Vestibuloplasty in dentistry with implants. Vestibuloplasty - indications, different approaches, reviews. Indications and contraindications for vestibuloplasty of the lower jaw

Reference:

Frenuloplasty

Vestibuloplasty

3. Osteomyelitis.

1. Mental illness.

3. Dysmorphophobia.

4. Cerebral lesions.

Frenuloplasty Y-shaped

Vestibuloplasty

Tunnel vestibuloplasty

prof. A.I. Grudyanov

cand. honey. Sciences A.I. Erokhin

Reference:

Frenuloplasty is an intervention aimed at eliminating the pathological mechanical impact of inadequately attached frenulums 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 oral region (labial, chin, buccal, lingual and facial) and as a result of this 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 patchwork 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. Transferred radiation exposure in the head and neck.

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 a 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 impact of inadequately attached frenulums of the lips and tongue on the marginal periodontium (Fig. 1, 2).

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

Fig.2. Formation of a diastema and 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, performed using Ultracain D-S forte with an epinephrine content of 1: 100,000 in a volume of 1.7 ml, the fixed frenulum is excised with a scalpel and / or gingival scissors (Fig. 3.4). After excision of the frenulum, the defect on the mucous membrane acquires a diamond shape. The mucous membrane adjacent to the incision is cut along the edges for the purpose of mobilization, and a thin rasp is moved under the mucous tissues along the periosteum in the apical direction (Fig. 5). The mobilized mucous membrane is fixed with catgut in the depth 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 on lip retraction.

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 displaced along the periosteum deep into the formed vestibule.

Fig.6. The mobilized mucous membrane of the edges of the incision 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, performed using Ultracain D-S forte with an epinephrine content of 1: 100,000 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 in such a way that the central incision is horizontal (Fig. 10). An important point is the preparation of the receiving bed, since simply stitching the edges of the incisions together within the mucosa 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 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 in the previous manipulation: the submucosal tissues are exfoliated along the periosteum with a raspator. Then, the horizontal incision is tightly sutured with interrupted catgut sutures, while fixing the flaps to the periosteum (Fig. 11). Additional incisions are also sutured tightly, but without fixing the flaps to the periosteum (Fig. 12, 13).

Fig.8. Infiltration anesthesia in the region 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 exfoliated, 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 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 with the aim of subsequent cushioning of the tension created by the group of muscles and strands surrounding the mouth. The depth of the formed vestibule should

be not less than 5 mm and not more than 10 mm.

Vestibuloplasty according to Edlan Meyher recommended for the lower jaw and when combined with this operation with cystectomy.

After local infiltration anesthesia, carried out using Ultracain D-S forte with an epinephrine content of 1: 100,000 in a volume of 5.1 ml, preferably by the hydropreparation method, for easier subsequent exfoliation of the mucous flap.

A scalpel is used to make an incision 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 region of premolars and molars (although in this area one should strictly focus on the exit site of the vascular -nerve bundle) (Fig. 14, 15). Scissors bluntly exfoliate 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 mucous flap.

Fig.16. Exfoliation of the mucous flap from the submucosal tissues.

After that, 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 ones (Fig. 17). On the lower jaw, you should work very carefully in the area of \u200b\u200bthe chin holes. A very important point is the removal of the remaining muscle and fibrous fibers from the wound surfaces of the periosteum and mucous flap, since their presence usually leads to recurrence of the cords (Fig. 18). The exfoliated mucous flap is fixed to the periosteum with catgut sutures in the depth of the formed vestibule (Fig. 19).

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

Fig.18. Removal of muscle fibers with scissors.

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

A protective dressing is applied to the remaining wound defect (Fig. 20) until a protective fibrin film is formed. As a result, all this greatly 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, performed using Ultracain D-S forte with an epinephrine content of 1: 100,000 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). Scissors exfoliate the mucous flap 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 the operation.

Fig.22. The state of the vestibule before the operation. Positive symptom of ischemia on lip retraction.

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, as well as according to the method of Edlan - Meyher - is moved along the periosteum to a depth of 10 mm in the frontal section and 6-7 mm - in the lateral,

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

Fig.25. Moving the raspator of the complex of submucosal tissues along the periosteum to a new depth.

The mucous flap is fixed to the periosteum with catgut sutures in the depth of the formed vestibule. At the same time, a rather 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 depth of the vestibule.

Rice. 27. Applying a protective film "Diplen-Dent" on 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 the powerful muscles and tendons in the lower jaw can often significantly offset the initial results in the future.

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

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

Tunnel vestibuloplasty

After local infiltration anesthesia, performed using Ultracain D-S forte with an epinephrine content of 1: 100,000 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 region 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 by the type of hydroseparation, the true depth of the vestibule is revealed.

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

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

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

Fig.34. The condition of the tissues of the vestibule before the operation. "Transparent" mucous membrane of the alveolar process, generalized recessions.

Fig.35. After carrying out infiltration anesthesia by the type of hydroseparation or "creeping" infiltrate, the true depth of the vestibule of the oral cavity is revealed.

Fig.36. After the central and 2 lateral incisions are made, a mucus tunnel is formed.

Fig.37. The complex of submucosal tissues along the periosteum is displaced through the inside of the tunnel access with the help of a raspator, completely dissecting the fibers attached to the periosteum.

In a blunt way, using a raspator or a wide trowel, the mucous membrane is exfoliated from the complex of submucosal tissues for the entire length of the operated area (Fig. 32, 36). Submucosal tissues, muscle cords are again separated from the periosteum by means of a raspator to the planned depth by intratunnel access. Visually and instrumentally determine whether there are no muscle cords attached to the periosteum (Fig. 37). Exfoliated mucous flaps at the level of the line of exfoliation of muscle cords are fixed through the mucous membrane to the periosteum at a distance of 10-12 mm from the alveolar margin (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 dressing 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). Pain in the postoperative period is practically absent due to minimization of the wound defect. The operation is equally effective on both jaws.

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

Rice. 41. The condition of the vestibule 6 months after vestibuloplasty.

Management of patients after vestibuloplasty

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

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

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

* Touching the apical border of the formed vestibule with the tip of the tongue (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. Appointment of patients with local hemostatics in the postoperative period.

2. Change in sensitivity in the area of intervention.

As a rule, it disappears 6-9 months after the operation. Appointment of myogymnastics, physiotherapy.

3. Postoperative recurrent bands and scars. Repeated surgical intervention with the removal of residual muscle fibers.

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

Efficiency in the use of medical technology

Evaluation of the effectiveness of surgical treatment was carried out on the basis of a comprehensive examination of 746 patients, of which 597 people - in order to prepare for patchwork operations, 112 - to prepare for orthodontic treatment, 37 patients - in order to create a prosthetic bed before complete removable prosthetics.

When evaluating 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 the operation, a powerful capillary network was formed in the marginal gum. Near the bare necks of the teeth, a tissue roller of a bright pink color appeared, which eventually increased in volume up to 1-1.5 mm. Subsequently, the apical part of the gingiva 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 can be different in intensity and time. However, this increase usually did not exceed 2 mm, and the process itself varied over time from 3 months to 1 year. With a combined traumatic impact (the presence of supracontacts, inadequate prosthetics, bite pathology) and in the older age group, a long-term stabilization of the marginal gingiva was noted.

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

Comparing the groups of patients operated on before complete removable prosthetics, it was proved that the fixation of removable prostheses is carried out perfectly and without the need for adhesive gels, while in patients who refused to be operated on, such fixation was only in 37%.

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

prof. A.I. Grudyanov

cand. honey. Sciences A.I. Erokhin

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. Incorrect 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.

Don't miss the chance! Sign up for a free consultation in October!

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 mobile 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 sour, spicy or salty), maintain oral hygiene and perform antiseptic treatment of wounds in a timely manner.

Cost of vestibuloplasty

The price of vestibuloplasty in DentaLux-M dentistry will pleasantly surprise you! Sign up for a free consultation now.

Table of contents [Show]

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 dressing 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.

New technologies in the field of dentistry have made it possible to use the method of vestibuloplasty in plastic surgery.

An effective operation for anomalies of the lower jaw allows you to eliminate any defects in the vestibule of the oral cavity.

Vestibuloplasty is a surgical operation that is performed for the purpose of corrective manipulations in the anterior part of the oral cavity, limited from the outside by the cheeks and lips, and from the inside by the alveolar processes of the jaws and dental units.

If we consider the characteristics of the operation, then it can be attributed to interventions aimed at the plastic elimination of deformations and defects of organs and tissues, however, its purpose is to get rid of dental problems.

The method allows to reduce the tension of the gums through surgical dysplasia of the muscular tissues of the oral cavity. Also, when carrying out the technique, the area of \u200b\u200bthe gum tissue and the deepening of the entire region of the anterior part of the oral cavity (vestibule) increase.

Grounds for holding

The technique is applied both on the upper and on the lower jaw, if the indications require it:

chronic periodontal disease;
partial change in the mucosa before correction of malocclusion and jaw defects or implantation of the structure;
violation of distinct pronunciation;
decrease in the height of the gum volume in the neck of the tooth (recession);
malocclusion;
changes in dental bone tissue;
exposure of the tooth root;
if the gum tissue is highly adjacent to the tooth.

Contraindications

The operation is allowed in the absence of the following diseases and pathologies:

cerebral vasculitis;
poor blood clotting due to heredity;
oncological pathological processes in the oral cavity and beyond;
recovery period after radiation therapy of malignant tumors;
pronounced violations of the relief of the surface of the soft tissues of the oral cavity with the formation of dense scars;
purulent infection, accompanied by an inflammatory process that spreads to all structures of the jaw system (osteomyelitis);
psychoneurological disorders;
addiction to alcohol, drugs, nicotine.

Principle of preparation

Based on the fact that vestibuloplasty is performed by surgical methods, that is, by direct intervention in the structure of soft tissues, it is necessary to conduct a thorough diagnosis before using it.

To establish an accurate diagnosis and detect possible limitations of the technique, specialists resort to standard studies:

visual study of the area;
thorough examination with instruments;
radiographic diagnosis.

In addition to preparatory manipulations by a specialist, the patient must adhere to special recommendations.

Its actions are as follows:

5-7 hours before the operation, do not eat solid foods that can damage the gum tissue.
Eliminate the use of painkillers, as this may affect the effect of local anesthesia.

The dentist must perform a thorough cleaning of the dentition from amorphous deposits, plaque and stones.

Operation types

When performing plastic surgery, doctors use several modifications.

Edlan-Meihar method

The method is used quite often and managed to establish itself on the positive side. After the operation, persistent changes are observed.

However, the technique has a significant drawback, which is expressed in the exposure of part of the lip. The procedure is carried out in several stages:

temporary decrease in pain sensitivity;
surgical dissection of the inner shell of the oral cavity along the line of the bend of the bone arch;
detachment of the inner shell from the edge of the incision to the jaw;
formation of the vestibule of the oral cavity, followed by fixation of the inner shell;
applying a soft gauze bandage with a sterile agent to the wound area.

The recovery period lasts about 2 weeks.

In the video you can see the process of vestibuloplasty using the Edlan-Meihar method.

Schmidt modification

The Schmidt method has some differences from the previous method. During this operation, the connective tissue surrounding the bone from the outside (periosteum, periosteum) is not exfoliated.

The procedure is performed in the following order:

local anesthesia;
cutting off a tight cord in the muscle along the periosteum;
insertion of a tissue flap into the deepening of the new corrected anterior part of the mouth;
fixation of the tissue flap with sutures.

Vestibuloplasty according to Clark

This type of plastic is considered the simplest and most convenient. During the surgical intervention, the specialist makes an incision on the inside at the junction of the gum tissue with the mobile areas of the mucous membrane of the anterior part of the oral cavity, while not affecting the periosteum.

The dissection is performed within the tissues of the anterior part of the oral cavity up to the periosteum and in the direction with the bone arc along the entire incision with a depth of 1.5 cm.

The edge of the inner shell is brought into the recess of the newly formed anterior part of the oral cavity and sewn with special threads to the periosteum. A bandage with iodoform is applied to the wound site.

Vestibuloplasty according to Glickman

This method is used in the small anterior part of the oral cavity, both in a large area and in a separate pathological area.

The procedure consists in making an incision at the junction of the labial commissure with the gum tissue. Next, soft tissues are peeled off without the use of sharp instruments near the periosteum to a depth of 1.5 cm in the area of the dentition.

The cords are crossed with scissors, and the tissue flap is sutured to the inner shell in the recess of the newly formed anterior part of the oral cavity to the connective tissue surrounding the bone tissue from the outside.

The open wound site heals with repeated tension under a protective bandage.

tunnel method

This method has several positive aspects. Firstly, it is ideal for eliminating defects in both jaws, and secondly, it is a gentle correction option.

During the operation, the surgeon makes 3 incisions. The first is performed parallel to the strand of the mucous membrane, and the next two are horizontally towards the small molars.

When using this method, the wound area is small, which accelerates healing. As a rule, after 10 days, soft tissues are completely restored.

The procedure for performing the operation using the tunnel method, see the video.

With a laser

This innovation of plastic surgery is gaining momentum in the field of dentistry. The technique allows you to perform the operation without the use of a scalpel, which almost completely eliminates injuries.

The procedure involves the use of a laser beam, which gives it the following advantages:

the possibility of qualitative expansion of the anterior part of the oral cavity;
the admissibility of increasing the area of fixed gum tissue;
exclusion of swelling of soft tissues;
all cuts are made with extreme precision;
bleeding is excluded;
the risk of infection is reduced;
aesthetics are top notch.

The rehabilitation period when using this technique is much shorter than that of other modifications.

rehabilitation period

In the first three days after surgery, it is necessary to carry out hygienic cleaning of the oral cavity with a brush with soft bristles, without using paste. Baths based on antiseptic agents are recommended.

Only on the fourth, fifth day of the recovery period is it allowed to fully complete the procedure for cleaning the oral cavity and dentition.

In order for the results of vestibuloplasty to be positive, it is recommended to adhere to special rules for eating food. Within 14 days, the patient must:

do not drink alcoholic beverages;
do not eat hot, spicy, salty foods;
exclude dairy and sour-milk products (they are able to form hard plaque on dental units, which can provoke infection of the wound site);
food is desirable to grind or turn into a creamy mass.

After each meal, the oral cavity is thoroughly rinsed with clean water and treated with an antiseptic.

In addition to proper nutrition, the patient is prescribed facial gymnastic exercises and massage:

massage with fingertips on the outside;
increased attempts to puff out the lips, not including other muscles of the face in the exercise;
moving the tip of the tongue in different directions in the wound area.

Gymnastic training is performed for 3 minutes with the repetition of each exercise up to 6 times.

Patients noticed an interesting fact. If you perform an intense impact with a powerful jet of water from the outside, the healing of the wound site is much faster, and discomfort during the recovery period is reduced.

During the rehabilitation period, patients should not burden the body with physical activity.

To control the stages of healing, the dentist prescribes the necessary number of appointments in order to detect inflammation in a timely manner and prescribe appropriate and competent therapy.

Possible Complications

Possible complications include:

Bleeding gums. In this case, special compresses are used and hemostatic agents are prescribed.
Decreased sensitivity of formations at the ends of the processes of nerve fibers. It happens when the nerve endings are touched during an incision with a scalpel. As a rule, the injury goes away on its own after six months. In order to restore sensitivity as quickly as possible, doctors recommend using exercises for the muscles of the maxillofacial region and physiotherapy.
Formation of keloid scars. The formation depends on the quality of the vestibuloplasty technique. The problem is eliminated by the method of repeated surgical intervention to remove scar tissue.
A fistula forms at the site of transition of the buccal mucosa to the gum. Pathology occurs in the area of the surgical suture and is eliminated after the thread is removed.
Swelling of soft tissues. This complication always accompanies surgical interventions and disappears on its own after complete healing of the wound area.

Prices

The cost of surgery will directly depend on the method of its implementation:

Elan-Meikher method - 4000 rubles;
Schmidt's modification using a scalpel - 3500 rubles.
According to Clark - 4500 rubles.
According to Glikman - 4000-5000 rubles.
Tunnel method - 4800 rubles.
With the use of a laser - up to 10,000 rubles.

The cost of the service may vary on an individual basis depending on the complexity of the case and associated pathologies.

After the examination, the dentist may advise the patient to undergo a lower jaw vestibuloplasty procedure. Incomprehensible terms most often frighten people and make them think that something terrible and painful is ahead of them, but there is no need to be afraid of the vestibuloplasty procedure - it is used to effectively treat and prevent a number of dental diseases and pathologies.

We will talk in detail about what vestibuloplasty of the lower jaw is, how it is useful for the patient below - in the sections of the review material. After reading the article, you will be able to study in detail the indications and contraindications for the operation, the methods of its implementation, and find out where you can go for the vestibuloplasty service in Moscow.

Vestibuloplasty of the lower jaw: what is this operation?

Each person has his own, individual structure of the oral cavity and jaws, and in some people there may be a clear lack of space between the lip and the dentition. Such a lack of space causes excessive muscle tension in this area, which is fraught with the development of a variety of dental diseases and pathologies. Eliminate the defect of excessive muscle tension and is designed to help the operation of vestibuloplasty.

A vestibuloplasty procedure is performed in dentistry, and during the manipulations, the specialist expands the space between the teeth and the lip in an operative way, shifting the muscle fibers in the right direction. Most often, a vestibuloplasty of the lower jaw is performed, less often the procedure is prescribed for carrying out in the maxillary region.

Indications and contraindications for vestibuloplasty of the lower jaw

Vestibuloplasty of the lower jaw can be performed for a number of reasons. Sometimes the operation is prescribed as an effective measure for the prevention of certain pathologies, in some cases - for the treatment of existing diseases. Vestibuloplasty is also used in pediatric dentistry, as well as before prosthetics and implantation in adult patients.

The range of indications for vestibuloplasty of the lower jaw includes the following conditions:

Metabolic disorders in bone tissue.
speech problems.
The need to gain access to the root of the dental units.
For high-quality orthodontic treatment, implantation, prosthetics. In the last two options, preliminary vestibuloplasty of the lower jaw will achieve maximum stability and fixation of implants and prostheses in the area of manipulation.

Vestibuloplasty is also used to eliminate aesthetic defects and to prevent periodontal disease. However, in addition to indications, vestibuloplasty also has a fairly extensive list of contraindications to conduct. It is not carried out if the patient has chronic blood diseases, diseases of an oncological or mental nature, osteomyelitis. These limitations are permanent, but there are also temporary contraindications to mandibular vestibuloplasty. For example, tobacco, alcohol dependence of the patient, multiple caries, poor oral hygiene, chemotherapy.

Temporary contraindications can be eliminated and after that the patient can undergo vestibuloplasty of the lower jaw. The decision on the expediency of the operation is always made by the dentist treating the patient. When deciding on the need for vestibuloplasty in a particular case, the specialist will carefully examine the patient's condition, conduct a series of studies and then advise whether to apply vestibuloplasty or look for an alternative to this procedure.

We work with 1994 of the year

we are one of the first to open private dentistry in Moscow

The best materials

only new and modern equipment for dental treatment

Free

consultation with a dentist

Payment Options

cash
plastic cards
cashless payments

Experience of doctors

with great experience
graduated
conference participants

Vestibuloplasty techniques

In modern dentistry, lower jaw vestibuloplasty can be performed using different technologies, each of which has its own unique features. With the nuances of the operation of vestibuloplasty by different methods, we will get acquainted in detail below, having examined in detail each of the existing methods.

Vestibuloplasty according to Clark

Vestibuloplasty by the Clark method is the simplest version of this type of operation. However, this technology is traditionally used for vestibuloplasty in the region of the maxillary region. Performing manipulations, the surgeon makes a dissection of the soft tissues between the teeth and the lip and slightly exfoliates the mucosa. This action will achieve the desired change in the position of the muscle fibers.

The Edlan-Meikher method during vestibuloplasty of the lower jaw

This technique is used exclusively for vestibuloplasty of the lower jaw, and experts recognize it as the most effective. Excision of tissues is performed in the longitudinal direction, and exfoliation of the mucosa - in the perpendicular direction. Part of the tissue is shifted inward or sideways, unnecessary parts are carefully removed. The operation of vestibuloplasty is completed by fixing the muscles with sutures.

Schmidt technique for vestibuloplasty of the lower jaw

This method of carrying out vestibuloplasty of the lower jaw allows not to affect the periosteal tissues during manipulations. An incision is made along the bone and a piece of tissue is pulled inward and firmly fixed.

Glickman technology

The use of the technique makes it possible to carry out vestibuloplasty in significant areas of the oral cavity. The incision of the tissues is carried out strictly in the area of the connection of the lip, and then the flap obtained as a result of exfoliation of the mucous membrane is sewn to the vestibule of the oral cavity.

Tunnel vestibuloplasty is a sparing method of vestibuloplasty

This method is considered universal, since it allows effective vestibuloplasty of the lower and upper jaws. The technique belongs to sparing technologies and is often used for vestibuloplasty of the lower jaw in very young patients, for example, to solve orthodontic and speech therapy problems. Less trauma is achieved by making several small incisions instead of one large one.

The modern method of carrying out vestibuloplasty is an operation using a laser. The use of a laser in vestibuloplasty of the lower jaw can significantly reduce the pain of the procedure, as well as its trauma for patients. The actions performed by a specialist will be similar to manipulations with other methods, but the process uses innovative tools that provide maximum accuracy and accuracy of the cuts, and due to this, the operation of the vestibuloplasty of the lower jaw takes place with less discomfort for the patient, and the wound after it heals much faster.

It is important to understand that the effectiveness and positive effect after vestibuloplasty depend to a greater extent not on the choice of technique, but on the qualifications and professionalism of the dentist who will perform the operation. In our dental clinic "Vanstom" vestibuloplasty is performed by surgeons of the highest qualification level, and therefore, by contacting us, you are guaranteed to receive a service of the European level of quality and a 100% positive result after vestibuloplasty!

Free consultation on the cost of treatment in our dentistry

Leave a request and the clinic administrator will contact you within 15 minutes!

Preparation and stages of vestibuloplasty

In order for vestibuloplasty of the lower jaw to be effective and without complications in the future, it is necessary to properly prepare for the operation. The oral cavity before vestibuloplasty must be thoroughly cleaned, and six hours before the start of the operation, exclude solid foods from your diet, do not take medicines, except for those that will be prescribed to you by your doctor. If you are taking drugs prescribed by specialists from other fields of medicine, be sure to inform your dentist about this before the vestibuloplasty operation!

The correct psychological attitude is also important: there is no need to be afraid of the operation of vestibuloplasty of the lower jaw, it passes quickly enough, and anesthesia helps to remove all pain during surgical procedures. If you can cope with anxiety before vestibuloplasty on your own, you can’t – discuss the upcoming operation with your doctor!

The operation of vestibuloplasty is divided into several main stages:

1. The introduction of an anesthetic drug, the choice of which is carried out by a doctor and based on a detailed study of the individual characteristics of the case and the patient's body. Competent selection of anesthetics allows you to save the patient from acute pain during vestibuloplasty of the lower jaw.

2. Vestibuloplasty of the lower jaw is performed according to one of the methods described above. On average, a vestibuloplasty operation will take about one hour.

3. Upon completion of all manipulations, a bag of dry ice is applied to the area of vestibuloplasty, which the patient will need to keep on the jaw for at least a quarter of an hour. You can also apply ice at home, this will help relieve swelling and reduce pain after vestibuloplasty of the lower jaw.

Swelling and pain for some time after vestibuloplasty are considered normal. Reducing the intensity of pain manifestations will help the use of anesthetics, which will be prescribed to you by your doctor. The specialist will also give you the most detailed advice on post-operative care and oral hygiene. It is important to follow all the recommendations of the dentist after vestibuloplasty of the lower jaw, otherwise various complications are possible!

Possible complications after vestibuloplasty of the lower jaw and the price of the procedure

The main causes of complications after vestibuloplasty of the lower jaw are non-compliance with the doctor's recommendations and poor oral hygiene. Among the main possible complications after vestibuloplasty are bleeding, low sensitivity, scarring, severe swelling of the gums. If the listed phenomena do not disappear after performing vestibuloplasty for several days, seek the advice of a specialist to eliminate the risk of developing inflammatory processes.