Zengiski Aline Cristina Soares, Basso Isabela Bittencourt, Cavalcante-Leão Bianca L, Stechman-Neto José, Santos Rosane Sampaio, Guariza-Filho Odilon, Zeigelboim Bianca Simone, Taveira Karinna Veríssimo Meira, de Araujo Cristiano Miranda
Undergraduate Dentistry Program, Tuiuti University of Paraná, Curitiba, Brazil.
Postgraduate Program in Dentistry, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
Clin Oral Investig. 2022 Jan;26(1):109-117. doi: 10.1007/s00784-021-04223-w. Epub 2021 Oct 15.
The aim of this systematic review is to synthesize the evidence on the effectiveness and longevity of the botulinum toxin in the treatment of individuals with excessive gingival exposure.
The search was adapted to six electronic databases and gray literature. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool for Non-Randomized and Randomized Studies of Interventions. Meta-analyses and meta-regression were performed using random effects models.
A total of 5247 articles were collected during the final search in the database, resulting in 17 articles included. There was a mean decrease of 3.42 mm [95% CI = -4.50 to -2.34; I = 97%] in the level of gingival exposure 2 weeks after the application of botulinum toxin. The application time explained 29.58% of the observed variance (p < 0.001), with a tendency for the effect size to decrease from the second week of application onwards, with values returning close to baseline levels in 24 weeks.
Botulinum toxin is an alternative technique considered effective for reducing gummy smile, especially for gummy smiles up to 4 mm, with a longevity of at least 12 weeks, returning close to initial values within 24 weeks after application.
The knowledge about the longevity and effectiveness of botulinum toxin in the treatment of gummy smile allows for a more adequate clinical planning for these cases, as well as for clinical decisions, as for prognostic factors.
本系统评价旨在综合关于肉毒杆菌毒素治疗牙龈过度暴露个体的有效性和持久性的证据。
检索了六个电子数据库和灰色文献。使用Cochrane干预性非随机和随机研究偏倚风险评估工具评估偏倚风险。采用随机效应模型进行荟萃分析和荟萃回归。
在数据库的最终检索中总共收集到5247篇文章，最终纳入17篇文章。应用肉毒杆菌毒素2周后，牙龈暴露水平平均下降3.42 mm [95% CI = -4.50至-2.34；I² = 97%]。应用时间解释了观察到的29.58%的方差（p < 0.001），从应用的第二周起效应量有下降趋势，在24周时数值接近基线水平。
肉毒杆菌毒素是一种被认为对减少露龈笑有效的替代技术，尤其是对于露龈笑程度达4 mm及以下者，其效果可持续至少12周，应用后24周内接近初始值。
了解肉毒杆菌毒素治疗露龈笑的持久性和有效性，有助于针对这些病例进行更充分的临床规划以及临床决策，包括预后因素方面的决策。
