Botox as an adjunct to lip repositioning for the management of excessive gingival display in the presence of hypermobility of upper lip and vertical maxillary excess

Abstract

Background:Excessive gingival display (GD) is a frequent finding that can occur because of various intraoral or extraoral etiologies. This work describes the use of a mucosal repositioned flap for the management of a gummy smile associated with vertical maxillary excess (VME) and hypermobility of the upper lip followed by injection of Botox.Materials and Methods:Seven female patients in the age range of 17–25 years presented with a gummy smile. At full smile, the average GD ranged from 6 to 8 mm. A clinical examination revealed hypermobility of the upper lip. A cephalometric analysis pointed to the presence of VME. The mucosal repositioned flap surgery was conducted followed by injection with botulinum toxin type A (Botox) 2 weeks postsurgically.Results:After 4 weeks, results were definitely observed with a decrease from 8 mm gingival exposure to 3 mm, which was considered as normal GD for an adult during smiling.Conclusion:For patients desiring a less invasive alternative to orthognathic surgery, the mucosal repositioned flap is a viable alternative. Moreover, Botox is a useful adjunct to enhance the esthetics and improve patient satisfaction where surgery alone may prove inadequately in moderate VME.

Gummy Smile: A Review of Etiology, Manifestations, and Treatment

“…41 Polo 41 reported a relapse of around 2 mm after 24 weeks of following up. This was similar for Indra et al, 42 by reporting a relapse of treatment in the third month. Yet it is still a viable option for those who do not prefer undergoing surgeries, and need only a minimal treatment procedure.…”

A successful management of sever gummy smile using gingivectomy and botulinum toxin injection: A case report

“…These outcomes were not in accordance with this case results as the effect of BT regressed in less than 3 months. This could be due to the length of gingival exposure of this case was the longest in comparison with other reported cases [ [21] , [22] , [37] , [38] , [39] ]. Therefore, the duration of BT effectiveness does not related to increasing or decreasing the dose of BT units, but depends on frequency of muscles’ mobility and the length of gingival exposed during smiling.…”

Esthetic lip repositioning: A cosmetic approach for correction of gummy smile – A case series

“…Invasive procedures such as myotomy, myectomy, and orthognathic surgery have been indicated for the correction of GS, whereas there are also conservative techniques such as lip repositioning, crown lengthening, or the use of botulinum, which have promising results. [91011]…”