Durability of botulinum toxin and qualitative analysis for the treatment of gummy smile

Daniella Pilon MUKNICKA; Angélica Castro PIMENTEL

doi:10.1590/1807-2577.20260015

Artigo Original

Durability of botulinum toxin and qualitative analysis for the treatment of gummy smile

Durabilidade da toxina botulínica tipo A e análise qualitativa para o tratamento do sorriso gengival

Daniella Pilon MUKNICKA; Angélica Castro PIMENTEL

http://dx.doi.org/10.1590/1807-2577.20260015 Rev. odontol. UNESP, vol.55, e20260015, 2026

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Abstract

Introduction: Societal beauty standards may lead individuals to seek orofacial harmonization procedures, in which dentists play a role in promoting aesthetics, self-esteem, and patients’ well-being, including the treatment of gummy smile with botulinum toxin type A.

Objective: To quantitatively evaluate the improvement in aesthetics and the lowering of the upper lip following gummy smile (GS) treatment for muscle hypercontraction using toxin type A (BTXA).

Material and method: The study included 16 patients who received 8 units of BTXA bilaterally. Evaluations were conducted at four time points: T0 (before application), T1 (15 days), T2 (2 months), and T3 (4 months). Two distances were measured: (a) from the anterior nasal spine to the lower border of the upper lip, and (b) from the lower border of the upper lip to the incisal edge of the upper right central incisor. The impact of BTXA on quality of life was further assessed through patient satisfaction, using the Visual Analog Scale (VAS).

Result: 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 (8.4) was higher than at T0 (4.5), T1 (8.5), and T2 (8.9).

Conclusion: BTXA qualitatively improved the patient's quality of life and exhibited a durability of at least four months.

Keywords

Botulinum toxins, type A, smiling, quality of life

Resumo

Introdução: Os padrões estéticos impostos pela sociedade podem levar à busca por procedimentos de harmonização orofacial, nos quais o cirurgião-dentista atua na promoção da estética, autoestima e bem-estar dos pacientes, incluindo o tratamento do sorriso gengival com toxina botulínica tipo A.

Objetivo: Avaliar quantitativamente a melhora estética e o rebaixamento do lábio superior após o tratamento do sorriso gengival decorrente de hipercontração muscular com toxina botulínica tipo A.

Material e método: O estudo incluiu 16 pacientes que receberam 8 unidades de toxina botulínica tipo A bilateralmente. As avaliações foram realizadas em quatro momentos: T0 (antes da aplicação), T1 (15 dias), T2 (2 meses) e T3 (4 meses). Foram mensuradas duas distâncias: (a) da espinha nasal anterior até a borda inferior do lábio superior e (b) da borda inferior do lábio superior até a borda incisal do incisivo central superior direito. O impacto da toxina botulínica tipo A na qualidade de vida foi adicionalmente avaliado por meio da satisfação dos pacientes, utilizando a Escala Visual Analógica (EVA).

Resultado: Ao mensurar a distância da espinha nasal anterior até a borda inferior do lábio superior em T3 (14,95 mm), observou-se que a média foi maior que em T0 (14,82 mm), porém menor que em T1 (16,53 mm) e T2 (15,42 mm). Em relação à distância média entre a borda inferior do lábio superior e a borda incisal do incisivo central superior direito, T3 (11,23 mm) foi inferior a T0 (12,11 mm), porém superior a T1 (8,94 mm) e T2 (8,52 mm). Quanto à satisfação dos pacientes, o escore da EVA em T3 (8,4) foi superior aos valores de T0 (4,5), T1 (8,5) e T2 (8,9).

Conclusão: A toxina botulínica tipo A promoveu melhora qualitativa na qualidade de vida dos pacientes e apresentou durabilidade de pelo menos quatro meses.

Palavras-chave

Toxinas botulínicas tipo A, sorriso, qualidade de vida

Referências

1 Kassir M, Babaei M, Hasanzadeh S, Rezaei Tavirani M, Razzaghi Z, Robati RM. Botulinium toxin applications in the lower face and neck: a comprehensive review. J Cosmet Dermatol. 2024 Apr;23(4):1205-16. https://doi.org/10.1111/jocd.16116. PMid:38059697.

2 Bulegon A, Sebben V, Rigo L. Assessment of pain and satisfaction after orofacial harmonization procedures. Aesthetic Plast Surg. 2025 Feb;49(3):607-17. https://doi.org/10.1007/s00266-024-04348-9. PMid:39269477.

3 Hexsel D, Dal’Forno T, Camozzato F, Valente I, Soirefmann M, Silva AF, et al. Effects of different doses of abobotulinumtoxinA for the treatment of anterior gingival smile. Arch Dermatol Res. 2021 Jul;313(5):347-55. https://doi.org/10.1007/s00403-020-02096-9. PMid:32725500.

4 Cengiz AF, Goymen M, Akcali C. Efficacy of botulinum toxin for treating a gummy smile. Am J Orthod Dentofacial Orthop. 2020 Jul;158(1):50-8. https://doi.org/10.1016/j.ajodo.2019.07.014. PMid:32414547.

5 Sung YT, Wu JS. The visual analogue scale for rating, ranking and paired-comparison (VAS-RRP): a new technique for psychological measurement. Behav Res Methods. 2018 Aug;50(4):1694-715. https://doi.org/10.3758/s13428-018-1041-8. PMid:29667082.

6 Rojo-Sanchis C, Montiel-Company JM, Tarazona-Álvarez B, Haas-Junior OL, Peiró-Guijarro MA, Paredes-Gallardo V, et al. Non-surgical management of the gingival smile with botulinum toxin A: a systematic review and meta-analysis. J Clin Med. 2023 Feb;12(4):1433. https://doi.org/10.3390/jcm12041433. PMid:36835971.

7 Hwang WS, Hur MS, Hu KS, Song WC, Koh KS, Baik HS, et al. Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. Angle Orthod. 2009 Jan;79(1):70-7. https://doi.org/10.2319/091407-437.1. PMid:19123705.

8 Gracco A, Tracey S. Botox and the gummy smile. Prog Orthod. 2010;11(1):76-82. https://doi.org/10.1016/j.pio.2010.04.004. PMid:20529632.

9 Mazzuco R, Hexsel D. Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. J Am Acad Dermatol. 2010 Dec;63(6):1042-51. https://doi.org/10.1016/j.jaad.2010.02.053. PMid:21093661.

10 Gupta N, Kohli S. Evaluation of a neurotoxin as an adjunctive treatment modality for the management of gummy smile. Indian Dermatol Online J. 2019 Aug;10(5):560-3. https://doi.org/10.4103/idoj.IDOJ_365_18. PMid:31544076.

11 Paula de Sa Earp A, Marmur ES. The five D’s of botulinum toxin: doses, dilution, diffusion, duration and dogma. J Cosmet Laser Ther. 2008 Jun;10(2):93-102. https://doi.org/10.1080/14764170701883660. PMid:18569262.

12 Romanos A, Semaan LB, Malak C, Basma H, Romanos GE. The combo strategy: triple approach for gummy smile-18-month case series. J Esthet Restor Dent. 2026;38(6):1125-39. https://doi.org/10.1111/jerd.70113. PMid:41556484.

13 Jaspers GW, Pijpe J, Jansma J. The use of botulinum toxin type A in cosmetic facial procedures. Int J Oral Maxillofac Implants. 2011 Feb;40(2):127-33. https://doi.org/10.1016/j.ijom.2010.09.014. PMid:20965695.

14 Malkinson S, Waldrop TC, Gunsolley JC, Lanning SK, Sabatini R. The effect of esthetic crown lengthening on perceptions of a patient’s attractiveness, friendliness, trustworthiness, intelligence, and self-confidence. J Periodontol. 2013 Aug;84(8):1126-33. https://doi.org/10.1902/jop.2012.120403. PMid:23137007.

15 Alaqeely R, AlRowis R, AlSeddiq A, AlShehri F, Aldosari M. Influence of gingival display on smile attractiveness assessed by Saudi Arabian laypersons and dental professionals. Sci Rep. 2023 Oct;13(1):18718. https://doi.org/10.1038/s41598-023-45641-y. PMid:37907618.

16 Mostafa D. A successful management of sever gummy smile using gingivectomy and botulinum toxin injection: a case report. Int J Surg Case Rep. 2018;42(C):169-74. https://doi.org/10.1016/j.ijscr.2017.11.055. PMid:29248835.

Submetido em:
01/04/2026

Aceito em:
09/09/2026

Durability of botulinum toxin and qualitative analysis for the treatment of gummy smile

Durabilidade da toxina botulínica tipo A e análise qualitativa para o tratamento do sorriso gengival

Daniella Pilon MUKNICKA; Angélica Castro PIMENTEL

Abstract

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Rev. odontol. UNESP