Evaluating Lip Repositioning for the Treatment of Excess Gingival Display with and without Pretreatment with Botox: A Randomized Clinical Trial.

Objectives: To evaluate and compare the treatment of excessive gingival display (EGD) with lip repositioning surgery (LRS), with or without presurgical Botox injection, using relapse as the primary outcome.

Materials and methods: Twenty-two periodontally healthy patients with EGD were recruited and allocated into two equal groups. The intervention group (n = 11) underwent LRS with Botox preinjection into the smile muscles 1-2 weeks before surgery, while the control group (n = 11) underwent only LRS. Participants were assessed for changes in gingival display and lip length at 3, 6, 9, and 12 months, as well as for pain and satisfaction. The data were recorded and statistically analyzed.

Results: The control group showed a statistically significant change in gingival display at 3 months (3.82 ± 2.09 mm) and 6 months (4.68 ± 1.72 mm) compared to baseline (5.91 ± 1.45 mm), but no significant changes at 9 months (5.55 ± 1.37 mm) and 12 months (5.64 ± 1.50 mm). The intervention group demonstrated a significant reduction in gingival display at 3 months (2.23 ± 1.29 mm) and 6 months (3.95 ± 1.39 mm), with stable results up to 12 months (4.27 ± 1.10 mm). The overall reduction in gingival display was significantly greater in the intervention group compared to the control group (1.86 mm, 0.27 mm, respectively). Patient satisfaction with the treatment was not significantly different between the two groups, except for willingness to repeat the procedure. Pain scores were significantly higher in the control group than in the Botox group at 24 h, with no significant differences at 3 and 7 days.

Conclusions: Botox pre-injection for LRS demonstrated its efficacy for management of EGD by enhancing lip length, reducing relapse, alleviating postoperative discomfort, and providing sustained results for 1 year.

Clinical significance: This study addresses effective treatments for EGD, improving esthetics and confidence. By evaluating LRS with and without Botox, it offers practical insights that improves EGD and reduces relapse, resulting in increased patient satisfaction and sustained results over a year. How to cite this article: Ghoniem OM, Madkor GG, Darhous MS. Evaluating Lip Repositioning for the Treatment of Excess Gingival Display with and without Pretreatment with Botox: A Randomized Clinical Trial. J Contemp Dent Pract 2025;26(2):119-126.