Palatal graft in preprosthetic surgery

Abstract

S ince Esser’ introduced the vestibular inlay skin grafting technique in 1917, surgeons have attempted to restore compromised denture function by improving the quality or the quantity of supporting bone and soft tissues. Kazanjian2 described a vestibuloplasty in which the interior of the lip was maintained by surgically relocating alveolar mucosa. Healing progressed by periosteal granulation and formation of scar tissue. This resulted in a 50 to 75 per cent loss of sulcus depth. Godwin recommended a submucosal reflection of denture-bearing mucosa with surgical relocation of the periosteum and resurfacing of the mandible with the reflected denture-bearing mucosa. Trauner“ advocated lowering the floor of the mouth and relocating the mylohyoid muscle attachment through a supraperiosteal dissection. Cooley5 advocated a similar technique for vestibular extension by performing a submucosal resection and a surgical repositioning of the periosteum, with the resurfacing of the exposed lingual surface of the mandible with the mucosa. This technique required the use of a surgical stent for relocation and retention of the mucosa. Clark6 alleged that granulating connective-tissue surfaces contracted steadily and were the most common cause for the loss of vestibular depth after preprosthetic surgery. He advocated a surgical procedure which left denuded connective tissue only in areas overlying bone, with relocation of epithelial flaps to create the vestibule. Caldwell advocated a subperiosteal procedure to smooth the sharp mylohyoid ridge and remove the mylohyoid from its attachment to the mandible. Lingual mucosa was sutured along the crest of the ridge. The mylohyoid was then relocated inferiorly. Krugels reviewed the theories and techniques for ridge extension in the maxilla and mandible. Obwegese?’ advocated sub-