Vestibuloplasty of the lower jaw - indications and methods. Vestibuloplasty of the lower jaw Vestibuloplasty of the gums

Not always the elimination of dental pathologies is managed by therapeutic methods. In some situations, it is necessary to resort to surgical interventions.

For each type of anomaly, its own effective operation is selected. One of them is vestibuloplasty, which is aimed at eliminating anomalies in the oral cavity.

Definition

Vestibuloplasty is an operation performed on the eve of the mouth in order to correct it. The anticipation is space between teeth and lip. According to its characteristics, it refers to plastic surgery, but is intended to solve dental problems.

Target

The main goal of this method is reduction of excessive tension gum tissue due to surgical displacement of the intraoral muscle tissue. Additionally, the technique is aimed at increasing the total area of the gums and deepening all parts of the vestibule.

Indications and contraindications

This procedure can be performed both on the upper and lower jaw, if there are certain indications for this:

periodontal disease in a chronic form;
mucosal adjustment before main orthodontic treatment or implantation;
diction disorder;
gum recession or its prevention;
pronounced facial aesthetic disorders;
worsening bone tissue quality;
exposure crown necks;
high attachment of gum tissue to the tooth.

Vestibuloplasty may be performed if the patient has there are no following contraindications:

cerebral lesion;
hemophilia hereditary type;
oncological pathologies both in the oral cavity and outside it;
undergoing radiation therapy;
presence in the problem area pronounced dense scars;
osteomyelitis;
pathology psycho-neurological nature;
alcohol, drugs or nicotine addiction.

Kinds

Vestibuloplasty has many options, each of which is aimed at solving a specific narrow problem. In dental practice, the following methods of vestibuloplasty are most often used:

Meyher. Of all the options for vestibuloplasty, this method is considered the most effective. It allows you to get guaranteed and accurately predictable results.
But at the same time, it has disadvantages: high trauma and complete exposure of the inner surface of the lip, which heals on its own. This technique is most often used to correct the lower jaw over the entire area of the mucosa and is performed under local anesthesia.

The whole process takes place in several steps: peeling off the mucosa, periosteum and moving the flap to the lateral sections and deep into the vestibule. After that, stitches and a special bandage are applied to the wound.
Schmidt. Unlike the previous method, only the mucosa is exfoliated here. The periosteum remains intact. This method of correction is equally used for the treatment of the upper and lower jaws in the case of localization of the anomaly only in the anterior vestibule.
The procedure involves less surgical intervention - the incision is made only in the central region of the vestibule. After that, the mucosa is shifted a little deeper.
Tunnel. As well as the Schmidt method, it can be used to treat both jaws. It is less traumatic than the previous options, and consists in applying only three limited incisions and shifting the mucosal flap deep into the vestibule.
The incisions are made in specific areas: one vertical incision parallel to the frenulum and 2 horizontal incisions parallel to the premolars. The area of the injured area is reduced three times compared to the methods described above.
Laser. This method of increasing the area of the vestibule and its depth cannot be called a separate technique. This is most likely one of the additional options for the methods described above.
The procedure is carried out in accordance with the chosen method, but a non-traumatic laser is used to cut soft tissues.

Thanks to its use, the risk of complications is reduced, there is no bleeding, and the period of tissue healing is reduced.

Stages

Despite the different types of vestibuloplasty techniques, the correction procedure always has common stages: preparation and operation.

Training

Since the operation involves a direct surgical effect on the soft tissues of the oral cavity, a thorough diagnosis is mandatory. To make a diagnosis and identify possible contraindications, standard methods are used:

visual inspection;
instrumental survey;
diagnostics using x-ray equipment.

The preparatory stage includes not only diagnostic manipulations, but also special training on the part of the patient and the dentist.

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Patient preparation is as follows:

minimum in 6 hours necessary before surgery eliminate all solid foods that can injure gum tissue;
do not take painkillers and other drugs, as this may affect the effect of anesthesia.

Preparation in the dental office involves the complete removal of deposits of the anterior dentition. To do this, the dentist conducts a professional cleaning of the teeth using a special paste.

Operation

Basically, local anesthesia is used for the operation, but if the patient wishes, general anesthesia can be placed. The operation takes place in several stages:

aseptic processing oral cavity.
Mucosal incision which is produced according to the chosen method. According to the Meicher method, the incision is made parallel to the jaw bone, observing its curves, over the entire visible area of the vestibule.
According to the standard, it is allowed to make an incision from premolar to premolar. According to the Schmidt method, a limited incision is made from canine to canine, without capturing the periosteum.
Exfoliation of the mucosa. During this manipulation, the dentist gently pushes adipose and muscle tissue away from the periosteum. If necessary, the cord is excised with a scalpel.
Positioning of the flap. To do this, it is moved to the problem area, evenly distributing the mucosa. After that, the wound flap is leveled and cleaned of unnecessary fibers.
After spreading the flap mucosa is fixed with conventional surgical sutures, then an aseptic dressing is applied to its surface.

The duration of surgery, depending on the method, is 30-60 minutes.

Rehabilitation

The recovery period will depend on the technique used. If a sparing option was used using a laser or a tunnel method, then the healing process lasts about 10 days. In the case of using traumatic methods, the rehabilitation period is 20 days.

To reduce discomfort and speed up the healing process, you should adhere to the following recommendations:

To remove swelling from the injured area, it is necessary immediately after the procedure apply a cool compress for at least 20 minutes.
The first few days for cleaning the dentition do not use hard toothbrushes or their electrical counterparts. They can damage the mucosa and cause flap displacement.
For cleaning, it is best to use classic brushes with soft bristles and anti-inflammatory pastes.
Until the wound surface is completely healed, it is imperative to use antiseptic, regenerating and anti-inflammatory drugs, for example, miramistin, holisal, metrogil-denta and etc.
From the diet follows remove all hard, as well as traumatic and irritating products.
In 5 days it is recommended to use myogymnastic exercises.

Complications

Vestibuloplasty, like any other surgical intervention, can cause a number of postoperative complications:

Bleeding. It can be caused by tissue injury when cleansing the mouth, poor blood clotting, thin vessels. To eliminate the complication, it is necessary to take hemostatic drugs in the first few days, for example, dicynone.
Low sensitivity nerve endings or its complete absence. It can be caused by damage to nerve fibers when tissue is cut. As a rule, the complication disappears after 6 to 10 months.
To speed up the process of restoring sensitivity, it is recommended to use myotherapy and physiotherapy (phonophoresis, DDT).
Formation of recurrent scars. Depends on the quality of the performed operation and on the trophism of soft tissues. In this case, an additional operation to excise the scars is necessary.
Education fistula along transitional folds. Most often appears in the area of suturing. Most of the problem is solved by removing the suture material.
Edema. This manifestation always accompanies traumatic operations and, as a rule, it disappears as the tissues heal.

Price

The average cost of a vestibuloplasty service is 6,500 rubles.

Depending on the scope of work and the technologies used, the price can vary significantly. An operation according to the Schmitt method using a standard scalpel has a cost 3000 rubles.

The same procedure, but with the use of laser equipment will cost 10000 rubles.

Some people suffer from a small vestibule, the space between the lip and teeth, which is made up of soft tissue. Vestibuloplasty reduces the resulting tension of the gums due to the displacement of the muscles of the mouth.

The procedure prevents periodontal disease, helps with the correction of existing dental and speech problems, and is sometimes used before implantation or prosthetics.

Most methods of vestibuloplasty are named after the doctors who developed them:

According to Clark - the most simple method. It is used with a wide vestibule of the upper jaw.
According to Edlan-Meikher - gives high efficiency, but has a drawback - an open area from the inside of the lip after the procedure. Used on the lower jaw.
Schmidt's modification is a modified previous method.
According to Glikman - a method used on both jaws, regardless of the extent of the intervention.
Tunnel vestibuloplasty - the method accelerates the healing of postoperative wounds, since several incisions are made and a "tunnel" is formed, which has a reduced wound surface. Used on both jaws.
Vestibuloplasty with a laser is carried out according to any of the methods described above, the essence is to use laser beams instead of a scalpel, a less traumatic method.

Indications for surgery

Indications for vestibuloplasty:

Prevention of periodontal diseases, alleviation or relief of existing pathologies.
It is used before prosthetics to improve the fixation of prostheses.
Orthodontists prescribe vestibuloplasty before correcting the bite to improve the attachment of structures or free up space when moving the dentition.
The operation eliminates speech therapy problems associated with impaired sound production due to a small vestibule of the oral cavity.
Prevention of gum recession.
Before interventions aimed at closing the exposed roots of teeth (patchwork operations).

The operation takes place in 3 stages:

Diagnosis and treatment plan. The dentist conducts a comprehensive examination using x-rays and tomography to determine the severity of the pathology and the best treatment tactics.
Carrying out the operation. Local anesthesia is used, incisions are made and, according to the type of intervention used, the position of the mucous membrane is changed.
Healing of postoperative wounds. Constant monitoring of the dentist is necessary to prevent the development of complications. Healing time - 10-20 days.

Execution Methods

The actions of the surgeon when using various techniques:

Clark method. After providing anesthesia, the mucous membrane is cut between the gum and the moving part of the lip. Depth - up to the muscle layer, the periosteum is not cut. Surgical scissors exfoliate the upper shell of the lip. Muscles with tendons are pulled inward along the periosteum. The formed flap is sutured to the bottom of the formed vestibule with catgut. The wound is covered with a film to protect against infection. Healing takes 12-15 days.
Edlan-Meikher method. After anesthesia, the mucosa is excised parallel to the bend of the bone. The flap is peeled off in the direction of the jaw. Takni under the mucous membrane move laterally. The formed vestibule is fixed with catgut sutures. Healing takes two weeks.
The Schmidt method differs from the previous one in that the periosteum does not exfoliate. All incisions are made parallel to it. The mucosal flap is attached in the depth of the formed vestibule.
According to the Glickman method, the incision is made at the place of attachment of the lip, in a blunt way, the tissues are stratified by 15 millimeters. The flap is sutured with self-absorbable threads in the formed cavity.
With tunnel vestibuloplasty, surgical access is provided using three short incisions. The first is vertical parallel to the central frenulum, two more are perpendicular to it, near the premolars. The incision area is reduced, resulting in a reduction in healing time of up to 10 days.
The listed methods can be performed using a laser.

Its advantages:

There is no swelling after the operation.
The cuts are precise, up to 0.01 mm.
Wounds do not bleed at the end of the procedure.
Provision of bactericidal action with irradiation of pathogenic microbes on the area of intervention.
Tissues regenerate faster than with traditional surgical instruments.
Scars at the site of the incisions are invisible or barely visible after healing.

Contraindications

Vestibuloplasty is contraindicated in patients with:

Deep caries on a large number of teeth, since foci of infection can spread to the formed postoperative wound and cause unwanted complications.
Radiation exposure of the head in the last month.
Recurrent diseases of the oral cavity, which are accompanied by inflammatory or allergic reactions.
Chronic diseases of the cardiovascular, hematopoietic systems.
Oncological diseases.
Damage to the brain or spinal cord.
Psychiatric diseases, accompanied by affect, violence, inadequacy.

Complications after surgery

Inaccurate work of the operating doctor leads to poor attachment of the flap. This is fraught with detachment and disorganization of the vestibule of the oral cavity. It is treated with a repeated operation with high-quality fixation at the end.

Postoperative inflammation develops due to infection during surgery or from within the body. Chronic foci in the mouth and neck are dangerous - tonsillitis, caries, sinusitis.

Advantages

Advantages of vestibuloplasty:

Inflammatory processes of the periodontium are stopped, similar diseases are prevented in the future.
Dental prostheses are securely fixed, the survival rate of implants increases.
Increases the effectiveness of orthodontic treatment.
The exposure of the roots of the teeth is prevented.
The articulation of the sounds of the labial-dental group improves.

Price

In Moscow, vestibuloplasty is carried out at a price of 4,000 rubles, using a laser - from 7,000 rubles.

In St. Petersburg, prices start from 3,500 rubles, with the use of a laser - from 6,000 rubles.

After operation

Patients who have undergone a vestibuloplasty procedure are recommended a sparing regimen. Habitual oral hygiene is resumed for 4-5 days using a soft toothbrush without paste. Physical activity, irritating food are limited for 2 weeks. The wound surface is regularly treated with an antiseptic, followed by the laying of wound healing preparations. Vestibuloplasty of the lower jaw involves the limited use of traumatic food to prevent damage to the sutures. Smokers should give up cigarettes for the healing period.

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To improve the effect of orthodontic treatment in dentistry, sometimes it is necessary to resort to surgical intervention. 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 vestibule of the oral cavity, that is, the gap between the lips and teeth. Today we will tell you what this operation is, we will understand its varieties 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 the insufficient area of this area can provoke various disorders and diseases. Surgical correction is performed in the following cases:

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

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

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

Vestibuloplasty according to Clark. This method is used mainly for the correction of the upper jaw, is carried out over a large area and is relatively simple. Without affecting the periosteum, the section between the mobile area of the mucous membrane and the gums is dissected. After exfoliation 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 can be removed. At the end of the operation, the mucosal flap is sewn to the periosteum with catgut, and the alveolar process is covered with a special film for the duration of wound healing.
Vestibuloplasty according to Edlan Meyher. This technique gives the most stable results, therefore it is practiced most often. Meicher's plasty of the oral cavity 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 sheet are removed, the mucosa is fixed in the new vestibule of the mouth, and a protective bandage is applied for two weeks.
tunnel surgery. The technique is universal, but vestibuloplasty of the lower jaw is more often done. It differs from the previous two options in minimal trauma. During its execution, only three small incisions are made - two horizontally to the premolars, the third - along the frenulum. Thanks to the sparing technique, the wounds are completely healed no later than after 2 weeks.
Glickman method. This is a universal technique that can be applied locally or immediately to a large area of the lower or upper jaw. In the place where the lip is attached, a dissection is performed, the soft tissues are detached to a depth of about 1.5 centimeters, and the free edge is sutured to the formed depression.
Schmidt method. It is carried out on the upper or lower jaw without detachment of the periosteal tissues. 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 to the depth of the new vestibule and fixed with sutures.
Carrying out vestibuloplasty with a laser 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 practically excluded, high precision of incisions and invisibility of scars are achieved, there is no bleeding, and healing proceeds very quickly. Naturally, the price of the procedure will be higher, but the pain and the 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 the clinical picture of a particular patient.

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

Follow a gentle regimen.
Within two weeks, avoid increased physical activity.
For the same period, refuse to eat any irritating food.
Regularly carry out a thorough antiseptic treatment of the operated area.
Perform applications with wound healing agents.

Complications are extremely rare and in most cases are associated with a 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 lesion;
malignant tumors;
coagulation disorders and other blood diseases;
osteomyelitis;
radiation exposure of the neck and head;
collagenoses;
recurrence of oral diseases.

It is important to understand that this is an ordinary dental operation that gives 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 with a laser. This video will convince you that there is nothing critically scary in vestibuloplasty.

In some cases, patients of the dentist require vestibuloplasty of the lower jaw. What is it, testimony, photos, reviews, we will describe further. Indeed, often people are faced with such procedures and are afraid to agree to them, since the unknown is frightening.

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

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

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

This procedure can be carried out for a variety of reasons. This is sometimes a warning of some diseases, and it happens that 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, gingivitis;
with malnutrition of the bone jaw;
to solve speech problems;
in order to expose the roots of the teeth in some cases;
in preparation for extensive orthodontic treatment;
when installing implants or removable dentures for their more convenient and reliable fastening;
sometimes cosmetic correction is also needed.

Whether or not to do such a procedure is up to the doctor, who will be able to take into account all the indications, the patient's health characteristics, the condition of the oral cavity and other factors.

Operation types

Let us briefly describe the most popular surgical techniques that are currently used in dentistry to solve a similar problem:

According to Clark - the easiest way, but most often it is used for the upper jaw. The doctor cuts the mucosa between the dentition and the lip and exfoliates it a little. Thus, the desired muscles are displaced deeper, and the dentist can manually remove some single fibers. Then the flap is sewn to the periosteum, and the wound itself is covered with a special protective film.
According to Edlan-Meikher - used to correct the lower jaw. It is believed that this method gives stable and good results. An incision is made along the bone in an arc, and part of the mucosa is peeled off towards the jaw. Some tissues are pushed deep or to the sides, excess ones are removed. Then the muscles are fixed with sutures and a bandage is applied.
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.
According to Glikman, it can be used both in small areas and more extensive ones. 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.
Tunnel vestibuloplasty is equally used for the correction of the upper jaw and lower. It is believed that such an operation is less traumatic and the wound heals much faster. Incisions are made in three places, instead of one large one. This method is best suited for the treatment of children.
Laser surgery - performed using a laser, which reduces the pain and trauma of manipulation. In this case, everything is done the same as in the usual procedure with a scalpel. But due to the use of a more technological tool, the whole process is carried out precisely, purposefully, with less pain for the patient himself, and the wound heals faster afterwards. Another plus of this procedure is an additional bactericidal effect in the operation area.

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

Whichever method is chosen, it must be carried out by a qualified, experienced doctor and it is imperative to use some kind of anesthesia. Depending on the sensitive patient, the characteristics of his health and age, local or general anesthesia is used. And they can also use in addition to pain relief in injections and other methods.

In order for the whole process to be successful and with the least negative consequences, the patient must take responsibility for the correct preparation for the operation. It is worth adhering to the following recommendations:

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

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

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

This method is referred to as plastic surgery. This method is used in cases where a person has a small vestibule of the mouth and for some other indications.

With the use of vestibuloplasty, the tension of the gums is reduced as a result of the movement of the intraoral muscles.

Vestibuloplasty is most often performed on the lower jaw. This intervention is used if it is necessary to deepen and (or) expand the vestibule of the mouth, when its small area can lead to various 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;
logopedic disorders;
in order to eliminate cosmetic defects.

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

The operation is not allowed in such cases:

the patient is diagnosed with osteomyelitis;
there is extensive dental caries;
radiation exposure of the head or neck area was carried out;
in case of recurrence of any disease of the oral cavity;
with existing blood pathologies and cerebral damage;
if malignant neoplasms are diagnosed.

In the presence of at least one of the above items, the body must be prepared in advance for surgical intervention.

For example, in the pathological condition of the teeth, 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.

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 more often used in order to correct the upper jaw.

Intervention progress:

First of all, anesthesia is administered to the patient;
dissect the space between the movable mucosa and the gum;
with the help of scissors, the mucous membrane of the lips exfoliates;
tendons and muscles are moved inward;
single muscle fibers are removed;
at the end, the mucosal flap is sutured to the periosteum.

Vestibuloplasty according to Edlan Meyher is considered to be more in demand because it gives a better result. But, despite this, it also has some drawbacks, the main of which is the exposure of the inside of the lip.

This type of intervention is used when it is necessary to correct the lower jaw. All the same manipulations are carried out as in the Clark method.

The peculiarity of this method is its versatility. Its application is possible not only on a large area, but also locally. Dissection - at the point of attachment of the lip. After that, the soft tissue is peeled off. The new free edge is sutured to the place of the indentation made.

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

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

The incisions are made along the frenulum and in a horizontal direction to the premolars. Due to this, wound defects are significantly reduced, which contributes to their faster healing already on the tenth day.

Refers to innovative methods. The laser acts as a scalpel. It should be borne in mind 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 several advantages:

slight swelling or its complete absence;
precise cut;
no bleeding;
reduction in the number of pathogenic microorganisms;
decrease in microcirculation of the walls of blood vessels;
fast recovery;
minimum scars.

Whichever of the correction methods is used, it is important to remember that a sparing regimen is necessary for recovery.

During the first two weeks after the surgery, it is important not to allow excessive physical exertion. In addition, it is recommended to exclude from the diet any irritating food:

acute;
salty;
roast;
solid foods.

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

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

The development of any serious consequences after this intervention is extremely rare. As a rule, only non-compliance with the prescribed postoperative regimen can provoke them. 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 there may be bleeding or a change in sensitivity at the site of the incision. Do not be afraid of this, since such phenomena pass after some time.

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

I had a Clarke correction just a week ago. After the procedure, no stitches were applied. In the place where the incision was, only an overlay was attached. A few hours later, she resolved on her own.

To press the incision, they also glued a patch to the chin. At the moment, healing is taking place without any complications, I do not feel any particular pain. Only with a smile there is discomfort and discomfort. 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. There have been quite a few unpleasant hours and days.

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 experienced specialists who performed the operation of vestibuloplasty 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 to fully heal and get used to it.

I felt severe pain only in the first three days after the operation, after that they arose only periodically, and then, this happened during a conversation and eating. At first, there was a feeling that the cheeks just hang down.

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

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

Natalia, Dnepropetrovsk

The price of vestibuloplasty will depend on the method used. The price threshold varies in the region of three to six thousand rubles. Laser method of carrying out the operation within 7-10 thousand rubles.

Vestibuloplasty - what is it? This question is asked by every patient who is assigned to such an intervention. There are several varieties of this procedure, as well as certain indications for which it is prescribed. The method by which the correction is carried out depends on the specific situation.

Vestibuloplasty is a type of oral cavity correction performed in the space between the lip and teeth. Dentists prescribe this operation in the case when the vestibule of the patient's mouth is too small. The need for correction is due to the fact that such a situation can cause the development of a number of dental problems. The main indications for mandatory intervention are the following situations:

the patient has been diagnosed with periodontal disease, in particular, periodontal disease or its complication in the form of periodontitis;
preparation for prosthetics to ensure high-quality fastening of the prosthesis;
implantation of the implant, especially with a very high attachment of the muscle to the alveolar process;
treatment by an orthodontist due to, for example, malocclusion;
according to the testimony of a speech therapist;
to prevent gum recession.

This procedure helps:

reduction of gum tension;
deepening of the vestibule of the mouth;
expansion of the attached gum area;
prevention of speech therapy, orthodontic and dental diseases.

However, there are also contraindications. The operation cannot be performed in the following situations:

multiple caries;
previous radiation therapy to the neck or head;
dental diseases in the stage of relapse;
cerebral lesions;
oncology;
blood diseases.

In such cases, it is necessary to prepare the body for vestibuloplasty (for example, to completely cure the teeth, to recover from radiation therapy). If this is not possible, you will have to seek alternative measures with the doctor.

Vestibuloplasty is an operation that is a correction of the area between the lip and teeth, called the vestibule of the mouth. Normally, the depth of the vestibule should be at least ten millimeters by the age of fifteen. Improper attachment of the bridle can prevent reaching such a depth: if this defect is not eliminated, it can subsequently provoke the appearance of significant dental problems. Correction is performed surgically using local anesthesia and does not require subsequent hospitalization of the patient.

Indications for vestibuloplasty surgery

Vestibuloplasty is performed in patients with a small vestibule of the mouth. The procedure is recommended:

in order to eliminate a cosmetic defect;
as a prevention of gingival atrophy or its recession;
before starting orthodontic treatment;
in the presence of speech therapy disorders due to the high attachment of the frenulum;
before prosthetics (if the small vestibule does not allow high-quality attachment of prostheses);
in preparation for patchwork operations;
for the treatment or prevention of periodontal disease.

When is vestibuloplasty surgery contraindicated?

This surgery is not carried out in the presence of:

oncology;
some serious blood diseases;
radiation therapy of the neck or head in history;
collagenosis;
cerebral lesion;
osteomyelitis;
diseases of the oral cavity in the period of exacerbation;
extensive caries.

Features of the operation of vestibuloplasty

Surgical intervention is the movement of the oral muscles, carried out using local anesthesia. It allows you to reduce the tension of the gums and deepen the vestibule of the mouth. There are various methods of carrying out the operation:

According to Edlan-Meikher. This method is most often performed vestibuloplasty of the lower jaw. The doctor cuts the mucosa, exfoliating its flap and more deeply displacing the submucosal tissue. After that, the flap is fixed with suture material, and a special protective bandage is applied on top. This type of procedure provides high efficiency of vestibuloplasty of the lower jaw, however, healing after it takes a long time.

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By Clark. This type of intervention is used if correction is needed in the area of the upper jaw. During it, the area between the gum line and the movable area of the mucosa is cut, after which the mucosa exfoliates, and the tendons and muscles move deeper. Recovery after this type of intervention lasts, as a rule, no more than 3 weeks.
Modified by Schmidt. The muscles are incised parallel to the periosteum. At the same time, there is no detachment of its tissues.
According to Glickman. In this way, both vestibuloplasty of the lower jaw and correction of the upper jaw are carried out. The incision is made in the area of attachment of the lip. After that, the doctor separates the soft tissue and sutures its edge to the indentation that has appeared. As a result, the wound is small, which reduces the healing time to about 10 days.
Tunnel vestibuloplasty. The doctor accesses the submucosa through three small incisions, which further reduces the area of the wound and accelerates healing.
With the help of a laser, which during the operation acts as a scalpel. This technique is characterized by minimal trauma, a small amount of blood loss, and the exclusion of bacteria entering the incision. Recovery after laser gum correction occurs very quickly, the scar is small, and there is practically no swelling. In addition, the microcirculation of the vascular wall is reduced.

Recovery after surgery lasts about two weeks. During this period, it is necessary to limit physical activity, eat soft food (but it should not be acidic, spicy or salty), maintain oral hygiene and timely carry out antiseptic treatment of wounds.

Cost of vestibuloplasty

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Plasty of the vestibule of the oral cavity is effective if it is necessary to correct the defects of this part of it. The essence of the operation of vestibuloplasty is to expand the zone of attached gums and redistribute soft tissues, due to which the vestibule of the oral cavity deepens. Why such a defect is dangerous, how to prepare for surgery when it is contraindicated, what are the existing methods of surgical intervention - the answers to these questions about vestibuloplasty can be found in this article.

The danger of the small vestibule of the oral cavity

Sometimes a person is born with a small vestibule of the mouth, but sometimes we are talking about an acquired defect. Its formation is provoked by injuries, burns or operations on the soft tissues of the lips, as a result of which there is a decrease in the depth of the vestibule due to the scarring process. The small vestibule is by no means a harmless defect, its danger lies in the complex of consequences listed below:

bad breath;
the development of periodontal diseases due to impaired blood supply to the gum tissue and its constant injury during eating (marginal periodontitis, periodontitis, gingivitis);
the formation of pathological periodontal pockets;
atrophy, gum recession;
violations in the pronunciation of sounds;
teeth become mobile;
the upper jaw lags behind in development;
an abnormal bite is formed;
in places where there is a strong tension of the gums of the incisors, inflammation of the mucous membranes develops;
places of attachment of ligaments and strands of dental necks and roots are exposed;
dentoalveolar deformities develop.

Indications and contraindications for vestibuloplasty

Vestibuloplasty is performed to correct the depth of the vestibule of both the lower jaw and the upper jaw. This method of surgical intervention has become widely used with the development of modern technologies and is intended to eliminate and prevent dental problems caused by a small vestibule.

The indications for the operation are:

high adhesion of gum tissues to teeth;
the root of the tooth is exposed;
changes in dental bone tissue begin;
malocclusion is formed;
gum recession is observed (in the area of the neck of the tooth, its height gradually decreases);
the distinct pronunciation of sounds is disturbed;
periodontal pathologies develop in chronic forms;
before the implantation of orthodontic structures, correction of jaw defects or bite anomalies, the mucous membranes partially change.

Despite the advantages, including the high efficiency of vestibuloplasty to correct the small vestibule, it is contraindicated in some categories of patients. Patients who suffer from poor blood clotting of hereditary etiology are prohibited from performing vestibuloplasty. Contraindications to the operation include:

Preparation for the procedure

Before carrying out the procedure to deepen the vestibule of the oral cavity, a comprehensive diagnosis is required, since we are talking about direct surgical intervention in the structure of the soft tissues of the oral cavity. To clarify the diagnosis and check the presence / absence of contraindications to the operation, a number of standard studies are carried out:

The specialist will carry out a complex of mandatory manipulations. Before the operation, the dentition will be thoroughly cleaned of all types of deposits. The patient will also need to prepare for the procedure for deepening the vestibule of the oral cavity. Before the operation, it is forbidden to take painkillers - they have an unpredictable effect on the effectiveness of local anesthesia. Solid foods that can injure (even slightly) gum tissue should not be eaten for at least 5 hours.

Methods

To perform plastic surgery of the vestibule of the oral cavity, the doctor will choose one of the existing methods of surgical intervention. Sometimes the operation is performed with a laser, sometimes the scalpel acts as the main tool. With any type of plastic surgery, the patient is given local anesthesia. Only the attending physician can determine which method will be used to correct the small vestibule of the oral cavity based on the results of complex diagnostics, as well as based on the level of equipment of the clinic.

According to Clark

Carrying out vestibuloplasty according to Clark is considered the most convenient and simplest of all methods that exist today. The main disadvantage is that the technique is more suitable for use on the upper jaw, and it is done on a large area of the vestibule of the oral cavity. The rehabilitation period takes about two weeks.

According to Edlan-Meikher

The Edlan-Meikher technique is quite popular, since the results of such an operation are distinguished by their durability. The main disadvantage of this type of oral vestibule plasty is that part of the lip is exposed during the surgical intervention. The rehabilitation period takes about two weeks.

Tunnel plastic

Tunnel vestibuloplasty is the most sparing type of surgical intervention. In addition, it is suitable for correcting the vestibule on both jaws - both upper and lower. When carrying out this type of plastic surgery, the wound area is characterized by a small area, due to which the recovery process takes only ten days. During the operation, the surgeon makes two horizontal incisions in the direction of the molars (small) and one parallel to the strand of the mucous membrane.

Laser vestibuloplasty

The use of a laser for surgical intervention is very popular among dentists and their patients due to the fact that this technique allows minimizing injuries, and the recovery period for such a procedure is the shortest possible. The advantages of laser vestibuloplasty are:

maintaining aesthetics at the highest possible level;
reduced risk of infection;
eliminates the risk of bleeding;
making particularly precise cuts;
swelling of soft tissues is excluded;
the area of fixed gum tissue can be enlarged compared to other methods;
the anterior section expands qualitatively and quickly.

Other techniques

In addition to the varieties listed above, Glickman's vestibuloplasty and Schmidt's modification are widely used. The first is distinguished by its versatility (it can be effectively applied both locally and in relatively large areas). The fundamental difference of the second is that there is no detachment of periosteal tissues.

How is the operation going?

The operation according to the Clark method is considered one of the simplest. In this case, surgery begins with local anesthesia. After that, the doctor makes a small incision on the inside, in the place where the moving parts of the anterior mucosa are connected to the gum tissue. The periosteum is not affected. Further vestibuloplasty is performed as follows:

The mucous membrane of the movable fold of muscles and skin is exfoliated from the connective tissues (they are looser). Depth - 10 mm. The tool is a special scissors. The doctor acts very carefully and carefully so as not to damage the tissues that are located at a greater depth.
An incision is made to a depth of 15 mm: in the area limited by the tissues of the anterior part of the oral cavity, up to the periosteum and along the incision in the direction of the bone arch.
Through the above actions, a new vestibule is formed. The edge of the inner shell is inserted into its recess and sewn to the periosteum with special threads.
A bandage with iodoform is applied to the wound area. You can clearly see what the operation is in the photo to the article.

Rehabilitation and possible complications

In order for the process of soft tissue recovery after surgery to be quick and bring the patient a minimum of discomfort, it is important to follow all the doctor's recommendations regarding care during rehabilitation.

Within 72 hours after vestibuloplasty, daily brushing of teeth should be carried out with a brush with ultra-soft synthetic bristles dipped in warm boiled water, without toothpaste. Also, the doctor may recommend mouth baths with antiseptic compounds.

Full hygienic procedures for brushing teeth and oral cavity can be performed only 4-5 days after the operation. It is also unacceptable to neglect the recommendations regarding the diet, which must be followed for 2 weeks:

food should be creamy or grated (you can pay attention to mashed potatoes for babies);
drinks containing alcohol (even in minimal quantities) should not be consumed;
you need to temporarily abandon sour-milk and dairy products;
salty, spicy and hot foods are prohibited.

Also, every time after eating, you need to thoroughly rinse your mouth with clean boiled water for 30-40 seconds and treat with an antiseptic. Massage and special gymnastics will help speed up healing (each exercise is repeated six times, and the duration of the workout should be at least 3 minutes).

After vestibuloplasty, a number of complications may develop, including: bleeding gums, swelling of soft tissues, the formation of a fistula at the point of transition of the buccal mucosa to the gum, the formation of keloid scars, the level of sensitivity of formations located at the ends of the processes of nerve fibers may decrease. In order to control the rehabilitation process, identify and eliminate complications as early as possible, the dentist will prescribe a certain number of visits, which cannot be neglected.