Stomatoplasty: Indications for Vestibuloplasty and Gingival Surgery
Stomatoplasty (vestibuloplasty / gingivoplasty) modifies oral vestibular depth and gingival architecture.
Primary Indications
- Vestibular deepening: Shallow vestibule → poor denture retention, hygiene difficulty, muscle pull on marginal gingiva.
- Prosthetic crown lengthening: Clinical crown extension for restorative access (ferrule effect).
- Gingival morphology correction: Uneven zeniths, asymmetric margins, "gummy smile" (esthetic crown lengthening).
- Frenum management: High/labial frenum attachment → diastema, recession, denture displacement → frenectomy/frenuloplasty.
- Pre-orthodontic: Adequate attached gingiva for tooth movement; esthetic arch form.
- Periodontal: Increase attached gingiva (free gingival graft, APF) for recession coverage, maintenance.
Techniques
- Secondary epithelialization (Clark, Obwegeser) — raw mucosal surface.
- Split-thickness skin graft (STSG) — keratinized, contracture-resistant.
- Free gingival graft / connective tissue graft — root coverage, keratinization.
- Laser (diode, CO₂) — hemostasis, reduced shrinkage.
Outcomes
- Improved denture stability, hygiene access, esthetics, periodontal health.
- Risks: Graft failure, contracture, sensory change, relapse.
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