Comparison of lip repositioning and lip repositioning with botulinum toxin application in gummy smile treatment.

This study evaluated the clinical outcomes, surgical accuracy, and patient satisfaction in treating excessive gingival display caused by altered passive eruption (APE) using a comprehensive digital workflow and double surgical guide. A prospective case series study was conducted enrolling 30 patients diagnosed with APE Type 1B. Cone-beam computed tomography (CBCT), intraoral scanning, and digital smile design were used to design and fabricate a 3D-printed double surgical guide for both gingivectomy and osteotomy. The primary outcome was surgical accuracy, assessed by the gingival margin relapse at 6 months. Secondary outcomes included gingival display (GD), clinical crown length (CCL), periodontal and papillary parameters, and patient satisfaction. Statistical analyses were performed with significance set at p < 0.05. Thirty participants were treated successfully. The digital workflow demonstrated high accuracy with a median gingival margin relapse of 0.69 [0.58-0.87] mm at 6 months. Regarding clinical efficacy, a statistically significant reduction in GD was observed (from 3.13 [2.90-3.85] to 1.06 [0.56-1.99] mm; p < 0.001) alongside a statistically significant increase in CCL (from 7.64 [7.25-8.16] to 10.00 [9.56-10.46] mm; p < 0.001). Patient-reported outcomes indicated 100.0% satisfaction with the esthetic result. Within the limitations of this case series, the described comprehensive digital workflow using a double surgical guide is a predictable and effective method for treating excessive gingival display. The technique achieves significant esthetic improvements and results in a high level of patient satisfaction. This study presents a comprehensive digital workflow for the treatment of gummy smile caused by altered passive eruption. By integrating digital planning with a double surgical guide, clinicians can achieve precise soft and hard tissue management, leading to predictable esthetic outcomes and high patient satisfaction.

626 - Intrusion of maxillary teeth anchored in advanced mechanics with miniplates for the treatment of gummy smile: a case report

This study presents a clinical case of gummy smile correction through gingivoplasty, gingivectomy, and osteoplasty, using a surgical guide as an auxiliary resource to achieve greater predictability of the outcome. The clinical sequence performed and the aesthetic validation obtained are reported, providing the patient with functional, harmonious, and psychological benefits. The objective of this study is to demonstrate feasible procedures for dentists in clinical practice, enabling predictable and safe smile aesthetics rehabilitation. The materials and methods included a detailed clinical examination, digital smile planning, fabrication of the surgical guide from diagnostic waxing, and the performance of gingivoplasty, gingivectomy, and osteoplasty techniques. The patient was instructed on postoperative care, including proper hygiene and the use of prescribed medication for pain and inflammation control. The expected outcome is the achievement of adequate dental proportions and smile harmony, contributing to the patient’s self-esteem and well-being. It is concluded that the use of a surgical guide associated with periodontal and bone techniques provides greater predictability, safety, and satisfactory results, both functional and aesthetic, being an efficient alternative in the treatment of gummy smile.

Gummy Smile, or excessive gingival display, is a clinical condition characterized by an overexposure of the maxillary gingiva during smiling, typically exceeding 3 mm. Although not pathological, this condition can lead to aesthetic discomfort and negatively impact the patient's self-esteem. In a normal, aesthetically pleasing smile, gingival exposure—defined as the distance between the lower margin of the upper lip and the cervical area of the upper central incisors—should not exceed 1–2 mm.1 Gummy Smile affects approximately 10% of individuals aged 20–30, with a higher prevalence among females.2 This condition has a multifactorial etiology, with each causative factor potentially acting independently or in combination with others, thereby complicating both the clinical presentation and case management.3 The main causes of excessive gingival exposure include: 1. Altered passive eruption (APE) 2. Dentoalveolar extrusion 3. Vertical maxillary excess (VME) 4. Gingival hyperplasia 5. Short upper lip 6. Hypermobility of the upper lip4 This study presents a systematic review of the scientific literature on therapeutic approaches for the treatment of Gummy Smile, offering a qualitative analysis of clinical indications, procedural techniques, aesthetic and functional outcomes, duration of results, post-treatment recovery, possible complications, and patient satisfaction. Based on the emerging evidence, a clinical decision-making algorithm has been developed to guide clinicians in the selection and management of Gummy Smile cases, according to their etiological profile. This algorithm is proposed

Lip repositioning surgery is a minimally invasive procedure used in the treatment of gummy smile. With the increasing demand for aesthetic dental procedures, platforms like YouTube™ have become popular sources for visual health information. This study aimed to evaluate the quality, reliability, and educational value of YouTube™ videos related to lip repositioning surgery and to identify factors influencing video quality. This research was conducted on YouTube™ using the term “lip repositioning” on February 20, 2025. The first 150 videos sorted by relevance were screened. According to the inclusion criteria, 53 videos were recorded. Data such as video duration, upload source, view count, comments, likes/dislikes, and country of origin were recorded. Viewer engagement was analyzed through interaction index and viewing rate. Content was evaluated using the Video Content Quality (VCQ) score, Global Quality Scale (GQS) and DISCERN tool. Statistical analyses were performed with a significance level of P < 0.05. Most videos were uploaded by dentists (64.2%), and 71.7% were educational. The mean VCQ score was 9.98 ± 3.95, indicating low-to-moderate content quality. Videos uploaded by professionals had higher quality scores (p < 0.001), while 56.6% were of poor content quality. Although YouTube™ is a widely used source for health information, videos on lip repositioning surgery lack sufficient educational value and reliability. Professional content creation should be encouraged.

ABSTRACTAim:This study aimed to compare the effectiveness, duration, and patient satisfaction of botulinum toxin A (BTX-A) and hyaluronic fillers in treating gummy smiles.Materials and Method:A prospective clinical study was conducted at D.Y. Patil University, involving 14 patients aged 18–40 years with a gummy smile of ≥3 mm. Participants were divided into two groups: Group A (BTX-A injections) and Group B (hyaluronic fillers). Gingival display was measured using standardized photographic methods at baseline and follow-up visits (14, 30, 60, and 90 days). Patient satisfaction was evaluated using the Global Aesthetic Improvement Scale (GAIS).Result:The results indicated that while BTX-A provided immediate improvements, hyaluronic fillers demonstrated more consistent and prolonged results. Patient satisfaction was higher in the hyaluronic filler group, with most patients reporting exceptional improvement (GAIS score of 1) across all follow-ups. No severe adverse effects were observed in either group.Conclusion:Hyaluronic fillers demonstrate superior effectiveness and patient satisfaction compared to BTX-A in the treatment of gummy smiles.

Botulinum toxin (BT), a neurotoxic substance produced by the bacterium Clostridium botulinum, has stood out as one of the most widely performed non-surgical aesthetic procedures worldwide due to its effectiveness in blocking acetylcholine release, leading to temporary muscle paralysis. This study aims to analyze, through a narrative literature review, the applicability of BT in both aesthetic and therapeutic procedures, with emphasis on the role of biomedical professionals. The research was conducted using indexed scientific databases, considering publications from 2019 to 2025. The results highlight the extensive use of type A BT in facial aesthetics, treatment of gummy smile, hyperhidrosis, rejuvenation, and keloids, as well as in therapeutic contexts such as dystonias, bruxism, and migraines. The study also discusses safety criteria and potential adverse effects associated with its application, ranging from mild bruising to rare systemic reactions. Moreover, it underscores the role of the aesthetic biomedical professional as a qualified practitioner, whose regulated practice contributes to the efficacy and safety of the procedure. It is concluded that BT represents a versatile tool in promoting well-being, provided it is administered by qualified professionals and in accordance with established legal and technical standards.

This study evaluated the durability of botulinum toxin type A in 16 patients (n=16), with 08 units bilaterally, at different time points, through photographs and measurements at T0 (before application), T1 (20 days), T2 (2 months), and T3 (4 months). Two distance measurements were taken: (a) the distance from the anterior nasal spine to the lower edge of the upper lip, and (b) the distance from the lower edge of the upper lip to the incisal edge of the upper right central incisor. The effect of botulinum toxin type A on improving quality of life was assessed by analyzing patient satisfaction using the visual analog scale (VAS). The results indicate that, when measuring the distance from the anterior nasal spine to the lower edge of the upper lip at T3 (14.95 mm), the average distance was greater than at T0 (14.82 mm) but lower than at T1 (16.53 mm) and T2 (15.42 mm). Regarding the average distance between the lower edge of the upper lip and the incisal edge of the upper right central incisor, T3 (11.23 mm) was lower than T0 (12.11 mm) but higher than T1 (8.94 mm) and T2 (8.52 mm). In terms of patient satisfaction, the VAS score at T3 (10) was higher than at T0 (4.5), T1 (8.5), and T2 (9). Botulinum toxin type A qualitatively improved the patient's quality of life and exhibited a durability of at least four months.

ABSTRACT Currently the search for aesthetic procedures has increased significantly in dentistry, with the aim of achieving a more harmonious and symmetrical smile. Among the most common aesthetic changes is the gummy smile, which can affect the individual’s self-esteem as it is outside the typical standards of a “perfect” smile. Excessive gingival display is primarily genetic, most frequently affecting women in the second decade of life and patients submitted to orthodontic treatment. Among the main ethiological factors is altered passive eruption, a phenomenon where there is a lack of apical migration of periodontal tissues during the end of tooth eruption, which gives the dental element the appearance of being shortened, affecting the aesthetics of the smile. The aim of this paper is to demonstrate, through a case report, the treatment of gummy smile caused by altered passive eruption using the technique of mucoperiosteal flap surgery with internal bevel incisions associated with ostectomy. After the procedure, we obtained a greater exposure of the anatomical crown elements, correcting the appearance of a gummy smile and promoting aesthetics. After a 90-days follow up, the results were stable, concluding that periodontal surgical procedures are a viable option for gummy smile correction, however, the clinician should be aware how to choose and perform the correct technique for each patient.

Excessive gingival display is a common problem that results in an unaesthetic appearance while smiling. Lip reposition surgery is a powerful, noninvasive surgery approach for gummy smile treatment, frequently performed in outpatient oral and maxillofacial surgery units. The procedure as such, provides camouflage of the increased gingival display through re-attachment of the upper lip and limits the pull effect of the muscles by reducing the depth of the upper vestibule. Few techniques of surgical treatment of maxillary gingiva overexposure have been described so far. Proposed midline double V- plasty provides anatomic reposition of the frenulum, whereas bilateral vertical M-plasty enables wider excision of the mucosa than the conventional approach providing better adaption of the wound margins without residual dog-ear defects giving more functional, esthetic, and satisfactory effect to the patients. It can also be performed in patients who do not desire orthognathic surgery with good esthetic results.

Gummy smile treatment with lip-repositioning surgery

Periodontal Treatment of Gummy Smile with Diode Laser

Aim of the study The aim of this study was to compare the results of the treatment of the gingival smile by two techniques, Botox injection (in the first group of patients) and laser therapy (the second group of patients). Materials and methods The study included 30 female patients diagnosed with anterior gummy smile, aged of 31 and 45, who were separated into two groups. The first group of 15 patients was injected with Botox (Allergan), and second group of patients received laser therapy (Fotona LightWalker Laser). A questionnaires with four parts was used, which contained: demographic data; the degree of pain intensity after the intervention; the patient satisfaction degree according to the applied therapy; the degree of changes in patients’ life quality after the applied treatment. Results On the fourth day after the interventions (the first follow-up session), the degree of pain intensity in the patients with laser gingivectomy was much higher than in the patients injected with Botox. The satisfaction of patients with gummy smiles who were treated with Botox therapy was the highest at all monitoring sessions, in contrast to the satisfaction of patients with laser therapy, which was above average to maximum at all monitoring sessions. The quality of life of the patients was greatly increased in both groups. Conclusions The impact of both therapies on the treatment of gummy smiles was beneficial. The aesthetics and psychological well-being increased after the applied therapies.

Background and Aim: The increasing demand for aesthetic enhancements has led to the widespread use of Botox for various facial concerns, including gummy smiles. While its efficacy in treating gummy smiles is established, the safety profile of Botox in patients with underlying medical conditions, such as asthma, remains relatively unexplored. This case report presents a patient with asthma who underwent Botox treatment to correct excessive gingival display. The study aims to demonstrate the potential of Botox for aesthetic improvement in this patient population while emphasizing the need for further research to assess its safety profile. Results: A two-week Botox treatment course successfully eliminated the patient's gummy smile without inducing any asthma-related complications or adverse effects. Conclusion: Although this case suggests the potential of Botox for treating gummy smiles in patients with asthma, it is essential to conduct larger studies to establish its safety and efficacy. A comprehensive medical evaluation is crucial before considering Botox treatment for individuals with underlying health conditions.

The International Society of Aesthetic Plastic Surgery estimates that 18,857,311 non-invasive aesthetic procedures were carried out worldwide in 2022. This represents an increase of 7.2% compared to 2021 and 57.8% compared to 2018. Brazil is the second country in the world, just behind the United States, in the number of aesthetic procedures, with 3,020,552. Of these, 971,294 were non-invasive, with the administration of botulinum toxin, at 433,263, being the most frequent procedure. In aesthetics, it is used for the treatment of facial asymmetries, expression lines, hyperhidrosis in the hands, feet, armpits, face, and inguinal region, and in the treatment of gummy smile, attenuation of forehead wrinkles, perioral wrinkles, mental creases, glabellar lines, periorbital wrinkles, nasal wrinkles, wrinkles found on the décolletage, nasal tip stabilization, drooping lips, eyebrow lifting, and platysma bands. The most common adverse reactions associated with the use of botulinum toxin are burning, pain, swelling, irritation at the application sites, hypersensitivity, anaphylaxis in extreme cases, blurred vision, dry mouth, rarely respiratory failure, and muscle weakness. The objective of the study was to describe the adverse events (AEs) reported in the Vigimed system between 2019 and 2022. In the period analyzed, only 50 possible AEs were reported, with the female gender and the age group of 18 to 44 years being the most frequent. The pharmaceutical industry was responsible for 82% of the notifications analyzed, however, when evaluating the reporting professional, it was observed that pharmacists reported in only 8% of the cases. When evaluating the most reported AEs, swelling and pain were the most frequent, at 30% and 24% respectively. The underreporting of these events and the need for public and private incentives to raise awareness among health professionals and users about the need for identification and reporting of AEs is clear.

The smile is a characteristic that expresses emotions and affects interpersonal relationships, significantly impacting self-esteem and influencing personal and professional life. The growing emphasis on aesthetics has made patients increasingly well-informed and demanding regarding available procedures. Excessive gingival display (EGD) can result from various factors, such as altered passive eruption, vertical maxillary excess, and short or hyperactive upper lip, among others. In this case report, where EGD was caused by upper lip hypermobility, the proposed treatment involved the modified lip repositioning surgical technique (MLRS) using sutures in the modified horizontal mattress technique, aiming to limit muscle and tissue movement and to approximate the mucosal edges. The outcome was an improved aesthetic harmony of the smile, with a more suitable position of the upper lip during spontaneous smiling, as observed in a six-month follow-up.

Botulinum toxin type A (BoNT-A) and hyaluronic acid (HA) dermal fillers are increasingly utilized in dentistry for therapeutic and aesthetic purposes. However, a comprehensive synthesis of their clinical applications and indications in dentistry is lacking. This systematic review aimed to analyze the clinical application and indications of BoNT-A and HA dermal fillers in dentistry, providing insights into their efficacy, safety profiles, and limitations. A systematic search was conducted in PubMed/MEDLINE databases to identify relevant studies published between 2018 and 2024. Medical Subject Headings (MeSH) terms and keywords related to BoNT-A, HA dermal fillers, dentistry, clinical applications, and indications were used. Study selection criteria included randomized controlled trials (RCTs) and non-RCTs involving human participants of any age group. Data extraction and synthesis followed established guidelines, focusing on study characteristics, participant demographics, intervention details, outcome measures, and key findings related to BoNT-A and HA dermal fillers' clinical application in dentistry. Systematic searches across electronic databases and grey literature identified 857 records, with an additional 73 from hand searches. After screening titles and abstracts, 542 records were excluded, leaving 374 full-text publications for evaluation. Ultimately, 12 RCTs and 13 non-RCTs were included. The systematic review encompassed diverse geographic locations: Brazil, Italy, Spain, Syria, India, Egypt, Korea, and the Netherlands, involving samples sizes ranging from 14 to 143 participants. The review synthesized findings on HA's efficacy in various areas, including bone repair, gingivitis management, temporomandibular joint disorders, postoperative swelling reduction, periodontal defect treatment, chin and check projection and lips augmentation. BoNT-A exhibited promising efficacy in managing orofacial pain conditions, gummy smile treatment and neuromodulation of the lower third muscles. Safety profiles varied among studies, with some reporting minimal adverse effects while others noted dose-related concerns. BoNT-A and HA dermal fillers offer a wide array of clinical applications in dentistry, ranging from therapeutic interventions to aesthetic enhancements. Despite promising efficacy, careful consideration and monitoring of safety outcomes are essential when integrating these interventions into clinical practice. Further research addressing methodological limitations and safety concerns is warranted to optimize their utilization and improve patient care in dentistry.

The use of botulinum toxin (BTX) represents an effective and safe approach in treating the gummy smile, reducing excessive gum exposure during smiling. This minimally invasive procedure can yield remarkable aesthetic results and contribute to an increase in the patient's self-confidence. The aim of this study is to report a clinical case of a female patient undergoing treatment to correct a gummy smile. The case study involves a 21-year-old patient with excessive gum exposure (5 mm when smiling) who sought dental treatment. The origin of her gummy smile was mixed, and the treatment involved the application of 6 units of BTX type A at three specific points on the face. No complications were observed during the three-month follow-up period. Based on the case report, it can be concluded that BTX application for gummy smile treatment proved to be effective, safe, and comfortable in terms of recovery. The BTX approach to correcting a gummy smile is considered safe and entails straightforward recovery, producing satisfactory results that contribute to the improvement of aesthetics and the patient's well-being.

Excessive gummy smile affects the aesthetics of the patient and can be the result of several factors, including altered passive eruption, which can be surgically corrected by aesthetic crown lengthening. Case report: 22-year-old female patient, who was treated by aesthetic crown lengthening for the correction of type 1B altered passive eruption. Discussion: Considering the patient's age and periodontal phenotype, surgical correction of the gummy smile by aesthetic crown lengthening shows stable long-term results. Conclusion: Surgically correcting excessive gingival exposure through esthetic crown lengthening can help patients improve the appearance of their smile and regain their self-confidence.