Goals/Purpose:
Excessive gingival display or "gummy smile" is defined as the display of 2 mm or more of gingival exposure of the maxilla upon smiling. Excessive gingival exposure can be unappealing and bothersome to patients. One factor that contributes to a "gummy smile" is hyperfunctional upper lip elevator muscles. The purpose of this study is to evaluate Botox as a safe and minimally invasive treatment option for a "gummy smile".
Methods/Technique:
Eleven consecutive patients were selected after meeting inclusion and exclusion criteria. Following pre-treatment photographic and video analysis, Botox was injected intramuscularly into the levator labii superioris alaeque nasi and levator labii superioris muscles. Objective measurements and repeat photographic and video analysis were collected at two weeks and three months. Patient-reported outcomes were collected at two weeks and data was compared to determine the correlative relationship.
Results/Complications:
The patients consisted of ten females and one male. An average of 5 units (range 4-6 U) were injected into three sites per side to target the aforementioned muscles. The average pre-injection gingival show over the central incisors and canines were 4.8 mm and 4.1 mm respectively. Post-injection gingival show demonstrated a decrease to a gingival show average of 0.4 mm (91% improvement) and 0.5 mm (87% improvement) over the central incisors and canines, respectively. The average follow-up time was 12.6 days. All patients showed significant improvement in gingival show. One patient experienced a "joker smile" effect. The remaining ten experienced no negative effects and agreed to undergo repeat treatments. There were no reports of change in oral competence following treatment.
Conclusion:
Utilizing Botox for treatment of a "gummy smile" is an effective, minimally invasive and safe nonsurgical therapy. According to objective measurements and patient-reported outcomes, this treatment option can lead to significant improvement in smile aesthetics and patient satisfaction.
Pre-injection
Post-injection
Pre-injection
Post-injection
Pre-injection
Post-injection "joker-smile"