To evaluate the effect and longevity of Botulinum toxin type A (Botox®) in the management of gummy smile - A longitudinal study upto 4 years follow-up.

Aim: the current study was aimed (1) To study the effect of Botulinum toxin (BT) A on gummy smile (2) To determine the efficacy, predictability & longevity of the effect of Botox® in the management of gummy smile and lastly (3)To identify the treatment groups for Botox® as a single modality for the non-surgical treatment of gummy smile.

Material And Method: only patients who were willing to get the treatment done with Botox® injection were enrolled in the study, irrespective for the need for the surgery. Thus, total of 32 patients were divided into two groups, group 1, having a gummy smile with less than 5 ​mm who were treated with 3 units of Botox® and group II, having gummy smile of more than 5 ​mm who were treated with 5 units of Botox® and each group underwent 2 cycles of injection 7 months apart given at the Yonsei's point and were followed for a period of 14 months.

Results: the procedure was tolerated well by the patients; none developed any allergic reaction or antibodies related to BT. In the less that 5 ​mm and more than 5 ​mm of gingival show group the results remain excellent till 3 months after which gummy smile gradually reaches to the baseline levels. Significant changes start to reappear by the 5th month.

Conclusion: Authors recommend use of BT for the treatment of gummy smile as the technique is safe, economical and easy to use. Though not long lasting, it may motivate patients to go for surgical procedure, mainly who have gummy smile of more than 5 ​mm because of maxillary vertical excess.