VESTIBULOPLASTY

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentala...
www.indiandentalacademy.com
 Definition:

``vestibuloplasty is the surgical procedure
whereby the oral vestibule is deepened
by changing the softtiss...
Factors :
 Age
 Physical status
 Amount & consistency of mucous

membrane
 Amount of alveolar and basal bone
 Positio...
TYPES OF VESTIBULOPLASTY


MUCOSAL ADVANCEMENT (SUBMUCOUS)V’PLASTY:
The mucous membrane of the vestibule is undermined
an...
MUCOSAL
ADVANCEMENT(SUBMUCOUS)V’PLASTY
Closed submucous v’plasty:
--To extend the vestibule to provide additional ridge
he...
--the success of mucosal advancement v’plsty
depends on the availability of adequate
bone,a sufficient amount of freely mo...
TECHNIQU
E
 L.A soln. is injected into the tissues
 Vertical incision is made in the midline thro

the mucosa only,exten...
 By blunt spreading dissection the mucosa is

separated from the submucosa on the right
nd left sides.

 A tunnel is for...
 Tunnel is carried posteriorly till the

zygomatic buttress or to the mental areas
of mandible.

 Additional vertical in...


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

Supraperiosteal tu...
 Freely movable mucosa is then adapted

to the deepened sulcus,the vertical incision
is sutured.
 A roll guaze is placed...
 The denture/splint with extended flanges is

secured to the maxilla or mandible with
peralveolar wires or pins or with c...
Closed submucous v’plasty

www.indiandentalacademy.com
Mandibular submucous v’plasty

www.indiandentalacademy.com
Open-view submucous v’plasty
 Walleneus proposed an open view method

instead of tunneling.
 A horizontal incision is ma...
 Large flap of mucosa is mobilized.
 Supraperiosteal dissection then is performed

to the desired extent for proposed ve...
www.indiandentalacademy.com
www.indiandentalacademy.com
SECONDARY EPITHELIZATION
VESTIBULOPLASTY
 It is indicated when sufficient bone is present

but the mucosa is either insuf...
KAZANJIAN’ S TECHNIQUE
 An incision is made in the mucosa of the lip

and a large flap of labial & vestibular mucosa
is r...
www.indiandentalacademy.com
 The flap is placed directly against the perios -

teum to which it is sutured.
 A rubber catheter stent is placed into ...
 Catheter is removed after 7 days.
 The labial donor site is coated with tincture

benzoin compound and left to granulat...
LIPSWITCH TECHNIQUE
 It is a variation of kazanjian’s tech.
 In this the mucosal flap is developed in the

same way as s...
 Now the periosteal flap containing the

connective tissue and muscle is transposed
outwardly (reflected)

 The perioste...
 Thus the vestibule is lined on osseus side

by mucosa and on the labial side by
periosteum.
 A new epithelial surface w...
www.indiandentalacademy.com
www.indiandentalacademy.com
CLARK’S TECHNIQUE
This can be considered as reverse of
kazanjian’s tech.
-- Clark based this tech. on 4 principles
1. Raw ...
3. Epithelial flaps must be undermined sufficiently
to permit repositioning and fixation without
tension.

4. Soft tissues...
TECHNIQUE
 An incision is made on the alveolar ridge &

a supraperiosteal dissection is made to the
depth desired.

 Muc...
 The soft tissue side of the vestibule is covered

with mucosa ,where as on the osseous side
the raw periosteal surface i...
GRAFTING VESTIBULOPLASTY
Indications:
- when there is an inadequate amount of bone
to compensate for relapse after vestibu...
Principles of skin grafting:
 Skin grafts should be removed from a relatively

hairless area (buttocks ,upper thigh,inner...
 Recepient or host site should have a good

blood supply.

 Hemostasis must be obtained in the recipi-

ent site before ...
 Graft should be immobilized until healing

has occurred(7-10 days)

 Skin grafts should be avoided in patients

with hi...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
Thank you
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
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Vestibuloplasty /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy
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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable

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  • Transcript of "Vestibuloplasty /certified fixed orthodontic courses by Indian dental academy "

    1. 1. VESTIBULOPLASTY INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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 www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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 www.indiandentalacademy.com
    7. 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. 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. 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. 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. 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. 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. 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. 14. Closed submucous v’plasty www.indiandentalacademy.com
    15. 15. Mandibular submucous v’plasty www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    18. 18. www.indiandentalacademy.com
    19. 19. www.indiandentalacademy.com
    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 www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    22. 22. www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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 www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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 www.indiandentalacademy.com
    28. 28. www.indiandentalacademy.com
    29. 29. www.indiandentalacademy.com
    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 . www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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 www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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. www.indiandentalacademy.com
    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 www.indiandentalacademy.com
    38. 38. www.indiandentalacademy.com
    39. 39. www.indiandentalacademy.com
    40. 40. www.indiandentalacademy.com
    41. 41. www.indiandentalacademy.com
    42. 42. www.indiandentalacademy.com
    43. 43. Thank you Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com

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