Abstract
Objective: This study aimed to compare the changes in the gummy smile in cases treated with botulinum toxin (BTX) application or orthognathic surgery. Methods: The retrospective sample comprised 61 subjects with gummy smile divided into 2 groups according to treatment received for gummy smile correction: 1-38 patients (6 male; 32 female), at a mean age of 28.60 years (s.d.=6.09), treated with BTX application; 2- 23 patients (7 males and 16 females) at a mean age of 29.59 years (s.d.=5.72) treated with orthognathic surgery. Patients from the BTX group refused to undergo orthognathic surgery. The measurement of the gingival exposure was performed in extraoral photographs of the posed smile, before and after treatment, and it was defined as the difference between the stomion of the upper lip and the incisal edge of the maxillary central incisor minus the height of maxillary central incisor obtained in the patient's dental casts. The data were obtained before (T1) and after treatment (T2) and change of gingival exposure with treatment (T2-T1). Intergroup comparison of gummy smile was performed with independent t-tests. Results: The surgical group presented significantly greater correction of the gummy smile with treatment than the BTX group. Conclusion: Gummy smile presented a greater improvement in patients treated with orthognathic surgery than with botulinum toxin application.
Highlights
IntroductionThe gummy smile is characterized by gingival overexposure during a smile and is one of the largest esthetic complaints of the patients [1, 2]
AND STATEMENT OF THE PROBLEMThe gummy smile is characterized by gingival overexposure during a smile and is one of the largest esthetic complaints of the patients [1, 2]
The sample size calculation was based on an alpha significance level of 5% (0.05) and a beta of 20% (0.20) to achieve 80% power of the test to detect a minimum difference of 1.17mm with a standard deviation of 1.4mm for the gingival display [11]
Summary
The gummy smile is characterized by gingival overexposure during a smile and is one of the largest esthetic complaints of the patients [1, 2]. This problem is classified as the difference between the lower edge of the upper lip and the top edge of the maxillary central incisor [3, 4]. The causes of the gummy smile may be related to muscular, skeletal, periodontal and dental problems or combination of them; and maybe the result of a short upper lip, short crown of the teeth, excessive vertical maxillary gingival. Patients with a gummy smile can be treated exclusively with orthodontics, but depending on the bone deformity, alternatives should be proposed, such as clinical crown increase, Botulinum Toxin Application (BTX), and orthognathic surgery for maxillary impaction [1, 3 - 5, 9 - 11]
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