Vestibuloplasty using an apically-shifted flap in patients with edentulous mandibles

BACKGROUND: One of the most common problems of the dental system in the residential and senile age is the complete absence of teeth. This pathology affects up to 35% of patients aged 55–70 years, and at the age of 75 years and older, more than 50% of patients have toothless jaws. A small vestibule of the oral cavity due to atrophy of the alveolar process on the lower jaw is an important reason for unsatisfactory fixation of a complete removable prosthesis, and therefore prosthetics of this group of patients is a complex clinical problem.

AIM: Study: to optimize the surgical stage of treatment during the operation of deepening the vestibule of the mouth by the method of apically displaced flap in the complete absence of teeth on the lower jaw by using the gel preparation “Emalan” (Zelenaya dubrava, Russia) based on collagen.

MATERIAL AND METHODS: The results of the study of 28 patients aged 67 to 76 years with complete absence of teeth in the lower jaw, whose treatment was carried out on the basis of the dental clinic “Prime Dentistry” of Ryazan, were analyzed. The study included elderly and senile patients, according to the WHO age classification. Patients were not assigned by gender. All patients were equally divided into 2 groups.

Clinical evaluation of the early postoperative period was carried out for 10 days after surgery on the 2nd, 5th and 10th days. A verbal descriptive pain scale was used to assess the intensity of pain.

In order to control the presence of an inflammatory reaction in the postoperative period, local thermometry was performed locally using an infrared scanner.

RESULTS: Examination on the 2nd day showed that patients of both the main and comparison groups had slightly pronounced edema of the surrounding soft tissues. No increase in body temperature was recorded in both groups. Assessing the postoperative wound, on the 2nd day, all patients of the comparison group had marked hyperemia and swelling of the mucous membrane in the area of the surgical wound, and in patients of the main group such changes were detected less frequently. On the 5th day, no mucosal edema was observed in patients of the main group, and hyperemia was noted twice. In the comparison group, swelling and hyperemia of the mucous membrane in the wound area were recorded in almost half of the group. Examination of the wound defect on the 10th day showed that in the main group in all patients the wound was epithelized, whereas in the comparison group the signs of epithelization were weakly expressed. When studying the dynamics of local thermal symmetry using an IR scanner, carried out three times: on the eve of the operation, on the 2nd and 5th days after the intervention, a difference in indicators was noted between the main group and the comparison group. Patients’ assessment of the intensity of pain in the postoperative period using a verbal descriptive pain scale showed the following results. After complete cessation of anesthesia, most patients of the main group had slight discomfort in the wound area. Patients of the comparison group mainly complained of severe pain. On the 2nd day and on the 5th day after surgical intervention, some patients of the comparison group had complaints of mild pain in the wound, all other patients, including patients of the main group, had no pain.

CONCLUSION: The use of collagen-based gel preparation “Emalan” to close wound postoperative defects with open methods of deepening the vestibule of the mouth gives positive results in the healing process of the wound defect in the form of absence or significant reduction of pain syndrome, reduction of inflammatory reaction in the wound and acceleration of epithelization.