- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04030767
Evaluating Lip Repositioning for the Treatment of Excess Gingival Display With and Without Pretreatment With Botox
Evaluating Lip Repositioning for the Treatment of Excess Gingival Display With and Without Pretreatment With Botox: a Randomized Clinical Trial
Since the introduction of the lip repositioning procedure by a number of modifications to the technique have been introduced. All these modifications were made to prevent the main complication of lip repositioning surgeries 'relapse'. Relapse was found to occur in 8% of the cases treated .
Botox injections have been suggested as a possible treatment for cases with relapse Botox acts by blocking muscular activity, however, Botulinum toxin technique has a transitory effect (6-7 months). . By combining Botox as a pretreatment and lip repositioning surgery, Botox injections maybe a useful adjunct in improving and stabilizing the results of achieved, by paralyzing the muscles during the healing period.
There are no studies, to the investigator's knowledge, exploring the use of botox combined with lip repositioning to decrease muscle pull and therefore decrease the relapse.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Normal gingival display has been defined by as the gum exposure between the inferior border of upper lip and gingival margin of anterior central incisors when smiling. An exposure of gingiva around 0-2 mm when smiling, and 2-4 mm of the maxillary incisor edges when the lips are at the rest state are considered as acceptable. While more than 2 mm of gingival exposure when a person smiles is stated by experts as an excessive gingival display, or what is known as "Gummy Smile",which is more of a descriptive term than a diagnosed condition, and affects a notable proportion of the population, especially women who are affected more than men.
Many studies have stated the main causes of excessive gingival display, presenting the most important factors which may lead to having a gummy Smile. The study of Roe described that lip length and the upper lip mobility rate are the main contributing factors. The previous research stated that the exposure of teeth and gingiva depends on the integrated effects of a number of variables (increased muscle capacity, vertical maxillary excess, greater inter-labial gap at resting position, and the amount of over-jet and over-bite). Pausch & Katsoulis mentioned that abnormal gingival and maxillary anterior teeth display may take place due to numerous anatomic or functional factors, either hereditary or inborn. A narrow upper lip, an irregular eruption of teeth, excessive protuberance or vertical maxillary growth, and hypermobility of the maxillary lip and elevator muscle are common reasons for a gummy Smile. In fact, several contributing factors are affecting individuals to have a gummy Smile. Sometimes one of them is presented, although in some cases more than only one cause can be seen. Correct diagnosis of the reason leads to a proper treatment plan.
Excessive gingival display can be managed by a variety of procedures. These procedures include surgical and non-surgical methods The underlying cause of excessive gingival display or gummy Smile has the main effect on the type of procedure that will be performed.
Study Type
Enrollment (Anticipated)
Phase
- Phase 1
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Gummy smile more than 3mm.
- Adults >18 years.
- Non-smokers.
- Patients with healthy systemic condition
- Normal clinical crown dimensions.
- Good oral hygiene.
Exclusion Criteria:
- Natural dentition upper anterior
- Pregnant or lactating women.
- Patients with inflamed gingiva or gingival enlargement.
- Inflammation or infection at the site of injection.
- Patients with allergy to botulinum toxin, lactose, and albumin.
- Concurrent use of aminoglycoside antibiotic that enhances the action of the toxin. (Jaspers, Pijpe, & Jansma, 2011)
- < 3 mm attached gingivae that might create difficulties in flap design, stabilization and suturing.
- Patients using anticholinesterase or other agents interfering with neuromuscular transmission
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: lip repositioning technique with Botox injection.
Botulinum toxin produces partial chemical denervation of the muscle resulting in localized reduction in muscle activity (Binder et al., 1998). Therefore, the technique is a useful adjunct in the esthetic improvement of the smile and provides better results when combined with resective gingival surgery(Pedron & Mangano, 2018). |
Botulinum toxin produces partial chemical denervation of the muscle resulting in localized reduction in muscle activity
Other Names:
|
Active Comparator: lip repositioning technique.
Lip repositioning aims to limit the retraction of elevator smile muscles.
Lip repositioning results in a shallow vestibuler restricting of the muscle pull; Thereby limiting the gingival display during smiling.(Makkiah,
2017) It is a less invasive, viable substitute for patients, has fewer post-operative complications and provides a faster recovery compared to orthognathic surgery(Grover, Gupta, & Luthra, 2014).
|
Botulinum toxin produces partial chemical denervation of the muscle resulting in localized reduction in muscle activity
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
change in amount of gingival display
Time Frame: recorded at baseline, 3, 6 ,9 months and 1 year
|
Amount of gingival display (from the inferior border of the upper lip vermillion border to the gingival margin of the central incisor) will be assessed from clinical photographs obtained during active smile, with a mm ruler in place
|
recorded at baseline, 3, 6 ,9 months and 1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient satisfaction: quesionnaire
Time Frame: o The level of satisfaction during the followed periods (after two weeks, after two months, after six months)
|
On the first follow-up visits, each patient from both groups answered a questionnaire addressing the following aspects:
|
o The level of satisfaction during the followed periods (after two weeks, after two months, after six months)
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2261986
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Gingival Overgrowth
-
Tokat Gaziosmanpasa UniversityCompletedGingival EnlargementTurkey
-
University of BaghdadRecruitingThickening; GingivalIraq
-
National Institute of Dental and Craniofacial Research...CompletedGingival OvergrowthUnited States
-
University of GuarulhosCompletedGingival OvergrowthBrazil
-
Tokat Gaziosmanpasa UniversityCompletedGingival Recession | Gingival EnlargementTurkey
-
T.C. Dumlupınar ÜniversitesiCompletedGingival Overgrowth
-
Alexandria UniversityCompletedGingival EnlargementEgypt
-
Panineeya Mahavidyalaya Institute of Dental Sciences...CompletedGingival OvergrowthIndia
-
University of Rome Tor VergataCompletedOrthodontic Appliance Complication | Gingival OvergrowthItaly
-
The University of Hong KongUnknown
Clinical Trials on Botox Injectable Product
-
Assiut UniversityCompletedOsteoarthritis Knees BothEgypt
-
Nova Scotia Health AuthorityDalhousie UniversityActive, not recruiting
-
Cairo UniversityRecruitingMyofascial Pain Syndrome | Myofascial Trigger Point PainEgypt
-
Mansoura UniversityCompletedPain | Haemorriodectomy | Anal SphincterotomyEgypt
-
Psoriasis Treatment Center of Central New JerseySun Pharmaceutical Industries LimitedUnknown
-
Tang-Du HospitalRecruitingMyasthenia Gravis, GeneralizedChina
-
University of UtahCompletedSynkinesis | Facial Asymmetry | Facial Nerve Injuries | Facial Paresis Associated With Facial Nerve Dysfunction
-
Federal University of PelotasCompleted
-
Hospital Israelita Albert EinsteinMinistry of Health, BrazilCompletedSpinal Muscular AtrophyBrazil