Botox as an adjunct to lip repositioning for the management of excessive gingival display in the presence of hypermobility of upper lip and vertical maxillary excess

Lobna Abdel Aziz Aly Abdel Aziz Aly, Nelly Ibrahim Hammouda



Background: Excessive gingival display (GD) is a frequent finding that can occur because of various

intraoral or extraoral etiologies. This work describes the use of a mucosal repositioned flap for the

management of a gummy smile associated with vertical maxillary excess (VME) and hypermobility

of the upper lip followed by injection of Botox.

Materials and Methods: Seven female patients in the age range of 17–25 years presented with a gummy

smile. At full smile, the average GD ranged from 6 to 8 mm. A clinical examination revealed hypermobility

of the upper lip. A cephalometric analysis pointed to the presence of VME. The mucosal repositioned flap

surgery was conducted followed by injection with botulinum toxin type A (Botox) 2 weeks postsurgically.

Results: After 4 weeks, results were definitely observed with a decrease from 8 mm gingival

exposure to 3 mm, which was considered as normal GD for an adult during smiling.

Conclusion: For patients desiring a less invasive alternative to orthognathic surgery, the mucosal

repositioned flap is a viable alternative. Moreover, Botox is a useful adjunct to enhance the esthetics

and improve patient satisfaction where surgery alone may prove inadequately in moderate VME.

Key Words: Botox, gum, smiling, lip, repositioning

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