Abstract
We read with interest the article by Cengiz et al in the July 2020 issue of American Journal of Orthodontics and Dentofacial Orthopedics in which botulinum toxin injections were used to treat a gummy smile (Cengiz AF, Goymen M, Akcali C. Efficacy of botulinum toxin for treating a gummy smile. Am J Orthod Dentofacial Orthop 2020;158:50-8). We have a few observations regarding the study.1.The authors considered the study to be a prospective cohort design. However, we believe that it was a randomized clinical trial. Hence, a more comprehensive reporting (following Consolidated Standards of Reporting Trials guidelines) especially in areas related to the period of the study, randomization, and blinding would have been helpful.2.Three systematic reviews and meta-analyses have been published on the topic,1Nasr M.W. Jabbour S.F. Sidaoui J.A. Haber R.N. Kechichian E.G. Botulinum toxin for the treatment of excessive gingival display: a systematic review.Aesthet Surg J. 2016; 36: 82-88Crossref PubMed Scopus (21) Google Scholar, 2Chagas T.F. Almeida N.V. Lisboa C.O. Ferreira D.M.T.P. Mattos C.T. Mucha J.N. Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis.Braz Oral Res. 2018; 32: e30Crossref Scopus (11) Google Scholar, 3Duruel O. Ataman-Duruel E.T. Tözüm T.F. Berker E. Ideal dose and injection site for gummy smile treatment with botulinum toxin-A: a systematic review and introduction of a case study.Int J Periodontics Restorative Dent. 2019; 39: e167-e173Crossref Scopus (4) Google Scholar but none were cited in any section of the manuscript.3.In the discussion, the authors justified the selection of orbicularis oris site for the study by citing Polo.4Polo 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 However, in a recent commentary, Dr Polo5Polo 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 has strongly objected to this technique saying, “With extensive experience in injecting botulinum toxin for gummy smiles, I am of the opinion that the OO muscle should never be injected for this particular purpose.”4.The study would have been more robust if factors such as the type of smile and lip characteristics that influence the outcome were included and discussed in the study. Efficacy of botulinum toxin for treating a gummy smileAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 158Issue 1PreviewThis study was conducted to investigate the efficacy of botulinum toxin applied to the different muscles of patients who have excessive gingival display and to evaluate the return to baseline gingival exposure value. Full-Text PDF Authors’ responseAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 159Issue 3PreviewThank you very much for your interest in our article and for your scientific contributions to it (Cengiz AF, Goymen M, Akcali C. Efficacy of botulinum toxin for treating a gummy smile. Am J Orthod Dentofacial Orthop 2020;158:50-8). Full-Text PDF
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