Comparison of lip repositioning and lip repositioning with botulinum toxin application in gummy smile treatment

TL;DR

This study compares lip repositioning surgery alone versus combined with botulinum toxin for treating gummy smiles, finding that surgery provides long-term results while botulinum toxin offers only short-term improvement.

Contribution

Demonstrates that botulinum toxin provides short-term enhancement but does not improve long-term outcomes compared to surgery alone.

Findings

Both groups showed significant within-group reductions in gingival display (p < 0.001).

Group B had greater improvement at 3 months (p < 0.001), but no significant difference at 12 months (p = 0.134).

Surgical outcomes remained stable over 12 months, while botulinum toxin effects were temporary.

Abstract

This study aimed to compare the effects of lip repositioning surgery alone versus its combination with botulinum toxin type A injection in reducing gingival display and to evaluate the esthetic stability of both approaches over a 1-year follow-up.

A retrospective analysis was conducted using clinical records of 29 patients with excessive gingival display. Group A (n = 14) underwent lip repositioning surgery alone, while Group B (n = 15) received the same surgery followed by botulinum toxin injection. Gingival visibility was assessed from archived clinical records at baseline and at 1, 3, and 12 months postoperatively, with available clinical photographs reviewed solely as supplementary documentation. Statistical analyses were performed according to data distribution.

Both groups showed significant within-group reductions in gingival display (p < 0.001). At 3 months, Group B demonstrated a significantly greater improvement (p < 0.001), indicating a short-term additive effect of botulinum toxin. However, by 12 months, the difference between groups was not statistically significant (p = 0.134), and surgical outcomes remained stable.

Within the limitations of a retrospective design and the variability of clinical records, lip repositioning surgery provided predictable and long-term esthetic results in managing gummy smile. While botulinum toxin may enhance short-term outcomes, its temporary effect limits long-term benefits. Treatment planning should consider both objective outcomes and patient esthetic expectations.

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