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Am J Orthod Dentofacial Orthop. 2005 Feb;127(2):214-8; quiz 261.

Botulinum toxin type A in the treatment of excessive gingival display.

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Department of Surgery, San Jorge Children's Hospital/Plastic and Reconstructive Center, 702 La Torre de Plaza, 525 F.D. Roosevelt Avenue, San Juan, Puerto Rico 00918-0702, USA.



One cause of excessive gingival display is the muscular capacity to raise the upper lip higher than average. Several surgical procedures have been reported to improve the condition, but surgery always involves risk and is costly. Botulinum toxin type A (BTX-A) (Botox; Allergan, Irvine, Calif) has been studied since the late 1970s for the treatment of several conditions associated with excessive muscle contraction or pain. This clinical pilot study was performed to determine whether BTX-A injections would reduce excessive gingival display.


Five subjects with excessive gingival display due to hyperfunctional upper lip elevator muscles were treated with BTX-A injections.


This treatment modality was effective, producing esthetically acceptable smiles in these patients. The improvements lasted 3 to 6 months.


Injection with BTX-A at preselected sites is a novel, cosmetically effective, minimally invasive alternative for the temporary improvement of gummy smiles caused by hyperfunctional upper lip elevator muscles.

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