Working Title], 2022
A smile plays an important role in determining a person’s initial impression, and its assessment has become integral to clinical evaluation. A smile with an esthetic appearance should be symmetrical and should reveal less than 2 mm of gums when smiling. A gingival smile, gummy smile, or high smile line, is defined as the number of excess gums on the upper jaw exposed. This may have some serious psychological repercussions on the patient, which may sometimes lead them to conceal their smile to avoid “embarrassment.” One of the most common methods of treating a gingival smile resulting from an overactive lip is lip reposition as a surgical procedure and the injection of type A (Botox) toxin as an injectable inhibitor of muscle action. However, many patients refrain from surgical treatment because of fear of complications and pain. In this case, injections of botulinum toxin group A are an excellent alternative to surgery. The injection of botulinum toxin takes less time and with the c...
Botulinum Toxin for the Treatment of Excessive Gingival Display: A Systematic Review
Aesthetic Surgery Journal, 2015
Background: To date, no standardized minimally invasive approach for the treatment of excessive gingival display exists. Objectives: This systematic review aims to assess the evidence in the literature regarding the role of botulinum toxin injection in the management of gummy smile. Methods: All publications through December 2014 and pertaining to the subject were electronically searched in PubMed, Embase, Scopus, and Web of Science, and the bibliographies of retrieved articles were manually screened. Results: Out of 33 articles, 29 were discarded based on exclusion criteria. Although all 4 selected articles were in line with a role for botulinum toxin injection in the treatment of gummy smiles and the importance of targeting the levator labii superioris alaeque nasi muscle, studies differed in the type and the dose of toxin administered and the technique adopted. Conclusions: Injection with botulinum toxin is a novel, safe, and cosmetically effective treatment for gummy smile when performed by experienced practitioners. However, further randomized controlled trials are warranted.
Improvement of Severe Gummy Smile by Botulinum Toxin Application and Gingivoplasty
Journal of Nepalese Society of Periodontology and Oral Implantology, 2018
Currently, the search for aesthetic excellence has become the main objective in the dental treatment. The gummy smile is one of the complaints from the patients, since this situation may influence their self-esteem and social relationship. The development of new techniques, such as the application of botulinum toxin, may be a therapeutic option more conservative, in the treatment of gummy smile. The purpose of this article is to present a case of a patient with dentogingival discrepancy and severe gummy smile, who was treated with gingivoplasty and application of botulinum toxin in order to optimise the harmony of the smile.
Treatment of Various Types of Gummy Smile With Botulinum Toxin-A
Journal of Craniofacial Surgery, 2019
The objective of this article is to present 3 various types of gummy smile treated with botulinum toxin-A injection per site at Yonsei points. The patients, who visited the department to demand a more aesthetic smile, were classified according to gummy smile type: asymmetric, anterior, and mixed. Botulinum toxin-A injection at Yonsei point was considered. Preinjection and postinjection pictures were taken, and the severity of excessive gingival display was measured for each tooth between second premolars. Two weeks after botulinum toxin injections, no complication was noted. The amount of excessive gingival display for each tooth between second premolars was measured less than 3 mm, and the percentage of improvement for each case was calculated 100%. The botulinum toxin injection at Yonsei point may be a predictable and noninvasive treatment option for various types of gummy smile.
Treatment of gummy smile using botulinum toxin: a review
Journal of Dental Rehabilitation and Applied Science, 2021
A beautiful smile is made when it is symmetrical and gums are displayed less than 2-3 mm. Excessive gingival display also known as "gummy smile" is often recognized to be unaesthetic. Causes of gummy smile can be caused by delayed eruption, vertical maxillary excess, hypermobile upper lip, or a short upper lip. Meanwhile botulinum toxin which is an exotoxin produced from Clostridium botulinum, works by blocking the release of acetylcholine from the cholinergic nerve end plates leading to inactivity of the muscles. The application site and weakens the muscle tone is drawing attention as a gummy smile treatment caused by hypermobile upper lip. There have been many studies about the method of injecting botulinum toxin into muscles around the lips, but there is still no standardized research method and treatment method, so there is controversy over the therapeutic effect. The aim of this study is to review the previous studies about the predictors of indication and effects of gummy smile treatment using botulinum toxin injection. Especially we tried to propose a protocol for optimal dose and efficient injection point through the anatomical considerations for gummy smile treatment using botulinum toxin.
2022
Due to its aesthetic implications, gummy smile is a common reason for consultation. When it is caused by a vertical excess of the maxilla, the ideal solution is orthognathic surgery. However, in borderline cases and when the cause is hyperactivity of the upper lip levator muscle complex, alternative conservative solutions can be considered, such as the application of botulinum toxin A (BTX-A). The main objective of this systematic review and meta-analysis is to analyze the effectiveness of BTX-A in the treatment of gummy smile in short and medium term, to study its stability and to evaluate potential complications. A thorough search of the PubMed, Scopus, Embase, Web of Science and Cochrane databases and a grey literature search were conducted. The inclusion criteria were: studies with a sample size greater than or equal to 10 patients with gingival exposure greater than 2 millimeters in smile, treated with BTX-A infiltration. The benefit of BTX-A in terms of improvement of gummy sm...
Adjunctive Treatment of Gummy Smile Using Botulinum Toxin Type-A (Case Report)
IOSR Journal of Dental and Medical Sciences, 2012
A 13 Year old female came for a consultation with chief complaints of protrusive lips and a gummy smile. The clinical examination showed a convex profile, a retrognathic mandible, excessively proclined and extruded maxillary incisors, and skeletal class II malocclusion with bimaxillary dento alveolar protrusion. Treatment was started using conventional mechanics for intrusion and retraction of upper anterior teeth, thereby improving soft tissue profile and correction of gummy smile. But only orthodontic treatment was not enough for correction of excessive gingival display during smile secondary to hyperactive upper labial muscle activity. Thus injection of Botulinum toxin type-A was given to correct gummy smile as an adjunctive treatment. Excellent correction of gummy smile following 2 weeks of Botox injection was achieved without any side effects. The patient received a satisfactory occlusion and an attractive smile.