Vestibuloplasty: what kind of operation is it? Reviews about it and approximate prices. Vestibuloplasty: the essence of the procedure, indications, techniques, prices Vestibuloplasty of the gums

Vestibuloplasty is a surgical correction performed in the vestibule of the oral cavity (the space between the lip and the teeth, consisting of soft tissue). It can be classified as plastic surgery of the oral cavity. The operation is performed in the presence of a small vestibule of the mouth, which creates certain dental problems. Vestibuloplasty helps relieve excessive gum tension by moving the intraoral muscles.

Indications for vestibuloplasty surgery

Vestibuloplasty involves expanding the area of ​​the attached gum and deepening the vestibule of the mouth. A small vestibule contributes to the development of a number of diseases that can be avoided by performing vestibuloplasty. We list the main cases in which surgery is necessary.

• Timely vestibuloplasty can prevent periodontal problems.
• It helps alleviate the condition and get rid of existing periodontal diseases (periodontitis, periodontal disease).
• It is used before the prosthetic procedure to better secure the dentures.
• In some cases it is necessary during implantation. For example, if the muscles have an excessively high attachment to the alveolar process, which can cause inflammation or ischemia.
• This surgical correction may be necessary before starting orthodontic treatment.
• For certain speech therapy problems, vestibuloplasty is indicated.
• Vestibuloplasty is performed before flap surgeries designed to cover exposed tooth roots.
• To prevent the appearance, a vestibuloplasty procedure is prescribed.

Contraindications for vestibuloplasty surgery

In some cases, such surgery is contraindicated. Let's list the main conditions:

• Extensive dental caries.
• The disease is ostyemyelitis.
• After radiation exposure to the head and neck area.
• For recurrent oral diseases.
• In case of cerebral damage.
• In the presence of collogenosis.
• Blood diseases.
• Malignant tumors.

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Types of vestibuloplasty

There are several ways to perform this operation, most of which are named after the surgeons who first used them.

Method 1: vestibuloplasty according to Clark

This is the simplest method of vestibuloplasty. It is usually performed on a large area of ​​the vestibule of the mouth. Most often used on the upper jaw.

After anesthetic procedures, an incision is made in the mucous membrane of the vestibule of the mouth. The location of the incision is between the gum border and the moving part of the mucosa. The periosteum is not cut. The incision is made to the depth of the mucous membrane. Then the mucous membrane of the lip is peeled off with surgical scissors. Detachment occurs in the submucosal layer at a depth of no more than 10 mm.

All submucosal tissues (muscles, tendons) are moved deeper along the periosteum in the lateral and frontal sections. Single muscle fibers are removed. The mucous flap is sutured using catgut to the periosteum in the depths of the newly formed vestibule of the mouth. The wound defect that appears on the alveolar process is covered with a protective film.

Healing of the oral vestibule after surgery using this method takes about two weeks.

Method 2: vestibuloplasty according to Edlan-Meicher

This method gives the most lasting results. Its disadvantage is that the inner side of the lip in the area of ​​the vestibule remains bare. Usually used on the lower jaw.

After anesthesia, a mucosal incision is made, running parallel to the bend of the bone arch. The mucous flap is peeled off from the incision line towards the jaw. Submucosal tissues are moved deeper into the frontal and lateral sections. The fibers remaining on the wound flap and the surface of the periosteum are removed. The mucous flap is fixed in the formed vestibule by suturing. A protective bandage is applied to the wound.

The approximate healing time is 2 weeks.

Method 3: vestibuloplasty in Schmidt's modification

This method differs from the previous one in that the periosteum tissue is not detached. Soft tissues, muscles and cords are dissected parallel to the periosteum. The free edge of the tissue flap is immersed deep into the formed vestibule and fixed.

Method 4: vestibuloplasty according to Glickman

This type of vestibuloplasty can be used both in large areas and in localized areas. The incision is made at the attachment point of the lip, then with a blunt instrument the soft tissue is peeled off to a depth of 15 mm. The free edge of the mucosal flap is sutured in the resulting depression.

Method 5: tunnel vestibuloplasty

The technique can be used on both jaws. It differs from previous methods in being less traumatic. Access to the submucous membranes occurs through three limited incisions. One vertical, running along the central frenulum and two horizontal near the premolars. In this case, the area of ​​the wound defect is reduced and healing occurs faster, 9-11 days.

Use of laser in vestibuloplasty

Laser vestibuloplasty is the most non-traumatic way to expand the vestibule of the oral cavity and increase the area of ​​​​fixed gums. The surgical techniques are the same; their choice depends on the specific situation. The difference is that the incisions are made not with a scalpel and other surgical instruments, but with a laser.

The main advantages of using a laser:

• Edema practically does not form or forms minimally.
• Greater cutting accuracy.
• No bleeding.
• Bactericidal action.
• Reduction of pathogenic microflora.
• Microcirculation of the vascular walls decreases.
• Tissue regeneration occurs faster.
• After the operation, minimal scarring remains.

Post-operative regimen

As after any surgical intervention, after vestibuloplasty it is recommended to maintain a gentle lifestyle. Physical activity should be limited for two weeks. For the same period, you should avoid eating irritating foods.

During the recovery period, regular antiseptic treatment of wound surfaces and application of wound-healing medications should be carried out.

Cost of the procedure

The cost of this procedure depends on how vestibuloplasty is performed. The price can vary from 3 to 10 thousand rubles. Performing vestibuloplasty using a laser is more expensive.

The average cost of vestibuloplasty performed with a scalpel: from 3 to 6 thousand rubles. Cost of laser vestibuloplasty: 7-10 thousand rubles.

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

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

What is mandibular vestibuloplasty?

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

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

Indications and contraindications

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

The most popular indications for its implementation are:

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

Photo

Types of surgery

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

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

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

Whatever method is chosen, it must be carried out by a qualified, experienced doctor and be sure to use some kind of anesthesia. Depending on the sensitivity of the patient, his health and age, local or general anesthesia is used. In addition to pain relief through injections, they can also use other methods.

Preparation for the procedure

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

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

Carrying out the operation

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

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

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

Rehabilitation

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

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

Complications

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

No matter what complications you may encounter, the main thing is to follow all the dentist’s recommendations and visit him on time. This is the only way to prevent most unpleasant consequences and speed up the healing process.

Cost of vestibuloplasty

Only a doctor can determine the price of the procedure, taking into account the patient’s health condition, choosing a specific method of operation, and taking into account other factors. Moreover, the cost of dental procedures also varies significantly in different clinics.

And yet, the average price category for vestibuloplasty ranges from 3,000 to 10,000 rubles. If the simplest correction method is chosen and the level of deepening is insignificant, then it can be done at a minimal cost. But the use of a laser suggests that the procedure will be expensive. Usually the price fluctuates around 10 thousand.

Video: vestibuloplasty according to Clark.

extended to 26 with preservation of his gingival “collar”

The flap is split so that its distal part consists only of the mucosa, and the part covering the recession is full-thickness, that is, it consists of the mucosa together with the periosteum (Fig. 145, 146). This prevents postoperative recession in the donor site and ensures its greater mechanical stability.

Rice. 145. The flap is detached and mobilized so that the medial part of the flap is mucoperiosteal, and the distal part is only mucous (in order to prevent recession in the donor site)

The exposed root surface is treated mechanically (Fig. 147) and chemically modified (Fig. 148). The severed epithelium and connective tissue are removed. The flap is mobilized, moved, placed on the exposed root surface, overlapping the edge of the tooth crown by 1.5-2.0 mm, and fixed with sutures (5-0 or 6-0) (Fig. 149). It is advisable to apply a protective bandage for the first 7 days (Fig. 150). The sutures are removed on the 14th day (Fig. 151, 152).

Rice. 146. The absence of tension is checked when placing the flap on the exposed root

Rice. 147. Smoothing and polishing of root surfaces with periodontal burs

Rice. 148. Biomodification of root surfaces with THC for 5 minutes

Rice. 149. After antiseptic treatment, a vertical and then a horizontal incision is sutured

Rice. 150. A transparent periodontal light-curing bandage Barricade is fixed over the surgical wound.

Rice. 151. Condition of tissues on the 14th day after surgery before removal of sutures

Rice. 152. Condition after 6 months. after the intervention

"Envelope" technique usingsubepithelial palatal flap

The "envelope" technique using a subepithelial palatal flap is indicated for the closure of wide recessions. It should be noted that the technique of this operation is technically complex, and therefore its implementation requires sufficient experience from the doctor.

To her benefits This means that the cut flap can be used to simultaneously close several recessions. Although the trauma to the palate with this technique is minor, the bleeding can be quite serious. In addition, the gum along the edges of the recession must be at least 1.5 mm thick so that it can be incised and a flap placed in this space. Therefore, the main thing contraindication is thinned gums.

It is also necessary to take into account the structural features of the donor site: with a wide and small palate, there is a risk of damage to the palatine artery.

After the examination, the dentist may advise the patient to undergo a mandibular vestibuloplasty procedure. Incomprehensible terms most often frighten people and make them think that they are in for something terrible and painful, but there is no need to be afraid of the vestibuloplasty procedure - it is used for the effective treatment and prevention of a number of dental diseases and pathologies.

We will discuss in detail below what mandibular vestibuloplasty is and how it is useful for the patient 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 vestibuloplasty services in Moscow.

Vestibuloplasty of the lower jaw: what kind of operation is it?

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

The procedure of vestibuloplasty is carried out in dentistry and during the manipulations, the specialist surgically expands the space between the teeth and lip, shifting the muscle fibers in the desired direction. Most often, vestibuloplasty of the lower jaw is performed; less often, the procedure is prescribed for the maxillary region.

Indications and contraindications for vestibuloplasty of the lower jaw

Mandibular vestibuloplasty can be performed for a number of reasons. Sometimes surgery is prescribed as an effective measure to prevent certain pathologies, in some cases - to treat existing diseases. Vestibuloplasty is also used in pediatric dentistry, as well as before prosthetics and implantation in adult patients.

The range of indications for mandibular vestibuloplasty includes the following conditions:

• Metabolic disorders in bone tissue.
• Speech therapy problems.
• The need to gain access to the root part of the teeth.
• For high-quality orthodontic treatment, implantation, prosthetics. In the last two options, preliminary vestibuloplasty of the lower jaw will allow achieving maximum stability and fixation of implants and dentures in the area of ​​manipulation.

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

Temporary contraindications can be eliminated and after this the patient can undergo vestibuloplasty of the lower jaw. The decision on the advisability of surgery 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 use vestibuloplasty or look for an alternative to this procedure.

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Techniques for vestibuloplasty

In modern dentistry, mandibular vestibuloplasty can be performed using different technologies, each of which has its own unique features. We will take a closer look at the nuances of performing vestibuloplasty using different methods below, having examined in detail each of the existing methods.

Vestibuloplasty according to Clark

Vestibuloplasty using the Clark method is the simplest option for this type of operation. However, this technology is traditionally used for vestibuloplasty in the maxillary region. When performing manipulations, the surgeon dissects the soft tissue between the teeth and lip and slightly peels off the mucous membrane. This action will allow you to achieve the desired change in the position of the muscle fibers.

Edlan-Meicher method for mandibular vestibuloplasty

This technique is used exclusively for vestibuloplasty of the lower jaw, and experts recognize it as the most effective. Excision of tissue is carried out in the longitudinal direction, and peeling of the mucous membrane is carried out in the perpendicular direction. Some of the tissue is moved inward or to the side, unnecessary parts are carefully removed. The vestibuloplasty operation is completed by fixing the muscles with sutures.

Schmidt technique for mandibular vestibuloplasty

This method of performing vestibuloplasty of the lower jaw allows you to avoid affecting the periosteal tissues when performing manipulations. An incision is made along the bone and a piece of tissue is pulled inward and firmly fixed.

Glickman technology

The use of this technique makes it possible to perform vestibuloplasty on large areas of the oral cavity. The tissue incision is made strictly in the area of ​​the lip junction, and then the flap obtained as a result of detachment of the mucous membrane is sewn to the vestibule of the oral cavity.

Tunnel vestibuloplasty - a gentle method of vestibuloplasty

This method is considered universal, since it allows effective vestibuloplasty of the lower and upper jaw. The technique is a gentle technology and is often used to perform 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.

A modern method of performing vestibuloplasty is surgery 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 traumatic nature for patients. The actions performed by a specialist will be similar to manipulations with other methods, but the process uses innovative instrumentation, which ensures maximum precision and accuracy of the incisions, and thanks to this, the mandibular vestibuloplasty operation takes place with less discomfort for the patient, and the wound heals much faster after it.

It is important to understand that the effectiveness and positive effect after vestibuloplasty depend largely not on the choice of technique, but on the qualifications and professionalism of the dentist who will perform the operation. In our Vanstom dental clinic, vestibuloplasty is performed by surgeons of the highest level of qualifications, 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!

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Preparation and stages of vestibuloplasty

In order for mandibular vestibuloplasty to be effective and without complications in the future, you should properly prepare for the operation. Before vestibuloplasty, the oral cavity must be thoroughly cleaned, and six hours before the operation, exclude solid foods from your diet and do not take medications other than those prescribed by your doctor. If you take medications prescribed by specialists from other fields of medicine, be sure to inform your dentist about this before vestibuloplasty surgery!

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

The vestibuloplasty operation is divided into several main stages:

1. Introduction of an anesthetic drug, the choice of which is made by the doctor and on the basis of a detailed study of the individual characteristics of the case and the patient’s body. Proper selection of anesthetics can relieve the patient from acute pain during mandibular vestibuloplasty.

2. The lower jaw vestibuloplasty itself is performed using 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. Taking anesthetics prescribed by your doctor will help reduce the intensity of pain. The specialist will also give you the most detailed advice on post-operative care and oral hygiene. It is important to follow all the dentist’s recommendations after vestibuloplasty of the lower jaw exactly, otherwise various kinds of complications cannot be ruled out!

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

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

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

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

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

When is vestibuloplasty contraindicated?

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

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

Preparing for surgery

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

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

Main stages of vestibuloplasty surgery

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

Stage 1. Aseptic treatment of the operated cavity.

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

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

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

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

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

Methods of mucosal dissection during vestibuloplasty

Clark's method

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

Tunnel vestibuloplasty

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

Edlan Meicher method

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

Glickman method

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

Schmidt technique

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

Limberg method

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

Using a laser for vestibuloplasty

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

Advantages of using laser in surgery:

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

For vestibuloplasty, the following types of lasers are used:

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

Rehabilitation activities

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

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

How to treat emerging complications

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