THE OPTIMAL VESTIBULOPLASTY IN PREPROSTHETIC SURGERY OF THE MANDIBLE

Two studies (1981-1990 retrospective, and 1989-1993 prospective) were performed to determine the optimal methods in preprosthetic surgery. T he first study deals with four different types of grafts (split-thickn ess skin, mucosal, mesh mucosal, palatal) in combination with vestibul oplasties and lowering of the floor of the mouth. The parameters, vest ibular depth, mobility and resilience of the transplants were examined . Keratinized grafts (split-thickness skin and palatal) showed advanta ges. On the basis of a high rate of complications at the site of harve sting of palatal mucosa and the limited amount of palatal mucosa avail able for grafting, we prefer a split-thickness skin graft. A second pr ospective study to compare the Edlan- and Kazanjian-plasty showed the disadvantages of both methods. The Edlan-plasty, in combination with i mplants, showed a small amount of bone resorption; the Kazanjian-plast y showed a significant loss of attached mucosa. Both methods were ther efore abandoned in our clinic. For cases with insufficient width of at tached mucosa, we recommend a vestibuloplasty secondarily, with kerati nized grafts. If there is a deep palatal vault and the need for a larg e amount of graft material, a split-thickness skin graft should be har vested. In cases of limited need and flat palatal vault, the graft can be harvested from the palate.