Vestibuloplasty /certified fixed orthodontic courses by Indian dental academy


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  • Vestibuloplasty /certified fixed orthodontic courses by Indian dental academy

    1. 1. VESTIBULOPLASTY INDIAN DENTAL ACADEMY Leader in continuing dental education
    2. 2.
    3. 3.  Definition: ``vestibuloplasty is the surgical procedure whereby the oral vestibule is deepened by changing the softtissue attachments’’  Vestibuloplasty—sulcoplasty — sulcus dee- pening procedures.
    4. 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
    5. 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.
    6. 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
    7. 7. --the success of mucosal advancement v’plsty depends on the availability of adequate bone,a sufficient amount of freely movable mucosa.
    8. 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.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. 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
    14. 14. Closed submucous v’plasty
    15. 15. Mandibular submucous v’plasty
    16. 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.
    17. 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. 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
    21. 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. 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.
    24. 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
    25. 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.
    26. 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.
    27. 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. 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 .
    31. 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.
    32. 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
    33. 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.
    34. 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.
    35. 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.
    36. 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.
    37. 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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    43. 43. Thank you Leader in continuing dental education