Surgeries For Vestibular Deepening

Surgeries have explored rising trends in dentistry with its own skew. The speed at which new concepts enter the dental field often outpace our ability about tissues when we think we might get closer to make sense of it all.

Bone tissue is a specialized & mineralized connective tissue, most resilient with significant physical properties as high resistance to tensile, stress & compression forces with some elasticity.

Throughout existence the bone mass has a tendency to be remodeled through bone formation & resorption,specifically in the oral cavity due to lack of stimulus there is gradual bone loss post extraction in the alveolar process from the initial 12mm /year post extraction to 0.2mm /year after 2 years.

This chronic, irreversible, mounting process of alveolar ridge resorption prevails on an average of four times greater in the mandible compared with the maxilla.

Preprosthetic surgeries

Vestibuloplasty is a preprosthetic mucogingival therapy for the purpose of increasing the attached gingiva by repositioning the mucosa of bone augmenting the contact surface area of the denture to restore the stomatognathic function in cases where stability for prosthesis has lost or implant placement is contradicted.

The main indication of vestibuloplasty is lowering of the smile line for rehabilitation of the masticatory system.

It is also associated with implants to recontour the alveolar crest along with graft like hydroxyapatite or biomaterials. It may be performed in inflammatory areas & tissue recession around implants by traction of mentonian muscle to facilitate soft tissue health adjacent to implants.

The surgical techniques for vestibuloplasty may be divided into four groups: submucosal, secondary epithelisation; by transposition flaps; by grafts.

The following are some of the commonly used techniques:  secondary epithelisation; vesitbuloplasty by mucosal advancement; skin grafts i.e. mucosal or allogeneic and partial thickness material; the Clark technique for augmenting the depth of floor of the mouth; the obwegeser technique for augmenting the vestibular region & the depth of the floor of the mouth with grafts.

Kazanian technique consists of an incision in the labial mucosa of the mandible at 1.5 cm,elevation of the mucosal flap,& its repositioning in the bottom of the new sulcus.The technique described by the obwegeser is combination of kazanjian and Clark used simultaneously together with the aim of deepening the floor of the mouth.

Misch recommends vestibulolasty associated with the use of implants, with the intention of increasing the height & shape of  the vestibular ridge tissues & muscle insertions upto the height of the periosteum filling with hydroxyapatite or biomaterial (freeze dried bovine bone).

Predominantly the objective of such reconstructive surgeries is to establish a base to support the insertion of a dental prosthesis, transforming the anatomic structure into functional biologic platform for support or retention of prosthetic rehabilitation.

Regards

Dr.Prof.Rajat Sachdeva

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