A modified approach for vestibuloplasty in severely resorbed mandible using an implant-retained postoperative stent: a case report

Background. Severely resorbed mandibles often present a short band of keratinized tissue associated with a shallow vestibule. As a result, prominent muscle insertions are present, especially in the mental region of the mandible. This case report describes the deepening of the vestibular sulcus in an atrophic mandible by combining free gingival grafts harvested from the palate and a postoperative acrylic resin stent screwed on osseointegrated implants placed at the anterior region of the mandible.Study design. During the second-stage surgery, a split-thickness labial flap was reflected and apically sutured onto the periosteum. Two free gingival grafts were obtained and then sutured at this recipient site. A previously custom-made acrylic stent was then screwed onto the most distally positioned implants. To document the procedure's stability over time, a metal ball was placed in the most apical part of the vestibule and standardized cephalometric radiographs were taken before and 6 months after the procedure. Linear measurements of vestibular depths over the observation time were realized using specific software for radiographic analysis.Results. The proposed technique augmented the band of attached masticatory mucosa, deepened the vestibule and prevented the muscle reinsertion. The difference between the 2 measurements of vestibular depths was 9.39 mm (initial 20.88 mm, final 11.49 mm) after a 6-month postoperative period.Conclusion. The technique, in combination with palatal mucosal graft and use of a postoperative stent, decreased the pull of mentalis muscle and provided a peri-implantally stable soft tissue around implants. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: e7-e14)

Removal of epulis fissuratum associated to vestibuloplasty with carbon dioxide laser

There have been numerous surgical techniques developed for removing the epulis fissuratum lesions in order to improve alveolar ridge contour and improving adaptation of full prostheses. Most of these techniques can cause postoperative complications, such as oedema, pain, difficulty in swallowing and jaw movements, haemorrhage, infections and slow placement of final prostheses. The use of carbon dioxide (CO2) laser for the surgical removal of epulis lesions has resulted in many significant improvements including convenient mucosa removal, no bleeding or need for sutures, and minimal postoperative pain and oedema. This study is of 15 cases of removal of extensive epulis with vestibuloplasty in the maxilla and mandible that was carried out with CO2 laser, with no postoperative complications, rapid healing, and excellent aesthetic and functional outcome, all of which allowed for more rapid placement of final prosthesis.

Vestibuloplasty by modified kazanjian technique in treatment with dental implants

Dentists are often faced with extensively resorbed mandibular ridges with shallow buccal vestibule and high insertion of the mentalis muscle in relation to the crest of the ridge, causing the displacement of the prosthesis. Vestibuloplasty techniques aim at eliminating the muscle insertions, reposition the mucosa, and increase the area chapeável, giving more stability to the prosthesis. Among the techniques to deepen the vestibule are submucosal vestibuloplasties by secondary epithelialization and with mucosal and skin grafts. We will discuss vestibuloplasty by secondary epithelialization with emphasis on the so-called modified Kazanjian technique. This technique provides an appropriate result and does not require hospitalization, additional surgery at the donor, or prolonged periods without the use of prosthesis. © 2013 by Mutaz B. Habal, MD.

Avaliação radiográfica da altura mandibular anterior após vestibuloplastia por inversão de retalhos: estudo em humanos

A proposta do presente estudo foi de analisar, através de análise cefalométrica por telerradiografias de perfil, a altura óssea na região mandibular anterior após a realização de vestibuloplastia pela técnica de inversão de retalhos. Foram avaliados 13 pacientes (8 mulheres e 5 homens), com média igual a 54,3 anos que apresentavam, em média, 25,01 mm de altura mandibular anterior. As medidas foram obtidas utilizando-se traçado cefalométrico e comparando-se o período pré-operatório com os períodos pós-operatórios, que consistiram de 30, 90 e 180 dias. Durante o período analisado, houve uma redução da altura mandibular anterior, estatisticamente não significante, de 0,6 mm.

Topical effect of propolis in the repair of sulcoplasties by the modified Kazanjian technique. Cytological and clinical evaluation.

A study was conducted to analyze the effects of propolis mouth rinse on the repair of surgical wounds after sulcoplasty by the modified Kazanjian technique. Twenty-seven patients who underwent sulcoplasty were divided into three groups: C1--patients who did not use the mouth rinse C2--patients who used a mouth rinse containing 5% aqueous alcohol T--patients who used a mouth rinse containing 5% propolis in aqueous alcohol solution. The patients returned 7, 14, 30, and 45 days after surgery for cytological and clinical evaluation. It was concluded that: 1) the mouth rinse containing propolis in aqueous alcohol solution aids repair of intra-buccal surgical wounds and exerts a small pain-killing and anti-inflammatory effect; 2) the vehicle employed has a minor irritant effect on intra-buccal surgical wounds; 3) exfoliative cytology allows epithelization of intrabuccal surgical wounds.

Estudo clínico comparativo da manutenção do aprofundamento de sulco nas vestibuloplastias mandibulares, através das técnicas de tuneilização submucosa e epitelização secundária

For some time, oral surgeons have tried several surgical procedures to improve the alveolar ridge for prosthetic appliance construction. The techniques used for this purpose are divided into four groups: submucosal vestibuloplasty; secondary epithelization; soft tissue grafting and transpositional flaps. Twenty patients who had problems to wear dentures due to unsatisfactory retention and stability were selected at the Oral and MaxilloFacial Surgery and Traumatology Clinic of Dental School of São José dos Campos. They were divided in two groups and operated by submucosal vestibuloplasty using stents and secondary epithelization vestibuloplasty by Clark's technique and were evaluated twelve months after operations in relationship of the sulcus depth. The results were obtained by clinical and radiological examination before and after surgery, and they are similar to those found in the literature reaching satisfactory functional judgement

A systematic review assessing soft tissue augmentation techniques

AIM: The aim of the present review was to systematically assess the dental literature in terms of soft tissue grafting techniques. The focused question was: is one method superior over others for augmentation and stability of the augmented soft tissue in terms of increasing the width of keratinized tissue (part 1) and gain in soft tissue volume (part 2). METHODS: A Medline search was performed for human studies focusing on augmentation of keratinized tissue and/or soft tissue volume, and complemented by additional hand searching. Relevant studies were identified and statistical results were reported for meta-analyses including the test minus control weighted mean differences with 95% confidence intervals, the I-squared statistic for tests of heterogeneity, and the number of significant studies. RESULTS: Twenty-five (part 1) and three (part 2) studies met the inclusion criteria; 14 studies (part 1) were eligible for comparison using meta-analyses. An apically positioned flap/vestibuloplasty (APF/V) procedure resulted in a statistically significantly greater gain in keratinized tissue than untreated controls. APF/V plus autogenous tissue revealed statistically significantly more attached gingiva compared with untreated controls and a borderline statistical significance compared with APF/V plus allogenic tissue. Statistically significantly more shrinkage was observed for the APF/V plus allogenic graft compared with the APF/V plus autogenous tissue. Patient-centered outcomes did not reveal any of the treatment methods to be superior regarding postoperative complications. The three studies reporting on soft tissue volume augmentation could not be compared due to lack of homogeneity. The use of subepithelial connective tissue grafts (SCTGs) resulted in statistically significantly more soft tissue volume gain compared with free gingival grafts (FGGs). CONCLUSIONS: APF/V is a successful treatment concept to increase the width of keratinized tissue or attached gingiva around teeth. The addition of autogenous tissue statistically significantly increases the width of attached gingiva. For soft tissue volume augmentation, only limited data are available favoring SCTGs over FGG.

Enlargement of keratinized peri-implant mucosa at the time of second stage surgery (re-entry)

A tightly attached keratinized mucosa around endosseous dental implants is believed to be protective against peri-implant bone loss. Tension caused by buccal frena and mobile non keratinized mucosa is to avoid. This case report documents the optimization of peri-implant mucosal conditions in the upper and lower jaw. At the time of second stage surgery (re-entry) at submucosally osseointegrated dental implants an enlargement of keratinized mucosa and a thickening of soft tissue was obtained administrating a vestibuloplasty combined by a free gingival graft or a vestibuloplasty combined by an apically moved flap.