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a: The sites of injections of total 20 units of BT. b: After 5 days of first visit of Botox injection. c: After 14 days of 20 units of Botox injection. 

a: The sites of injections of total 20 units of BT. b: After 5 days of first visit of Botox injection. c: After 14 days of 20 units of Botox injection. 

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Introduction: A gummy smile (GS) affects the esthetic and the psychological status as it usually decreases the self-confidence leading to hidden or controlling the smile. A smile with more than 2 mm exposed gingiva is called gummy smile. It may be due to one or more of the following etiologies; altered passive eruption of teeth, dentoalveolar extr...

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Context 1
... anesthesia application. The injections were done on 2 sites; the first site, 4 units were injected on each side of the nasolabial fold, 1 cm lateral and below the nasal ala -Yonsei point -while on the second site, 2 units were injected on each side of nasolabial fold, at the point of the greatest lateral contraction during the smile as shown in Fig. 4a. The depth of administration was intramuscular with the needle perpendicular to the skin sur- face and bevel facing upwards. The patient was advised not to lie down, do exercise, or massage the injected area during the first 4 h after the ...
Context 2
... days later, the patient was re-evaluated as the exposed area of gingiva decreased 5 mm as shown in Fig. 4b. She desired more esthetic smile, so another two doses of Botox were injected to the following sites, 2 units below the nose, two-thirds above the lip on each the ridge of the philtrum (orbicularis oris muscle) and another 2 units beside of nasolabial fold, besides the point of the greatest lateral contraction during the smile (Fig. ...
Context 3
... as shown in Fig. 4b. She desired more esthetic smile, so another two doses of Botox were injected to the following sites, 2 units below the nose, two-thirds above the lip on each the ridge of the philtrum (orbicularis oris muscle) and another 2 units beside of nasolabial fold, besides the point of the greatest lateral contraction during the smile (Fig. ...
Context 4
... reported. Pre-injection gingival display was mea- sured by periodontal probe UNC-15 resulting 9-10 mm relatively. After 2 months, a total dose of 20 U of BT was administered in two visits. The patient was reviewed after two weeks and the results showed a definite change upon smiling where the gingival display decreased to 1 mm, which is seen in Fig. 4c. Neither of redness, inflammation, edema, urticaria, swelling, tenderness was reported at the sites of injection. Patient stated that she had some difficulty in contraction her lips during kissing. No evidence of any other side effects such as difficulties during smiling or talking or eating. Not only she was truly satisfied, but she ...
Context 5
... gingi- val exposed area, but gingivectomy only wasn't sufficient to correct her severe GS entirely. Then, BT was injected with a total dose of 20 U; 4 units on each side of the nasolabial fold (at the Yonsei point), 4 units on each side of nasolabial fold (divided into 4 injections) and 2 units below the nose (orbicularis oris muscle) as shown in Fig. 4a. This approach was in disagreement with polo's opinion [35] as he stated that the total dose of BT injection should be 10 U if the gingival exposure was more than 8.5 mm and the orbicularis oris muscle should not be injected. But in our case, results start to be more observed and effective after increasing the dose of Botox to reach 20 ...

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... To achieve a beautiful smile, all these anatomical structures must be in harmony with each other [1]. The various causes of gummy smile are altered passive eruption of teeth, dentoalveolar extrusion, vertical maxillary excess, short or hyperactive muscles of the upper lip, or a combination of them [2]. ...
... Four buccal miniscrews with a diameter of 1.6 and 6 mm were installed: two screws were placed in the 2 BioMed Research International mesial side of the canines and two screws between the first molar and the second molar. An 80 g force was exerted from each screw using SS closed coil springs. ...
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... 2 Gummy smile dapat terjadi akibat beberapa faktor, yaitu bibir atas yang pendek, bibir atas yang hipermobilitas, Vertical Maxillary Excess (VME), dan adanya Delayed Passive Eruption (DPE). 2,3 Penentuan etiologi penyebab gummy smile yang tepat sangat diperlukan untuk menentukan rencana perawatan kasus tersebut. 4 Beragam perawatan dapat dilakukan untuk me nangani gummy smile. ...
... 4 Beragam perawatan dapat dilakukan untuk me nangani gummy smile. 3,4,5 Perawatan yang dilakukan harus disesuaikan dengan etiologi penyebab gummy smile. 5 Bedah ortognatik dapat dilakukan bila gummy smile disebabkan oleh vertical maxillary excess growth, bila gummy smile disebabkan oleh hiperplasi gingiva atau altered passive eruption maka dapat dilakukan tindakan crown lengthening atau lip reposition. ...
... 5 Pemeriksaan yang tepat menjadi faktor yang sangat penting dalam menentukan rencana perawatan kasus gummy smile, yaitu: (1) relasi dengan tulang maksila, (2) kondisi yang berhubungan dengan pembesaran gingiva, (3) relasi antara rahang atas dan bibir atas, dan (4) model senyum pada pasien. 3 Faktor penting dalam perawatan gummy smile adalah menciptakan senyum ideal dengan kontur gingiva yang simetris, seimbang dengan bibir dan gigi anterior dan posterior. Prosedur lip reposition pertama kali dijelaskan pada tahun 1973 oleh Rubinstein dan Kostianovsky sebagai bagian dari bedah plastik medis, kemudian diperkenalkan dalam kedokteran gigi setelah dimodifikasi pada tahun 2006 oleh Rosenblatt dan Simon. ...
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... When a subject presents the chief complaint related to his GS, several steps must be taken to reach an accurate diagnosis. Diagnosis of GS should include determination of clinical crown length, anatomical crown length, probing depth, and width of keratinized gingiva [34], beyond the distance from the cementoenamel junction to the alveolar bone crest, through transgingival probing, or imaging tests [35]. ...
... In addition to the clinical examination, an imaging exam should be performed to determine the level of the alveolar bone crest, maxillary protrusion, and maxillary vertical excess that may be present [34]. Also, an effective method is periapical radiography which, despite its limitations as two-dimensional image formation with overlapping structures, has a lower radiation dose compared to tomography and a low cost. ...
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To compare the efficacy between the surgical techniques of gingivectomy with high-power laser (HPL) and conventional gingivectomy for correction of a gummy smile (GS) due to altered passive eruption (APE). This was a case series of six female patients diagnosed with GS associated with APE. For the conventional gingivectomy procedure and for the one using the diode laser (808 nm, 2 W, in continuous mode), the six upper anterior teeth were divided into two groups (control (CG)-# 11, # 12, # 13, and test (TG)-# 21, # 22, # 23). Analyses of intraoperative bleeding and levels of pain and postop-erative tissue repair were performed. The thermal pattern analysis was performed using infrared thermography. The level of significance was set at p < 0.05. There was no intraoperative bleeding in the TGs (p = 0.002). The CG showed tissue repair significantly better than the TG on the 14th postoperative day (p = 0.004). There were no statistically significant differences regarding the level of postoperative pain between the groups (p > 0.05). Regarding the thermographic analysis, there were also no statistically significant differences (p > 0.05). HPL gingivectomy was more effective, regarding the absence of intra-operative bleeding, while the conventional technique promoted better tissue repair. No significant differences were observed in the other parameters, possibly due to the minimal damage caused by gingivectomy, with either HPL or the conventional procedure, as there was no removal of bone tissue.
... Several studies reported injection of botulinum with or without conjunctive periodontal surgeries in patients with VME who refused to undergo orthognathic surgery. 45 However, it must be considered that this approach Fig. 6. Soft tissue changes following superior repositioning of the maxilla. ...
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Excessive gingival show is mainly caused by hypermobility of the upper lip, altered passive eruption, gingival hyperplasia, and bony maxillary vertical excess. Orthognathic surgery is the optimal treatment option for patients with moderate and severe vertical maxillary excess. Surrounding anatomic structures and soft tissue changes such as alternation in the nasal morphology confine the amount of impaction. Therefore, Le Fort 1 may be performed in conjunction with horseshoe osteotomy or partial turbinectomy. The possible necessity of further mandibular orthognathic surgeries and chin repositioning has to be considered. No common major complication and long-term relapse have been reported for maxillary impaction.
... Several studies showed results like those of our study regarding the aspect of evaluating Botox injection in treatment of gummy smile, 1,3,10,16,17 but others showed results that disagreed with our results. 18 In all the mentioned studies, none of them reported the effect of repeated Botox applications through follow-up intervals, as they all gave only one dose of Botox. ...
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The present study was performed to evaluate the effect of repeated botulinum toxin injections and their long-term effects, using a customized injection point and dosage technique in the treatment of excessive gingival display. Twenty women who had gummy smile due to hypermobility of the upper lip or gingival display, ranging from 4 to 6 mm‚ were included in the study. All patients were injected with Botox injections at different injection points according to the type of smile. Pre- and postoperative measurements were taken by measuring digitally the gingival display at smiling, using Adobe Photoshop software via standardized digital photographs. Patients were followed up at 14 days, 4 months, 8 months, and 12 months. Postoperative measurements showed marked improvement at 14-day follow-up, with a significant reduction in the amount of gingival display. Relapse, however, occurred at 4 months and later. For excessive gingival display, Botox is an effective treatment that lasts for 2–3 months, with almost complete relapse at 4 months. We concluded from the results of our study that, despite repeated Botox injections at two follow-up intervals (4 and 8 months), the theory that repeated Botox injections may offer a permanent effect is still questionable.
... Para isso, diversos protocolos de aplicação de toxina botulínica tipo A (TXBA) para sorriso gengival (SG) por hipercontração muscular são definidos, e seus aspectos positivos e negativos devem estar claros para alertar sobre benefícios e malefícios à saúde. Trata-se de uma proteína que apresenta uma vida útil no corpo de aproximadamente quatro a seis meses, e com um importante papel imunogênico (Mostafa, 2018. Gupta & Kohli, 2019, sendo necessária atenção do profissional quanto à dose aplicada em cada sessão. ...
... der as limitações relacionadas a seu emprego. Trata-se de uma modalidade de tratamento minimamente invasiva que pode servir como adjuvante como, por exemplo, na associação de técnicas de gengivectomia e aplicação da neurotoxina para sorriso gengival em paciente com hipercontração muscular associado a erupção passiva alterada (Zangrando et al., 2017. Mostafa, 2018, ou substituto para o procedimento cirúrgico, como por exemplo na substituição de cirurgia ortognática maxilar por hiperplasia óssea, sendo um método mais conservador, rápido e seguro (Sucupira & Abramovitz, 2012. Zangrando et al., 2017. Gupta & Kohli, 2019, mas que necessita de estudos posteriores para confirmação de protocolos adequad ...
... 2017. Zangrando et al., 2017. Pedron & Mangano, 2018. Gupta e Kohli, 2019, relacionando seu excelente resultado com o baixo risco de reações adversas provenientes do processo terapêutico e do material usado, sendo corroborada por todos os pesquisadores sua sugestiva eficácia como alternativa a outros métodos mais invasivos. (Zangrando et al., 2017. Mostafa, 2018. Quando o SG estiver associado à hiperfunção muscular, a combinação de técnicas de cirurgia periodontal e aplicação da neurotoxina podem ser viáveis. Quando o SG estiver relacionado ao excessivo crescimento vertical maxilar, técnicas cirúrgicas ortognáticas em ambiente hospitalar são indicadas, principalmente quando causas esqueletais e ...
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Objetivo Este trabalho se propôs avaliar a ação da toxina botulínica tipo A para o sorriso gengival misto por hiperfunção muscular em uma amostra do gênero feminino e masculino (n=5) que apresentavam 3mm ou mais de exposição de tecido gengival queratinizado em um sorriso habitual. Materiais e Métodos Utilizou-se como protocolo, a aplicação de 8 unidades de toxina botulínica tipo A da marca Botulifit®, sendo 2 unidades em cada ponto, totalizando 4 pontos e 8 unidades bilateralmente. Protocolo fotográfico foi instituído, antes e após o procedimento, a fim de exemplificar a melhora quantitativa da exposição gengival e os resultados do trabalho. Resultados Os resultados foram avaliados após 30 dias (T1) e 5 meses (T2) de aplicação, indicando, para toda a amostra a diminuição da exposição gengival pelo protocolo utilizado, mesmo 5 meses após a aplicação da toxina botulínica. Conclusão Concluiu-se com esse trabalho, que a aplicação de 8 unidades de toxina botulínica tipo A é um método terapêutico eficiente para correção clínica do sorriso gengival misto por hiperfunção muscular, apresentando pouco risco de reações adversas, baixa sensação dolorosa à punção e alta aceitabilidade do paciente, visto que sua ação é temporária e atraumática.
... As a result, periodontal surgery has become a routine treatment in the dental clinic, being used as a fundamental element for the correction of gingival excess. (NUNES, 2020) A smile with more than 2 mm of exposed gingiva is called a gingival smile (MOSTAFA, 2018). Gum enlargement is among the physiological or pathological conditions that most affect the smile, commonly occurring in the upper anterior teeth. ...
... Esthetic considerations have lately taken over in the dentistry fields. In order to define an esthetic smile, three main components have to be considered: teeth, lips and gingiva [1]. In some patients, an altered relationship between the teeth, the alveolar bone, and the soft tissue may result in a clinical condition known as gummy smile. ...
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Altered passive eruption (APE) is a genetic condition characterized by a coronary position of the gingiva on the enamel which results in short clinical crowns. There are several clinical and radiological ways to diagnose the altered passive eruption as well as several treatment possibilities depending on the case and the classification of the APE. A successful new smile requires an adequate knowledge of the periodontal parameters, a reliable diagnosis, an effective surgical protocol and the respect of the principle of tissue preservation. In this case report, an altered passive eruption was diagnosed clinically and radiologically and treated through gingivectomy, osteoplasty and osteotomy.
... O sorriso é uma das expressões faciais mais importantes do rosto e que está interligado com a autoestima dos pacientes (Gupta & Kohli, 2019). Apesar de não existir um padrão absoluto de beleza, o excesso de exposição gengival pode prejudicar a aparência de acordo com os padrões de simetria facial (Mostafa, 2018). Porém, é necessário levar em consideração o conceito de beleza de cada indivíduo que é influenciado por fatores psicossocial e econômico, os quais devem ser respeitados e analisados tanto a opinião quanta a expectativa de cada paciente (Al-Fouzan et al., 2017). ...
... É recomendado que a comercialização da toxina seja feito na forma a vácuo, por ser bastante segura. O uso deve ser feito com menor tempo possível e evitar armazenar o produto já pronto (Mostafa, 2018). Porém, devido ao vácuo, deve-se ter cuidado no momento da diluição na solução salina para que não aconteça de forma rápida resultando em quebra das moléculas e em relação à recongelar pode ter perca da eficácia da toxina ao longo do tempo (Nunes, Ferrão Junior, Teixeira, Leandro & Guevara, 2015). ...
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A busca pela excelência estética é uma das metas da odontologia, pois faz parte da estética do sorriso, pois interfere diretamente na autoestima e na qualidade de vida do paciente. Conceitualmente, o sorriso gengival é a exposição excessiva de gengiva ao sorrir, podendo ser considerada a partir de 2mm. Uma das opções de correção é com o uso da toxina botulínica. Em vista disso, o objetivo do presente estudo foi realizar uma revisão da literatura sobre os estudos científicos atuais acerca da correção do sorriso gengival com a toxina botulínica tipo A. Para tanto, realizou-se uma busca dos principais artigos publicados nos últimos 5 anos nas bases de dados: PubMed, SciELO, LILACS e BVS utilizando como descritores inglês “smile”, “gummy smile”, “gingiva” e “Botulinum ToxinsType A”. Baseado no resultado da busca dos 22 artigos encontrados, o tratamento do sorriso gengival com toxina botulínica tipo A atua sobre a hiperatividade dos músculos envolvidos no sorriso causando um relaxamento temporário, podendo ser uma técnica independente ou coadjuvante de outros procedimentos. Apresentando eficácia, resultados positivos estéticos e baixo índice de complicações. No entanto, a principal desvantagem consiste no efeito temporário, com duração média de 4 a 6 meses, necessitando de reaplicações com o passar do tempo. Diante desse contexto, pode-se concluir que o uso desta toxina para a redução do sorriso gengival é uma opção de procedimento seguro, rápido, eficaz e conservador. Entretanto, ensaios clínicos randomizados bem delineados são necessários para fortalecer as evidências.
... The majority of authors used the overlapping points of LLSAN and LLS, LLS, and ZMn as the landmark for BTX-A injections ,2,5,6,10,11 while few studies suggested injections into the LLSAN and LLS muscles. 1,9,[13][14][15] Hwang et al 13 Similarly, hyperactivity of the zygomaticus group of muscles (ZM and ZMn) are responsible for lifting the upper lip laterally, resulting in a posterior gummy smile. Patients with a posterior gummy smile received an injection at the origin and insertion areas of ZM and ZMn. ...
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Background. The present study aimed to assess the effect of botulinum toxin type A (BTX-A) for the management of gummy smile and evaluate its stability after administrating BTX-A clinically and using electromyography. Methods. The investigators designed and implemented a prospective clinical study on 10 patients with a gummy smile. Patients with different types of gummy smile were injected with BTX-A in the levator muscles of the upper lip and were followed for six months. The effect of BTX-A was evaluated clinically and using electromyography preoperatively and after two weeks and three and six months. Statistical analyses were carried out using repeated measures ANOVA and post hoc Bonferroni tests for pairwise comparisons. Results. The sample consisted of 10 patients with an anterior gummy smile (n=3), posterior gummy smile (n=2), mixed gummy smile (n=3), and asymmetrical gummy smile (n=2). There were significant differences (P<0.001) between the mean gingival display and compound muscle action potential at two-weeks and three-month follow-ups. The maximum result was obtained at the two-week interval. The mean gingival display and C-MAP values increased slightly at the three-month postoperative interval and gradually increased to the baseline values at six-month follow-up. Conclusion. BTX-A is an effective, minimally invasive, and temporary treatment modality for gummy smiles. The electromyographic study is a convenient method for assessing changes in the upper lip muscle contractility to quantify the effect of BTX-A in the treatment of gummy smile.