Clinical Research Directory

Botulinum Toxin Type A Versus Cross-Linked Hyaluronic Acid Filler Myomodulation for Non-Surgical Management of Excessive Gingival Display: A Randomized Controlled Trial

This randomized controlled trial compared the clinical efficacy and patient satisfaction of two non-surgical treatments for excessive gingival display (gummy smile): botulinum toxin type A (BTX-A) and cross-linked hyaluronic acid (HA) filler myomodulation. Excessive gingival display is defined as exposure of 3 mm or more of gingival tissue during maximal smiling. It affects approximately 14% of women and 7% of men and is associated with reduced self-confidence, smile suppression in social settings, and impaired quality of life. When caused by hyperactivity of the upper lip elevator muscles, it can be treated without surgery using injectable therapies. Twenty patients (18 females, 2 males; age 18-45 years) with excessive gingival display greater than 3 mm were randomly allocated 1:1 to one of two groups. Group A (n=10) received bilateral injections of botulinum toxin type A (Refinex; 5 IU per side) at the Yonsei point. Group B (n=10) received cross-linked hyaluronic acid filler (Juvederm Voluma with lidocaine; 1.0 mL total) injected at six periosteal sites around the nose and upper lip using a myomodulation technique. Participants were assessed at baseline and at 1, 3, and 6 months after treatment. The primary outcome was maximum gingival display measured in millimeters using a calibrated periodontal probe. Secondary outcomes included patient satisfaction measured by Visual Analog Scale and a 12-item questionnaire, and adverse event monitoring. Both treatments produced equivalent gingival display reductions at one month (BTX-A: 69.6%; HA: 63.0%). At six months, the HA group maintained a statistically significant 26.4% improvement while the BTX-A group showed near-complete relapse. Despite this, BTX-A patients reported higher categorical satisfaction. Both treatments had excellent safety profiles.

EMG-guided Botox Injection Versus Conventional Botox Injection in Gummy Smile Patients

The goal of this clinical trial is to compare the effect of EMG-guided Botox injection with conventional Botox injection in Yonsei point, in patients with excessive gingival display. The main question it aims to answer is: • Does the use of electromyography (EMG) as a guide during Botox injection for patients with gummy smile has better effect than conventional injection in Yonsei point? Participants will be randomized in equal proportions between intervention and control groups. * Preoperative assessment of amount of gingival display, lip length (philtrum and vermilion length), and smile type. * For the intervention group, EMG readings will be done in Clinical Neurophysiology Department, Kasr Al-Ainy Hospital EMG-guided Botox injection (Intervention group). Conventional Botox injection in Yonsei point (Control group).

The Effect Of Botox In Patients With Gummy Smile With And Without Zinc And Phytase Supplementation.

Participants with esthetic concern of excessive gingival display who meets the inclusion criteria, will be carried out including history taking, clinical examination and initial therapy. The initial therapy will consist of periodontal treatment (phase I therapy) including supragingival scaling, subgingival debridement if needed. The mechanical plaque control instructions for each patient include brushing and interdental cleaning techniques. Patients who have inadequate crown length and width ratio or short clinical crown will receive esthetic crown lengthening procedure to adjust gingival levels before being included in this study. Patients in the intervention group I will take zinc gluconate 50 mg 1 per day to increase zinc level with phytase supplement 176mg (800FTU) 2 tablets per day to give the maximum absorption of zinc, both supplements will be given for 4 days before botulinum toxin injections. Patients in the intervention group II will take zinc gluconate 50 mg 1 per day to increase zinc level, 4 days before botulinum toxin injections. Patients in the control group will receive the Botulinum toxin injections only Clinical photographs will be taken at baseline, 2 weeks, 1 month, 3 months postoperatively.