摘要

Objectives: Muscle imperfections used to be treated only through chemical myomodulation, or neuromodulation. Currently, we also have specific techniques to treat the muscle with mechanical myomodulation. While neuromodulation refers to the use of botulinum toxin, mechanical myomodulation is performed with cross-linked hyaluronic acid. This study will show specific techniques in order to treat muscle imperfections that lead to severe cases of gummy smile by mechanical myomodulation with a new 25 mg/ml cross-linked HA. Introduction: Gingival smile is a multifactorial, non-pathological condition responsible for a described disharmony between the components of the smile (lips, teeth and gingiva) by exposing more than 2 mm of coronal gingiva to the maxillary incisors, encompassing both the static and dynamic frame. According to Mercado-Rosso gingival smile classification, type 1 gummy smile is characterised by lack of structural support due to bone deficiency, type 2 by an imbalance of the length-tension relationship and type 3 by an excessive mechanical action. There are certain advantages for using physical myomodulation a Materials / method: 25 mg/ml cross-linked HA was administered at different depths depending on the amount of muscle activity aimed. For hypokinetic muscle, HA was placed under the muscle, at periosteal or submuscular level. For hyperkinetic muscle, HA was placed on the surface of the muscle. 3 bolus of 0.5-0.7 mm depth were performed at the zygomaticus major at each side, as this area does not have important vascular elements, the injection was performed directly with needle. At orbicularis oris, around 0.5-0.7 ml of HA was injected below the muscle, at the supraperiostic level, in this case a 22G cannula was use Results: We obtained positive results with high level of patient satisfaction as muscle alterations were immediately corrected improving all patient smiles. Analysing the underlying anatomy of the muscle problem at the initial diagnosis was key to obtain optimal results, therefore, identifying the agonist and antagonist muscles of the treating area is essential in order to maintain both functional and aesthetic balance and give the patient a natural result. In vitro studies have demonstrated that succinic acid stimulates human fibroblasts increasing antiaging markers which help to provide an improvemen Conclusion: We have proven that the specific techniques proposed in this lecture are safe and effective for correcting severe cases of gummy smile by mechanicall myomodulation. The cross-linked HA used are new products that also produced cell biostimulation due to succinic acid.