Vestibuloplasty - indications, various approaches, reviews. Vestibuloplasty of the lower jaw - indications and techniques Vestibuloplasty of the gums

Vestibuloplasty is a surgical method of correction of the oral cavity, in which, as a result of the redistribution of soft and mucous tissues, the space between the lip and the dentition deepens. The main purpose of such an operative procedure is to shift the internal contours of the mouth and the gum attachment zone, reducing and completely eliminating ischemia and excessive tension of the soft tissues and attached mucous surface of the gums, and improving blood circulation.

Vestibuloplasty effectively alleviates the patient’s condition; you can resort to it by:

• cosmetic indications
  • pronounced aesthetic disturbances and cosmetic defects of the face caused by the small vestibule of the oral cavity;
  • bite correction;
  • increased tone of the mental muscles;
• orthodontic indications
  • correction and preparation of orthodontic mucous tissues before extensive treatment, prosthetics, implantation;
  • to improve the convenience and reliability of fixation of dentures on the gums;
  • chronic disease of periodontal tissue. Preventive measures for periodontal disease, periodontitis, gingivitis;
  • prevention and treatment of oral diseases accompanied by receding gum tissue and exposure of the tooth root (), caused by: tartar and plaque, mechanical trauma and damage, ingestion of arsenic, complications during dental interventions;
  • patchwork operations to cover exposed tooth roots;
  • correction of anatomical features that lead to gum recession: thinned cortical bone, high-set lip frenulum, malocclusion;
  • facilitating the process of implantation of dental implants;
• speech therapy indications
  • disturbance of sound production and complicated phonation of some sounds due to the small oral vestibule;
  • speech defects.

When is vestibuloplasty contraindicated?

In some clinical conditions there are a number of contraindications for this surgical intervention:

• complicated, multiple dental caries;
• pathologies of blood and hematopoiesis (leukemia, hemophilia), blood cancer;
• tendency to form keloid scars, collagenosis;
• maxillofacial osteomyelitis with destructive changes in bone tissue;
• recent radiation exposure to the cervical region and head;
• often recurrent chronic inflammation of the oral mucosa;
• the presence of malignant neoplasms;
• severe cases of diabetes;
• dysmorphophobia;
• cerebral vascular lesions;
• the patient has mental disorders, alcohol and drug addiction.

Preparing for surgery

To successfully undergo direct surgical intervention, dentists recommend following the following rules:

• undergo preliminary x-ray diagnostics of the operated cavity;
• Do not use any medications, especially painkillers. If you need to constantly take any medications, indicate this to the doctor performing the operation;
• solid food is excluded 8-10 hours before surgery;
• it is necessary to perform proper hygiene procedures to remove accumulated plaque;
• Before surgery, check with your doctor about any concerns you may have. This will help get rid of excessive anxiety and fear, and will allow you to have a positive psychological attitude towards the operation. In this case, the period of rehabilitation and recovery will take place in the shortest possible time, with minimal discomfort.

Main stages of vestibuloplasty surgery

Vestibuloplasty is usually performed under local infiltration anesthesia. In children and in severe cases, inhalation or intravenous general anesthesia may be used.

Stage 1. Aseptic treatment of the operated cavity.

Stage 2. Dissection, cutting the space into the depth of the mucous membrane, between the movable part of the jaw and the gums. Depending on the required results, it can be produced using various methods, which will be discussed below.

Stage 3. Peel off the inner surface of the lip using special scissors. At the same time, along the periosteum, submucosal tissues (muscle, fat, tendons) are carefully moved deeper into the frontal and lateral sections. If necessary, dental papillae (cords) are excised with a scalpel.

Stage 4. The necessary positioning of the detached flap is performed. In this case, the exfoliated tissue is moved to the desired location and evenly distributed throughout the entire depth of the newly formed vestibule. An important point is that it is necessary to completely remove fibrous and muscle fibers from both the periosteum and the detached flap.

Stage 5. Fixation of the mucosal flap with ligature threads to the periosteum.

Stage 6. Applying a special aseptic, dental, forming dressing to the wound surface to form a protective fibrin film that will protect it until complete healing. A pressure bandage is applied to the lip and chin area.

Methods of mucosal dissection during vestibuloplasty

Clark's method

Vestibuloplasty according to Clark is an open method of vestibuloplasty and is the optimal solution for correcting the upper jaw. Its exceptional feature is that dissection can be performed over large areas of the oral vestibule without affecting the periosteal tissue. The incision is made to the depth of the oral mucosa along the transitional fold between the mucosa and the gums. The complex of submucosal tissues is moved along the periosteum line to a new depth, in the lateral section - 6-7 mm, in the frontal section - 10 mm. After the operation, a dental forming plate is applied, special attention is paid to the alveolar process, and it is covered with a special film. The period for complete healing is 15-20 days after surgery.

Tunnel vestibuloplasty

This method belongs to the closed methods of vestibuloplasty, is minimally traumatic (often used to eliminate dental problems in children) and can be used to correct both jaws. After infiltration anesthesia, dissection of the mucous membrane is performed, with 3 limited, small incisions made - in a vertical plane 20-25 mm long along the frenulum, along its entire length (from the place of attachment to the lip to the place of attachment to the gum) and two incisions in horizontal plane, along the connecting fold, towards the premolars with a length of about 20 mm. Through these incisions the mucous membranes are manipulated. Healing of the postoperative defect occurs quite quickly - 9-12 days from the date of surgery.

Edlan Meicher method

Most often used for correction of the lower jaw over the entire mucosal area. Local infiltration anesthesia is carried out using the hydropreparation method for better detachment of the mucosal flap. The mucosal surface is dissected along an arc parallel to the jaw line. At the same time, 10-12 mm recede from the gingival border of both canines; in the area of ​​premolars and molars, 7-10 mm recede. Due to the positive dynamics and sustainable results, this method is widely practiced for vestibuloplasty and has a healing period of up to 2 weeks.

Glickman method

This vestibuloplasty is suitable for both local, small areas and relatively large areas. The dissection is made at the place of attachment of the lip, followed by detachment of soft tissue to a depth of 15 mm. The free edge of the resulting mucosal flap is sutured, offset, to the formed depression.

Schmidt technique

This technique involves, after an incision, detaching only the mucosal surface, while the periosteal tissue is not separated. The edge of the mucosal flap is immersed to the required depth of the cavity of the oral vestibule, and then sutured. A dental shaping bandage is applied to the operated areas, and a special pressure bandage is placed on the chin.

Limberg method

With this technique, 2 triangular opposing flaps of the lower lip are formed. The main dissection is along the crest of the frenulum, at the point of its attachment to the alveolar process. Next, two additional incisions are made: one at an angle of 70° from the main incision along the alveolar process, the other at an angle of 80° from the main incision along the mucous membrane of the lip. The length of the incisions in children is 0.5-2 cm, in adults - 2.5-3 cm. After gentle separation of the tissue, the mucosal flaps are mutually moved and stitched with catgut.

Using a laser for vestibuloplasty

Vestibuloplasty using laser technologies is the most promising, innovative, minimally invasive surgical intervention. Using a laser, you can clearly predict the timing and results of plastic surgery, and clearly organize the entire treatment process.

Advantages of using laser in surgery:

• minimal impact on the nerve endings of the cut tissues, little pain;
• rapid postoperative tissue regeneration;
• precise and non-bleeding incision;
• burns of surrounding tissues are excluded, hypersensitivity of tooth enamel is not caused;
• prevention of disturbances in microcirculation processes;
• improved marginal fit of contacting surfaces;
• the possibility of infection of the operated tissues is excluded;
• destruction of pathological microflora, exclusion of purulent-destructive inflammatory processes;
• stimulation of tissue regeneration, absence of scar growths.

For vestibuloplasty, the following types of lasers are used:

• neodymium Nd:YAG laser - with good absorption in pigmented tissues (hemoglabin, melanin). Capable of cutting surfaces in continuous and pulse modes. The radiation is supplied via a flexible light guide;
• argon - with high speed and degree of polymerization of light-curing materials. When used, bleeding is effectively prevented and almost completely stopped;
• diode semiconductor laser - with good hemostatic effect and absorption by pigmented tissues. It has compact overall dimensions, is easily applicable in clinical settings, and has an effect that stimulates tissue regeneration.

Rehabilitation activities

Depending on individual characteristics, patients after vestibuloplasty may experience numbness and loss of sensitivity of the oral mucosa, swelling, and discomfort when speaking. During the rehabilitation period, you can get rid of these manifestations by doing the following:

• rinse your mouth with a doctor-recommended mouthwash after each meal. Light brushing of teeth with a soft brush on the 4-5th day after surgery;
• following special dietary recommendations. The main diet should consist of pureed, soft dishes, purees. Alcohol, spicy, sour, hot and solid foods, dairy products are prohibited (they can provoke the formation of unnecessary bacteria)
• simple, regular, restorative exercises: external, light massage of the skin covering the operated area, touching the area of ​​the vestibule of the mouth with the tip of the tongue, periodically pouting the lips for a period of time< 2 мин/до 5-и раз в день;
• Regular visits to the doctor to monitor recovery and regenerative processes. Clinical control 3.6 months after the intervention.

How to treat emerging complications

• severe bleeding. To eliminate it, you should use hemostatic tablets, make cold applications with liquids for better blood clotting;
• the appearance of ligature fistulas. May be caused by individual intolerance to suture material. In this case, you should consult a doctor to prescribe healing medications;
• excessive swelling. It may be an individual feature; as a rule, it completely disappears within 3-5 days from the date of surgery;
• loss of sensation in the operated area. The norm is that the period of complete restoration of sensitivity can range from six months to 9 months. Physiotherapy (hydromassage, paraffin baths) and rehabilitation exercises help speed up the process.

This is one of the types of surgical operations at a dental appointment, aimed at increasing the depth of the initially pathologically small vestibule of the oral cavity. The vestibule of the oral cavity is the area located between the dental arches and lips (cheeks) and is represented by soft tissues. The normal depth of the vestibule should be 5 - 10 mm. The essence of vestibuloplasty is to move the intraoral muscles, which leads to a decrease in gum tension, which is observed with a small vestibule and, as a result, prevents the development of dental diseases of a periodontal nature.

Indications for vestibuloplasty

• The depth of the vestibule does not reach five millimeters.
• The labial frenulum is woven into the gingival papilla.
• If you retract the lip, the mobility of the gingival margin is determined.
• The mucous membrane contains powerful lateral strands of transitional folds.
• Resorption of the bone located between the incisors (resorption is diagnosed by x-ray).
• Excessive tension is created in the place where the frenulum is attached.
• The mucous membrane has grown around artificial structures in the form of strands and folds.

How is vestibuloplasty performed?

Vestibuloplasty can be performed either traditionally using surgical instruments or with a laser.

Dentists prefer the laser method, since this procedure is minimally invasive and bloodless. Scarring and postoperative swelling rarely occur after laser surgery.

There are several methods of surgical intervention using traditional surgical instruments:

Operation using the Clark method

This method is designed for large gaps in the upper jaw.

First, anesthesia is administered, after which the doctor uses a surgical scalpel to cut the mucous membrane at the junction of the mobile and fixed gums. The periosteum layer is not cut during this operation. After the incision is made, the dentist, using surgical scissors, peels off the mucous membrane of the lip, moves all the tissues of the submucosal layer, and, if necessary, some fibers of the muscle tissue are cut out. A flap of detached mucosa is sewn to the periosteum layer, and the open wound formed on the jaw bone is covered with a special film. The healing period lasts up to fourteen days.

Operation according to the Edlan-Meicher technique

This is the most commonly performed mandibular surgery. However, such vestibuloplasty has one significant drawback - exposure of the lip from the oral cavity.

Once the anesthesia has taken effect, the dentist makes an incision in the mucous membrane, parallel to the base of the bony arch. After this, the flap of the mucous membrane along with the periosteum is peeled off towards the jaw itself. The tendons and muscles are repositioned properly, and the tissue remaining on the periosteum and wound flap is removed. The mucous flap is fixed with sutures, and a protective bandage is applied to the open wound. The healing period also lasts 14 days.

Vestibuloplasty according to Schmidt

This method differs little from the Edlan-Meicher operation. The only difference is that the periosteum in this case is not exfoliated, but soft tissues, muscle fibers and cords are cut parallel to the periosteum layer.

Lengthening the vestibule using the Glickman method

This operation can be performed on both small and large areas of the vestibule. This method can also be called universal. The mucous membrane is cut at the place where the lip is attached. In this case, the soft tissues are peeled off to a depth of 1.5 cm. The rehabilitation period is the same as that of the methods described above.

Tunnel vestibuloplasty

It is considered a low-traumatic surgical procedure. Access to the submucosal tissues is made not using the method of an extensive incision, but through three small limited incisions: two horizontal incisions and one vertical in the middle. The rehabilitation period in this case is reduced to ten days.

But all these traditional surgical methods have a number of postoperative complications: acute pain, postoperative swelling and bleeding. That is why today dentists all over the world prefer laser surgery to traditional ones.

What are the advantages of laser treatment?

• In this case, it is possible to correct the vestibule on both jaws at once.
• You can safely operate on a large area of ​​the gingival margin.
• This effect is safe and minimally invasive.
• Postoperative swelling either does not form at all, or if it does appear, it goes away very quickly.
• The laser has an antibacterial effect.
• This operation is bloodless. The risk of post-operative infection or scarring is reduced to a minimum.
• Such wounds heal within a few days, and they are practically painless.

To improve the effect of orthodontic treatment in dentistry, it is sometimes necessary to resort to surgery. Depending on the indications, a certain type of operation is selected. One of the most common is the method of vestibuloplasty - an operation performed in the area of ​​the vestibule of the oral cavity, that is, the space between the lips and teeth. Today we will tell you what this operation is, we will understand its types and indications for performance.

Indications for surgery

The operation is performed on both the lower and upper jaw. It is needed in order to deepen and expand the vestibule of the mouth, since insufficient area of ​​this area can provoke various disorders and diseases. Surgical correction is performed in the following cases:

• chronic periodontal diseases;
• speech therapy problems caused by a small vestibule of the mouth;
• preparation for orthopedic treatment to increase its effectiveness;
• when implanting dental implants;
• to prevent gum recession;
• before performing patchwork operations;
• to eliminate cosmetic defects.

These are the most common indications, but the doctor may decide to perform vestibuloplasty in some other cases.

Types of vestibuloplasty

There are several correction methods using vestibuloplasty. Each of them has its own advantages, disadvantages and features. Let's take a quick look at them.

1. Vestibuloplasty according to Clark. This method is used primarily for correction of the upper jaw, is carried out over a large area and is relatively simple. Without affecting the periosteum, the area between the mobile area of ​​the mucosa and the gums is dissected. After detachment of the lip mucosa by 1 cm, the muscles and tendons move along the periosteum deeper in the lateral and frontal sections. Single muscle fibers may be removed. At the end of the operation, the mucosal flap is sutured to the periosteum with catgut, and the alveolar process is covered with a special film while the wounds heal.
2. Vestibuloplasty according to Edlan Meicher. This technique gives the most lasting results, therefore it is practiced most often. Meicher oral surgery is usually used to correct the lower jaw. The dissection is carried out as in the first case, but a deeper displacement of the submucosal tissues - muscles and tendons - is used. The fibers remaining on the wound tissue are removed, the mucous membrane is fixed in the new vestibule of the mouth and a protective bandage is applied for two weeks.
3. Tunnel surgery. The technique is universal, but vestibuloplasty of the lower jaw is more often done. It differs from the previous two options in that it is minimally traumatic. During its implementation, only three small incisions are made - two horizontally to the premolars, the third along the frenulum. Thanks to the gentle technique, the wounds heal completely within no later than 2 weeks.
4. Glickman method. This is a universal technique that can be applied locally or immediately to a large area of ​​the lower or upper jaw. At the site of attachment of the lip, a dissection is performed, soft tissue is detached to a depth of about 1.5 centimeters, and the free edge is sutured to the resulting depression.
5. Schmidt's technique. It is performed on the upper or lower jaw without detachment of the periosteum tissue. The operation is characterized by cutting off the cords with muscles in a direction parallel to the periosteum. As a result, a flap is formed, the free edges of which are immersed into the depth of the new vestibule and fixed with sutures.
6. Laser vestibuloplasty is possible using any of the methods described above. Its only difference is the use of a laser instead of a scalpel. This method has many advantages. Complications are virtually eliminated, high precision incisions are achieved and scars are invisible, there is no bleeding, and healing proceeds very quickly. Naturally, the price of the procedure will be higher, but the pain and rehabilitation period will be reduced.

The operation can be performed by any of these methods at the discretion of the attending physician, depending on the indications and clinical picture of the individual patient.

Recovery after surgery

This is a simple operation that is performed quite often, but, as with any other surgical intervention, after it is performed, you must adhere to certain rules.

1. Follow a gentle regimen.
2. Avoid increased physical activity for two weeks.
3. For the same period, stop eating any irritating food.
4. Regularly carry out thorough antiseptic treatment of the operated area.
5. Perform applications with wound healing agents.

Complications and contraindications

Complications occur extremely rarely and in most cases are associated with violation of the recommended regimen. Most often, purulent-inflammatory processes develop, but they do not exceed 0.1% of the total number of operations performed.

In some cases, the operation may be refused, as there are a number of contraindications:

• multiple dental caries;
• cerebral damage;
• malignant tumors;
• bleeding disorders and other blood diseases;
• osteomyelitis;
• radiation irradiation of the neck and head;
• collagenoses;
• relapses of oral diseases.

It is important to understand that this is an ordinary dental operation that carries a minimal risk of complications, so you should not refuse it if you have indications for it. We invite you to watch the final video, which demonstrates plastic surgery using a laser. This video will convince you that there is nothing critically scary about vestibuloplasty.

Reference:

Frenuloplasty

Vestibuloplasty

3. Osteomyelitis.

1. Mental illness.

3. Dysmorphophobia.

4. Cerebral lesions.

Frenuloplasty Y-shaped

Vestibuloplasty

Tunnel vestibuloplasty

prof. A.I. Grudyanov

Ph.D. honey. Sciences A.I. Erokhin

Reference:

Frenuloplasty is an intervention aimed at eliminating the pathological mechanical effect of inadequately attached frenulum of the lips and tongue on the marginal periodontium.

Vestibuloplasty- manipulation aimed at increasing the width of the attached gum in order to eliminate mechanical trauma to the marginal periodontium by muscle cords of the muscles of the perioral area (labial, chin, cheek, lingual and facial muscles) and, as a result, prevents the development of destructive processes in periodontal tissues.

Indications for the use of medical technology:

1. Prevention of gum recession.

2. Preparation of periodontal tissues before performing flap operations.

3. Preparation for orthodontic tooth movement.

4. Preparation for prosthetics.

Contraindications to the use of medical technology:

1. Recurrent diseases of the oral mucosa.

2. Received radiation exposure in the head and neck area.

3. Osteomyelitis.

4. Multiple dental caries and its complications.

1. Mental illness.

2. Alcohol abuse and drug addiction.

3. Dysmorphophobia.

4. Cerebral lesions.

5. Collagenosis and tendency to form keloid scars.

6. Blood diseases (hemophilia, leukemia).

7. Oncological diseases.

Description of medical technology

Frenuloplasty is a manipulation that is carried out in order to eliminate the pathological mechanical effect of inadequately attached frenulums of the lips and tongue on the marginal periodontium (Fig. 1, 2).

Fig.1. Formation of recession in a 7-year-old child due to improper attachment of the frenulum of the lower lip.

Fig.2. The formation of a diastema and the creation of conditions for increased accumulation of microbial plaque due to the low attachment of the frenulum of the upper lip.

Frenuloplasty Y-shaped

After local infiltration anesthesia, carried out using Ultracain D-S forte containing epinephrine 1:100000 in a volume of 1.7 ml, the fixed frenulum is excised with a scalpel and/or gum scissors (Fig. 3,4). After excision of the frenulum, the defect on the mucous membrane takes on a diamond shape. The mucous membrane adjacent to the incision is cut at the edges for the purpose of mobilization, and with a thin rasp is moved under the mucous tissue along the periosteum in the apical direction (Fig. 5). Using catgut, the mobilized mucous membrane is fixed in the depths of the formed vestibule to the periosteum with an interrupted suture (Fig. 6). The wound is sutured tightly (Fig. 7).

Fig.3. Low attachment of the frenulum of the upper lip. Ischemia when retracting the lip.

Fig.4. After infiltration anesthesia, the frenulum was excised with a scalpel.

Fig.5. The edges of the incision are mobilized. The complex of submucosal tissues is shifted along the periosteum into the depths of the formed vestibule.

Fig.6. The mobilized mucous membrane of the incision edges is fixed to the periosteum with catgut sutures.

Fig.7. Condition of tissues after suturing.

Frenuloplasty according to Limberg (Z-shaped)

After local infiltration anesthesia, carried out with Ultracain D-S forte containing 1:100,000 epinephrine in a volume of 1.7 ml, a vertical incision is made in the middle of the frenulum (Fig. 8). Two oblique cuts are made from opposite ends in different directions from the first cut at an angle of 60 - 85 degrees (Fig. 9). The formed triangular flaps are mobilized and fixed so that the central incision is horizontal (Fig. 10). An important point is the preparation of the receiving bed, since simply suturing the edges of the incisions together within the mucous membrane will only weaken the tension, but will not eliminate it completely. It is the omission of this moment that significantly reduces the effect of this technique, which has led to the insignificant use of this intervention. In this regard, the preparation of the receiving bed is carried out in the same way as during the previous manipulation: the submucosal tissues are peeled off along the periosteum with a raspatory. Then, the horizontal incision is sutured tightly using interrupted catgut sutures, while fixing the flaps to the periosteum (Fig. 11). Additional incisions are sutured just as tightly, but without fixing the flaps to the periosteum (Fig. 12, 13).

Fig.8. Infiltration anesthesia in the area of ​​the low-attached frenulum of the upper lip.

Fig.9. Vertical and 2 oblique cuts, forming the Latin letter "Z".

Fig. 10. Triangular mucous flaps are detached and mobilized. The complex of submucosal tissues is displaced apically along the periosteum.

Fig. 11. The flaps are moved and fixed to the periosteum along a horizontal line.

Fig. 12. Condition of tissues on the 7th day after surgery.

Fig. 13. Condition of the tissues on the 14th day after the intervention.

Vestibuloplasty

Vestibuloplasty is aimed at creating a direct attachment of the non-keratized oral mucosa to the periosteum and bone of the alveolar process in order to subsequently absorb the tension created by the group of muscles and cords surrounding the mouth. The depth of the formed vestibule should

be no less than 5 mm and no more than 10 mm.

Vestibuloplasty according to Edlan Meicher recommended for use on the lower jaw and when combining this operation with cystectomy.

After local infiltration anesthesia, carried out using Ultracain D-S forte with an epinephrine content of 1:100000 in a volume of 5.1 ml, preferably using the hydropreparation method for easier subsequent peeling of the mucous flap.

Using a scalpel, an incision is made in the mucous membrane parallel to the bend of the jaw, departing from the mucogingival border by 10 - 12 mm in the area from canine to canine and by 7 - 10 mm in the area of ​​​​premolars and molars (although in this area one should strictly focus on the place of exit of the vascular -nerve bundle) (Fig. 14, 15). Using scissors, bluntly peel off the mucous flap from the incision line to the jaw (Fig. 16).

Fig. 14. The state of the vestibule of the oral cavity after infiltration anesthesia.

Fig. 15. Making an incision on the lip to form a mucosal flap.

Fig. 16. Peeling of the mucous flap from the submucosal tissue.

After this, the submucosal tissues (muscles, tendons) are moved along the periosteum to a depth of 10 mm in the frontal section and 6-7 mm in the lateral sections (Fig. 17). On the lower jaw, you should work extremely carefully in the area of ​​the chin openings. A very important point is the removal of remaining muscle and fibrous fibers from the wound surfaces of the periosteum and mucosal flap, since their presence usually leads to recurrence of the strands (Fig. 18). The detached mucous flap is fixed to the periosteum with catgut sutures in the depths of the formed vestibule (Fig. 19).

Fig. 17. Displacement of submucosal tissues along the periosteum to the depth of the formed vestibule.

Fig. 18. Removing muscle fibers with scissors.

Fig. 19. The mucous flap is fixed to the fixed periosteum with sutures.

A protective bandage is applied to the remaining wound defect (Fig. 20) until a protective fibrin film is formed. As a result, all this significantly facilitates the patient’s condition in the postoperative period (Fig. 21). The initial area of ​​the wound defect is about 8 - 12 cm2. The healing period with this technique is 12 - 14 days.

After local infiltration anesthesia, carried out using Ultracain D-S forte containing epinephrine 1:100000 in a volume of 5.1 ml, an incision is made with a scalpel along the transitional fold to the depth of the mucous membrane (Fig. 22, 23). Using scissors, the mucous flap is peeled off from the incision line to the lip by approximately 10 mm (Fig. 24).

Fig.20. Condition of tissues on the 1st day after surgery.

Fig.21. Condition of tissues on the 14th day after surgery.

Fig.22. State of the vestibule before surgery. Positive symptom of ischemia when retracting the lip.

Fig.23. After anesthesia, an incision is made along the transitional fold to the depth of the mucous membrane without affecting the periosteum.

Fig.24. Mobilization of the mucosal flap with scissors to prevent narrowing of the red border of the lips.

The complex of submucosal tissues - muscles, tendons, in the same way as according to the Edlan-Meicher method - is moved along the periosteum to a depth of 10 mm in the frontal section and 6-7 mm in the lateral sections,

and also remove single fibers of cords and muscles (Fig. 25).

Fig.25. Using a raspatory, a complex of submucosal tissues is moved along the periosteum to a new depth.

The mucous flap is fixed to the periosteum with catgut sutures in the depths of the formed vestibule. In this case, a fairly extensive wound defect remains on the alveolar process, which is covered with a protective bandage (Fig. 26, 27).

Fig.26. Fixation of the mucous flap to the periosteum with catgut sutures in the depths of the vestibule.

Rice. 27. Applying a protective film “Diplen-Denta” to the wound surface.

The healing period with this technique is 15 days (Fig. 28, 29). The wound defect is about 8 - 12 cm2. The operation is optimal for the upper jaw, given that in the lower jaw powerful muscles and tendons can often subsequently significantly neutralize the initially obtained results.

Fig.28. Condition of tissues on the 7th day after surgery.

Fig.29. Healing on the 15th day after surgery.

Tunnel vestibuloplasty

After local infiltration anesthesia, carried out using Ultracaine D-S forte with an epinephrine content of 1:100000 in a volume of 5.1 ml (Fig. 30, 34, 35), a vertical incision is made along the central frenulum of the vestibule of the oral cavity for its entire length (from the place of its fixation on the attached gum and to the place of its fixation on the lip - approximately 20-25 mm). In the area of ​​the premolars, horizontal incisions are made along the transitional fold, about 20 mm long (Fig. 31).

Fig.30. Condition before surgery. After infiltration anesthesia, the true depth of the vestibule is revealed using the type of hydroseparation.

Fig.31. After making incisions (central and 2 oblique in the premolar area), a submucosal tunnel is formed.

Fig.32. After moving the complex of submucosal tissues and removing residual connective tissue and muscle fibers, the mucous membrane is fixed to the periosteum in the depths of the formed vestibule.

Fig.33. The central incision is sutured, the mucosa is fixed to the periosteum. In the area of ​​the lateral incisions, the same is done, leaving minor wound defects to prevent the development of pronounced edema (when mobilizing the buccal mucosa, it can be sutured tightly).

Fig.34. Condition of the vestibule tissues before surgery. "Transparent" mucous membrane of the alveolar process, generalized recessions.

Fig.35. After infiltration anesthesia using the type of hydroseparation or “creeping” infiltrate, the true depth of the vestibule of the oral cavity is revealed.

Fig.36. After making a central and 2 lateral incisions, a mucosal tunnel is formed.

Fig.37. Through an internal tunnel access, a rasp is used to displace the complex of submucosal tissues along the periosteum, completely dissecting the fibers attached to the periosteum.

Bluntly, using a rasp or a wide trowel, peel off the mucous membrane from the complex of submucosal tissues along the entire length of the operated area (Fig. 32, 36). Submucosal tissues and muscle cords are again separated from the periosteum using a raspator to the planned depth using intratunnel access. Visually and instrumentally determine whether there are any muscle cords attached to the periosteum (Fig. 37). Detached mucous flaps at the level of the line of detachment of muscle cords are fixed through the mucous membrane to the periosteum at a distance of 10-12 mm from the alveolar edge (Fig. 33, 38).

Rice. 38. Fixation of the mucous tunnel with catgut sutures to the periosteum.

Rice. 39. The central incision is sutured tightly, minor wound defects are left in the lateral areas.

The vertical incision is sutured, fixing the mucosa to the periosteum at a given depth. The mucous membrane in the area of ​​horizontal incisions is sutured to the periosteum at a distance of 5 - 8 mm from the gingival margin. A protective bandage is applied to the remaining wound areas with a total area of ​​1.5-2 cm2.

The healing period when using this technique is 9-11 days (Fig. 40, 41). There is virtually no pain in the postoperative period due to the minimization of the wound defect. The operation is equally effective on both jaws.

Rice. 40. Condition of tissues 2 weeks after surgery.

Rice. 41. Condition of the vestibule 6 months after vestibuloplasty.

Management of patients after vestibuloplasty

After completion of the intervention, it is recommended to apply an ice pack to the facial skin in the area of ​​the operation for at least 6 hours (20 minutes - cold, 20 minutes - break, to reduce collateral edema).

Considering the presence of a wound defect in the oral cavity that heals by secondary intention, it is necessary to prescribe a gentle diet to patients (food should not be hot, sour, spicy or salty).

* Pouting lips (at least 5 times for 2 minutes a day).

* Touching the tip of the tongue to the apical border of the formed vestibule (at least 5 times for 2 minutes a day).

* External finger massage (at least 5 times for 2 minutes a day).

Possible complications when using medical technology and ways to eliminate them

1. Postoperative bleeding. Prescribing local hemostatic agents to patients in the postoperative period.

2. Change in sensitivity in the area of ​​intervention.

As a rule, it disappears 6-9 months after surgery. Prescription of myogymnastics and physiotherapy.

3. Postoperative recurrent cords and scars. Repeated surgery with removal of residual muscle fibers.

4. Ligature fistulas along the transitional fold. Complete removal of catgut residues from the fistula tract.

Effectiveness of the use of medical technology

The effectiveness of surgical treatment was assessed on the basis of a comprehensive examination of 746 patients, of which 597 people - for the purpose of preparing for flap operations, 112 - for preparing for orthodontic treatment, 37 patients - for the purpose of creating a prosthetic bed before complete removable prosthetics.

When assessing the results of vestibuloplasty in patients, we noted the so-called “creeping attachment” phenomenon, indicating the elimination of traumatic effects on the marginal periodontium. This phenomenon was expressed in the fact that at the intervention site, 5-7 days after surgery, a powerful capillary network was formed in the marginal gum. A bright pink tissue ridge appeared near the exposed necks of the teeth, which over time increased in volume to 1-1.5 mm. Subsequently, the apical part of the gingival strip changed in color: it became paler and compared in structure with the attached gingiva, and in the coronal direction the growth process described above was again observed. It should be noted that this growth may vary in intensity and time. However, usually this increase did not exceed 2 mm, and the process itself varied in time from 3 months to 1 year. With combined traumatic effects (presence of supracontacts, inadequate prosthetics, occlusion pathology) and in the older age group, long-term stabilization of the level of the marginal gum was noted.

Measurement of periodontal pockets after vestibuloplasty showed a decrease in their depth by 23 ± 7% compared to the preoperative state. When studying the condition of the alveolar process in patients undergoing orthodontic treatment, it was noted that there was no formation of recessions in moved teeth in 94% of cases, while in the control group it was 73%.

Comparing groups of patients operated on before complete removable prosthetics, it was proven that fixation of removable dentures is carried out ideally and without the need to use adhesive gels, while in patients who refused to undergo surgery, only 37% had such fixation.

Thus, the results obtained indicate the high effectiveness of the proposed methods of vestibuloplasty and frenuloplasty in the complex treatment of inflammatory periodontal diseases.

prof. A.I. Grudyanov

Ph.D. honey. Sciences A.I. Erokhin

In some cases, dental patients require lower jaw vestibuloplasty. We will describe what it is, indications, photos, reviews further. After all, people are often faced with similar procedures and are afraid to agree to them, because the unknown is scary.

The operation itself is performed in order to prevent various diseases in the oral cavity. By nature, not everyone has enough space between the teeth and the lip. Sometimes the tension in these muscles is too strong and needs to be removed for comfort.

What is mandibular vestibuloplasty?

The procedure itself is an increase in the space in the recess of the oral cavity between the teeth and lip. Due to various manipulations, which depend on the chosen correction method, the muscle fibers responsible for gum tension are displaced.

The operation is sometimes performed on the upper jaw, but most often vestibuloplasty concerns the lower row.

Indications and contraindications

This procedure can be carried out for a variety of reasons. Sometimes this is a prevention of some diseases, and sometimes it is also for the treatment of existing ones. Vestibuloplasty is also used in prosthetics and pediatric dentistry.

The most popular indications for its implementation are:

• to prevent periodontal inflammation and gingivitis;
• for violations of the nutrition of the bone jaw;
• to solve speech therapy problems;
• for the purpose of exposing the roots of teeth in some cases;
• in the process of preparing extensive orthodontic treatment;
• when installing implants or removable dentures for their more convenient and reliable fastening;
• Sometimes correction of cosmetic defects is also necessary.

• in the presence of hereditary hemophilia;
• blood cancer;
• cerebral lesions;
• cancer and radiation therapy;
• osteomyelitis;
• tendency to form scars;
• constant chronic inflammation of the mucous membrane;
• extensive caries;
• in cases of alcohol and drug addiction;
• as well as people with various mental disorders.

Types of surgery

Let us briefly describe the most popular surgical techniques that are used today in dentistry to solve this problem:

1. According to Clark, this is the simplest method, but most often it is used for the upper jaw. The doctor cuts the mucous membrane between the teeth and the lip and peels it off a little. Thus, the desired muscles are moved deeper, and the dentist can remove some single fibers manually. Then the flap is sewn to the periosteum, and the wound itself is covered with a special protective film.
2. According to Edlan-Meicher - used for correction of the lower jaw. It is believed that this method gives lasting and good results. An incision is made along the bone in an arc, and part of the mucous membrane is peeled off towards the jaw. Some tissues are moved deeper or to the sides, and excess tissues are removed. Then the muscles are fixed with sutures and a bandage is applied.
3. According to Schmidt, this is a simpler method in which the periosteal tissue is not touched. Only an incision is made parallel to the bone and the edge of the flap is pulled inward and fixed.
4. According to Glickman, it can be used in both small and larger areas. The incision itself is made, in this case, exactly at the junction of the lip. The detached flap is sutured to the vestibule of the cavity.
5. Tunnel vestibuloplasty is used equally for the correction of the upper and lower jaws. It is believed that such an operation is less traumatic and the wound heals much faster. The cuts are made in three places, instead of one large one. This method is best suited for treating children.
6. Laser surgery is performed using a laser, which reduces the pain and trauma of the procedure. In this case, they do everything the same as in the usual procedure with a scalpel. But due to the use of a more technologically advanced tool, the entire process occurs accurately, purposefully, with less pain for the patient himself, and the wound subsequently heals faster. Another advantage of this procedure is the additional bactericidal effect in the surgical area.

The laser method is often used to remove the frenulum as an alternative to the conventional procedure. This helps reduce the child's fear, pain at the incision site and significantly speeds up healing.

Preparation for the procedure

In order for the entire process to be successful and with the least negative consequences, the patient must take responsibility for proper preparation for the operation. You should adhere to the following recommendations:

• Clean your mouth thoroughly using a soft brush and toothpaste.
• Avoid solid foods six hours before surgery.
• You should not take various medications unless prescribed by a doctor. Sedatives, painkillers or any other medications can lead to negative consequences during the procedure. If you took something, be sure to tell your doctor what exactly it is.
• The psychological mood of the patient is also important. Don't be afraid and beat yourself up. If you cannot cope with panic, then talk to your doctor about what worries you and be sure to reduce your level of anxiety.

Carrying out the operation

At the very beginning, anesthesia is required. The method chosen will depend on the patient's age, fear, sensitivity and other factors. Next, the doctor chooses the appropriate correction method and carries out the necessary manipulations. The operation usually lasts about an hour or a little less.

After completion of the procedure, an ice pack is placed on the patient’s operated jaw, which is recommended to be kept for at least 20 minutes. Then you need to let the operated area rest and apply ice to it again. You can do this for up to six hours in a row. Due to anesthesia, the patient will not feel pain immediately after the operation.

After some time, painful sensations may begin. How to deal with them, how long it takes for the wound to heal, what to do during this time - the doctor should tell you in detail. The patient's task is to follow clear instructions and recommendations.

Rehabilitation

Most people feel quite unpleasant sensations - swelling, numbness, pain, discomfort when talking, etc. It all depends on individual characteristics. But in the postoperative period you should adhere to the following rules:

• In the first days, it is better to brush your teeth only with a soft brush and not use toothpaste. It will be possible to fully carry out the necessary hygienic manipulations only 3-4 days after the operation.
• Pay special attention to your food choices during this period. It should not be hot. Avoid hard, sour and spicy foods so as not to irritate the mucous membranes.
• Doctors recommend eliminating dairy products from the diet for a while, as they form a special coating that is difficult to remove. And since high-quality cleaning is excluded at this time, it is better not to provoke the formation of excess bacteria in the oral cavity.
• The use of alcoholic beverages is completely contraindicated.
• Mashed potatoes, pureed dishes and any soft food are what you should now switch to in your diet. Try to use salt and spices in minimal quantities.
• After each meal you need to rinse with antiseptic solutions. Usually the doctor prescribes what exactly.
• Do regular exercises, which your dentist will also tell you about. Thanks to such simple exercises, you can quickly restore lost sensitivity and speed up the rehabilitation process.
• Visit your doctor throughout this period so that he can monitor how healing and recovery occurs. It is better not to miss scheduled appointments.

Complications

Their main reason is most often ignoring recommendations and not visiting a doctor. The occurrence of pathological consequences is a matter of chance, but if they are not noticed and eliminated in time, then you will have to spend much more effort on treatment. We present in the table the main options for unpleasant consequences that a patient may encounter during vestibuloplasty.

Vestibuloplasty - indications, various approaches, reviews

A person's success and confidence largely depends on how good he looks. The overall image includes a beautiful smile, a neat, well-groomed appearance, and pleasant speech.

But not everyone can boast of a pleasant appearance, straight and white teeth. In these cases, many resort to dental services to change their appearance.

In modern medicine, there are many methods that allow you to change the internal and external contours of the mouth. Among them, a type of surgical intervention stands out: vestibuloplasty, which is the correction of the oral cavity through surgery.

This method is classified as a plastic type of surgical intervention. This method is used in cases where a person has a small vestibule of the mouth and for some other indications.

By using vestibuloplasty, the tension on the gums is reduced as a result of the intraoral muscles moving.

Indications and contraindications

Vestibuloplasty is most often performed on the lower jaw. This intervention is used if it is necessary to deepen and (or) widen the vestibule of the mouth, when its small area can lead to various kinds of disorders and pathologies.

Indications for use are:

• prevention of gum recession;
• chronic periodontitis;
• in order to increase efficiency in preparation for orthopedic treatment;
• implantation of dentures;
• speech therapy disorders;
• in order to eliminate cosmetic defects.

The listed indications are considered the most common. However, according to the decision of a specialist, vestibuloplasty can be performed in some other situations.

The operation is unacceptable in the following cases:

• The patient is diagnosed with osteomyelitis;
• there is extensive dental caries;
• the head or neck area has been irradiated;
• in case of relapse of any oral disease;
• with existing blood pathologies and cerebral damage;
• if malignant neoplasms are diagnosed.

If at least one of the above points is present, the body must be prepared in advance for surgery.

For example, if the teeth have a pathological condition, they need to be cured; after radiation therapy, it is important to restore the body, and the like. If this is not possible, the specialist will offer an alternative solution.

Types of surgical intervention

Vestibuloplasty according to Clark is one of the easiest. It is carried out on a large area in front of the mouth. It is also worth noting that this method is often used to correct the upper jaw.

• First of all, the patient is given anesthesia;
• cut the space between the mobile mucosa and the gum;
• using scissors, the mucous membrane of the lips is peeled off;
• tendons and muscles are moved deeper;
• single muscle fibers are removed;
• Once completed, the mucosal flap is sutured to the periosteum.

Edlan-Meicher method

Vestibuloplasty according to Edlan Meicher is considered more popular because it gives better results. But, despite this, it also has some disadvantages, the main one of which is the exposure of the inside of the lip.

This type of intervention is used when correction of the lower jaw is necessary. All the same manipulations are carried out as in Clark’s method.

Glickman method

The peculiarity of this method is its versatility. Its use is possible not only over a large area, but also locally. The cut is at the attachment point of the lip. After this, the soft tissue is peeled off. The new free edge is hemmed to the place where the recess was made.

This type of surgery differs from previous ones. During its implementation, there is no detachment of the periosteal tissue. Muscle cutting is carried out parallel to its direction. The free edges of the new flap are advanced inward and fixed with sutures.

Tunnel method

This option of vestibuloplasty is used to correct the lower or upper jaw. This method is the least traumatic compared to the others.

Incisions are made along the frenulum and in a horizontal direction to the premolars. Thanks to this, wound defects are significantly reduced, which promotes faster healing already on the tenth day.

Laser exposure

Refers to innovative methods. The laser acts as a scalpel. It should be taken into account that such a correction is even less traumatic.

There is a great opportunity to increase the area and expand the vestibule.

Vestibuloplasty, which is performed with a laser, has a number of advantages:

• slight swelling or its complete absence;
• precise cut;
• no bleeding;
• reducing the number of pathogenic microorganisms;
• decreased microcirculation of vessel walls;
• fast recovery;
• minimum scarring.

Whatever correction method is used, it is important to remember that a gentle regime is necessary for recovery.

Rehabilitation period

During the first two weeks after surgery, it is important to avoid excessive physical activity. In addition, it is recommended to exclude any irritating foods from the diet:

For subsequent maintenance treatment, the doctor prescribes antiseptic drugs. Their use is necessary for wound treatment, which should be carried out daily.

• massage with fingers, which is performed externally;
• touching the tip of the tongue to the vestibule of the oral cavity;
• pouting your lips for two minutes, this exercise is done up to five times a day.

Possible complications

The development of any serious consequences after this intervention is extremely rare. As a rule, they can only be provoked by non-compliance with the prescribed postoperative regimen. In some situations, purulent inflammation may occur. But these are only isolated cases, the percentage of which is less than 0.1 of the total number of operations.

Sometimes bleeding may occur or sensitivity may change at the site of the incision. You should not be afraid of this, since such phenomena pass after some time.

Through surgery to a new life

Reviews from patients who underwent vestibuloplasty in one way or another.

I had a Clark correction just a week ago. No stitches were required after the procedure. They just attached an overlay to the place where the cut was. A few hours later it resolved on its own.

To compress the incision, they also glued a plaster to the chin. At the moment, healing is proceeding without any complications, I don’t feel any particular pain. Only when smiling does discomfort and unpleasant sensations arise. I hope that this operation will help me get rid of periodontitis and bleeding gums.

Elena, Krasnodar

The need for this operation arose after a terrible car accident. Quite a lot of unpleasant hours and days were experienced.

I have already lost all hope for a beautiful smile and straight teeth. However, at the moment, five months after the operation, everything is fine with me. And this is only thanks to the experienced specialists who performed the vestibuloplasty operation with such a strange name - according to Kazanyan.

Maria, Moscow

More than a year and a half has passed since the day I had the correction. It is worth noting that the rehabilitation lasted quite a long time. It took a lot of time and effort for complete healing and adaptation.

I felt severe pain only in the first three days after the operation, after which it occurred only periodically, and this only happened while talking and eating. At first it felt like my cheeks were just hanging down.

But, as they later explained to me, these were only the consequences of residual swelling, which went away after a few days. After this, a scar formed in the incision area. Quite an unpleasant phenomenon, I want to say, but he later disappeared. All this lasted about a year.

Restoration of sensitivity also did not occur immediately. For a long time, it seemed like I couldn’t feel my chin, it was just numb. I would like to note that, despite the long recovery in my case, it was worth it, the roots of my teeth are no longer exposed.

Natalya, Dnepropetrovsk

The price of vestibuloplasty will depend on the method used. The price threshold varies around three to six thousand rubles. The laser method of performing the operation costs 7-10 thousand rubles.

Vestibuloplasty: what kind of operation is it? Reviews about it and approximate prices

The main indicators of success and self-confidence are a beautiful smile, clear diction, contact behavior and an attractive aesthetic appearance.

Not all people can boast of a beautiful appearance, a seductive smile, charming facial expressions and straight teeth. Sometimes you have to seek the help of a dentist to help achieve fundamental changes in your appearance.

Modern medicine has great opportunities and innovative methods for shaping the external and internal contours of the mouth.

Not everyone is familiar with the term vestibuloplasty. This is a very delicate surgical intervention, the purpose of which is to eliminate pathology of the oral cavity.

This operation is performed in situations where the patient has a very small vestibule of the mouth. This deficiency can lead to serious dental problems.

Normally, the depth of the vestibule is considered to be 4–5 mm in children aged 6–7 years, 6–8 mm at the age of 8–9 years, and by the age of 14–15 it should reach 10–14 mm. High attachment of the frenulum of the lower lip can cause the development of gingivitis and local periodontitis.

Plastic and modern jaw surgery can solve many problems in the facial area.

Indications for surgery

• If the patient has periodontal disease. In this case, surgical intervention will alleviate the patient’s condition and subsequently relieve these ailments.
• Before starting the prosthetic procedure to better secure the dentures.
• In case of implantation of a dental implant. For example, if the muscle is attached to the alveolar process too high. In this case, if surgery is not performed, an inflammatory process will occur.
• Before starting orthodontic treatment.
• If there are speech therapy problems.
• Before an operation that will solve the problem with exposed tooth roots.
• As a preventive measure against gum recession.

Types of this surgical intervention

There are several methods for performing this operation. Surgical intervention technologies are quite diverse.

According to Clark

This is an intervention for a minimally short period. The simplest method used for pathologies in the upper jaw.

Progress of the operation: First of all, anesthesia is done. The second step is when the surgeon cuts the mucous membrane between the gum line and the mobile area of ​​the mucous membrane. The depth of the incision corresponds to the depth of the mucosa. Then, using scissors, the mucous membrane of the lips is peeled off. Muscles and tendons move deeper along the periosteum. Healing occurs in 2 – 3 weeks.

According to Edlan–Meicher

This technique is used to correct defects of the lower jaw. This method of intervention guarantees the greatest effect.

Progress of the operation: anesthesia is performed, the mucous membrane is cut, the mucous flap is peeled off and the submucosal tissue is moved deeper. The patch is fixed with sutures. A protective bandage is applied to the wound. The disadvantage of this method is the duration of healing.

Schmidt modification

The peculiarity of this method is the absence of detachment of periosteal tissue. The muscles are dissected parallel to the periosteum.

According to Glickman

This technique is used with equal success on all problem areas of the jaw. In this case, an incision is made in the area where the lip attaches.

Using a blunt instrument, the surgeon peels off the soft tissue, the free edge of which is sutured to the formed depression.

This operation is considered low-traumatic. The wound area is small, healing occurs within 10 – 11 days. This method is suitable for both jaws. It is also called tunnel vestibuloplasty.

Contraindications

In some cases, vestibuloplasty is contraindicated.

1. When a patient is diagnosed with multiple and complicated dental caries.
2. The patient has osteomyelitis.
3. In the presence of recurrent chronic diseases of the oral mucosa.
4. With cerebral damage.
5. If the patient has a tendency to form keloid scars.
6. For blood diseases such as hemophilia and leukemia.
7. After undergoing radiation therapy in the head or neck area.
8. In the presence of malignant tumors.

Use of laser in vestibuloplasty

During surgery, the laser plays the role of a scalpel.

This technique for expanding the vestibule of the mouth and increasing the area of ​​​​fixed gums is the least traumatic of all the above.

Advantages of using laser:

1. With surgery this way, blood loss is minimized.
2. And another important advantage of this method is the complete absence of pathogenic bacteria and infections from entering the incision.
3. Using a laser, the surgeon can cut through tissue with high precision.
4. After such an operation, the patient practically does not form scars.
5. No swelling after surgery.
6. Patients experience a decrease in microcirculation of the vascular wall.
7. After surgery, using this method, a rapid process of restoration of damaged tissue occurs.

Each method has its own properties and characteristics. Based on these indicators, the doctor decides which option for a particular patient will be the most optimal.

After the operation, the doctor is obliged to give the patient recommendations regarding the management of the postoperative period, which will last 2–3 weeks.

In the video you can see how vestibuloplasty is performed using a laser:

To avoid complications, you must strictly follow all the dentist’s recommendations:

1. Regularly treat the wound with antiseptics.
2. Do not forget to use wound healing agents prescribed by your doctor.
3. Eliminate spicy, sour and salty foods from food; they greatly irritate the mucous membrane of the mouth.
4. Maintain oral hygiene.
5. During this period, it is necessary to minimize physical stress on the body.