The submucosal vestibuloplasty as described by Obwegeser may be the procedure of choice for correction of soft tissue attachment on or near the crest of the alveolar ridge of the maxilla. This technique is particularly
useful when maxillary alveolar ridge resorption has occurred but the residual bony maxilla is adequate for proper denture support. In this technique, underlying submucosal tissue is either excised or, repositioned to allow direct apposition of the labiovestibular mucosa to the periosteum of the remaining maxilla. To provide adequate vestibular depth without producing an abnormal appearance of the upper lip, adequate . mucosal length must be available in this area. A sunple test to. determine whether adequate lablovestibular mucosa is present is performed by placing a dental mouth mirror under the upper lip and elevating the superior
aspect of the vestibule to the desired postoperative depth (Fig. 13-41). If no inversion or shortening of the lip occurs, then adequate mucosa is present- to perform a proper submucosal vestibuloplasty, The submucosal vestibuloplasty can generally be performed with local anesthetic and intravenous (IV) seda tion in an outpatient setting. A midline incision is made in the anterior maxilla, and the mucosa is undermined and separated from the underlying submucosal tissue (see Fig. 13-41). A supraperiosteal tunnel is then developed by dissecting the muscular and submucosal attachments from the periosteum. The intermediate layer of tissue created
by the two tunneling dissections is incised at its attachment area near the crest of the alveolar ridge. This submucosal and muscular tissue can be repositioned superiorly or excised. After closure of the midline incision,
a preexisting denture or prefabricated splint is modified to extend into the vestibular areas and is secured with palatal screws for 7 to 10 .days to hold the mucosa over the ridge in close apposition to the’ periosteum. When healing takes place, usually within 3 weeks, the mucosa is closely adapted to the anterior and lateral walls of the maxilla at the required depth of the vestibule. The maxillary submucosal vestibuloplasty can also be combined with HA augmentation of the alveolar ridgearea. subperiosteal tunnelcan be created using a technique similar to standard maxillary HA augmentation
procedures.V By incising the periosteum high on the Iateral aspect of the mandible, the periosteal envelope can be enlarged to allow greater HA augmentation in this area
These techniques provide a predictable increase in vestibular depth and attachment of mucosa over the denture-bearing area. A properly relined denture can often be worn immediately after the surgery or after removal of the splint.. and Impress+. is for final denture relining or construction can be completed 2 to 3 weeks after surgery. .