PMC5985251_01
Sever gingival display during smiling.
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A 24 year old female patient presented to the periodontal clinics, in our institution with the chief complaint of excessive gingival display during smiling (as shown in Fig. 1) which affected her confidence and physiological state and corresponding to that she used to hide her smile by her hands.
The incisor display at rest position.
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While, the incisor display at rest position measured from upper lip to incisal edges of maxillary incisors was 6 mm (Fig. 2).
a: Immediately after gingivectomy. b: 1 week postoperatively. c: 2 months postoperatively.
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The results are presented in Fig. 3a-c.
a: The sites of injections of total 20 units of BT. b: After 5 days of first visit of Botox injection. c: After 14 days of 20 units of Botox injection.
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The injections were done on 2 sites; the first site, 4 units were injected on each side of the nasolabial fold, 1 cm lateral and below the nasal ala -Yonsei point - while on the second site, 2 units were injected on each side of nasolabial fold, at the point of the greatest lateral contraction during the smile as shown in Fig. 4a. Five days later, the patient was re-evaluated as the exposed area of gingiva decreased 5 mm as shown in Fig. 4b. She desired more esthetic smile, so another two doses of Botox were injected to the following sites, 2 units below the nose, two-thirds above the lip on each the ridge of the philtrum (orbicularis oris muscle) and another 2 units beside of nasolabial fold, besides the point of the greatest lateral contraction during the smile (Fig. 4a). The patient was reviewed after two weeks and the results showed a definite change upon smiling where the gingival display decreased to 1 mm, which is seen in Fig. 4c.