Esthetic perception of gummy smile with the application of botulinum toxin, via eye-tracking
DOI:
https://doi.org/10.33448/rsd-v11i6.29518Keywords:
Smile; Botulinum Toxin Type A; Gingival display; Visual perception; Eye-tracking; Health teaching.Abstract
We aimed to evaluate laypeople’s visual perception of the gingival smile before and after botulinum-toxin application, using eye-tracking technology. Two frontal photographs of a female volunteer’s face with a gingival smile were used. One before and another 30 days after the toxin application in the upper lip elevator muscle region. The images were evaluated by 58 participants. Using the OGAMA software, visualization data were obtained in three areas of interest (AOI) through eye-tracking. A visual analog scale (VAS) was used to assess facial attractiveness, and a questionnaire to assess the perception of sympathy, satisfaction with the smile, dissatisfaction with dental and gingival exposure, and shyness. Heat and point maps showed that the participants visually concentrated on the mouth region, with a small transition to the nose and eyes in the pre-procedure image. The mouth region was the AOI where the first visualization occurred in a shorter time compared to the latter areas (p<0.05). VAS revealed that attractiveness increased in the image with less gingival exposure (p<0.05). After the toxin application, satisfaction with the smile increased (p<0.05), and dissatisfaction with gingival exposure decreased (p<0.05). However, dissatisfaction with dental exposure increased (p<0.05). We discovered that the mouth attracted greater attention from participants in less time compared to other AOI. The decrease in gingival exposure after the botulinum toxin application resulted in improved facial esthetics. There was a perceptible increase in “satisfaction with the smile” and a decrease in “dissatisfaction with gingival exposure.” Conversely, the “dissatisfaction with dental exposure” increased.
References
Abdullah, W. A., Khalil, H. S., Alhindi, M. M. & Marzook, H. (2014). Modifying gummy smile: a minimally invasive approach. J Contemp Dent Pract, 15(6), 821-826. 10.5005/jp-journals-10024-1625
Albino, J. E., Lawrence, S. D. & Tedesco, L. A. (1994). Psychological and social effects of orthodontic treatment. Journal of behavioral medicine, 17(1), 81-98. . 10.1007/BF01856884
Bagepally, B. S. (2015). Gaze pattern on spontaneous human face perception: An eye tracker study. ournal of the Indian Academy of Applied Psychology, 41(3), 128-131.
Berlyne, D. E. (1958). The influence of complexity and novelty in visual figures on orienting responses. J Exp Psychol, 55(3), 289-296. 10.1037/h0043555
Celikdelen, M. & Bicakci, A. A. (2020). Factors Affecting Smile Attractiveness: An Eye Tracking Study. Journal of Research in Medical and Dental Science, 8, 56-70. 10.1016/j.ajodo.2019.07.014
Cengiz, A. F., Goymen, M., & Akcali, C. (2020). Efficacy of botulinum toxin for treating a gummy smile. Am J Orthod Dentofacial Orthop, 158(1), 50-58.
Chagas, T. F., Almeida, N. V., Lisboa, C. O., Ferreira, D., Mattos, C. T., & Mucha, J. N. (2018). Duration of effectiveness of Botulinum toxin type A in excessive gingival display: a systematic review and meta-analysis. Braz Oral Res, 32, e30. 10.1590/1807-3107bor-2018.vol32.0030
Chang, C. A., Fields, H. W., Jr., Beck, F. M., Springer, N. C., Firestone, A. R., Rosenstiel, S., et al. (2011). Smile esthetics from patients' perspectives for faces of varying attractiveness. Am J Orthod Dentofacial Orthop, 140(4), e171-180. 10.1016/j.ajodo.2011.03.022
Flanary, C. (1992). The psychology of appearance and the psychological impact of surgical alteration of the face. Modern practice in orthognathic and reconstructive surgery, 3-21.
Gasparello, G. G., Acciaris, F., Mota Júnior, S. L., Castilhos, J. S., Bark, M. J., Hartmann, G. C., et al. (2022). Perception of mandibular position in Caucasian models in a sagittal view via eye-tracking. Research, Society and Development, 11(1), e15411629036, 15411629031-15411629010.
Geron, S. & Atalia, W. (2005). Influence of sex on the perception of oral and smile esthetics with different gingival display and incisal plane inclination. Angle Orthod, 75(5), 778-784. 10.1043/0003-3219(2005)75[778:IOSOTP]2.0.CO;2
Gobel, S. M. (2015). Up or down? Reading direction influences vertical counting direction in the horizontal plane - a cross-cultural comparison. Front Psychol, 6, 228. DOI:10.3389/fpsyg.2015.00228
Guo, J., Gong, H., Tian, W., Tang, W. & Bai, D. (2011). Alteration of gingival exposure and its aesthetic effect. Journal of Craniofacial Surgery, 22(3), 909-913. 10.1097/SCS.0b013e31820f7f7a
Hickman, L., Firestone, A. R., Beck, F. M. & Speer, S. (2010). Eye fixations when viewing faces. J Am Dent Assoc, 141(1), 40-46.
Howells, D. J., & Shaw, W. C. (1985). The validity and reliability of ratings of dental and facial attractiveness for epidemiologic use. Am J Orthod, 88(5), 402-408. 10.1016/0002-9416(85)90067-3
Hwang, W. S., Hur, M. S., Hu, K. S., Song, W. C., Koh, K. S., Baik, H. S. et al. (2009). Surface anatomy of the lip elevator muscles for the treatment of gummy smile using botulinum toxin. Angle Orthod, 79(1), 70-77. 10.2319/091407-437.1
Itti, L. (2004). The iLab Neuromorphic Vision C++ Toolkit: Free tools for the next generation of vision algorithms. The Neuromorphic Engineer, 1(1), 10.
Jaspers, G. W., Pijpe, J., & Jansma, J. (2011). The use of botulinum toxin type A in cosmetic facial procedures. Int J Oral Maxillofac Surg, 40(2), 127-133. 10.1016/j.ijom.2010.09.014
Johnson, E. K., Fields, H. W., Jr., Beck, F. M., Firestone, A. R. & Rosenstiel, S. F. (2017). Role of facial attractiveness in patients with slight-to-borderline treatment need according to the Aesthetic Component of the Index of Orthodontic Treatment Need as judged by eye tracking. Am J Orthod Dentofacial Orthop, 151(2), 297-310. 10.1016/j.ajodo.2016.06.037
Kattimani, V., Tiwari, R. V. C., Gufran, K., Wasan, B., Shilpa, P. & Khader, A. A. (2019). Botulinum toxin application in facial esthetics and recent treatment indications (2013-2018). Journal of International Society of Preventive & Community Dentistry, 9(2), 99. 10.4103/jispcd.JISPCD_430_18
Ker, A. J., Chan, R., Fields, H. W., Beck, M. & Rosenstiel, S. (2008). Esthetics and smile characteristics from the layperson's perspective: a computer-based survey study. J Am Dent Assoc, 139(10), 1318-1327. 10.14219/jada.archive.2008.0043
Kokich, V. O., Jr., Kiyak, H. A. & Shapiro, P. A. (1999). Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent, 11(6), 311-324. 10.1111/j.1708-8240.1999.tb00414.x
Martins, C. M., Lacerda, P. B., G., Maenosono, R. M., Catelan, A., & Batista, V. E. S. (2021). Perception of smile attractiveness by dentistry professionals, dental students and laypeople before and after esthetic procedures. Research, Society and Development, 10(3), e50010313690, 50010313691-50010313697.
Mertens, I., Siegmund, H., & Grusser, O. J. (1993). Gaze motor asymmetries in the perception of faces during a memory task. Neuropsychologia, 31(9), 989-998. 10.1016/0028-3932(93)90154-r
Moore, T., Southard, K. A., Casko, J. S., Qian, F., & Southard, T. E. (2005). Buccal corridors and smile esthetics. Am J Orthod Dentofacial Orthop, 127(2), 208-213; quiz 261. 10.1016/j.ajodo.2003.11.027
Parrini, S., Rossini, G., Castroflorio, T., Fortini, A., Deregibus, A., & Debernardi, C. (2016). Laypeople's perceptions of frontal smile esthetics: A systematic review. Am J Orthod Dentofacial Orthop, 150(5), 740-750. 10.1016/j.ajodo.2016.06.022
Pithon, M. M., Santos, A. M., Viana de Andrade, A. C., Santos, E. M., Couto, F. S., & da Silva Coqueiro, R. (2013). Perception of the esthetic impact of gingival smile on laypersons, dental professionals, and dental students. Oral Surg Oral Med Oral Pathol Oral Radiol, 115(4), 448-454. 10.1016/j.oooo.2012.04.027
Polo, M. (2008). Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). Am J Orthod Dentofacial Orthop, 133(2), 195-203. 10.1016/j.ajodo.2007.04.033
Richards, M. R., Fields, H. W., Jr., Beck, F. M., Firestone, A. R., Walther, D. B., Rosenstiel, S. et al. (2015). Contribution of malocclusion and female facial attractiveness to smile esthetics evaluated by eye tracking. Am J Orthod Dentofacial Orthop, 147(4), 472-482. 10.1016/j.ajodo.2014.12.016
Silberberg, N., Goldstein, M. & Smidt, A. (2009). Excessive gingival display--etiology, diagnosis, and treatment modalities. Quintessence Int, 40(10), 809-818.
Sriphadungporn, C. & Chamnannidiadha, N. (2017). Perception of smile esthetics by laypeople of different ages. Prog Orthod, 18(1), 8. 10.1186/s40510-017-0162-4
Sucupira, E., & Abramovitz, A. (2012). A simplified method for smile enhancement: botulinum toxin injection for gummy smile. Plast Reconstr Surg, 130(3), 726-728. 10.1097/PRS.0b013e31825dc32f
Tjan, A. H., Miller, G. D. & The, J. G. (1984). Some esthetic factors in a smile. The Journal of prosthetic dentistry, 51(1), 24-28. 10.1016/s0022-3913(84)80097-9
Wang, C., Hu, W. j., Liang, L. z., Zhang, Y. l., & Chung, K. H. (2018). Esthetics and smile‐related characteristics assessed by laypersons. Journal of Esthetic and Restorative Dentistry, 30(2), 136-145. 10.1111/jerd.12356
Wang, X., Cai, B., Cao, Y., Zhou, C., Yang, L., Liu, R., et al. (2016). Objective method for evaluating orthodontic treatment from the lay perspective: An eye-tracking study. Am J Orthod Dentofacial Orthop, 150(4), 601-610. 10.1016/j.ajodo.2016.03.028
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Copyright (c) 2022 Susiane Queiroz Bastos; Orlando Motohiro Tanaka; Giovanna Andraus Kirsten; Gil Guilherme Gasparello; Thiago Martins Meira; Elisa Souza Camargo; Sérgio Aparecido Ignácio
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