A noble method of using intravenous infusion set as a stent in localized lower posterior vestibuloplasty: A technical note.

Vestibuloplasty is the procedure for shallow vestibule, prior to the prosthesis. Usually, vestibuloplasty is carried out in patients with completely edentulous arches. There are multiple techniques of vestibuloplasty described in the review of literature. However, it has not been emphasized on isolated shallow vestibule. This article describes our experience in the isolated or localized vestibuloplasty for a partially edentulous individual with a shallow vestibule pertaining to a single missing tooth.

Vestibuloplasty is a preprosthetic surgery, which is the treatment for most cases of reduced and shallow vestibule. Preprosthetic surgery is the surgery carried out prior to prosthesis like a removable partial denture or complete prosthesis. Vestibuloplasty procedure increases the depth of the denture retention for complete rehabilitation.[1] Denture adaptation is better if the sulcus depth is satisfactory. Denture floats if the depth is shallow or minimal.

Vestibuloplasty (Clarke's technique) is described in the earlier literature as a comfortable and reliable technique for attaining sulcus depth.[234] It is indicated in case of completely edentulous ridges to create a betterment of anatomical sulcus length. We encountered an isolated shallow vestibule with dentition in anterior and posterior to the ridge. We planned for a minimally invasive minor operation to improve the condition of the soft tissues around the atrophied mandible region.

Technical Note

A case was referred to our department with a complaint of reduced sulcus depth in relation to the particular region, isolated to lower posterior vestibule. Resorbed bone or residual bone with a superiorly positioned gingiva following extraction was noted. History of extraction of the tooth, before 7 years and had a trauma 20 years before. Following the healed region after extraction, patient ended up with a shallow and reduced vestibular sulcus depth [Figure 1]. Patient opted for a removal partial denture as he was not affordable for fixed partial denture or an endosseous implant. Most patients will not afford this procedure.[5]

Figure 1

Preoperative

Patient was planned for a vestibular deepening in relation to the right lower first molar site. Sulcus deepening procedure performed in the mandible under local anesthesia as a chairside procedure.[67] Local anesthesia was delivered in the right inferior alveolar nerve region as a nerve block. Incision placed over the edentulous crest of the first mandibular molar area extending along the premolar labial side (cervix) [Figure 2]. Mucosal attachment from the crest was relieved using periosteal elevation. Mucosal flap was reattached to a depth that is needed.

Figure 2

Incision placed and flap elevated

A stent was designed from the EO sterilized nonvented intravenous (IV) infusion tube set [Figure 3]. The approximate size of the stent was designed based on the extent of the shallow vestibule to the localized area.

Figure 3

Stent-intravenous infusion set

Flap was reposition and rotated to desired and most possible level and IV infusion stent was placed and stabilized using 26 Gauge stainless steel wire in the lower posterior region and the flap was sutured with 3-0 silk [Figure 4].

Figure 4

Immediate postoperative

Discussion

Preprosthetic surgery for a stable and retentive ridge has been reported in literature for decades. Exposed bone has to be covered with material including mucosal and skin grafts, which are regarded as suitable for grafting in oral and maxillofacial surgery.[1]

Grafts are viable and reliable for covering of the surgical wound to prevent the contracture following sulcus deepening procedure. Thereby maintaining the desired depth.[1]

Insufficient residual ridges had a vestibuloplasty with split-skin graft performed in the mandible under local anesthesia on an out-patient basis.[67] The conventional method proved not to be easier and more time-consuming by utilizing the stent and provided results that were marginally superior to those of the other options.[8]

The healing of the tissue was satisfactory on the postoperative follow-up [Figure 5]. During the removal of the IV stent, granulating tissue was seen at the anterior-most region of the flap, which was comparatively same to the Samandari et al.[2]

Figure 5

Healing after suture removal

This procedure was similar to Clark's technique with a slight change in the incision, as it was placed over the edentulous ridge and extended as a crevicular incision in the dentulous area. IV infusion set tube was used as stent to maintain the depth of the sulcus, postoperatively.[234]

Following the tube placement, the wound healing was monitored in the 3rd and 7th day. Wound healing was satisfactory without any infection of candidiasis, which was not the same in Hillerup et al. study.[9]

Various procedure and techniques have been evolved for vestibule maintenance, like fibrin glue,[8] but still in our case stent was found to be effective.

Results

Follow-up of the patient was done till the 7th postoperative day. Healing was good. Stent was removed, and a desired sulcus depth was achieved for denture retention. During the follow-up on the 3rd postoperative day, white soft tissue layer anterior to the flap was noted, which was confirmed as slough. In this case experience, there was not any source of infection or complication following the treatment of localized vestibuloplasty. This procedure was simple and less time-consuming and more effective with better results.

Conclusion

Vestibuloplasty is a procedure followed with stent placement to hold the reattached flap at a desired sulcus depth was simple and less time-consuming and more effective. Various stent placement techniques were practiced for a long posture but in this case, we were using a non-prefabricated readily available stent, which is economical and effective.