Maintenance of oral hygiene is required for the best possible periodontal overall health that enhances the longevity in the person’s all-natural dentition. The goal of periodontal remedies are to reproduce an environment which results in a high common of common hygiene because inadequate common hygiene is usually associated with mucogingival deformities.
Gum plastic surgery focuses on biological, efficient problems that affect the periodontium and focused to improve esthetic appearance.
The happening of mucogingival deformities generally has an influence on patients in provisions of aesthetics and performance. A short vestibule can often be associated with plaque accumulation and therefore marginal gingival inflammation.
Gingival recession is defined as exposure of root surface by the apical migration of junctional epithelium (JE), ends in an unaesthetic appearance and dentinal hypersensitivity.
Aberrant frenum along with inadequate vestibular depth which in turn causes a gingival recession. Gingival recession is a very common medical finding inside the front region of the reduced jaw.
Several surgical methods have been intended for vestibuloplasty which includes submucosal vestibuloplasty, secondary epithelisation vestibuloplasty, Edlan-Mejchar vestibuloplasty and soft tissues grafting vestibuloplasty.
A 45-year-old female offered the chief issue of trauma while combing in the decrease anterior area reported to the outpatient of Department of Periodontology, Sardar Patel Postgraduate Institute of Dental Medical Science, Lucknow. On intraoral examination, it was found that patient got Millers class I flexibility with the lowered width of attached gingiva in the reduced anterior place along with.
Phase I therapy included full-mouth scaling and root planning, the occlusal correction was done in which indicated and oral health instructions were reinforced towards the patient., a vestibular extension of the sufferers mandibular labial vestibule to enhance the width of attached gingiva was planned. Schedule blood investigations (total and differential leukocyte counts, blood glucose- going on a fast and post-prandial, hemoglobin, bleeding and coagulation time) were carried out.
Pre-surgical preparation included scrubbing with the facial skin all around the oral cavity with povidone-iodine remedy and the affected person was made to wash with 0. 2% Chlorhexidine digluconate mouthrinse for one tiny. The patient was anesthetized applying 2% Lidocaine with Adrenaline concentration of 1: 80000. The surgical procedure because described simply by Edlan and Mejchar was followed. Incisions were started by giving up and down incision mesial to one from the mandibular teeth and starting at the verse of the fastened and free of charge gingiva a great incision was performed for a range of twelve to doze mm stretching on to the lower lip. An identical incision was handed a parallel to the additional mandibular canine and both of these incisions had been joined with a horizontal incision across the midline. A divided thickness flap then separated the loose labial mucosa from the actual muscle. The result was a loose flap of labial mucosa with its bottom on the gingiva which was in that case folded up and a horizontal cut was made for the periosteum, which now becomes visible. The incision from the periosteum was extended within a vertical path at its ends. The periosteum was in that case separated from the bone, forming a second argument with its bottom on the apical portion of the mandible. The loose argument of the labial mucosa was folded back and placed on the bone from where the periosteum was removed.
It was set with interrupted sutures to the inner surface area of the periosteum, which was removed from the cuboid. The upper border of the periosteum was also sutured for the mucous membrane layer of the lips to cover the location denuded by reflection in the first (labial mucosal) from where the periosteum was taken out. It was set with cut off sutures to the inner surface area of the periosteum, which was taken out of the cuboid.
Following the surgical procedure, a periodontal dressing was placed to guard the controlled area. The patient was recommended Amoxicillin 500 mg TID for 5 days and anti-inflammatory (Paracetamol 500 mg) BD pertaining to 5 days for post-operative pain and discomfort. The patient was directed to have intermittent cold fièvre on the first postoperative day time and soft/liquid diet for 1 week combined with the maintenance of good oral health. The patient was recalled after two weeks for removal of assemblée and re-evaluation of the medical parameter. At two weeks the width of attached gingiva recorded was 6mm about. The patient was recalled after 6 months and one year for regular follow-up and it was observed that the achieved width attached gingiva remained frequent throughout.
Edlan and Mejchar (1963) depicted a technique intended for vestibuloplasty which will appeared to be especially applicable to patients in whom there are no wallets and little or no gingival muscle present. Treatment also appeared to increase the thickness of the fastened gingiva exactly where other types of procedures were impracticable due to deficiency of vestibular depth2, 3, 5 We hereby present a case report of your patient whom presented with the main complaint of mobility in the lower preliminar teeth and whom vestibular extension was done with the technique described by Edlan and Mejchar to correct the shallow prologue.
Edlan and Mejchar strategy also known as lip switch procedure. The advantage of this system is that recovery occurs by the first purpose and no bone is kept exposed, thereby minimizing the chances of bone resorption and further recession. In the present circumstance, an excellent medical result was obtained that has been maintained even one year following surgery.
Several brushing tactics require the location of the toothbrush at the gingival margin, which can not always be possible with reduced vestibular depth. It is often reported that with little of 1 mm of attached gingiva, correct gingival health cannot be proven. This finding is consistent with the observations of Wade (1969).
Thus, depending on the studies of the present case it could be concluded that in the event with a shallow vestibule and a reduced width of attached gingiva on the labial facet of the mandibular anterior tooth, the strategy advocated by Edlan and Mejchar provides a predictable way in which gingival well being can be attained and maintained.
