This treatment may give patients the prettiest smile

For treating a gummy smile, orthognathic surgery may result in greater improvements in attractiveness compared to botulinum toxin (BTX). The study was recently published in the Journal of Cranio-Maxillofacial Surgery.

Despite being more invasive, orthognathic surgery with impacted upper jaw teeth offers permanent improvements in smile attractiveness, the authors wrote.

"There was a significant improvement in smile attractiveness with treatment in both groups; however, the improvement was significantly better in the surgical group than in the BTX group," wrote the authors, led by Daniela Bezerra de Menezes Borba of the Ingá University Center Department of Orthodontics in Brazil (J Craniomaxillofac Surg, June 10, 2024).

For the study, the retrospective sample included 26 patients who were divided into two groups. The  BTX group consisted of 13 patients with an average gingival exposure during smiling of 5.18 mm and who were treated with BTX. The surgical group consisted of 13 patients with an average gingival exposure during smiling of 5.21 mm who were treated with orthognathic maxillary impaction surgery, according to the study.

The evaluators were 143 orthodontists, 62 dentists, and 112 laypeople. The evaluators, unaware of the treatment type, rated photographs of posed smiles taken before and after treatment through a questionnaire, they wrote.

Initially, the surgical group had significantly lower smile attractiveness compared to the BTX group, likely due to their slightly larger gummy smiles. After treatment, the surgical group exhibited significantly more attractive smiles than the BTX group, they wrote.

Furthermore, this greater attractiveness in the surgical group may be attributed to the dental alignment achieved through orthodontic treatment before surgery, the study's authors wrote. The study had limitations. The sample was obtained retrospectively, which limits the study, as it prevents the assessment of patient satisfaction with both treatments, the authors added.

"Notably, the orthodontic-surgical treatment provided a more attractive smile at the end of the treatment," they wrote