Use of Botulinum toxin-A in Gummy smile treatment

Aim: This study aimed to investigate the effect of Botulinum toxin type A on reducing the gingival smile (gummy smile) in orthodontic patients who apply to the orthodontic clinic because of the visibility of the gingiva while smiling, but do not want to undergo interventional orthognathic surgical treatments or have a gingival smile due to hyper-mobile upper lip muscles. was made to determine Material and Method: Twenty-five patients between the ages of 18-32 who were disturbed by the visible gingiva during the smile, whose growth development was completed, participated in our study. All participants were injected with 5-7 U (unit) Botulinum toxin for each side targeting the right and left LLSAN (Levator Labii Superior Alaque Nasi) muscle. The patients were called for control on the 15th day. 2-3 U Botulinum toxin was added to 7 patients. Pre-treatment (T0) and post-treatment 15th day (T1), 1st month (T2), 4th month (T3), 5th month (T4) and 6th month (T5) frontal smile photos were recorded. The length of the philtrum, the thickness of the upper lip, and the amount of gingiva visible on the right central tooth during smile were measured on the photographs. In this way, the effectiveness of the treatment and the duration of relapse were evaluated. Patient satisfaction was determined by using the VAS (Visual Analog Scale) scale with the help of photographic records. The change in smile index was measured for each patient. Photographs of individuals working on smile aesthetics and participating in the study were shown to doctors and dentists from different specialties, and they were asked to evaluate the treatment on the VAS scale. Conclusion: As a result of the evaluation, the amount of gingiva visible during smiling decreased from an average of 3.63 ± 1.26 mm to -0.23 ± 1.42 mm. Filtrum length increased from 9.69 ± 2.49 mm to 12.05 ± 2.54 mm on average. After the 4th month, the efficacy of the treatment started to return, and in the 6th month, it almost returned to the initial values. Smile index T2 measurements were found to be significantly higher than the treatment initiation photographs. In the evaluation of the patients on the VAS scale, patient satisfaction was found to be significantly higher in the 1st month. A high correlation was observed in the mean VAS scores, in which dentists and medical practitioners evaluated patient photographs. When the mean VAS scores of the physicians were evaluated, the difference between the onset of treatment and T2 measurements was found to be significantly higher (p<0.01). There was no significant difference between the mean VAS scores of the physicians in the T0 and T5 periods. (p>0.5) Results: Botulinum toxin injection was thought to be an effective method in patients who had a gingival smile but did not accept invasive treatments. Key words: Botulinum toxin, Gummy Smile, Orthodontics, Smile Aesthetics, Smile Index