Periodontolojide Vestibüloplasti: Endikasyonlar, Cerrahi Teknikler ve Klinik Başarı Kriterleri
Özet
Vestibüloplasti, oral vestibül derinliğini artırmak ve keratinize mukoza genişliğini geliştirmek amacıyla uygulanan önemli bir mukogingival cerrahi prosedürdür. Yetersiz vestibül derinliği ve sınırlı keratinize doku varlığı, plak kontrolünü zorlaştırarak gingival inflamasyon, periodontal doku instabilitesi ve peri-implant hastalık riskinde artışa yol açabilmektedir. Bu nedenle vestibüloplasti, özellikle mobil mukozanın marjinal gingiva üzerine traksiyon uyguladığı, keratinize mukoza genişliğinin yetersiz olduğu ve etkin oral hijyenin sağlanamadığı olgularda endike kabul edilmektedir. Cerrahi teknikler temel olarak apikal pozisyonlandırılmış flep (APF), serbest dişeti grefti (FGG) ile kombine yaklaşımlar ve biyomateryal destekli modifiye teknikler şeklinde sınıflandırılmaktadır. APF daha düşük morbidite sunarken, FGG keratinize doku kazanımı ve uzun dönem stabilite açısından en öngörülebilir yöntemlerden biri olarak kabul edilmektedir. Periosteal fenestrasyon gibi modifikasyonlar ise relaps riskini azaltarak yapışık mukoza kazanımını artırabilmektedir. Postoperatif bakım, cerrahi alanın stabilizasyonu ve enfeksiyon kontrolü açısından kritik öneme sahiptir. Klinik başarı; vestibül derinliğinde kalıcı artış, keratinize mukoza genişliğinde stabil kazanım, inflamatuar parametrelerde iyileşme ve hastanın plak kontrolünü rahatlıkla sürdürebilmesi gibi kriterlerle değerlendirilmelidir. Uygun hasta seçimi, doğru cerrahi teknik ve etkin postoperatif bakım ile vestibüloplasti, periodontal ve peri-implant dokuların uzun dönem stabilitesine önemli katkı sağlayan güvenilir bir tedavi yaklaşımıdır.
Referanslar
Sanz M, Schwarz F, Herrera D, McClain P, Figuero E, Molina A, et al. Importance of keratinized mucosa around dental implants: Consensus report of group 1 of the DGI/SEPA/Osteology Workshop. Clin Oral Implants Res. 2022;33(S23):47–55. doi:10.1111/clr.13956
Ramanauskaite A, Schwarz F, Sader R. Influence of width of keratinized tissue on the prevalence of peri-implant diseases: A systematic review and meta-analysis. Clin Oral Implants Res. 2022;33(S23):8–31. doi:10.1111/clr.13766
Scheyer ET, Sanz M, Dibart S, Greenwell H, John V, Kim DM, et al. Periodontal soft tissue non-root coverage procedures: A consensus report from the AAP Regeneration Workshop. J Periodontol. 2015;86(2S):S73–S76. doi:10.1902/jop.2015.140377
Thoma DS, Gil A, Hämmerle CHF, Jung RE. Management and prevention of soft tissue complications in implant dentistry. Periodontol 2000. 2022;88(1):116–129. doi:10.1111/prd.12415
Mahardawi B, Jiaranuchart S, Damrongsirirat N, Arunjaroensuk S, Mattheos N, Somboonsavatdee A, et al. The lack of keratinized mucosa as a risk factor for peri-implantitis: A systematic review and meta-analysis. Sci Rep. 2023;13(1):3778. doi:10.1038/s41598-023-30890-8
Golmayo P, Barallat L, Losada M, Valles C, Nart J, Pascual-La Rocca A. Keratinized tissue gain after free gingival graft augmentation procedures around teeth and dental implants: A prospective observational study. J Clin Periodontol. 2021;48(2):302–314. doi:10.1111/jcpe.13394
Hong I, Jeong S, Shin HJ, Thoma DS, Strauss FJ, Lee JS. Periosteal fenestration procedure in apically positioned flap increases the attached mucosal width: An in vivo experimental study. J Clin Periodontol. 2025;52(9):1362–1371. doi:10.1111/jcpe.14188
Montero E, Molina A, Matesanz P, Monje A, Sanz-Sánchez I, Herrera D. Efficacy of soft tissue substitutes, in comparison with autogenous grafts, in surgical procedures aiming to increase the peri-implant keratinized mucosa: A systematic review. Clin Oral Implants Res. 2022;33(S23):32–46. doi:10.1111/clr.13751
Mancini L, Strauss FJ, Lim HC, Tavelli L, Jung RE, Naenni N, et al. Impact of keratinized mucosa on implant-health related parameters: A 10-year prospective re-analysis study. Clin Implant Dent Relat Res. 2024;26(3):554–563. doi:10.1111/cid.13314
Kalakonda B, Farista S, Koppolu P, Baroud K, Uppada U, Mishra A, et al. Evaluation of patient perceptions after vestibuloplasty procedure: A comparison of diode laser and scalpel techniques. J Clin Diagn Res. 2016;10(5):ZC96–ZC99. doi:10.7860/JCDR/2016/17623.782
Carnio J, Miller PD. Increasing the amount of attached gingiva using a modified apically repositioned flap. J Periodontol. 1999;70(9):1110–1117. doi:10.1902/jop.1999.70.9.1110
Menceva Z, Dimitrovski O, Popovska M, Spasovski S, Spirov V, Petrushevska G. Free gingival graft versus mucograft: Histological evaluation. Open Access Maced J Med Sci. 2018;6(4):675–679. doi:10.3889/oamjms.2018.127
Parvini P, Galarraga-Vinueza ME, Obreja K, Magini R de S, Sader R, Schwarz F. Prospective study assessing three-dimensional changes of mucosal healing following soft tissue augmentation using free gingival grafts. J Periodontol. 2021;92(3):400–408. doi:10.1002/JPER.19-0640
Referanslar
Sanz M, Schwarz F, Herrera D, McClain P, Figuero E, Molina A, et al. Importance of keratinized mucosa around dental implants: Consensus report of group 1 of the DGI/SEPA/Osteology Workshop. Clin Oral Implants Res. 2022;33(S23):47–55. doi:10.1111/clr.13956
Ramanauskaite A, Schwarz F, Sader R. Influence of width of keratinized tissue on the prevalence of peri-implant diseases: A systematic review and meta-analysis. Clin Oral Implants Res. 2022;33(S23):8–31. doi:10.1111/clr.13766
Scheyer ET, Sanz M, Dibart S, Greenwell H, John V, Kim DM, et al. Periodontal soft tissue non-root coverage procedures: A consensus report from the AAP Regeneration Workshop. J Periodontol. 2015;86(2S):S73–S76. doi:10.1902/jop.2015.140377
Thoma DS, Gil A, Hämmerle CHF, Jung RE. Management and prevention of soft tissue complications in implant dentistry. Periodontol 2000. 2022;88(1):116–129. doi:10.1111/prd.12415
Mahardawi B, Jiaranuchart S, Damrongsirirat N, Arunjaroensuk S, Mattheos N, Somboonsavatdee A, et al. The lack of keratinized mucosa as a risk factor for peri-implantitis: A systematic review and meta-analysis. Sci Rep. 2023;13(1):3778. doi:10.1038/s41598-023-30890-8
Golmayo P, Barallat L, Losada M, Valles C, Nart J, Pascual-La Rocca A. Keratinized tissue gain after free gingival graft augmentation procedures around teeth and dental implants: A prospective observational study. J Clin Periodontol. 2021;48(2):302–314. doi:10.1111/jcpe.13394
Hong I, Jeong S, Shin HJ, Thoma DS, Strauss FJ, Lee JS. Periosteal fenestration procedure in apically positioned flap increases the attached mucosal width: An in vivo experimental study. J Clin Periodontol. 2025;52(9):1362–1371. doi:10.1111/jcpe.14188
Montero E, Molina A, Matesanz P, Monje A, Sanz-Sánchez I, Herrera D. Efficacy of soft tissue substitutes, in comparison with autogenous grafts, in surgical procedures aiming to increase the peri-implant keratinized mucosa: A systematic review. Clin Oral Implants Res. 2022;33(S23):32–46. doi:10.1111/clr.13751
Mancini L, Strauss FJ, Lim HC, Tavelli L, Jung RE, Naenni N, et al. Impact of keratinized mucosa on implant-health related parameters: A 10-year prospective re-analysis study. Clin Implant Dent Relat Res. 2024;26(3):554–563. doi:10.1111/cid.13314
Kalakonda B, Farista S, Koppolu P, Baroud K, Uppada U, Mishra A, et al. Evaluation of patient perceptions after vestibuloplasty procedure: A comparison of diode laser and scalpel techniques. J Clin Diagn Res. 2016;10(5):ZC96–ZC99. doi:10.7860/JCDR/2016/17623.782
Carnio J, Miller PD. Increasing the amount of attached gingiva using a modified apically repositioned flap. J Periodontol. 1999;70(9):1110–1117. doi:10.1902/jop.1999.70.9.1110
Menceva Z, Dimitrovski O, Popovska M, Spasovski S, Spirov V, Petrushevska G. Free gingival graft versus mucograft: Histological evaluation. Open Access Maced J Med Sci. 2018;6(4):675–679. doi:10.3889/oamjms.2018.127
Parvini P, Galarraga-Vinueza ME, Obreja K, Magini R de S, Sader R, Schwarz F. Prospective study assessing three-dimensional changes of mucosal healing following soft tissue augmentation using free gingival grafts. J Periodontol. 2021;92(3):400–408. doi:10.1002/JPER.19-0640
