Maxillo-Facial Surgery, Facial Plastic Surgery, Stomatology and Oral Surgery, Hospices Civils de Lyon, Lyon-Sud Hospital - Claude-Bernard Lyon 1 University, 165 chemin du Grand-Revoyet 69495, Pierre-Bénite 69310, France; University Institute of the Face and Neck, Côte d'Azur University, Nice University Hospital, 31 Avenue de Valombrose, Nice 06100, France.
University Institute of the Face and Neck, Côte d'Azur University, Nice University Hospital, 31 Avenue de Valombrose, Nice 06100, France.
J Stomatol Oral Maxillofac Surg. 2022 Nov;123(6):e717-e723. doi: 10.1016/j.jormas.2022.05.016. Epub 2022 May 14.
Gummy smile has traditionally been treated with invasive or demanding surgical and orthodontic techniques. Several studies have shown that targeted injection of the upper lip elevator muscles with botulinum toxin is an effective treatment for this condition. However, no standardized injection protocol with reproducible results has yet been published. A systematic review of the literature has been performed using Medline, Scopus, and Embase. All articles relevant to the research question were analyzed. After removing duplicates, 162 articles were selected, of which 9 were included in the analysis after applying exclusion and inclusion criteria, for a total of 269 patients. Onabotulinum toxin type A (ONA-BoNTA) was used in 7 studies and abobotulinum toxin type A (ABO- BoNTA) in 2 studies, at various dilutions. The number of sites injected varied from 1 to 3 per side, with variable targeting of the Levator labii superioris alaeque nasalis, Levator labii superioris, Zygomaticus minor, Zygomaticus major and Orbicularis oris. The dose used per side varied from 1.25 to 6 U of ONA-BoNTA and from 2.5 to 7.5 U of ABO- BoNTA. The injection protocol was tailored to the type of gingival smile in one study only, another study compared results of targeting two different muscles, and one study evaluated different dosages of toxin for the same injection site. The average improvement ranged from 24.85% to 99.65% and the effect persisted from 12 to 36 weeks. Very good patient satisfaction was reported in 6 studies. Fourteen adverse events were reported, all of them mild and transient. The treatment of gummy smile by botulinum toxin injection is effective, safe, rapid, minimally invasive and reversible. Protocols vary widely in the literature and no standardized procedure emerges. A patient-specific approach, adapted to their anatomy, type of gummy smile and the severity of the exposure seems to be the most appropriate. Randomized controlled studies are needed to make this approach more systematic.
微笑时露龈过多传统上采用侵入性或要求较高的手术和正畸技术进行治疗。多项研究表明，通过肉毒毒素注射定位上唇提肌是治疗这种情况的有效方法。然而，目前尚未发表具有可重复性结果的标准化注射方案。使用 Medline、Scopus 和 Embase 对文献进行了系统回顾。分析了所有与研究问题相关的文章。去除重复项后，共选取了 162 篇文章，其中 9 篇文章在应用排除和纳入标准后被纳入分析，共有 269 例患者。使用了 7 项研究中的注射用A型肉毒毒素（ONA-BoNTA）和 2 项研究中的注射用 A 型肉毒毒素（ABO-BoNTA），并以不同的稀释度进行了使用。每侧注射的部位数量从 1 到 3 不等，针对上唇提肌鼻翼、上唇提肌、颧小肌、颧大肌和口轮匝肌的靶向性各不相同。每侧使用的剂量从 1.25 到 6U 的 ONA-BoNTA 到 2.5 到 7.5U 的 ABO-BoNTA 不等。仅在一项研究中根据牙龈微笑的类型调整了注射方案，另一项研究比较了针对两个不同肌肉的结果，一项研究评估了同一注射部位不同剂量的毒素。平均改善率从 24.85%到 99.65%，效果持续 12 到 36 周。6 项研究报告了非常好的患者满意度。报告了 14 例不良事件，均为轻度和短暂的。肉毒毒素注射治疗微笑时露龈过多是一种有效、安全、快速、微创和可逆的方法。文献中的方案差异很大，没有出现标准化程序。针对患者个体情况，根据其解剖结构、微笑类型和露龈严重程度进行个体化治疗似乎是最合适的。需要进行随机对照研究，使这种方法更加系统。
