Vestibuloplasty/certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different …

The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com VESTIBULOPLASTY www.indiandentalacademy.com
  • 2. www.indiandentalacademy.com
  • 3.  Definition: ``vestibuloplasty is the surgical procedure whereby the oral vestibule is deepened by changing the softtissue attachments’’  Vestibuloplasty—sulcoplasty — sulcus dee- pening procedures. www.indiandentalacademy.com
  • 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 www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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 www.indiandentalacademy.com
  • 7. --the success of mucosal advancement v’plsty depends on the availability of adequate bone,a sufficient amount of freely movable mucosa. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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 www.indiandentalacademy.com
  • 14. Closed submucous v’plasty www.indiandentalacademy.com
  • 15. Mandibular submucous v’plasty www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 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. www.indiandentalacademy.com
  • 18. www.indiandentalacademy.com
  • 19. www.indiandentalacademy.com
  • 20. www.indiandentalacademy.com
  • 21. 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 www.indiandentalacademy.com
  • 22. 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. www.indiandentalacademy.com
  • 23. www.indiandentalacademy.com
  • 24.  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. www.indiandentalacademy.com
  • 25.  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 www.indiandentalacademy.com
  • 26. 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. www.indiandentalacademy.com
  • 27.  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. www.indiandentalacademy.com
  • 28.  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 www.indiandentalacademy.com
  • 29. www.indiandentalacademy.com
  • 30. www.indiandentalacademy.com
  • 31. www.indiandentalacademy.com
  • 32. 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 . www.indiandentalacademy.com
  • 33. 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. www.indiandentalacademy.com
  • 34. 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 www.indiandentalacademy.com
  • 35.  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. www.indiandentalacademy.com
  • 36. 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. www.indiandentalacademy.com
  • 37. 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. www.indiandentalacademy.com
  • 38.  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. www.indiandentalacademy.com
  • 39.  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 www.indiandentalacademy.com
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  • 44. www.indiandentalacademy.com
  • 45. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com