J Dent Rehabil Appl Sci.  2021 Jun;37(2):61-72. 10.14368/jdras.2021.37.2.61.

Treatment of gummy smile using botulinum toxin: a review

  • 1Department of Orofacial Pain and Oral Medicine, Yonsei University College of Dentistry, Seoul, Republic of Korea


A beautiful smile is made when it is symmetrical and gums are displayed less than 2 - 3 mm. Excessive gingival display also known as “gummy smile” is often recognized to be unaesthetic. Causes of gummy smile can be caused by delayed eruption, vertical maxillary excess, hypermobile upper lip, or a short upper lip. Meanwhile botulinum toxin which is an exotoxin produced from Clostridium botulinum, works by blocking the release of acetylcholine from the cholinergic nerve end plates leading to inactivity of the muscles.The application site and weakens the muscle tone is drawing attention as a gummy smile treatment caused by hypermobile upper lip. There have been many studies about the method of injecting botulinum toxin into muscles around the lips, but there is still no standardized research method and treatment method, so there is controversy over the therapeutic effect. The aim of this study is to review the previous studies about the predictors of indication and effects of gummy smile treatment using botulinum toxin injection. Especially we tried to propose a protocol for optimal dose and efficient injection point through the anatomical considerations for gummy smile treatment using botulinum toxin.


gummy smile; lip; botulinum toxin; cosmetic; aesthetic; gingivectomy


  • Fig. 1 Flow diagram of the study selection process.

  • Fig. 2 Main muscle involved in gingival exposure.

  • Fig. 3 Recommended injection point for gummy smile treatment. Usually it is located 1 centimeter lateral from ala of nose.



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