A 45 year oldfemale presented with the chief complaint of trauma while brushing in the loweranterior region reported to the outpatient of Department of Periodontology,Sardar Patel Postgraduate Institute of Dental & Medical Science, Lucknow.
Onintraoral examination it was found that patient had Millers grade I mobility withreduced width of attached gingiva in the lower anterior region along with gradeII recession in 31, 41. Width of attach gingiva was severly reduced , measuring2mm. (Fig.1)Phase I therapywas initiated with patient education and motivation, full mouth scaling androot planing, home plaque care measures and oral hygiene instructions werereinforced to the patient. Vestibular extension of the patient’s mandibularlabial vestibule to increase the width of attached gingiva was planned. Routineblood investigations (haemoglobin, total and differential leukocyte counts, bloodglucose- fasting and post-prandial, bleeding and clotting time) were carriedout.
Fig 1. Preoperative Fig 2. Vertical & Horizontal incision made Fig 3.
Suture placed Fig 4. Mesurements made after 15 days SURGICAL TECHNIQUE: Pre-surgicalpreparation was done by scrubbing of the facial skin all around the oral cavitywith povidine iodine solution and the patient was made to rinse with 0.2%Chlorhexidine digluconate mouthrinse for 30 seconds. The patient wasanesthetized using 2% Lidocainewith Adrenalineconcentration of 1:80000. The surgicalprocedure Lip switch technique as described by Edlan and Mejchar was followed.With the help of BP blade no. 15 vertical incisions were given on mesial aspectof the both mandibular canines and starting at the junction of the attached andfree gingiva. An incision was made for a distance of 11 to 12 mm extending onto the lower lip.
These two incisions were joined by a horizontal incisionacross the midline. A split thickness flap was then separated the loose labialmucosa from the underlying muscle. Now periosteum was visible.
The incision ofthe periosteum was extended in a vertical direction at its ends. Periosteum wasseparated from the bone. Then interrupted sutures were placed on the innersurface of the periosteum, which was separated from the bone. Aftersurgical procedure a periodontal dressing (Coe Pac) was placed to protect theoperated area. The patient was prescribed Cap Amoxicillin 500 mg TID for 5 daysand anti-inflammatory Tab Diclofenac 50 mg BD for 5 days for post-operativepain.
Patient was instructed to have soft diet for 1 week along with otherpost-operative instructions. The patient was recalled after two weeks for removalof sutures. No postoperativecomplications were created. At two weeks the width ofattached gingiva recorded was 7 mm approximately.
The patient was recalledafter every month and 3 months follow up was recorded and it was observed thatthe achieved width attached gingiva remained constant throughout.