Gummy smile, also known as excessive gingival display, is a smile that shows gum under the upper lip. It is a common clinical condition, which can be caused by an abnormal dental eruption (delayed passive eruption), hyperfunction of the upper lip elevator muscle, excessive vertical growth of the maxilla bone, over-eruption of the maxillary anterior teeth, or a combination of the above described factors. [1] [2] Several treatment options have been proposed to enhance the smile display and to reduce the gingival exposure. [3]
Treatment option include orthodontics, [4] surgery (gingivectomy), [5] botulinum toxin A injections, [6] and micro-autologous fat transplantation (MAFT). [7]
Botox is considered one of the safest and most widely used injectables. Botox (BTX-A) has been successful in the treatment of gummy smiles. Botox lip flip can last for an average of 6 months. [8] The material is injected into the hyperactive muscles of upper lip, which causes a reduction in the upward movement of lip thus resulting in a smile with a less exposure of gingiva. [9] Botox is usually injected in the three lip elevator muscles that converge on the lateral side of the ala of the nose; the levator labii superioris (LLS), the levator labii superioris alaeque nasi muscle (LLSAN), and the zygomaticus minor (ZMi). [10]
Botulism is a rare and potentially fatal illness caused by botulinum toxin, which is produced by the bacterium Clostridium botulinum. The disease begins with weakness, blurred vision, feeling tired, and trouble speaking. This may then be followed by weakness of the arms, chest muscles, and legs. Vomiting, swelling of the abdomen, and diarrhea may also occur. The disease does not usually affect consciousness or cause a fever.
Botulinum toxin, or botulinum neurotoxin, is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromuscular junction, thus causing flaccid paralysis. The toxin causes the disease botulism. The toxin is also used commercially for medical and cosmetic purposes. Botulinum toxin is an acetylcholine release inhibitor and a neuromuscular blocking agent.
Piriformis syndrome is a condition which is believed to result from nerve compression at the sciatic nerve by the piriformis muscle. It is a specific case of deep gluteal syndrome.
The lips are a horizontal pair of soft appendages attached to the jaws and are the most visible part of the mouth of many animals, including humans. Vertebrate lips are soft, movable and serve to facilitate the ingestion of food and the articulation of sound and speech. Human lips are also a somatosensory organ, and can be an erogenous zone when used in kissing and other acts of intimacy.
The zygomaticus minor muscle is a muscle of facial expression. It originates from the zygomatic bone, lateral to the rest of the levator labii superioris muscle, and inserts into the outer part of the upper lip. It draws the upper lip backward, upward, and outward and is used in smiling. It is innervated by the facial nerve (VII).
The mentalis muscle is a paired central muscle of the lower lip, situated at the tip of the chin. It originates from the mentum of the mandible, and inserts into the soft tissue of the chin. It is sometimes referred to as the "pouting muscle" due to it raising the lower lip and causing chin wrinkles.
The facial artery, formerly called the external maxillary artery, is a branch of the external carotid artery that supplies blood to superficial structures of the medial regions of the face.
The superior tarsal muscle is a smooth muscle adjoining the levator palpebrae superioris muscle that helps to raise the upper eyelid.
The marginal mandibular branch of the facial nerve arises from the facial nerve in the parotid gland at the parotid plexus. It passes anterior-ward deep to the platysma and depressor anguli oris muscles. It provides motor innervation to muscles of the lower lip and chin: the depressor labii inferioris muscle, depressor anguli oris muscle, and mentalis muscle. It communicates with the mental branch of the inferior alveolar nerve.
Ptosis, also known as blepharoptosis, is a drooping or falling of the upper eyelid. This condition is sometimes called "lazy eye", but that term normally refers to the condition amblyopia. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism, so it is especially important to treat the disorder in children before it can interfere with vision development.
Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.
Synkinesis is a neurological symptom in which a voluntary muscle movement causes the simultaneous involuntary contraction of other muscles. An example might be smiling inducing an involuntary contraction of the eye muscles, causing a person to squint when smiling. Facial and extraocular muscles are affected most often; in rare cases, a person's hands might perform mirror movements.
Levator ani syndrome is a condition characterized by burning pain or tenesmus of the rectal or perineal area, caused by spasm of the levator ani muscle. The genesis of the syndrome is unknown; however, inflammation of the arcus tendon is a possible cause of levator ani syndrome.
A gum lift is a cosmetic dental procedure that raises and sculpts the gum line. This procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or symmetrical teeth, thereby making the smile more aesthetically pleasing. This procedure is typically done to reduce excessively gummy smiles or to balance out an asymmetrical gum line. The procedure, also known as crown-lengthening, has historically been used to treat gum disease. It is only within the past three to five years that dentists have commonly used this procedure for aesthetic purposes. The practice of cosmetic gum lifts was first developed in the late 1980s, but there were few oral surgeons and dental practitioners available to perform the procedures. Gum lifts can also include bone shaping to reduce the prominence of the upper jaw and even out the tooth and gum ratio. This method provides permanent results, while simple gum contouring may result in relapse or regrowth of the gingiva.
Botulinum toxin therapy of strabismus is a medical technique used sometimes in the management of strabismus, in which botulinum toxin is injected into selected extraocular muscles in order to reduce the misalignment of the eyes. The injection of the toxin to treat strabismus, reported upon in 1981, is considered to be the first ever use of botulinum toxin for therapeutic purposes. Today, the injection of botulinum toxin into the muscles that surround the eyes is one of the available options in the management of strabismus. Other options for strabismus management are vision therapy and occlusion therapy, corrective glasses and prism glasses, and strabismus surgery.
The management of strabismus may include the use of drugs or surgery to correct the strabismus. Agents used include paralytic agents such as botox used on extraocular muscles, topical autonomic nervous system agents to alter the refractive index in the eyes, and agents that act in the central nervous system to correct amblyopia.
William J. Binder is an American facial plastic surgeon. He is best known for his 1992 discovery of the use of Botox to alleviate chronic migraine.
Laser gingivectomy is a dental procedure that recontours or scalpels the gingival tissue to improve long term dental health or aesthetics. Compared to conventional scalpel surgery, soft-tissue dental lasers, such as laser diode, Nd:YAG laser, Er:YAG laser, Er,Cr:YSGG laser, and CO2 lasers, can perform this procedure, offering a precise, stable, bloodless, often less painful, and accelerated healing experience. However, the laser diode gained more popularity due to its versatility, less interaction with hard tissue, ease of use, and the less expensive set up.
Alan Brown Scott was an American ophthalmologist specializing in eye muscles and their disorders, such as strabismus. He is best known for his work in developing and manufacturing the drug that became known as Botox, research described as "groundbreaking" by the ASCRS.
Lip flip is a cosmetic procedure that modifies the shape of the lips using botulinum neurotoxin type A and occasionally adding hyaluronic acid fillers. The procedure is performed in order to increase the size of the lips. The procedure typically involves injection of the neurotoxin along the vermilion border of the lips. This leads to a relaxation of the underlying muscle and eversion of the lip. Hyaluronic acid fillers are sometimes added in order increase volume in the lips.
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