Vestibuloplasty is a surgical procedure to deepen the oral vestibule by changing the attachments of the soft tissues. There are several types of vestibuloplasty procedures, including mucosal advancement vestibuloplasty, secondary epithelization vestibuloplasty, and grafting vestibuloplasty. Mucosal advancement vestibuloplasty involves undermining and advancing the oral mucosa to line both sides of the extended vestibule. Secondary epithelization vestibuloplasty uses the oral mucosa to line one side and allows the other side to heal through secondary epithelization. Grafting vestibuloplasty uses skin, mucous membrane, or der
3. Definition:
``vestibuloplasty is the surgical procedure
whereby the oral vestibule is deepened
by changing the softtissue attachments’’
Vestibuloplasty—sulcoplasty — sulcus dee-
pening procedures.
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4. 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
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5. 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.
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6. 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
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7. --the success of mucosal advancement v’plsty
depends on the availability of adequate
bone,a sufficient amount of freely movable
mucosa.
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8. 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.
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9. 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.
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10. 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.
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11.
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.
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12. 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.
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13. 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
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16. 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.
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17. 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.
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20. 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
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21. 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.
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23. 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.
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24. 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
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25. 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.
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26. 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.
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27. 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
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30. 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 .
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31. 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.
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32. 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
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33. 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.
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34. 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.
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35. 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.
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36. 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.
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37. 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
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