Use of Botulinum Toxin in the Treatment of Gummy Smile

Year 2024, Volume: 9 Issue: 1, 144 - 156, 31.03.2024

Ezgi Gürbüz , Zeki Kaçar

https://doi.org/10.25279/sak.1134768

Abstract

The therapeutic effect of botulinum toxin produced by the bacterium Clostridium botulinum is due to its blocking of acetylcholine release in cholinergic neuron synapses and inhibition of muscle contraction. The use of botulinum toxin, which is applied for cosmetic and therapeutic purposes, has spread to many medical fields such as ophthalmology, gastroenterology, urology, orthopedics, and dermatology. It is used for therapeutic purposes in the head and neck region in many conditions such as trigeminal neuralgia, migraine, oesophageal speech after laryngectomy, facial nerve paralysis, sialorrhea, temporomandibular joint disorders, bruxism, myalgia in the masticatory muscles and hemifacial spasm. Botulinum toxin is also successfully used in perioral cosmetic conditions such as gummy smile, smile asymmetry, and facial asymmetry due to unilateral masseter hypertrophy. For the correction of gummy smile, caused by hyperactive lip muscles, botulinum toxin injection is preferred as a minimally invasive approach in terms of ease of application and safety. In this traditional review, up-to-date information on the use of botulinum toxin for the correction of gummy smile is included by scanning the literature in the electronic environment.

Keywords

Botulinum toxins, Gingiva, Gummy smile

Botulinum Toksinin Gummy Smile Tedavisinde Kullanımı

Abstract

Clostridium botulinum adlı bakteri tarafından üretilen botulinum toksininin terapötik etkisi, kolinerjik nöron sinapslarında asetilkolin salınımını bloke etmesinden ve kas kontraksiyonuna engel olmasından kaynaklanmaktadır. Terapötik amacın yanı sıra kozmetik amaçla da uygulanan botulinum toksininin kullanımı oftalmoloji, gastroenteroloji, üroloji, ortopedi ve dermatoloji gibi birçok medikal alana yayılmıştır. Baş ve boyun bölgesinde trigeminal nevralji, migren, larenjektomi sonrası özofageal konuşma, fasiyal sinir paralizi, siyalore, temporomandibular eklem bozuklukları, bruksizm, çiğneme kaslarında miyalji ve hemifasiyal spazm gibi birçok durumda terapötik amaçla kullanılmaktadır. Botulinum toksini aynı zamanda gummy smile, gülme asimetrisi, unilateral masseter hipertrofisine bağlı gelişen fasiyal asimetri gibi perioral kozmetik uygulamalarda da başarıyla kullanılmaktadır. Hiperaktif dudak kaslarının neden olduğu gummy smile tedavisinde botulinum toksini enjeksiyonu, uygulama kolaylığı ve güvenliği açısından minimal invaziv bir yaklaşım olarak tercih edilmektedir. Bu geleneksel derlemede, elektronik ortamda kaynak taraması yapılarak botulinum toksininin gummy smile tedavisinde kullanımına dair elde edilen güncel bilgiler yer almaktadır.

Keywords

Botulinum toksinleri, Diş eti, Diş eti gülümsemesi

References

• Arnett, G. W. ve Bergman, R. T. (1993). Facial keys to orthodontic diagnosis and treatment planning. Part I. American Journal of Orthodontics and Dentofacial Orthopedics, 103(4), 299-312.
• Bhogal, P. S., Hutton, A., & Monaghan, A. (2006). A review of the current uses of Botox for dentally-related procedures. Dental Update, 33(3), 165-168.
• Bigalke, H. (2013). Botulinum toxin: application, safety, and limitations. Current Topics in Microbiology and Immunology, 364, 307-317.
• Bonaparte, J. P., Ellis, D., Quinn, J. G., Ansari, M. T., Rabski, J., & Kilty, S. J. (2013). A comparative assessment of three formulations of botulinum toxin A for facial rhytides: a systematic review and meta-analyses. Systematic Reviews, 2, 40.
• Borodic, G. (2006). Immunologic resistance after repeated botulinum toxin type a injections for facial rhytides. Ophthalmic Plastic and Reconstructive Surgery, 22(3), 239-240.
• Burgen, A. S., Dickens, F., & Zatman, L. J. (1949). The action of botulinum toxin on the neuro-muscular junction. The Journal of Physiology, 109(1-2), 10-24.
• Carruthers, J. D. ve Carruthers, J. A. (1992). Treatment of glabellar frown lines with C. botulinum-A exotoxin. The Journal of Dermatologic Surgery and Oncology, 18(1), 17-21.
• Chu, S. J., Karabin, S., & Mistry, S. (2004). Short tooth syndrome: diagnosis, etiology, and treatment management. Journal of the California Dental Association, 32(2), 143-152.
• Coté, T. R., Mohan, A. K., Polder, J. A., Walton, M. K., & Braun, M. M. (2005). Botulinum toxin type A injections: adverse events reported to the US Food and Drug Administration in therapeutic and cosmetic cases. Journal of the American Academy of Dermatology, 53(3), 407-415.
• Critchfield, J. (2002). Considering the immune response to botulinum toxin. The Clinical Journal of Pain, 18(6 Suppl), S133-141.
• Davis, N. C. (2007). Smile design. Dental Clinics of North America, 51(2), 299-318, vii.
• Dolt, A. H. ve Robbins, J. W. (1997). Altered passive eruption: an etiology of short clinical crowns. Quintessence International, 28(6).
• Dressler, D., Adib Saberi, F., & Benecke, R. (2002). Botulinum toxin type B for treatment of axillar hyperhidrosis. Journal of Neurology, 249(12), 1729-1732.
• Duruel, O., Ataman-Duruel, E. T., Berker, E., & Tözüm, T. F. (2019). Treatment of Various Types of Gummy Smile With Botulinum Toxin-A. The Journal of Craniofacial Surgery, 30(3), 876-878.
• Dym, H. ve Pierre, R., 2nd (2020). Diagnosis and Treatment Approaches to a "Gummy Smile". Dental Clinics of North America, 64(2), 341–349.
• Erbguth, F. J. ve Naumann, M. (1999). Historical aspects of botulinum toxin: Justinus Kerner (1786–1862) and the “sausage poison”. Neurology, 53(8), 1850-1853.
• Ezquerra, F., Berrazueta, M. J., Ruiz-Capillas, A., & Arregui, J. S. (1999). New approach to the gummy smile. Plastic and Reconstructive Surgery, 104(4), 1143-1150; discussion 1151-1142.
• Fulton, J. E. (1998). Botulinum toxin. The Newport Beach experience. Dermatologic Surgery, 24(11), 1219-1224. Gadhia, K. ve Walmsley, A. D. (2009). Facial aesthetics: is botulinum toxin treatment effective and safe? A systematic review of randomised controlled trials. British Dental Journal, 207(5), E9; discussion 216-217.
• Garber, D. A. ve Salama, M. A. (1996). The aesthetic smile: diagnosis and treatment. Periodontology 2000, 11, 18-28.
• Garcia, A. ve Fulton Jr, J. E. (1996). Cosmetic denervation of the muscles of facial expression with botulinum toxin A dose‐response study. Dermatologic Surgery, 22(1), 39-43.
• Hwang, W. S., Hur, M. S., Hu, K. S., Song, W. C., Koh, K. S., Baik, H. S., . . . Lee, K. J. (2009). Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. The Angle Orthodontist, 79(1), 70-77.
• Ishida, L. H., Ishida, L. C., Ishida, J., Grynglas, J., Alonso, N., & Ferreira, M. C. (2010). Myotomy of the levator labii superioris muscle and lip repositioning: a combined approach for the correction of gummy smile. Plastic and Reconstructive Surgery, 126(3), 1014-1019.
• Jankovic, J. (2004). Botulinum toxin in clinical practice. Journal of Neurology, Neurosurgery, and Psychiatry, 75(7), 951-957.
• Jorgensen, M. G. ve Nowzari, H. (2001). Aesthetic crown lengthening. Periodontology 2000, 27, 45–58. Kessler, K. R., Skutta, M., & Benecke, R. (1999). Long-term treatment of cervical dystonia with botulinum toxin A: efficacy, safety, and antibody frequency. German Dystonia Study Group. Journal of Neurology, 246(4), 265-274.
• Klein, A. W. ve Mantell, A. (1998). Electromyographic guidance in injecting botulinum toxin. Dermatologic Surgery, 24(11), 1184-1186.
• Lang, A. M. (2002). Botulinum toxin therapy for myofascial pain disorders. Current Pain and Headache Reports, 6(5), 355-360.
• Lee, E. A. (2004). Aesthetic crown lengthening: classification, biologic rationale, and treatment planning considerations. Practical Procedures & Aesthetic Dentistry: PPAD, 16(10), 769-778; quiz 780.
• Leippold, T., Reitz, A., & Schurch, B. (2003). Botulinum toxin as a new therapy option for voiding disorders: current state of the art. European Urology, 44(2), 165-174.
• Litton, C. ve Fournier, P. (1979). Simple surgical correction of the gummy smile. Plastic Reconstructive Surgery, 63(3), 372-373.
• Majid, O. W. (2010). Clinical use of botulinum toxins in oral and maxillofacial surgery. International Journal of Oral and Maxillofacial Surgery, 39(3), 197-207.
• Mazzuco, R. ve Hexsel, D. (2010). Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. Journal of the American Academy of Dermatology, 63(6), 1042-1051.
• Michaels, B. M., Csank, G. A., Ryb, G. E., Eko, F. N., & Rubin, A. (2012). Prospective randomized comparison of onabotulinumtoxinA (Botox) and abobotulinumtoxinA (Dysport) in the treatment of forehead, glabellar, and periorbital wrinkles. Aesthetic Surgery Journal, 32(1), 96-102.
• Mostafa, D. (2018). A successful management of sever gummy smile using gingivectomy and botulinum toxin injection: A case report. International Journal of Surgery Case Reports, 42, 169-174.
• Naumann, M., Albanese, A., Heinen, F., Molenaers, G., & Relja, M. (2006). Safety and efficacy of botulinum toxin type A following long-term use. European Journal of Neurology, 13 Suppl 4, 35-40.
• Niamtu, J., 3rd. (2003). Botulinum toxin A: a review of 1,085 oral and maxillofacial patient treatments. Journal of Oral and Maxillofacial Surgery, 61(3), 317-324.
• Oliveira, A. T., Paes-Souza, S. A., Garcia, M. A. C., Mattos, C. T., & Nojima, M. (2021). Therapeutic effects of botulinum toxin type A in subjects with gummy smile: A longitudinal sEMG approach. International Orthodontics, 19(4), 652-658.
• Osako, M. ve Keltner, J. L. (1991). Botulinum A toxin (Oculinum) in ophthalmology. Survey of Ophthalmology, 36(1), 28-46.
• Park, K. S., Lee, C. H., & Lee, J. W. (2016). Use of a botulinum toxin A in dentistry and oral and maxillofacial surgery. Journal of Dental Anesthesia and Pain Medicine, 16(3), 151-157.
• Peck, S. ve Peck, L. (1995). Selected aspects of the art and science of facial esthetics. Seminars in Orthodontics, 1(2), 105-126.
• Pessa, J. E. (1992). Improving the acute nasolabial angle and medial nasolabial fold by levator alae muscle resection. Annals of Plastic Surgery, 29(1), 23-30.
• Polo, M. (2005). Botulinum toxin type A in the treatment of excessive gingival display. Am J Orthod Dentofacial Orthop, 127(2), 214-218; quiz 261.
• Polo, M. (2008). Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). American Journal of Orthodontics and Dentofacial Orthopedics, 133(2), 195-203.
• Rosenblatt, A. ve Simon, Z. (2006). Lip repositioning for reduction of excessive gingival display: a clinical report. The International Journal of Periodontics & Restorative Dentistry, 26(5), 433-437.
• Rubin, L. R. (1974). The anatomy of a smile: its importance in the treatment of facial paralysis. Plastic and Reconstructive Surgery, 53(4), 384-387.
• Rubin, L. R., Mishriki, Y., & Lee, G. (1989). Anatomy of the nasolabial fold: the keystone of the smiling mechanism. Plastic and Reconstructive Surgery, 83(1), 1-10.
• Scott, A. B. (1980). Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Journal of Pediatric Ophthalmology and Strabismus, 17(1), 21-25.
• Serrera-Figallo, M. A., Ruiz-de-León-Hernández, G., Torres-Lagares, D., Castro-Araya, A., Torres-Ferrerosa, O., Hernández-Pacheco, E., & Gutierrez-Perez, J. L. (2020). Use of Botulinum Toxin in Orofacial Clinical Practice. Toxins, 12(2), 112.
• Silberberg, N., Goldstein, M., & Smidt, A. (2009). Excessive gingival display--etiology, diagnosis, and treatment modalities. Quintessence International, 40(10), 809-818.
• Suber, J. S., Dinh, T. P., Prince, M. D., & Smith, P. D. (2014). OnabotulinumtoxinA for the treatment of a "gummy smile". Aesthetic Surgery Journal, 34(3), 432-437.
• Sucupira, E. ve Abramovitz, A. (2012). A simplified method for smile enhancement: botulinum toxin injection for gummy smile. Plastic and Reconstructive Surgery, 130(3), 726-728.
• Tan, E. K. ve Jankovic, J. (2000). Treating severe bruxism with botulinum toxin. Journal of the American Dental Association, 131(2), 211-216.
• Tinastepe, N., Küçük, B. B., & Oral, K. (2015). Botulinum toxin for the treatment of bruxism. Cranio : The Journal of Craniomandibular Practice, 33(4), 291-298.
• Tintner, R. ve Jankovic, J. (2001). Focal dystonia: the role of botulinum toxin. Current Neurology and Neuroscience Reports, 1(4), 337-345.
• Tjan, A. H., Miller, G. D., & The, J. G. (1984). Some esthetic factors in a smile. The Journal of Prosthetic Dentistry, 51(1), 24-28.
• Whelchel, D. D., Brehmer, T. M., Brooks, P. M., Darragh, N., & Coffield, J. A. (2004). Molecular targets of botulinum toxin at the mammalian neuromuscular junction. Movement Disorders, 19 Suppl 8, S7-s16.