GINGIVAL SMILE CORRECTION USING THE FLAPLESS TECHNIQUE

Background: The pursuit of esthetic excellence has become a major goal in the dental treatment. Gummy smile is one of the complaints of the patients, since such a situation can influence self-esteem and social relationships. The beauty of the smile is not only constituted by the shape, position and size of the teeth, but also based on the characteristics of the gingival tissue and conformation of the lips, which should be as harmonious as teeth. The development of new more conservative techniques may provide a better therapeutic option than surgical procedures, such as the application of botulinum toxin, in the treatment of gummy smile. Purpose: to present the case of a patient who presented dentogingival discrepancy caused by gingival overgrowth and gummy smile, treated by gingivoplasty and complemented by application of botulinum toxin. Description of the case: The gingivoplasty was performed followed by the application of botulinum toxin type A. Results: The gingivoplasty resulted of the improvement of gingival arches and the application of botulinum toxin promoted the dehiscence of upper lip, reducing the gingival exposure. Conclusions: The application of botulinum toxin, associated with gingivoplasty, is an important tool at the management of gummy smile, optimizing smile harmony and achieving improved self-esteem and quality of life.

The gummy smile is characterized by a marked gingival exposure on smiling and it has been considered as one of the main complaints of patients, also influencing on self-esteem and social relationship. The development of new techniques such as botulinum toxin application may be a more conservative treatment option than surgical intervention (myectomy and Le Fort I osteotomy) in the treatment of gummy smile. Objective: To present the case of a patient who presented dental-gingival discrepancy and gummy smile, treated by gingival resection surgery and complemented by the application of botulinum toxin. Case report: A female patient, 23 years old, presented dental-gingival discrepancy and gummy smile, treated by gingival resection surgery and complemented by the application of botulinum toxin. Results: The gingival resection surgery promoted improvement of dental relationship, caused by increase of dental zenith and the application of botulinum toxin caused uniform dehiscence of the upper lip, increasing the harmony of the smile and improving self-esteem and quality life. Conclusion: Botulinum toxin is an additional option in the cosmetic improvement of the smile and gives better results when combined with gingival resection surgery.

Gummy Smile Correction Using Botulinum Toxin With Respective Gingival Surgery

Currently, the search for esthetic excellence has become the main objective in the facial treatment. The gummy smile is one of the complaints from the patients, since this situation may influence their self-esteem and social relationship. The development of new techniques, such as the application of botulinum toxin, may be a conservative therapeutic option in the treatment of gummy smile. The purpose of this letter is to comment some points about a case report publicated in Dermatology Online Journal, of a patient with dentogingival discrepancy and severe gummy smile, who was treated with application of botulinum toxin in order to optimize the harmony of the smile.

Currently, the search for aesthetic excellence has become the main objective in the dental treatment. The gummy smile is one of the complaints from the patients, since this situation may influence their self-esteem and social relationship. The development of new techniques, such as the application of botulinum toxin, may be a therapeutic option more conservative, in the treatment of gummy smile. The purpose of this article is to present a case of a patient with dentogingival discrepancy and severe gummy smile, who was treated with gingivoplasty and application of botulinum toxin in order to optimise the harmony of the smile.

Management of excessive gingival display using botulinum toxin type A: a descriptive study

The aim of this systematic review is to synthesize the evidence on the effectiveness and longevity of the botulinum toxin in the treatment of individuals with excessive gingival exposure. The search was adapted to six electronic databases and gray literature. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool for Non-Randomized and Randomized Studies of Interventions. Meta-analyses and meta-regression were performed using random effects models. A total of 5247 articles were collected during the final search in the database, resulting in 17 articles included. There was a mean decrease of 3.42 mm [95% CI = -4.50 to -2.34; I2 = 97%] in the level of gingival exposure 2 weeks after the application of botulinum toxin. The application time explained 29.58% of the observed variance (p < 0.001), with a tendency for the effect size to decrease from the second week of application onwards, with values returning close to baseline levels in 24 weeks. Botulinum toxin is an alternative technique considered effective for reducing gummy smile, especially for gummy smiles up to 4 mm, with a longevity of at least 12 weeks, returning close to initial values within 24 weeks after application. The knowledge about the longevity and effectiveness of botulinum toxin in the treatment of gummy smile allows for a more adequate clinical planning for these cases, as well as for clinical decisions, as for prognostic factors.

Currently, concern about facial attractiveness is increasing, and this fact has led to orthodontics in adult patients being an increasingly demanded treatment, and with it, multi-disciplinary work. When it is caused by a vertical excess of the maxilla, the ideal solution is orthognathic surgery. However, in borderline cases and when the cause is hyperactivity of the upper lip levator muscle complex, alternative conservative solutions can be considered, such as the application of botulinum toxin A (BTX-A). Botulinum toxin is a protein produced by a bacterium and causes a reduction in the force of muscle contraction. The multi-factorial nature of the smile requires an individualized diagnosis in each patient, since there are multiple ways to treat the gummy smile (orthognathic surgery, gingivoplasty, orthodontic intrusion). In recent years, interest has grown in the simplest techniques that allow the patient to quickly return to their usual routine, such as lip replacement. However, this procedure shows recurrences in the first 6–8 post-operative weeks. The main objective of this systematic review and meta-analysis is to analyze the effectiveness of BTX-A in the treatment of gummy smile in the short term, to study its stability, and to evaluate potential complications. A thorough search of the PubMed, Scopus, Embase, Web of Science, and Cochrane databases and a grey literature search were conducted. The inclusion criteria were studies with a sample size greater than or equal to 10 patients with gingival exposure greater than 2 mm in smile, treated with BTX-A infiltration. Those patients whose exclusive etiology of their gummy smile was related to altered passive eruption, gingival thickening, or overeruption of upper incisors were excluded. In the qualitative analysis, the mean pre-treatment gingival exposure ranged between 3.5 and 7.2 mm, reaching a reduction of up to 6 mm after infiltration with botulinum toxin at 12 weeks. Although multiple muscles are involved in the facial expression, the muscles par excellence selected for blockade with BTX-A were levator labii superioris, levator labii superioris ala nasalis, and zygomaticus minor, infiltrating from 1.25 to 7.5 units per side. In the quantitative analysis, the difference in mean reduction between both groups was −2.51 mm at two weeks and −2.24 mm at three months. The benefit of BTX-A in terms of improvement of gummy smile is demonstrated, as a significant reduction in gummy smile is estimated by BTX-A therapy two weeks after its application. Its results gradually decrease over time, however, they stay satisfactory without returning to their initial values after 12 weeks.

The pursuit of esthetic excellence has become a major goal in the dental treatment. The beauty of the smile is not only constituted by the shape, position and size of the teeth, but also based on the characteristics of the gingival tissue and conformation of the lips, which should be as harmonious as teeth. Gummy smile is one of the complaints of the patients, since such a situation can influence self-esteem. The purpose of this article is to present the case of a patient who presented dentogingival discrepancy and gummy smile, treated by gingivectomy and by application of botulinum toxin.

Este estudo teve como objetivo traçar o perfil do ensino de gestão nos cursos de graduação em Odontologia no Brasil. Caracteriza-se como pesquisa transversal com abordagem quantitativa a partir de dados secundários. A amostra foi composta por 327 Instituições de Ensino Superior (IES) que possuem cursos graduação em Odontologia cadastrados no Ministério da Educação. A coleta ocorreu a partir de consultas aos sítios web das IES, dos quais foram analisadas as matrizes curriculares dos cursos de Odontologia e ementas, e observada a existência de componentes curriculares que abordassem o ensino de gestão. Quando presentes, foram colhidas as seguintes informações: região da IES, categoria administrativa da IES, natureza do componente curricular, semestre ofertado, carga horária, metodologia empregada e nomenclatura. Dos 327 cursos de graduação em Odontologia pesquisados, apenas 27,83% ofertam o ensino de gestão em suas matrizes curriculares. A maioria dos componentes curriculares é de natureza obrigatória (74,72%), ofertadas predominantemente no 8° (25,28%) e 9° (24,17%) semestres, com a carga horária variando entre 31 e 60 horas de aulas (79,12%) e natureza teóricas (60,31%). Assim, concluiu-se que o ensino de gestão é pouco explorado pelos cursos de graduação em Odontologia no Brasil, fazendo-se necessária a sua inclusão nas matrizes curriculares a fim de preparar o cirurgião-dentista para atuar na área da gestão em saúde.

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.

In this article, we present an analysis of the contribution of social sciences to teaching undergraduate dentistry courses. Based on a literary review of the influence of behavioral and social sciences on oral health research and a case report from a public university in Porto Alegre, Brazil, I propose to consider the interface between health and social sciences, presenting some of our contributions to the training process of undergraduate students at the Federal University of Rio Grande do Sul. Introductory social sciences classes have been incorporated into various healthcare faculties, such as nutrition, dentistry, physiotherapy, medicine, obstetrics, and nursing. The acknowledgment of the importance of social sciences to the formation of health care professionals is reflected in the introduction in the curriculum of topics such as human rights, ethics in the relation of professionals and patients, as well as the challenges presented by social inequalities and the humanistic perspective of integral attention. In this sense, social sciences present undergraduates with a privileged perspective to the understanding of the patient both as a subject of rights, situated in a social, cultural, economic, and political context, and as a critical interpreter and agent of his own body, capable of recognizing and identifying illness processes, choosing, and attending therapy protocols and, therefore, capable of contributing to the continuity as well as transformation of healthcare practices. The inclusion of social sciences classes in undergraduate dentistry courses has given students an invaluable perspective on patients as individuals with rights situated within a social, cultural, economic, and political context. This understanding enables students to identify and tackle social inequalities, maintain ethical standards in their professional practice, and offer holistic care when training in programs integrated into the Brazilian Unified Health System. In addition, social sciences classes equip students with critical thinking skills that enable them to analyze and interpret patient experiences, make informed decisions regarding treatment protocols, and contribute to better treatment adherence, prevention practices, and therapy continuity.

Gummy smile is a condition characterized by excessive exposure of the gums during smiling. The demand for treatment for this condition has increased in recent years, and numerous techniques have been reported to treat gummy smile, such as gingivectomy, orthognathic surgery, lip repositioning surgery, and botulinum toxin injections. The objective of the work was to answer the guiding question: “What is the effect of botulinum toxin type A in the management of excessive gingival exposure – gummy smile?”. The databases Pubmed, Scielo and LILACS were used. The search was carried out in an advanced form, considering the descriptors: botulinum toxin, gummy smile, gum, botox and minimally invasive procedures. The inclusion criteria used were complete articles available in full, in the listed databases, published in the last 5 years in Portuguese, English and Spanish languages. Off-topic publications; in vitro and animal studies, literature reviews, theses, monographs and book chapters were excluded. 143 articles were retrieved, of which 77 were excluded due to duplication. After analyzing the titles and abstracts, 17 works were selected. At the end of the selection, 11 articles were included after reading the full text. It was concluded that the application of botulinum toxin is a safe and effective procedure for managing excessive gummy smile. It presented low rates of complications and high levels of satisfaction among patients. However, the patient must be aware that the clinical effect of botulinum toxin is temporary and requires periodic touch-ups to maintain the desired result. Keywords: Botulinum toxin. Gummy smile. Gingiva. Botox. Minimally invasive procedures.

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.

To analyse the presence and characteristics of curricular components related to management, entrepreneurship, leadership and marketing as part of the structure and teaching methods of undergraduate courses in dentistry in Brazil. This is an observational study that used the Ministry of Education's Undergraduate Course Accreditation Platform, which included 424 undergraduate courses in Dentistry on the last date of collection (August 31 2019). The following items were analysed as follows: the existence of curricular components in relation to the proposed themes, the most recurring denominations of curricular components, minimum and maximum workload, mandatory/optional classification, theoretical/practical teaching condition and in which year the curricular components were inserted. 367/424 (86.6%) of dentistry courses in Brazil included at least one of the topics: management, entrepreneurship, leadership and marketing curricular components in their curriculum, whilst 57/424 (13.4%) did not have these curricular components in their curricular structure. The most frequent names were "Management" 99 (45.21%) and "Entrepreneurship" 80 (36.5%). There was a predominance of the "theoretical method" and the number of hours varied considerably, with the most common course hours between 40 and 60h. The majority of curricular components were inserted in the third to fifth year and offered on a compulsory basis. Most curricular matrices of dentistry courses in Brazil had components related to the topics studied. However, due to the variety of curricular components' names, hours, periods of courses and different teaching methodologies, there is a need to redesign the teaching and learning process, defining educational and evaluation models with common curricular components.