Gen Dent. 2021 Mar-Apr;69(2):52-55.
A "gummy smile," considered to be exposure of more than 3.0 mm of gingival tissue during a forced smile, negatively affects smile esthetics. The present case series describes the clinical indications and technique for applying botulinum neurotoxin type A (BoNTA) to correct a gummy smile and assesses the outcomes and satisfaction levels of 3 patients. The patients were told about the risks and benefits of the procedure and advised that their gummy smile was likely to recur within 6 months posttreatment. After the exposed gingival tissue of the patients was measured with a ruler, photographs were taken, and the patients recorded their pretreatment level of satisfaction with their smile on a visual analog scale (VAS), the patients were treated with BoNTA. The BoNTA was diluted in 1 mL of sterile saline according to the manufacturer's instructions, and an extraoral point of application was marked 1 mm lateral to each of the patient's nasal wings, close to the insertion of the elevator muscles of the upper lip and the nasal wings. At each location, 4 U was injected by tilting the syringe 45° in relation to the skin. Fourteen days after treatment, the gingival tissue exposed during a smile was again measured with a ruler, new photographic records were taken, and the patients' level of satisfaction with the treatment and the esthetic result was determined. Repositioning of the upper lip was observed in all patients. No adverse effects or complaints were reported. All 3 patients reported that they were satisfied with the outcome and wanted to continue therapy with BoNTA as needed. The results of the reported cases suggest that the application of BoNTA constitutes a safe, effective treatment for the correction of gummy smile and is well accepted by patients. However, for the treatment to be successful, it is essential that clinicians master the facial topographic anatomy and the technique to be employed.
“露龈笑”是指在强制微笑时暴露超过 3.0 毫米的牙龈组织,会对微笑美观产生负面影响。本病例系列描述了应用肉毒毒素 A 型(BoNTA)矫正露龈笑的临床适应证和技术,并评估了 3 名患者的治疗效果和满意度。告知患者该手术的风险和益处,并告知他们的露龈笑可能会在治疗后 6 个月内再次出现。在使用尺子测量患者暴露的牙龈组织后,拍照,并让患者在视觉模拟量表(VAS)上记录他们对微笑的治疗前满意度水平,然后对患者进行 BoNTA 治疗。根据制造商的说明,将 BoNTA 稀释在 1 毫升无菌盐水中,在每个患者的鼻翼外侧标记一个额外的注射点,距离上唇提升肌和鼻翼的插入部位 1 毫米。在每个部位,将 4 U 以与皮肤成 45°角的角度倾斜注射器进行注射。治疗后 14 天,再次使用尺子测量微笑时暴露的牙龈组织,拍摄新的照片记录,并确定患者对治疗和美学效果的满意度。所有患者均观察到上唇重新定位。未报告任何不良反应或投诉。所有 3 名患者均表示对治疗结果满意,并希望根据需要继续使用 BoNTA 进行治疗。报告病例的结果表明,BoNTA 的应用是矫正露龈笑的一种安全有效的治疗方法,患者对此治疗方法接受度良好。然而,为了取得成功的治疗效果,临床医生必须掌握面部解剖学和所需的技术。