Department of Oral and Maxillofacial Surgery

VESTIBULOPLASTY
OR
RIDGE EXTENSION PROCEDURE
 Introduction
 Vestibuloplasty is a surgical procedure wherein
oral vestibule is deepened by changing the soft
tissue attachments.
 To utilize this treatment option, sufficient amount
of height of the alveolar bone should be
available.
 Vestibuloplasty can be performed in both the
maxilla and the mandible, either on the labial or
the lingual side.
 Labial approach
1. KAZANIJIAN TECHNIQUE
2. GODWIN’S MODIFICATION
3. CLARK’S TECHNIQUE
4. LIPSWITCH TECHNIQUE
5. OBWEGESER’S MODIFICATION
6. MAXILLARY POCKET INLAY VESTIBULOPLASTY
7. SUBMUCOSAL VESTIBULOPLASTY
 Lingual approach
1. TRAUNER’S TECHNIQUE
2. CALDWELL’S TECHNIQUE
 Combination of Buccal & Lingual
vestibuloplasty
OBWEGESER’S TECHNIQUE
LABIAL
PROCEDURES
 Kazanijian technique
 Mucosal flap from inner aspect of the lower lip is used
to increase the vestibular depth in anterior
mandibular labial vestibule (premolar to premolar
region).
 Raw area is left on the lip side to be healed by
secondary intentions.
 Periosteum of bone is left intact.
 Drawback – scaring of mucosa with subsequent
decreased flexibilty of lower lip.
 Godwin’s modifications

 In this procedure, flap is reflected from the inner

aspect of the lip till the alveolar crest and
periosteum is reflected from crest of the ridge till
the desired depth of the vestibule.
 This periosteum is now sutured to the lip mucosal
margin and then lip flap is sutured at the required
vestibular depth.
 Stent or splint is used for adaptation .
 Advantage – less scaring of the lip mucosa
 Clark’s technique
 Here flap is reflected from alveolar crest till
vermilian border of the lip.
 Supraperiosteal dissection is done till desired
vestibular depth and edge of the mobilized flap is
pushed into vestibular depth.
 This flap is held in position with sutures passed
through the chin area extraoarally and tied around
the rubber catheter.
 Here alveolar bone is covered by periosteum which
heals quickly by granulation
 Lipswitch technique
 It is a variation of kazanjian’s tech.
 In this the mucosal flap is developed in the same way as
suggested by kazanjian.
 After reflecting the mucosal flap till the crest of alveolar
ridge ,the periosteum is incised high on the alveolar
ridge.
 Now the periosteal flap containing the connective tissue
and muscle is transposed outwardly (reflected).
 The periosteal flap is sutured to the raw wound on the lip.
 Then the mucosal flap is turned down against the bare
bone and sutured to the periosteum deep in the vestibule.
 Thus the vestibule is lined on osseous side by mucosa
and on the labial side by periosteum.
 A new epithelial surface will grow on the periosteal
surface in 2-3 weeks
 Obwegeser’s modification

 Here everything is same but the only

modification is that the alveolar bone
with periosteal attachment is covered
with the split thickness skin graft or
mucosal graft.
 Pocket inlay vestibuloplasty
 Here incision is made in the vestibule from molar to
molar region and supraperiosteal dissection is carried
out.
 Now a split thickness graft is placed on the extended
flanges of prefabricated denture and this denture is
positioned in extended vestibular depth which is fixed
with circumzygomatic wiring.
 Wound margins are sutured to the graft.
 New denture will be constructed after 6 weeks.
 Advantages:
• Better retention of the dentures.
• Helps to restore deficiency in the region of nasolabial
fold with improved contour.
 Submucosal vestibuloplasty
 First described by MacIntosh and Obwegeser (1967).
 Indication – unstable denture because of shallow vestibular
depth with good underlying bone height and contours.
 A mouth mirror is placed in the vestibule and elevated
against the bone to the desired vestibular depth, if mobile
tissue is present and no abnormal shortening of lip occurs
then submucosal vestibuloplasty can be performed.
 A vertical midline incision is made in labial vestibule and
supra- periosteal tunnel is made from premolar(R) to
premolar(L) area.
 In maxilla, further incisions may be given in first molar
region for further advancement.
 The intervening submucosal tissue is then excised or
repositioned superiorly and maintained by placement of
preformed dentures which can be fixed to the mandible
with circummandibular wiring and to the maxilla by per
alveolar wiring.
LINGUAL
PROCEDURES
 Trauner’s technique
 This procedure is used to increase the depth of floor
of the mouth in mylohyoid region.
 Incision is given over lingual side of the alveolar
ridge bilaterally in posterior region (2 nd molar
region).
 Supraperiosteal dissection is done to identify
mylohyoid muscle, which is separated from its
attachment and sutured to the new desired
vestibular depth.
 Skin graft is placed and sutured with the
prefabricated stent over it.
 Caldwell’s technique
 Entire lingual mucoperiosteal flap is reflected from
molar to molar region.
 Mylohyoid and genioglosus muscle attachments are
dissected and sutured below to the desired depth of
the vestibule.
 Rubber tubing is placed in the lingual vestibule and
the flap is held in place at desired vestibular depth
which is sutured with the sutures passing extraorally
, at inferior border of the mandible
 Obwegeser’s technique
 Here incision is given on the alveolar ridge and
mucosal flap is raised buccally and lingually .
 Mylohyoid muscle and only superficial fibres of
genioglossus muscle attachments are separated on
the lingual side.
 Edges of buccal and lingual flaps attached/sutured
to each other , below inferior border of mandible.
 Skin graft is placed over entire alveolar ridge and
prefabricated acrylic stents are fixed with
circummandibular wiring.
Mental nerve transposition
 Many times patient with severe atrophic ridge,
complaints of pain after wearing complete denture.
This is because that the position of mental nerve is
superior because of severe mandibular atrophy so
this is the reason for pain on compression.
 Here the flap is reflected on buccal aspect in the
mental nerve region.
 The nerve is held with the hook lightly and a bony
groove is cut below mental foramen only in buccal
cortex.
 Then nerve is positioned in that groove secured in
place with gelfoam and flap is sutured.