A NOVEL METHOD FOR TEMPORARY TREATMENT OF GUMMY SMILE

Atalia Wasserstein D.MD

www.lingualnews.com Vol 2 No 2 nov 2004

I would like to recommend on of the article "Botulinum toxin type A in the treatment of excesssive gingival display" in the American Journal of  Orthodontics, volume 127, number 2, February 2005, 214-218 by Mario Polo from Puerto Rico.

One of the causes of excessive gingival display according to the author is hyperfunctional upper lip elevator muscles, mostly the levator labii superioris muscles. Several surgical techniiques are described to improve the condition, and the new non surgical way, the use of one of the eight types of butolinum toxin, the one that is the most commonly used in medicine, type A (BTX-A). The author descibes the known course of action of BTX-A for blocking muscular contraction and the trials for getting the minimal optimal dosage for best improvement of gummy smiles of 5 chosen patients.

The effect the BTX-A began about 10 days after the injection, reached its peack after 14 days and lasted for 3 to 6 months. The author suggests that the ideal dosage might be 2.5U per side at the levator labii superioris and at the overlap of the levator labii superioris and the zygomaticus minor
muscle, and 1.25 per side at the orbicularis oris site. The measured and the viewed improvemet are very impressive.

The study is a preliminary one, however very promising for improving sitations of an excessive incisors exposure at rest, as well as unesthetic gingival exposure at smile, for which conventional orthodontics do not have a satisfactory solution. However it should be remembered that the procedure gives short term improvement.  Case selection seems to be very important as well as the practitioner's skill.

www.lingualnews.com
Adult and Lingual Orthodontics
EDITORS:
Dr. Silvia Geron D.M.D., M.Sc
Dr. Rafi Romano D.M.D., M.Sc
Dr. Pablo Echarri D.M.D., M.Sc