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Chapter 24 - Botulinum Toxin in the Treatment of Gummy Smile

Published online by Cambridge University Press:  02 November 2023

By
Rosemarie Mazzuco  and
Doris Hexsel
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett ,
Christopher Zachary  and
Mayank Pathak
Daniel Truong
Affiliation:
University of California, Riverside
Dirk Dressler
Affiliation:
Hannover Medical School
Mark Hallett
Affiliation:
National Institutes of Health (NIH)
Christopher Zachary
Affiliation:
University of California, Irvine
Mayank Pathak
Affiliation:
Truong Neuroscience Institute
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Summary

The gingival smile or gummy smile (GS) occurs when more than 2 to 3 mm of gum is exposed. It may be related not only to the excessive elevation of the upper lip by the involved muscles, but also to alterations in anatomical features like lip length, bone and periodontal and dental structures. The amount of exposed gum can largely differ from patient to patient, with some individuals presenting gum exposure of up to 10 mm. This chapter discusses the different subtypes of gummy smile – anterior, posterior, mixed – using detailed anatomical illustrations of each, including the pertinent musculature. A table lists the specific muscles to target for injection in each subtype.

Keywords

Botulinum toxinonabotulinumtoxinAabobotulinumtoxinAgummy smilegingival smile
Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 207 - 213
Publisher: Cambridge University Press
Print publication year: 2023

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References

Ascher, B, Talarico, S, Cassuto, D et al. (2010). International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit) – Part II: wrinkles on the middle and lower face, neck and chest. J Eur Acad Dermatol Venereol, 24, 1285–95.Google Scholar
Hexsel, D, Dal’Forno, T, Camozzato, F et al. (2020). Effects of different doses of abobotulinumtoxinA for the treatment of anterior gingival smile. Arch Dermatol Res, 313(5), 347–55. http://doi.org/10.1007/s00403-020-02096-9Google ScholarPubMed
Hwang, WS, Hur, MS, Hu, KS et al. (2009). Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. Angle Orthod, 79, 70–77.Google Scholar
Kane, M, Donofrio, L, Ascher, B et al. (2010). Expanding the use of neurotoxins in facial aesthetics: a consensus panel’s assessment and recommendations. J Drugs Dermatol, 9(1 Suppl), s7–22, quiz s23–5.Google ScholarPubMed
Mazzuco, R, Abdalla, BMZ. (2020). Botulinum toxin for special conditions: gummy smile – advanced points and indications. In da Costa, A (ed.) Minimally Invasive Aesthetic Procedures. Cham: Springer, pp. 245–8.Google Scholar
Mazzuco, R, Hexsel, D (2010). Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. J Am Acad Dermatol, 63, 1042–51.Google Scholar
Polo, M (2008). Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofacial Orthop, 133, 195–203.Google Scholar
Rajagopal, A, Goyal, M, Shukla, S, Mittal, N. (2021). To evaluate the effect and longevity of botulinum toxin type A (Botox®) in the management of gummy smile – a longitudinal study up to 4 years follow-up. J Oral Biol Craniofac Res, 11, 219–24.CrossRefGoogle Scholar
Robbins, JW. (1999). Differential diagnosis and treatment of excess gingival display. Pract Periodontics Aesthet Dent, 11, 265–72, quiz 273.Google Scholar
Sucupira, E, Abramovitz, A (2012). A simplified method for smile enhancement: botulinum toxin injection for gummy smile. Plast Reconstr Surg, 130, 726–8.CrossRefGoogle ScholarPubMed
Sundaram, H, Signorini, M, Liew, S et al. (2016). Global Aesthetics Consensus: botulinum toxin type A – evidence-based review, emerging concepts, and consensus recommendations for aesthetic use, including updates on complications. Plast Reconstr Surg, 137, 518e–29e.CrossRefGoogle ScholarPubMed

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