الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Objectives: This randomized clinical trial was conducted to assess the extent of patient’s satisfaction and measure the degree of improvement in gingival display using BTX-A injection in comparison with modified surgical lip repositioning . Materials And Methods : Twenty patients with an age range of 18-35 years which included both males and females were enrolled in this study. and they were divided into two groups:group I ” the intervention group” : patients were treated by botox injection. group II ” the comparator group” : patients were treated by modified lip repositioning surgery. Patients included in the study had excessive gingival display more than 3 mm during smiling , hypermobile upper lip with or without (mild / moderate) vertical maxillary excess , normal morphology of clinical crowns , normal lip separation (ILG) at rest and were medically free . Subjects were recorded to acquire digital videographic film during full smile allowing the clinician to capture the best videoframe represents a patient’s nonposed smile. The smile images were then uploaded on OrisCeph Rx3 computer software , by which , soft tissue measurements were done , including gingival display and other parameters of lower facial esthetics like Upper lip length , Vermilion border width and interlabial gap upon smiling. Both botox injection and modified lip repositioning were applied to subjects according to the grouping generated previously. VAS ( Visual Analogue Scale ) from 0 to 10 was used to score patient’s satisfaction . Posttreatment records were taken at 4,8,12 and 24 weeks in a time line taken 6 months. posttreatment records were taken at 4,8,12 and 24 weeks in a time line taken 6 months. Results: patients’ satisfaction scores , revealed significant difference between the two groups in T1 and T2 as p < 0.05, while insignificant difference at T3 and T4 although both groups showed 80% average reduction in gingival display combined with increase in upper lip length , vermillion border length and interlabial gap reduction which were stable for the first 3 months of follow-up period. However, after six months follow up complete relapse was seen . Conclusion :This results suggest that modified lip repositioning dididnot offer the degree of patient satisfaction as botox injection due to pain and tension , patients had felt during talking and smiling meantime after surgery even that the gingival display was improved almost equally by both procedures.