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Maintenance of
oral hygiene is required for optimum periodontal health that increases the
longevity of the person’s natural dentition. The objective of periodontal
therapy is to reproduce an environment which results in high standard of oral
hygiene as inadequate oral hygiene is associated with mucogingival deformities.Periodontal
plastic surgery emphasize on biological, functional problems that affect the
periodontium and focused to improve esthetic appearance. The occurrence
of mucogingival deformities often has an impact on patients in provisions of aesthetics
and function. A shallow vestibule is often associated with plaque accumulation
and consequently marginal gingival inflammation. Gingival
recession is defined as exposure of root surface by the apical migration of
junctional epithelium (JE), results in a unesthetic appearance and dentinal
hypersensitivity.1Aberrant frenum
along with inadequate vestibular depth which causes gingival recession.
Gingival recession is a very common clinical finding in front region of lower
jaw.Various
surgical modalities have been used for vestibuloplasty including sub mucosal
vestibuloplasty, secondary epithelisation vestibuloplasty, Edlan-Mejchar
vestibuloplasty and soft tissue grafting vestibuloplasty. METHOD:A 45 year old
female presented with the chief complaint of trauma while brushing in the lower
anterior region reported to the outpatient of Department of Periodontology,
Sardar Patel Postgraduate Institute of Dental & Medical Science, Lucknow. On
intraoral examination it was found that patient had Millers grade I mobility with
reduced width of attached gingiva in the lower anterior region along with
(Fig.1)Phase I therapy
included full mouth scaling and root planing, occlusal correction was
done where indicated and oral hygiene instructions were reinforced to the
patient. , a vestibular extension of the patient’s mandibular labial vestibule
to increase the width of attached gingiva was planned. Routine
blood investigations (total and differential leukocyte counts, blood glucose-
fasting and post-prandial, haemoglobin, bleeding and clotting time) were
carried out.              SURGICAL TECHNIQUE: Pre-surgical
preparation was done by scrubbing of the facial skin all around the oral cavity
with povidine iodine solution and the patient was made to rinse with 0.2%
Chlorhexidine digluconate mouthrinse for one minute. The patient was
anesthetized using 2% Lidocainewith Adrenaline
concentration of 1:80000. The surgical procedure asdescribed by
Edlan and Mejchar was followed. Vertical incisions were given on mesial aspect of
the both mandibular canines and starting at the junction of the attached and
free gingiva. An incision was made for a distance of 11 to 12 mm extending on
to the lower lip. These two incisions were joined by a horizontal incision
across the midline. A split thickness
flap then separated the loose labial mucosa from the underlying muscle. The
incision of the periosteum was extended in a vertical direction at its ends..It was fixed
with interrupted sutures to the inner surface of the periosteum, which was
removed from the bone. After
surgical procedure a periodontal dressing (Coe Pac) was placed to protect the
operated area. The patient was prescribed. Amoxicillin 500 mg TID for 5 days
and anti-inflammatory (Diclofenac 50 mg) BD for 5 days for post-operative pain.
Patient was instructed to have liquid/soft diet for 1 week along with other post-operative
instructions. The patient was recalled after two weeks for removal of sutures. At
two weeks the width of attached gingiva recorded was 7 mm approximately. The
patient was recalled after 6 months and one year for regular follow up and it
was observed that the achieved width attached gingiva remained constant
throughout. DISCUSSION:Edlan and
Mejchar (1963) depicted a technique for vestibuloplasty which appeared to be
particularly applicable to patients in whom there were no pockets and little or
no gingival tissue present. This procedure also appeared to increase the width
of the attached gingiva where other procedures were impracticable due to lack
of vestibular depth2,3,4 We hereby present a case report of a patient who
presented with the chief complaint of mobility in the lower anterior teeth and
in whom vestibular extension was done with the technique described by Edlan and
Mejchar to correct the shallow vestibule. Edlan and
Mejchar technique also known as lip switch procedure. The advantage of this technique
is that healing occurs by first intention and no bone is left exposed, thereby
minimizing the chances of bone resorption and further recession. In the present
case, an excellent clinical result was obtained which was maintained even one
year after surgery.Various brushing
techniques require the placement of the toothbrush at the gingival margin, which
may not be possible with reduced vestibular depth. It has been reported that
with minimal of 1 mm of attached gingiva, proper gingival health cannot be
established.This finding is consistent with
the observations of Wade (1969)5.

Thus, based on the findings
of the present case it can be concluded that in cases with a shallow vestibule
and a reduced width of attached gingiva on the labial aspect of the mandibular
anterior teeth, the technique advocated by Edlan and Mejchar provides a
predictable way in which gingival health can be achieved and maintained

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