الفهرس 
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Abstract
This randomized clinical trial was conducted to assess the longevity of repeated injection of botulinum toxin A for correction of excessive gingival display due to hypermobile lip and mild VME as well as assessment of patient satisfaction of both procedure and results.
eighteen adult female patients with more than 3 mm gingival display were recruited for this study from the outpatient clinic of the Orthodontic Department, Faculty of Dentistry, Ain Shams University. The sample was equally divided into two groups. Both groups were treated with a similar protocol of injection of botulinum toxin A except for that group I received two injections that were four months apart where the assessment of results were made 4 month after the 2nd injection, while group II received three injections that were 4 months apart where the final assessment was made four months after the third injection, as well as patient satisfaction questionnaires for both groups that included questions about the pain encountered during the intervention and symptoms of inflammation post operatively as well as satisfaction by results presenting as reduction of gummy smile and willingness to repeat the intervention if needed.
For anterior gummy smile, botulinum toxin A (xeomin, incobotulinum A) was injected in the Yonsei point while for posterior gummy smile it was injected at a point 1 cm away from the commissures, the number of units was 2.5 U for mild gummy smile less than 5 mm and 5 U were used for more extensive gummy smile.
Assessment of treatment results were done using standardized 2D photographs of maximum smile. The resting as well as maximum smile photographs were acquired at T0 “before injection” and T1 “14 days after 1st injection”, T2 “4 month after 1st injection”, T3” 14 days after 2nd injection”, T4” 4 months after 2nd injection”, T5 “14 days after 3rd injection” and T6” 4 months after 3rd injection”. The standardized digital photographs were used to assess the effect of treatment on the amount of reduction of gingival display.
Both groups showed a statistically significant reduction in the amount of gingival display at T1, T3 for both groups and at T5 for the second group, there was no statistically significant difference between two groups at T0 to T4, for group 1 there was no statistically significant difference between mean gingival display at T0, T2 and T4. for group 2 The mean gingival display at T6 showed statistically significantly lower value compared to gingival display at T0.
Regarding upper lip mobility, at T0, T1, T2, T3 as well as T4, there was no statistically significant difference between mean upper lip length mobility measurements between the two groups. Both groups showed a statistically significant reduction in upper lip mobility at T1, T3 for both groups and at T5 for the second group, for group 1 there was no statistically significant difference between mean upper lip mobility at T0, T2 and T4. However, for group 2 at T6 showed statistically significantly lower value compared to gingival display at T0.
As for upper lip length reduction, at T0, T1, T2, T3 as well as T4, there was no statistically significant difference in mean upper lip length reduction measurements between the two groups, Both groups showed a statistically significant reduction in upper lip length reduction at T1,T3 for both groups and at T5 for the second group, for group 1 there was no statistically significant difference between mean upper lip length reduction at T0, T2 and T4. However, for group 2 the at T6 showed statistically significantly lower value compared to upper lip length reduction at T0.
Regarding survey results, only 12.5% of participants felt dizzy or sick during or after injection. About one fifth of participants (18.8%) felt cold-like symptoms after injection. None of the participants had extensive allergy that required medical attention. The majority of participants (87.5%) agreed to repeat Botox injection if needed.