A vital dental implantology procedure that requires specific techniques for successful outcomes
Vestibuloplasty is a surgical procedure performed in dental implantology to enhance the depth and width of the oral vestibule. It is a crucial step in the rehabilitation of patients requiring dental implants in areas with inadequate gingival tissue. The procedure involves the manipulation and reconstruction of the vestibular depth to create an optimal environment for successful dental implant placement.[i] However, like any surgical procedure, vestibuloplasty poses several challenges and requires specific techniques to ensure favourable outcomes.
One of the main challenges is determining the appropriate depth and width required for the oral vestibule. The ideal depth of the vestibule is determined by various factors such as the type of dental prosthesis planned, the patient’s buccal cavity, and the expected aesthetic outcome. Achieving the correct depth is crucial to ensure the optimal placement of dental implants and the successful integration of the prosthetic.[ii] The width of the keratinised gingiva and the attached gingiva is still a matter of discussion but researchers have currently agreed upon 2mm of keratinised gingiva and 1mm of attached gingiva as the gold standard.ii
Another challenge is identifying the correct surgical technique. Various methods are available, including the split-thickness flap and full-thickness flap techniques. The choice of procedure depends on the individual patient’s needs, the desired outcome, and the success rate of each technique dependent on the individual case.[iii],[iv] The dental clinician must have a thorough understanding of these techniques and the ability to select the most appropriate one for each patient.
Post-op complications
Managing post-operative complications is another hurdle. Common complications can include graft failure, infection, and wound dehiscence.[v] The success of vestibuloplasty depends on proper wound healing[vi] and the integration of the graft.[vii] Vigilant post-operative monitoring and adequate patient compliance are essential to minimise the occurrence of complications and ensure optimal outcomes.[viii]
To overcome these challenges, certain techniques can be implemented in vestibuloplasty procedures. First and foremost, a meticulous pre-operative evaluation is crucial. This should include a thorough assessment of the patient’s medical history, anatomical considerations, and the desired outcome. Proper radiographic examinations such as Cone Beam Computed Tomography (CBCT) can aid in assessing the adequacy of bone availability and planning the surgical approach.[ix]
During the surgical procedure, proper tissue handling and preservation techniques are vital. Maintaining the blood supply to the surgical site is essential for graft survival.[x] Atraumatic tissue handling, ensuring adequate irrigation, and minimising trauma to the soft tissues can ensure optimal outcomes. Additionally, the use of tissue biocompatible biomaterials, such as collagen-based membranes[xi] or acellular dermal matrices,[xii] can aid in promoting wound healing and graft integration.
Regenerative techniques
Another technique that can be employed is the use of tissue engineering and regenerative techniques. Utilising growth factors and bioactive materials can enhance the healing process and maximise tissue regeneration. Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are examples of these regenerative techniques that have shown promising results in improving tissue healing and graft integration.[xiii]
The main difference between PRP and PRF lies in their method of preparation, composition and fibrin architecture.[xiv] PRF offers a more sustained release of bio-active products such as cytokines and growth factors due to the fibrin matrix. Additionally, PRF retains leukocytes, which have osteo-immune modulating properties that have been shown to significantly enhance hard and soft tissue healing and regeneration.[xv]
To address post-operative care and minimise complications, patient education and compliance are essential.[xvi] Patients should be educated about the importance of maintaining good oral hygiene, adhering to dietary restrictions, and following post-operative instructions. Regular post-operative follow-ups and close monitoring by the dental team can help identify and address any complications in a timely manner.
Accredited training
Vestibuloplasty is just one of the vital elements covered in the Postgraduate Certificate in Implant Dentistry run by Ucer Education. Led by eminent specialist oral surgeon Professor Cemal Ucer, Ucer Education is an accredited provider of postgraduate courses and offers dental professionals the chance to develop clinical competence in a range of implant techniques, with courses ranging from Full Mouth Oral Implant Rehabilitation to an MSc in Dental Implantology. Whether you’re a GDP or looking to take your practice to the next level of implant dentistry, there is a range of postgraduate implant courses and hands-on clinical training to suit your needs. Courses take place at the ICE Postgraduate Dental Institute and Hospital in Salford Quays, Manchester, which boasts state-of-the-art teaching and clinical facilities.
Vestibuloplasty in dental implantology presents several challenges that require specific techniques for successful outcomes. Achieving the appropriate depth and width of the oral vestibule, selecting the correct surgical technique, and managing post-operative complications are some of the challenges faced.
However, with meticulous pre-operative evaluation, proper tissue handling techniques, and the utilisation of regenerative techniques, these challenges can be effectively managed. Additionally, patient education and compliance play a vital role in achieving favourable outcomes. By addressing these challenges and implementing appropriate techniques, dental clinicians can enhance the success of vestibuloplasty procedures and improve the overall patient experience.
For more information, please contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co
01612 371842
https://icedentalimplants.co.uk/
[i] Wüster, J., Sachse, C., Sachse, C. et al. Vestibuloplasty and its impact on the long-term survival and success of dental implants in irradiated and non-irradiated patients after head and neck tumor therapy: a retrospective study. Clin Oral Invest 27, 4695–4703 (2023). https://doi.org/10.1007/s00784-023-05096-x [Accessed January 2024]
[ii] Kalakonda B, Farista S, Koppolu P, Baroudi K, Uppada U, Mishra A, Savarimath A, Lingam AS. Evaluation of Patient Perceptions After Vestibuloplasty Procedure: A Comparison of Diode Laser and Scalpel Techniques. J Clin Diagn Res. 2016 May;10(5):ZC96-ZC100. doi: 10.7860/JCDR/2016/17623.7820. Epub 2016 May 1. PMID: 27437370; PMCID: PMC4948546. [Accessed January 2024]
[iii] Lim K-O, Lee W-P. Technical Note on Vestibuloplasty around Dental Implants Using Erbium YAG Laser-Assisted Periosteal Fenestration (LA-PF). Medicina. 2023; 59(10):1884. https://doi.org/10.3390/medicina59101884 [Accessed January 2024]
[iv] Shakeel A, Mohammad A, Mohammed H, December 2020 Comparison between two surgical techniques for vestibuloplasty – A retrospective study
https://www.joooo.org/article-details/12742 [Accessed January 2024]
[v] Rosen RD, Manna B. Wound Dehiscence. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551712/ [Accessed January 2024]
[vi] Babaki D, Khoshsimaybargard M, Yaghoubi S, Gholami M. Comparison of Vestibular Depth Relapse and Wound Healing After Reconstructive Preprosthetic Surgery Using Cryopreserved Amniotic Membrane and Acellular Dermal Matrix – A Comparative Study. Ann Maxillofac Surg. 2021 Jan-Jun;11(1):12-16. doi: 10.4103/ams.ams_322_20. Epub 2021 Jul 24. PMID: 34522647; PMCID: PMC8407648. [Accessed January 2024]
[vii] Ku JK, Leem DH. Retrospective case series analysis of vestibuloplasty with free gingival graft and titanium mesh around dental implant. J Korean Assoc Oral Maxillofac Surg. 2020 Dec 31;46(6):417-421. doi: 10.5125/jkaoms.2020.46.6.417. PMID: 33377467; PMCID: PMC7783179. [Accessed January 2024]
[viii] Alvira-González J, Gay-Escoda C. Compliance of postoperative instructions following the surgical extraction of impacted lower third molars: a randomized clinical trial. Med Oral Patol Oral Cir Bucal. 2015 Mar 1;20(2):e224-30. doi: 10.4317/medoral.20121. PMID: 25475774; PMCID: PMC4393987. [Accessed January 2024]
[ix] Deryabin G, Grybauskas S. Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: a retrospective multicenter study of implant success and survival rates, and lower lip sensory disturbances. Int J Implant Dent. 2021 Jun 9;7(1):44. doi: 10.1186/s40729-021-00334-x. PMID: 34105021; PMCID: PMC8187674. [Accessed January 2024]
[x] Tonelli P, Duvina M, Barbato L, Biondi E, Nuti N, Brancato L, Rose GD. Bone regeneration in dentistry. Clin Cases Miner Bone Metab. 2011 Sep;8(3):24-8. PMID: 22461825; PMCID: PMC3279056. [Accessed January 2024]
[xi] Zafiropoulos GG, Al-Asfour AA, Abuzayeda M, Kačarević ZP, Murray CA, Trajkovski B. Peri-Implant Mucosa Augmentation with an Acellular Collagen Matrix. Membranes (Basel). 2021 Sep 12;11(9):698. doi: 10.3390/membranes11090698. PMID: 34564515; PMCID: PMC8466111. [Accessed January 2024]
[xii] Babaki D, Khoshsimaybargard M, Yaghoubi S, Gholami M. Comparison of Vestibular Depth Relapse and Wound Healing After Reconstructive Preprosthetic Surgery Using Cryopreserved Amniotic Membrane and Acellular Dermal Matrix – A Comparative Study. Ann Maxillofac Surg. 2021 Jan-Jun;11(1):12-16. doi: 10.4103/ams.ams_322_20. Epub 2021 Jul 24. PMID: 34522647; PMCID: PMC8407648. [Accessed January 2024]
[xiii] Inbarajan A, Veeravalli PT, Seenivasan MK, Natarajan S, Sathiamurthy A, Ahmed SR, Vaidyanathan AK. Platelet-Rich Plasma and Platelet-Rich Fibrin as a Regenerative Tool. J Pharm Bioallied Sci. 2021 Nov;13(Suppl 2):S1266-S1267. doi: 10.4103/jpbs.jpbs_74_21. Epub 2021 Nov 10. PMID: 35017968; PMCID: PMC8687040. [Accessed January 2024]
[xiv] Rizk HM, Salah Al-Deen MSM, Emam AA. Comparative evaluation of Platelet Rich Plasma (PRP) versus Platelet Rich Fibrin (PRF) scaffolds in regenerative endodontic treatment of immature necrotic permanent maxillary central incisors: A double blinded randomized controlled trial. Saudi Dent J. 2020 Jul;32(5):224-231. doi: 10.1016/j.sdentj.2019.09.002. Epub 2019 Sep 21. PMID: 32647469; PMCID: PMC7336024. [Accessed January 2024]
[xv] Marenzi G, Riccitiello F, Tia M, di Lauro A, Sammartino G. Influence of Leukocyte- and Platelet-Rich Fibrin (L-PRF) in the Healing of Simple Postextraction Sockets: A Split-Mouth Study. Biomed Res Int. 2015;2015:369273. doi: 10.1155/2015/369273. Epub 2015 Jul 26. PMID: 26273612; PMCID: PMC4529911. [Accessed January 2024]
[xvi] Tachalov VV, Orekhova LY, Isaeva ER, Kudryavtseva TV, Loboda ES, Sitkina EV. Characteristics of dental patients determining their compliance level in dentistry: relevance for predictive, preventive, and personalized medicine. EPMA J. 2018 Nov 13;9(4):379-385. doi: 10.1007/s13167-018-0152-8. PMID: 30538789; PMCID: PMC6261882. [Accessed January 2024]
