Comparison of Botulinum Toxin and Orthognathic Surgery for G
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The gummy smile is characterized by gingival overexposure during a smile and is one of the largest esthetic complaints of the patients. 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 hypertrophy or hyperactivity of the upper lip levator muscle. Identification of the cause is important for planning the proper treatment. 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.

The use of BTX, compared to surgical procedures, is a less invasive, quick, safe and effective alternative that produces harmonic and pleasing results to the patient, when applied to the proper muscles (lift the upper lip, nose wing, zygomatic major and minor), respecting the appropriate dose and type of smile.

Therefore, the objective of this study was to compare gummy smile changes in patients treated with botulinum toxin application and orthognathic surgery for maxillary impaction. 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, treated with BTX application; 2- 23 patients (7 males and 16 females) at a mean age of 29.59 years 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). The surgical group presented significantly greater correction of the gummy smile with treatment than the BTX group.

There was a statistically significant difference in gummy smile changes between patients treated with the BTX application and orthognathic surgery with maxillary impaction. Gummy smile presented significantly greater improvement in patients treated with orthognathic surgery than with botulinum toxin application.