Introduction-The shallow vestibule was one of the mucogingival problems cited by Friedman in the late 1950s that required apicocoronal dimension of gingiva. Problems with shallow vestibule includes, – Unable to perform intra-sulcular cleaning or modified Bass method, as it requires placement of tooth brush bristle into the gingival sulcus. In patients with reduced vestibular depth this couldn’t be possible. Thus it interferes with oral hygiene procedures causing ineffective plaque control. It compromises the denture retention and stability, predisposes the gingiva to recession which compromises the esthetics and often leads to dentinal hypersensitivity and root caries on exposed root surface.
Vestibuloplasty is a mucogingival procedure that aims at the surgical modification of the gingiva-mucous membrane relationships including deepening of the vestibular trough, altering the position of the frenulum or muscle attachments, and widening of the zone of attached gingiva. It is indicated to halt the progression of gingival recession, to regain the width of attached gingiva, for effective plaque control procedures, better esthetics, to improve denture retention and stability, and to prevent inflammatory alterations and tissue recession around implants. It is contraindicated in areas showing bone loss due to chronic periodontitis or traumatic extraction and in cases with ridge resorption around implants.
Treatment Modalities- A variety of vestibuloplasty techniques have been advocated in literature such as Clark’s vestibuloplasty, Edlanplasty, Kazanjian vestibuloplasty, etc. Most of these techniques have been used as pre-prosthetic procedure to enhance the vestibular depth related to edentulous denture bearing areas. Major drawbacks of these conventional vestibuloplasty procedures were the severe pain and discomfort and the delayed healing with the high chances of relapse making them less acceptable.
Laser vestibuloplasty with the Diode laser represents a contemporary non-invasive alternative to conventional scalpel method. PIOON Laser offers different wavelengths like 450nm, 810nm/980nm which can either be used in contact or non-contact manner to perform this procedure. In this case wavelength of 450nm was selected and 400 micron initiated tip was used in non-contact/slightly contact mode, starting at the mucogingival junction with a horizontal stoke directing the laser parallel to the bone slowly relieving the muscle fibers till the desired depth. Laser safety glasses were worn by the clinician, assistant and the patient and proper precautions were taken.
According to a study by Carlo Fornaini et al 2016, blue light lasers provide minimal discomfort to patients with little traces of carbonization in the histopathological investigation. Again an interesting study by C. Fornaini et al 2017 suggested decreased excision time with a blue diode laser (wavelength 450nm) with much lesser rise in temperature.
Rationale behind Use of Lasers Lasers offer an array of advantages over the traditional scalpel in providing a clean sterile field with excellent hemostasis for the clinician and by providing less pain and swelling postoperatively for the patient.
Conclusion-. Lasers prove to be a viable, safe, and minimally invasive alternate to scalpel in vestibuloplasty procedures with better patient compliance and more predictable outcomes.
References
1. Fornaini C et al. 450nm diode laser: A new help in oral surgery. World J Clin Cases 2016. 16;4(9): 253-257
2. Fornaini C et al. 450nm blue laser and oral surgery: preliminary ex vivo study. The Journal of Contemporary Dental Practice. 2016;17(10):795-800
Preoperative View (Courtesy- Dr. Sana Farista)
1 week Post-operative View (Courtesy- Dr. Sana Farista)
