Vestibuloplasty study done by Axel Ergenholtz and Anders
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, secondary epithelisation
technique, Edlan-Mejchar vestibuloplasty) and
soft tissue grafting vestibuloplasty.
Mejchar technique was given by Edlan and B Mejchar (1963) and it is secondary
epithelisation vestibuloplasty. In secondary epithelisation the mucosa of
vestibule is used to line one side of the extended vestibule, and the other
side heals by growing new epithelial surface. Edlan and Mejchar technique is a
modification of Kazanjian technique.
Mejchar depicted a technique for vestibuloplasty which was applicable to
patients in whom there were no pockets and little or no gingival tissue present.
This procedure also increases the width of the attached gingiva where other
procedures were impracticable due to lack of vestibular depth.2,3,4 This
technique is also indicated in treatment of localized recession or for
elimination of a broad, high frenum.
Mejchar technique known as lip switch procedure or transpositional flap or
Edlan vestibuloplasty. The advantage of this technique no bone is left exposed,
it minimizes the chances of bone resorption and recession. Another advantage of
this technique is there are no relapses of the vestibule and scar formation is
minimal. In the present case, an excellent clinical result was obtained which
was maintained even 3 month after surgery.
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. Compared to another widely used
periosteal fenestration technique there is minimal contraction of the
vestibular depth gained and minimal scar formation. 5
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
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 cannot be established.
Based on the clinical
findings of the present case it can be concluded that in cases with a shallow vestibule
and a reduced width of attached gingiva on the labial aspect of the mandibular
anterior teeth, this technique provides a predictable way in which oral health
can be achieved and maintained.