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A vestibuloplasty is a series of surgical procedures designed to restore alveolar ridge height by lowering the muscles and ligament attached to the buccal, labial, and lingual aspects of the jaws. A vestibuloplasty is performed to enlarge the denture-bearing area and to ensure the comfort, function, and stability of a denture.[1] David E. Stall, DMD, of West Chester, PA, uses his LightScalpel CO2 laser to perform vestibuloplasties in the following 2 cases. In both cases patients needed to gain sufficient vestibular height to ensure better denture stability.
Laser Vestibuloplasty Case # 1
For this patient, Dr. Stall used the LightScalpel CO2 laser at 4 W, 20 Hz, SuperPulse (2 watts average power) with 0.25 mm focal spot size. He also used 5 W of continuous wave for additional hemostasis. First, the upper lip was pulled outward in order to maintain tension on the vestibule throughout the dissection. Then a wide supraperiosteal laser incision was created along the border of the maxillary attached gingiva from the second molar to the second molar contralaterally. No bone grafting was needed. Multiple 5-0 chromic gut sutures were placed to hold released labial mucosa to the periosteum above the release [figure 2]. White-yellowish fibrous coagulum layer, shown in figure 3, served as a protective dressing. This patient did not wear their dentures for the first 2-3 weeks to allow for healing. Healing progressed without complications. This patient gained a minimum of 5 mm, with some areas more. After adequate healing a new denture was made.
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- Figure 1: Pre-op
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- Figure 2: Immediately post-op
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- Figure 3: 1-week post-op
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- Figure 4: 3-weeks post-op
Laser Vestibuloplasty Case # 2
For this patient Dr. Stall used the LightScalpel CO2 laser at 2 watts, 20 Hz, SuperPulsed (1.2 watts of average power) to perform a full vestibuloplasty. The laser focal spot size was 0.25 mm. He placed 10 chromic gut 5-0 sutures to hold the labial mucosa to the periosteum above the releases. This patient gained a minimum of 5 mm, with some areas more. This patient did not wear their dentures for the first 2-3 weeks to allow for healing. After adequate healing the patient’s existing denture was relined.
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- Figure 5: Pre-op
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- Figure 6: Immediately post-op
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- Figure 7: 1-week post-op
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- Figure 8: 3-weeks post-op
The LightScalpel 10,600-nm CO2 laser offers numerous advantages over traditional methods and other dental laser wavelengths for soft-tissue surgery. Some of these benefits include faster procedure, less bleeding, minimal postoperative swelling, reduced postoperative pain, and good patient acceptance.
About Dr. Stall
David E. Stall, DMD, is originally from the Catskill Mountain region of New York State and graduated from SUNY at Buffalo in 1977 with his B.A. in Geography. After receiving his master’s degree in Public Health at Tulane University, he moved to Philadelphia in 1979 to attend one of the top 5 dental schools in the nation, the University of Pennsylvania School of Dental Medicine. Following graduation in 1983, he spent the next year as a resident at the Mount Sinai Medical Center in New York City, where he received additional training in General and Hospital Dentistry. In 1985 he opened his dental practice in West Chester, Pennsylvania.
In 1989, Dr. Stall received the prestigious Academy of General Dentistry Fellowship Award, given to those dentists who have shown dedication to patient care through continuing education. Dr. Stall has taken over 1800 hours of continuing dental education courses since 1983 and is a past clinical instructor in restorative and cosmetic dentistry at the University of Pennsylvania. In addition, he mentors other dentists in areas relating to implant and restorative dentistry.
Learn more about Dr. Stall at www.davidstalldental.com
References
- Levine R, Vitruk P. The Use of a 10,600-nm CO2 Laser Mandibular Vestibular Extension in a Patient with a Chromosomal Disorder. Compend Contin Educ Dent. 2016 Sept;37(9):527-533.
