Implantation with one-stage vestibuloplasty

The author:
Kobyakov Aleksandr Vladimirovich
A maxillofacial surgeon

The principal place of work:
N.I. Pirogov Regional Hospital,
the Division of Maxillofacial Surgery;
the Department of Dental Surgery and Maxillofacial Surgery of N.I. Pirogov Vinnitsa National Medical University

Clinical case

A patient M., 33 years old, complained of missing teeth in the left mandible. The teeth had been extracted because of curiosity complications.

Detected: while oral examination a free-end edentulous space in the left mandible was found (missing teeth 46-48). Movable mucous membrane of the mucogingival line is fixed to the top of the alveolar process.

CBCT showed no peculiar properties of the edentulous space of the alveolar process, residual bone tissue is represented in the volume enough for a classic implantation perforation.

Taking into account the local status and CBCT data (for the mandible), the decision was taken to place two implants Bio3 Advanced 4.6/10 in a subcrestal position with one-stage vestibuloplasty according to the Kazanjian’s method.

The surgery process

After local anaesthesia with Ultracain D-S forte and the oral cavity processing with Betadine solution a U-shaped cut on the mucous membrane of the mucogingival line at the level of the denture defect was made in 1.5cm from the connected area of the alveolar bridge mucous membrane in the mandible towards the cheek. The mucous membrane was separated from the cheek muscle and periostal coverage fibers by sharp dissection, a split flap was formed.

Cut in the periostal coverage to the bone under the formed split flap and at the level of the connected membrane was made, a full mucous-periostal flap was mobilized above the alveolar process top. A flap retraction towards the tongue was made. Initiating osteotomy and formation of the further implant position were conducted with the help of a pilot drill. According to the recommended protocol Bio3 Implants, consistent osteotomy and formation of a bony bed for the implants were made. Taking into consideration the density of the bony tissue D2 and the two-stage protocol, as well as the design of the Bio3 Advanced implant, the formed bed was marked by a bone thread former Advanced with a diameter 4.6 mm.

The osteotomy area was cleaned with a sodium chlorine solution, the surplus of the bone remnants was removed from the socket. The implant Bio3 Advanced was inserted with the help of the equipment and fixed with the force 15-20N in a subcrestal position 1.5 mm lower than the bridge top is situated. The check X-ray of the placed implants was made. Before the formed flap is put and the wound is closed up, the spot of the cheek muscle connection was displaced apically by 0.5 cm by means of its separation from the periost with the help of an elevator. The flap was put onto its place, the split part of the flap was sewn on to the periostal coverage.

Thus, the part of the mucous membrane connected to the cheek muscle was displaced and fixed to the periostal coverage.

For the postoperative period antibacterial and anaesthetic treatment was prescribed according to the conventional standards. Processing of the wound area with the Solcoseryl gel was prescribed as well.

The state of the mucous membrane covering the edentulous space in the mandible: the border between the movable and immovable parts of the mucous membrane is marked with a blue line.

The cut design: the part of the mucous membrane covering the cheek muscle is mobilized.

The view of the mobilized flap: а) the full and split flap part is moved towards the tongue; b) the cortical plate of the alveolar bridge; c) periostal coverage; d) the cheek muscle fibers.