Maintenance oforal hygiene is required for optimum periodontal health that increases thelongevity of the person’s natural dentition. The objective of periodontaltherapy is to reproduce an environment which results in high standard of oralhygiene as inadequate oral hygiene is associated with mucogingival deformities.Periodontalplastic surgery emphasize on biological, functional problems that affect theperiodontium and focused to improve esthetic appearance.
The occurrenceof mucogingival deformities often has an impact on patients in provisions of aestheticsand function. A shallow vestibule is often associated with plaque accumulationand consequently marginal gingival inflammation. Gingivalrecession is defined as exposure of root surface by the apical migration ofjunctional epithelium (JE), results in a unesthetic appearance and dentinalhypersensitivity.1Aberrant frenumalong with inadequate vestibular depth which causes gingival recession.Gingival recession is a very common clinical finding in front region of lowerjaw.Varioussurgical modalities have been used for vestibuloplasty including sub mucosalvestibuloplasty, secondary epithelisation vestibuloplasty, Edlan-Mejcharvestibuloplasty and soft tissue grafting vestibuloplasty. METHOD: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(Fig.1)Phase I therapyincluded full mouth scaling and root planing, occlusal correction wasdone where indicated and oral hygiene instructions were reinforced to thepatient. , a vestibular extension of the patient’s mandibular labial vestibuleto increase the width of attached gingiva was planned. Routineblood investigations (total and differential leukocyte counts, blood glucose-fasting and post-prandial, haemoglobin, bleeding and clotting time) werecarried out. 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 one minute. The patient wasanesthetized using 2% Lidocainewith Adrenalineconcentration of 1:80000. The surgical procedure asdescribed byEdlan and Mejchar was followed.
Vertical incisions were given on mesial aspect ofthe 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 thicknessflap then separated the loose labial mucosa from the underlying muscle. Theincision of the periosteum was extended in a vertical direction at its ends..It was fixedwith interrupted sutures to the inner surface of the periosteum, which wasremoved from the bone. Aftersurgical procedure a periodontal dressing (Coe Pac) was placed to protect theoperated area. The patient was prescribed.
Amoxicillin 500 mg TID for 5 daysand anti-inflammatory (Diclofenac 50 mg) BD for 5 days for post-operative pain.Patient was instructed to have liquid/soft diet for 1 week along with other post-operativeinstructions. The patient was recalled after two weeks for removal of sutures. Attwo weeks the width of attached gingiva recorded was 7 mm approximately. Thepatient was recalled after 6 months and one year for regular follow up and itwas observed that the achieved width attached gingiva remained constantthroughout. DISCUSSION:Edlan andMejchar (1963) depicted a technique for vestibuloplasty which appeared to beparticularly applicable to patients in whom there were no pockets and little orno gingival tissue present. This procedure also appeared to increase the widthof the attached gingiva where other procedures were impracticable due to lackof vestibular depth2,3,4 We hereby present a case report of a patient whopresented with the chief complaint of mobility in the lower anterior teeth andin whom vestibular extension was done with the technique described by Edlan andMejchar to correct the shallow vestibule.
Edlan andMejchar technique also known as lip switch procedure. The advantage of this techniqueis that healing occurs by first intention and no bone is left exposed, therebyminimizing the chances of bone resorption and further recession. In the presentcase, an excellent clinical result was obtained which was maintained even oneyear after surgery.
Various brushingtechniques require the placement of the toothbrush at the gingival margin, whichmay not be possible with reduced vestibular depth. It has been reported thatwith minimal of 1 mm of attached gingiva, proper gingival health cannot beestablished.This finding is consistent withthe observations of Wade (1969)5.Thus, based on the findingsof the present case it can be concluded that in cases with a shallow vestibuleand a reduced width of attached gingiva on the labial aspect of the mandibularanterior teeth, the technique advocated by Edlan and Mejchar provides apredictable way in which gingival health can be achieved and maintained