What is Vestibuloplasty?

A bone graft is used to recreate bone and soft supporting tissues lost Those procedures designed to widen the zone of attached gingiva and deepen the vestibular depth which will facilitate the clearance of the area for natural food passage, and provide access for toothbrushing and interdental stimulation.

Effects of Vestibuloplasty

The patients appearance may also be improved because a prosthodontic restoration can now be molded to provide contour and support for the lower lip and cheek portions of the resected area. Improvement of speech is less noticeable in patients who lack tongue mobility.

Candidates for Vestibuloplasty

In oral and maxillofacial surgery palatal mucosal grafts are routinely used to cover mucosal defects caused by vestibuloplasty. However, the quantity of palatal mucosa is a limiting factor in more extensive operations. This study investigated whether autologous cultured sheets of mucosa can serve as a dressing for these wounds.

Procedure

Punch biopsies (diameter, 4 mm) were taken from the hard palate of eight patients (five men, three women; mean age 43 years). Epithelial cells were enzymatically dissociated from these tissue specimens and grown in vitro in the presence of a fibroblast feeder layer. Within 3 weeks, a transplantable epithelial sheet of about 20 cm2 was obtained. The sheet was detached from the culture flask by enzyme treatment and fixed to a carrier of Vaseline (Cheeseborough Ponds Inc, Greenwich, CT) gauze. Using a split-mouth technique, the sheet was placed on half of a mucosal defect created by vestibuloplasty, while the other half of the defect was covered by a conventional split-thickness palatal graft. Both the cultured and conventional graft were held in place by the patient’s relined denture fixed with perimandibular sutures. One week postsurgery, the denture and Vaseline gauze were removed. Three months after vestibuloplasty, biopsy specimens of each grafted site were taken and processed for light and transmission electron microscopy (LM, TEM).

Recovery

A white necrotic soft tissue layer could be seen with underlying hyperemic tissue and an average reduction of 1 to 3 mm in the depth of the labial vestibule after a week. By the end of the second week, the necrotic layer had disappeared, leaving slightly hyperemic mucosal tissue under. By the third week, the graft area could be noticed but the amnion had completely degenerated and disappeared. After 4 weeks, the subjects could be referred for their prosthodontic treatment. The reduction in the depth of the buccal vestibule ranged from 17% to 40% after 6 months’ follow-up.

Risks

Management of bilateral fractures of the atrophic mandible is a difficult problem. A recent skin graft vestibuloplasty with lowering of the floor of the mouth compromises the blood supply to the fractured segments and jeopardizes the changes for bony union. The viability of the skin graft and the stability of the vestibular extension are also at risk.

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FAQs

Is a vestibuloplasty always necessary?

A vestibuloplasty is a surgical procedure designed to restore the alveolar ridge height by lowering muscles attached to the buccal, labial and lingual aspects of the jaw. This procedure can be done after two or three months of healing. Depending on the extent of the augmentation, the re-establishment of a normal buccal-labial sulcus with a vestibuloplasty may be indicated.

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Can OsteoGraf/D be used in conjunction with endosseous implants?

The placement of endosseous implants through a ridge that has been augmented with dense hydroxylapatite is not recommended. Implants must be placed into bone (dense hydroxylapatite will not remodel into bone).

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How long before denture reconstruction can begin?

Fibrous connective tissue will usually encapsulate the graft in 7-10 weeks. If the ridge appears to be firm, primary impressions may begin.

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