Vestibuloplasty /certified fixed orthodontic courses by Indian dental academy

VESTIBULOPLASTY

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

 Definition:

``vestibuloplasty is the surgical procedure
whereby the oral vestibule is deepened
by changing the softtissue attachments’’

 Vestibuloplasty—sulcoplasty — sulcus dee-

pening procedures.

Factors :
 Age
 Physical status
 Amount & consistency of mucous

membrane
 Amount of alveolar and basal bone
 Position & tension of adjacent muscles
 Presence of bony projections and ridges
 Neurovascular foramina

TYPES OF VESTIBULOPLASTY


MUCOSAL ADVANCEMENT (SUBMUCOUS)V’PLASTY:
The mucous membrane of the vestibule is undermined
and advanced to line both sides of the extended vestibule.



SECONDARY EPITHELIZATION VESTIBULOPLASTY:
The mucosa of the vestibule is used to line one side of the
extended vestibule,and the other side heals by growing a
new epithelial surface.



GRAFTING VESTIBULOPLASTY:
Skin ,mucousmembrane and dermis can be used as a free
graft to line one or both sides of the extended vestibule.

MUCOSAL
ADVANCEMENT(SUBMUCOUS)V’PLASTY
Closed submucous v’plasty:
--To extend the vestibule to provide additional ridge
height.



--To excise or transfer the submucous connective tissue and the adjacent muscles to
a position farther from the crest of the ridge to prevent
relapse.
--This procedure is especially applicable to the
maxillary vestibule, where better results are obtained


--the success of mucosal advancement v’plsty
depends on the availability of adequate
bone,a sufficient amount of freely movable
mucosa.


TECHNIQU
E
 L.A soln. is injected into the tissues
 Vertical incision is made in the midline thro

the mucosa only,extending from the muco gingival junction into the lip.
 With the lip in everted in a horizontal plane

a scissors is introduced thro the incision.

 By blunt spreading dissection the mucosa is

separated from the submucosa on the right
nd left sides.

 A tunnel is formed b/w mucosa nd submu -

cosa extending from mucogingival junc.
Into
the cheek and lip,so that mucosa is complete
ly undermined.

 Tunnel is carried posteriorly till the

zygomatic buttress or to the mental areas
of mandible.

 Additional vertical incisions can be made at

premolar/molar regions for posterior dissec tion.
 Now the vertical incision is deepened till

periosteum at the midline.



The muscles & periosteum is dettached from periosteum by
supraperiosteal dissection using scissors.

Supraperiosteal tunnels are made as far posteriorly as possible on right and left side.





A wedge shaped strip of connective tissue remains between
two tunnels.
-The tissue can be excised/cut allowing it to retract
into lip nd cheek.


 Freely movable mucosa is then adapted

to the deepened sulcus,the vertical incision
is sutured.
 A roll guaze is placed into the vestibule to

support the mucosa temporarily.
 A compound impression is made of the ext-

ended vestibule by using patients denture
or a splint.


 The denture/splint with extended flanges is

secured to the maxilla or mandible with
peralveolar wires or pins or with circumzygomatic-circummandibular wires for 10-14
days

 A new denture can usually be made in 3-4 weeks


Closed submucous v’plasty


Mandibular submucous v’plasty


Open-view submucous v’plasty
 Walleneus proposed an open view method

instead of tunneling.
 A horizontal incision is made along the mu -

cogingival junction thro mucosa only.
 The mucosa is dissected from the submuc-

osa far out into the lip.


 Large flap of mucosa is mobilized.
 Supraperiosteal dissection then is performed

to the desired extent for proposed vestibular
extn.
 Stay sutures are placed in the flap to fix it to

periosteum deep in the vestibule.
 The free margin of the flap then is returned

to its original position and sutured.

SECONDARY EPITHELIZATION
VESTIBULOPLASTY
 It is indicated when sufficient bone is present

but the mucosa is either insufficient in qty.
or of poor quality.

TYPES:
-Kazanjian’s tech

-Lipswitch tech
-Clarks tech

KAZANJIAN’ S TECHNIQUE
 An incision is made in the mucosa of the lip

and a large flap of labial & vestibular mucosa
is reflected.

 Vestibule is deepened by a supraperiosteal

dissection.
 Flap of mucosa is turned downward from its

attachment on the alveolar ridge.

 The flap is placed directly against the perios -

teum to which it is sutured.
 A rubber catheter stent is placed into the

deepened sulcus and fixed thru the lip to the
outer surface with percutaneous sutures.

 The catheter helps to hold the flap in its new

position and to maintain the depth of vestib ule during the initial stages of healing.

 Catheter is removed after 7 days.
 The labial donor site is coated with tincture

benzoin compound and left to granulate &
left to granulate by secondary epithelization


LIPSWITCH TECHNIQUE
 It is a variation of kazanjian’s tech.
 In this the mucosal flap is developed in the

same way as suggested by kazanjian.
 After reflecting the mucosal flap till the

crest of alveolar ridge ,the periosteum is
incised high on the alveolar ridge.

 Now the periosteal flap containing the

connective tissue and muscle is transposed
outwardly (reflected)

 The periosteal flap is sutured to the raw

wound on the lip.

 Then the mucosal flap is turned down

against the bare bone and sutured to the
periosteum deep in the vestibule.

 Thus the vestibule is lined on osseus side

by mucosa and on the labial side by
periosteum.
 A new epithelial surface will grow on the

periosteal surface in 2-3 weeks


CLARK’S TECHNIQUE
This can be considered as reverse of
kazanjian’s tech.
-- Clark based this tech. on 4 principles
1. Raw surfaces on connective tissue contract
whereas the same surfaces undergo minimal
contraction when covered with epithelium .


2. Raw surface overlying bone cannot contract .

3. Epithelial flaps must be undermined sufficiently
to permit repositioning and fixation without
tension.

4. Soft tissues undergoing plastic revision have a
tendency to return to their former position , so
overcorrection and firm fixation are necessary.

TECHNIQUE
 An incision is made on the alveolar ridge &

a supraperiosteal dissection is made to the
depth desired.

 Mucosa of the lip is undermined till the vermi -

llion border.

 Three non absorbable percutaneous sutures

are placed in the free margin of the mucosal flap
and are carried thro the skin and tied over the cotton
roll

 The soft tissue side of the vestibule is covered

with mucosa ,where as on the osseous side
the raw periosteal surface is left to granulate
and epithelize.


GRAFTING VESTIBULOPLASTY
Indications:
- when there is an inadequate amount of bone
to compensate for relapse after vestibuloplasty.
- when a bone graft has been placed before in
the surgical site.
- when a large surgical defect would otherwise
be present.

Principles of skin grafting:
 Skin grafts should be removed from a relatively

hairless area (buttocks ,upper thigh,inner area of
upper arm).
 A thin split thickness graft will be less likely to

have hair follicles in the dermis and is preferred
to a thick graft.
 Recepient site should be free from any infection.

 Recepient or host site should have a good

blood supply.

 Hemostasis must be obtained in the recipi-

ent site before graft is placed.
 Graft is placed against the periosteum not

on cortical bone.

 Graft should cover the entire raw area.

 Graft should be immobilized until healing

has occurred(7-10 days)

 Skin grafts should be avoided in patients

with history of keloid formation or systemic
dermatological disorders


Thank you
Leader in continuing dental education


Vestibuloplasty /certified fixed orthodontic courses by Indian dental academy

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