|Year : 2016 | Volume
| Issue : 3 | Page : 192-194
Vestibular deepening procedure
Mohammad Arif Khan, Sanjay Gupta, Amitandra Kumar Tripathi, Charanjeet Singh Saimbi, Deepti Chandra
Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
|Date of Web Publication||5-Aug-2016|
Dr. Mohammad Arif Khan
Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Various factors such as bacterial plaque, aggressive tooth brushing, trauma from oclussion, multiple high frenum, and shallow vestibule that involved in the development and progression of gingival recession, but the multiple high frenum along with shallow vestibule have been major factors of gingival recession, especially in the lower anterior region along with inadequate width of attached gingiva. Multiple techniques have been developed to increase the depth of vestibule and the width of attached gingiva. This case report present, to remove the multiple aberrant frenum and increasing the width of attached gingiva and vestibular depth, in single visit by vestibular deepening procedure.
Keywords: Gingival extension procedure, multiple aberrant frenum, vestibular deepening
|How to cite this article:|
Khan MA, Gupta S, Tripathi AK, Saimbi CS, Chandra D. Vestibular deepening procedure. Int J Health Allied Sci 2016;5:192-4
| Introduction|| |
Periodontal esthetic surgery not only emphasized on biological and functional problems that affect the periodontium but also focused to improve esthetic appearance. Gingival recession is defined as exposure of root surface by the apical migration of junctional epithelium, results in a unesthetic appearance and dentinal hypersensitivity.  Aberrant frenum along with inadequate vestibular depth which causes a gingival recession is a very common clinical finding in the front region of the lower jaw.
The term mucogingival surgeries were introduced by Freidman and Levin in 1957, to describe the surgical procedure that correct the relationship between the gingival and oral mucous membrane such as attached gingiva, shallow vestibules, and aberrant frenum. 
Shallow vestibule, gingival recession, and aberrant frenum which causes mucogingival problems, several independent and effective surgical procedure have been developed. The aim of this case report is to increase the depth of vestibule and the width of attached gingiva in single visit by vestibular deepening procedure.
| Case Report|| |
A 24-year-old female reported to the Department of Periodontology, Career Postgraduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India, with the chief complaint of unesthetic appearance of gingiva on the front lower teeth [Figure 1]a. On her intraoral examination revealed, Class III gingival recession (Miller, 1985) and inadequate width of attached gingiva (approximately 2.0 mm) [Figure 1]b on her front lower teeth and also inadequate the vestibular depth was found in that region. Thus, to prevent the progression of gingival recession and increase in width of attached gingiva, vestibular deepening procedure was planned, and the patient was informed about the procedure.
|Figure 1: (a) Preoperative view. (b) Preoperative view: Measured the width of attached gingiva (approximately 2.0 mm)|
Click here to view
Before surgery, nonsurgical periodontal therapy such as scaling and root planning was done. At the time of surgery, local anesthesia was administered, and a horizontal incision was placed at the mucogingival line with No. 15 B. P. blade [Figure 2]. The flap was undermined [Figure 3] and sutured with continuous locking suture [Figure 4]. The lead foil was placed in the vestibule, to prevent both edges of epithelium attachment [Figure 5]. The operated area was covered with periodontal pack [Figure 6]. Postoperatively, the adequate width of attached gingiva (approximately 4.0 mm) and vestibular depth was obtained [Figure 7] and no postoperative complications were developed after 6-months.
|Figure 7: Postoperative view: Obtained adequate width of attached gingiva (approximately 4.0 mm) and vestibular depth|
Click here to view
| Discussion|| |
Gingival recessions and shallow vestibule may occur without any symptoms, but this may explore the patient due to unesthetics appearance, difficulty to perform plaque control procedures, dentinal hypersensitivity, etc., Several studies indicated that role of adequate depth of vestibule is very important for the maintenance of oral hygiene. Wennstrom and PiniPrato reported 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 hygiene. 
The techniques to deepen the vestibule in edentulous patients was primarily introduced in 1924 by Kazanjian and Goldman et al. were first introduced the rationale and techniques of the emerging field of mucogingival surgery in 1956. ,
However, several techniques have been developed since 1956, but most of them are unsatisfactory due to scar formation and frequent relapse of the state of the vestibule, all these techniques exposing the extensive areas of bone. Thus, the purpose of these vestibular deepening procedures is to prevent gingival traction produced by muscular and fibrous attachments due to the shallow vestibule and an inadequate amount of attached gingiva, lead to progression of gingival recession, and plaque accumulation. 
Wade reported that that before root coverage procedures, adequate width of attached gingiva is common requirement.  However, the presence of adequate amount of attached gingival zone is required for maintaining the periodontal health.  Thus, in this case report successfully obtained the adequate width of attached gingiva (approximately 4.0 mm) and vestibular depth after 6-month through vestibular deepening procedure in a single visit.
| Conclusion|| |
The conventional vestibular deepening is a successful procedure for gaining adequate depth of vestibule and width of attached gingiva, to 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.
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: CV. Mosby Co.; 1956. p. 301-11.
Kazanjian VH. Surgical operations as related to satisfactory dentures. Dent Cosm 1924;66:387.
Ochsenbein C. Newer concept of mucogingival surgery. J Periodontol 1960;31:175-85.
Wade AB. Vestibular deepening by the technique of Edlan and Mejchar. J Periodontal Res 1969;4:300-13.
Nabers CL. Repositioning the attached gingiva. J Periodontol 1954;25:38.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]