Vestibuloplasty is a surgical procedure to deepen the oral vestibule by changing the attachments of the soft tissue. There are several types of vestibuloplasty procedures, including mucosal advancement, secondary epithelization, and grafting. Mucosal advancement involves undermining and advancing the oral mucosa, while secondary epithelization uses the oral mucosa to line one side and allows the other side to heal through epithelization. Grafting can use skin, mucosa, or dermis grafts to line the extended vestibule. The document discusses techniques for each type of vestibuloplasty procedure.

1. VESTIBULOPLASTY
Prepared by :- Vrushali D Patel
Intern

2. Definition: “vestibuloplasty is the surgical procedure whereby
the oral vestibule is deepened by changing the soft tissue
attachments’’.
 Vestibuloplasty— sulco plasty — sulcus deepening procedures.

3. 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

4.  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 ,mucous membrane and dermis can be used as a free graft to line one
or both sides of the extended vestibule.

5.  MUCOSAL ADVANCEMENT(SUBMUCOUS)V’PLASTY
Closed submucous v’plasty: --
 To extend the vestibule to provide additional ridge height.
 To excise or transfer the sub mucous 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.
 The success of mucosal advancement v’plsty depends on the availability of adequate bone, a
sufficient amount of freely movable mucosa.

6.  TECHNIQUE :-
 L.A soln. is injected into the tissues
 Vertical incision is made in the midline through the mucosa only, extending from the
mucogingival junction into the lip.
 With the lip in everted in a horizontal plane a scissors is introduced through the
incision.
 By blunt spreading dissection the mucosa is separated from the sub mucosa on the
right and left sides.
 A tunnel is formed between mucosa and sub mucosa extending from mucogingival
junction Into the cheek and lip, so that mucosa is completely undermined.

7.  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 dissection.
 Now the vertical incision is deepened till periosteum at the midline.
 The muscles & periosteum is detached 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 and cheek.

8.  Freely movable mucosa is then adapted to the deepened sulcus, the vertical incision is
sutured.
 A roll gauze is placed into the vestibule to support the mucosa temporarily.
 A compound impression is made of the extended vestibule by using patients denture or a
splint.
 The denture/splint with extended flanges is secured to the maxilla or mandible with per
alveolar wires or pins or with circumzygomatic-circummandibular wires for 10-14 days.
 A new denture can usually be made in 3-4 weeks.

11.  Open-view submucous v’plasty
 Walleneus proposed an open view method instead of tunnelling.
 A horizontal incision is made along the mucogingival junction through mucosa only.
 The mucosa is dissected from the sub mucosa far out into the lip.
 Large flap of mucosa is mobilized.
 Supraperiosteal dissection then is performed to the desired extent for proposed
vestibular extention.
 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.

14. SECONDARY EPITHELIZATION VESTIBULOPLASTY
 It is indicated when sufficient bone is present but the mucosa is either insufficient in
quantity or of poor quality.
TYPES: -
Kazanjian’s tech
Lipswitch tech
Clarks tech

15.  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.
 The flap is placed directly against the periosteum to which it is sutured.
 A rubber catheter stent is placed into the deepened sulcus and fixed through 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 vestibule during the initial
stages of healing.
 Catheter is removed after 7 days.
 The labial donor site is coated with tincture benzoin compound and left to granulate by secondary
epithelisation.

16. 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.
 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.
 Thus the vestibule is lined on osseous side by mucosa and on the labial side by periosteum.
 A new epithelial surface will grow on the periosteal surface in 2-3 weeks

19.  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 on the overlying bone cannot contract .
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.

20.  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 vermillion 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.
 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.

21. Lingual vestibuloplasty :-
It is used in mandible ,when the mylohyoid and genioglossus attachment are close to alveolar ridge.
It is done by the following methods :-
Trauner’s technique
Caldwell’s technique

22. Trauner’s technique:-
Used for increasing the depth of the floor of the mouth in mylohyoid region.
Bilateral incision is given from 2nd molar to 2nd molar region.
Supra periosteal dissection is done.
Instrument is passed below the mylohyoid muscle to separate from bony attachment.
Fixation of incisal edge of mylohyoid muscle to a new desired depth on lingual side is done by :-
sutures passed extra orally over the skin at inferior border of mandible.
placement of the skin graft and preformed denture/stent.

23. Caldwell technique :-
Entire lingual mucoperiosteal flap is reflected from molar to molar region.
Mylohyoid ridge is reduced/removed along the reduction of the genial tubercle.
Mylohyoid muscle and superficial fibres of genioglossus are pushed inferiorly.
Rubber tube is placed in lingual vestibule and the sutures are passed through skin extra orally.

24. Obwegeser’s technique:-
Combination of buccal and lingual vestibuloplasty.
Incision is given on the alveolar ridge.
Mucosal flap is raised both buccally and lingually.
Mylohyoid muscle attachment and only superficial fibres of genioglossus muscle are separated on
lingual side.
Edges of the buccal and lingual flaps attached/ sutured to each other , below inferior border of
mandible.
Skin graft is placed over entire alveolar ridge.
Preformed acrylic stent /denture placed to fix mandible, with circummandibular wiring.

25.  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.
 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.
 Recipient site should be free from any infection.

26.  Recipient or host site should have a good blood supply.
 Haemostasis must be obtained in the recipient site before graft is placed.
 Graft is placed against the periosteum not on cortical bone.
 Graft should cover the entire raw area.
 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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