Authors' response

Abstract

Thank you very much for your letter and interest in our article (Cengiz AF, Goymen M, Akcali C. Efficacy of botulinum toxin for treating a gummy smile. Am J Orthod Dentofacial Orthop 2020;158:50-58). As you mentioned, we started to work with the desire to see the long-term results on the basis of the studies in the literature regarding the clinical application of this method, which is minimally invasive and has high patient satisfaction. In addition to breaking new ground in this field, your detailed and successful works have inspired us. Nowadays, when smile esthetics are gaining more and more importance, it is good to be able to offer a method to reduce gingival visibility to patients with surgical fear, even with a temporary effect. “How soon will the injection be repeated?” is the first question that comes to mind after application to the patients. Both the hypothesis and application stages of this study may provide an answer to this question; the muscles you use for injection, application doses, and study results have been an important guide for us.1Polo M. Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile).Am J Orthod Dentofacial Orthop. 2008; 133: 195-203Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar, 2Polo M. Botulinum toxin type A in the treatment of excessive gingival display.Am J Orthod Dentofacial Orthop. 2005; 127: 214-218Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar, 3Polo M. Commentary on: botulinum toxin for the treatment of excessive gingival display: a systematic review.Aesthet Surg J. 2016; 36: 89-92Crossref PubMed Scopus (11) Google Scholar Unfortunately, the clinical practice of botulinum toxin application, which is an interesting subject for patients and physicians, contains risky points, as you mentioned. We also think that you are right to be concerned in this regard. It should be well understood by clinicians that many functions that we do in daily life might be blocked by overdose. As we mentioned in our article, although the orbicularis oris site has some advantages, such as the requirement of a low toxin dose and a significant decrease in gingival appearance on the third day, 15th day, first month, and fourth month after injection, it should be remembered that it is riskier in terms of manifesting the problems associated with these muscle functions mentioned above. Botulinum toxin for gummy smile correctionAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 158Issue 3PreviewEighteen years after my initial undertaking in 2002, searching for a minimally invasive, nonsurgical treatment alternative using botulinum toxin (Botox; onabotulinumtoxin A) for gummy smile correction,1,2 I now enjoy reading the article by Cengiz et al (Cengiz AF, Goymen M, Akcali C. Efficacy of botulinum toxin for treating a gummy smile. Am J Orthod Dentofacial Orthop 2020;158:50-8). The novel concept presented in 2002 was accepted positively by a few orthodontic colleagues, skeptically by others, and rejected by many. Full-Text PDF