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Vestibuloplasty by Lip Switch Procedure - A Case Report
Periodontal plastic surgery emphasizes biological, functional troubles that affect the periodontium and focused to improve esthetic appearance.
The occurrence of mucogingival deformities usually has an influence on sufferers in provisions of aesthetics and function. A shallow vestibule is typically connected with plaque accumulation and consequently marginal gingival inflammation.
Gingival recession is defined as exposure of root surface by the apical migration of junctional epithelium (JE), results in an unaesthetic appearance and dentinal hypersensitivity.
Aberrant frenum along with inadequate vestibular depth which causes a gingival recession. Gingival recession is a quite typical clinical locating in the front region of the reduced jaw.
Various surgical modalities have been used for vestibuloplasty like submucosal vestibuloplasty, secondary epithelisation vestibuloplasty, Edlan-Mejchar vestibuloplasty and soft tissue grafting vestibuloplasty.
A 45-year-old female presented with the chief complaint of trauma although brushing in the decrease anterior area reported to the outpatient of Department of Periodontology, Sardar Patel Postgraduate Institute of Dental & Medical Science, Lucknow. On intraoral examination, it was found that patient had Miller’s grade I mobility with the lowered width of attached gingiva in the lower anterior area along with.
Phase I therapy included complete-mouth scaling and root preparing, the occlusal correction was carried out where indicated and oral hygiene directions were reinforced to the patient. , a vestibular extension of the patient’s mandibular labial vestibule to boost the width of attached gingiva was planned. Routine blood investigations (total and differential leukocyte counts, blood glucose- fasting and post-prandial, hemoglobin, bleeding and clotting time) have been carried out.
Pre-surgical preparation incorporated scrubbing of the facial skin all about the oral cavity with povidone-iodine remedy and the patient was created to rinse with .2% Chlorhexidine digluconate mouthrinse for 1 minute. The patient was anesthetized employing two% Lidocaine with Adrenaline concentration of 1:80000. The surgical procedure as described by Edlan and Mejchar was followed. Incisions had been started by giving vertical incision mesial to one particular of the mandibular canines and starting at the junction of the attached and free gingiva an incision was produced for a distance of ten to 12 mm extending on to the lower lip. A similar incision was provided a parallel to the other mandibular canine and these two incisions have been joined by a horizontal incision across the midline. A split thickness flap then separated the loose labial mucosa from the underlying muscle. The outcome was a loose flap of labial mucosa with its base on the gingiva which was then folded upward and a horizontal incision was created on the periosteum, which now becomes visible. The incision of the periosteum was extended in a vertical direction at its ends. The periosteum was then separated from the bone, forming a second flap with its base on the apical portion of the mandible. The loose flap of the labial mucosa was folded back and placed on the bone from which the periosteum was removed.
It was fixed with interrupted sutures to the inner surface of the periosteum, which was removed from the bone. The upper edge of the periosteum was also sutured to the mucous membrane of the lip to cover the area denuded by the reflection of the 1st (labial mucosal) from which the periosteum was removed. It was fixed with interrupted sutures to the inner surface of the periosteum, which was removed from the bone.
Following the surgical process, a periodontal dressing was placed to safeguard the operated location. The patient was prescribed Amoxicillin 500 mg TID for five days and anti-inflammatory (Paracetamol 500 mg) BD for five days for post-operative discomfort and discomfort . The patient was instructed to have intermittent cold fomentation on the 1st postoperative day and soft/liquid diet regime for 1 week along with the maintenance of excellent oral hygiene. The patient was recalled after two weeks for removal of sutures and re-evaluation of the clinical parameter. At two weeks the width of attached gingiva recorded was 6mm around. The patient was recalled right after 6 months and one year for normal follow up and it was observed that the achieved width attached gingiva remained continual all through.
Edlan and Mejchar (1963) depicted a method for vestibuloplasty which appeared to be especially applicable to patients in whom there have been no pockets and small or no gingival tissue present. This process also appeared to enhance the width of the attached gingiva exactly where other procedures have been impracticable due to lack of vestibular depth2,three,four We hereby present a case report of a patient who presented with the chief complaint of mobility in the reduce anterior teeth and in whom vestibular extension was accomplished with the method described by Edlan and Mejchar to right the shallow vestibule.
Edlan and Mejchar method also known as lip switch procedure. The benefit of this approach is that healing occurs by the 1st intention and no bone is left exposed, thereby minimizing the probabilities of bone resorption and additional recession. In the present case, an superb clinical result was obtained which was maintained even 1 year right after surgery.
Different brushing methods call for the placement of the toothbrush at the gingival margin, which might not be possible with decreased vestibular depth. It has been reported that with minimal of 1 mm of attached gingiva, appropriate gingival well being cannot be established. This locating is consistent with the observations of Wade (1969).
Thus, primarily based on the findings of the present case it can be concluded that in instances with a shallow vestibule and a reduced width of attached gingiva on the labial aspect of the mandibular anterior teeth, the approach advocated by Edlan and Mejchar gives a predictable way in which gingival wellness can be accomplished and maintained.
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Level: Medical School
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