Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-03-13, 09:28:55 | version 1.38.0
| case report Surgical crown lengthening and botulinum toxin in the manage- ment of the orthodontic patient with gummy smile Dr Irineu Gregnanin Pedron, Brazil Introduction The demand for cosmetic procedures has grown expo- nentially. Dental procedures, as well as medical ones, besides working to obtain the principle of health promo- tion, seek to achieve smile aesthetics, as the smile is a form of communication and social expression of many feelings.1–3 Facial aesthetic harmony correlates directly with the smile and this, in turn, is formed by the union of three com- ponents: teeth, gingivae and lips.1–4 The smile becomes aesthetically pleasing when these elements are disposed in suitable proportion and exposure of the gingival tissue is limited to 3 mm. When the gingival exposure is greater than 3 mm, it characterises the unaesthetic condition called gummy smile, which affects some patients psy- chologically.1, 3, 5–8 Several therapeutic modalities have been proposed for the correction of gummy smile, among them gingivec- tomy or gingivoplasty,1–3, 5, 6, 8 myectomy6, 8 and orthog- nathic surgery.6, 8, 9 The last two procedures are more invasive and associated with high morbidity.7 In contrast, the use of botulinum toxin can be considered a therapeu- tic alternative to surgery, because it is a more conserva- tive method, more effective, faster and safer than surgi- cal procedures.5, 10 Botulinum toxin is synthesised by the Gram-positive anaerobic bacterium Clostridium botulinum and inhib- its the release of acetylcholine at the neuromuscular junction, preventing muscle contraction3, 6, 8, 9. There are seven distinct serotypes of toxins, A, B, C1, D, E, F and G. However, the subtype A is the most frequently used clinically and the most powerful.3, 6 with other disorders, such as temporomandibular dis- orders (hypertrophy of the masseter muscle, bruxism, clenching) and myofascial pain.3, 6, 9 The purpose of this article is to report on a case of a patient who presented with gummy smile and was treated with a combination of surgical crown lengthening (gingivoplasty) and applica- tion of botulinum toxin. Case report A 27-year-old African-descendant female patient attended the clinic with the complaint of gummy smile (Fig. 1). Clinically, the patient had an anatomical discrep- ancy between the length of the anterior teeth and evi- dent gingival exposure greater than 3 mm, character- ising gummy smile (Fig. 2a). Chu’s Proportion Gauge (Hu-Friedy, Chicago, US) was used to measure the length of the teeth (Fig. 2b). Surgical crown lengthening (gingivoplasty) was pro- posed and later, after the presentation of the results, the application of botulinum toxin for the correction of gummy smile. However, the patient was informed about the recurrence of gingival smile six months after appli- cation, because of its temporary result. Under local infil- trative anaesthesia, bleeding points were determined with the aid of a millimetred probe and the union of these points was performed with electrocautery.2 The length of the teeth was increased, characterising the dental zenith. Subsequently, the scraping was performed, resembling the technique of external bevel gingivectomy, in order to enhance tissue healing. There was no need for the use of surgical cement, given that wound healing would occur by secondary intention. The patient reported no com- plaints or complications after surgery. Botulinum toxin has been shown to be effective in the treatment of gummy smile in patients with hyperfunction of the muscles involved in smiling, as well as in patients At the subsequent consultation 30 days later, the orthodontic appliance was removed and satisfactory tissue repair was observed (Fig. 3), and no changes or complaints were reported by the patient. However, 10 ortho 1 2018