الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Excessive Gingival Display (EGD) is a common feature where
many patients find it displeasing and hence seek treatment to
enhance it. Lip repositioning surgery was introduced as a solution
for elimination of EGD caused by hyperactive lip. However,
relapse was shown to occur despite it was not adequately reported
in literature. Moreover, all published literature was case studies
and lacked long term follow-up for the cases. The aim of our
research is to assess the relapse resulting from the lip
repositioning surgery and the adjunctive use of BTX-A injections
with the surgery, provided with a long term follow-up.
Twenty patients were allocated and divided randomly into two
groups. The study group had BTX-A injections followed by lip
repositioning surgery while the control group underwent the
surgery alone. All patients were planned to undergo standardized
photographic assessment pre-operative, one, three, six and nine
months post-operative. Nine measurements had been performed
for the patients including the amount of gingival display and
consequent soft tissue changes.
The results showed significant decrease in amount of gingival
display in both groups in one and three month post-op. Yet the
amount of gingival display started to show relapse in the six
month post-op follow-up in the control group, in comparison to
the study group which showed relapse in the nine month post-op
follow-up.
Other soft tissue measurements showed significant changes in the
control group as outer lip length during smiling and vermillion
Summary and Conclusion
91
height at both rest and smiling. On the other hand, most of those
measurements changes were not significant in the study group.
Conclusion:
Excessive Gingival Display (EGD) etiology should be
well diagnosed to decide which treatment option is most
suitable for the patient.
Hyperactive lip as a cause for EGD has a controversial
management, and more studies are needed to detect which
line of the treatment is the most effective. Lip
repositioning surgery is a simple and less aggressive
procedure to be done in those cases. However, long term
results showed near complete relapse with the procedure.
Adjunctive use of Botulinum toxin injections with the
surgery did not add benefit regarding the amount of
gingival display after surgery. However, it showed to
decrease the soft tissue changes caused by the surgery.
Moreover, it delayed the relapse to be in the nine months
post-op instead of six months post-op