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Meta-Analysis
. 2022 Jan;26(1):109-117.
doi: 10.1007/s00784-021-04223-w. Epub 2021 Oct 15.

Effect and longevity of botulinum toxin in the treatment of gummy smile: a meta-analysis and meta-regression

Aline Cristina Soares Zengiski  1 , Isabela Bittencourt Basso  2 , Bianca L Cavalcante-Leão  3 , José Stechman-Neto  3 , Rosane Sampaio Santos  3 , Odilon Guariza-Filho  4 , Bianca Simone Zeigelboim  3 , Karinna Veríssimo Meira Taveira  5 , Cristiano Miranda de Araujo  6
Affiliations
Meta-Analysis

Effect and longevity of botulinum toxin in the treatment of gummy smile: a meta-analysis and meta-regression

Aline Cristina Soares Zengiski et al. Clin Oral Investig. 2022 Jan.

Abstract

Objective: The aim of this systematic review is to synthesize the evidence on the effectiveness and longevity of the botulinum toxin in the treatment of individuals with excessive gingival exposure.

Methods: The search was adapted to six electronic databases and gray literature. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool for Non-Randomized and Randomized Studies of Interventions. Meta-analyses and meta-regression were performed using random effects models.

Results: A total of 5247 articles were collected during the final search in the database, resulting in 17 articles included. There was a mean decrease of 3.42 mm [95% CI = -4.50 to -2.34; I2 = 97%] in the level of gingival exposure 2 weeks after the application of botulinum toxin. The application time explained 29.58% of the observed variance (p < 0.001), with a tendency for the effect size to decrease from the second week of application onwards, with values returning close to baseline levels in 24 weeks.

Conclusion: Botulinum toxin is an alternative technique considered effective for reducing gummy smile, especially for gummy smiles up to 4 mm, with a longevity of at least 12 weeks, returning close to initial values within 24 weeks after application.

Clinical relevance: The knowledge about the longevity and effectiveness of botulinum toxin in the treatment of gummy smile allows for a more adequate clinical planning for these cases, as well as for clinical decisions, as for prognostic factors.

Keywords: Botulinum toxins, Type A; Gummy smile; Longevity; Meta-analysis.

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