|Year : 2015 | Volume
| Issue : 2 | Page : 58-61
Single-stage surgical procedure for increasing depth of vestibule and the width of attached gingiva
Mohammad Arif Khan, Amitandra Kumar Tripathi, Rajeev Kumar Jaishwal, Poonam Agrawal
Department of Periodontology, Career P.G. Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
|Date of Web Publication||22-Dec-2015|
Mohammad Arif Khan
H. N. 25, Dak Bangla Road, Ghosi, Mau, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Shallow vestibule along with the inadequate width of attached gingiva is a common cause of the gingival recession. Multiple techniques have been developed, separately, to increase the depth of vestibule and the width of attached gingival but this case report present a single stage surgical procedure for increasing both depth of vestibule and the width of attached gingiva by vestibular deepening procedure.
Keywords: Gingival extension procedure, multiple aberrant frenum, single stage technique, vestibular deepening, width of attached gingiva
|How to cite this article:|
Khan MA, Tripathi AK, Jaishwal RK, Agrawal P. Single-stage surgical procedure for increasing depth of vestibule and the width of attached gingiva. J Oral Res Rev 2015;7:58-61
|How to cite this URL:|
Khan MA, Tripathi AK, Jaishwal RK, Agrawal P. Single-stage surgical procedure for increasing depth of vestibule and the width of attached gingiva. J Oral Res Rev [serial online] 2015 [cited 2020 Feb 26];7:58-61. Available from: http://www.jorr.org/text.asp?2015/7/2/58/172496
| Introduction|| |
Periodontal practice not only emphasized on biological and functional problems that affect the periodontium but also focused to improve esthetic appearance due to recent advances in periodontal therapy. Gingival recession is defined as exposure of root surface by the apical migration of junctional epithelium which causes poor esthetic appearance, root hypersensitivity, and root caries.  Gingival recession along with the inadequate width of attached gingiva and inadequate vestibular depth are very common clinical finding in the front region of the lower jaw.
However, the vestibular depth, defined either as the distance between the crest of the lip and greatest concavity of the mucobuccal fold (referred to as VL) or the distance between the coronal border of the attached gingiva and the mucobuccal fold (referred to as Vg) could be measured.
In 1957, Friedman given the term mucogingival surgeries to describe the surgical procedure that correct the relationship between the gingival and oral mucous membrane with reference to three following areas:
- Attached gingiva,
- Shallow vestibules, and
- Aberrant frenum that interfere in the maintenance of marginal gingival health. 
In 1953, Goldman emphasized that a shallow vestibule leads to food impaction against the gingival margin and into the interproximal spaces, which makes it difficult for the patient to clean the area. 
However, several effective and independent surgical techniques have been developed for the management of shallow vestibule, gingival recession, the inadequate width of attached gingiva and aberrant frenum which set out mucogingival problems.
The aim of this vestibular extension procedure is to increase the depth of vestibule and the width of attached gingival in a single visit and giving sutures which does not allow both the edges of epithelium to come in contact during the process of healing (secondary healing).
| Case Report|| |
A 20-year-old female patient reported to the Department of Periodontology, Career P.G. Institute of Dental Sciences and Hospital, Lucknow, U.P, India, with the chief complaint of receding gums of her front lower teeth [Figure 1]. On intraoral examination, it was found class II gingival recession (Acc. to P.D. Miller, 1985) on the front lower teeth due to the shallow vestibule and inadequate width of attached gingiva. Primarily, to prevent the progression of gingival recession and to increases the width of attached gingiva, vestibular deepening procedure was planned.
The patient was informed about the procedure and signed a consent form by the patient. Before surgery, oral hygiene instructions were given, scaling, and root planning was performed. Two weeks after phase I therapy, the patient was prepared for surgical procedures.
At the time of surgery, local anesthesia was administered first, and a horizontal incision was given with 15-no. B. P. blade at the mucogingival junction [Figure 2]. A split thickness flap was reflected sharply toward the alveolar mucosa along with dissecting the muscle fibers and tissue from the periosteum [Figure 3].
Lead foil which act as separating media, was placed in the vestibule that prevent both edges of epithelium attachment [Figure 4] and flap was undermined for changing the direction of epithelium inwards and wound heal by secondary intention, then undermined flap was sutured with continuous locking suture in the depth of the vestibule [Figure 5]. The operated area was covered with periodontal pack [Figure 6]. Suture and the periodontal dressing were removed after 14 days of surgical procedure [Figure 7]. Healing was proceeded uneventfully and satisfactory with secondary wound closure. No postoperative complications were created, and there were no signs of relapse at the end of 1 year [Figure 8].
|Figure 8: After 1-year = Obtain adequate vestibular depth and width of attached gingiva|
Click here to view
| Discussion|| |
Several studies indicated that role of the adequate width of attached gingiva is very important for the maintenance of oral hygiene. Wennstrom and Piniprato stated that combination of the shallow vestibule and inadequate width of attached gingiva might favor the food accumulation during mastication and difficulty to maintain the oral hygine.  In 1956, Goldman et al. first introduced the rationale and techniques of the emerging field of mucogingival surgery. 
Among mucogingival problems, shallow vestibule and gingival recessions which cause an esthetic as well as a functional problem are very common finding in lower front teeth. The gingival recessions and Shallow vestibule may occur without any symptoms but this may explore the patient due to unesthetics appearance, difficulty to perform oral hygiene procedures, dentinal hypersensitivity, and also tooth loss.
However, gingival traction produced by muscular and fibrous attachments due to the shallow vestibule and an inadequate amount of attached gingival zone, lead to progression of gingival recession, and plaque accumulation.  Thus, the presence of adequate amount of attached gingival zone is required for the maintenance of periodontal health.  In 1969, Wade concluded that prior to root coverage procedures, the adequate width of attached gingiva is a common requirement.  Hence, vestibular deepening is a successful procedure for gaining the width of attached gingiva and prevent the progression of gingival recession.
In 1924, Kazanjian was first introduced techniques to deepen the vestibule in edentulous patients.  Several technique have been developed since 1956, but most of them are unsatisfactory due to scar formation and frequent relapse of the state of the vestibule because of previous techniques exposing the extensive areas of bone and are covered only with a periodontal dressing. , Hence, the aim of these modification of previous techniques is to retain a protective cover of mucosa or periosteum over bone and to avoid relapse and the postoperative pain. Thus, In this case, report, adequate vestibular depth, and width of attached gingival was obtained after 1 year of vestibular deepening procedures.
| Conclusion|| |
The conventional procedures of the vestibular deepening in the case of shallow vestibule along with the inadequate width of attached gingiva is a successful procedure for gaining the width of attached gingiva and vestibular depth, mainly in the front region of the lower jaw and prevent the progression of gingival recession.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc 2003;134:220-5.
Freidman N, Levin HL. Mucogingival surgery. Tex Dent J 1957;75:358.
Goldman HM. Periodontia. In: Goldman HM, editor 3 rd
ed. St. Louis: C. V. Mosby Co.; 1953. p. 552-61.
Wennstrom J, Piniprato GP. Mucogingival therapy periodontal plastic surgery. In: Lindhe J, Karring T, Lang N, editors. Clinical Periodontology and Implant Dentistry. 4 th
ed. Copenhagen: Blackwell Munksgaard; 2003. p. 576-650.
Goldman HM, Schluger S, Fox L. Periodontal Therapy. St .Louis: C. V. Mosby Co.; 1956. p. 301-11.
Ochsenbein C. Newer concept of mucogingival surgery. J Periodontol 1960;31:175-85.
Nabers CL. Repositioning the attached gingiva. J Periodontol 1954;25:388.
Wade AB. Vestibular deepening by the technique of Edlan and Mejchar. J Periodontal Res 1969;4:300-13.
Kazanjian VH. Surgical operations as related to satisfactory dentures. Dent Cosm 1924;66:387.
Bohannan HM. Studies in the alteration of vestibular depth: I. Complete denudation. J Periodontol 1962;33:120.
Bohannan HM. Studies in the alteration of vestibular depth: II. Periosteum retention. J Periodontol 1962;33:354.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]