University J Dent Scie 2018; Vol.

4, Issue 1
University
Journal of
Dental Sciences

VESTIBULOPLASTY BY LIP SWITCH

PROCEDURE - A CASE REPORT
Case
Report
1 2 3 4
Neetu Rani, Amitabh Srivastava, Priyanka Tandon, Saransh Srivastava
1
Reader, Department of Periodontics, Sardar Patel Post Graduate Institute of Dental &
Medical Sciences, Lucknow 2Professor & Head, Department of Periodontics, Sardar
Patel Post Graduate Institute of Dental & Medical Sciences, Lucknow
3,4
Post Graduate Student, Department of Periodontics, Sardar Patel Post Graduate
Institute of Dental & Medical Sciences, Lucknow.

Keywords:
ABSTRACT : Background: A 45 years old female patient complaint of trauma while brushing in lower
Vestibuloplasty,
front teeth. An extremely shallow vestibule was observed with gingival recession in 31 and 41.The Lip switch technique,
mandibular labial vestibule was extended using the lip switch procedure or the Lip switch technique. The Edlan Mejchar technique.
procedure yielded a considerable gain in the width of the attached gingiva, which maintained itself even 3
months after the surgical procedure. Lip switch technique leads to a consistent and predictable increase in Conflict of interest: Nil
the width of the attached gingiva and may be successfully used in the treatment of a shallow vestibule. No conflicts of interest : Nil

INTRODUCTION : The overall oral health is maintained by impact on patient's aesthetics, oral hygiene maintenance and
proper oral hygiene. Maintenance of oral hygiene increases function. A shallow vestibule is associated with plaque
longevity of natural dentition. accumulation and consequently marginal gingival
inflammation which leads to mobility, bone loss, gingiva
Goal of oral hygiene is to remove plaque, calculus, prevent recession.
dental caries and periodontal disease. It has been documented
that oral hygiene is directly linked to periodontal disease. If Gingival recession refers to exposure of root surface by the
oral hygiene is compromised it leads to periodontitis. apical migration of junctional epithelium (JE), results in a
unesthetic appearance and dentinal hypersensitivity.1
The objective of periodontal therapy is to create an
environment which results in good oral hygiene practice by We hereby present a case report of a patient who presented
the patient. with the chief complaint of trauma while brushing in lower
anterior teeth and in whom vestibular extension was done
Mucogingival surgery is done to rectify defect in with the technique described by Lip switch technique to
morphology, position & amount of gingiva and alveolar correct the shallow vestibule.
mucosa. Mucogingival surgery term was introduced by
Nathan Friedman in 1957. In 1996, World Workshop in CASE REPORT: A 45 year old female presented with the
Clinical Periodontics renamed Mucogingival surgery as chief complaint of trauma while brushing in the lower anterior
Periodontal Plastic Surgery. Periodontal plastic surgery term region reported to the outpatient of Department of
was proposed by Miller in 1993. Periodontology, Sardar Patel Postgraduate Institute of Dental
& Medical Science, Lucknow. On intraoral examination it
The occurrence of mucogingival deformities often has an was found that patient had Millers grade I mobility with

University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 124
University J Dent Scie 2018; Vol. 4, Issue 1

reduced width of attached gingiva in the lower anterior region

along with grade II recession in 31, 41. Width of attach
gingiva was severly reduced , measuring 2mm. (Fig.1)

Phase I therapy was initiated with patient education and

motivation, full mouth scaling and root planing, home plaque
care measures and oral hygiene instructions were reinforced
to the patient. Vestibular extension of the patient's mandibular
labial vestibule to increase the width of attached gingiva was
planned. Routine blood investigations (haemoglobin, total
and differential leukocyte counts, blood glucose- fasting and Fig 4. Mesurements made after 15 days
post-prandial, bleeding and clotting time) were carried out.
SURGICAL TECHNIQUE: Pre surgical preparation was
done before the surgery with povidine iodine solution & 0.2%
Chlorhexidine digluconate rinse for 30 seconds. The patient
was anesthetized using 2% Lidocaine with Adrenaline
concentration of 1:80000. The surgical procedure Lip switch
technique as described by Edlan and Mejchar was followed.
With the help of BP blade no. 15 vertical incisions were given
on distal aspect of the both mandibular lateral incisors and
extending 11 to 12mm till the lower lip. These two incisions
were joined by a horizontal incision across the midline. A split
Fig 1. Preoperative thickness flap was raised & periosteum was visible. The
horizontal incision was placed on the periosteum & separated
from the bone. The inner surface of the periosteum was
sutured to the margin of the incision.

After surgical procedure a periodontal dressing (Coe Pac) was

placed to protect the operated area. The patient was prescribed
Cap Amoxicillin 500 mg TID for 5 days and anti-
inflammatory Tab Diclofenac 50 mg BD for 5 days for post-
operative pain. Patient was instructed to have soft diet for 1
week along with other post-operative instructions. The
patient was recalled after two weeks for removal of sutures.
Fig 2. Vertical & Horizontal incision made No postoperative complications were created. At two weeks
the width of attached gingiva recorded was 7 mm
approximately. The patient was recalled after every month
and 3 months follow up was recorded and it was observed that
the achieved width attached gingiva remained constant
throughout.

DISCUSSION: Vestibuloplasty is a surgical procedure

designed to deepened oral vestibule by changing soft tissue
attachments. Various surgical modalities have been used for
vestibuloplasty including sub mucosal vestibuloplasty,
Fig 3. Suture placed secondary epithelisation vestibuloplasty (Kazanjian

University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 125
University J Dent Scie 2018; Vol. 4, Issue 1

technique, Edlan-Mejchar vestibuloplasty) and soft tissue cannot be established.

grafting vestibuloplasty.
CONCULSION : Based on the clinical findings of the
Edlan and Mejchar technique was given by Edlan and B present case it can be concluded that in cases with a shallow
Mejchar (1963) and it is secondary epithelisation vestibule and a reduced width of attached gingiva on the labial
vestibuloplasty. In secondary epithelisation the mucosa of aspect of the mandibular anterior teeth, this technique
vestibule is used to line one side of the extended vestibule, and provides a predictable way in which oral health can be
the other side heals by growing new epithelial surface. Edlan achieved and maintained.
and Mejchar technique is a modification of Kazanjian
technique. REFERENCES:
1. Kassab MM, Cohen RE; The etiology and prevalence of
Edlan and Mejchar depicted a technique for vestibuloplasty gingival recession. J Am Dent Assoc., 2003; 134(2): 220-
which was applicable to patients in whom there were no 225.
pockets and little or no gingival tissue present. This procedure 2. Wade A. Vestibular deepening by the technique of Edian
also increases the width of the attached gingiva where other and Mejchar. J Periodont Res 1969 4:300-31.
procedures were impracticable due to lack of vestibular 3. Bergenholtz A, Hugoson A. Vestibular sulcus extension
depth.2,3,4 This technique is also indicated in treatment of surgery in the mandibular front region. The Edlan-
localized recession or for elimination of a broad, high frenum. Mejchar method--a five-year follow-up study. J
Edlan and Mejchar technique known as lip switch procedure Periodontol. 1973 May;44(5):309-11.
or transpositional flap or Edlan vestibuloplasty. The 4. Edlan A, Mejchar B. Plastic surgery of the vestibulum in
advantage of this technique no bone is left exposed, it periodontal therapy. Int Dent J 1963;13:593-596.
minimizes the chances of bone resorption and further 5. Madani SM, Thomas B. Edlan- Mejchar Vestibular
recession. Another advantage of this technique is there are no Deeping in a Failing Implant Case. Int J Oral Implantol
relapses of the vestibule and scar formation is minimal. In the Clin Res 2013;4(3):108- 111.
present case, an excellent clinical result was obtained which 6. Wade AB: Vestibular deepening by the technique of
was maintained even 3 month after surgery. Edlan and Mejchar, J Periodont Res 4: 300-313, 1969.

Several techniques have been developed since 1956, but most

of them are unsatisfactory due to scar formation and frequent CORRESPONDING AUTHOR
relapse of the state of the vestibule. Compared to another Dr. Priyanka Tandon
widely used periosteal fenestration technique there is minimal 5/139 Vikas Nagar, Lucknow,
contraction of the vestibular depth gained and minimal scar Uttar Pradesh 226022
formation. 5 Email: [email protected]
Mob.: 9140241254
This finding is consistent with the observations of Wade
(1969)6. A study done by Axel Ergenholtz and Anders
Hugoson stated that net gain was of 7.7 mm which was
followed upto 5 years. The condition was stabilized and
maintained.3

Problem associated with shallow vestibule is improper

maintenance of oral hygiene because of traumatic brushing.
Various brushing techniques require the placement of the
toothbrush at the gingival margin, which may not be possible
with reduced vestibular depth. It has been reported that with
minimal of 1 mm of attached gingiva, proper gingival health

University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 126